International Conference on Hospice & Palliative Care September 01-02, 2015 Orlando, USA

Bachelor of Medicine and Surgery at Barcelona University. Catalonia (Spain) Specialist in Geriatric Medicine Master in Palliative care at Barcelona University. Catalonia (Spain) Doctorate “cum laude” at Rovira i Virgili University, Tarragona. Catalonia (Spain) Coordinator of PADES team (home supportive care programme team) in Reus (Tarragona). Catalonia (Spain) Associate professor, Rovira i Virgili University, Tarragona. Catalonia (Spain) Associate professor of Master of “Aging and Health”, Rovira i Virgili University,Tarragona. Catalonia (Spain) Coordinator of subjects “Practical assistance to geriatric syndromes and interdisciplinary work” and “End-of-life care”, Master of “Aging and Health”, Rovira i Virgili University, Tarragona. Catalonia (Spain).

Definition: The complexity is caused by the emerging of processes, that when they interact, fulfill the criteria to be defined complex systems. \r\n\r\nReference model: Our base model is modeled on the needs of patients and families, thus obtaining six areas of complexity: Physical needs, psycho-emotional, socio-family, spiritual, area related directly with death (situation in the last days, grief), and area of ethical aspects. \r\n\r\nAreas and criteria of complexity: In each area the following are obtained: Base definitions, situations usually creating complexity and criteria of complexity grouped in three levels: Low medium and high. \r\n\r\nModel of Intervention: The proposal is- Low complexity: Intervention of the community health care team with occasional intervention of the palliative care team. Medium complexity: Shared caring decided between the community health care team and the palliative team. High complexity: main intervention by the palliative team or hospital admission. \r\n\r\nConclusions: It is necessary to differentiate between situations that are usually complex and criteria of complexity. The first are those situations that often behave as an emerging process, whereas the criteria of complexity correspond to the actual emergence or its results. The intervention model proposed should improve the collaboration between community care and the palliative team, as this is a co-responsible and dynamic model that does not divide the intervention.\r\n

Neva L Crogan received her BSN from the University of the State of New York in 1983, a Master’s in Nursing from Eastern Washington University in 1992 and a PhD from Washington State University in 1998. Her Post-doctorate education includes a Geriatric Nurse Practitioner Certificate in 2007 from the University of Virginia. A systems approach to improving the quality of life of nursing home elders is her nursing and research focus. She is a Fellow of the American Academy of Nursing and was the co-recipient of the 2013 Sigma Theta Tau International Research Utilization Award. She has published more than 60 data based research articles and has presented at multiple regional, national and international conferences.

The purpose of this study was to test the efficacy of the Sorbet Increases Salivation (SIS) intervention on managing nursing home elder drug-induced xerostomia. The specific aims were to test the effects of SIS on resident food intake and body weight. Using a two-group design, thrity-nine nursing home residents (from two nursing homes) were given 2 ounces of lemon-lime sorbet prior to lunch and dinner meals for 6 weeks. Participants were offered 2 ounces of a non-citrus drink prior to the lunch and dinner meals for 6 weeks during comparison weeks. Twenty-two residents completed both the ocmparison and intervention periods. Of those, 8 gained weight, 10 maintained and 4 lost weights. The amounts of food ingested during dinner increased significantly (p=0.001) from the comparison period to the intervention period (208-253 g). For liquids, the amounts ingested during dinner decreased significantly (p=0.002) from the comparison periods to the intervention period (from 356 ml to 310 ml). This innovative and person-centered approach to alleviating elder dry mouth utilized a simple, easy-to-implement intervention that has the potential of increasing food intake in this at-risk population. The product is inexpensive and the intervention requires very little staff training to initiate. Further study is needed to test the efficacy of the intervention with a larger sample of residents from multiple nursing homes.

Background: Anaemia is a common problem in patients with advanced cancer. However, few of these patients receive a blood transfusion. There is little guidance available to help in identifying which groups of patients are more likely to benefit. The decision to transfuse remains based upon patient symptom burden and clinical judgement.\r\nAims: The main aims of this audit were to outline the use of blood transfusions in patients with advanced cancer in a palliative care unit and to find the impact of blood transfusion on patient symptom burden and survival.\r\nMethods: Retrospective audit of all patients with advanced cancer receiving a blood transfusion in a specialist palliative care unit over an eight month period. Patients receiving cancer treatment were excluded. Data collected included demographics, haemoglobin (Hb) and symptoms pre- transfusion, units transfused, Hb and symptoms post-transfusion and survival post-transfusion.\r\nResults: Over the study period 13 patients were transfused a total of 31 units of blood in 15 transfusion episodes. Most patients received a single transfusion of 2 units of blood with a pre- transfusion mean Hb of 7.06g/dl, and post-transfusion Hb of 8.98g/dl. Blood transfusion produced symptomatic benefit in 73% of all episodes, and mean survival was 35 days after first transfusion.\r\nConclusion: The decision to transfuse a patient who has advanced cancer remains difficult and requires a considered approach. This audit supports the use of a restrictive blood transfusion policy but highlights the need for clear guidelines to allow clinicians to make evidence-based decisions.

