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  1. Article ; Online: Palliative Care in the Time of COVID-19: Reflections From the Frontline.

    Koh, Mervyn Y H

    Journal of pain and symptom management

    2020  Volume 60, Issue 1, Page(s) e3–e4

    MeSH term(s) COVID-19 ; Coronavirus Infections/therapy ; Humans ; Palliative Care/methods ; Palliative Care/psychology ; Pandemics ; Pneumonia, Viral/therapy ; Singapore
    Keywords covid19
    Language English
    Publishing date 2020-04-08
    Publishing country United States
    Document type Letter
    ZDB-ID 639142-4
    ISSN 1873-6513 ; 0885-3924
    ISSN (online) 1873-6513
    ISSN 0885-3924
    DOI 10.1016/j.jpainsymman.2020.03.023
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  3. Article ; Online: Palliative Care in the Time of COVID-19

    Koh, Mervyn Y.H.

    Journal of Pain and Symptom Management

    Reflections From the Frontline

    2020  Volume 60, Issue 1, Page(s) e3–e4

    Keywords Anesthesiology and Pain Medicine ; General Nursing ; Clinical Neurology ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 639142-4
    ISSN 0885-3924
    ISSN 0885-3924
    DOI 10.1016/j.jpainsymman.2020.03.023
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article: Palliative Care in a COVID-19 Intensive Care Unit (ICU): Challenges and Recommendations for Palliative Care Teams in a Pandemic ICU

    Poi, Choo Hwee / Koh, Mervyn Y. H. / Neo, Han Yee / Hum, Allyn Y. M.

    Annals Academy of Medicine Singapore

    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #777142
    Database COVID19

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  5. Article ; Online: Protocol for a randomised controlled trial on impact of comprehensive geriatric and supportive assessment versus standard care in older adults with cancer undergoing curative treatment: The Geriatric Oncology SuPportive clinic for ELderly (GOSPEL) study.

    Goh, Wen Yang / Neo, Han Yee / Teo, Hui Lin / Koh, Mervyn Y H / Griva, Konstadina / Lim, Ming Yann / Ho, Francis C H / Hum, Allyn Y M

    Journal of geriatric oncology

    2022  Volume 14, Issue 1, Page(s) 101342

    Abstract: Cancer affects older adults with varying levels of frailty, but cancer treatment is extrapolated from clinical trials involving predominantly young and robust subjects. Recent geriatric oncology randomised controlled trials (RCT) report that geriatric ... ...

    Abstract Cancer affects older adults with varying levels of frailty, but cancer treatment is extrapolated from clinical trials involving predominantly young and robust subjects. Recent geriatric oncology randomised controlled trials (RCT) report that geriatric assessment leading to frailty-guided intervention reduces treatment-related toxicity whilst maintaining survival and improving quality of life (QoL). However, these positive results have not have been consistently reported in the literature. We postulate that the impact of geriatric interventions has been underestimated in these studies with the inclusion of subjects receiving palliative-intent chemotherapy in whom dose reduction is common. Integrating supportive care with current geriatric oncology models may improve the QoL of older adults undergoing treatment. However, no studies as yet have examined such integrated geriatric and supportive models of care. The Geriatric Oncology SuPportive clinic for Elderly (GOSPEL) study is a single-centre, open-label, analyst-blinded RCT evaluating the impact of comprehensive geriatric and supportive care on QoL of older adults with cancer undergoing curative treatment. Older adults aged above 65, with a Geriatric-8 score ≤ 14, with plans for high dose radiotherapy and/or curative chemotherapy will be recruited. The primary QoL outcome is measured using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-ELD14 mobility scale at 12 weeks. Secondary outcomes include overall and disease-free survival, treatment-related adverse events, and hospital admissions. We pre-powered this study to recruit 200 subjects based on the minimally clinically important difference for EORTC QLQ-ELD14 to achieve 80% statistical power (alpha 0.05), assuming 25% attrition. Outcomes will be analysed using intention-to-treat. Intervention consists of multi-domain comprehensive geriatric and supportive care assessments from a multidisciplinary team targeting unmet needs. These include functional decline, falls, incontinence, cognitive impairment, multi-morbidity, polypharmacy, and symptom relief, as well as social and psycho-spiritual concerns. Standard care entails routine oncological management with referral to geriatrics based on the discretion of the primary oncologist. Recruitment has been ongoing since August 2020. Results from the GOSPEL study will increase understanding of the impact of integrated geriatric and supportive care programs in older adults with cancer receiving curative treatment. Trial registration: This study is registered under ClinicalTrials.gov (ID NCT04513977).
    MeSH term(s) Aged ; Humans ; Frailty ; Neoplasms/therapy ; Medical Oncology ; Geriatrics ; Geriatric Assessment/methods ; Quality of Life ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2022-07-15
    Publishing country Netherlands
    Document type Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2556813-9
    ISSN 1879-4076 ; 1879-4068
    ISSN (online) 1879-4076
    ISSN 1879-4068
    DOI 10.1016/j.jgo.2022.07.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: ED-PALS: A Comprehensive Palliative Care Service for Oncology Patients in the Emergency Department.

