Timely Referral to Hospice Care for Oncology Patients: A Retrospective Review.

Hospice care is medical care provided to terminally ill patients with a life expectancy of 6 months or less. Hospice services include symptom control, pain management, palliative care, and other supportive services such as providing for home equipment or oxygen; however, it does not provide for life-prolonging therapies such as chemotherapy. Although oncologic benchmarks suggest patients should be enrolled in hospice 3 months prior to death, studies show that most hospice referrals are being made too late. These shorter stays in hospice result in increased cost of care especially at the end of life with most patients dying on aggressive treatments in the hospital. Thus, identifying barriers to hospice placement is critical in improving the referral process and enhancing the quality of end-of-life care. This retrospective study collected data on 418 oncologic patients who passed in 2015 and categorized patients based on hospice status at the time of death. Our study found that the demographics between hospice and nonhospice patients were not significantly different. Hospice patients spent a median of 10 days in hospice and 71% (n = 161) of patients were in hospice 30 days or less. Additionally, 56% of patients were in hospice 10 days or less. Increased education for patients and health-care providers along with better utilization of palliative care services and incorporating a nurse navigator to help with transitioning patients to hospice would improve earlier referral to hospice care and enhance patients' quality of life.

Lanthanide extraction selectivity of a tripodal carbamoylmethylphosphine oxide ligand system.

Four tripodal carbamoylmethylphosphine oxide (CMPO)-based ligands are reported here and assessed with regard to lanthanide (Ln) coordination chemistry and selective extraction of lanthanide ions from aqueous solution. Inspired by previous liquid-liquid extraction studies that suggested a preference for terbium(iii), the current work further probes the extraction behavior of a tris-(2-aminoethyl)amine (TREN) capped, ethoxy substituted CMPO ligand with respect to the entire series of lanthanides. Upon confirmation of Tb3+ extraction selectivity versus the whole series, experiments were conducted to assess the effect of increasing the alkyl chain length within the ligand TREN cap, as well as changing the CMPO substituents by replacing the ethoxy groups with more hydrophobic phenyl groups to promote solubility in the organic extraction solvent. Extraction efficiencies remained low for most lanthanides upon increasing the cap size, with %E values consistently around 5%, and a complete loss of Tb3+ preference was noted with a decrease in %E from 18% to 3.5%. For the agent employing the original, smaller TREN cap but with phenyl substituents on the CMPO units, an increase in extraction toward the middle of the row was again observed, albeit modest, with relatively high %E values for both Gd3+ and Tb3+versus the other lanthanides (13 and 11%, respectively). A more dramatic extraction selectivity for the phenyl substituted ligand was achieved upon modification of the ligand to metal ratio, with a 100 : 1 ratio resulting in a near linear decrease in %E from 41% for La3+ to 3.7% for Lu3+. Finally, modification of the TREN capping scaffold by adding an oxygen atom to the central nitrogen led to consistently low %E values, revealing the effect of TREN cap oxidation on Ln extraction for this tripodal CMPO ligand system.