Embrace: addressing anticipatory grief and bereavement in the perinatal population: a palliative care case study.

Anticipatory grief is experienced by families who are informed that their unborn child may not survive in utero or during or after delivery. The child who survives delivery, but is critically ill, brings a combination of emotions to the family: joy in welcoming a new life and fear for the future. The healthcare team members caring for the patient and family often witness this grief and are impacted. In the perinatal setting, the care continuum for these patients begins at diagnosis, typically in the prenatal setting, and continued support extends beyond the presumed life expectancy of the child. This case study is provided to demonstrate the utilization of a palliative care interdisciplinary approach to meeting the complex bereavement needs of a family who was expecting a child with a life-impacting congenital condition.

Advance care planning.

Advance care planning is important; the discussion should start early, prior to a life-threatening illness and repeated as necessary when there are changes in a patient's status. It is not necessarily the final document that is important, but the communication that occurs during the process of ACP. It is during the discussion the physician and family will learn about and understand the patient's wishes. As Teno commented, "Even the most detailed written directive is likely to be of limited value if there has been no communication among patient, provider team, and proxy decision-maker." If an advance directive document is not completed, the wishes of the patient must be documented in the medical record. We know from the 2005 South Dakota "Dying to Know" survey that only 35 percent of South Dakotans have completed an advance directive and 39 percent want their physicians to initiate the conversation. South Dakota physicians can take an active role in increasing these percentages by initiating the advance directive discussion with their patients and completing their own directives. We can help our patients realize that the discussion of their values at end of life is a natural part of caring for themselves and their family.

Prognostic outcomes after the initiation of an electronic telemedicine intensive care unit (eICU) in a rural health system.

APACHE (Acute Physiology and Chronic Health Evaluation) mortality predictions and other outcomes are reported after the initiation of a telemedicine intensivist staffing program to monitor the intensive care unit patients of a rural health system. Mortality, length of ICU stay, and length of hospital stay were significantly less than predicted. Length of stay was identical to one year previously in the largest hospital reported, but the case mix index of severity had increased. More severely ill patients were being treated without increase in length of stay.

Case report: 66 year-old man with recurrent pneumonias and sinusitis.

A current myth is that Cystic Fibrosis (CF) is a disease of childhood. However, among adults with CF, 64% are between the ages of 18 and 29 years of age; 25% are between 30 and 39 years of age; 10% are between 40 and 49 years old; and 2% are 50 years of age. We report a case of a 66 year-old male with newly diagnosed cystic fibrosis after a history of recurrent pneumonias and sinusitis, with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Physicians must maintain a high index of suspicion to make the diagnosis of cystic fibrosis in elderly presenting with COPD exacerbation and recurrent pneumonias and sinusitis.