Care For Treatment Of Patients Research Articles

Existing psychological supportive care interventions for cervical cancer patients: a systematic review and meta-analysis.

Cervical cancer patients commonly experience psychological supportive care needs, necessitating diverse interventions to enhance psychological well-being and alleviate physical symptoms. This systematic review, covering English-published articles from January 1999 to April 2023, assessed the impact of psychological supportive care interventions on anxiety and depression. Twenty-Six studies, including 11,638 patients, were analyzed, comprising randomized controlled trials; quasi-experimental, and pre-post-test designs from PubMed; Science Direct; Wiley online library; Google Scholar; Cochrane Library; and JSTOR. The extraction of data was done by two independent authors and a third independent author checked the data extraction. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 2020 statement was adopted. The population, intervention, comparator, and outcomes (PICO) search strategy was applied. Effective Public Health Practice Project (EPHPP) tool was used to assess the quality of selected articles. Various interventions, such as psychological nursing, exercise, counselling, psycho-curative approaches, peer and family education, psychotherapy, and medication, were identified. Two studies incorporated homework sessions, predominantly administered by nursing staff. Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were commonly used instruments. Statistical analysis revealed a significant difference in anxiety and depression scores between treatment and control groups (p < 0.005) post-intervention across all studies. A subsequent meta-analysis of eight homogeneous studies, utilizing a random-effects model, showed a moderate-to-high overall effect size (1.35, 95% CI: 0.75 to 1.94), indicating a statistically significant positive impact. Various studies exhibited variability in effect sizes ranging from low to high. While the meta-analysis included 936 participants, the forest plot visually represents individual study effect sizes and the combined effect size. Preliminary evidence supports the positive impact of psychological supportive care interventions on cervical cancer outcomes, urging further research, especially exploring long-term effects and employing rigorous study designs.

Recent Advances and Clinical Approach to Cancer Treatment with Nanotechnology Derived Biomolecule.

Cancer nanomedicine has the potential to take advantage of the multifunctionality and diverse biological activity of nanostructures based on biomolecules. Novel drug delivery vehicles can be designed by programming the supramolecular features of biomolecules to achieve multiple therapeutic goals at once, including efficient in vivo transport and targeted drug administration. Proteins, peptides, nucleic acids, and polysaccharides can all be engineered into multipurpose nanomedicines. Even while numerous cancer medications reduce mortality, they are still insufficient. Early cancer cell detection and high-specificity therapeutic administration optimise treatment and prevent toxicity. Nanotechnology is improving cancer diagnosis and treatment due to increased systemic toxicity and refractoriness with current methods. Nanotechnology-based immunotherapeutic drugs have reduced cancer cell invasiveness while protecting healthy cells in several cancer types. Carbon nanotubes, polymeric micelles, and liposomes improve cancer medication pharmacokinetics and pharmacodynamics. Nanomedicines' use in patient care and promising nanotechnology-based cancer interventions have been covered in this article. Nanomaterials used in treating cancer have been discussed. Additionally, nanomaterial obstacles that hinder their applicability and clinical translation in certain cancer types are addressed.

Cardiocerebrovascular benefits of early rhythm control in patients with atrial fibrillation detected after stroke: a systematic review and meta-analysis

ObjectiveThis study aimed to evaluate the impact of early rhythm control (ERC) on the occurrence of cardiocerebrovascular events in patients diagnosed with atrial fibrillation detected after stroke (AFDAS).MethodsA systematic search was conducted across nine databases from inception to October 15, 2023 to identify clinical trials comparing ERC with usual care interventions in AFDAS patients. The primary outcome assessed was recurrent stroke, with secondary outcomes including all-cause mortality, adverse events related to arrhythmias, and dementia.ResultsAnalysis of five studies, consisting of two randomized clinical trials (RCTs) involving 490 patients and three cohort studies involving 95,019 patients, revealed a reduced rate of recurrent stroke [odds ratio (OR) = 0.30, 95% confidence interval (CI) 0.11–0.80, P = 0.016 in RCTs; OR = 0.64, 95% CI 0.61–0.68, P &amp;lt; 0.00001 in cohort studies] and all-cause mortality (hazards ratio = 0.94, 95% CI 0.90–0.98, P = 0.005 in cohort studies) in the ERC group compared to the usual care group. In addition, ERC was associated with superior outcomes in terms of dementia.ConclusionsPatients with AFDAS who underwent ERC treatment exhibited a decreased risk of cardiocerebrovascular events compared to those receiving usual care. These results support the potential benefits of implementing an ERC strategy for this specific patient population.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, Identifier [CRD42023465994].

