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BACKGROUND: Improving palliative care for inpatients is urgently needed. Data from patient-reported experience measures (PREM) can assist in identifying areas for focused improvement. This study aimed to describe patient reported experience of care in inpatients with palliative care needs, to inform a baseline understanding of care experience and identify key areas for improvement. METHODS: Cross-sectional study design where inpatients with palliative care needs were invited to complete 'consideRATE,' a patient reported experience measure of care, over six months in 2022. Inpatients with palliative care needs receiving care on an oncology, general medicine/renal and general medicine/respiratory ward (n = 3) at an Australian metropolitan hospital were screened for eligibility. Carers could provide proxy responses where inpatients were unable to participate. Descriptive statistics were used to analyse quantitative ratings, whilst free text responses were analysed using integrated thematic analysis. RESULTS: One-hundred and twenty participants (108 patients and 12 carers) completed consideRATE. The questions with the highest number of 'very good' responses were attention to symptoms, attention to feelings and attention to what matters most; the questions with the lowest number of 'very good' responses was attention to patients' affairs, what to expect, and the environment of care. Almost half (n = 57, 48%) indicated that attention to patients' affairs 'did not apply' to their inpatient stay. Analysis of 532 free text responses across 8 questions highlighted the importance of feeling supported, feeling informed, feeling heard and navigating the clinical environment. CONCLUSION: Enabling inpatients with palliative care needs to provide feedback about their experience of care is one method of ensuring improvements matter to patients. Supporting clinical teams to understand and use these data to make tailored improvements is the next step in this multi-phase research.
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Pacientes Internados , Cuidados Paliativos , Humanos , Estudos Transversais , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Cuidados Paliativos/psicologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Idoso de 80 Anos ou mais , Adulto , Austrália , Inquéritos e Questionários , Satisfação do Paciente , Medidas de Resultados Relatados pelo PacienteRESUMO
Background: This study aims to validate the feasibility of a hub-and-spoke model for pelvic exenteration (PE) surgery while upholding favorable patient outcomes. Methods: A retrospective analysis of patients undergoing PE at our trust October 2017 and December 2023 was conducted. Descriptive statistics and Kaplan-Meier survival analysis were employed. Results: Sixty-seven patients underwent PE during the study period, mainly for locally advanced colorectal cancer (n=61, 91.04%). Minimally invasive surgery was performed in 16 cases (Robotic 3, 4.47% / Laparoscopic 13, 19.40) while the rest of patients 51 had open surgery (75.11%). Median hospital stay was 12 days (range:8-20). While 24 patients (35.82%) developed major complications (CD III-IV) post-surgery, there were no mortalities associated with pelvic exenteration in this study. Of the 67 patients undergoing surgery with curative intent, negative margins (R0 resection) were achieved in 57 patients (85.12%). This is comparable to outcomes reported by the PelvEx collaborative (85.07% versus 79.8%). At a median follow-up of 22 months, 15 patient (22.38%) recurred with 10.44% local recurrence rate. The 2 years overall and disease-free survival were 85.31% and 77.0.36%, respectively. Conclusion: Our study suggests that a nascent PE service, supported by specialist expertise and resources, can achieve good surgical outcomes within a district general hospital.
