Hospice Education: 1. ICU and Palliative Care; 2. Too many cardiac procedures?

ICU doctors definitely need education and exposure to the benefits of palliative care. Patients and families would benefit greatly, not to mention exorbitant cost burdens to the health care system as a whole.

JOURNAL
Journal of palliative care

DOI
10.1177/0825859720951361

Abstract
Background: There is growing interest in the use of a Palliative care approach in Intensive care. However, it tends to remain inconsistent, infrequent or non-existent, as does its acceptance by intensive care physicians. This study sought to explore the perceptions, level of knowledge, perceived barriers, and practices of physicians regarding palliative care practices (PC) in Intensive Care Units (ICU). Conclusions: palliative care-ICU interactions are influenced by training, a positive perception of palliative care and less perceived institutional barriers. An integrated ICU-palliative caremodel that strengthens the PC training of those who work in ICU and provides clearer guidelines for interaction practices, may help overcome perceived barriers and improve the perception of the potential impact of PC.

https://www.focalize.md/find-journals/?a=Dwq3PIMBjZS8LUbgmqrS

Survival After Invasive or Conservative Management of Stable Coronary Disease.

This study points out that there was no difference in all-cause mortality in coronary artery disease patients who had invasive cardiac procedures versus those who were managed conservatively. It raises the question as to whether some patients are subjected to invasive procedures who might better be managed with modifications to diet and exercise and with medications only.

JOURNAL
Circulation

DOI
10.1161/CIRCULATIONAHA.122.062714

Author(s)
Hochman|Judith S|JS|0000-0002-5889-5981;Anthopolos|Rebecca|R|;Reynolds|Harmony R|HR|0000-0003-0284-0655;Bangalore|Sripal|S|0000-0001-9485-0652;Xu|Yifan|Y|;O'Brien|Sean M|SM|;Mavromichalis|Stavroula|S|;Chang|Michelle|M|;Contreras|Aira|A|;Rosenberg|Yves|Y|;Kirby|Ruth|R|;Bhargava|Balram|B|;Senior|Roxy|R|0000-0001-6579-7039;Banfield|Ann|A|;Goodman|Shaun G|SG|0000-0001-8068-2440;Lopes|Renato D|RD|0000-0003-2999-4961;Pracoń|Radosław|R|0000-0001-7519-0003;López-Sendón|José|J|0000-0002-0871-9197;Maggioni|Aldo Pietro|AP|0000-0003-2764-6779;Newman|Jonathan D|JD|0000-0001-6855-7305;Berger|Jeffrey S|JS|0000-0001-8216-4647;Sidhu|Mandeep S|MS|;White|Harvey D|HD|0000-0001-7712-6750;Troxel|Andrea B|AB|;Harrington|Robert A|RA|0000-0001-5450-8676;Boden|William E|WE|;Stone|Gregg W|GW|0000-0002-3416-8210;Mark|Daniel B|DB|0000-0001-6340-8087;Spertus|John A|JA|0000-0002-2839-2611;Maron|David J|DJ|0000-0002-4867-8588;|||

Abstract
BACKGROUND The ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) compared an initial invasive versus an initial conservative management strategy for patients with chronic coronary disease and moderate or severe ischemia, with no major difference in most outcomes during a median of 3.2 years. Extended follow-up for mortality is ongoing. METHODS ISCHEMIA participants were randomized to an initial invasive strategy added to guideline-directed medical therapy or a conservative strategy. Patients with moderate or severe ischemia, ejection fraction ≥35%, and no recent acute coronary syndromes were included.

CONCLUSIONS There was no difference in all-cause mortality with an initial invasive strategy compared with an initial conservative strategy, but there was lower risk of cardiovascular mortality and higher risk of noncardiovascular mortality with an initial invasive strategy during a median follow-up of 5.7 years. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04894877.

https://www.focalize.md/find-journals/?a=3iGLJoYBjZS8LUbggdEW