Abby Luck Parish

Utilization and determinants of palliative care in the trauma intensive care unit: Results of a national survey

Background: There is a paucity of data evaluating utilization of palliative care in trauma intensive care units. Aim: We sought to determine current indications and determinants of palliative care consultation in the trauma intensive care units. Design: Using a cross-sectional assessment, we surveyed trauma surgeons to understand indications, benefits, and barriers trauma surgeons perceive when consulting palliative care. Setting/participants: A total of 1232 surveys were emailed to all members of the Eastern Association for the Surgery of Trauma. Results: A total of 362 providers responded (29% response rate). Majority of respondents were male (n = 287, 80.2%) and practiced in Level 1 (n = 278, 77.7%) trauma centers. Most common indicators for referral to palliative care were expected survival 1 week to 1 month, multisystem organ dysfunction >3 weeks, minimal neurologic responsiveness >1 week, and referral to hospice. In post hoc analysis, there was a significant difference in frequency of utilization of palliative care when respondents had access to board-certified palliative care physicians (χ2 = 56.4, p < 0.001). Although half of the respondents (n = 199, 55.6%) reported palliative care consults beneficial all or most of the time, nearly still half (n = 174, 48.6%) felt palliative care was underutilized. Most frequent barriers to consultation included resistance from families (n = 144, 40.2%), concerns that physicians were “giving up” (n = 109, 30.4%), and miscommunication of prognosis (n = 98, 27.4%) or diagnosis (n = 58, 16.2%) by the palliative care physician. Conclusion: Although a plurality of trauma surgeons reported palliative care beneficial, those surveyed indicate that palliative care is underutilized. Barriers identified provide important opportunities to further appropriate utilization of palliative care services.

Long-Term Care Acquired Urinary Tract Infections' Antibiotic Resistance Patterns and Empiric Therapy: A Pilot Study

Long-term care (LTC) acquired urinary tract infections (UTIs) are increasingly resistant to antibiotics, and the selection of appropriate empiric antibiotic therapy can be challenging for clinicians. The purpose of this study is to describe LTC-acquired UTI empiric antibiotic prescription patterns and UTI resistance patterns among older adults admitted to an acute psychiatric facility. This retrospective study found that ciprofloxacin was the agent most often used for empiric therapy (76% of cases). However, LTC-acquired UTIs in the sample were susceptible to ciprofloxacin in only 31% of cases. The study has implications for antibiotic stewardship with recommendations for empiric antibiotic selection for LTC-acquired UTIs given the prevalence of fluoroquinolone-resistant bacterial strains in the LTC setting.

Polypharmacy and Medication Management in Older Adults

Polypharmacy in older adults is a global problem that has recently worsened. Approximately 30% of adults aged 65 years and older in developed countries take 5 or more medications. Although prescribed and over-the-counter medications may improve a wide range of health problems, they also may cause or contribute to harm, especially in older adults. Polypharmacy in older adults is associated with worsening of geriatric syndromes and adverse drug events. Given the risks and burdens of polypharmacy and potentially inappropriate medications, nurses must use patient-centered approaches and nonpharmacologic strategies to treat common symptoms and to optimize patient function and quality of life.

Degenerative or Debilitative Neurologic Syndromes

Neurodegenerative disorders are progressive, debilitating impairments of neurologic function. Dementia affects cognition and function. Persons with cognitive deficits should undergo a full workup and may be treated with cholinesterase inhibitors and/or memantine. Behavioral and psychological symptoms of dementia may be assessed and treated individually. Parkinson disease is a disorder of movement. Levodopa is the standard treatment of dopamine-related movement symptoms. Associated symptoms should be assessed and treated. Other neurodegenerative syndromes are less common but highly debilitating. Currently, there are no curative or disease-modifying therapies for neurodegenerative disorders. Novel therapies or research are in the pipeline.

Assessment and management of pain in persons with dementia

World-wide 46.8 million individuals were living with dementia in 2015 representing

A Case Study Using the Beers List Criteria to Compare Prescribing by Family Practitioners and Geriatric Specialists in a Rural Nursing Home

818 billion in costs.1 The number of people diagnosed with dementia is projected to reach 131.5 million by 2050.1 Since the risk of developing a painful condition increases in the older adult population,1 the numbers of people with both pain and dementia will increase,2 presenting a significant public health and economic concern.1 Pain in persons with dementia can be challenging to adequately measure,3 particularly as verbal and behavioral expressions of chronic pain may be diminished or absent despite the presence of pain.4 Although multiple tools exist to help assess pain in dementia,5 pain often remains inadequately treated even when the individual has been diagnosed with a painful condition.2 Untreated pain in persons with dementia not only presents an ethical issue6 but also increases morbidity7 as well as financial, personal, and caregiver burdens.3