Phlegmonous enterocolitis

Eight cases of phlegmonous enterocolitis which involved the small intestine exclusively in 5 patients, colon exclusively in 2, and both small intestine and colon in one are reported. Seven of the cases were studied at autopsy. The intestinal lesion was clearly the cause of death in 3 patients and was probably a secondary finding in 4 others. In one case, the cecum was involved and this segment was surgically resected. Five of the patients gave a history of alcoholism. The livers of the 7 patients studied at autopsy were all abnormal; cirrhosis was present in 4, severe fatty metamorphosis in 2, and moderate fatty metamorphosis in 1. The clinical, morphological, and bacteriological aspects of phlegmonous gastritis and phlegmonous enterocolitis are similar, and these two conditions are thought to represent the same infectious disease involving different levels of the gastrointestinal tract. In most patients the factor(s) predisposing to infection of the gastric and intestinal wall are unknown. In some patients mucosal injury of varied type and septicemia appear to have been the forerunners of the phlegmonous lesion. The possible relationships of ischemic bowel injury, alcoholis, and liver disease to phlegmonous inflammation of the gastrointestinal tract are discussed.     

The dignity in advanced dementia (diadem) study: Developing an integrated geriatric palliative homecare program

Background: The prevalence of dementia is rising globally. Many patients suffer from the burdensome complications of advanced dementia as they are still poorly addressed. Aims: To describe the development of an interdisciplinary palliative homecare program for patients with advanced dementia and to develop a workflow that delineates the seamless continuation of care between the hospital and community with the homecare program. Design: Palliative care needs of patients and caregivers were established through a qualitative review of the literature. Appraisal tools were chosen based on their validity and feasibility in the homecare setting. Gaps in the healthcare system were identified and addressed as part of the integration of care between the hospital and the community. Setting/participants: Patients at Functional Assessment Staging (FAST) 7 with pneumonia, albumin level <35?g/L and/or enteral feeding were enrolled from a tertiary care hospital into the homecare program. Results: Patients’ symptom burden and quality of life were assessed. Caregivers were engaged in the planning of patients’ care. With the homecare program, patients and caregivers received support at home. Two physicians, seven nurses, and three social work professionals were educated about advanced dementia palliative care and medical information was communicated between different healthcare sites. Preliminary analysis of 306 patients revealed the presence of pain and neuropsychiatric behaviors. Impact of caregiving was mild to moderately severe. Conclusion: Advanced dementia is under-recognized as a terminal illness requiring specialized palliative intervention. Integrating a homecare palliative program into advanced dementia care is the first step towards palliating suffering at the end-of-life.