Most individuals at the end of life express an interest in remaining at home, and home deaths are trending upwards in the United States. While home deaths may be desirable, there are a number of complex symptoms such as delirium, agitation, and nausea that can occur as individuals approach death. Hospice can prescribe medications such as Haldol to manage these symptoms, but oftentimes the responsibility of determining how and when to administer medications falls on family members. This study set out to examine how often informal caregivers are expected to make decisions about Haldol administration by examining the records of 317 hospice patients (188 women, 129 men) who died at one of 2 residential homes for the dying in upstate New York. In these settings, volunteers serve as surrogate family members and administer hospice-prescribed medications, and records are kept documenting when Haldol was given, how much was given, and what the maximum dosage allowed was. To assess Haldol prescription practices and utilization, both PRN (as needed) and scheduled doses of drug prescribed and administered were recorded for the first 24 hours at the care home and on the day of each patient's death. Results revealed that Haldol prescriptions were common, with 98 patients (30.9%) being prescribed the drug at some point while at a care home. Of these patients, thirty seven (37.8%) were prescribed Haldol as a PRN medication. Analyses of changes in drug use revealed that there was a significant increase in the average maximum total dose allowed in the first 24 hours (3.42mg) and the last 24 hours (5.67mg) (t(82)=-3.37, p=0.001) as well as in the average amount of Haldol administered from the first day of care (.78mg) to the day (2.69mg) patients died (t(82)=-3.75, p < 0.001). The results show that caregivers are frequently asked to make decisions on whether to use Haldol to manage terminal delirium. These findings suggest that family members caring for dying individuals at home may benefit from additional support.
Background. Scientific illustrations and diagrams have been used for thousands of years to portray and relay information. As the different fields of science, technology, engineering and math progressed, diagrams evolved along with the scientific concepts they illustrated. Yet, there is no set standard for creating a scientific diagram or illustration. The field is continually evolving and growing, utilizing multiple dimensions including digital interfaces and virtual reality. Aims. To analyze the research on the use and effectiveness of different multimedia platforms for learning and to examine the effectiveness of learning outcomes using two dimensional vs three dimensional models. A specific focus was placed on level of detail and the role of color in medical diagrams. Another aim of this project was to develop novel medical illustrations and scientific diagrams based on these findings. Method. A literature search from January 1965 to January 2021 was conducted using the key words, scientific diagram, medical illustration, details, engagement, color, dimensions, models, learning, neuroscience, memory, among others. Databases and books from Union College's Schaffer library were utilized. Findings. There was some evidence that the different components that make up scientific diagrams may influence learning outcomes. For example, some colors (i.e. warm) may facilitate learning. The value in the level of detail included in a diagram seems dependent on multiple factors such as subject material, intended audience etc., . It has been suggested that certain artistic styles of illustrations better facilitate learning over others (i.e. cartoons better facilitate learning of medical information over anatomical and CT scan imaging), but the research conducted in the field was limited by inconsistent methodologies across studies. Conclusions. Scientific illustration has real world implications given its use in educating the medical professionals and leaders in STEM fields of tomorrow, yet research on the effectiveness of learning aids is limited. Further research is needed to identify how different sensory information might enhance learning, especially as more digital interface platforms, learning aids, and virtual reality techniques are being developed.
