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BackgroundA Fatigue and Activity Management Education in Work (FAME-W) programme was developed for individuals with inflammatory arthritis to manage fatigue in work (McCormick, 2018). FAME-W was designed as an in-person programme;however, due to COVID-19 pandemic it was modified to be an online group-based self-management intervention.ObjectivesThis study tested the effectiveness of an online format of FAME-W for future use by occupational therapist to help individuals with inflammatory arthritis to stay in work.MethodsParticipants were randomly allocated to intervention or control groups. Participants in the intervention group received the online four-week FAME-W and the control group participants received a FAME-W handbook. Participants in the intervention group attended a focus group immediately after the completion of the online FAME-W programme. A qualitative descriptive design was used with semi-structured focus groups. Data were analysed by thematic analysis (Braun and Clark, 2021).ResultsTwenty-six individuals took part in five separate focus groups. The average number of participants per group was 5 individuals with the largest group having 8 and smallest having 3 participants. The majority of participants were female, working full time and had Rheumatoid Arthritis. The four themes emerging from the focus groups were: "content and delivery of the programme” where participants discussed the relevance of the content to their symptoms and the online delivery format of FAME-W. In the second theme, participants discussed "understanding the effects of symptoms on their own and combined” and how symptoms effect mood, work, cognitive and physical abilities. In the third theme, "implementing the knowledge gained from the programme” through goal setting and practicality of the self-management strategies provided were discussed. Final theme "impact of the FAME-W on symptoms and work” including reassurance of normalising symptoms, change in mindset and approach to their condition were discussed.Table 1.ThemesQuotesContent and delivery of the programme"Each of the four sections were all very relevant” "I am quite happy that it is online because face to face would depend on location if I had the choice”Understanding the effects of symptoms on their own and combined"Now I know that I can sleep better when I manage my pain, and I can manage my pain by managing fatigue” "When you have a long-term illness, you don't look at the symptoms individually, you need to break it and look at it individually to know how to manage it”Implementing the knowledge gained from the programme"I'm in a different place today than I was four weeks ago. I am doing well now. So, for me the goal setting is excellent” "Helps you implement the knowledge into your regular routine and check in with yourself”Impact of the FAME-W on symptoms and work"Just a lightbulb moment to say, great, this is not my fault, because you can blame yourself for all the symptoms”ConclusionPreliminary results show that participants found the online FAME-W to be effective, relevant, reassuring, and helpful. These results suggest that work-related self-management skills are essential in assisting participants with symptom management in the workplace. Furthermore, these preliminary results suggest that the online format of FAME-W may be helpful for individuals with inflammatory arthritis to stay in work and it may become a standard part of clinical care for occupational therapists.References[1] McCormack, RC, O'Shea, F, Doran, M, Connolly, D. Impact of a fatigue management in work programme on meeting work demands of individuals with rheumatic diseases: A pilot study. Musculoskeletal Care. 2018;16: 398– 404.[2] Braun, V., & Clarke, V. (2021). Thematic analysis: A practical guide. SAGE.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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What this paper adds: * This case study demonstrated that facilitating ongoing education opportunities that draw on the expertise of local palliative care champions or internal specialists can enhance care provision. * Nurse care managers believe the value of generalist services, particularly home care services, in the generalist-specialist palliative care partnership, needs to be understood and respected. * Tailored investment in home care to provide a general palliative approach would be beneficial given the unique challenges of this mobile workforce. Keywords: Palliative care;home care services;Education, Nursing;qualitative research;Nurse Practitioner BACKGROUND Palliative care focuses on improving the quality of life of people affected by life-threatening illnesses, including the prevention and relief of suffering through identification, assessment and treatment.1 This care extends to family members, and encompasses physical, psychological, social and spiritual support. Home nursing and care organisations are key providers of community-based palliative care, with staff often the linchpin, in supporting palliative clients, organising and providing care, coordinating the input of other professionals and of specialist equipment.5 Previous research has identified the difficulties faced by home care nurses in meeting their clients' palliative care needs, such as symptom management and communication, as well as requirements for further training to enhance their knowledge and confidence of caring for palliative clients.5-7 In this context, generalist palliative care is delivered by health and care professionals with broad clinical responsibilities who provide primary, ongoing care;and have established relationships with the person and their care community.2 This is distinct from specialist palliative care services which support complex needs through multidisciplinary teams with specialised palliative care training. FINDINGS AND DISCUSSION Thematic analysis identified the following overarching themes: 1) targeted education increased staff knowledge and confidence, but more is needed;2) collaborative teamwork with effective communication and information sharing underpins a successful generalist-specialist partnership;3) the home care setting is unique and requires accessible systems and processes.
