Barriers and facilitators to caring for individuals with serious persistent mental illness in long-term care.

OBJECTIVE: Many older adults in the United States with serious persistent mental illness reside in long-term facilities, and evidence suggests increasing numbers of long-term care residents with serious persistent mental illness. Healthcare professionals in these settings may face challenges in providing care to these residents. The purpose of this study was to describe health care professionals' perceptions of the barriers and facilitators to caring for long-term care residents with serious persistent mental illness. METHODS: A qualitative descriptive design was employed. RESULTS: Ten healthcare professionals working in long-term care were interviewed. Themes that emerged from the interviews were: coming to know the individual and their unique needs takes time; offering choices and being flexible facilitates trust; respecting the inherent worth of each individual promotes caring. CONCLUSIONS: Caring for individuals with serious persistent mental illness in long-term care requires an individualized, person-centered approach.

Challenges experienced and resources identified by young to midlife couples 1-3 years post-cancer diagnosis.

OBJECTIVE: The purpose of this study was to explore what young to midlife couples viewed as their strengths as a couple and the greatest challenges in their experience with cancer 1-3 years post-diagnosis. METHODS: We used qualitative content analysis to extract common themes from open-ended questions from 42 cancer survivors and their partners (aged 27-58). Patterns of themes by age and gender of the survivor were also explored. RESULTS: Couples described both positive and negative impacts of the cancer experience: (1) strengthened the relationship, bringing couples closer together; (2) brought emotional strain to many areas of life, especially for partners; (3) created positive changes in lifestyle and new priorities for the couple; (4) created strain in the couple's relationship and intimacy; and (5) altered the role of family in supporting the couple. Couples also described four key strengths in dealing with the cancer experience: (1) drawing strength from shared love and mutuality; (2) communicating openly, even about the difficult stuff; (3) working together as a team to support each other; and (4) drawing strength from shared values and goals. Couples reported unmet needs related to the emotional and relational strain of the cancer experience, managing longer term survivor symptoms, fertility and physical intimacy, and lack of support or attention to the partner who often assumed the role of care partner. CONCLUSIONS: Themes are discussed in light of current dyadic concepts and importance of couple-based interventions.

Hospice Use Among Individuals With Severe Persistent Mental Illness.

BACKGROUND: Severe persistent mental illness (SPMI) currently affects an estimated 11.2 million adults in the United States (National Institute of Mental Health, 2019). Affected individuals are known to experience inequities in care, and on average, they die earlier than individuals without SPMI. Currently, little is known about hospice use among individuals with SPMI, including what factors contribute to the use of hospice services. AIMS: The aim of this integrated review was to identify factors associated with the use of hospice services by individuals with SPMI. METHODS: A review of the available literature on this topic was performed in accordance with PRISMA guidelines. The databases Cumulative Index to Nursing and Allied Health Literature, PubMed, and PsycInfo were searched, and relevant records were identified. Ultimately, eight studies were identified and selected for analysis. RESULTS: Themes illustrating the factors associated with hospice use and, within them, challenges to obtaining hospice care were discovered. The three themes identified within the eight studies were fragmentation of care, inadequate communication, and the need for advance care planning. These patterns indicated that multiple barriers to utilizing hospice care exist for individuals with SPMI when compared with the general population. CONCLUSIONS: By recognizing and addressing factors influencing the use of hospice care, as well as barriers to receiving hospice, improved provision of timely end-of-life care that is consistent with individuals' preferences may be facilitated.

The Role of Financial Security on Physical and Mental Health in Young-Midlife Couples Surviving Cancer.

BACKGROUND: A cancer diagnosis carries a significant economic burden. Yet little is known about perceived financial security on the health of couples with a partner diagnosed with cancer. OBJECTIVE: The current study explored perceived financial security in young-midlife couples. METHODS: The study included 49 couples (aged 27-58 years) 1 to 3 years after diagnosis. Multilevel modeling was used to examine the association of perceived financial security on physical and mental health of couples controlling for interdependent data; hierarchical linear regression was used to examine perceived financial security on survivor symptoms and partner care strain. RESULTS: Mean age of survivors was 43.5 (±9.0) years. Most survivors were female (69%) and 2.2 (±0.6) years after diagnosis. Lower levels of perceived financial security were significantly associated with poorer physical (P < .001) and mental (P < .05) health status for survivors, controlling for age, sex, education, and years since diagnosis; there were no significant associations with partner health status. Lower levels of perceived financial security were significantly associated with higher survivor pain severity (P < .001), pain interference (P < .001), and fatigue (P < .01); there was no significant association with partner care strain. CONCLUSIONS: Financial security plays a role on the physical and mental health of couples after diagnosis. IMPLICATIONS FOR PRACTICE: Screening for financial hardship at diagnosis and posttreatment can identify couples at high risk and in need of additional resources and counseling. Greater assessment and reporting of financial security in studies of families surviving cancer are needed to understand the impact on health outcomes.

Locating chronically implanted subdural electrodes using surface reconstruction.

OBJECTIVE: To determine the accuracy of locating subdural electrodes by means of 3-D surface rendering of CT scans. METHODS: Open source software has been developed and posted on the web which segments the electrodes into 3-D surfaces and allows their 3-D locations to be exported to other EEG analysis programs. The accuracy of the technique was determined by studying 410 subdural electrodes implanted in four epilepsy patients. Accuracy was determined by comparing the locations from the rendering analysis to the locations of the same electrodes determined by conventional analysis of their appearance on individual CT slices. RESULTS: The average accuracy of a study of 410 electrodes imaged in four patients repeated two times by three observers was 0.91 (+/- 0.41) mm, with a maximum error of 3.3 mm, about half of the diameter of an electrode. CONCLUSIONS: The location of subdural electrodes can easily and quickly be determined within high-resolution CT scans through the use of 3-D rendering. SIGNIFICANCE: This relatively fast and easy method for determining the location of subdural electrodes should facilitate their use in both clinical and research investigations.