Mortality in patients with psoriatic arthritis in Sweden: a nationwide, population-based cohort study.

OBJECTIVES: To compare all-cause mortality and causes of death between patients with psoriatic arthritis (PsA) and the general population in Sweden. METHODS: Adults with at least one main PsA diagnosis (International Classification of Diseases-10: L40.5/M07.0-M07.3) from outpatient rheumatology/internal medicine departments 2001-2017 were identified from the National Patient Register. Each case was matched to five population comparator-subjects on sex/county/age at the case's first arthritis diagnosis. Follow-up ran from 1 January 2007, or from first PsA diagnosis thereafter, until death, emigration or 31 December 2018. Mortality was assessed overall, and stratified by sex and duration since diagnosis (diagnosis before/after 1 January 2007), using matched Cox proportional hazard regression (excluding/including adjustments for comorbidity) or Breslow test, as appropriate. Incidence rate ratios (IRR) of death, overall and stratified by sex/duration since diagnosis/age, as well as causes of death in PsA cases and comparator-subjects were also described. RESULTS: All-cause mortality was elevated in PsA (HR: 1.11 (95% CI: 1.07 to 1.16); IRR: 1.18 (95% CI: 1.13 to 1.22)), mainly driven by increased risks in women (HR: 1.23 (95% CI: 1.16 to 1.30)) and cases with longer time since diagnosis (HR: 1.18 (95% CI: 1.12 to 1.25)). IRR of death were significantly increased for all ages except below 40 years, with the numerically highest point-estimates for ages 40-59 years. When adjusted for comorbidity, however, the elevated mortality risk in PsA disappeared. Causes of death were similar among PsA cases/comparator-subjects, with cardiovascular disease and malignancy as the leading causes. CONCLUSIONS: Mortality risk in PsA in Sweden was about 10% higher than in the general population, driven by excess comorbidity and with increased risks mainly in women and patients with longer disease duration.

Long-Term Effect of Receiving a Family Strengths-Oriented Intervention on Family Cancer Caregiver Stress, Anxiety, and Depression Symptoms: A Longitudinal Quasi-Experimental Study.

The aim of this longitudinal study was to evaluate the long-term effects of providing a therapeutic conversation intervention, based on Family Systems Nursing, to family caregivers of a close relative with advanced cancer over the period before and during bereavement. To prevent adverse outcomes, caregivers need ongoing support that begins pre-loss and extends into the post-loss period. This study employed a one-group pre-test, post-test quasi-experimental design. Twenty-four caregivers participated in two intervention trials conducted over a 42-month period, receiving two intervention sessions pre-loss (Trial 1) and one intervention session post-loss (Trial 2). Significant decreases in anxiety and stress were noted over the three post-loss assessments. The final post-loss stress outcome was significantly lower than the first pre-loss score. For the depression score, there was not a significant change over time within the pre- or post-loss period. The findings provide evidence of decreasing anxiety and stress following the implementation of an extended family nursing intervention for bereaved family caregivers.

Development of an international Core Outcome Set (COS) for best care for the dying person: study protocol.

BACKGROUND: In contrast to typical measures employed to assess outcomes in healthcare such as mortality or recovery rates, it is difficult to define which specific outcomes of care are the most important in caring for dying individuals. Despite a variety of tools employed to assess different dimensions of palliative care, there is no consensus on a set of core outcomes to be measured in the last days of life. In order to optimise decision making in clinical practice and comparability of interventional studies, we aim to identify and propose a set of core outcomes for the care of the dying person. METHODS: Following the COMET initiative approach, the proposed study will proceed through four stages to develop a set of core outcomes: In stage 1, a systematic review of the literature will identify outcomes measured in existing peer reviewed literature, as well as outcomes derived through qualitative studies. Grey literature, will also be included. Stage 2 will allow for the identification and determination of patient and proxy defined outcomes of care at the end of life via quantitative and qualitative methods at an international level. In stage 3, from a list of salient outcomes identified through stages 1 and 2, international experts, family members, patients, and patient advocates will be asked to score the importance of the preselected outcomes through a Delphi process. Stage 4 consists of a face-to-face consensus meeting of international experts and patient/family representatives in order to define, endorse, and propose the final Core Outcomes Set. DISCUSSION: Core Outcome Sets aim at promoting uniform assessment of care outcomes in clinical practice as well as research. If consistently employed, a robust set of core outcomes for the end of life, and specifically for the dying phase, defined by relevant stakeholders, can ultimately be translated into best care for the dying person. Patient care will be improved by allowing clinicians to choose effective and meaningful treatments, and research impact will be improved by employing internationally agreed clinically relevant endpoints and enabling accurate comparison between studies in systematic reviews and/or in meta-analyses.

