Different Types Of Care Research Articles

The influence of care types on the development of orphans--An empirical study from China.

Care typess is considered the cornerstone of orphan's happiness and health. In 2022, China had more than 190,000 orphans in different types of care. The purpose of the study is to examine the relationship between care types and development of orphans in China. We conducted an empirical study using cross-sectional survey data related to orphans from LZ City, Sichuan Province, China, in 2020. The data sample consists of 320 valid samples of orphans and their families, including 166 boys and 154 girls. The study conducted multiple linear regression model to analyze the relationship between care types and other family variables and the development of orphans. The results indicate that compared with other care types, grandparent care has a significant positive impact on the overall development and psychological status of orphans, with this impact being moderated by the social participation of guardians. The higher the social participation of guardians, the greater the positive impact of grandparent care on the development of orphans. Further analysis, grouped by sex and age, revealed that the effects of care types on orphan development are influenced by the gender and age of orphans. Specifically, girls and younger orphans tend to exhibit better development in a grandparent care family. The research results of this study provide an empirical basis for the government to formulate policies, and for the government, society and family to jointly ensure the better development of orphans.

Application effect of psychological counseling intervention based on WeChat platform in chemotherapy of gastrointestinal tumors with completely implanted venous infusion ports.

This study's objective was to observe the application effect of psychological counseling intervention based on the WeChat platform for patients with gastrointestinal tumors undergoing chemotherapy with completely implanted venous infusion ports. From October 2022 to December 2023, 110 patients with gastrointestinal tumors undergoing chemotherapy with completely implanted venous infusion ports were selected from our hospital. Patients were divided into 2 groups according to the different types of care. The control group received routine psychological counseling intervention, while the WeChat group received psychological counseling intervention based on the WeChat platform in addition to the routine intervention provided to the control group. A comparison was made between the 2 groups in terms of adverse events, compliance, hope level scores, and changes in coping strategy scores. The WeChat group experienced 7 adverse events, with an occurrence rate of 12.73%, while the control group experienced 17 adverse events, with an occurrence rate of 30.91%. The occurrence rate of adverse events in the WeChat group was significantly lower than that in the control group, showing a statistically significant difference (P < .05). The hope level scores before intervention in the 2 groups were compared (P > .05). Compared to before intervention, both groups showed an increase in scores for life attitude, proactive behavior, intimate relationships, and total scores. The WeChat group had higher scores after intervention compared to the control group (P < .05). The coping strategy scores before intervention in the 2 groups were compared (P > .05). Compared to before intervention, both groups showed an increase in facing scores and a decrease in avoidance and resignation scores (P < .05). After intervention, the WeChat group had higher facing scores and lower avoidance and resignation scores compared to the control group (P < .05). The overall chemotherapy compliance in the WeChat group was higher than that in the control group (P < .05). Psychological counseling intervention based on the WeChat platform can improve the level of hope, promote patients to face the disease with a positive attitude, increase chemotherapy compliance, and reduce the occurrence of adverse events in patients with gastrointestinal tumors undergoing chemotherapy with completely implanted venous infusion ports.

Access to healthcare services during the COVID-19 pandemic: a cross-sectional analysis of income and user-access across 16 economically diverse countries

BackgroundNational health systems have different strengths and resilience levels. During the COVID-19 pandemic, resources often had to be reallocated and this impacted the availability of healthcare services in many countries. To date there have been few quantitative contemporary studies of inequalities in access to healthcare within and between countries.In this study, we aim to compare inequality within and between 16 economically diverse countries.MethodsOnline surveys were conducted on 22 150 adults in 16 countries across six continents in 2022. Quota sampling and post-stratification weighting was used to obtain an age, gender, geographically, and educationally representative sample. The study assesses the differences in challenges in access to healthcare during the pandemic (for GP, surgical/clinical and digital GP services) using country-specific expanded health-needs-adjusted Erreygers’ concentration indices and compares these values between countries using a Spearman’s rank correlation coefficient.ResultsResults show wide variation in income-related challenges in access within countries for different types of care. For example, Erreygers’ concentration index for digital services in Colombia exhibited highly regressive inequality at 0·17, compared to Japan with an index of -0·15. Inequalities between countries were also evident, with Spearman rank coefficients of -0·69 and -0·65 (p-values of 0·003 and 0·006) for digital and surgical access, indicating that lower income countries had greater inequality in healthcare access challenges.ConclusionDuring the pandemic, inequalities in challenges to accessing healthcare were greatest in low and middle-income countries. Digital technologies offer a reasonable means to address some of this inequality if adequate support is provided and accessible digital infrastructure exists.