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Background: Post-COVID-19 syndrome is a new and debilitating disease without adequate treatment options. eHealth could be a reasonable approach for symptom management. Objectives: This study aims to evaluate the acceptance for eHealth interventions for symptom management in individuals with post-COVID-19 syndrome, as well as drivers and barriers influencing acceptance. Design: Cross-sectional study. Methods: This study was conducted from January 19 until 24 May 2022. Recruitment took place with a web-based survey. Acceptance and predictors of eHealth interventions were measured by the extended UTAUT model. Included in the model were the core predictor performance expectancy, social influence, and effort expectancy. Previously diagnosed mental illness was estimated and mental health by using the well-established Generalized Anxiety Disorder Scale-7 and the Patient Health Questionnaire Depression Scale. The effect of sociodemographic and medical data was assessed. Multiple hierarchical regression analyses as well as group comparisons were performed. Results: 342 individuals with post-COVID-19 syndrome were examined. The acceptance of eHealth interventions for symptom management was moderate to high (M = 3.60, SD = 0.89). Acceptance was significantly higher in individuals with lower/other education, patients with moderate to severe symptoms during initial COVID-19 infection, still significantly impaired patients, and individuals with a mental illness. Identified predictors of acceptance were age (ß = .24, p < .001), current condition including moderate (ß = .49, p = .002) and still significantly impaired (ß = .67, p < .001), digital confidence (ß = .19, p < .001), effort expectancy (ß = .26, p < .001), performance expectancy (ß = .33, p < .001), and social influence (ß = .26, p < .001). Conclusion: Patients with post-COVID-19 syndrome reported a satisfying level of acceptance and drivers and barriers could be identified. These factors need to be considered for the implementation and future use of eHealth interventions.
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BACKGROUND: The anticipatory prescribing of injectable medications is recommended practice in controlling distressing symptoms in the last days of life. A 2017 systematic review found practice and guidance was based on inadequate evidence. Since then, there has been considerable additional research, warranting a new review. AIM: To review the evidence published since 2017 concerning anticipatory prescribing of injectable medications for adults at the end-of-life in the community, to inform practice and guidance. DESIGN: Systematic review and narrative synthesis. METHODS: Nine literature databases were searched from May 2017 to March 2022, alongside reference, citation and journal hand-searches. Gough's Weight of Evidence framework was used to appraise included studies. RESULTS: Twenty-eight papers were included in the synthesis. Evidence published since 2017 shows that standardised prescribing of four medications for anticipated symptoms is commonplace in the UK; evidence of practices in other countries is limited. There is limited data on how often medications are administered in the community. Prescriptions are 'accepted' by family caregivers despite inadequate explanations and they generally appreciate having access to medications. Robust evidence of the clinical and cost-effectiveness of anticipatory prescribing remains absent. CONCLUSION: The evidence underpinning anticipatory prescribing practice and policy remains based primarily on healthcare professionals' perceptions that the intervention is reassuring, provides effective, timely symptom relief in the community and prevents crisis hospital admissions. There is still inadequate evidence regarding optimal medications and dose ranges, and the effectiveness of these prescriptions. Patient and family caregiver experiences of anticipatory prescriptions warrant urgent investigation. PROSPERO REGISTRATION: CRD42016052108.
