Wolfbagge3418
To report on direct experiences from advanced head and neck cancer patients, family carers and healthcare professionals, and the barriers to integrating specialist palliative care.
Using a naturalistic, interpretative approach, within Northwest England, a purposive sample of adult head and neck cancer patients was selected. Their family carers were invited to participate. Healthcare professionals (representing head and neck surgery and specialist nursing; oncology; specialist palliative care; general practice and community nursing) were recruited. All participants underwent face-to-face or telephone interviews. A thematic approach, using a modified version of Colazzi's framework, was used to analyze the data.
Seventeen interviews were conducted (9 patients, 4 joint with family carers and 8 healthcare professionals). Two main barriers were identified by healthcare professionals "lack of consensus about timing of Specialist Palliative Care engagement" and "high stake decisions with uncertainty about treat differ from those used for the wider cancer population. Clearer ways to effectively communicate goals of care are required potentially involving collaboration between Specialist Palliative Care and the wider head and neck cancer team.
Child poverty rates are rising in Norway with potential negative consequences for children. Services for families with low income are often fragmented and poorly integrated, and few coordinated initiatives have been implemented and evaluated in Norway.
The aim of the current study is to evaluate how integrated and coordinated services provided over a prolonged period by a family coordinator are related to changes across a wide range of health, wellbeing and home environment indicators for the participants.
The study uses a mixed methods approach utilising survey and register data, as well as information from interviews and shadowing, to document and evaluate outcomes associated with the intervention and the process of implementation. Data are gathered at baseline and annually throughout the duration of the study. Participants are identified to facilitate longer-term follow-up using register data.
This project will develop important knowledge about the implementation of coordinated services to families with a low income, and how this way of organizing services influences important outcomes for the family members in the short and long term.
This project will develop important knowledge about the implementation of coordinated services to families with a low income, and how this way of organizing services influences important outcomes for the family members in the short and long term.
The attention of healthcare professionals is directed mainly towards the recipients of care and often insufficiently towards family carers. However, an effective collaboration between professionals and family carers is vital to provide quality palliative and end-of-life care. Such collaboration is under-studied in a palliative care context.
This study aimed to investigate how family carers of people who live at home with a life-limiting chronic illness experience and perceive collaboration with different healthcare professionals in the last phase of life.
Face-to-face semi-structured interviews were conducted with the primary family carers of people with a life-limiting chronic illness. Interpretative phenomenological analysis was used to analyse the data.
A heterogeneous sample of 30 family carers of people with cancer, heart failure or dementia was recruited through a variety of care providers and services, in order to reflect the heterogeneity of caregiving in serious illness.
Five main themes emons of family carers of people with a chronic life-limiting illness living at home regarding the collaboration with different healthcare providers in the last phase life, showed that family carers experience a lot of possibilities, but perceive missed opportunities as well, for healthcare professionals to effectively collaborate with them for palliative care.Polypharmacy poses risks associated with drug-drug interactions, increased adverse effects, pill burden, poor compliance and unfavorable treatment outcomes. Whether polypharmacy affects treatment outcomes among people living with HIV (PLHIV) is largely unknown. A prospective study was conducted among PLHIV followed-up at a tertiary-care clinic of an academic medical center during January 2012 to December 2017. The clinic provided comprehensive HIV care with multidisciplinary team approach focusing on treatment adherence. Polypharmacy was defined as concurrent use of 5 or more non-antiretroviral (ARV) drugs for at least one year. Of the 248 PLHIV included, 23 (9%) received polypharmacy. PLHIV with polypharmacy were older (median age 45 vs. 36 years), were more likely to have underlying diseases (65% vs. 18%) and had lower median initial CD4 counts (40 vs. 214 cells/mm3). The rates of virologic suppression at 12 months after ARV therapy were 96% and 92% in polypharmacy and non-polypharmacy groups, respectively (P = 0.70), while the median CD4 cell count increase was higher among the non-polypharmacy group at 12 months (207 vs. 403 cells/mm3; P less then 0.001). There were no differences in rates of adverse effects and experienced drug-drug interactions. Decarboxylase inhibitor Hospitalization due to HIV-related diseases within 12 months after ARV initiation [adjusted odds ratio (aOR) 11.63, P = 0.004] and lower 3-item score for ARV adherence (aOR 0.49, P = 0.01) were independently associated with failure of virologic suppression at 12 months. These findings suggest that polypharmacy did not affect the virological outcomes among our PLHIV. Patients with the characteristics associated with virological failure should be closely monitored.Otosyphilis is a serious complication of syphilis.329 participants enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis underwent portable audiometry (250 Hz to 8000 Hz at 5-75 dB); it was repeated in 33 after otosyphilis treatment. Treponema pallidum spp pallidum (T. pallidum) DNA in blood was quantitated by polymerase chain reaction. Odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs) were determined by logistic, ordinal or Cox regression.166 (50.5%) had normal hearing; 15 (4.6%) had low frequency (LF) loss alone, 93 (28.3%) had high frequency (HF) loss alone, and 55 (16.7%) had both. Adjusted odds of any hearing loss were higher with detectable blood T. pallidum DNA (3.00 [1.58-5.69], p = 0.001), CSF pleocytosis (2.02 [1.12-3.66], p = 0.02), and older age (2.22 per 10-year increase, [1.70-2.91], p less then 0.001). HRs of normalization of LF and HF loss were lower for older individuals (0.20 [0.07-0.63, p = 0.005] and 0.22 [0.05-0.94, p = 0.04]), and HRs for normalization of HF loss were lower for those with more severe loss (0.