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Neoplasias Colorretais , Hospitais de Distrito , Hospitais Gerais , Exenteração Pélvica , Humanos , Estudos Retrospectivos , Masculino , Feminino , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Resultado do Tratamento , Pessoa de Meia-Idade , Exenteração Pélvica/métodos , Hospitais de Distrito/estatística & dados numéricos , Idoso , Estudos de Viabilidade , Tempo de Internação/estatística & dados numéricos , Adulto , Romênia/epidemiologia , Laparoscopia/métodos , Idoso de 80 Anos ou mais , Protectomia/métodos , Estimativa de Kaplan-Meier , Estadiamento de NeoplasiasRESUMO
OBJECTIVES: To synthesize current evidence on the association between anticipatory anxiety, defined as apprehension-specific negative affect that may be experienced when exposed to potential threat or uncertainty, and cancer screening to better inform strategies to maximize participation rates. METHODS: Searches related to cancer screening and anxiety were conducted in seven electronic databases (APA PsycINFO, Scopus, Web of Science, Embase, Cochrane Library, PubMed, CINAHL), with potentially eligible papers screened in Covidence. Data extraction was conducted independently by multiple authors. Barriers to cancer screening for any type of cancer and relationships tested between anticipatory anxiety and cancer screening and intention were categorized and compared according to the form and target of anxiety and cancer types. RESULTS: A total of 74 articles (nparticipants = 119,990) were included, reporting 103 relationships tested between anticipatory anxiety and cancer screening and 13 instances where anticipatory anxiety was reported as a barrier to screening. Anticipatory anxiety related to a possible cancer diagnosis was often associated with increased screening, while general anxiety showed no consistent relationship. Negative relationships were often found between anxiety about the screening procedure and cancer screening. CONCLUSION: Anticipatory anxiety about a cancer diagnosis may promote screening participation, whereas a fear of the screening procedure could be a barrier. Public health messaging and primary prevention practitioners should acknowledge the appropriate risk of cancer, while engendering screening confidence and highlighting the safety and comfort of screening tests.
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Detecção Precoce de Câncer , Neoplasias , Humanos , Ansiedade/diagnóstico , Neoplasias/diagnóstico , IncertezaRESUMO
AIM: To compare the clinical efficacy and safety of glargine-U100 (Lantus/Gla-100) with glargine-U300 (Toujeo/Gla-300) in adult patients with type 2 diabetes (T2D) and type 1 diabetes (T1D). MATERIALS AND METHODS: A literature search on Gla-300/Gla-100 in diabetes management was conducted using the MEDLINE/Embase/Cochrane databases from inception to 10 January 2021. Eligible studies considered for inclusion were parallel-design, randomized controlled trials (RCTs). The Cochrane risk-of-bias tool was used to evaluate the quality of the included studies. The random-effects model was applied for interpretation of the results. RESULTS: Of 5348 records screened, 592 were assessed for eligibility and 15 RCTs were considered for data extraction and meta-analysis (T2D [N = 10; n = 7082]; T1D [N = 5; n = 2222]). In patients with T1D, all safety parameters were comparable between Gla-100 and Gla-300. In T2D, statistically significant differences were observed in favour of Gla-300 over Gla-100 for nocturnal and total hypoglycaemia. For efficacy parameters, a statistically and clinically significant difference favouring Gla-100 in basal insulin dose requirement was observed for both T2D and T1D. Change in HbA1c showed a statistically but not clinically significant reduction with Gla-100 compared with Gla-300 in T1D. Statistically significant but clinically less relevant differences favoured Gla-300 for control of body weight in T1D and T2D and Gla-100 for fasting blood glucose in T2D. CONCLUSIONS: Gla-100 and Gla-300 had comparable efficacy and safety profiles in both T1D and T2D populations. Gla-300 showed a lower risk of nocturnal and total hypoglycaemia, significant in insulin-experienced/exposed patients with T2D. Patients on Gla-300 required significantly more units of insulin daily than the Gla-100 group to achieve equivalent efficacy.