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AimRespiratory failure remains the most common cause of death in Cystic Fibrosis (CF) with chronic/complex infection a significant contributory factor. Infection frequency and associated treatment burden increase the risk drug-resistant organisms;however, stewardship strategies are challenging to translate to CF care.The CFTR modulator Kaftrio® (elexacaftor/tezacaftor/ivacaftor) launched in the UK in August 2020. Initial phase 3 clinical trials1 2 and a subsequent open-label extension study3 demonstrated promising data on health-related quality of life, including reduced pulmonary exacerbation (PEx) rates (63%), hospitalisation (71%) and PEx requiring IV antibiotics (78%). This evaluation aimed to provide a ‘real-world' review of the impact of Kaftrio® on IV antibiotic burden (admission rates, ‘bed-days', bed-day cost, total IV antibiotic use and ‘AWaRE' antibiotic use) in CF patients aged 12–16 years at a single tertiary centre.MethodA single-centre retrospective observational evaluation was conducted. All 12–16 year olds on Kaftrio® were identified using the local CF database. For each patient: month/year Kaftrio® commenced and prior CFTR modulator therapy were determined. Clinical trial patients were excluded. Digital clinical information systems were used to identify ‘chest-related' admissions for IV antibiotics in the 24 months prior to starting Kaftrio® and the treatment period post, up to June 2022. For each admission, drugs, doses administered and ‘IV antibiotic bed-days' were determined. ‘Bed-day' costs were calculated and use of ‘Restricted' or ‘Watch' antibiotics (WHO AWaRE/local Policy) were identified. IV antibiotic burden pre- and post Kaftrio® was evaluated.Results44 admissions in 33 patients were identified prior to Kaftrio®, compared with 13 admissions post-Kaftrio®, demonstrating a 65–70% overall reduction in admissions (PEx: rate 66/100patient/year vs 23/100patient/year). Pre-Kaftrio® 639 ‘bed days'/24 months were directly attributed to delivery of IV antibiotics-a total estimated cost of £383,400 (estimate £600/day/medical bed). From October 2020-June 2022, the number of IV antibiotic ‘bed days' fell to 183. A total reduction of 71%, with an estimated cost saving of £273,600. In the 24 months prior to Kaftrio® a total 2849 doses of IV antibiotics were administered vs 657 doses in the same patient cohort in the period post-Kaftrio® to June 2022, an absolute reduction of 2192 doses (77%). Of the 2849 IV antibiotics pre-Kaftrio® doses, 84% were restricted/watch antibiotics (R=706;W= 1681). Usage dropped by 37.5% and 89% respectively post-Kaftrio®.ConclusionResults suggest Kaftrio® reduces overall IV antibiotic burden in CF patients, providing real-word data supporting the phase 3 study outcomes. Significant reductions in PEx rates, IV antibiotic use, ‘bed days' and associated costs were all observed. Data demonstrated an absolute reduction in the use of ‘AWaRE' antibiotics, although use still accounts for a high overall proportion in this cohort. Results are limited by the data periods. Potential impact of the COVID-19 pandemic on PEx rates (‘shielding' population) should be considered. Nonetheless, the significance of these findings on overall outcomes and stewardship should not be downplayed. Ongoing review, including expanded patient populations (adults;6–11 years) is essential. Further works looking at oral antibiotics use, epidemiology, genotype and previous CFTR treatment would support extended evaluation of the overall impact of Kaftrio® on infection management in CF.ReferencesMiddleton PG, Mall MA, Drevineck P, et al. Elexacaftor-tezacaftor-ivacaftor for Cystic Fibrosis with a single Phe508del Allele. New England Journal of Medicine 2019;381:1809–1819.Southern K, Murphy J, Sinha I, et al. Corrector therapies (with or without potentiators) for people with cystic fibrosis with class II CFTR gene variants. Cochrane Database of Systematic Review 2020;12;1–313.Griese M, Costa, S, Linnemann R, et al. Safety and e ficacy of Elexacaftor/Tezacaftor/Ivacaftor for 24 weeks or longer in people with cystic fibrosis and one or more F598del Allele: Interim Results of an Open-Label Phase 3 Clinical Trial. American Journal of Respiratory and Critical Medicine 2021;203;381–384.
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BACKGROUND: The Internal Medicine Training (IMT) Programme is an evolution of Core Medical Training introduced in 2019. The IMT curriculum places an increased emphasis on palliative care; however, access to palliative care training is variable. Project ECHO (Extension of Community Healthcare Outcomes) develops communities of practice and is a valuable tool for medical education. We report on an evaluation of Project ECHO to deliver palliative medicine training across a geographically large deanery in the North of England. METHODS: The Project ECHO training programme involved multipoint video technology, telementoring, expert talks and case-based discussions over six sessions, and was fully mapped to the palliative care component of the IMT curriculum. We collected data particularly around attendance and self-reported confidence and knowledge. RESULTS: By creating a community of practice, we provided virtual placements and over 9 hours of virtual direct contact with palliative medicine consultants; and in total, 921 individual attendances occurred, with 62% attending all six sessions. The course was associated with an increase in self-reported confidence and high satisfaction. DISCUSSION: Project ECHO is an effective method of delivering teaching to trainees across a large geographical area. Course evaluation shows outstanding results in trainee satisfaction, confidence, knowledge, patient care, clinical skills and reduction in fear when managing death and dying.
