Establishing a regional, multisite database for quality improvement and service planning in community-based palliative care and hospice.

BACKGROUND: Outpatient palliative care, an evolving delivery model, seeks to improve continuity of care across settings and to increase access to services in hospice and palliative medicine (HPM). It can provide a critical bridge between inpatient palliative care and hospice, filling the gap in community-based supportive care for patients with advanced life-limiting illness. Low capacities for data collection and quantitative research in HPM have impeded assessment of the impact of outpatient palliative care. APPROACH: In North Carolina, a regional database for community-based palliative care has been created through a unique partnership between a HPM organization and academic medical center. This database flexibly uses information technology to collect patient data, entered at the point of care (e.g., home, inpatient hospice, assisted living facility, nursing home). HPM physicians and nurse practitioners collect data; data are transferred to an academic site that assists with analyses and data management. Reports to community-based sites, based on data they provide, create a better understanding of local care quality. CURRENT STATUS: The data system was developed and implemented over a 2-year period, starting with one community-based HPM site and expanding to four. Data collection methods were collaboratively created and refined. The database continues to grow. Analyses presented herein examine data from one site and encompass 2572 visits from 970 new patients, characterizing the population, symptom profiles, and change in symptoms after intervention. CONCLUSION: A collaborative regional approach to HPM data can support evaluation and improvement of palliative care quality at the local, aggregated, and statewide levels.

Relationships between polybrominated diphenyl ether concentrations in house dust and serum.

Polybrominated diphenyl ethers (PBDEs) have been measured in the home environment and in humans, but studies linking environmental levels to body burdens are limited. This study examines the relationship between PBDE concentrations in house dust and serum from adults residing in these homes. We measured PBDE concentrations in house dust from 50 homes and in serum of male-female couples from 12 of the homes. Detection rates, dust-serum, and within-matrix correlations varied by PBDE congener. There was a strong correlation (r = 0.65-0.89, p < 0.05) between dust and serum concentrations of several predominant PBDE congeners (BDE 47, 99, and 100). Dust and serum levels of BDE 153 were not correlated (r < 0.01). The correlation of dust and serum levels of BDE 209 could not be evaluated due to low detection rates of BDE 209 in serum. Serum concentrations of the sum of BDE 47, 99, and 100 were also strongly correlated within couples (r = 0.85, p = 0.0005). This study provides evidence that house dust is a primary exposure pathway of PBDEs and supports the use of dust PBDE concentrations as a marker for exposure to PBDE congeners other than BDE 153.

Reliving, emotions, and fragmentation in the autobiographical memories of veterans diagnosed with PTSD

Fifty veterans diagnosed with posttraumatic stress disorder (PTSD) each recalled four autobiographical memories: one from the 2 years before service, one non-combat memory from the time in service, one from combat, and one from service that had often come as an intrusive memory. For each memory, they provided 21 ratings about reliving, belief, sensory properties, reexperiencing emotions, visceral emotional responses, fragmentation, and narrative coherence. We used these ratings to examine three claims about traumatic memories: a separation of cognitive and visceral aspects of emotion, an increased sense of reliving, and increased fragmentation. There was evidence for a partial separation of cognitive judgments of reexperiencing an emotion and reports of visceral symptoms of the emotion, with visceral symptoms correlating more consistently with scores on PTSD tests. Reliving, but not fragmentation of the memories, increased with increases in the trauma relatedness of the event and with increases in scores on standardized tests of PTSD severity. Copyright © 2004 John Wiley & Sons, Ltd.