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Biomedical subjects

Charles F von Gunten

Publications and source records attributed to Charles F von Gunten.

At least 19 recordsLinked to original sources
PubMed2006

Evaluating the California Hospital Initiative in Palliative Services.

BACKGROUND: Inpatient palliative care programs can improve care of patients with serious illness. We developed the California Hospital Initiative in Palliative Services (CHIPS) program to assist hospitals in establishing these programs. CHIPS included an introductory conference followed by 10 months of mentoring with telephone calls, e-mails, on-site consultation at the hospital, and a reunion conference. METHODS: To evaluate CHIPS and the factors associated with establishing inpatient palliative care programs, we conducted a cross-sectional telephone survey of leaders from the 38 hospitals that participated in CHIPS. We assessed the number of inpatient palliative care consultation services established by hospitals that participated in CHIPS (success) and hospital characteristics associated with success. RESULTS: Participants gave CHIPS high ratings. Six hospitals (16%) had a palliative care consultation service at enrollment in CHIPS and 19 hospitals (60%) established one after participation in CHIPS (P<.001). In bivariable comparisons, successful hospitals were more likely to have a hospitalist program (P = .003) or to be located in an urban setting (P = .03). CONCLUSIONS: CHIPS seemed to help many hospitals establish inpatient palliative care programs. Hospitals with hospitalists and those in an urban setting were more likely to succeed in developing palliative care programs. Future studies should focus on the quantity and quality of care provided by these programs.

California↗
PubMed2006

Assessment of palliative care needs.

Caring for a patient at the end of life requires a thorough understanding of the patient's disease and a detailed investigation into all domains of the patient's being. The patient's goals of care should be revealed, and the interdisciplinary team must work together to provide the patient with maximal care to ensure the best possible quality of life. We must devise a comprehensive and flexible plan so that any anticipated issues may be resolved quickly. As Sir William Osler stated, our goal as physicians is "to cure sometimes, to relieve often, to comfort always."

Activities of Daily Living↗
PubMed2005

The academic hospice.

The academic hospice is a recent development in health care. Hospice programs and hospitals evolved from the same historical roots in Greek and Roman medicine. The academic hospital emerged as a place where patient care, education, and research are pursued as inextricable parts of the mission. The unique role of the academic medical center in health care is supported by the government, the medical profession, and the public. This article provides a perspective on the emergence of the academic hospice. Dr. Cicely Saunders, who died on 14 July 2005, founded the first such hospice in London, England, in 1967. The authors show that the philosophy of hospice care has the same historical roots as standard health care and describe those elements that distinguish academic hospice programs from other kinds of hospice programs. Finally, the authors note that demographic and economic challenges in the United States and elsewhere only increase the need for academic hospice programs.

Biomedical Research↗
PubMed2005

Interventions to manage symptoms at the end of life.

The aim of this article is to summarize the current evidence base about interventions that improve symptoms at the end of life. Moderate to severe symptoms are highly prevalent in the weeks and months before death: 1.4 million individuals have dyspnea; and 1 million have pain. Of those with pain, 300,000 want more pain relief. 700,000 may need more relief, but do not receive it because of the myth of opioid addiction; their physicians do not know how to manage the adverse effects of pain relieving therapies, or they don't know the various options that are available for pain relief. Of the 1 million Americans who die in hospitals, 324,000 had fatigue, 280,000 anorexia, 244,000 dyspnea, 232,000 xerostomia, 208,000 cough, 196,000 pain, 148,000 confusion, 148,000 depression, 140,000 nausea, 92,000 insomnia in 23, and 88,000 vomiting. This is caused in part by clinician ignorance. In a representative sample of oncologists, the most important source of information about symptom control was trial-and-error in practice. In addition, large, well-designed, well-controlled studies of patients at the end of life have not been performed. Clinical practice is guided by extrapolation of data from other populations and from anecdote. The system of care provided by hospice programs in the U.S. provides improved symptom control as compared with hospitals, home health agency, and nursing home systems. Population-based studies of prevalence are needed to gauge outcomes of the implementation of measures to relieve symptoms. Well-powered, definitive studies of both existing and new approaches in terminally ill patients with the most common symptoms are needed. The health care system interventions that are effective in hospice care must be studied so that they can be broadly applied to the care of all dying Americans.

Biomedical Research↗
PubMed2004

Financing palliative care.