    Koh, Mervyn Y H / Lee, Jia F / Montalban, Socrates / Foo, Chik L / Hum, Allyn Y M

    The American journal of hospice & palliative care

    2019  Volume 36, Issue 7, Page(s) 571–576

    Abstract: Background: The American College of Emergency Physicians has identified early palliative care referral for patients with advanced cancer as a key competent of the Choosing Wisely campaign.: Objectives: To study the feasibility of a new 3-way model of ...

    Abstract Background: The American College of Emergency Physicians has identified early palliative care referral for patients with advanced cancer as a key competent of the Choosing Wisely campaign.
    Objectives: To study the feasibility of a new 3-way model of care between emergency department (ED), hospital palliative care department, and inpatient/home hospice.
    Methods: This was a prospective, descriptive study that included oncology patients who attended the hospital ED over a 3-year period from January 2015 to December 2017. The inclusion criteria were as follows: (1) presence of metastatic cancer with either; (2) any 1 of the following symptoms: pain, dyspnea, nausea and vomiting, delirium, or swelling; or (3) potential care difficulties (requiring home hospice care or inpatient hospice).
    Results: A total of 340 patients were referred from the ED. Mean age was 72 years, 59% were males and 41% females, and the majority (88%) were Chinese. The most common cancers were lung 89 (26%), colorectal 71 (21%), and hepatobiliary cancer 49 (14%). The most common symptoms on Edmonton Symptom Assessment Scale scoring were pain (34%), poor appetite (31%), and dyspnea (26%).
    Conclusions: This tripartite model of palliative care, hospice, and ED collaboration allows earlier access to palliative care in the ED and direct admissions to the palliative care unit and comfort care rooms. The ED patients who did not need admission were also attended to in the palliative care "Hot Clinics" within a week with home hospice help. Patients who required inpatient hospice care were directly admitted there from the ED.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Decision Making ; Emergency Medical Services/standards ; Emergency Medical Services/statistics & numerical data ; Female ; Hospice and Palliative Care Nursing/standards ; Hospice and Palliative Care Nursing/statistics & numerical data ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Neoplasms/nursing ; Practice Guidelines as Topic ; Prospective Studies ; Referral and Consultation/standards ; Referral and Consultation/statistics & numerical data ; United States
    Language English
    Publishing date 2019-01-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1074344-3
    ISSN 1938-2715 ; 1049-9091
    ISSN (online) 1938-2715
    ISSN 1049-9091
    DOI 10.1177/1049909119825847
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Burnout and Resilience After a Decade in Palliative Care: What Survivors Have to Teach Us. A Qualitative Study of Palliative Care Clinicians With More Than 10 Years of Experience.

    Koh, Mervyn Y H / Hum, Allyn Y M / Khoo, Hwee Sing / Ho, Andy H Y / Chong, Poh Heng / Ong, Wah Ying / Ong, Joseph / Neo, Patricia S H / Yong, Woon Chai

    Journal of pain and symptom management

    2019  Volume 59, Issue 1, Page(s) 105–115

    Abstract: Context: Burnout is common among palliative care clinicians (PCCs). Resilience helps to reduce burnout, compassion fatigue, and is associated with longevity in palliative care.: Objectives: We aimed to study PCCs who have remained in the field for ... ...