Work disability in gout: a population-based case-control study.

OBJECTIVES: To examine the extent and cost of work disability among patients with gout compared with matched population controls and to analyse predictors of work disability. METHODS: A regional cohort study using data from Swedish national and regional registries from January 2000 through December 2012, including 4571 patients with gout of working age, with a first recorded diagnosis of gout in the years 2003-2009 and 22 482 population controls, matched by age, sex and place of residence. Differences in baseline characteristics (educational level, income, previous employment and comorbidities) and the number of work-loss days (absenteeism) due to sick leave and disability pension for 3 years after identification were calculated. Predictors for new-onset work absenteeism (>90 days/year) in a subset were determined by conditional logistic regression. RESULTS: Patients with gout (median age 53 years) had significantly more comorbidities, lower income and lower level of education than matched controls. The average work absentee rate during the 3-year follow-up period was higher among patients with gout than controls, 22% and 14%, respectively (P<0.0001). New-onset absenteeism was in multivariate analyses significantly predicted by gout (OR 1.47; 95% CI 1.23 to 1.75). Other variables independently related to new-onset absenteeism were education ≤12 years, previous unemployment and history of sick leave, in addition to several comorbidities (renal disease, cardiovascular disease, alcohol abuse and obesity). CONCLUSIONS: Gout is associated with substantially higher work absenteeism and costs for society due to productivity loss, after adjusting for associated comorbidities and socioeconomic differences. Whether more intensive treatment of gout is cost-effective needs to be addressed in future studies.

Integrating nurse-facilitated advance care planning for patients newly diagnosed with advanced lung cancer.

BACKGROUND: Advance care planning (ACP) is well recognised as an important component of palliative care. However, there is still a need to explore ways in which it can become a part of routine practice, ensuring a timely and person-centred discussion. OBJECTIVES: To explore patients newly diagnosed with advanced lung cancer and their family members' experiences of engaging in a person-centred and structured ACP discussion facilitated by palliative care nurses in an outpatient oncology clinic at the University Hospital of Iceland. METHODS: An exploratory qualitative design employing semi-structured interviews and thematic analysis. The intervention included a structured ACP discussion, aided by a booklet. RESULTS: Key themes emerged describing families' and patients' experiences and highlighted that the timing and approach of the ACP discussion was appropriate and helpful, even though the discussion was sensitive and difficult. Using a routine approach with a flexible structure normalised the discussion and made it easier for the patients to take the lead in the discussion. CONCLUSIONS: ACP discussion can be part of an integrated palliative care and oncology service if implemented in a systematic way.

A multicenter study of attitudinal barriers to cancer pain management.

PURPOSE: The purpose of this study was to examine attitudinal barriers to cancer pain management and their relationship to pain, analgesic use, clinical, and demographic variables, as well as QOL, in a large sample of patients receiving strong opioids for pain in three European countries. METHODS: Participants in the present study were 555 patients with cancer, 18 years and older recruited from six centers in Germany, Iceland, and Norway. All had received strong opioids for at least 72 h. Data was collected with the Barriers Questionnaire-II, the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer QLQ-C30. RESULTS: The mean (SD) age of patients was 61.68 (12.35) years and 53% were men. Most common diagnoses were gastrointestinal, lung, prostate, and breast cancer. The mean (SD) time from diagnosis was 32.24 (44.55) and 4.97 (9.64) months from start of opioid therapy. Mean (SD) pain severity was 3.19 (1.93) on a 0 to 10 scale, and 46.5% reported worst pain of 7 or higher. Attitudinal barriers had a mean (SD) of 1.95 (0.82) on a 0-5 scale, with fear of addiction as the strongest barrier across countries 2.85 (1.49). Barrier scores increased with age, and were higher among men than women. Higher barrier scores were associated with higher pain severity and interference, and lower performance status, but not with global health-QOL. Patients who had been on opioids for a shorter time reported higher barriers. CONCLUSIONS: Attitudinal barriers are frequent in cancer pain patients on opioids and are associated with less effective pain control.