Assessment of care provision integration in a community-based mental health system: balanced care model implementation in Andalusia (Spain)

BackgroundAndalusia is the second largest region in Spain, and it has developed a comprehensive mental health (MH) plan that encourages the consolidation of the balanced care model. However, its geographical and socioeconomic disparity is a great challenge for a community-based MH system. Both the assessment of the implementation of the MH plan and the development of new tools to support decision-making can be considered critical.ObjectivesThe present study aims (i) to assess how the integration of different types of MH care may influence system performance and (ii) to check the performance evolution of the integration process geographically regarding the small MH areas of Andalusia.MethodsThe performance of the Andalusian MH system was assessed by combining Monte Carlo simulation, fuzzy inference and data envelopment analysis. The relative technical efficiency was the main performance indicator.ResultsA correct integration of appropriate types of MH care, according to population needs, increases the performance of the Andalusian MH system both from global and regional perspectives. The spatial representation (based on small MH areas) of the results highlights how the performance depends on specific geographical characteristics. By analyzing the identified spatial clusters, defined by different management patterns depending on user and socioeconomic characteristics, benchmark areas and areas for improvement can be studied to design evidence-informed policies and interventions.ConclusionsA global analysis of MH system performance was carried out, including both the successive integration of different types of care and its spatial evolution. Although an appropriate integration of different types of MH care has a positive effect on the Andalusian MH system, this process has different profiles depending on specific geographically based user and socioeconomic characteristics. The balanced care model can be considered the paradigm for assessing the performance of a large and populated territory such as Andalusia, which has a community-based MH system. This methodological approach (performance assessment and spatial analysis) may be used as a guide for developing future evidence-informed policies and managerial interventions.

Describing the status quo of person-centred dementia care in different types of care units in German nursing homes: A convergent mixed methods study

BackgroundThe policies and mission statements of nursing homes support the implementation of person-centred dementia care. The Dementia Policy Questionnaire assesses the content of person-centred dementia care in policies. To date, it is unknown whether these policies exist exclusively in dementia care units and whether the policies are consistent with the mission statements of nursing homes. ObjectiveWe aimed to (1) investigate nursing home care unit types regarding the existence of policies measured by the Dementia Policy Questionnaire, (2) explore whether these policies are addressed in the mission statements of the nursing homes, and (3) integrate both results. DesignThis is a convergent mixed methods study performed with a quantitative and qualitative dataset that was collected in the BeStaDem survey (2020). SettingThe BeStaDem survey included licensed nursing homes in Germany. ParticipantsA total of 134 nursing home administrators provided informed consent to participate in the BeStaDem survey. MethodsFor quantitative data, we performed Fisher's exact test to identify differences in the Dementia Policy Questionnaire item distribution of several types of care units (aim 1). To support the results of Fisher's exact test, we additionally applied logistic regression analysis. For qualitative data, we analyzed the mission statements deductively with the qualitative content analysis method (aim 2). For integration, we used a convergent triangulation approach (aim 3). ResultsThe quantitative data collected from 134 German nursing homes show significant associations among person-centred dementia care policies, such as behavior assessment, and nursing homes with dementia care units. Regarding the qualitative data, of the 60 mission statements in total, eight mission statements of nursing homes with dementia care units exclusively address aspects such as dementia-specific interventions. The convergent triangulation approach shows that the answers given by the nursing homes in the quantitative survey are not always consistent with what they address in their mission statements. ConclusionsNursing homes with dementia care units provide more person-centred dementia care policies than other care unit types do but mostly do not address these aspects in their mission statements. The implementation of person-centredness benefits from the existence of policies and mission statements if nursing homes clearly address what is meant by person-centred dementia care in their nursing home.

Association of patient-reported experience of care with cancer clinical trial participation.

