Evidence-based Clinical Practice Guidelines for Caregivers of Palliative Care Patients on the Prevention of Pressure Ulcer.

Objectives: Pressure ulcers are the most common condition among palliative care patients at home care facilities and impose a significant burden on patients, their relatives, and caregivers. Caregivers play a vital role in preventing pressure ulcers. When the caregivers are knowledgeable about preventing pressure ulcers, they will be able to avoid lots of discomfort for the patients. It will help the patient to achieve the best quality of life and spend the last days of life peacefully and comfortably with dignity. It is essential to develop evidence-based guidelines for caregivers of palliative care patients on pressure ulcer prevention, which may play a major role in preventing pressure ulcers. The primary objective is to implement evidence-based guidelines for caregivers of palliative care patients on pressure ulcer prevention.The secondary objective is to improve the knowledge and practice of caregivers and enable them to take measures to prevent pressure ulcer development among palliative care patients, thereby improving the quality of life of palliative care patients. Materials and Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a systematic review was conducted. The search was conducted using electronic databases Pub Med, CINHAL, Cochrane and EMBASE database. The studies selected were in the English language and with free full text. The studies were selected and assessed for quality using the Cochrane risk assessment tool. Clinical practice guidelines, systematic reviews, and randomized controlled trials conducted on pressure ulcer prevention in palliative care patients were selected for the review. Twenty Eight studies were found to be potentially relevant after screening the search results. Twelve studies were not found suitable. 5 RCTs did not meet the inclusion criteria. Finally, four systematic reviews, five RCTs, and two clinical practice guidelines were included in the study, and guidelines were prepared. Results: Based on the best available research evidence, clinical practice guidelines were developed on skin assessment, skin care, repositioning, mobilization, nutrition, and hydration to prevent pressure ulcers to guide caregivers of palliative care patients. Conclusion: The evidence-based nursing practice integrates the best research evidence with clinical expertise and patient values. Evidence-based nursing practice leads to a problem-solving approach which is existing or anticipated. This will contribute to choosing appropriate preventive strategies for maintaining patients' comfort, thereby improving the quality of life of palliative care patients. The guidelines were prepared through an extensive systematic review, RCT, and other guidelines followed in different settings and modified to suit the current setting.

Knowledge on Prevention of Pressure Ulcers Among Caregivers of Patients Receiving Home-based Palliative Care.

Objectives: Pressure Ulcer (PUs) remains one of the most crucial aspects of any home-based palliative care setting. The objective of this need assessment study was to assess caregivers' knowledge regarding the prevention of pressure ulcers (PUs) among home-based palliative care patients. Materials and Methods: Study design: This study was a quantitative cross-sectional survey. Setting: The study was conducted among caregivers of home-based palliative care patients residing in Olavanna Panchayath, Kozhikode. Population: Caregivers of home-based palliative care patients at risk of developing bedsores. Sample and sample size: Using the purposive sampling technique, the need assessment was conducted among 20 caregivers of home-based palliative care patients. Data were collected using a structured knowledge interview schedule. Data analysis: The obtained data were analyzed using descriptive statistics. Results: Knowledge assessment among care providers reveals that 10% had good knowledge, 40% had average knowledge, 50% had poor knowledge, and none had very good or very poor knowledge. Conclusion: Providing evidence-based clinical practice guidelines and structured teaching programs can improve the knowledge of caregivers. Measures to improve the availability of helping hands at home through volunteer training, ensuring the necessary equipment and regular supervision are crucial for contributing to patient comfort and safety, which will enhance the quality of life of palliative care patients.

Empowering Nurses to Meet Challenges and Lead Palliative Care for Achieving Triple Billion Targets.

Objectives: Nurses provide care to patients in all contexts and at all stages of their lives. Their contributions are crucial to meeting global goals like Universal Health Coverage (UHC) and the Sustainable Developmental Goals (SDG) which present challenges and opportunity to improve nursing services including rehabilitation and palliative care. This study identifies challenges for empowering nurses to lead palliative care and achieve triple billion targets'. Determine reasons for challenges to empower nurses. Recommends strategies to overcome challenges in order to empower nurses to lead palliative care and achieve triple billion targets'. Materials and methods: Multiple brainstorming sessions were conducted through the Zoom platform among the three authors to 'identify challenges for empowering nurses to lead palliative care and achieve triple billion targets' and recommend strategies to overcome those challenges. Narrative literature review was conducted and experts' opinions were elicited. Identified aspects were discussed in further brainstorming sessions. Result: Challenges and reasons for empowering nurses to lead palliative care and achieve triple billion targets' were identified and strategies to overcome those challenges were recommended. Conclusion: Equitable, competent and compassionate palliative care is a primary tool to relieve serious health-related suffering. There is a pressing necessity to provide available, accessible, acceptable, quality, and cost-effective palliative nursing care. WHO proposed the triple billion targets to improve the health of billions where palliative care is an essential element that can be achieved only with proper identification of challenges and meticulous planning and implementation of strategies to overcome those challenges.