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Education, Medical , Hospice and Palliative Care Nursing , Palliative Medicine , Humans , Palliative Care , CurriculumABSTRACT
OBJECTIVE: Following the outbreak of COVID-19, access to in-person oncology acupuncture service was temporarily disrupted at Dana-Farber Cancer Institute, a National Cancer Institute (NCI)-designated cancer center. During this period, a virtual acupuncturist-guided session of patient self-acupressure was implemented to provide continuity of supportive care for cancer patients. We provide preliminary findings on the feasibility and potential impact of remotely delivered acupressure on patient-reported symptom burden in cancer populations. METHODS: This is a retrospective chart review of cancer patients who received virtual acupressure service at a single academic cancer center from May 11 to December 31, 2020. Each telehealth session consisted of a one-on-one appointment between the patient and acupuncturist. A semi-standardized set of acupoints were used, including Yintang, ST36, GB20, PC6, and HT7 as well as Relaxation Point on the ear. At the start of each session, Edmonton Symptom Assessment System (ESAS) was used to collect patient-reported symptom burden. For patients with at least one follow-up within 14 days of the baseline visit, paired t-test was used to analyze changes in ESAS scores from baseline to first follow-up. RESULTS: A total of 102 virtual acupressure sessions were administered to 32 patients. Most patients were females (90.6%) and white (84.4%), and the mean age was 55.7 (range = 26-82; SD = 15.7). The most common cancer diagnosis was breast (53.1%), followed by pancreatic (12.5%) and lung (9.4%). Baseline ESAS Total, Physical, and Emotional scores were 21.5 (SD = 11.1), 12.4 (SD = 7.5), and 5.2 (SD = 3.8), respectively. Of 32 patients, 13 (41%) had a second acupressure session within 14 days. For these 13 patients, there was a statistically significant reduction in Total symptom burden (-4.9 ± 7.6; p = 0.04) and in Physical (-3.5 ± 5.4; p = 0.04) and Emotional (-1.2 ± 1.8; p = 0.03) subscales from baseline to follow-up. CONCLUSION: Virtual acupressure was associated with significant reduction in symptom burden among cancer patients from their baseline to follow-up visits. Larger scale randomized clinical studies are needed to confirm these findings and better understand the impact of virtual acupressure on symptom burden in cancer populations.
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Acupressure , Acupuncture Therapy , COVID-19 , Neoplasms , Female , Humans , Middle Aged , Male , Retrospective Studies , COVID-19/therapy , Neoplasms/therapyABSTRACT
purpose was to explore the symptoms and supportive care needs experienced by patients in remission after tisa-cel or liso-cel chimeric antigen receptor (CAR) T-cell therapy. Though CAR T-cell therapy is expanding in application to various types of cancers, little information is available about the patient symptom experience, symptom management, and supportive care needs, especially three months or more after therapy. This was a qualitative study. Participants were recruited from a comprehensive medical center if they met the following criteria: > 18 years of age, English-speaking, history of B-cell lymphoma, received tisa-cel or liso-cel between 3 months to one year, and currently in remission. Data collection utilized semi-structured telephone interviews that were audio-recorded and transcribed. Two independent coders used NVivo Software to code transcripts. Content analysis was used to analyze the interview data. Data analysis is ongoing. Ten patients who received tisa-cel (n=7) or liso-cel (n=3) for B-cell lymphoma participated in the study. The average time since infusion was 187.5 days, ranging from 113 to 261 days. Participant mean age was 64.5 years. Cytokine Release Syndrome (CRS) and Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS) toxicity grades were gathered from medical chart review: CRS grade 0 (n=3), CRS grade 1 (n=5), CRS grade 2 (n=i), CRS grade 3 (n=i), and ICANS grade 0 (n=io). The most commonly described symptoms included fatigue, weakness, joint pain, and memory-issues. Most participants reported they were self-sufficient in their activities of daily living. However, some participants expressed physical limitations and social isolation, due to compromised immune systems and concerns related to COVID -19. Participants described the perceived burden for their caregivers. Supportive care needs included cooking meals and grocery shopping. Though our study focused on patients in remission to avoid confounding with ongoing disease or treatment, patients still reported symptoms and side effects. Notably, some participants experience symptoms (e.g., neuropathy) from prior chemotherapy treatments. Participants expressed being unsure of whether ongoing symptoms were related to prior treatments or from the CAR T-cell therapy. Oncology nurses should continue to assess symptoms among adult CAR T-cell patients in remission and offer supportive care as needed. Future research may determine what patients are more at risk of developing long-term symptoms, to describe symptom trajectory, and develop targeted interventions to reduce symptom burden and meet supportive care needs.
