Abstract
Letter to the Editor
Voluntarily reported medication errors are collected using an exception/audit form completed by any staff member in the inpatient unit who observes a medication error or perceived medication error. (page 679)
Brief Reports
Pilot study describing the role of professional chaplains in established pediatric palliative care programs in children's hospitals in the United States. (page 704)
Fast Facts and Concepts
#160 Screening for Intensive Care Unit Delirium
#239 Prognostication in Severe Traumatic Brain Injury in Adults (page 781)
Personal Reflection
How are we to consider the divergence in the plans of care given the similarities in Rose and Maria's situations? (page 789)
Case Discussions in Palliative Medicine
Speech language pathologist services utilized to provide augmentative and alternative communication assistance to nonspeaking, critically ill patients in the ICU, their caregivers, and medical staff. (page 791)
Book and Media Reviews
(page 796)
Recent Literature
(page 797)
Radiation Therapy, Bone Metastases, and Sleep
Among 400 patients being treated with radiation therapy for painful bony metastases, 25% of patients had moderate sleep disturbance and 36% of patients reported severe sleep disturbance. There was an improvement in sleep scores for patients whose pain improved with radiation and those whose pain did not improve, at weeks 4 and 8, but scores worsened for nonresponders at week 12. (page 708)
Witnessed CPR and Bereavement
In a prospective study of cardiopulmonary resuscitation (CPR) in hospital emergency departments, there were no differences in family outcomes between resuscitations witnessed by family and those not witnessed by family. It appears that although depression and posttraumatic stress disorders are seen in family members of a patient who dies after cardiopulmonary resuscitation in the emergency department, the magnitude of the effect is not affected by whether or not the family witnessed the resuscitation attempt. (page 715)
Symptoms of Chronic Obstructive Pulmonary Disease and Congestive Heart Failure
In 105 outpatients with clinically stable, but advanced COPD (GOLD stage III or IV) and 80 patients with advanced CHF (NYHA class III or IV) comorbidities were reported by 96% of the CHF patients and 62% of the COPD patients. Patients suffered from multiple symptoms, like dyspnea, fatigue, muscle weakness, coughing, low mood, sleeplessness and frequent micturition. For most symptoms, only the minority of patients had received symptom-related treatment. Involvement of allied healthcare professionals was low. The majority of COPD and CHF patients had received home adaptation and medical aids. (page 735)
Evaluation of Teamwork Ability
The competencies required for effective collaborative teamwork are only now emerging and methods to evaluate them must be developed. The adaptation of the traditional Objective Structured Clinical Examination (OSCE) for assessment of a team addressing palliative care issues was undertaken. Students and observers found the TOSCE to be an acceptable and feasible assessment tool for both sets of competencies. Reliability and validity data show that the items in both the clinical and interprofessional checklists fit well together, and interrater reliability is readily achieved. (page 744)
Comorbidities of Hospice Patients
Patients with cancer who enrolled in hospice care had an average Charlson comorbidity index value of 1.24, including 19% who suffered from comorbid dementia. In analyses adjusted for patient demographics, site of primary cancer, and number of days with hospice, higher comorbidity burden was associated with higher likelihood of ED admission (odds ratio [OR] = 1.69, 95% confidence interval [CI] 1.52, 1.87), intensive care unit (ICU) admission (OR = 3.28, 95% CI 2.45, 4.38), inpatient hospitalization (OR = 2.14, 95% CI 1.90, 2.42), hospice disenrollment (OR = 1.41, 95% CI 1.29, 1.56) and hospital death (OR = 2.51, 95% CI 2.08, 3.02). These findings underscore the complexity of the hospice patient population and highlight a potential need to risk adjust the per diem hospice reimbursement rates to account for increased resource requirements for patients with higher comorbidity burden. (page 751)