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Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Hipoglicemia , Adulto , Humanos , Glicemia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobinas Glicadas , Hipoglicemia/induzido quimicamente , Hipoglicemia/prevenção & controle , Hipoglicemiantes/efeitos adversos , Insulina Glargina/efeitos adversos , Insulina Regular Humana , Resultado do TratamentoRESUMO
AIM: To establish the pharmacokinetic (PK) and pharmacodynamic (PD) equivalence of proposed biosimilar Insulin N (Biocon's Insulin-N; Biocon Biologics Ltd., Bangalore, India) and US-licensed Humulin® N (Humulin-N; Eli Lilly and Company, Indianapolis, IN, USA) in healthy subjects. MATERIALS AND METHODS: This was a phase-1, single-centre, double-blind, randomized, three-period, six-sequence, partially replicated, crossover, 24-h euglycaemic clamp study. Overall, 90 healthy subjects were randomized, of whom 85 completed the study. The subjects received either two single doses of Biocon's Insulin-N and a single dose of Humulin-N or two single doses of Humulin-N and a single dose of Biocon's Insulin-N subcutaneously at a dose of 0.4 IU/kg. The primary PK endpoints were the area under the insulin concentration-time curve from 0 to 24 h (AUCins.0-24h ) and the maximum insulin concentration (Cins.max ). The primary PD endpoints were the area under the glucose infusion rate (GIR) curve from 0 to 24 h (AUCGIR.0-24h ) and the maximum GIR (GIRmax ). RESULTS: Biocon's Insulin-N was found to be equivalent to Humulin-N for the primary PK (geometric 90% confidence interval for the least squares mean ratio: AUCins.0-24h , 100.98%-115.66% and Cins.max , 95.91%-110.16%) and PD endpoints (intra-subject variability ≥0.294; 95% upper confidence interval [(µT - µR)2 - θσ2 WR] <0; point estimates of geometric least squares mean ratio: AUCGIR.0-24h , 104.61% and GIRmax , 100.81%). The safety profile of Biocon's Insulin-N was similar to that of Humulin-N, and no serious adverse events were reported. CONCLUSION: PK and PD equivalence was shown between Biocon's Insulin-N and Humulin-N in healthy subjects, and both treatments were well tolerated and considered safe.
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Medicamentos Biossimilares , Insulina , Humanos , Insulina Regular Humana , Medicamentos Biossimilares/uso terapêutico , Hipoglicemiantes , Voluntários Saudáveis , Índia , Insulina Isófana , Proteínas Recombinantes , Área Sob a Curva , Método Duplo-Cego , Estudos Cross-Over , Equivalência TerapêuticaRESUMO
BACKGROUND: Understanding patterns of health care use in the last year of life is critical in health services planning. AIM: To describe hospital-based service and palliative care use in hospital in the year preceding death for patients who died of heart failure or cardiomyopathy in Queensland from 2008 to 2018 and had at least one hospitalisation in the year preceding death. DESIGN: A retrospective data linkage study was conducted using administrative health data relating to hospitalisations, emergency department visits and deaths. PARTICIPANTS AND SETTING: Participants included were those aged ⩾60 years, had a hospitalisation in their last year of life and died of heart failure or cardiomyopathy in Queensland, Australia. RESULTS: Of the 4697 participants, there were 25,583 hospital admissions. Three quarters (n = 3420, 73%) of participants were aged ⩾80 years and over half died in hospital (n = 2886, 61%). The median number of hospital admissions in the last year of life was 3 (interquartile range [IQR] 2-5). The care type was recorded as 'acute' for 89% (n = 22,729) of hospital admissions, and few (n = 853, 3%) hospital admissions had a care type recorded as 'palliative.' Of the 4697 participants, 3458 had emergency department visit(s), presenting 10,330 times collectively. CONCLUSION: In this study, patients who died of heart failure or cardiomyopathy were predominantly aged ⩾80 years and over half died in hospital. These patients experienced repeat acute hospitalisations in the year preceding death. Improving timely access to palliative care services in the outpatient or community setting is needed for patients with heart failure.
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Cardiomiopatias , Insuficiência Cardíaca , Assistência Terminal , Humanos , Idoso , Estudos Retrospectivos , Web Semântica , Cuidados Paliativos , Hospitais , Hospitalização , Serviço Hospitalar de EmergênciaRESUMO
The radioactive contamination has been reported frequently from agricultural lands and ground water. The main reason behind the radioactive pollution is unprotected mining of radioactive elements, unsafe discard of nuclear industrial waste, military applications, dumping of medically used radioisotopes, globally situated (>400) nuclear power plants and use of phosphate fertilizers in farming. Radionuclides are well known potent carcinogens that may cause the various types of cancers to human and animals due to the long exposure to radioactive contaminated sites. To get rid of from the radioactive pollution there is a need of practically successful and cost effective bioremediation technologies that should able to decontaminate the effected lands and water to benefit the mankind. Microbial and phytoremediation are well studied methods for decreasing or gradually eliminating the radioactive contaminants. In this review, we discussed the different strategies of microbial and phytoremediation of radionuclides and recent advancements, that can play the major role in bioremediation of soil and water.