Looking Beyond Mortality Prediction: Primary Care Physician Views of Patients' Palliative Care Needs Predicted by a Machine Learning Tool.

To assess primary care physicians' (PCPs) perception of the need for serious illness conversations (SIC) or other palliative care interventions in patients flagged by a machine learning tool for high one-year mortality risk. We surveyed PCPs from four Brigham and Women's Hospital primary care practice sites. Multiple mortality prediction algorithms were ensembled to assess adult patients of these PCPs who were either enrolled in the hospital's integrated care management program or had one of several chronic conditions. The patients were classified as high or low-risk of one-year mortality. A blinded survey had PCPs evaluate these patients for palliative care needs. We measured PCP and machine learning tool agreement regarding patients' need for an SIC/elevated risk of mortality. Of 66 PCPs, 20 (30.3%) participated in the survey. Out of 312 patients evaluated, 60.6% were female, with a mean (SD) age of 69.3 (17.5) years, and a mean (SD) Charlson comorbidity index of 2.80 (2.89). The machine learning tool identified 162 (51.9%) patients as high-risk. Excluding deceased or unfamiliar patients, PCPs felt that an SIC was appropriate for 179 patients; the machine learning tool flagged 123 of these patients as high-risk (68.7% concordance). For 105 patients whom PCPs deemed SIC-unnecessary, the tool classified 83 as low-risk (79.1% concordance). There was substantial agreement between PCPs and the tool (Gwet's agreement coefficient of 0.640). A machine learning mortality prediction tool offers promise as a clinical decision aid, helping clinicians pinpoint patients needing palliative care interventions.

Integrating Board-Certified Psychiatric Pharmacists in a Certified Community Behavioral Health Clinic.

Demand for mental health services has dramatically increased in recent years, raising concerns about the availability of service providers to meet these increased needs. One approach to expanding access to care is the use of highly qualified board-certified psychiatric pharmacists (BCPPs). However, the implementation of programs for integrating BCPPs has not been well characterized in community mental health settings. This column describes the development and implementation of a comprehensive practice model to incorporate BCPPs in a certified community behavioral health clinic. The authors report the results from the first 14 months of BCPP integration (based on 3,221 direct patient care interventions), offer recommendations, and highlight lessons learned.

Nurse-Led, Telephone-Based Primary Palliative Care Intervention for Patients With Lung cancer: Domains of Quality Care.

Nurse-Led, Telephone-Based Primary Palliative Care Intervention for Patients With Lung cancer: Domains of Quality Care.

Analysis of current situation and influencing factors of marital adjustment in patients with Crohn's disease and their spouses.

The purpose of this study was to investigate the marital adjustment of patients with Crohn's disease and their spouses, and to analyze its influencing factors. It lays the investigation foundation for the follow-up binary study of Crohn's disease patients and their spouses. Using convenience sampling, 177 pairs of patients and their spouses from a tertiary hospital in Nanjing, China were selected. With face-to-face electronic questionnaires to survey the patient and spouse, the contents include the Lock-Wollance Marriage Adjustment Test, Subjective Well-Being Scale for Chinese Citizens, Couple Support Questionnaire, and Distress Self-Disclosure Scale. The marital adjustment score of patients was (99.03 ± 24.25), and the marital adjustment score of spouses was (99.61 ± 25.39). The proportions of patients with marital disorders and their spouses with marital disorders were 52.5% and 46.9%, respectively. Multiple linear regression showed that the spouse's age, family monthly income, time of diagnosis of Crohn's, distress self-disclosure, marital support, and subjective well-being were important factors influencing the marital adjustment of patients. Self-disclosure of spousal distress, marital support, age, and subjective well-being were important factors that influenced spouses' marital adjustment. Most couples with Crohn's disease have marital disorders, and their marital adjustment affects each other. However, the assessment results of one partner should not be limited to replacing those of the couple. In clinical practice, patient age, monthly family income, self-disclosure of distress, marital support, and subjective well-being should be considered. Spouses should be encouraged to participate in patient care and patient-spouse interventions should be implemented as a whole to improve marital stability.

