Impact of community based, specialist palliative care teams on hospitalisations and emergency department visits late in life and hospital deaths: a pooled analysis

Objective: To determine the pooled effect of exposure to one of 11 specialist palliative care teams providing services in patients’ homes.Design: Pooled analysis of a retrospective cohort study.Setting: Ontario, Canada.Participants: 3109 patients who received care from specialist palliative care teams in 2009-11 (exposed) matched by propensity score to 3109 patients who received usual care (unexposed).Intervention: The palliative care teams studied served different geographies and varied in team composition and size but had the same core team members and role: a core group of palliative care physicians, nurses, and family physicians who provide integrated palliative care to patients in their homes. The teams’ role was to manage symptoms, provide education and care, coordinate services, and be available without interruption regardless of time or day.Main outcome measures: Patients (a) being in hospital in the last two weeks of life; (b) having an emergency department visit in the last two weeks of life; or (c) dying in hospital.Results: In both exposed and unexposed groups, about 80% had cancer and 78% received end of life homecare services for the same average duration. Across all palliative care teams, 970 (31.2%) of the exposed group were in hospital and 896 (28.9%) had an emergency department visit in the last two weeks of life respectively, compared with 1219 (39.3%) and 1070 (34.5%) of the unexposed group (P<0.001). The pooled relative risks of being in hospital and having an emergency department visit in late life comparing exposed versus unexposed were 0.68 (95% confidence interval 0.61 to 0.76) and 0.77 (0.69 to 0.86) respectively. Fewer exposed than unexposed patients died in hospital (503 (16.2%) v 887 (28.6%), P<0.001), and the pooled relative risk of dying in hospital was 0.46 (0.40 to 0.52).Conclusions: Community based specialist palliative care teams, despite variation in team composition and geographies, were effective at reducing acute care use and hospital deaths at the end of life.

Improving a regional chemotherapy service by learning from deaths occurring within 30 days of treatment with systemic anti-cancer therapy.

Background: Outwith clinical trials, patient outcomes specifically related to SACT (systemic anti-cancer therapy) are not well reported despite a significant proportion of patients receiving active treatment at the end of life. The NCEPOD reviewing deaths within 30 days of SACT found SACT caused or hastened death in 27% of cases.

Method: Across the Northern Ireland cancer network, 95 patients who died within 30 days of SACT for solid tumours were discussed at the Morbidity and Mortality monthly meeting during 2013. Using a structured template, each case was independently reviewed, with particular focus on whether SACT caused or hastened death.

Results: Lung, GI and breast cancers were the most common sites. Performance status was recorded in 92% at time of final SACT cycle (ECOG PS 0-2 89%).

In 57% the cause of death was progressive disease. Other causes included thromboembolism (13%) and infection (5% neutropenic sepsis, 6% non-neutropenic sepsis). In 26% with death from progressive disease, the patient was first cycle of first line treatment for metastatic disease. In the majority discussion regarding treatment aims and risks was documented. Only one patient was receiving SACT with curative intent, who died from appropriately managed neutropenic sepsis.

A definitive decision regarding SACT's role in death was made in 60%: in 49% SACT was deemed non-contributory and in 11% SACT was deemed the cause of death. In 40% SACT did not play a major role, but a definitive negative association could not be made.

Conclusion: Development of a robust review process of 30-day mortality after SACT established a benchmark for SACT delivery for future comparisons and identified areas for SACT service organisation improvement. Moreover it encourages individual practice reflection and highlights the importance of balancing patients' needs and concerns with realistic outcomes and risks, particularly in heavily pre-treated patients or those of poor performance status.

Bell Family Bible, Deaths, 1862-1916

A single page from the Deaths section of the Bell Family Bible listing the names and dates of death for various members of the family.The handwritten entries appear to read as follows: "John William Taylor, died April 30th Anne Domini 1862; aged 52 years. Jess J Bell died April 11th 1872 O Mary Franices Bell died August 20th 1872. Mrs. Susan Hall. Died May, 24th, 1898 Born January 1st 1829 age. 69 William B Bell died March 19th 1897 Richard Jones died June 6th 1912 Mastam Jone died Charles H. Hall died November 11th 1916."