Symptoms and functional status of palliative care patients in Iceland.

BACKGROUND: Palliative care patients experience many debilitating symptoms and functional loss, but few longitudinal studies on the subject are available. AIMS: To assess the symptoms and functional status of patients admitted to specialised palliative care, to investigate whether changes occur over the admission period, and to establish whether symptoms and physical and cognitive function differ, based on the service setting. In addition, to participate in the development of the interRAI Palliative Care instrument (interRAI PC). METHODS: A prospective longitudinal study (N=123) was conducted at three time points: at admission to specialised palliative care, 14 days post-admission, and at discharge or death. The interRAI PC version 8 was used for data collection. Descriptive statistics were used, together with the Friedman statistical test and Wilcoxon post-hoc test. RESULTS: Patients experienced a wide spectrum of symptoms; the most frequent were fatigue, loss of appetite, pain, difficulty sleeping, insufficient nutritional intake and nausea. Some symptoms stayed relatively stable over time, but others increased, while physical and cognitive function decreased over time. The interRAI PC version 8 proved comprehensive and simple to use. CONCLUSIONS: Patients experienced a significant symptom burden and functional loss from admission to discharge or death. Symptoms indicating progressive deterioration became more frequent and severe, while physical and cognitive function decreased at all levels. Overall, inpatients had more symptoms and functional decline than home-care patients. The interRAI PC version 8 proved valuable in collecting clinical information and detecting changes over time as other interRAI suite instruments.

In the shadow of death: existential and spiritual concerns among persons receiving palliative care.

This study explores existential and spiritual concerns from the perspective of people receiving palliative care. It examines the meaning of these concerns, their influence on people's lives and investigates the connections between them. In-depth qualitative interviews were conducted with ten persons. Findings reveal existential and spiritual aspects as interconnected and an integral part of the participants' everyday existence. It concludes with a call for a better understanding of these phenomena in the palliative care context.

A multidisciplinary evaluation, exploration, and advancement of the concept of a traumatic birth experience.

BACKGROUND: Understanding a woman's traumatic birth experience benefits from an approach that considers perspectives from various fields of healthcare and social sciences. AIM: To evaluate and explore the multidisciplinary perspectives surrounding a traumatic birth experience to form a theory and to capture its structure. METHODS: A multidisciplinary advanced principle-based concept analysis was conducted, including the following systematic steps: literature review, assessment of concept maturity, principle-based evaluation, concept exploration and advancement, and formulating a multidisciplinary concept theory. We drew on knowledge from midwifery, psychology, childbirth education, bioethics, obstetric & gender violence, sociology, perinatal psychiatry, and anthropology. RESULTS: Our evaluation included 60 records which were considered as 'mature'. Maturity was determined by the reported concept definition, attributes, antecedents, outcomes, and boundaries. The four broad principles of the philosophy of science epistemology, pragmatics, linguistics, and logic illustrated that women live in a political, and cultural world that includes social, perceptual, and practical features. The conceptual components antecedents, attributes, outcomes, and boundaries demonstrated that a traumatic birth experience is not an isolated event, but its existence is enabled by social structures that perpetuate the diminished and disempowered position of women in medical and institutionalised healthcare regulation and management. CONCLUSION: The traumatic childbirth experience is a distinctive experience that can only occur within a socioecological system of micro-, meso-, and macro-level aspects that accepts and allows its existence and therefore its sustainability - with the traumatic experience of the birthing woman as the central construct.

