Palliative Care Consultation in the Intensive Care Unit Reduces Hospital Costs: A Cost-Analysis.

BACKGROUND: Palliative care aims to improve or maintain quality of life for patients with life-limiting or life-threatening diseases. Limited research shows that palliative care is associated with reduced intensive care unit length of stay and use of high-cost resources. METHODS: This was an observational, non-experimental comparison group study on all patients 18 years or older admitted to any intensive care unit (ICU) at Memorial Hermann - Texas Medical Center for 7 to 30 days from August 2013 to December 2015. Length of stay (LOS) and hospital costs were compared between the treatment group of patients with palliative care in the ICU and the control group of patients with usual care in the ICU. To adjust for confounding of the palliative care consultation on LOS and hospital cost, an inverse probability of treatment weighted method was conducted. Generalized linear models using gamma distribution and log link were estimated. All costs were converted to 2015 US dollars. RESULTS: Mean LOS was 13 days and mean total hospital costs were USD 58,378. In adjusted and weighted analysis, LOS for the treatment group was 8% longer compared to the control group. The mean total hospital cost was estimated to decrease by 21% for the treatment group versus the control group. We found a reduction of USD 33,783 in hospital costs per patient who died in the hospital and reduction of USD 9113 per patient discharged alive. CONCLUSION: Palliative care consultation was associated with a reduction in the total cost of hospital care for patients with life-limiting or life-threatening diseases.

Conference report: complex clinical, legal, and ethical issues of pregnant and postpartum women as subjects in clinical trials.

BACKGROUND: The Office of the Vice President for Research and School of Nursing of the University of Texas Medical Branch convened a multidisciplinary conference to address the national problem of underrepresentation of pregnant women in clinical trials. METHODS: Conference participants reviewed pertinent issues through lectures and panel discussions. RESULTS: More funded studies are needed to specifically examine pharmacokinetic, physiological, and pharmacological interactions in the pregnant woman. Legal, ethical, and financial issues need to be better delineated, and more focus is needed on specific diseases with particular import for pregnant women and their fetuses. CONCLUSIONS: This paper provides a report on the conference and the powerful consensus statements developed by the participants.

Considerations for hospital approval of human participant research.

BACKGROUND: Hospitals often accept as sufficient the federal requirement that human participant research studies have Institutional Review Board (IRB) review and approval, but IRBs usually do not consider many practical matters that arise in the implementation and operation of an interventional clinical trial in the complex environment of the modern acute care hospital. METHODS: A large hospital system in Texas implemented a policy requiring that any activity associated with human participant research receive prior hospital system review and approval. This hospital system review and approval process, which occurs in parallel with IRB review, focuses separately on patient safety and operational, financial, and special risk issues. RESULTS: A centralized research institute proactively gathers information needed to evaluate a proposed research study and forwards this information to unit directors and other key personnel in the affected hospitals for their review. When all reviewers have signed off on the study and the institute is satisfied that all pertinent issues have been resolved, it authorizes the principal investigator to begin the study in the designated hospitals. CONCLUSIONS: This review and approval process reduces risk, benefiting patients, hospital personnel who support research studies, research teams, and hospitals as institutions.

Pediatric art preferences: countering the "one-size-fits-all" approach.

OBJECTIVE: To determine the stated art preferences of pediatric patients through an art survey and determine whether preferences vary, with different age groups associated with different stages of cognitive development. BACKGROUND: Exposure to visual art has been shown to have an impact on improved health and satisfaction outcomes. However, there is little literature on the effect of art on pediatric patients. While designing pediatric wards, a common assumption is to use fantasy and Disney-like themes; but research across all age groups on whether children prefer these themes is limited. METHODOLOGY: A survey including 20 images with a variety of subject matter and styles was administered to 64 pediatric inpatients (ages 5-17) at Memorial Hermann Hospital in Houston, TX. Children were asked to rate the selection of, and their emotional response to, the images in the survey. Qualitative comments were recorded. Results were analyzed for each of the three age groups (5-6, 7-10, and 11-17 years) according to Piaget's developmental stages, as well as across all age groups. RESULTS: There were significant differences in art preferences across the different age groups, especially with respect to child art (art created by children). Overall, the results for 5-10-year-olds were more significant than those for 11-17-year-olds (adolescents). Nature elements were preferred across all age groups, but all nature images were not rated similarly. Images that were bright and colorful were rated better than images that were pale. The presence of a strong context that children could associate with was a defining feature of preferred images. Content drove preference more than style, though color was a key determinant. Comments on the artwork tended to be more objective/absolute for the youngest patients and more subjective/relative for the oldest. CONCLUSIONS: The combination of bright colors, engaging themes, and nature content is consistently highly rated by pediatric patients. However, pediatric preferences vary significantly among the three operational stages, so one should be careful before using the "one-size-fits-all" approach. Child art, typically used in pediatric wards, is better suited for younger children than for older children.

Determination of required content of the informed consent process for human participants in biomedical research conducted in the U.S. A practical tool to assist clinical investigators.

Clinical Investigators conducting biomedical research involving human participants in the U.S. are responsible for the content of the consent document(s) and for the conduct of the informed consent conference(s) with the human participants. The content of the consent forms and consent process may be governed by two different sets of U.S. regulations and may be impacted upon by separate, generally accepted, international guidelines. It can be difficult and confusing for an Investigator to determine which set(s) of regulations or guidelines apply to which studies. This article compares the two sets of U.S. regulations and two sets of well-respected international guidelines with respect to their requirements for the content of the consent document and consent conference. A practical decision tree is proposed as a tool to assist Investigators in determining which set(s) of requirements is applicable to a particular study.