Bell Family Bible, Deaths, Tyrrell, 1886-1908

The Deaths page from the Bell Family Bible listing the deaths of Jane Tyrrell in 1886, William C. Tyrrell in 1898, and Lewis Tyrrell in 1908. This Bible was in the possession of the Rick Bell family of St. Catharines, Ontario. Relatives of the Bell family were former Black slaves from the United States who settled in Canada.The handwritten entry appears to read as follows: "Jane Tyrrell, died March 1st 1886 age 64 yrs. William C. Tyrrell died January 15th 1898 by accident in Albany N.Y. age 33 yrs 3 months Lewis Tyrrell died September 25th 1908 at his late residence Vine and Welland Ave. St. Catharines age 81 yrs 5 months." There are various spellings of the Tyrrell name within the Bell family archive. Other forms of the name include Tyrell, Tyrrill, and Terrell.

Clippings - Births, Deaths, Engagements

Clipping of a birth announcement of a daughter to Mr. and Mrs. P.C. Band, 1924. Clipping of a birth announcement of a son to Mr. and Mrs. Percy C. Band, September 11, 1927. Clipping of the obituary of Mrs. Annie Leslie Woodruff, widow of Welland Woodruff, 1934. Clipping of the announcement of the funeral of Mrs. Annie Leslie Woodruff, February 3, 1934. Clipping of the write-up of the funeral of Mrs. Annie Leslie Woodruff, 1934. Clipping of the obituary of Mr. B. Harvey Foster, n.d. Clipping of the funeral of Mr. Bernard H. Foster in Sheffield, England, n.d. Clipping of the obituary of Mrs. Mary Lanman Douw Ferris, widow of Morris Patterson Ferris, n.d. Clipping of the engagement announcement of Margaret Julia Woodruff to Captain Percy Carruthers Band, n.d.

Clippings - Births, Deaths, Marriage

Clipping of the obituary of Mrs. Mary Lanman Douw Ferris, widow of Morris Patterson Ferris, n.d. Clipping of the obituary of Alfred Sanderson Woodruff, March 20, 1926. Clipping describing the wedding of Margaret Julia Woodruff and Captain Percy Carruthers Band, n.d. Clipping of a birth announcement of a daughter to Mr. and Mrs. P.C. Band, 1924. Clipping of a birth announcement of a son to Mr. and Mrs. Percy C. Band, Sept. 11, 1927.

Plan Colombia’s Onset: Effects on Homicides and Violent Deaths

In this paper, the link between Plan Colombia and violence is explored. This paper exploits the difference in the success of the program among the different regions to identify the potential side effects on homicides and violent deaths. Results show no significant effects observed on homicides. On the other hand, evidence was found of increases in the number of violent deaths for women living in urban areas, and an opposite negative effect for men living in rural areas. These findings are consistent for different specifications of the model, the cut-off end of the program, and the classification of the regions’ criteria.

The lives and deaths of young medieval women: the osteological evidence

Written sources from the medieval period focus mainly on the activities of adults, particularly males and often those from the wealthier sections of society. Recent scholarship has attempted to redress this balance by giving attention to medieval women and children, but we are still limited by what we can learn about the daily lives of all members of medieval English society. Osteology, the study of human skeletal remains, suffers from no such bias and can provide substantial and detailed information on growth, health and daily life of the general population. This paper presents the results of a new analysis of the skeletal remains of over 300 medieval girls and young women aged at between 14 and 25 years from a number of English cemetery sites. We incorporate data from the published archaeological literature as well as documentary evidence to provide new insights into the lives and deaths of young medieval women.

Corporate liability for workplace deaths and injuries-reflecting on Victoria's laws in the light of the Esso Longford explosion

The purpose of this article is to consider some different legal models for the liability of corporations for the deaths and serious injuries of their employees, with particular emphasis on the law in Victoria.

Two recent developments in Victoria prompt this consideration. First, on 30 July 2001, the Victorian Supreme Court handed down its sentencing decision in the case arising from the explosion on 25 September 1998 at the Longford gas plant operated by Esso Australia Pty Ltd. The decision marked the end of the formal public consideration of a devastating event in Victorian industrial history, which began with the Royal Commission set up on 20 October 1998 to investigate the causes of an explosion in which two workers died and eight others were injured. Second, in early 2002, the Victorian Government failed in its attempt to introduce new criminal offences for corporate employers whose employees are killed or seriously injured at work. In spite of their failure to be passed by the Legislative Council in Victoria, these proposals warrant consideration. They represent a growing trend by policy makers in attempting to address more effectively the question of the liability for deaths and serious injuries of workers to employers who operate through the corporate form.

R v Scobie, finally taking the Royal Commission into aboriginal deaths in custody seriously?

Royal Commission into Aboriginal Deaths in Custody examined in the context of R v Scobie - the use made of the Commission's recommendations by Justice Gray in R v Scobie - questioning the value of imprisonment for certain types of offenders.