Sexual satisfaction and its predictors in patients with advanced cancer and their family caregivers in six European countries: Baseline data from the DIAdIC study.

OBJECTIVE: To identify predictors of sexual satisfaction in patients with advanced cancer and their family caregivers. METHODS: Cross-sectional study using baseline survey data from a randomized controlled trial in six European countries. Patients with advanced cancer and their family caregiver completed measures on sexual satisfaction (one item from Functional Assessment of Cancer Therapy - General questionnaire for patients and Caregiver Quality of Life Index-Cancer scale for family caregivers) and health-related characteristics. Multivariable linear regressions were performed for all predictors (identified based on literature) with sexual satisfaction as dependent variable. RESULTS: The sample comprised 431 patient-family caregiver dyads. Patients with prostate or gynecological cancer reported lower sexual satisfaction (respectively B = -0.267 95% CI: -1.674, -0.594 and B = -0.196, 95% CI -2.103, -0.452). Higher emotional (B = 0.278, 95% CI 0.024, 0.057) physical (B = 0.305, 95% CI 0.012, 0.025) and social functioning (B = 0.151, 95% CI 0.001, 0.013), global health (B = 0.356, 95% CI 0.007, 0.013) and social wellbeing (B = 0.161, 95% CI 0.013, 0.082) among patients were associated with higher sexual satisfaction. Among family caregivers, sexual satisfaction was lower with increased age (B = -0.142, 95% CI -0.022, -0.004). Higher emotional functioning (B = 0.027, 95% CI 0.011, 0.043) and quality of life (B = 0.165, 95% CI -0.165, 0.716) were associated with higher sexual satisfaction in family caregivers. CONCLUSIONS: The results underscore that sexual wellbeing of patients and family caregivers is related to health related factors in physical, emotional, and social domains. Patients and family caregivers could benefit from a dyadic approach to address sexual wellbeing.

RT-QuIC detection of chronic wasting disease prion in platelet samples of white-tailed deer.

BACKGROUND: Chronic wasting disease (CWD) is a prion disease of captive and free-ranging cervids. Currently, a definitive diagnosis of CWD relies on immunohistochemistry detection of PrPSc in the obex and retropharyngeal lymph node (RPLN) of the affected cervids. For high-throughput screening of CWD in wild cervids, RPLN samples are tested by ELISA followed by IHC confirmation of positive results. Recently, real-time quacking-induced conversion (RT-QuIC) has been used to detect CWD positivity in various types of samples. To develop a blood RT-QuIC assay suitable for CWD diagnosis, this study evaluated the assay sensitivity and specificity with and without ASR1-based preanalytical enrichment and NaI as the main ionic component in assay buffer. RESULTS: A total of 23 platelet samples derived from CWD-positive deer (ELISA + /IHC +) and 30 platelet samples from CWD-negative (ELISA-) deer were tested. The diagnostic sensitivity was 43.48% (NaCl), 65.22% (NaI), 60.87% (NaCl-ASR1) or 82.61% (NaI-ASR1). The diagnostic specificity was 96.67% (NaCl), 100% (NaI), 100% (NaCl-ASR1), or 96.67% (NaI-ASR1). The probability of detecting CWD prion in platelet samples derived from CWD-positive deer was 0.924 (95% CRI: 0.714, 0.989) under NaI-ASR1 experimental condition and 0.530 (95% CRI: 0.156, 0.890) under NaCl alone condition. The rate of amyloid formation (RFA) was greatest under the NaI-ASR1 condition at 10-2 (0.01491, 95% CRI: 0.00675, 0.03384) and 10-3 (0.00629, 95% CRI: 0.00283, 0.01410) sample dilution levels. CONCLUSIONS: Incorporation of ASR1-based preanalytical enrichment and NaI as the main ionic component significantly improved the sensitivity of CWD RT-QuIC on deer platelet samples. Blood test by the improved RT-QuIC assay may be used for antemortem and postmortem diagnosis of CWD.

Safeguarding adults: A concept analysis.