“ … Objec4ve/Design Fa.ma Ropri Advisor: Carol Weisse , PhD Results Table 1. Frequencies of … like to first and foremost thank my thesis advisor, Dr. Carol Weisse . This … ”
Abstract
Background: Many patients approaching the end of life experience symptoms that are managed through the use of medications. Lorazepam (Ativan) is a benzodiazepine that is often used to treat anxiety and other symptoms common at end of life, such as seizures and nausea. When patients are on hospice at home, familial caregivers are responsible for administering lorazepam to treat these symptoms. Hospice can prescribe lorazepam for a scheduled regimen, or "as needed" PRN regimen to allow caregivers the freedom to administer additional medication if necessary. Since there is no requirement to document medication, little is known about the use of lorazepam at home and how often caregivers are burdened with making decisions about its use. The goal of this study was to examine lorazepam prescribing practices in a community-run residential home for the dying, where hospice records all medication prescriptions. Caregivers also document how often medications are administered. The extent to which lorazepam regimens were on a scheduled vs. PRN basis was studied as a way of determining how often caregivers had to gauge when to administer lorazepam. The frequency with which changes in patient medications were made and total lorazepam consumption were also examined to assess caregiver burden. Methods: Data on the dose of lorazepam prescribed vs. administered was recorded from the files of 216 hospice patients who were cared for at the Joan Nicole Prince Home in Scotia, New York between February 2007 and July 2019. Scheduled and PRN lorazepam doses were calculated for the first 24 hours of care and on the day of death. Results: A majority (81.8%) of patients were prescribed lorazepam at the home and most of these patients (94.4%) had PRN prescriptions. There was a significant increase in the total amount of lorazepam consumed from the day entering the home (17%) to the last 24 hours of care (27%). Discussion: Lorazepam was prescribed to hospice patients very frequently and caregivers were often tasked with making decisions about whether to administer as needed doses to patients. While the administration of lorazepam increased as patients progressed toward death, consumption was low compared to doses allowed, which may have been the result of several issues, including caregivers' hesitation to administer full doses allowed by hospice. These results suggest that greater support of caregivers may be needed when caring for terminally ill patients experiencing anxiety at the end of life.
“ … Advisor: CarolWeisse, PhD Results Table 1. Mean maximum dose … pain. Acknowledgements I would like to thank Dr. CarolWeisse, my thesis advisor, the Schenectady Community Home … ”
Abstract
Roxanol is a common hospice pain medication that can be prescribed under different regimens with varying doses and schedules. In home care settings, caregivers are not required to record when medication is administered to patients; therefore, little is known about home hospice-prescribed Roxanol regimens and whether specific prescribing practices are associated with actual administration of medication during patients' final days of life. A retrospective review of patient care records of 227 deceased hospice patients who received routine home care between 2007 and 2020 was conducted. The overall amount of Roxanol administered to patients was examined by determining the doses prescribed as well as actual doses administered seven days prior to death and on the day of death. In addition, the extent to which Roxanol was administered based on prescribed regimen (i.e. scheduled, PRN, or combined scheduled plus PRN) and whether prescriptions were written with flexibility (i.e. varied doses, varied times, or varied doses and times) was also examined at both time points. Roxanol was prescribed to a large percentage (60.4%) of patients a week prior to death with even more (86.80%) on the day of death. The dose prescribed and the overall percentage of medication administered increased significantly during the last week of life; however, the overall quantity of Roxanol administered to patients remained relatively low seven days before death (23.40%) and on the day of death (30.68%). The most prevalent regimen prescribed shifted during the last week of life from PRN only (54.79%) to combined PRN/scheduled (57.14%) on the day of death. Nearly half of all prescriptions written contained some variability seven days before death (49.32%) and on the day of death (48.57%), and there was a greater likelihood that prescriptions were written with flexible dosing as opposed to varied time intervals. Administration rates were highest when prescriptions were more structured and did not vary by time or dose. The low overall Roxanol administration rates observed in this study suggest that certain regimens may not result in desired medication usage and that caregivers may need more clarity and guidance regarding when, how often, and how much Roxanol to administer.
“ … . CarolWeisse, and Schenectady Community Home, Inc., for … ”
Abstract
Depression is frequently experienced at the end of life and can increase pain and suffering. Antidepressants can alleviate depression among the terminally ill; however, many patients have difficulty swallowing oral tablets as death approaches and may be at risk for antidepressant discontinuation syndrome (ADS). This study retrospectively examined antidepressant prescription patterns among 227 hospice patients in a residential care home to determine the extent to which patients were prescribed antidepressants during their final month of life and at what time in the dying process patients may have stopped taking their medication. Results revealed that 67 (30%) of the hospice patients at the care home were prescribed one or more antidepressants. The vast majority (96.1%) of patients did not consume their prescribed antidepressant on their day of death. For those who died at the home, most (62.7%) did not receive their medication during their last 3 days whereas about a quarter of patients (23.6%) stopped receiving their medication 4-7 days prior to their death and a smaller percentage (13.9%) went without medication from 8-34 days prior to death. Records revealed that antidepressants were not consumed during patients' final days for a variety of reasons including difficulty swallowing, minimal consciousness, confusion, nausea, and patient refusal. These results suggest that hospice patients may be at risk for ADS, a factor that could add to suffering during patients' final days. Alternative routes of administering antidepressants at the end of life may be helpful in ensuring that patients are not suffering unnecessarily while they are dying.