Stress, Coping, and Lived Experiences among Caregivers of Cancer Patients on Palliative Care: A Mixed Method Research.

AIM: The aim of this study is to assess stress and coping among caregivers of cancer patients on palliative care and to acquire a deeper understanding of their lived experiences. MATERIALS AND METHODS: A mixed method study was conducted among caregivers of cancer patients on palliative care using mixed method approach and triangulation design. Data were gathered using self-administered stress rating scale, brief COPE inventory, and structured interview schedule. Nested sampling technique was adopted. The sample size for quantitative approach was eighty and qualitative approach was eight. RESULTS: The results showed that 74% of the participants were females and 30% of them belong to the age group between 51 and 60 years. Fifty-four percent of them belong to Hindu religion and 40% were unemployed. Sixty-two percent of the patients were dependent on caregivers for all activities of daily living. Assessment of stress revealed that 82% of the participants had moderate stress and 18% had severe stress. Participants adopted both negative and positive coping. There was a significant negative correlation (r = -0.722, P = 0.001) between stress and coping. Similar findings were also observed in the phenomenological approach. The theme evolved was "caring companionship to palliative care." CONCLUSION: Palliative caregiving is stressfull, challenging and can impact the caregiver's physical, emotional, psychological, and social well-being. Understanding lived experiences of caregivers of cancer patients on palliative care is important for the health professionals to improve the support, guidance, and education given to the caregivers of cancer patients on palliative care.

Fluorescein analogue xanthene-9-carboxylic acid: a transition-metal-free CO releasing molecule activated by green light.

6-Hydroxy-3-oxo-3H-xanthene-9-carboxylic acid is introduced as the first transition-metal-free carbon monoxide releasing molecule activated by visible light (photoCORM). This water-soluble fluorescein analogue releases carbon monoxide in both water and methanol upon irradiation at 500 nm. When selectively irradiated in the presence of hemoglobin (Hb) under physiological conditions, released CO is quantitatively trapped to form carboxyhemoglobin (COHb). The reaction progress can be accurately monitored by characteristic absorption and emission properties of the reactants and products.

Fluorescein analogues as photoremovable protecting groups absorbing at ∼520 nm.

A new photoremovable protecting group, (6-hydroxy-3-oxo-3H-xanthen-9-yl)methyl (1), with a molar absorption coefficient ε of ∼4 × 10(4) m(-1) cm(-1) at ∼520 nm for the release of carboxylates or phosphates is reported. Three derivatives of 1 (diethyl phosphate, acetate, and bromide) were isolated as complexes with DDQ and shown to release the ligands with quantum yields ≤2.4% in aqueous solution.

Photochemical synthesis of substituted indan-1-ones related to donepezil.

A photoenolization reaction is shown to be the key reaction step in the preparation of substituted indan-1-ones as convenient precursors for the synthesis of donepezil, a well-known acetylcholinesterase inhibitor. Model 2,5-dialkylphenacyl chlorides, differently substituted in the alpha-carbon position, were found to produce indan-1-ones upon irradiation in non-nucleophilic solvents in high chemical yields via hydrogen chloride release. While direct excitation of 4,5-dimethoxy-2-methylphenacyl chloride led to a complex mixture of photoproducts, photolysis of the corresponding benzoate was found to form 5,6-dimethoxyindan-1-one in 62-72% chemical yields and a relatively low quantum efficiency (Phi approximately 0.02). This compound can then be easily converted to donepezil by standard synthetic steps described in the literature. Isotopic exchange and quenching experiments revealed that the product is obtained by the photoenolization process via the triplet excited state, while minor side-photoproducts originate from the singlet excited state. Irradiation of the reactant in neat acetone, used both as a triplet sensitizer and solvent at the same time, was found to form 5,6-dimethoxyindan-1-one exclusively in high (90%) chemical yield.