11117 Background: Few individuals diagnosed with cancer participate in clinical trials. Patient-reported experience of care (PEC), assessing patients’ perspectives on interactions with healthcare providers and systems, is important in evaluating quality of care. To help identify patient-centered strategies that may enhance trial enrollment, we examined whether PEC may predict enrollment in clinical trials. Methods: This study utilized Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) linked data, including SEER registry data, CAHPS PEC surveys, and Medicare claims. Individuals in SEER-CAHPS who were diagnosed with lung cancer 2000-2018 and completed a CAHPS survey ≥6 months following diagnosis were included. The study outcome, clinical trial enrollment after cancer diagnosis, was determined using Medicare claims; among individuals who enrolled in clinical trials, only those completing a CAHPS survey before trial enrollment were included. PEC was assessed using 5 global ratings (Overall Care, Personal Doctor, Specialist, Health Plan, and Prescription Drug Plan) and 6 composite measures (Doctor Communications, Getting Needed Care, Getting Care Quickly, Getting Needed Drugs, Care Coordination, and Customer Service); all were scored 0 (worse PEC) to 10 (best PEC). Associations of trial participation and PEC were assessed using multivariable logistic regression, controlling for age, race/ethnicity, dual Medicaid status, fee-for-service vs Medicare Advantage plan at diagnosis, and physical problems limiting activities, and were weighted to correspond to the overall SEER population. Results: The study included 5,361 individuals diagnosed with lung cancer; 4.8% of the weighted population enrolled in a clinical trial. Patients with higher PEC ratings for their Specialist (odds ratio [OR] for a 1-point higher PEC score 0.86, 95% CI 0.76, 0.98); for their Health Plan (OR 0.87, 95% CI 0.80, 0.96); and for Getting Needed Care (OR 0.89, 95% CI 0.81, 0.98) had significantly (p&lt;0.05) lower oddsof having enrolled in a clinical trial. Among individuals without physical limitations, association of PEC and trial enrollment were similar. Among individuals with physical limitations, higher PEC ratings for Getting Care Quickly were associated with higher odds (OR 1.20, 95% CI 1.03, 1.39) of having enrolled in a trial. Conclusions: In this population, reporting worse PEC in certain domains was significantly associated with increased clinical trial enrollment. This suggests patients less happy with their clinical care may be more likely to enroll in trials, perhaps to receive different types of care and/or from different providers. PEC associations with trial enrollment differ between patients with vs without physical limitations, suggesting different strategies may be effective for increasing trial enrollment among these two sub-groups.

Use of antimicrobials and other medical products in an ethnic minority context of South-Central Vietnam: A qualitative study of vulnerability.

Despite the global threat of antimicrobial resistance (AMR), evidence on the use and quality of medicines at community level is limited, particularly in impoverished, rural areas where prevalence of (bacterial) infections is high. To better understand the processes that drive vulnerability to AMR' effects, this study aimed to assess social factors underpinning access to-and use of-medical products and healthcare, among people from the Raglai ethnic minority in Ninh Thuan Province, Vietnam. We conducted ethnographic research in eight villages in 2018-2019, using interviewing and participant observation methods for data collection. Different types of informants (including community members and healthcare providers) were selected using purposive sampling strategies and analysis was retroductive. Our findings show that, despite the existence of a government-funded health insurance scheme, Raglai people's flexible therapeutic itineraries did not systematically start with formal healthcare. Different types of care (private/informal, public, shamanic) were combined in parallel or in alternation, determined by distance to the provider, cost, workload, perceived diagnostic capacity, perceived severity and aetiology of the illness, and trust in the provider. Available medicines were often tablets dispensed in plastic bags containing labelled tablets, unlabelled tablets (in bulk) or tablets ground to powder. Treatment was often considered effective when it relieved symptoms, which led to abandonment of the treatment course. When symptoms did not speedily abate, the illness aetiology would be reinterpreted, and "stronger" medicines would be sought. The precarious socio-economic status of some Raglai drove them in cycles of severe poverty when additional unforeseen factors such as illness, animal disease or loss of crops arose, hampering access to (in)formal healthcare providers and/or appropriate diagnosis and treatment. We conclude that Raglai communities are structurally unable to buffer themselves against the threat and consequences of AMR. Despite this vulnerability, they are among the least targeted by efforts to optimize antibiotic use, which are concentrated in secondary and tertiary healthcare facilities targeted at urban populations.