Different remediation technologies based on physical (precipitation, extraction and membrane separation technologies) and chemical (chemical extraction and leaching, hydrolysis, etc.) methods to remediate the radioactive compounds from soils and water are being developed and evaluated. Most of these technologies are cost intensive and only applicable to little contaminated sites. On the other hand phytoremediation and microbial bioremediation are scientifically proven for applying at large scale and economical. Phytoremediation is one of the bioengineering treatments in which terrestrial and aquatic plants have been successfully used for cleaning the radioactive pollutants from diverse environments. Present review article is a updating the recent developments came in the different bioremediation methods. Moreover aim of this manuscript is also emerging the research gaps and identified the future research frontiers to unlock the complexity of phyto and microbial remediation advancements. Although several plants and numerous bacteria and fungi have been identified as the potential radioactive accumulator but their complete mechanism of bioremediation is still unknown. Present article will help the researchers to understand the process of bioremediation of radionuclides in more depths and will aware about the requirements of the coming future.HighlightsPhyto and microbial bioremediation of radioactive elements, possibilities and challenges.Causes of radioactive contamination in soil and water.Nanophytoremediation is an advanced technology of phytoremediation.Drawbacks of phytoremediation.
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Elementos Radioativos , Poluentes do Solo , Humanos , Biodegradação Ambiental , Poluentes do Solo/análise , Agricultura , Radioisótopos , SoloRESUMO
In the pursuit of effective wastewater treatment and biomass generation, the symbiotic relationship between microalgae and bacteria emerges as a promising avenue. This analysis delves into recent advancements concerning the utilization of microalgae-bacteria consortia for wastewater treatment and biomass production. It examines multiple facets of this symbiosis, encompassing the judicious selection of suitable strains, optimal culture conditions, appropriate media, and operational parameters. Moreover, the exploration extends to contrasting closed and open bioreactor systems for fostering microalgae-bacteria consortia, elucidating the inherent merits and constraints of each methodology. Notably, the untapped potential of co-cultivation with diverse microorganisms, including yeast, fungi, and various microalgae species, to augment biomass output. In this context, artificial intelligence (AI) and machine learning (ML) stand out as transformative catalysts. By addressing intricate challenges in wastewater treatment and microalgae-bacteria symbiosis, AI and ML foster innovative technological solutions. These cutting-edge technologies play a pivotal role in optimizing wastewater treatment processes, enhancing biomass yield, and facilitating real-time monitoring. The synergistic integration of AI and ML instills a novel dimension, propelling the fields towards sustainable solutions. As AI and ML become integral tools in wastewater treatment and symbiotic microorganism cultivation, novel strategies emerge that harness their potential to overcome intricate challenges and revolutionize the domain.
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From the surface of the earth to the depths of the ocean, microplastics are a hazard for both aquatic and terrestrial habitats. Due to their small size and vast expanse, they can further integrate into living things. The fate of microplastics in the environment depends upon the biotic components such as microorganisms which have potential enzymes to degrade the microplastics. As a result, scientists are interested in using microorganisms like bacteria, fungi, and others to remediate microplastic. These microorganisms release the cutinase enzyme, which is associated with the enzymatic breakdown of microplastics and plastic films. Yet, numerous varieties of microplastics exist in the environment and their contaminants act as a significant challenge in degrading microplastics. The review discusses the cutinases enzyme degradation strategies and potential answers to deal with existing and newly generated microplastic waste - polyethylene (PE), polyethylene terephthalate (PET), poly-ε-caprolactone (PCL), polyurethanes (PU), and polybutylene succinate (PBS), along with their degradation pathways. The potential of cutinase enzymes from various microorganisms can effectively act to remediate the global problem of microplastic pollution.