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Physical activity (PA) promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially to reduce joint pain associated with adjuvant hormonal treatment. The purpose is to describe the adaptation process for an evidence-based exercise and education curriculum (i.e., Fit & Strong!) to support older BCS participating in the Using Exercise to Relieve Joint Pain and Improve Aromatase Inhibitor Adherence in Older Breast Cancer Survivors trial. We reviewed all educational materials with scientific/clinical experts to identify necessary content changes. Next, we conducted semistructured phone interviews with BCS to review all educational materials and conducted a real-time pretest for the trial. Overall, BCS found the adapted materials and experience acceptable (mean score of 9.2/10 for satisfaction). Content changes included simplifying exercise instructions, prioritizing content related to the trial goals, and updating photographs. Because of COVID, the pretest was conducted via Zoom. Our multistep adaptation process provided an acceptable intervention to meet the needs of older BCS. Lessons learned will be applied to the forthcoming pilot trial.
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BACKGROUND: At the start of the COVID-19 pandemic, unprecedented pressure was placed on health care services globally. An opportunity to alleviate this pressure was to introduce a digital health platform that provided COVID-19-related advice and helped individuals understand and manage their COVID-19 symptoms. Therefore, in July 2020, the Your COVID Recovery website was launched by the National Health Service of England with the aim of creating a practical tool that provides advice and support to individuals recovering from COVID-19. The website includes information on many of the key COVID-19 symptoms. To date, public use of the Your COVID Recovery website and user behavior remain unknown. However, this information is likely to afford insight into the impact of the website and most commonly experienced COVID-19 symptoms. OBJECTIVE: This study aimed to evaluate public use of the Your COVID Recovery website, a digital health platform that provides support to individuals recovering from COVID-19, and determine user behavior during its first year of operation. METHODS: Google Analytics software that was integrated into the Your COVID Recovery website was used to assess website use and user behavior between July 31, 2020, and July 31, 2021. Variables that were tracked included the number of users, user country of residence, traffic source, number of page views, number of session views, and mean session duration. User data were compared to COVID-19 case data downloaded from the UK government's website. RESULTS: During the study period, 2,062,394 users accessed the Your COVID Recovery website. The majority of users were located in the United Kingdom (1,265,061/2,062,394, 61.30%) and accessed the website via a search engine (1,443,057/2,062,394, 69.97%). The number of daily website users (n=15,298) peaked on January 18, 2021, during the second wave of COVID-19 in the United Kingdom. The most frequently visited pages after the home page were for the following COVID-19 symptoms: Cough (n=550,190, 12.17%), Fatigue (n=432,421, 9.56%), Musculoskeletal pain (n=406,859, 9.00%), Taste and smell (n=270,599, 5.98%), and Breathlessness (n=203,136, 4.49%). The average session duration was 1 minute 13 seconds. CONCLUSIONS: A large cohort of individuals actively sought help with their COVID-19 recovery from the website, championing the potential of this tool to target an unmet health care need. User behavior demonstrated that individuals were primarily seeking advice on how to relieve and manage COVID-19 symptoms, especially symptoms of cough, fatigue, and musculoskeletal pain. COVID-19 rehabilitation programs should use the results of this study to ensure that the program content meets the needs of the post-COVID-19 population.
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BackgroundThe COVID-19 pandemic placed heightened demand on statutory NHS services and to optimise timely patient care to our end-of-life patients, rapid changes to service delivery were required to work alongside our original Hospice at Home service (Etkind, Bone, Lovell, et al., 2020. J Pain Symptom Manage. 60: 31). There was a need for rapid flexibility and ongoing service development to drive forward this innovative practice/service change.AimTo ensure our palliative patients received a timely, flexible and responsive service in their homes, whilst supporting hospital discharges, preventing admissions, and reducing calls to 111/999.MethodFlexible deployment of the existing clinical team was used to operationalise the Roaming Service, whilst continuing to deliver our commissioned Hospice at Home model. The Roaming Service to deliver care 7 nights a week 9.30pm to 6.30am. A RGN and HCA travelling between patients in a donated vehicle, providing responsive care across the county for any referred patients at end-of-life requiring interventions including symptom management, personal care, patient/carer support, and verification of death.ResultsThe Roaming Service proved an effective model for our patients at end of life and significantly reduced the impact on statutory services.From 15/04/2020 to 11/05/2022:Over 1829 referrals have been received for the Roaming Service.The Roaming Service carried out 1951 patient visits.3197 symptom management interventions were performed, preventing the need for NHS attendance.5125 support calls were made or received in support of a patient.Individual patient may receive one or more visit.ConclusionDevelopment of the Roaming Service played an essential role in ensuring quality end-of-life care was maintained, whilst responding rapidly and flexibly in response to COVID-19 (Etkind, Bone, Lovell, et al., 2020). Evaluations of the service reveal that 92% of patients supported by the service remained and died at home. User and staff evaluations have been exceptionally positive and the joint model of care our service now provides has proved successful.