"To cherish each day as it comes": a qualitative study of spirituality among persons receiving palliative care.

PURPOSE: Spirituality is one of the main aspects of palliative care. The concept is multidimensional and encompasses the existential realm as well as value-based and religious considerations. The aim of this study was to explore spirituality from the perspective of persons receiving palliative care and examine their experience of spirituality and its influence on their lives and well-being. METHODS: Qualitative interviews were conducted with ten persons receiving palliative care from Palliative Care Services in Iceland. The interviews were tape-recorded, transcribed and analysed. The study is in the field of practical theology and used the theoretical approach of hermeneutical phenomenology. RESULTS: Thematic analysis found that the spiritual dimension was of significance for the participants who understood it as a vital element connected to seeking meaning, purpose and transcendence in life. Religious and non-religious aspects of spirituality were expressed including strong spiritual components of family relationships, the meaning of God/a higher being and spiritual practices which served as a key factor in giving strength, activating inner resources and motivating hope. Nine of the participants expressed their spirituality as faith. CONCLUSIONS: Spirituality was experienced broadly as an important dimension of how participants lived with terminal illness. Religious and non-religious characteristics were recognised which reveals the complex nature of the phenomenon. Faith was a significant part of the participants' spirituality indicating the importance of attending to this aspect of palliative care. The study suggests the potential contributions of theological approaches which are relevant for palliative care research and practice.

Pain and other symptoms and their relationship to quality of life in cancer patients on opioids.

PURPOSE: The purpose of this study was to assess pain, other symptoms and QOL, and the relationship between these variables, among cancer patients on strong opioids. METHODS: The study was cross-sectional, descriptive, and correlational. A convenience sample of 150 cancer patients, ≥18 years, all on strong opioids for ≥ 3 days was recruited. RESULTS: The mean (SD) age was 64.7 (12.7) years, and 59 % were women. Mean (SD) time from cancer diagnosis was 36.3 (55.1) months. The median number of symptoms was 9, range 1-16 and the mean (SD) severity was 1.9 (0.5) on a 1-4 scale. Pain was one of the most prevalent (90 %) and severe symptoms with a mean (SD) of 2.56 (0.9). Number of symptoms explained 25.8 % of the variance in QOL, adjusted for age and sex. Another model, also adjusted for age and sex, showed that pain, fatigue, insomnia and depression, explained 33.6 % of the variance in QOL. CONCLUSIONS: The symptomatology in this study was similar to studies on patients with advanced cancer. QOL was associated with the number of symptoms patients experience and individual symptoms, notably fatigue and pain. Despite the use of strong opioids, pain was both common and severe, suggesting under-treatment. Pain and other symptoms need to be assessed and managed in order to improve patients' QOL. Special attention needs to be paid to multisymptom management in patients on opioids.

Childbirth experience questionnaire 2 - Icelandic translation and validation.

OBJECTIVE: The aim of this study was to translate the Childbirth Experience Questionnaire (CEQ2) to Icelandic and assess its psychometric characteristics. METHODS: The CEQ2 was translated to Icelandic using forward-to-back translation and tested for face-validity (n = 10). Then data was collected in an online survey to test validation in terms of reliability and construct validity (n = 1125). Reliability was assessed by calculating Cronbach's alpha for the total scale and subscales. Cronbach's alpha > 0.7 was regarded as satisfactory. Construct validity was measured using known-groups validation with data collected on women's birth outcomes known to be associated with more positive birth experiences. A comparison was made of CEQ2 subscale scores and total CEQ2 score for country of origin, social complications, parity, pregnancy complications, birthplace, mode of birth, maternal autonomy and decision making (MADM), and mothers on respect index (MORi). Mann WhitneyUand Kruskal Wallis H tests were used to compare scale scores between the groups. Principal components analysis with varimax rotation was chosen to determine whether the Icelandic version of the CEQ had similar psychometric properties as the original version. RESULTS: The face validity and internal consistency reliability (Cronbach's alpha > 0.85 for the total scale and all subscales) of the Icelandic version of CEQ2 was good. Our findings indicate that two of the items in the 'own capacity' domain were not sufficiently related to other items of the scale to warrant inclusion. CONCLUSIONS: The Icelandic CEQ2 is a valid and reliable measure of childbirth experience but further work is needed to determine the optimal number of items and domains of the Icelandic CEQ2.

