RESUMO
OBJECTIVES: Specialist-provided end-of-life scenarios (SP-EOLS) may improve advance care planning (ACP) implementation in primary care by helping overcome barriers such as uncertain prognosis and poor interprofessional collaboration. We aimed to explore the current use and potential impact of SP-EOLS on ACP in Dutch primary care. METHODS: We performed a mixed-methods study. From patients discussed in a hospital-based academic palliative care multidisciplinary team meeting between 2016 and 2019 and died, we collected primary care electronic medical records data on SP-EOLS, actual EOLS, and ACP initiation and applied descriptive and comparative analyses. Subsequently, we interviewed general practitioners (GPs) and thematically analyzed the transcripts. RESULTS: In 69.7% of 66 reviewed patient files, SP-EOLS were found. In patients whose GP had received SP-EOLS, ACP conversations were more often reported (92.0 vs. 61.0%, p = 0.006). From 11 GP interviews, we identified 4 themes: (1) SP-EOLS guide GPs, patients, and relatives when dealing with an uncertain future perspective; (2) SP-EOLS provide continuity of care between primary and secondary/tertiary care; (3) SP-EOLS should be tailored to the individual patient; and (4) SP-EOLS need to be personalized and uniformly transferred to GPs. SIGNIFICANCE OF RESULTS: SP-EOLS may facilitate ACP conversations by GPs. They have the potential to help overcome existing barriers to ACP implementation by providing guidance and supporting interprofessional collaboration. Future research should focus on improving SP-EOLS and tailor them to the needs of all end users, focusing on improving their effect on ACP conversations.
RESUMO
OBJECTIVES: Adenotonsillectomy (ATE) is one of the most performed surgeries in children. Extensive research on which operation technique is the best in terms of minimal pain and complications, operative time and duration of hospital stay is being done mostly in highly resourced developing countries. In developing countries a need for cost effective and time saving operation techniques is essential due to the low-resource setting. This study aims to investigate whether the Guillotine Sluder operation techniques is ideal in a limited resource developing country setting. METHODS: A retrospective cohort study was conducted on children below 12 years of age who underwent ATE at the Kilimanjaro Christian Medical Center, a tertiary hospital in Northern Tanzania, in a period of 2 years to compare the guillotine Sluder and classic dissection ATE techniques. All procedures were done by the same surgeon. Incomplete patient information and congenital syndromes were exclusion criteria for the study. RESULTS: Both operative time and duration of hospital stay were significantly shorter in the guillotine Sluder group (3,5 min with 95% CI 1,1 to 5,9 min, and 0,4 days with 95% CI 0,2 to 0,6 days respectively). The rate of complications was not statistically different between the two groups. The overall rate of complications was comparable to that of Western countries. No difference was found in mean amount of blood loss during operation. CONCLUSIONS: Our results conclude that guillotine Sluder tonsillectomy is a safe procedure that has some advantages compared to classic dissection in children in Tanzania. The shorter operative time and time in hospital stay combined with the low complication rate makes the guillotine Sluder technique a very suitable technique for children in Tanzania and comparable limited resource developing country settings.