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BackgroundSince the COVID-19 pandemic, health and care services have been under unprecedented pressure. The need to keep hospital admissions for urgent and emergency cases has never been greater. The Winter Bed Pressure Project looked at the role of specialist palliative care interventions in the community, in reducing hospital admissions and readmissions for patients with a palliative diagnosis, with particular focus on nursing homes.Aim(s)The project aims to examine the education and support needs of nursing homes and to look at how specialist palliative care intervention may support patients to remain within their preferred place of care and death.MethodsBetween January 1st and March 31st 2022, 14 Nursing Home Managers were interviewed and 49 patient reviews took place. 390 urgent unscheduled home reviews were made by the community specialist palliative care team for symptom management. 53 patients were admitted to hospital and 33 patients to the hospice in-patient unit. 140 calls were made to the hospice out of hours’ advice line.ResultsPotentially avoidable admissions in the community include lack of advance care planning and ceilings of care, intravenous antibiotic administration, safeguarding concerns and carer breakdown.The project has highlighted significant delays in obtaining medication in nursing homes. Education was lacking in communication, syringe driver and symptom management.ConclusionsMedication delays are being addressed through collaboration with the Clinical Commissioning Group to look at improving processes and wider use of Independent Nurse Prescribers involved with nursing home patients. Education needs are being addressed by the local practice development teams. A quality improvement project is being planned to look at improving access to the out of hours’ advice-line and plans for nurse-led admission to the hospice are underway.
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Background and purpose:The COVID-19 pandemic has led to the introduction of alternative on-treatment and post-treatment radiographer-led review clinics in an attempt to protect patients, staff and the public. Pre-COVID, patient reviews were routinely undertaken face-to-face, led by therapeutic review radiographers with advanced practice qualifications and skills in radiotherapy symptom management, triage, referral and support services. During the COVID-19 pandemic, an alternative option has been to follow-up in the form of telephone reviews to reduce face-to-face exposure whilst continuing to manage patient radiotherapy treatment-related toxicities. The aim of the narrative review is to explore the subject of telephone reviews and how therapeutic review radiographers might need to adapt communication skills so that they can continue to effectively assess and manage radiotherapy patient treatment reactions remotely.Method and discussion:A narrative review was conducted using the SCOPUS database and 28 publications were included from 2013 to 2021. The review highlights a paucity of literature exploring specific telephone training for radiographers and other allied healthcare professionals. Experiences within medical and nursing programmes demonstrate that development and integration of training in this area is critical in preparing for patient interaction via telephone.Conclusion and implications for practice:Multiple teaching modalities including simulation are ideal for teaching telephone-specific skills and content, demonstrating improvement in student knowledge, competence and confidence. Less is known regarding whether this knowledge translates to an improved patient experience. Enhancements in education and training, guided by the Health and Care Professions Council, may be warranted to ensure that patients continue to receive the optimal quality of care in a world where remote reviews are likely to become commonplace. Patient-reported outcome measures might be utilized for future training evaluations to ensure that effective patient care is being maintained.
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BACKGROUND AND OBJECTIVE: Recent advances have led to cure or long-term disease control for patients with hematological malignancy (HM). Unfortunately, some of them still have poor prognoses and are often associated with significant symptom burden and poor quality of life for patients and families. These patients usually require supportive care including red blood cell and platelet transfusion, due to disease itself and the oncological treatment, apart from their symptom management. However, there is currently lack of the literatures review in these aspects. The objective of this review is to summarize practical supportive care recommendations for physicians or nurses practicing in palliative care (PC)/hematology-oncology unit, starting with core approaches in use of blood products for anemia and thrombocytopenia, management of tumor lysis syndrome, PC and oncology nursing care. METHODS: Evidence for this review was obtained from a search of the Cochrane database, PubMed, guidelines of European Society of Medical Oncology, British society of Hematology, American Society of Clinical Oncology, National Comprehensive Cancer Network and peer-reviewed journal articles. KEY CONTENT AND FINDINGS: For asymptomatic cancer patients who are anaemic, a threshold of haemoglobin level of 7 g/dL is considered to be safe and generally favored for blood transfusion. 'Single-unit' red cell transfusion is safer and at least as effective as 'double-unit' transfusion. Prophylactic platelet transfusion should be given to stable patients without bleeding and with platelet count less than 10×109/L. In febrile patients, the threshold is lifted to 20×109/L. There are also recommendations for the use of blood products during COVID-19 pandemic. In general, HM patients were more prone to painful infections when compared with solid cancer patients. Thus, antibiotics to treat underlying infections should be applied whenever possible and as required to control pain. CONCLUSIONS: This narrative review showed the recent literatures in the supportive care and symptom management of advanced HM patients. However, it is limited by some of the 'evidence-based' recommendations for interventions (including symptom management) based on early phase of HM populations rather than those receiving end-of-life care.