ELISA assay for the quantification of ipilimumab in human serum, plasma, milk, and cerebrospinal fluid

Ipilimumab is an immune checkpoint inhibitor of the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). Ipilimumab has become part of the standard of care for different types of cancer. The efficacy of these treatments is limited due to immune-related toxicity and high economic costs. Dose rationalization studies based on pharmacokinetic data may help to address these limitations. For this purpose, more sensitive analytical methods are needed. We report the development and validation of the first enzyme-linked immunosorbent assay (ELISA) for sensitive determination of ipilimumab concentrations in human serum, plasma, cerebrospinal fluid (CSF), and milk. Our assay is based on the specific capture of ipilimumab by immobilized CTLA-4. The lower limit of quantifications of ipilimumab in serum, plasma, and milk are 50 ng/mL and 10 ng/mL in CSF. The ELISA method showed long-term storage stability for at least one year at −80°C and was successfully cross-validated with ultraperformance liquid chromatography coupled with tandem mass spectrometry. The ELISA method is reliable, relatively inexpensive, and can be used in serum, plasma, CSF, and milk from patients treated with ipilimumab, as evidenced by the analysis of real clinical samples.

Unconditional Care Beyond the Carceral Education State: A Call for Abolitionist Departure

This paper wrestles with the concept of care and its role in the movement towards abolitionist education. I draw from my experiences as a teacher / ethnographer in an alternative high school, called FREE LA, that serves and was created by system-impacted young people who have been pushed out of or barred from, or otherwise refused to participate in, traditional schooling. Grounded in students’ perceptions of how this space departs from traditional schools and other carceral institutions, I grapple with their consistent emphasis on care. Students’ juxtaposition between the type of care they experienced in traditional schools, and a different type of care experienced at FREE LA, leads me to consider both the violent genealogies of conditional care as endemic to state schooling, and the potential for reclaiming old-new genealogies of unconditional care that map radically reimagined educational space(s). The juxtaposition between these two types of care opens broader questions about the limitations of educational reform and the possibilities for abolitionist departure.

Comorbidity costs for the healthcare of mental patients

IntroductionMost patients with mental disorders exhibit multiple comorbidities. Without doubt the presence of multiple co-occurring somatic and mental disorders is associated with a higher insurance spending for the psychiatric patients. The details of this association need to be elucidated.ObjectivesThe aim of current study was 1) to delineate the typical nonmental comorbidities that occur among mental patients, and 2) to investigate social health insurance spending on comorbidities compared to the direct mental care costs of the same population. The analysis offers unique insight into the health care spending, since it focuses not only the costs of psychiatric care but reflects the whole range of treatments delivered to this group.MethodsA database with the claim records of the Hungarian NHIF was created including direct healthcare costs for mental diagnosis. Patients were recorded either in primary or in specialist care with at least one mental health diagnosis in the last pre-pandemic year (2019). Adopting a case-control design, spending and comorbidities were compared to the control group, which comprised patients who did not have any mental diagnosis. Cases and controls were matched on demographic characteristics like age, gender, place of residence with deprivation index and marital status..ResultsMental problems affected in 2019 more than 1,5 million persons in Hungary. Half of them did not access specialist care but were only seen with the mental diagnosis by a GP. Direct insurance spending for mental care is around 156 million EUR/year with 4% of the total direct health spending. Besides these costs another 665 million EUR (+17% of all health spending) were reimbursed for the same patient group for the treatment of other diseases. With regards to affected patient numbers, the three most important comorbidities were cardio-vascular conditions (34% of mental patients with 14% of all spending of the group); diseases of the digestive system (29% vs 14%); and musco-sceletal conditions (28% / 9% ) In terms of spending three other disease groups also have to be considered as of high significance: carcinomas (4% patients vs 13% of spending); neurological disorders (13% /vs 7%); and diseases of the endocrine, nutritional and metabolic system (24% vs 6%).ConclusionsThe analysis aims to raise awareness for the complex issues of comorbidities of mental patients. We see that this patient group suffers heavily from other conditions the costs of which is much higher than the direct mental care costs. A better understanding of the coexistence of somatic and mental disorders and a holistic approach of treatment (care integration, reimbursement across different types of care, etc.) would be desirable.Disclosure of InterestNone Declared

Health care Utilization and Expenditures in Health Professional Shortage Areas.