Reviewing birth experience following a high-risk pregnancy: A feasibility study.

BACKGROUND: Complications during pregnancy and birth are known risk factors for negative birth experience. Women value the opportunity to review their birth experiences, but limited knowledge exists about appropriate interventions and the feasibility of providing this care for women following high-risk pregnancies. OBJECTIVE: To describe the construction and evaluate the feasibility and acceptability of a postpartum midwifery counselling intervention for women following high-risk pregnancies. DESIGN: A mixed-method study. SETTING: A high-risk antenatal outpatient clinic at Landspítali University Hospital in Reykjavík, Iceland. SAMPLE, RECRUITMENT AND DATA COLLECTION: Thirty women who experienced high-risk pregnancies were invited to write about and review their birth experience with a known midwife 4-6 weeks postpartum. Eight midwives working in a high-risk antenatal clinic provided the intervention after a special training. Data including birth outcomes, birth experience and experience of the intervention were collected by questionnaires from women at two time points before and after the counselling intervention. Midwives providing the intervention completed diaries and participated in focus group interview to explore their experiences of the process. DATA ANALYSIS: Descriptive and content analysis. FINDINGS: Women and midwives perceived the intervention positively and feasible in this context. Midwives evaluated the pre-training program as helpful. Most women would like to review their birth experience with a midwife they know, 4-6 weeks postpartum. Almost half of the women wrote about their birth experiences. KEY CONCLUSIONS: The findings indicate that women experiencing high-risk pregnancies might benefit from a follow up by a midwife they know. Women and midwives perceived the counselling intervention as an acceptable and feasible option in maternity care. The training program sufficiently prepared the midwives to provide the counselling intervention. IMPLICATIONS FOR PRACTICE: The findings provide an opportunity to offer the intervention on a larger scale to explore the effects further and subsequently implement into routine care after birth for high-risk women.

Developing and testing inter-rater reliability of a data collection tool for patient health records on end-of-life care of neurological patients in an acute hospital ward.

AIM: Develop and test a data collection tool-Neurological End-Of-Life Care Assessment Tool (NEOLCAT)-for extracting data from patient health records (PHRs) on end-of-life care of neurological patients in an acute hospital ward. DESIGN: Instrument development and inter-rater reliability (IRR) assessment. METHOD: NEOLCAT was constructed from patient care items obtained from clinical guidelines and literature on end-of-life care. Expert clinicians reviewed the items. Using percentage agreement and Fleiss' kappa we calculated IRR on 32 nominal items, out of 76 items. RESULTS: IRR of NEOLCAT showed 89% (range 83%-95%) overall categorical percentage agreement. The Fleiss' kappa categorical coefficient was 0.84 (range 0.71-0.91). There was fair or moderate agreement on six items, and moderate or almost perfect agreement on 26 items. CONCLUSION: The NEOLCAT shows promising psychometric properties for studying clinical components of care of neurological patients at the end-of-life on an acute hospital ward but could be further developed in future studies.

The National Prevalence of Clinically Diagnosed Psoriatic Arthritis in Sweden in 2017.