AIMS: This article aimed to examine the concept of safeguarding adults and establish an operational definition for application to practice, research and policy. DESIGN: Rodgers' evolutionary and inductive method of concept analysis was used. DATA SOURCES: A systematic search was conducted across four electronic databases, CINAHL, PsycINFO, Scopus and PubMed, covering the period from January 2014 to May 2023. This systematic database search aimed to gather a broad spectrum of research and scholarly literature to inform and support the concept analysis. A total of 10 peer-reviewed articles were reviewed using a data chart to identify the context, definitions, antecedents, attributes and consequences of safeguarding adults. RESULTS: The analysis of the included articles helped to develop a better understanding of safeguarding adults by offering a practical operational definition tailored to the specific needs of practising nurses. The implications for practice, research and policy are discussed, highlighting the potential for improving the quality of care and ensuring the well-being of adults at risk of abuse. CONCLUSION: By employing Rogers' evolutionary concept analysis method, we developed a deeper insight into safeguarding adults in health care. A synthesis of literature revealed the intricate layers and adaptations within safeguarding practices. This concept analysis lays the groundwork for future research, policy development and educational initiatives, enhancing the well-being and safety of adults at risk of abuse within care. IMPACT: By undertaking a concept analysis of the term safeguarding adults' nurses can be more prepared to engage in and reinforce the key principles of safeguarding adults, providing guidance to ensure the protection and well-being of adults at risk of abuse. PATIENT OR PUBLIC CONTRIBUTION: Not applicable. WHAT THIS PAPER CONTRIBUTES TO THE WIDER BODY OF KNOWLEDGE: This concept analysis helps to define and clarify the conceptual term 'safeguarding adults' promoting a shared understanding of the key components of adult protection and providing a comprehensive framework for assessment and management of adults at risk of abuse in this field of practice.

Informal caregivers' experiences of transitioning during end-of-life care-A scoping review.

BACKGROUND: Dying well at home usually requires the help and assistance of an informal caregiver. This role is usually unpaid, wide-ranging and oftentimes demanding. From diagnosis to death of a loved one, informal caregivers can experience one and frequently numerous transitions, however, little is known about this process. The purpose of this scoping review is to chart, explore and understand caregivers' experiences of transitioning when providing end-of-life care. A preliminary search of the literature indicated a paucity of research highlighting a notable absence of caregiver's perspectives and acknowledgements of the support they need to ensure successful transitions during this time. Consequently, this review has the potential to make a valuable contribution to the literature. METHODS: Arksey and O'Malley's (2005) framework, further enhanced by Levac et al. (2010) and Peters et al. (2020) was used to conduct this scoping review. The Extension for Scoping Reviews (PRISMA-ScR) guided reporting. A systematic search of the databases PUBMED, PsychINFO, CINAHL, EMBASE, and Web of Science and a selection of grey literature was undertaken from the year 1990 to date by two researchers. Titles and abstracts of the literature identified were screened and finally, a narrative synthesis of 11 articles was undertaken to answer the following research question: What is known from the literature about informal caregivers' transitions when caring for a dying person in the home? CONCLUSIONS: Current knowledge on this topic is limited; however, from this review, two main themes were identified: 'Challenges arising during transitioning' with subthemes of burden of care and fading away. The second theme 'Coping strategies' comprised subthemes of meaning-making, seeking normality and hope. This evidence may support the development of transitional care interventions in the future and improve patient and caregiver outcome measures and experiences to inform a larger research study exploring this phenomenon. PATIENT OR PUBLIC CONTRIBUTION: N/A as this is a Scoping Review. WHAT THIS PAPER CONTRIBUTES TO THE WIDER GLOBAL COMMUNITY: An understanding of the experiences of transitioning when caring for a loved one dying at home could help mitigate challenges informal caregivers face when providing end-of-life care in the home. While informal caregivers are crucial to support people who want to die at home, the role is often invisible and family carers need support and recognition to reduce the burden of care and challenges they experience as they transition in their role.

Taste disturbance in patients with advanced cancer: a scoping review of clinical features and complications.