Healthcare provider shortages are associated with adverse health outcomes, presumably stemming from the lack of access to primary care. This study examines the impact of Health Professional Shortage Areas (HPSAs) on healthcare utilization and spending across different types of care. Using the Medical Expenditure Panel Survey from 2002 to 2019, this study estimates the difference in healthcare utilization in HPSAs compared with non-HPSAs using a generalized random forest, which allows for more complex modeling of the outcome and a principled examination of heterogenous treatment effects. The results indicate HPSAs are associated with a 5% reduction in medical office visits, but no reduction in hospital-based care. These effects are concentrated in older persons living in urban areas, Black persons, and Medicaid beneficiaries. No statistically significant effects on annual spending were observed. These results offer insight into potential areas for further policy efforts aimed at reducing provider shortages.

Nurse-led care versus neurologist-led care for long-term outcomes of patients who underwent craniotomy in traumatic brain injuries: an efficacy analysis.

After craniotomy, patients require rehabilitation efforts for the recovery process, and neurologists are mostly engaged for that (in the management of post-craniotomy complications). However, neurologists are not always available for care after neurosurgery during follow-up (situation of our institute). The objectives of the study were to compare the effects of two different types of care (nurse-led and neurologist-led) on various long-term outcomes in patients who have undergone craniotomy due to traumatic brain injuries. Electronic medical records of patients (aged ≥18 years) who underwent craniotomy for traumatic brain injuries and their caregivers were extracted and retrospectively reviewed. Patients received nurse-led care (NL cohort, n = 109) or neurologist-led care (GL cohort, n = 121) for 6 months after craniotomy. Before the nurse-or neurologist-led care (BC), all patients had activities of daily living (ADL) ≤ 11, ≤ 50 quality of life (QoL), and 69% of patients had definitive anxiety, 87% of patients had definitive depression, and all caregivers had Zarit Burden interview scores ≥50. Nurse-led post-surgical care was associated with improved ADL and QoL, relieved anxiety and depression of patients, relieved the burden on caregivers, and the higher overall satisfaction of patients and their caregivers after 6-months of care (AC) as compared to their BC condition (p < 0.05) and also compared to those of patients in the GL cohort under AC condition (p < 0.01). Patients in the GL cohort reported pressure sores (p = 0.0211) and dizziness [15 (12%) vs. 5 (5%)] after craniotomy during follow-up than those in the NL cohort. ADL, QoL, and psychological conditions of patients who undergo craniotomy for traumatic brain injuries must be improved and the burdens of their caregivers must be relived. Not only is the care provided by nursing staff equivalent to that offered by neurologists, but in some aspects, it is superior for patients who have undergone craniotomy for traumatic brain injuries and their caregivers during follow-up.

Health Problems and Illnesses: Overwhelming on Living Conditions of Elderly Individuals

The main objective of this research paper is to acquire an efficient understanding of various types of health problems and how they are overwhelming on living conditions of elderly individuals. The senior citizens are overwhelmed by different types of health problems and illnesses. These are experienced in a major or minor form. The senior citizens are required to be well-versed in terms of different types of methodologies and procedures, which would be facilitating in treating various types of health problems and illnesses. Within rural communities, the health care and medical facilities are not in a well-developed state, whereas, in urban communities, these are in a well-developed state. The senior citizens, migrate to urban communities in order to get their health problems and illnesses treated. As a consequence of promoting good health and well-being, the individuals in old age will render an important contribution in bringing about improvements in their overall quality of lives. The senior citizens in some cases are not ambulatory and are required to depend upon other individuals in order to take care of their needs and requirements. Hence, they are required to form cordial and amiable terms and relationships with other individuals, including family and community members. Hence, it is of utmost significance to take care of different types of health problems and illnesses. Therefore, it is understood on a comprehensive basis that health problems and illnesses are overwhelming on living conditions of elderly individuals. The main concepts that are taken into account in this research paper are, health problems and illnesses are overwhelming in old age, health issues in geriatrics, health issues among senior citizens and measures to be implemented in promoting good health and well-being.