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COVID-19 , Hematologic Neoplasms , Neoplasms , Humans , Palliative Care , Quality of Life , Pandemics , COVID-19/therapy , Hematologic Neoplasms/drug therapyABSTRACT
During the COVID-19 pandemic, the care of critically ill and dying patients in isolation wards, intensive care units (ICUs), and regular wards was severely impaired. In order to support physicians in communicative and palliative care skills, an e-learning tool was developed as part of the joint project "Palliative Care in Pandemic Times" (PallPan). This study investigates the feasibility of this e-learning tool. Secondly, we aim to analyze changes in knowledge and attitude upon completion of the e-learning tool. A 38-item questionnaire-based evaluation study with assessment of global and specific outcomes including ICU and non-ICU physicians was performed. In total, 24 questionnaires were included in the anonymous analysis. Feasibility was confirmed by a very high rate of overall satisfaction (94% approval), with relevance reaching 99% approval. Overall, we detected high gains in knowledge and noticeably lower gains on the attitude plane, with the highest gain in naming reasons for incorporating palliative care. The lowest learning gain on the attitude plane was observed when the participants were confronted with their own mortality. This study shows that e-learning is a feasible tool for gaining knowledge and even changing the attitudes of physicians caring for critically ill and dying patients in a self-assessment evaluation.
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COVID-19 , Computer-Assisted Instruction , Physicians , Terminal Care , Attitude of Health Personnel , COVID-19/epidemiology , Critical Illness , Humans , Palliative Care , Pandemics , Surveys and QuestionnairesABSTRACT
The COVID-19 pandemic posed challenges to a community-based participatory research (CBPR) project for rural-dwelling adults with cancer in eastern North Carolina. This project trained Latino community leaders as palliative care lay advisors (PCLAs) to deliver information on cancer symptom management and advance care planning (ACP). Pandemic impacts were assessed using data from team meetings and fieldnotes, journal memos, online booster sessions, participant encounter forms and digital correspondence. Three key results were: 1) the disproportionate effects of COVID -19 on PCLAs and their communities;2) the need for a major study redesign that extended the recruitment region and changed the mode of intervention delivery;and 3) the adoption of new channels of communication. Online discussions and in-person meetings with PCLAs sustained engagement, resulting in a two-year, 73 percent retention rate, and addressed community concerns about COVID-19. Applied outcomes included the selection by the regional cancer center of a 2022 goal to improve cultural care for Latinos and the empowerment of PCLAs as community advocates. The challenges created by COVID-19 were met by the study team's ongoing commitment to CBPR principles, flexible adaptations to a changing environment, and strong relationships forged with community members and advocacy groups.
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OBJECTIVES: To describe multinational prescribing practices by palliative care services for symptom management in patients dying with COVID-19 and the perceived effectiveness of medicines. METHODS: We surveyed specialist palliative care services, contacted via relevant organisations between April and July 2020. Descriptive statistics for categorical variables were expressed as counts and percentages. Content analysis explored free text responses about symptom management in COVID-19. Medicines were classified using British National Formulary categories. Perceptions on effectiveness of medicines were grouped into five categories; effective, some, limited or unclear effectiveness, no effect. RESULTS: 458 services responded; 277 UK, 85 rest of Europe, 95 rest of the world, 1 missing country. 358 services had managed patients with confirmed or suspected COVID-19. 289 services had protocols for symptom management in COVID-19. Services tended to prescribe medicines for symptom control comparable to medicines used in people without COVID-19; mainly opioids and benzodiazepines for breathlessness, benzodiazepines and antipsychotics for agitation, opioids and cough linctus for cough, paracetamol and non-steroidal anti-inflammatory drugs for fever, and opioids and paracetamol for pain. Medicines were considered to be mostly effective but varied by patient's condition, route of administration and dose. CONCLUSIONS: Services were largely consistent in prescribing for symptom management in people dying with COVID-19. Medicines used prior to COVID-19 were mostly considered effective in controlling common symptoms.