    Abstract Context: Burnout is common among palliative care clinicians (PCCs). Resilience helps to reduce burnout, compassion fatigue, and is associated with longevity in palliative care.
    Objectives: We aimed to study PCCs who have remained in the field for longer than 10 years to deepen our understanding on their views on burnout and resilience.
    Methods: We conducted a qualitative study using semistructured interviews and purposive sampling on 18 PCCs - five doctors, 10 nurses, and three social workers who worked in various palliative care settings (hospital palliative care team, home hospice, and inpatient hospice). The mean age of the interviewees was 52 years, and the mean number of years practicing palliative care was 15.7 years (range 10-25). The interviews were recorded verbatim, transcribed, and analyzed using a grounded theory approach.
    Results: Four major themes emerged from our analysis - struggling, changing mindset, adapting, and resilience. Intervening conditions, such as self-awareness, reflection, and evolution, were also important factors. The core phenomenon of our study was that of transformational growth - a process that PCCs have to go through before they achieve resilience. We also further classified resilience into both personal and collective resilience.
    Conclusion: Our findings highlight the evolving process of transformational growth that PCCs must repeatedly undergo as they strive toward sustained resilience and longevity. It also stresses the importance of taking individual and collective responsibility toward building a culture of personal and team resilience.
    MeSH term(s) Adult ; Burnout, Professional/psychology ; Compassion Fatigue/psychology ; Female ; Hospice and Palliative Care Nursing ; Humans ; Job Satisfaction ; Male ; Middle Aged ; Nurses/psychology ; Palliative Care ; Physicians/psychology ; Qualitative Research ; Resilience, Psychological ; Social Workers/psychology
    Language English
    Publishing date 2019-08-26
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639142-4
    ISSN 1873-6513 ; 0885-3924
    ISSN (online) 1873-6513
    ISSN 0885-3924
    DOI 10.1016/j.jpainsymman.2019.08.008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2252: Show issues Location:
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  8. Article ; Online: Comfort and Satisfaction With Care of Home-Dwelling Dementia Patients at the End of Life.

    Tay, Ri Yin / Hum, Allyn Y M / Ali, Noorhazlina B / Leong, Ian Y O / Wu, Huei Yaw / Chin, Jing Jih / Lee, Angel O K / Koh, Mervyn Y H

    Journal of pain and symptom management

    2019  Volume 59, Issue 5, Page(s) 1019–1032.e1

    Abstract: Context: Despite the preference to pass away at home, many dementia patients die in institutions, resulting in a paucity of studies examining end-of-life care outcomes in the home setting.: Objective: The objective of this study was to identify ... ...

    Abstract Context: Despite the preference to pass away at home, many dementia patients die in institutions, resulting in a paucity of studies examining end-of-life care outcomes in the home setting.
    Objective: The objective of this study was to identify modifiable factors associated with the comfort of dementia patients dying at home and families' satisfaction with care.
    Methods: This is a prospective cohort study conducted from October 2014 to April 2019 in Singapore. Dementia patients at Stage 7 on the Functional Assessment Staging Scale, with albumin <35 g/L, enteral feeding, or pneumonia, were recruited from a palliative homecare program. Independent variables included demographics, medical information, and care preferences. The Comfort Assessment in Dying with Dementia scale assessed dying patients' comfort, whereas the Satisfaction with Care at the End-of-Life in Dementia scale evaluated family caregivers' satisfaction two months after bereavement. Gamma regression identified factors independently associated with comfort and satisfaction.
    Results: The median age of 202 deceased patients whose comfort was assessed was 88 years. Anti-cholinergic prescription (60.4% of patients) [β (95% CI) = 1.823 (0.660-2.986), P = 0.002] was positively associated with comfort, whereas opioid prescription (89.6%) [β (95% CI) = -2.179 (-4.107 to -0.251), P = 0.027] and >1 antibiotic courses used in the last two weeks of life (77.2%) [β (95% CI) = -1.968 (-3.196 to -0.740), P = 0.002] were negatively associated. Independent factors associated with families' satisfaction with care were comfort [β (95% CI) = 0.149 (0.012-0.286), P = 0.033] and honoring of medical intervention preferences (96.0%) [β (95% CI) = 3.969 (1.485-6.453), P = 0.002].
    Conclusion: Achieving comfort and satisfaction with care for dementia patients dying at home involves an interplay of modifiable factors. Honoring medical intervention preferences, such as those with palliative intent associated with patients' comfort, determined families' satisfaction with care.
    MeSH term(s) Aged, 80 and over ; Death ; Dementia/therapy ; Humans ; Nursing Homes ; Palliative Care ; Patient Satisfaction ; Personal Satisfaction ; Prospective Studies ; Singapore ; Terminal Care
    Language English
    Publishing date 2019-12-16
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639142-4
    ISSN 1873-6513 ; 0885-3924
    ISSN (online) 1873-6513
    ISSN 0885-3924
    DOI 10.1016/j.jpainsymman.2019.12.004
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  9. Article ; Online: International Critical Care-From an Indulgence of the Best-Funded Healthcare Systems to a Core Need for the Provision of Equitable Care.

