Objective Aggressive care interventions at the end of life (ACE) are reported metrics of sub-optimal quality of end of life care that are modifiable by palliative medicine consultation. Our objective was to evaluate the association of inpatient palliative medicine consultation with ACE scores and direct inpatient hospital costs of patients with gynecologic malignancies. Methods A retrospective review of medical records of the past 100 consecutive patients who died from their primary gynecologic malignancies at a single institution was performed. Timely palliative medicine consultation was defined as exposure to inpatient consultation ≥30 days before death. Metrics utilized to tabulate ACE scores were ICU admission, hospital admission, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission <3 days. Inpatient direct hospital costs were calculated for the last 30 days of life from accounting records. Data were analyzed using Fisher's Exact, Mann–Whitney U, Kaplan–Meier, and Student's T testing. Results 49% of patients had a palliative medicine consultation and 18% had timely consultation. Median ACE score for patients with timely palliative medicine consultation was 0 (range 0–3) versus 2 (range 0–6) p = 0.025 for patients with untimely/no consultation. Median inpatient direct costs for the last 30 days of life were lower for patients with timely consultation, $0 (range 0–28,019) versus untimely, $7729 (0–52,720), p = 0.01. Conclusions Timely palliative medicine consultation was associated with lower ACE scores and direct hospital costs. Prospective evaluation is needed to validate the impact of palliative medicine consultation on quality of life and healthcare costs.

Our data suggests that the APCU may provide cost effective, acute care for the patients with advanced chronic illness as well as the imminently dying in need of intensive symptom management.

The excretion of clusterin was compared with that of N-acetyl-beta-glucosaminidase (NAG) in rats given gentamicin daily for 2 months to determine whether clusterin excretion stays elevated after NAG excretion falls during chronic gentamicin administration. Clusterin was measured by radioimmunoassay and NAG by the hydrolysis of 4-methylumbelliferyl-N-acetyl-beta-D-glucosaminide. Gentamicin at 110 mg/kg was given daily for 44 days and thereafter, at 90 mg/kg daily. The excretion rate of both proteins rose rapidly, peaked, and then declined; however, the clusterin values stayed significantly above control values for the entire study, whereas NAG values were close to normal during the last 10 days, even though tubulointerstitial disease was active at that time. For this reason, the further evaluation of clusterin as a marker of renal tubular cell injury or death is warranted.

Although palliative care consultants provided initial evaluation and management of multiple symptoms, there was not a large ongoing need. Integration of palliative services into the care of patients receiving LVADs can be incorporated into the workflow of the cardiothoracic and palliative care teams, resulting in improved ACP for all patients receiving LVADs and better care coordination for patients at the end of life.

The current study was to answer the question: Is enough mercury absorbed from dental amalgam fillings to produce renal damage? One hundred healthy adults (18-44 years old) filled out health questionnaires and voided urine samples. Urine mercury concentration and N-acetyl-beta-glucosaminidase (NAG) were measured. Subjects were grouped into those having amalgam fillings (N = 66) and those without (N = 34). Median (95% Confidence Interval) urine mercury was 1 (1-2) and 0 (0-0.6) ng/ml (P < 0.01) and median urine NAG was 23 (18-27) and 16 (11-18) units (P < 0.05) in the two groups respectively. People with mercury amalgam fillings excreted slightly more mercury than people without them, and have a very small increase in urinary NAG excretion that is probably of no clinical significance. This dose of mercury absorbed from amalgam appears to be too little to be a public health hazard for renal injury.

Objective: There is limited information regarding the role of a palliative care consultation for ethnically and racially diverse women with gynecologic malignancies. The purpose of this study was to determine the characteristics, clinical findings and outcomes of patients with gynecologic malignancies who were referred for hospital inpatient palliative medicine consultation. Methods: Patients with gynecologic malignancies were identified who requested a Palliative Medicine consultation from January 1, 2007 to June 1, 2010. Their medical records were reviewed for information including demographics, disease status, reasons for the consultation, clinical findings, interventions, and outcomes. Results: 84 evaluable patients were identified. Forty-five percent (n=38) of patients were referred by their primary Gynecologic Oncologist. The average age was 63 years (range 22-96). The disease site was: uterus/endometrium (n=37, 44%), ovary (n=24, 29%), cervix (n=15, 18%), and vulva (n=5, 6%). Racial distribution included, African American (n=3, 39%), Caucasian (n=33, 28%), and Hispanic (n=13, 16%). Reasons for consultation were pain (n = 41; 45%), future goals of care (n=42; 46%) nausea/vomiting (n = 1; 1%), bowel obstruction (n=3, 3.3%) and dyspnea (n=4, 4%). Seventy-five percent of patients had medical co-morbidities, 27% had psychiatric co-morbidities and six patients were identified to have altered mental status at the time of interview. Eighty percent of patients were on narcotic medications at the time of consultation; however pain was adequately controlled in only 45% of patients. In 81% of the consultations, pharmacologic interventions were advised. The median number of days from consultation to death was 31. Hospice referral was recommended for 19 patients and thirty-eight patients were transitioned to “do not resuscitate” (DNR) status after consultation. The median number of days from DNR status to death was 19, and the median number of days from consult to DNR was 8. Sixteen patients (19%) died in the hospital setting. Conclusion: This patient population represents a unique perspective of racial diversity and predominantly advanced or recurrent gynecologic cancers. Pharmacologic interventions were advised in the majority of consults, however end-of-life decision making was a common reason for consultation. The consultation team proved effective in transitioning patients to DNR status, however there may be barriers to early palliative intervention and symptom control as the median time of intervention to death was only one month. Pain and symptom control remain a significant challenge that earlier intervention may alleviate. This diverse, minority and low socio-economic status population may be resistant and/or unable to seek palliative care outside the hospital or their home. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5026. doi:10.1158/1538-7445.AM2011-5026

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