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Microplásticos , Poluentes Químicos da Água , Plásticos , Hidrolases de Éster Carboxílico/metabolismo , PolietilenotereftalatosRESUMO
AIM: To establish equivalence in the pharmacokinetic (PK) and pharmacodynamic (PD) endpoints between proposed biosimilar Insulin-R (Biocon's Insulin-R) and Humulin® R using the euglycaemic clamp technique in healthy subjects. MATERIALS AND METHODS: In this phase-1 automated euglycaemic glucose clamp study, 42 healthy subjects were randomized (1:1) to receive a single dose of 0.3 IU/kg of Biocon's Insulin-R and Humulin-R. Plasma insulin concentrations and glucose infusion rates (GIRs) were assessed over 12 hours. Primary PK endpoints were area under the insulin concentration-time curve from 0 to 12 hours (AUCins.0-12h ) and maximum insulin concentration (Cins.max ). Primary PD endpoints were area under the GIR time curve from 0 to 12 hours (AUCGIR.0-12h ) and maximum GIR (GIRmax ). RESULTS: Equivalence was demonstrated between Biocon's Insulin-R and Humulin-R for the primary PK and PD endpoints. The 90% confidence intervals were within 80.00% to 125.00% limits. The PK and PD profiles were comparable. There were no significant differences in the safety profiles of the two treatments, and no serious adverse events were reported. CONCLUSION: PK and PD equivalence was demonstrated between Biocon's Insulin-R and Humulin-R in healthy subjects. Treatment with Biocon's Insulin-R and Humulin-R was well tolerated.
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Medicamentos Biossimilares , Área Sob a Curva , Medicamentos Biossimilares/uso terapêutico , Estudos Cross-Over , Método Duplo-Cego , Voluntários Saudáveis , Humanos , Hipoglicemiantes/efeitos adversos , Insulina , Insulina Regular Humana , Equivalência TerapêuticaRESUMO
AIM: To establish the pharmacokinetic (PK) and pharmacodynamic (PD) equivalence of proposed biosimilar insulin 70/30 (Biocon's Insulin-70/30) and HUMULIN® 70/30 (HUMULIN-70/30; Eli Lilly and Company, IN). MATERIALS AND METHODS: In this phase 1, automated euglycaemic glucose clamp study, 78 healthy subjects were randomized (1:1) to receive a single dose of 0.4 IU/kg of Biocon's Insulin-70/30 and HUMULIN-70/30. Plasma insulin concentrations and glucose infusion rates (GIRs) were assessed over 24 hours. Primary PK endpoints were area under the insulin concentration-time curve from 0 to 24 hours - AUCins.0-24h - and maximum insulin concentration - Cins.max . Primary PD endpoints were area under the GIR time curve from 0 to 24 hours - AUCGIR.0-24h - and maximum GIR - GIRmax . RESULTS: Equivalence was shown between Biocon's Insulin-70/30 and HUMULIN-70/30 for the primary PK/PD endpoints. The 90% confidence intervals of the treatment ratios were entirely within the acceptance range of 80.00%-125.00%. The secondary PK/PD profiles were also comparable. There were no clinically relevant differences in the safety profiles of the two treatments and no serious adverse events were reported. CONCLUSION: PK/PD equivalence was demonstrated between Biocon's Insulin-70/30 and HUMULIN-70/30 in healthy subjects. Treatment with Biocon's Insulin-70/30 and HUMULIN-70/30 was well tolerated.