OBJECTIVE: Psoriatic arthritis (PsA) prevalence estimates vary across studies; studies based on national data are few. We aimed to estimate the prevalence of clinically diagnosed PsA in Sweden in 2017, overall and stratified by sex, age, education, and geography, and to quantify disease-modifying antirheumatic drug (DMARD) use among those in contact with specialized rheumatology care between 2015 and 2017. METHODS: Individuals who were 18 to 79 years of age, alive and residing in Sweden on December 31, 2017, and had a prior PsA diagnosis were identified from the National Patient Register (NPR) and/or the Swedish Rheumatology Quality Register (SRQ). PsA prevalence was estimated according to a base case (BC) definition (ie, ≥ 1 main PsA International Classification of Diseases code from rheumatology or internal medicine departments in the NPR or a PsA diagnosis in the SRQ), according to 4 sensitivity analysis definitions, and for those seen in specialized rheumatology care between 2015 and 2017. In the latter group, DMARD use during 2017 was also assessed. Data for stratifications were retrieved from national registers. RESULTS: The crude national prevalence of PsA for adults, aged 18 to 79 years, was estimated at 0.39%, according to the BC definition; 0.34% after accounting for diagnostic misclassification; and 0.32% to 0.50% across all sensitivity analyses. The prevalence was lower in males and in those with a higher level of education. The prevalence for those seen in specialized rheumatology care between 2015 and 2017 was estimated at 0.24%. During 2017, 32% of patients in this population received biologic or targeted synthetic DMARDs, and 41% received conventional synthetic DMARDs only. CONCLUSION: The prevalence of clinically diagnosed PsA in adults, aged 18 to 79 years, in Sweden in 2017 was around 0.35%. Among PsA cases in recent contact with specialized rheumatology care, almost three-fourths received DMARD therapy in 2017.

Cost-effectiveness analysis of bimekizumab for the treatment of active psoriatic arthritis in Sweden.

AIMS: To evaluate the cost-effectiveness of bimekizumab, an inhibitor of IL-17F and IL-17A, against biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARD) for psoriatic arthritis (PsA) from the Swedish healthcare system perspective. MATERIALS AND METHODS: A Markov model was developed to simulate the clinical pathway of biologic [b] DMARD-naïve or tumor necrosis factor inhibitor experienced [TNFi-exp] PsA patients over a lifetime horizon. Treatment response was incorporated as achievement of the American College of Rheumatology 50% (ACR50) and Psoriasis Area and Severity Index 75% (PASI75) response, and changes in the Health Assessment Questionnaire-Disability Index (HAQ-DI) score. The efficacy of bimekizumab was obtained from the BE OPTIMAL (bDMARD-naïve) and BE COMPLETE (TNFi-experienced) trials while a network meta-analysis (NMA) informed the efficacy of the comparators. Resource use and drug costs were obtained from published studies and databases of drug retail prices in Sweden. A willingness-to-pay threshold of €50,000 per quality-adjusted life year (QALY) was applied. RESULTS: In bDMARD-naïve patients, bimekizumab achieved greater QALYs (14.08) than with all comparators except infliximab (14.22), dominated guselkumab every 4 and 8 weeks, ixekizumab, secukinumab 300 mg, ustekinumab 45 mg and 90 mg, and was cost-effective against risankizumab, tofacitinib, upadacitinib and TNFis, except adalimumab biosimilar. In TNFi-experienced patients, bimekizumab led to greater QALYs (13.56) than all comparators except certolizumab pegol (13.84), and dominated ixekizumab and secukinumab 300 mg while being cost-effective against all other IL-17A-, IL-23- and JAK inhibitors. LIMITATIONS: An NMA informed the comparative effectiveness estimates. Given gaps in evidence of disease management and indirect costs specific to HAQ-DI scores, and sequential clinical trial evidence in PsA, non-PsA cost data from similar joint conditions were used, and one line of active treatment followed by best supportive care was assumed. CONCLUSIONS: Bimekizumab was cost-effective against most available treatments for PsA in Sweden, irrespective of prior TNFi exposure.

Assessing survival in widowers, and controls - a nationwide, six- to nine-year follow-up.

BACKGROUND: The aim of this study was to assess if widowers had an increased mortality rate during the first 6 to 9 years after the death of their wife, compared initially to an age-matched control group and also compared to the general population of Iceland. METHODS: The study base was comprised of all 371 men born in 1924-1969 who were widowed in Iceland in 1999-2001 and 357 controls, married men, who were matched by age and residence.The widowers and controls were followed through the years 2002-2007 using information from Statistics Iceland. Mortality rates were compared between the groups and also with the general population. The mortality rate comparisons were: study group vs. control group, on the one hand, and study group vs. general population on the other. Causes of death were also compared between widowers and their wives. RESULTS: A statistically significant increase in mortality in the widowers' group, compared to controls, was observed.Lifestyle-related factors could not be excluded as contributing to cause of death in these cases. CONCLUSIONS: Being a widower was related to an increased risk of death for at least 9 years after the death of their wife.