“ … like to thank Professor Carol Weisse for her continued guidance throughout not only … but also my time at Union. … also like to thank Lou Carol Comley and Tracie Denny, the Volunteer Coordinators … ”
Abstract
As the US population ages, more elderly individuals are living out their final days in nursing homes. This is especially true for people with dementia who may feel especially isolated. This presentation will describe an Alzheimer's Buddy Program aimed at improving the well-being of seniors with dementia. The program was developed to connect dementia residents living in local nursing homes with Union College students. Through the support of an Obenzinger Fellowship, the Union College Kenney Community Center, and the Alzheimer's Association of Albany, I coordinated volunteer programs with both Schenectady County Glendale Home and Baptist Health Nursing and Rehabilitation Center. As coordinator of the program, I recruited student volunteers and organized informational sessions in which logistics about the program were discussed as were guidelines for how to interact with patients with dementia. The program began in October of 2019 and continued to the beginning of March of 2020. The group of volunteers comprised a total of 13 Union students, and each volunteer visited their assigned nursing home once a week for approximately 1.5 hours (as suggested by the nursing homes). Time at the nursing homes was spent participating in a wide variety of activities with the residents from assisting with meals, completing puzzles, going on walks, or simply engaging with residents socially. Although data was not collected from the nursing home residents, student volunteers appreciated the opportunity to learn more about the residents and hopefully the visits increased the residents' activity levels and brightened their days.
“ … on January 4, 2020. Ramkissoon, N., DeBono, K., & Weisse, … hospice patients being cared for in a home setting (Ramkissoon, DeBono & Weisse, 2019). Additionally, unanticipated side effects … ”
Abstract
At the end of life, most individuals express an interest in remaining at home and home
deaths are trending upwards in the United States. While this may be desirable, there are numerous complex symptoms such as delirium, agitation, and nausea that can occur as death approaches. Hospice prescribes medications such as haloperidol (Haldol), but oftentimes, the responsibility of administering medications falls on family members. Managing medications can be complicated by side effects, polypharmacy, caregiver characteristics, and inconsistent professional support. This study set out to examine how often informal caregivers make Haldol administration decisions by examining the records of 317 hospice patients (188 women, 129 men) who died at one of two community care homes. To assess prescription practices and drug use, PRN and scheduled doses of Haldol prescribed and administered were recorded for the first and last 24 hours at the care home. Haldol prescriptions were common; 98 patients (30.9%) were prescribed the drug at some point. Analyses of changes in drug use showed a significant increase in the average maximum total dose allowed in the first 24 hours (3.42mg) and the last 24 hours (5.67mg) (t(82)=-3.37, p=0.001) as well as in the average amount of Haldol administered from the first day of care (0.78mg) to the day patients died (2.69mg)(t(82)=-3.75, p < 0.001). These findings show that caregivers of dying individuals at home may require additional support.
Depression is frequently experienced at the end of life and can increase pain and suffering. Antidepressants can alleviate depression among the terminally ill; however, many patients have difficulty swallowing oral tablets as death approaches and may be at risk for antidepressant discontinuation syndrome (ADS). This study retrospectively examined antidepressant prescription patterns among 227 hospice patients in a residential care home to determine the extent to which patients were prescribed antidepressants during their final month of life and at what time in the dying process patients may have stopped taking their medication. Results revealed that 67 (30%) of the hospice patients at the care home were prescribed one or more antidepressants. The vast majority (96.1%) of patients did not consume their prescribed antidepressant on their day of death. For those who died at the home, most (62.7%) did not receive their medication during their last 3 days whereas about a quarter of patients (23.6%) stopped receiving their medication 4-7 days prior to their death and a smaller percentage (13.9%) went without medication from 8-34 days prior to death. Records revealed that antidepressants were not consumed during patients' final days for a variety of reasons including difficulty swallowing, minimal consciousness, confusion, nausea, and patient refusal. These results suggest that hospice patients may be at risk for ADS, a factor that could add to suffering during patients’ final days. Alternative routes of administering antidepressants at the end of life may be helpful in ensuring that patients are not suffering unnecessarily while they are dying.