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Medicamentos Biossimilares , Insulina , Área Sob a Curva , Medicamentos Biossimilares/efeitos adversos , Medicamentos Biossimilares/farmacocinética , Estudos Cross-Over , Método Duplo-Cego , Voluntários Saudáveis , Humanos , Insulina Isófana , Insulina Regular Humana , Proteínas Recombinantes , Equivalência TerapêuticaRESUMO
BACKGROUND: Individuals with chronic heart failure experience high symptom burden, reduced quality of life and high health care utilisation. Although there is growing evidence that a palliative approach, provided concurrently with usual treatment improves outcomes, the method of integrating palliative care for individuals living with chronic heart failure across the care continuum remains elusive. AIM: To examine the key elements of integrated palliative care recommended for individuals living with chronic heart failure across the care continuum. DESIGN: Scoping review. DATA SOURCES: Databases searched were CINAHL, Ovid MEDLINE, Scopus and OpenGrey. Studies written in English and containing key strategic elements specific to chronic heart failure were included. Search terms relating to palliative care and chronic heart failure and the Joanna Briggs Institute methodology for scoping reviews was used. RESULTS: Seventy-nine (79) articles were selected that described key elements to integrate palliative care for individuals with chronic heart failure. This review identifies four levels of key strategic elements: 1) clinical; 2) professional; 3) organisational and 4) system-level integration. Implementing strategies across these elements facilitates integrated palliative care for individuals with chronic heart failure. CONCLUSIONS: Inter-sectorial collaborations across systems and the intersection of health and social services are essential to delivering integrated, person-centred palliative care. Further research focussing on patient and family needs at a system-level is needed. Research with strong theoretical underpinnings utilising implementation science methods are required to achieve and sustain complex behaviour change to translate key elements.
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Insuficiência Cardíaca , Cuidados Paliativos , Doença Crônica , Continuidade da Assistência ao Paciente , Insuficiência Cardíaca/terapia , Humanos , Qualidade de VidaRESUMO
International clinical practice guidelines recommend that patients with chronic heart failure receive timely and high-quality palliative care. However, integrating palliative care is highly variable and dependent on decision-making and care models. This meta-synthesis aimed to examine health care professionals' decision-making processes and explore factors impacting decisions to refer or deliver palliative care in chronic heart failure. The electronic databases SCOPUS, CINAHL, and Medline were searched. Included studies were those that reported health care professionals' perceptions of palliative care in chronic heart failure through qualitative data collection, were written in English, and were peer-reviewed articles. Included articles were analysed using Thomas and Harden's approach. The dual-process theory was used and applied a priori to organise the findings. The perception of palliative care as a transition and active treatment failure fit within the intuitive system of thinking in the dual-process theory. The theme that overlapped into both intuitive and analytical systems of thinking was acquiring patient and illness information themes reflecting the analytical system of thinking were professional role and experience, pre-existing decision pathways, and balancing viewpoints. This meta-synthesis identified factors influencing the decision-making process in referring patients with chronic heart failure to palliative care. The findings from this review highlight the need for further development of decision-making tools or facilitate guidelines to assist health care professionals' shared decision-making to improve patient outcomes.
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Tomada de Decisões , Insuficiência Cardíaca/terapia , Cuidados Paliativos/métodos , HumanosRESUMO
BACKGROUND: Palliative care for individuals with chronic heart failure is recommended for improving patients' symptoms, function and overall quality of life. Despite this mandate, there is limited access and referral to specialist palliative care for individuals with chronic heart failure. OBJECTIVES: To explore healthcare professionals' perspectives on access to palliative care for patients with chronic heart failure, focussing on patient, provider and system factors. METHODS: Cardiologists, palliative care specialists, heart failure nurses and palliative care nurses in acute and community care settings were interviewed using semi-structured interviews. Purposive and snowball sampling methods were used for recruitment. Interview data were analysed using thematic analysis. The COREQ checklist guided data collection and reporting. RESULTS: There were 15 participants in the study, and the majority were female. Participants included palliative medicine physicians, a palliative care nurse consultant, cardiologists, a general practitioner and advanced heart failure nurses. The themes derived from the thematic analysis centred on patient, provider and system factors impacting access and referral to palliative care in the context of chronic heart failure. The patient themes were (a) patient and family preconception of palliative care and (b) patient's clinical profile influences referral. The provider themes were (a) conflict, (b) making decisions and (c) education needs, and the system themes were (a) accessing services and resources and (b) improving the model of care. CONCLUSIONS: The patient's clinical profile, education needs of healthcare professionals and improving access to services and resources need to be considered to enhance palliative care access and referral as well as the interacting and influencing elements of the patient, provider and system.