Palliative care services are financed by a combination of revenue from a variety of sources: hospital, nursing home, hospice, and physician. Cost avoidance is calculated based on the patterns of care of the patients seen compared with control patients. Most programs also use grants and philanthropy as part of their "mix."

Hospice Care↗
PubMed2004

Development of a medical subspecialty in palliative medicine: progress report.

There is significant interest in seeking professional recognition of expertise in caring for people with serious life-threatening illness and their families through creation of a specialty in palliative medicine. Certification of physicians and accreditation of training programs are key elements for formal recognition. The American Board of Hospice and Palliative Medicine was established to achieve these goals. The next step in the maturation of the subspecialty of palliative medicine is to have both the certification and the accreditation recognized by the professional self-governing bodies in organized medicine. This paper answers common questions about obtaining recognition by the Accreditation Council of Graduate Medical Education, the American Board of Medical Specialties and its member boards. Formal recognition of the subspecialty of palliative medicine is sought in order to extend the knowledge and skills inherent in the domains of palliative medicine. Such recognition will also encourage more physicians to enter the field and assure standards of care for those patients and their families who need it.

Accreditation↗
PubMed2004

Assessment of the Education for Physicians on End-of-Life Care (EPEC) Project.

PURPOSE: Palliative medicine is assuming an increasingly important role in patient care. Yet, most physicians did not learn this during their formal training. The Education for Physicians in End-of-life Care (EPEC) Project aims to increase physician knowledge in palliative care by disseminating the EPEC Curriculum through a train-the-trainer approach. An assessment of its use to help the project reach its targets was performed. METHOD: An independent evaluation pursued a two-step qualitative and quantitative approach to assess the ways that the curriculum is used by EPEC Trainers. RESULTS: The main findings are: (1) The EPEC Curriculum is well regarded by a quota sample of 200 physicians who were trained to use the curriculum between January 1999 and March 2000. When asked, "How would you rate the effect of EPEC training on your knowledge of end-of-life care?," 62% (123/200) selected 'greatly improved it.' When asked, "What was the effect of the EPEC conference on your ability to teach end-of-life care?," 72% (144/200) selected 'greatly improved it.' (2) Dissemination has been effective. Ninety-two percent (184/200) use the curriculum for teaching. Of these, 83% (153/184) presented the material in 30-60 minute sessions as part of regularly scheduled conferences. We estimate that these 184 EPEC Trainers have presented 1 or more of the 16 EPEC Curriculum modules to approximately 120,000 professionals. DISCUSSION: There is evidence that physicians selected to be EPEC Trainers judge the EPEC Curriculum to be high in quality, respected, and most importantly, usable. They use the EPEC Curriculum as part of a train-the-trainer dissemination strategy. The interpretation of this enthusiastic assessment is tempered by the study's limitations including respondent bias and possible acquiescence. Nevertheless, it appears that the EPEC Curriculum has set a standard of knowledge in the field and is an example of disseminating new information to physicians in practice. We conclude that the EPEC Curriculum is an effective vehicle to transmit palliative care information to physicians in practice.

Curriculum↗
PubMed2004

Intravenous lidocaine relieves severe pain: results of an inpatient hospice chart review.

BACKGROUND: Parenteral lidocaine has been reported to relieve neuropathic pain and/or pain refractory to opioid therapy. METHOD: A retrospective chart review of 768 consecutive patients acutely admitted to a hospice inpatient unit was performed to assess the efficacy and tolerability of parenteral lidocaine for pain relief. RESULTS: Eighty-two patients (approximately 11%) received parenteral lidocaine. Typically, a patient received a parenteral bolus and pain relief was evaluated 30 minutes later. If there was an effect, a continuous infusion was started. Sixty-one patients receiving lidocaine were evaluable for pain relief response. Fifty patients (82% of evaluable patients) reported a major response of their pain to lidocaine. Five patients (8% of evaluable patients) reported a partial response. Six (10% of evaluable patients) reported no benefit. DISCUSSION: Evaluable patients in an opioid refractory class had a 91% major response rate to lidocaine. Overall, lidocaine was well tolerated. Approximately 30% of evaluable patients reported some adverse event; the most common being lethargy. However, the effect was not clearly related to lidocaine. CONCLUSION: Parenteral lidocaine appears to be rapidly effective for opioid refractory pain and is well tolerated. A randomized controlled trial is needed to confirm these impressive but preliminary uncontrolled results.

Adult↗