To determine success and complication rates for lumbar spinal fusion surgery, predictors of good outcomes, whether improves laminectomy specific low back disorders.English-language journal articles published from 1966 through April 1991, identified MEDLINE searching (spinal plus limiting terms), bibliography review, expert consultation.Articles were selected only if they reported at least 1 year follow-up data enabling the classification clinical outcomes as satisfactory or unsatisfactory 30...

<h3>Importance</h3> Efforts to improve end-of-life care have focused primarily on patients with cancer. High-quality is also critical for other illnesses. <h3>Objective</h3> To compare patterns of and family-rated quality dying different serious <h3>Design, Setting, Participants</h3> A retrospective cross-sectional study was conducted in all 146 inpatient facilities within the Veteran Affairs health system among who died between October 1, 2009, September 30, 2012, clinical diagnoses...

To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia.Cluster randomized controlled trial.Twenty-four nursing homes North Carolina.Residents with dementia and problems their surrogates.Intervention surrogates received an audio or print on dementia. Controls usual care.Primary outcome was the Decisional Conflict Scale (range: 1-5) measured at 3 months; other main outcomes were surrogate knowledge, frequency communication providers,...

Dementia is a leading cause of death in the United States. This article outlines current understanding advanced dementia and identifies research priorities for next decade. Research over past 25 years has largely focused on describing experience patients with dementia. work delineated abundant opportunities improvement, including greater recognition as terminal illness, better treatment distressing symptoms, increased access to hospice palliative care services, less use costly aggressive...

Background/Objective The COVID‐19 pandemic has resulted in rapid changes to end‐of‐life care for hospitalized older adults and their families, including visitation restrictions. We examined bereaved families' perceptions of the quality communication among Veterans, families staff Veterans Affairs (VA) medical centers during pandemic. Design Qualitative descriptive study using data from a survey family members administered March–June 2020. Data were analyzed qualitative content analysis....

The COVID-19 pandemic resulted in visitation restrictions across most health care settings, necessitating the use of remote communication to facilitate among families, patients and teams.To examine impact on families' evaluation end-of-life during pandemic.Retrospective, cross-sectional, mixed methods study using data from an after-death survey administered March 17-June 30, 2020. primary outcome was next kin's global assessment Veteran's last month life.Data were obtained next-of-kin 328...

Increasing inpatient palliative care delivery is prioritized, but large-scale, experimental evidence of its effectiveness lacking.

Objectives To describe quality of care for feeding problems in advanced dementia and probability predictors weight loss mortality. Design Prospective cohort. Setting Twenty‐four nursing homes ( NH s). Participants Nursing home residents with family surrogates (N = 256). Measurements Family reported on at enrollment 3 months. Chart reviews 3, 6, 9 months provided data problems, treatments, more than 5% 30 days or 10% 6 months, Organizational variables were obtained from administrator surveys...

Medicare hospice beneficiaries discontinue disease-modifying treatments because the benefit limits access. While veterans have concurrent access to care and Veterans Affairs (VA) Medical Center (VAMC)-provided treatments, association of this with changes in treatment costs veterans' end-of-life is unknown. To determine whether increasing availability care, without restrictions on associated reduced aggressive medical at end life. A modified difference-in-differences study design, using...

Background: Apathy, the major manifestation of impaired goal-directed behavior (GDB), is most common neuropsychiatric syndrome associated with behavioral variant frontotemporal degeneration (bvFTD). The and biological mechanisms apathy, however, are not well understood. We hypothesized that GDB has multiple components – including at least initiation, planning motivation supported by a network frontal brain regions. In this study, we examined hypothesis evaluating selective breakdown in...

BACKGROUND To the authors’ knowledge, little is known regarding relationship between patients’ and families’ satisfaction with aggressive end‐of‐life care. Herein, authors examined associations episodes of care (ie, chemotherapy, mechanical ventilation, acute hospitalizations, intensive unit admissions) within last 30 days life evaluations among patients non‐small cell lung cancer (NSCLC). METHODS A total 847 NSCLC (34% whom were aged &lt;65 years) who died in a nursing home or care,...

Despite growing interest in quality of life (QOL) as an important variable nursing and health care, little research focuses on QOL women with ovarian cancer (OVCA). The purpose this study was to examine OVCA survivors. convenience sample consisted 152 all disease stages. Quantitative data were collected using the QOL-Cancer Survivors tool a demographic sheet. Qualitative by asking participants write their definitions experiences since diagnosis. Reliability validity findings established....

Objectives To assess the efficacy of a self-management group intervention in improving physical functioning, mood, and pain among elderly persons with chronic pain, to identify factors that may be associated improvement. Materials Methods Forty-five residents three retirement communities (86% women; mean age, 82.0 years) were assigned randomly 7-week or an educational booklet control condition. Participants completed self-report measures depression, pain-related beliefs at baseline, 9 weeks...

Approximately 20% of deaths in the United States occur nursing homes. That percentage is expected to increase as population continues age. As a setting for end-of-life care, homes provide both challenges and opportunities. This article examines factors that impede delivery high-quality care homes, such inadequate staff physician training, regulatory reimbursement issues, poor symptom management, lack psychosocial support staff, residents, families. In addition discussing hindrances providing...

Chronic pain is a common, disabling problem in older adults. Pain self-management training multimodal therapy that has been found to be effective young middle-aged adult samples; however, few studies have examined the effectiveness of this In randomized, controlled trial, we evaluated group (SMG) intervention as compared with an education-only (BOOK) control condition. Participants, 65 years age or who experienced persistent, noncancer limited their activities, were recruited from 43...

Unlike Medicare, the Veterans Health Administration (VA) health care system does not require veterans with cancer to make "terrible choice" between receipt of hospice services or disease-modifying chemotherapy/radiation therapy. For this report, authors characterized VA's provision concurrent care, defined as days in last 6 months life during which simultaneously received and chemotherapy radiation This retrospective cohort study included veteran decedents 2006 through 2012 who were...

Almost 1.7 million older Americans live in nursing homes, representing a large proportion of the frailest, most vulnerable elders needing long-term care. In future, increasing numbers adults are expected to spend time and die homes. Thus, understanding addressing palliative care needs this population critical. The goals paper describe briefly current state knowledge about needs, processes, outcomes for home residents; identify gaps knowledge; propose priorities future research area.