Characteristics and Outcomes of People With Gout Hospitalized Due to COVID-19: Data From the COVID-19 Global Rheumatology Alliance Physician-Reported Registry.

OBJECTIVE: To describe people with gout who were diagnosed with coronavirus disease 2019 (COVID-19) and hospitalized and to characterize their outcomes. METHODS: Data on patients with gout hospitalized for COVID-19 between March 12, 2020, and October 25, 2021, were extracted from the COVID-19 Global Rheumatology Alliance registry. Descriptive statistics were used to describe the demographics, comorbidities, medication exposures, and COVID-19 outcomes including oxygenation or ventilation support and death. RESULTS: One hundred sixty-three patients with gout who developed COVID-19 and were hospitalized were included. The mean age was 63 years, and 85% were male. The majority of the group lived in the Western Pacific Region (35%) and North America (18%). Nearly half (46%) had two or more comorbidities, with hypertension (56%), cardiovascular disease (28%), diabetes mellitus (26%), chronic kidney disease (25%), and obesity (23%) being the most common. Glucocorticoids and colchicine were used pre-COVID-19 in 11% and 12% of the cohort, respectively. Over two thirds (68%) of the cohort required supplemental oxygen or ventilatory support during hospitalization. COVID-19-related death was reported in 16% of the overall cohort, with 73% of deaths documented in people with two or more comorbidities. CONCLUSION: This cohort of people with gout and COVID-19 who were hospitalized had high frequencies of ventilatory support and death. This suggests that patients with gout who were hospitalized for COVID-19 may be at risk of poor outcomes, perhaps related to known risk factors for poor outcomes, such as age and presence of comorbidity.

Nordic Specialist Course in Palliative Medicine: Evaluation and Impact on the Development of Palliative Medicine in the Nordic Countries: A Survey among Participants from Seven Courses 2003-2017.

Background: The five Nordic Associations for palliative medicine (PM) have since 2003 organized a common specialist course for six weeks in two years. Aim: To describe the course: participants, evaluations, impact on participants' careers, and on the development of PM in the Nordic countries. Methods: Information on participants taken from the course archive and national registries. A web survey sent to graduates from the courses 2003-2013 (n = 150) and 2013-2017 (n = 72). Results: Mean age at course start was 46.9 years; 66% were women. Mean overall evaluation score 5.7 (range 5.4-6.0, max 7.0). Survey response rate 84% (n = 186); 80% of respondents were working in PM, the majority as leaders, >90% engaged in teaching PM. About 40% were active in PM associations, lobbying, and guideline development. Conclusion: The Nordic Specialist Course in PM has had a profound impact on the participants' postcourse careers, influencing the development of PM in the Nordic countries.

The Impact of Receiving a Family-Oriented Therapeutic Conversation Intervention Before and During Bereavement Among Family Cancer Caregivers: A Nonrandomized Trial.

Effective communication is the foundation of quality care in palliative nursing. As frontline palliative home care providers, nurses could foster more effective bereavement coping skills through therapeutic conversations. The purpose of this study was to evaluate the impact of a nursing intervention offered to bereaved family cancer caregivers. This was a quasi-experimental design, with a posttest-only comparison of the intervention and control groups receiving usual care. Bereaved caregivers (n = 51) receiving services from a specialized palliative home care unit participated and completed measures of depression, anxiety, stress, and grief reactions 3, 5, and 6 months after their close relative had died.There was a significant decrease in anxiety symptoms in the intervention group compared with the control group across all 3 time points. Anxiety and stress symptoms also decreased over time in the 2 groups combined, but this decrease was not observed for depression. When evaluating grief reactions, the intervention group had a lower mean of controlled grief responses, across the posttest period, than the control group.Results demonstrate that providing bereaved family caregivers the opportunity to participate in a therapeutic conversation intervention might reduce distressing symptoms in early bereavement.