“ … of Biological Sceinces and Psychology, June 2016. ADVISOR: Carol Weisse PhD Background: There is a growing need for … 21 Acknowledgements I would like to thank Professor Carol Weisse for her constant guidance and support, Mackenzie … ”
Abstract
Background: There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid unnecessary hospitalizations and remain with their regular outside care providers.
Objective: To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine, a community healthcare system serving New York's Capital District.
Design: A prospective cohort study tracking patient outcomes over the course of one year.
Subjects and setting: One hundred twenty-three patients (49 men, 74 women) with serious illnesses who were new enrollees in Care Choices
Measurements: Patient satisfaction, symptom management, and hospital utilization were used to measure effectiveness. Phone interviews were conducted assessing satisfaction after one month of care and again around three months later. Quality of life was assessed at baseline and after 1 month on service. The number of emergency room visits and in-patient hospitalizations was recorded pre- and post-enrollment.
Results: Patients were highly satisfied with their initial care and reported greater satisfaction and stable symptom management over time. Fewer emergency room and inpatient hospital admissions occurred while enrolled in the program.
Conclusion: An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients' desire to remain at home, avoid hospital admissions, and retain the option of outside care while on the program.
“ … of pain. Department of Psychology, June 2016. ADVISOR: Carol Weisse PhD Abstract With the growing population of … pain metrics. For example, in a recent study by Pouliot, Weisse, Pratt, and DiSorbo (2015), patients’ pain symptoms … ”
Abstract
With the growing population of chronically ill patients wishing to receive care at home, care providers face unique challenges managing the pain of patients with quickly changing illness trajectories. Treating patients outside of institutionalized settings, where regular monitoring is standard, requires careful symptom management. This project was a retrospective review examining nurses' documentation of pain for patients enrolled in Care Choices, a new home-based palliative care program coordinated through a visiting nurse service and community hospital. The extent to which nurses documented patients' pain score, site, type and pain goal as well as nursing interventions and plan of care in Allscripts electronic medical record (EMR) was assessed over a 3-month period. Records from a total of 204 home visits were analyzed for 15 chronically ill patients. The results revealed inconsistent tracking of pain and variations by pain metric. Variable recording practices in the EMR made it difficult to determine whether pain crises were being managed within a desired time period. Aspects of the EMR with the ability to trend quantitative clinical data and chart patient pain goals were also underutilized. Ways of improving the tracking of pain management decisions in chronically ill populations are discussed.
“ … like to thank Professors Linda Stanhope, Dan Burns, and Carol Weisse for showing me what it means to be not only … ”
Abstract
Error management theory (EMT) posits that when there are asymmetrical costs of false-positive and false-negative errors over evolutionary history, selection will favor psychological mechanisms biased toward less costly errors. In the mating domain, EMT explains the fact that men consistently overperceive women's sexual intent (SI), while women consistently underestimate men's commitment (CI). From a sexual selection perspective, underestimating women's SI (false-negative) is more costly for men than overestimating (false-positive); whereas overestimating a man's CI (false-positive) would have been more costly for women than underestimating (false-negative). Though the pattern of sex differences in SI and CI perception has been replicated many times, it is unknown whether sex of the perceiver or sex of the target mate (or perhaps even sexual orientation) determines the type of error-minimizing strategy employed (over- or under-estimation). Collecting data from homosexual and heterosexual samples allowed us to examine these previously untested distinctions. Participants rated the degree to which various behaviors indicated one's own, or a potential mate's, SI and CI. Results indicated that heterosexual women and lesbians perceived SI and CI similarly, whereas heterosexual and gay men did not. We conclude that homosexual mating strategy is complex: it is neither a simple continuation of heterosexual evolved mating psychology nor a gender-role reversal.
