What relatives of older medical patients want us to know - a mixed-methods study.

BACKGROUND: Relatives of acutely hospitalised older medical patients often act as case managers during a hospital trajectory. Therefore, relatives' experiences of collaboration with staff and their involvement in care and treatment are highly important. However, it is a field facing many challenges. Greater knowledge of the values and areas that are most important to relatives is needed to facilitate the health care staff to better understand and prepare themselves for collaboration with relatives and to guide family care. METHODS: The aims were to 1) describe the aspects of collaboration with staff during the hospital care trajectory emphasised by relatives of older medical patients 2) compare the characteristics of relatives who wrote free-text notes and those who did not. Relatives of acutely hospitalised older medical patients responded to a structured questionnaire (n = 180), and nearly half wrote free-text comments (n = 79). Free text was analysed with qualitative content analysis. Differences between (+) free text/ (-) free text groups were analysed with χ2 test and Kruskal-Wallis test. RESULTS: Analysis disclosed three categories I) The evasive white flock, concerning the experienced evasiveness in staff attitudes and availability, II) The absence of care as perceived by the relatives and III) Invisible & unrecognised describing relatives' experience of staff's lack of communication, involvement and interactions with relatives especially regarding discharge.Significant differences were found between relatives who wrote free-text and those who did not regarding satisfaction, trust and having a health care education. CONCLUSIONS: This study provides knowledge of aspects relatives of older medical patients find particularly problematic and, further, of characteristics of relatives using the free-text field. Overall, these relatives were met with evasiveness from staff, an absence of care and felt invisible and unrecognised in the lacking collaboration with staff. Hence, strategies to ensure quality care and systematic involvement of relatives are needed, and the findings in this study may contribute to, and guide, quality improvement of family centered care in acute hospital wards.

Effect of bupivacaine lozenges on oral mucositis pain: a randomized controlled multicenter phase II study.

INTRODUCTION: A nonblinded parallel-group randomized controlled study investigated the efficacy and tolerability of repeated administration of a bupivacaine lozenge (25 mg) as pain management for oral mucositis pain in head and neck cancer patients as add-on to standard systemic pain management. OBJECTIVE: The primary end point was the difference between the intervention group (Lozenge group) and the Control group in daily mean pain scores in the oral cavity or pharynx (whichever was higher). METHOD: Fifty patients from 2 hospitals in Denmark were randomized 1:1 to 7 days of treatment with bupivacaine lozenges (taken up to every 2 hours) plus standard pain treatment minus topical lidocaine (Lozenge group) or standard pain treatment including topical lidocaine (Control group). The efficacy analysis included 38 patients, as 12 patients were excluded because of changes in study design and missing data. RESULTS: Mean pain in the oral cavity or pharynx (whichever was higher) was significantly lower 60 minutes after taking lozenges (35 mm [n = 22]) than for the Control group (51 mm [n = 16]) (difference between groups -16 mm, 95% confidence interval: -26 to -6, P = 0.0032). Pain in the oral cavity was also significantly lower in the Lozenge group (18 mm) vs the Control group (36 mm, P = 0.0002). Pharyngeal mucositis pain did not differ significantly (37 mm [Lozenge group] vs 48 mm [Control group], P = 0.0630). No serious adverse events were reported. CONCLUSION: These results show that the bupivacaine lozenge as an add-on to standard pain treatment had a clinically significant pain-relieving effect in patients with oral mucositis. CLINICALTRIALSGOV: NCT02252926.

Twenty-four-hour mobility during acute hospitalization in older medical patients.

BACKGROUND: Inactivity during hospitalization in older medical patients may lead to functional decline. This study quantified 24-hour mobility, validated the accelerometers used, and assessed the daily level of basic mobility in acutely admitted older medical patients during their hospitalization. METHODS: This is a prospective cohort study in older medical patients able to walk independently (ambulatory patients) and those not able to walk independently (nonambulatory patients) on admission. The 24-hour mobility level during hospitalization was assessed by measuring the time in lying, sitting, and standing and/or walking, by two accelerometers. Basic mobility was quantified within 48 hours of admission and repeated daily throughout hospitalization. RESULTS: Forty-three ambulatory patients and six nonambulatory patients were included. The ambulatory patients tended to be hospitalized for fewer days than the nonambulatory patients (7 vs 16, p = .13). The ambulatory patients were lying median 17 hours, (interquartile range [IQR]: 14.4-19.1), sitting 5.1 hours (IQR: 2.9-7.1), and standing and/or walking 1.1 hours (IQR: 0.6-1.7) per day. On days with independency in basic mobility, the ambulatory patients were lying 4.1 hours less compared with days with dependency in basic mobility (p < .0001), sitting 2.4 hours more (p = .0004), and standing 0.9 hours more (p < .0001). The algorithm identification for lying, sitting, and standing and/or walking of the accelerometers, corresponded by 89%-100% with positions performed by older medical patients. CONCLUSIONS: Older acutely hospitalized medical patients with walking ability spent 17h/d of their in-hospital time in bed, and the level of in-hospital mobility seemed to depend on the patients' level of basic mobility. The accelerometers were valid in assessing mobility in older medical patients.