PURPOSE: The purpose of this scoping review is to appraise the published literature on taste disturbance in patients with advanced cancer, with the specific objectives being to determine its prevalence, clinical features and complications. METHODS: This scoping review was conducted using the recommended methodological framework. A detailed search of databases (Medline, Embase, CINAHL and PsycInfo) was conducted to identify eligible studies: eligible studies needed to include patients with advanced cancer and needed to include details of clinical features and/or complications of taste disturbance. Standard bibliographic/systematic review software was used to store the records and manage the review process, respectively. RESULTS: Twenty-five studies were identified from the database searches. The studies identified included eight physical and/or psychological symptom studies, six symptom cluster studies, five oral symptom studies and six taste and/or smell specific studies. Detailed data is presented on the clinical features and complications of taste disturbance and on the symptom clusters involving taste disturbance in this cohort of patients. CONCLUSION: This scoping review identified a relatively small number of relevant studies involving a relatively small number of participants. Nevertheless, it confirms that taste disturbance is a common problem in patients with advanced cancer and is associated with significant morbidity because of the primary condition and the associated complications.

Integrated care for children living with complex care needs: an evolutionary concept analysis.

Children with complex care needs (CCNs) are in need of improved access to healthcare services, communication, and support from healthcare professionals to ensure high-quality care is delivered to meet their needs. Integrated care is viewed as a key component of care delivery for children with CCNs, as it promotes the integration of healthcare systems to provide family and child-centred care across the entire health spectrum. There are many definitions and frameworks that support integrated care, but there is a lack of conceptual clarity around the term. Furthermore, it is often unclear how integrated care can be delivered to children with CCNs, therefore reinforcing the need for further clarification on how to define integrated care. An evolutionary concept analysis was conducted to clarify how integrated care for children with CCNs is defined within current literature. We found that integrated care for children with CCNs refers to highly specialised individualised care within or across services, that is co-produced by interdisciplinary teams, families, and children, supported by digital health technologies.  Conclusion: Given the variation in terms of study design, outcomes, and patient populations this paper highlights the need for further research into methods to measure integrated care. What is Known: • Children with complex care needs require long-term care, and are in need of improved services, communication, and information from healthcare professionals to provide them with the ongoing support they need to manage their condition. • Integrated care is a key component in healthcare delivery for children with complex care needs as it has the potential to improve access to family-centred care across the entire health spectrum. What is New: • Integrated care for children with CCNs refers to highly specialised individualised care within or across services, that is co-produced by interdisciplinary teams, families, and children, supported by digital health technologies. • There is a need for the development of measurement tools to effectively assess integrated care within practice.

Spirituality in palliative care.

Although being recognized by the World Health Organization as an essential domain of palliative care, spiritual care is still one of the most neglected component of the healthcare system. In this editorial, we set the context and invite contributions for a BMC Palliative Care Collection of articles titled 'Spirituality in Palliative Care'.

The perceived effects of COVID-19 while living with a chronic illness.

INTRODUCTION: A diagnosis of chronic illness posed a serious threat to people during the recent COVID-19 pandemic. People with chronic illnesses were faced with increased mortality and reduced access to healthcare. Self-care is the process of maintaining health and managing a chronic illness. Nurses working in specialist services provide healthcare education to people with chronic illnesses. Access to these nurses was decreased during periods of the COVID-19 virus escalation due to the reconfiguration of services and redeployment of nurses. The purpose of the research was to learn from the experiences of people with a chronic illnesses in self-care behaviors and accessing altered healthcare services to inform future practices. DESIGN: A population survey design. METHODS: A mixed methods survey was designed, combining validated questionnaires and scales with open-ended questions. A convenience sample was utilized via using social media platforms. Data analysis included descriptive and inferential statistics. Content analysis was used to analyze open-ended responses. RESULTS: There were 147 responses, with approximately half reporting no changes in face-to-face healthcare contact, 41% reporting decreased contacts and 12% increased contacts. Non-face-to-face contacts were reduced by almost 9%, did not change by almost 60%, while 33% indicated an increase. Participants reported mixed perceptions in contact with healthcare providers during restrictions. In the Patient Assessment of Chronic Illness Care and the Self-Care of Chronic Illness scales, participants scored statistically lower scores than in previous studies. Participants indicated that public health restrictions negatively impacted their confidence, created challenges with re-engaging and that access to care was more difficult. CONCLUSION: This research highlights the importance of providing continued support to people with chronic illness irrespective of other challenges to healthcare services. A structured approach to virtual self-care education is required. CLINICAL RELEVANCE: This research concluded that the experience of access to one healthcare professional as opposed to diverse multidisciplinary input was similar for a number of chronic illnesses groups of people during the COVID-19 pandemic. There was an altered dynamic of virtual contacts with healthcare providers and a lack of confidence interpreting what monitoring was required by people with a chronic illnesses due to a lack of preparedness for virtual healthcare delivery.