CONTACT: AN ONLINE COACHING TOOL TO EMPOWER CARE PARTNERS TO FACILITATE CONVERSATIONS IN NURSING HOMES

Abstract In the post COVID-19 context, nursing homes struggle with staffing. The role of care partners (CPs; relative, friend) has never been more crucial, including the need to advocate for persons living with dementia (PLWD) and being an integral part of the care team. The online CONversaTion cAre Coaching Tool (CONTACT) empowers CPs of PLWD prepare for conversations that may include communicating what matters to the PLWD, need for a different type of care, or treatment decisions. We engaged CPs to complete and provide feedback on CONTACT, which includes four sections: 1) education about nursing homes to clarify key terms/processes 2) guidance on goal setting to identify what is important; 3) creation of action plan to achieve the goal; and 4) reflection on the impact of achieving the goal. CPs (n=8) completed a survey about using the tool (acceptability (4 items), appropriateness (4 items), feasibility (4 items); scale of 1=strongly disagree to 5=strongly agree), and participated in a focus group to discuss the tool’s content and function. CPs favorably rated the tool. Mean ratings for acceptability ranged from 4.13 – 4.25, appropriateness 3.88 – 4.43, and feasibility 4.13 – 4.57. CPs reported that the tool was clear, simple, logically organized, informative, and it provided direction for starting a conversation. They liked the definitions of terms, large response buttons and that instructions were provided via video and in writing. Recommendations included additional videos depicting conversation prompts and scenarios, and utilizing community-based programs such as the Ombudsman office to disseminate CONTACT.

How do we increase interest in working with people with dementia? Career preferences of undergraduate healthcare professionals in dementia

Background:With population ageing, an emergent issue in workforce planning is how to ensure that future healthcare professionals are both competent and willing to work with older adults with complex needs. This includes dementia care; which is widely recognised as a policy and practice priority. Yet research suggests that working with older people is unattractive to undergraduate healthcare students. However, how students view a career working with people with dementia is not well understood, in either related specialities (such as geriatrics or old age mental health) or as a general clinical interest.Objective and Methods:This sequential mixed methods study aimed to identify the factors that contribute to preferences for working with people with dementia. A summary of three papers will be presented: 1)Preferences of nursing and medical students for working with older adults and people with dementia: a systematic review.2)Preferences of newly qualified healthcare professionals for working with people with dementia: a qualitative study (n=27).3)Student nurses' career preferences for working with people with dementia: A longitudinal cohort study (n=840).Results and conclusions:The findings from these studies have contributed to the development of a conceptual framework for understanding career preferences for working with people with dementia in students and newly qualified nurses. key factors related to dementia preferences include: Student characteristics (e.g. gender, attitudes and knowledge) and whether students perceive their attributes are aligned with dementia care;Impact of experiences including dementia educational programmes;Importance of making a difference to patients’ lives;Perception of working with people with dementia as a ‘different type of care’;Perceptions of people with dementia including care challenges;Career characteristics.The findings will be discussed in relation to implications for education and policy for how preferences for working with people with dementia may be developed in line with workforce needs.

Commercial Payments for COVID-19–Associated Inpatient Stays in 2020

This cross-sectional study reports the allowed reimbursement amounts for inpatient COVID-19 care for different types of hospitals.

Does False Lumen Thrombosis Lead to Better Outcomes in Patients with Aortic Dissection: A Meta-Analysis and Systematic Review.

For a long time, the association of the false lumen status and the outcomes of patients suffering from aortic dissection has been unclear, so this review article aims to study whether the unobstructed of the false lumen is related to the outcome of patients suffering from aortic dissection. We performed this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta Analyzes Protocols (PRISMA) statement 2009 and registered with PROSPERO (CRD42022381869). We searched PubMed, the Cochrane library, Web of Science and Embase to collect potential studies. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. The main outcome is long-term survival. Data included in the study were summarized using the risk ratio or mean difference and 95% confidence interval. There were 16 trials, 2829 patients in total, with a mean age of 62.1 years. Compared with completely thrombosed false lumen, patent group has better long-term survival (risk ratio (RR), 0.88; 95% CI, 0.79 to 0.97; p = 0.01; I2 = 58%) and smaller yearly aortic growth rate (mean difference (MD), 1.03; 95% CI, 0.23 to 1.82; p = 0.01; I2 = 98%). In addition, patients with a patent false lumen had a lower risk of aortic event (RR, 0.81; 95% CI, 0.68 to 0.97; p = 0.02; I2 = 37%), but higher risk of aortic rupture (RR, 7.02; 95% CI, 2.55 to 19.3; p = 0.0002; I2 = 0) and hospital death (RR, 2.72; 95% CI, 1.45 to 5.08; p = 0.002; I2 = 0). Completely thrombosed of the false lumen is more beneficial to the long-term survival of patients with aortic dissection. And the risk of aortic rupture and hospital death in patients with patent false lumen is 7 times and 3 times that of patients with complete thrombosed false lumen. It is expected to provide individualized medical care for different types of patients according to different false lumen status to minimize death and related complications.