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Atitude do Pessoal de Saúde , Insuficiência Cardíaca/terapia , Cuidados Paliativos/organização & administração , Encaminhamento e Consulta/organização & administração , Tomada de Decisões , Feminino , Humanos , Masculino , Pesquisa QualitativaRESUMO
Individuals with chronic heart failure have high utilisation of hospital-related services towards the end of life and receive treatments that provide symptom relief without improving life expectancy. The aim of this discussion paper is to determine chronic heart failure patients' use of acute hospital-based services in their last year of life and to discuss the potential for palliative care to reduce service utilisation. A systematic search of the literature was conducted. Medline, Cumulative Index for Nursing and Allied Health (CINAHL) and SCOPUS databases were used to systematically search for literature from database commencement to September 2016. Specific inclusion criteria and search terms were used to identify relevant studies on heart failure patients' use of hospital services in their last year of life. There were 12 studies that evaluated the use of hospital-based services by chronic heart failure patients at the end of life. In all studies, it was found that chronic heart failure patients used acute hospital-based services as death approached. However, only two studies examined if palliative care consultations were obtained by patients, and neither study assessed the impact that these consultations had on service utilisation in the last year of life. Heart failure negatively impacts health status, and this is a predictor of service utilisation. Further research is needed to determine the efficacy of both primary and secondary palliative care in reducing resource use towards the end of life and improving the quality of end of life care.
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Recursos em Saúde/economia , Insuficiência Cardíaca/terapia , Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Insuficiência Cardíaca/psicologia , Serviços Hospitalares de Assistência Domiciliar/provisão & distribuição , Hospitalização/estatística & dados numéricos , Humanos , Cuidados Paliativos/normas , Qualidade de Vida/psicologiaRESUMO
BACKGROUND: Chronic heart failure is a complex and multifaceted syndrome characterised by an unpredictable trajectory, high symptom burden and reduced quality of life. Although palliative care is recommended, patient, provider and system factors limit access. AIM: To examine the knowledge, attitudes and perspectives of health care professionals towards end of life care and palliative care for patients with chronic heart failure. DESIGN: This is an integrative review. DATA SOURCES: CINAHL, Academic Search Complete and SCOPUS were searched. Specific inclusion criteria and search terms were used. The integrative review method entailed analysing data from primary articles using the constant comparison method and then synthesising data. RESULTS: Twenty-six (26) articles were selected that explored health care professionals' perspectives towards end of life care and palliative care. The categories that emerged were grouped into patient, provider and system issues. Most health care professionals involved in providing care to heart failure patients have misperceptions of palliative care, often confusing it with end of life and hospice care. This hinders patients' access to palliative care as determining the end of life period in heart failure is difficult. CONCLUSIONS: Exploring health care professionals' perspectives towards the delivery of end of life care and palliative care is important for understanding how their practice influences the delivery of palliative care for heart failure patients. Emphasis on increasing awareness of the principles of palliative care in the health care community, as well as addressing organisational issues will improve the care delivered to these patients.