Older people's experiences of elder abuse in residential care settings: A scoping review.

BACKGROUND: Elder abuse is a global human rights issue, particularly in residential care settings where there is limited understanding of older people's experiences of this phenomenon. This scoping review aims to map and describe the existing literature on this phenomenon. METHODS: Using Arksey and O'Malley's scoping review methodology, further developed by Levac et al. and the Joanna Briggs Institute, a systematic search of six databases was conducted to identify relevant studies published from inception to January 2023. Studies were included if they focused on older people's experience of abuse within residential care settings. A comprehensive data extraction process was employed to identify key themes from the included studies. RESULTS: The initial search yielded a total of 3701 articles of which eight met the inclusion criteria. The findings revealed a range of abusive experiences encountered by older people living in residential care settings, including psychological, physical, financial, neglect and sexual abuse. The common attributes of residents vulnerable to abuse were evident throughout each of the studies. Finally, the theme of organizational neglect was apparent through the absence of effective safeguarding measures in the included studies. The findings revealed the insufficient implementation of safeguarding measures increases the risk of abuse among residents. CONCLUSION: This scoping review highlights the limited research on the experiences of older people who have encountered elder abuse in residential care settings. The findings stress the need for further research exploring the complex interplay of factors contributing to elder abuse within aged care settings. The insights gained from this scoping review can inform the development of comprehensive safeguarding strategies to prevent and address elder abuse in residential care settings, promoting the well-being and safety of older people. PATIENT OR PUBLIC CONTRIBUTION: This project is a scoping review of the literature; therefore, no patient or public contribution was deemed necessary. WHAT THIS PAPER CONTRIBUTES TO THE WIDER GLOBAL COMMUNITY: Most research on elder abuse has been conducted in the community rather than in Residential Care Settings where there is a limited understanding of older people's experiences of abuse within the published literature. The scoping review highlights the presence of inadequate safeguarding strategies in Residential Care Settings within the reviewed studies, providing recommendations for developing and improving safeguarding measures in Residential Care Settings to prevent abuse, neglect, and harm in the future.

Interventions for interpersonal communication about end of life care between health practitioners and affected people.