End-of-life Decision-making Differs Between a Cancer and a Dementia Patient: Influences of the Physician's Background Factors.

Appropriate decision-making is essential for end-of-life (EOL) care without futile therapies. However, these decisions might vary in cases of cancer and other advanced diseases according to physicians' experience, education, and values. This study aimed to compare the decisions in EOL care of advanced cancer and dementia and the factors that influence them in medical students, general practitioners (GPs), and physicians with special competence in palliative medicine (cPM). A questionnaire presenting patient scenarios concerning different decisions and ethical aspects of EOL care with additional questions on attitudes and background factors was delivered to 500 Finnish GPs, all Finnish physicians with cPM (n=82), and all graduating medical students (n=639) in 2015-2016. Altogether 601 responses were obtained (53%). Palliative care was chosen more often for a patient with advanced prostate cancer (83%) than for a patient with advanced dementia (41%) (both patients males, same age). A suspicion of iatrogenic bleeding in the prostate cancer patient decreased the willingness to choose palliative care, especially among the students. Patient benefit was regarded as an important background factor in decision making by all respondent groups, but physicians' legal protection was not considered as important among the physicians with cPM as it was among the other respondent groups. Finnish doctors and students were more likely to choose palliative care options for an advanced prostate cancer patient than for an advanced dementia patient. Decision-making was influenced by respondents' background factors and attitudes. Education on EOL care for different types of advanced and incurable diseases is highly needed.

Evaluation of a French adaptation of a community-based advance serious illness planning decision aid

ObjectiveThe Plan Well Guide™ (PWG) is a decision aid that empowers lay persons to better understand different types of care and prepares them, and their substitute decision-makers, to express both their authentic values and informed treatment preferences in anticipation of serious illness. We aimed to determine the acceptability of the newly translated French PWG and to evaluate decisional readiness and decisional conflict following its use by lay people. MethodsThis is an acceptability and exploratory outcomes evaluation.Participants were requested to read and complete the French PWG and to engage in an online interview. We used the Acceptability Scale to determine the acceptability and the Preparation for Decision-making Scale and decisional conflict Scale to evaluate decisional readiness. ResultsForty-two (42) people participated. The average score on the Acceptability Scale was 18.1 (scale range: 4–20 [high–better]) and 26.6 on the Preparation for Decision-Making Scale (scale range: 6–30 [high–better]). A significant number of respondents reported needing more support to help them make better decisions. ConclusionThe French PWG has been deemed acceptable and relevant for lay people not currently facing clinical decisions. InnovationThe Plan Well Guide is innovative as it is the first decision aid empowering lay people for advance serious illness planning.

Referrals, Symptoms and Treatment of Patients Referred to a Secondary Spine Centre-How Can We Help?

Spinal disorders are amongst the conditions with the highest burden of disease. To limit the increase of healthcare-related costs in the ageing population, the selection of different types of care for patients with spinal disorders should be optimized. The first step is to investigate the characteristics of these patients and the relationship with treatment. The primary aim of this study was to provide insights in the characteristics, symptoms, diagnosis and treatment of patients referred to a specialized spinal health care centre. The secondary aim was to perform an in-depth analysis of resource utilization for a representative subgroup of patients. This study describes the characteristics of 4855 patients referred to a secondary spine centre. Moreover, an extensive analysis of a representative subgroup of patients (~20%) is performed. The mean age was 58.1, 56% of patients were female, and the mean BMI was 28. In addition, 28% of patients used opioids. Mean self-reported health status was 53.3 (EuroQol 5D Visual Analogue Scale), and pain ranged from 5.8 to 6.7 (Visual Analogue Scale neck/back/arm/leg). Additional imaging was received by 67.7% of patients. Surgical treatment was indicated for 4.9% of patients. The majority (83%) of non-surgically treated patients received out-of-hospital treatment; 25% of patients received no additional imaging or in-hospital treatment. The vast majority of patients received non-surgical treatments. We observed that ~10% of patients did not receive in-hospital imaging or treatment and had acceptable or good questionnaire scores at the time of referral. These findings suggest that there is potential for improvement in efficacy of referral, diagnosis, and treatment. Future studies should aim to develop an evidence base for improved patient selection for clinical pathways. The efficacy of chosen treatments requires investigation of large cohorts.