    Lumb, Philip D / Adler, Diane C / Al Rahma, Hussain / Amin, Pravin / Bakker, Jan / Bhagwanjee, Satish / Du, Bin / Bryan-Brown, Christopher W / Dobb, Geoffrey / Gingles, Bruce / Jacobi, Judith / Koh, Younsuck / Razek, Assem Abdel / Peden, Carol / Shrestha, Gentle S / Shukri, Khalid / Singer, Mervyn / Taylor, Phil / Williams, Ged

    Critical care medicine

    2021  Volume 49, Issue 10, Page(s) 1589–1605

    MeSH term(s) Congresses as Topic ; Critical Care/methods ; Critical Care/trends ; Financial Management, Hospital/standards ; Financial Management, Hospital/trends ; Health Policy/economics ; Health Services Accessibility/economics ; Health Services Accessibility/standards ; Health Status Disparities ; Humans
    Language English
    Publishing date 2021-07-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005188
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    Zs.A 1261: Show issues Location:
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  10. Article ; Online: Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.

    Evans, Laura / Rhodes, Andrew / Alhazzani, Waleed / Antonelli, Massimo / Coopersmith, Craig M / French, Craig / Machado, Flávia R / Mcintyre, Lauralyn / Ostermann, Marlies / Prescott, Hallie C / Schorr, Christa / Simpson, Steven / Wiersinga, W Joost / Alshamsi, Fayez / Angus, Derek C / Arabi, Yaseen / Azevedo, Luciano / Beale, Richard / Beilman, Gregory /
    Belley-Cote, Emilie / Burry, Lisa / Cecconi, Maurizio / Centofanti, John / Coz Yataco, Angel / De Waele, Jan / Dellinger, R Phillip / Doi, Kent / Du, Bin / Estenssoro, Elisa / Ferrer, Ricard / Gomersall, Charles / Hodgson, Carol / Møller, Morten Hylander / Iwashyna, Theodore / Jacob, Shevin / Kleinpell, Ruth / Klompas, Michael / Koh, Younsuck / Kumar, Anand / Kwizera, Arthur / Lobo, Suzana / Masur, Henry / McGloughlin, Steven / Mehta, Sangeeta / Mehta, Yatin / Mer, Mervyn / Nunnally, Mark / Oczkowski, Simon / Osborn, Tiffany / Papathanassoglou, Elizabeth / Perner, Anders / Puskarich, Michael / Roberts, Jason / Schweickert, William / Seckel, Maureen / Sevransky, Jonathan / Sprung, Charles L / Welte, Tobias / Zimmerman, Janice / Levy, Mitchell

    Intensive care medicine

    2021  Volume 47, Issue 11, Page(s) 1181–1247

    MeSH term(s) Critical Care ; Humans ; Sepsis/therapy ; Shock, Septic/therapy
    Language English
    Publishing date 2021-10-02
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-021-06506-y
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