BACKGROUND: Communication about end of life (EoL) and EoL care is critically important for providing quality care as people approach death. Such communication is often complex and involves many people (patients, family members, carers, health professionals). How best to communicate with people in the period approaching death is not known, but is an important question for quality of care at EoL worldwide. This review fills a gap in the evidence on interpersonal communication (between people and health professionals) in the last year of life, focusing on interventions to improve interpersonal communication and patient, family member and carer outcomes. OBJECTIVES: To assess the effects of interventions designed to improve verbal interpersonal communication about EoL care between health practitioners and people affected by EoL. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL from inception to July 2018, without language or date restrictions. We contacted authors of included studies and experts and searched reference lists to identify relevant papers. We searched grey literature sources, conference proceedings, and clinical trials registries in September 2019. Database searches were re-run in June 2021 and potentially relevant studies listed as awaiting classification or ongoing. SELECTION CRITERIA: This review assessed the effects of interventions, evaluated in randomised and quasi-randomised trials, intended to enhance interpersonal communication about EoL care between patients expected to die within 12 months, their family members and carers, and health practitioners involved in their care. Patients of any age from birth, in any setting or care context (e.g. acute catastrophic injury, chronic illness), and all health professionals involved in their care were eligible. All communication interventions were eligible, as long as they included interpersonal interaction(s) between patients and family members or carers and health professionals. Interventions could be simple or complex, with one or more communication aims (e.g. to inform, skill, engage, support). Effects were sought on outcomes for patients, family and carers, health professionals and health systems, including adverse (unintended) effects. To ensure this review's focus was maintained on interpersonal communication in the last 12 months of life,  we excluded studies that addressed specific decisions, shared or otherwise, and the tools involved in such decision-making. We also excluded studies focused on advance care planning (ACP) reporting ACP uptake or completion as the primary outcome. Finally, we excluded studies of communication skills training for health professionals unless patient outcomes were reported as primary outcomes. DATA COLLECTION AND ANALYSIS: Standard Cochrane methods were used, including dual review author study selection, data extraction and quality assessment of the included studies. MAIN RESULTS: Eight trials were included. All assessed intervention effects compared with usual care. Certainty of the evidence was low or very low. All outcomes were downgraded for indirectness based on the review's purpose, and many were downgraded for imprecision and/or inconsistency. Certainty was not commonly downgraded for methodological limitations. A summary of the review's findings is as follows. Knowledge and understanding (four studies, low-certainty evidence; one study without usable data): interventions to improve communication (e.g. question prompt list, with or without patient and physician training) may have little or no effect on knowledge of illness and prognosis, or information needs and preferences, although studies were small and measures used varied across trials.  Evaluation of the communication (six studies measuring several constructs (communication quality, patient-centredness, involvement preferences, doctor-patient relationship, satisfaction with consultation), most low-certainty evidence): across constructs there may be minimal or no effects of interventions to improve EoL communication, and there is uncertainty about effects of interventions such as a patient-specific feedback sheet on quality of communication.  Discussions of EoL or EoL care (six studies measuring selected outcomes, low- or very low-certainty evidence): a family conference intervention may increase duration of EoL discussions in an intensive care unit (ICU) setting, while use of a structured serious illness conversation guide may lead to earlier discussions of EoL and EoL care (each assessed by one study). We are uncertain about effects on occurrence of discussions and question asking in consultations, and there may be little or no effect on content of communication in consultations.  Adverse outcomes or unintended effects (limited evidence): there is insufficient evidence to determine whether there are adverse outcomes associated with communication interventions  (e.g. question prompt list, family conference, structured discussions) for EoL and EoL care. Patient and/or carer anxiety was reported by three studies, but judged as confounded. No other unintended consequences, or worsening of desired outcomes, were reported. Patient/carer quality of life (four studies, low-certainty evidence; two without useable data): interventions to improve communication may have little or no effect on quality of life.  Health practitioner outcomes (three studies, low-certainty evidence; two without usable data): interventions to improve communication may have little or no effect on health practitioner outcomes (satisfaction with communication during consultation; one study); effects on other outcomes (knowledge, preparedness to communicate) are unknown. Health systems impacts: communication interventions (e.g. structured EoL conversations) may have little or no effect on carer or clinician ratings of quality of EoL care (satisfaction with care, symptom management, comfort assessment, quality of care) (three studies, low-certainty evidence), or on patients' self-rated care and illness, or numbers of care goals met (one study, low-certainty evidence). Communication interventions (e.g. question prompt list alone or with nurse-led communication skills training) may slightly increase mean consultation length (two studies), but other health service impacts (e.g. hospital admissions) are unclear. AUTHORS' CONCLUSIONS: Findings of this review are inconclusive for practice. Future research might contribute meaningfully by seeking to fill gaps for populations not yet studied in trials; and to develop responsive outcome measures with which to better assess the effects of communication on the range of people involved in EoL communication episodes. Mixed methods and/or qualitative research may contribute usefully to better understand the complex interplay between different parties involved in communication, and to inform development of more effective interventions and appropriate outcome measures. Co-design of such interventions and outcomes, involving the full range of people affected by EoL communication and care, should be a key underpinning principle for future research in this area.

Nursing and midwifery workforce readiness during a global pandemic: A survey of the experience of one hospital group in the Republic of Ireland.

AIM: To explore the mobilization of nurses/midwives in a designated hospital group in Ireland during a global pandemic. BACKGROUND: The recent global pandemic has resulted in the large-scale worldwide mobilization of registered nurses and midwives working in the acute care sector. There is a dearth of literature reporting the mobilization of this professional workforce. METHOD: Mixed-methods design using an electronic survey and facilitated discussion across one Irish hospital group. RESULTS: Eight of 11 hospitals responded to the survey. There was a 2% vacancy rate prior to the pandemic. Mobilization included reconfiguration of clinical areas and redeployment of 9% of the nursing/midwifery workforce within 2 weeks of the pandemic. A total of 11% (n = 343) of nurses/midwives were redeployed in 3 months. Nurses/midwives required re-skilling in infection prevention control, enhancement of critical care skills and documentation. CONCLUSIONS: Three key areas were identified to enable the nursing workforce readiness. These are referred to as the three 'R's': Reconfiguration of specific resources, Redeployment of nurses to dedicated specialist areas and Re-skilling of nurses to safely care for the patients during the pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: A centralized approach to reconfiguration of clinical areas. Redeployment is enabled by closing non-essential departments. Hands-on re-skilling and reorientating staff are essential.