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COVID-19 , Palliative Care , Humans , Acetaminophen , Cough , BenzodiazepinesABSTRACT
Iphsj-22-12747(R);Published: 09-Jun-2022, DOI: 10.36648/1791809X.16.S7.948 Introduction The disease caused by a B-coronavirus, an RNA virus, had its beginnings in 2019 in Wuhan - China where a series of cases of pneumonia caused by this agent were identified, currently six serotypes that produce diseases in humans are known., four of these are prevalent and cause typical cold symptoms, the remaining two are responsible for the appearance of severe acute respiratory syndrome SarsCoV and Middle East respiratory syndrome MERS-CoV;After nucleic acid sequencing of lower respiratory tract epithelial cells from 4 patients with confirmed pneumonia of unknown cause by real-time reverse transcription PCR at Beijing Hospital, a novel 2019-nCoV beta coronavirus was found, which was then was called SARS-CoV-2, also giving as a result that this new virus has information from the subgenus Sarbecovirus, of the Orthocoronavirinae family, which makes it different from SARS-CoV and MERS-CoV, however according to various reports it was identified that the genome of SARS-Co V-2, is between 75% and 80% identical to SARS-CoV and therefore its name, SARS-CoV-2 belongs to this genus of coronavirus and its genome consists of a single-stranded RNA 29 kb in length. The last protein is present inside the virion and is associated with the viral RNA, and the other 3 proteins are associated with the external structure of the virus, this disease causing the current pandemic of global importance is characterized by affinity to the respiratory system has characteristics important as the production of increased pro-inflammatory cytokines and a decrease in the response of T cells, which is directly related to inflammation and severe lung damage that occurs in patients infected with SarsCoV2, also highlighting the onset of given symptoms from 5 days, the incubation period of approximately 14 days and the high transmission capacity of the virus given by various mechanisms such as droplet transmission (given when the infected person coughs or sneezes and these droplets released by this mechanism are inhaled by the people nearby), by contact (when an individual has direct contact with contaminated surfaces). inhaled and then passes these through the eyes and mouth) and by aerosols (this occurs when the respiratory droplets of the infected are in contact with the environment in places with little ventilation or closed that when inhaled cause infection), in addition From this, manifestations and alterations have been found in the gastrointestinal area, since enterocytes with high expression of ACE II receptors have been found in this area, which is why fecal transmission is also described in a smaller proportion and less frequently (1). Some monoclonal antibodies are currently used to treat COVID-19, standing out in this group itolizumab and tocilizumab, the group's mechanism of action is based on the fact that monoclonal antibodies bind to target molecules, which can be surface membrane receptors, proteins associated with enzymatic systems or circulating proteins, which produces direct or indirect effects on tissue function, where virus neutralization occurs when a sufficient number of epitopes (antigenic determinant is the portion of a macromolecule that is recognized by the immune system, specifically the sequence to which antibodies bind, B cell receptors or T cell receptors.) on the surface of the virus are occupied by antibodies. Severe Acute Respiratory Syndrome;Viral pneumonia;Coronavirus infections;Antibodies;Cytokines;lymphocytes;Vaccines;COVID-19 treatment and or. [...]including all the documents that will deal with the use of anti-mononuclear antibodies as a therapy for Covid-19, the data found was between 16-28 records, thus using 22 articles for the preparation of this document.
ABSTRACT
BACKGROUND: Health systems need evidence about how best to deliver home-based palliative care (HBPC) to meet the growing needs of seriously ill patients. We hypothesised that a tech-supported model that aimed to promote timely inter-professional team coordination using video consultation with a remote physician while a nurse is in the patient's home would be non-inferior compared with a standard model that includes routine home visits by nurses and physicians. METHODS: We conducted a pragmatic, cluster randomised non-inferiority trial across 14 sites (HomePal Study). Registered nurses (n=111) were randomised to the two models so that approximately half of the patients with any serious illness admitted to HBPC and their caregivers were enrolled in each study arm. Process measures (video and home visits and satisfaction) were tracked. The primary outcomes for patients and caregivers were symptom burden and caregiving preparedness at 1-2 months. RESULTS: The study was stopped early after 12 months of enrolment (patients=3533; caregivers=463) due to a combination of low video visit uptake (31%), limited substitution of video for home visits, and the health system's decision to expand telehealth use in response to changes in telehealth payment policies, the latter of which was incompatible with the randomised design. Implementation barriers included persistent workforce shortages and inadequate systems that contributed to scheduling and coordination challenges and unreliable technology and connectivity. CONCLUSIONS: We encountered multiple challenges to feasibility, relevance and value of conducting large, multiyear pragmatic randomised trials with seriously ill patients in the real-world settings where care delivery, regulatory and payment policies are constantly shifting.