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Atitude do Pessoal de Saúde , Pessoal de Saúde/normas , Insuficiência Cardíaca/terapia , Cuidados Paliativos/normas , Assistência Terminal/normas , HumanosRESUMO
This study investigates the impact of specific environmental conditions on the formation of colloidal U(IV) nanoparticles by the sulfate reducing bacteria (SRB, Desulfovibrio alaskensis G20). The reduction of soluble U(VI) to less soluble U(IV) was quantitatively investigated under growth and non-growth conditions in bicarbonate or 1,4-piperazinediethanesulfonic acid (PIPES) buffered environments. The results showed that under non-growth conditions, the majority of the reduced U nanoparticles aggregated and precipitated out of solution. High resolution transmission electron microscopy revealed that only a very small fraction of cells had reduced U precipitates in the periplasmic spaces in the presence of PIPES buffer, whereas in the presence of bicarbonate buffer, reduced U was also observed in the cytoplasm with greater aggregation of biogenic U(IV) particles at higher initial U(VI) concentrations. The same experiments were repeated under growth conditions using two different electron donors (lactate and pyruvate) and three electron acceptors (sulfate, fumarate, and thiosulfate). In contrast to the results of the non-growth experiments, even after 0.2 µm filtration, the majority of biogenic U(IV) remained in the aqueous phase resulting in potentially mobile biogenic U(IV) nanoparticles. Size fractionation results showed that U(IV) aggregates were between 18 and 200 nm in diameter, and thus could be very mobile. The findings of this study are helpful to assess the size and potential mobility of reduced U nanoparticles under different environmental conditions, and would provide insights on their potential impact affecting U(VI) bioremediation efforts at subsurface contaminated sites.
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Desulfovibrio/metabolismo , Nanopartículas/química , Urânio/química , Bicarbonatos/química , Soluções Tampão , Desulfovibrio/crescimento & desenvolvimento , Concentração de Íons de Hidrogênio , Microscopia Eletrônica de Transmissão , OxirreduçãoRESUMO
Next to xylanases, laccases from fungi and alkali-tolerant bacteria are the most important biocatalysts that can be employed for eco-friendly biobleaching of hard and soft wood pulps in the paper industry. Laccases offer a potential alternative to conventional, environmental-polluting chlorine and chlorine-based bleaching and has no reductive effect on the final yield of pulp as compared to hemicellulases (xylanases and mannanases). In the last decade, reports on biobleaching with laccases are based on laboratory observations only. There are several critical challenges before this enzyme can be implemented for pulp bleaching at the industrial scale. This review discusses significant factors like redox potential, laccase mediator system (LMS)-synthetic or natural, pH, temperature, stability of enzyme, unwanted grafting reactions of laccase, and cost-intensive production at large scale which constitute a great hitch for the successful implementation of laccases at industrial level.
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Microbiologia Industrial/métodos , Lacase/metabolismo , Lignina/metabolismo , Papel , Bactérias/enzimologia , Pesquisa Biomédica/tendências , Biotecnologia/tendências , Fungos/enzimologiaRESUMO
This research investigates into the efficacy of algae and algae-bacteria symbiosis (ABS) in efficiently decolorizing Remazol Red 5B, a prevalent dye pollutant. The investigation encompasses an exploration of the biosorption isotherm and kinetics governing the dye removal process. Additionally, various machine learning models are employed to predict the efficiency of dye removal within a co-culture system. The results demonstrate that both Desmodesmus abundans and a composite of Desmodesmus abundans and Rhodococcus pyridinivorans exhibit significant dye removal percentages of 75 ± 1% and 78 ± 1%, respectively, after 40 min. The biosorption isotherm analysis reveals a significant interaction between the adsorbate and the biosorbent, and it indicates that the Temkin model best matches the experimental data. Moreover, the Langmuir model indicates a relatively high biosorption capacity, further highlighting the potential of the algae-bacteria composite as an efficient adsorbent. Decision Trees, Random Forest, Support Vector Regression, and Artificial Neural Networks are evaluated for predicting dye removal efficiency. The Random Forest model emerges as the most accurate, exhibiting an R2 value of 0.98, while Support Vector Regression and Artificial Neural Networks also demonstrate robust predictive capabilities. This study contributes to the advancement of sustainable dye removal strategies and encourages future exploration of hybrid approaches to further enhance predictive accuracy and efficiency in wastewater treatment processes.