Experiences Related to Patients and Families' Expression of Spiritual Needs or Spiritual Support Within Healthcare Settings During the COVID-19 Pandemic: A Scoping Review.

The aim of this review was to explore the evidence surrounding patients and families' expression of spirituality, spiritual needs or spiritual support within healthcare settings during the COVID-19 pandemic from the perspective of nursing practice. While there is a plethora of research and publications related to COVID-19 and there are reports of increasing attention to nurses' psychological distress, there is little understanding of experiences related to patients' expression of spirituality, spiritual needs or spiritual support within healthcare settings during the COVID-19 pandemic. A scoping review was conducted to search and select potential studies and undertake data extraction and synthesis. Twenty-one studies published between March 2020 and August 2021 were identified. Themes and subthemes that emerged from analysis of the studies included spiritual needs, new awareness of spiritual needs and spiritual interventions, chaplaincy referrals, and improved well-being. The potential requirement for spiritual care during these times has anecdotally never been greater. At the same time the existent ethical challenges persist, and nurses remain reticent about the topic of spirituality. This is evident from the clear lack of attention to this domain within the published nursing literature and a limited focus on spiritual care interventions or the experiences and spiritual needs of patients and their families. Greater attention is needed internationally to improve nurses' competence to provide spiritual care and to develop and advance nursing and research practice in the field of spiritual care.

Providing Spiritual Care to In-Hospital Patients During COVID-19: A Preliminary European Fact-Finding Study.

Historically, there has be a close relationship between the nursing services and spiritual care provision to patients, arising due to the evolvement of many hospitals and nursing programmes from faith-based institutions and religious order nursing. With increasing secularism, these relationships are less entwined. Nonetheless, as nurses typically encounter patients at critical life events, such as receiving bad news or dying, nurses frequently understand the need and requirement for both spiritual support and religious for patients and families during these times. Yet there are uncertainties, and nurses can feel ill-equipped to deal with patients' spiritual needs. Little education or preparation is provided to these nurses, and they often report a lack of confidence within this area. The development of this confidence and the required competencies is important, especially so with increasingly multicultural societies with diverse spiritual and religious needs. In this manuscript, we discuss initial field work carried out in preparation for the development of an Erasmus Plus educational intervention, entitled from Cure to Care Digital Education and Spiritual Assistance in Healthcare. Referring specifically to post-COVID spirituality needs, this development will support nurses to respond to patients' spiritual needs in the hospital setting, using digital means. This preliminary study revealed that while nurses are actively supporting patients' spiritual needs, their education and training are limited, non-standardised and heterogeneous. Additionally, most spiritual support occurs within the context of a Judeo-Christian framework that may not be suitable for diverse faith and non-faith populations. Educational preparation for nurses to provide spiritual care is therefore urgently required.

Evaluating the specialist palliative care clinical nurse specialist role in an acute hospital setting: a mixed methods sequential explanatory study.

BACKGROUND: Special palliative care is provided in a range of settings including a patient's home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting. METHODS: This study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire (n = 121) and phase 2 involved part-taking in a focus group (n = 6) or individual interview (n = 4). RESULTS: Phase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support. CONCLUSIONS: This study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff.

Effectiveness of a nurse-delivered (FOCUS+) and a web-based (iFOCUS) psychoeducational intervention for people with advanced cancer and their family caregivers (DIAdIC): study protocol for an international randomized controlled trial.