Dr. Waqas Nawaz got his MBBS from King Edward Medical University in the year 2010. He is a resident physician under the category of PGY3 in Internal Medicine Department at Montefiore Medical Centre, Wakefield Campus, New York which will conclude in June 2016. He has published 10 clinical abstracts and several academic achievements. He is currently working at Montefiore Medical Campus with previous experiences from Carthage Area Hospital (Watertown, New York) and Mayo Hospital, Lahore.

Introduction: Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. In palliative and critical care medicine, brain death without cardiac death has always been a challenging dilemma due to inability of general population to differentiate it from coma. Here we describe a case of 50 year old female where lag of 7 days between brain and cardiac death offered significant challenge to the physicians and enormous emotional trauma to the family.\r\nMaterials & Methods: Case describes 50 year old female who had a cardiac arrest, was resuscitated and in tubated in ICU where she was started on vasopressors. Neurological exam and CT head showed loss of differentiation between grey and white matter consistent with anoxic brain injury. Neurological exam revealed absent brainstem reflexes suggesting possible brain death. The husband was explained about the concept of brain death. Brain death was confirmed by neurologist. She was not considered a candidate for apnea test given high PEEP requirements on ventilator. Brain perfusion scan and EEG were consistent with diagnosis of brain death. She was pronounced legally dead and death certificate was completed. Husband stated 2 previous such incidences in the family where patient recovered few months after being in “coma.” He did not accept her death and requested to continue with life support. Palliative care and bioethics were involved and family meetings with the husband and children were arranged where they were explained the difference between coma and death. They insisted upon continuing with life support and \"full code\" status in the event of cardiac arrest. They were explained that there is no such thing as code status once a patient is brain dead. The family did not accept her death due to her heart beat, some visible muscle twitching due to spinal reflexes and their religious views in spite of all medical explanation and counseling. Hospital administration, risk management, bioethics and palliative care were involved actively. Pastoral care was also provided respecting their religious views. 6 days later, the family reached upon a decision where they all agreed to discontinue the life support. They were given permission to attend the extubation that was immediately followed by cardiac death. Psychosocial and moral support was provided. Discussion: Brain death without cardiac death is not an uncommon entity in the era of advanced critical care but remains debatable as it is imbued with social, cultural, and religious meaning. It is a clinical diagnosis that requires the establishment of the cause of coma, the ascertainment of irreversibility, the recognition of possible confounding factors (e.g. hypothermia, barbiturate poisoning etc.) and the apnea test. Advanced neurological tests like cerebral scintigraphy, EEG, trans-cranial Doppler and cerebral angiography are indicated to confirm the diagnosis if apnea test cannot be done. Brain death is followed by cardiac death within6-7days in 97% of cases. Death certificate is done at the time of diagnosis of brain death and is dated and timed accordingly with comprehensive documentation. The organ donor network is contacted at the time of brain death. Two physicians are required to certify the time of death in case of organ donation.\r\nConclusions: Brain death is a clinical diagnosis that requires sancillary tests only in certain circumstances. Brain death is often not accepted by the family due to resemblance with coma, general concept of life with heart beat and religious beliefs. Cardio-respiratory support should be withdrawn in accordance with hospital policies, including those for organ donation.

Yi- Chun Lin has completed her PhD at the age of 37 years from National Chiao Tung University. In her academic career, she now serves at the Graduate School of Fire Science & Technology, Central Police University, Taiwan, R.O.C. She is also serving as a State Compensation board member of Fire Bureau New Taipei City Government and Taipei City Fire Department. She is also serving as the Building Technology Committee member of construction and planning Agency, Ministry of the Interior. She is also serving as the Director in Public Policy of the Consumer\'s Foundation.

When a disaster causes mass casualties, emergency medical technicians (EMTs) of the fire department shall rush to the disaster scene in the first instance, and shall effectively implement triage classification for large number of injured victims, so that the majority of injured victims can receive better pre-hospital medical care. The most important job of emergency medical service (EMS) at the disaster scene with mass casualties is to perform emergency triage classification, but the disparity in EMT triage classification often becomes a hot issue that we care about. In this research paper, through literature review and case study at home and abroad, and review of the status of triage classification system at present, I sorted out more important factors that would affect EMT triage classification competence, namely, individual traits of EMT, EMT rescue ability, and decision-making process. Empirical studies and survey questionnaires were taken, and the data obtained were analyzed using regression analysis, path analysis and other statistical methods. In the process, I picked out four major factors, which include \"rescue skills,\" \"vital signs,\" \"medical care related license,\" and \" lapse time since last rescue training.\" These were used in an interpretation model I constructed to help explain and identify the factors that would influence triage classification competence. It is recommended that the fire department shall continue to hold EMT trainings of all levels. These trainings shall incorporate the development of EMT decision-making ability and vital signs assessment skills. At regular intervals, emergency services technical skill appraisals and exercises simulating disaster with mass casualty shall be held, so as to strengthen EMT rescue skills. Their performance could be used for consideration of extension or renewal of their rescue license status. Training expenses and equipment purchase shall be increased. Site commander at the disaster scene is to select the triage personnel of professional rescue units with first priority placed on EMT P. The fire department shall also maintain good coordination with medical units and support groups, and good communication channels in order to receive their opinions and inputs for the implementation of their triage classification system.