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Background: Innovative models of collaborative palliative care are urgently needed to meet gaps in end-of-life care among people with heart failure. We sought to determine whether regionally organized, collaborative, home-based palliative care that involves cardiologists, primary care providers and palliative care specialists, and that uses shared decision-making to promote goal- and need-concordant care for patients with heart failure, was associated with a greater likelihood of patients dying at home than in hospital. Methods: We conducted a population-based matched cohort study of adults who died with chronic heart failure across 2 large health regions in Ontario, Canada, between 2013 and 2019. The primary outcome was location of death. Secondary outcomes included rates of health care use, including unplanned visits to the emergency department, hospital admissions, hospital lengths of stay, admissions to the intensive care unit, number of visits with primary care physicians or cardiologists, number of home visits by palliative care physicians or nurse practitioners, and number of days spent at home. Results: Patients who received regionally organized, collaborative, home-based palliative care (n = 245) had a 48% lower associated risk of dying in hospital (relative risk 52%, 95% confidence interval 44%-66%) compared with the matched cohort (n = 1172) who received usual care, with 101 (41.2%) and 917 (78.2%) patients, respectively, dying in hospital (number needed to treat = 3). Additional associated benefits of the collaborative approach included higher rates of clinician home visits, longer time to first hospital admission, shorter hospital stays and more days spent at home. Interpretation: Adoption of a model of regionally organized, collaborative, home-based palliative care that uses shared decision-making may improve end-of-life outcomes for people with chronic heart failure., Innovative models of collaborative, interdisciplinary palliative care that use shared decision-making to promote goal- and need-concordant care are urgently needed to meet rising demand among people with heart failure. (1,2) [...]

Points cles * Les recentes modifications apportees a la loi canadienne ont en fait cree 2 modes d'acces a l'aide medicale a mourir (AMM) selon que la mort est raisonnablement [...]

In 2016, medical assistance in dying (MAiD) was decriminalized in Canada with the passage of Bill C-14. Under Bill C-14, competent adults (aged [greater than or equal to] 18 yr) [...]

BACKGROUND: The risk of death in people after their first admission to hospital or first presentation to the emergency department for any reason is not known. The objective of this study was to estimate the risk of death among older adults who had had no admissions to hospital or emergency department visits in the preceding 5 years. METHODS: We used administrative data from Ontario, Canada, from 2007 to 2017 to measure the 5-year risk of death in community-dwelling adults aged 66 years and older after their first planned or unplanned hospital admission or emergency department visit, and among those who were neither admitted to hospital nor presented to the emergency department. We describe how this risk varied by age. RESULTS: Among 922 074 community-dwelling older adults, 12.7% died (116 940 deaths) over a follow-up of 3 112528 person-years (standardized mortality rate 53.8 per 1000 person-years). After the first unplanned hospital admission, 39.7% died (59234 deaths, standardized mortality rate 127.6 per 1000 person-years). After the first planned hospital admission, 13.0% died (10 775 deaths, standardized mortality rate 44.6 per 1000 person-years). After the first visit to the emergency department, 10.9% died (35 663 deaths, standardized mortality rate 36.2 per 1000 person-years). Among those with neither an emergency department visit nor hospital admission during follow-up, 3.1% died (11268 deaths, standardized mortality rate 29.6 per 1000 person-years). Slightly more than half of all deaths were in those with first unplanned hospital admission (50.7%). INTERPRETATION: Death within 5 years of first unplanned hospital admission for older adults is frequent and common. Knowledge of this risk may influence counselling and patient preferences and may be useful in research and analyses for health system planning., More than 420 million hospital admissions occur every year around the world. (1) Short-term prognosis is favourable; most people survive beyond admission. In North American adults, all-cause 1-year mortality after [...]

1 Un plan de reprise progressive des activites et une strategie de conservation d'energie sont indiques pour traiter la fatigue et la malaise post-effort associes a la COVID-19 de longue [...]

1 L'Organisation mondiale de la Sante a publie une definition de cas pour le syndrome post-COVID-19 (COVID-19 de longue duree) L'Organisation mondiale de la Sante a fait appel a des [...]

1 La fatigue est le symptome le plus courant de la COVID-19 de longue duree La fatigue est associee a une tolerance moindre a l'activite, a de l'inconfort suite a [...]

1 The World Health Organization has proposed a case definition for post-COVID-19 condition (long COVID) The World Health Organization used a Delphi consensus method that involved people with lived experience [...]

1 Fatigue is the most common symptom of long COVID Fatigue is associated with diminished activity tolerance and postexertional malaise and symptom exacerbation. Providers should assess its frequency, severity, duration, [...]

1 Fatigue and postexertional malaise associated with long COVID should be treated with titrated structured activity and energy conservation strategies (1) To avoid precipitating postexertional malaise, patients should be advised [...]

Selon des donnees emergentes, les personnes hypertendues ou diabetiques qui contractent le coronavirus du syndrome respiratoire aigu severe 2 (SRAS-CoV-2) et qui reqoivent un diagnostic de maladie a coronavirus 2019 [...]

Emerging data suggest that people with hypertension or diabetes who are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and diagnosed with coronavirus disease 2019 (COVID-19) are at an [...]