BACKGROUND: Worldwide, millions of people with advanced cancer and their family caregivers are experiencing physical and psychological distress. Psychosocial support and education can reduce distress and prevent avoidable healthcare resource use. To date, we lack knowledge from large-scale studies on which interventions generate positive outcomes for people with cancer and their informal caregivers' quality of life. This protocol describes the DIAdIC study that will evaluate the effectiveness of two psychosocial and educational interventions aimed at improving patient-family caregiver dyads' emotional functioning and self-efficacy. METHODS: We will conduct an international multicenter three-arm randomized controlled trial in Belgium, Denmark, Ireland, Italy, The Netherlands, and the United Kingdom. In each country, 156 dyads (936 in total) of people with advanced cancer and their family caregiver will be randomized to one of the study arms: 1) a nurse-led face-to-face intervention (FOCUS+), 2) a web-based intervention (iFOCUS) or 3) a control group (care as usual). The two interventions offer tailored psychoeducational support for patient-family caregiver dyads. The nurse-led face-to-face intervention consists of two home visits and one online video session and the web-based intervention is completed independently by the patient-family caregiver dyad in four online sessions. The interventions are based on the FOCUS intervention, developed in the USA, that addresses five core components: family involvement, optimistic outlook, coping effectiveness, uncertainty reduction, and symptom management. The FOCUS intervention will be adapted to the European context. The primary outcomes are emotional functioning and self-efficacy of the patient and the family caregiver, respectively. The secondary outcomes are quality of life, benefits of illness, coping, dyadic communication, and ways of giving support of the patient and family caregiver. DISCUSSION: DIAdIC aims to develop cost-effective interventions that integrate principles of early palliative care into standard care. The cross-country setup in six European countries allows for comparison of effectiveness of the interventions in different healthcare systems across Europe. By focusing on empowerment of the person with cancer and their family caregiver, the results of this RCT can contribute to the search for cost-effective novel interventions that can relieve constraints on professional healthcare. TRIAL REGISTRATION: Registration on ClinicalTrials.gov on 12/11/2020, identifier NCT04626349 . DATE AND VERSION IDENTIFIER: 20211209_DIAdIC_Protocol_Article.

Mass spectrometry studies of the fragmentation patterns and mechanisms of protonated peptoids.

Peptoids belong to a class of sequence-controlled polymers comprising of N-alkylglycine. This study focuses on using tandem mass spectrometry techniques to characterize the fragmentation patterns of a set of singly and doubly protonated peptoids consisting of one basic residue placed at different positions. The singly protonated peptoids fragment by producing predominately high-abundant C-terminal ions called Y-ions and low-abundant N-terminal ions called B-ions. Computational studies suggest that the proton affinity (PA) of the C-terminal fragments is generally higher than that of the N-terminal fragments, and the PA of the former increases as the fragments are elongated. The B-ions are likely formed upon dissociating the proton-activated amide bonds via an oxazolone structure, and the Y-ions are produced subsequently by abstracting a proton from the newly formed B-ions, which is energetically favored. The doubly protonated peptoids prefer to fragment closest to either the N- or the C-terminus and produce corresponding B/Y-ion pairs. The basic residue seems to dictate the preferred fragmentation site, which may be the result of minimizing the repulsion between the two charges. Water and terminal neutral losses are a facile process accompanying the peptoid fragmentation in both charge states. The patterns appear to be highly influenced by the location of the basic residue.

Differences in Outcomes Associated With Individual Radiologists for Emergency Department Patients With Headache Imaged With CT: A Retrospective Cohort Study of 25,596 Patients.

OBJECTIVE. The purpose of this study was to determine whether diagnostic radiologists impart variation into resource use and patient outcomes in emergency department (ED) patients undergoing CT for headache. MATERIALS AND METHODS. This was a single-institution retrospective quality assurance cohort study of 25,596 unique adult ED patients undergoing head CT for headache from January 2012 to October 2017. CT examinations were interpreted by 55 attending radiologists (25 neuroradiologists, 30 radiologists of other specialties) who each interpreted a mean of 1469.8 ± 787.9 CT examinations. Risk adjustment for variables thought to influence outcome included baseline risk (demographics, Elixhauser comorbidity score), clinical factors (vital signs, ED triage and pain scores, laboratory data, hydrocephalus, prior intracranial hemorrhage, neurosurgical consultation within last 12 months), and system factors (time of CT, physician experience, neuroradiology training). Multivariable models were built to analyze the effect of individual radiologists on subsequent outcomes. Any p value less than 0.007 was considered significant after Bonferroni correction. RESULTS. The study found 57.5% (14,718/25,596) of CT interpretations were performed by neuroradiologists, and most patients (98.1% [25,119/25,596]) had no neurosurgical history. After risk adjustment, individual radiologists were not an independent predictor of hospital admission (p = 0.49), 30-day readmission (p = 0.30), 30-day mortality (p = 0.14), or neurosurgical intervention (p = 0.04) but did predict MRI use (p < 0.001; odds ratio [OR] range among radiologists, 0.009-38.2), neurology consultation (p < 0.001; OR range, 0.4-3.2), and neurosurgical consultation (p < 0.001; OR range, 0.1-9.9). CONCLUSION. Radiologists with different skills, experience, and practice patterns appear interchangeable for major clinical outcomes when interpreting CT for headache in the ED, but their differences predict differential use of downstream health care resources. Resource use measures are potential quality indicators in this cohort.

Mechanisms and Origins of Spinal Pain: from Molecules to Anatomy, with Diagnostic Clues and Imaging Findings.

Spinal pain, especially low back pain (LBP), is a widespread clinical and diagnostic problem for both patients and physicians, because back pain has an equivalently wide variety of causes and provocations. Because of its variable nature and manifestations, back pain is challenging to diagnose and treat correctly. In addition, the pain is induced not only by direct mechanical pressure such as a herniated disk or degenerated bone but also by inflammation and associated proinflammatory cytokines. To help guide further diagnostic workup or the next step in management, radiologists should be familiar with the causes, mechanisms, and diagnostic clues provided by MRI. The authors review the microscopic and macroscopic mechanisms for each category of LBP and depict the relationship between imaging findings and pain mechanisms. This review focuses on the detailed anatomy related to the pain-signaling pathway and the roles of chemicals in inducing different mechanisms of LBP. MRI findings that serve as representative examples of key concepts are demonstrated according to each mechanism, and treatment options are reviewed on the basis of different causes of LBP. By knowing these concepts, radiologists can help correlate imaging findings with potential underlying mechanisms and help guide clinicians in the management of LBP. ©RSNA, 2020.

Equity and the financial costs of informal caregiving in palliative care: a critical debate.

BACKGROUND: Informal caregivers represent the foundation of the palliative care workforce and are the main providers of end of life care. Financial pressures are among the most serious concerns for many carers and the financial burden of end of life caregiving can be substantial. METHODS: The aim of this critical debate paper was to review and critique some of the key evidence on the financial costs of informal caregiving and describe how these costs represent an equity issue in palliative care. RESULTS: The financial costs of informal caregiving at the end of life can be significant and include carer time costs, out of pocket costs and employment related costs. Financial burden is associated with a range of negative outcomes for both patient and carer. Evidence suggests that the financial costs of caring are not distributed equitably. Sources of inequity are reflective of those influencing access to specialist palliative care and include diagnosis (cancer vs non-cancer), socio-economic status, gender, cultural and ethnic identity, and employment status. Effects of intersectionality and the cumulative effect of multiple risk factors are also a consideration. CONCLUSIONS: Various groups of informal end of life carers are systematically disadvantaged financially. Addressing these, and other, determinants of end of life care is central to a public health approach to palliative care that fully recognises the value of carers. Further research exploring these areas of inequity in more depth and gaining a more detailed understanding of what influences financial burden is required to take the next steps towards meeting this aspiration. We will address the conclusions and recommendations we have made in this paper through the work of our recently established European Association of Palliative Care (EAPC) Taskforce on the financial costs of family caregiving.

Stakeholder perceptions of curriculum design, development and delivery for continuing e-learning for nurses.

BACKGROUND: This paper reports the qualitative findings from stage 5 of an action research project which involved the redesign of continuing professional education (CPE) courses in one organisation. AIM: The aim of this study was to explore key stakeholders perceptions of the teaching, learning and outcomes of a new curriculum design for CPE involving e-learning. METHOD: This project used participatory action research, involving stakeholders as participants in a process of inquiry about the change. The study took place in an academic teaching hospital and consisted of three focus group interviews with a total of 20 nurses. Participants included stakeholders who had developed curricula and managers from clinical areas where CPE courses had been undertaken. FINDINGS: Four main themes emerged, revealing staff perceptions on the process of change and their own 'lightbulb moments' experienced during this process. Results also indicate that the change has resulted in learner-focused CPE, with a range of opportunities for continued educational development in future. CONCLUSION: Key stakeholders' experience is seldom reported in studies related to CPE. This study provides an insight into the experiences of key stakeholders in relation to the development and delivery of CPE courses. Stakeholders indicated that they were able to see the benefits of implementing new CPE curricula they had contributed to. They also commented that clinical-pertinent and competence-based courses were more learner focused as a result of combining online content with supported workshops.