Unveiling the unseen: next-generation cardiac magnetic resonance imaging

Unveiling the unseen: next-generation cardiac magnetic resonance imaging Cardiovascular disease (CVD) claims over 1.8 million European lives yearly, surpassing cancer, chronic respiratory disease and diabetes fatalities. Cardiac magnetic resonance imaging (CMR) is crucial for understanding and treating CVD, offering radiation-free comprehensive heart assessment. However, current CMR systems are slow, complex and require specialised expertise, limiting widespread adoption. SMHEART aims to revolutionise CMR with a one-click approach, creating a unique 3D whole-heart volume for automated cardiology diagnosis, prognosis and therapy selection. This project streamlines CMR, facilitating broader acceptance and optimising its impact on personalised patient care, including diagnosis, risk stratification, therapy selection, monitoring and image-guided interventions.

Optimizing the Maastricht Work-Related Support intervention in clinical patient care: the value of integrating action research into intervention mapping

BackgroundHealthcare professionals (HCPs) are increasingly recommended to play an important role in supporting people with chronic disease in work participation. An intervention for HCPs to provide work-related support to their patients in clinical care was developed with intervention mapping (Maastricht Work-Related Support; Maastricht WRS). Action research proposes ‘combining research and practice’, which allows us to incorporate experiences of HCPs while implementing and to realize intervention’s full potential. Therefore, the aim of this study is to explore, by integrating action research into an intervention mapping approach, how experiences of HCPs with early implementation can be used to optimize the Maastricht WRS in clinical care.MethodsSemi-structured interviews were held with nine HCPs (response rate 82%), involved in care for people with inflammatory arthritis, knee problems or inflammatory bowel disease. Some of them were not yet trained in the Maastricht WRS while others had received the training and were providing the Maastricht WRS.ResultsAll participants regarded WRS an important part of clinical care. Untrained HCPs indicated a lack of knowledge and skills in providing the Maastricht WRS, and a need for tools. Trained HCPs were satisfied with the training and tools, but stressed that practical limitations hindered providing the Maastricht WRS. Action research showed that the intervention meets the needs of HCPs, but need some optimizations: (1) organizing ‘intervision’ for HCPs, (2) inform and activate patients to discuss work with their HCP, (3) update initial tools and (4) including patients’ work status in the electronic patient system.ConclusionsAction research integrated into intervention mapping proved to improve the Maastricht WRS intervention. By involving HCPs, the intervention could be optimized to provide to support people with chronic diseases in clinical care in healthy and sustainable work participation.

Communicative impairment and its neural correlates in Alzheimer's disease and frontotemporal dementia.

Communication skills can deteriorate in neurodegenerative diseases such as Alzheimer's disease (AD) and frontotemporal dementia (FTD); however, their clinical assessment and treatment in patient care can be challenging. In the present study, we aimed to quantify the distinctive communication resources and barriers reported by patients and their relatives in AD and FTD and associated these communicative characteristics with clinical parameters, such as the degree of cognitive impairment and atrophy in language-associated brain areas. We assessed self-reported communication barriers and resources in 33 individuals with AD and FTD through an interview on daily-life communication, using the Aachener KOMPASS questionnaire. We correlated reported communication barriers and resources with atrophy from high-resolution 3T brain magnetic resonance imaging, neuropsychological assessment, and neurodegenerative markers from cerebrospinal fluid. Communicative impairment was higher in FTD compared to AD. Increased reported communication barriers in our whole sample were associated with the atrophy rate in the left middle temporal lobe, a critical site within the neuronal language network, and with depressive symptoms as well as the semantic word fluency from neuropsychological assessment. The best model for prediction of communicative impairment included the diagnosis (AD or FTD), semantic word fluency, and depressive symptoms. Our study demonstrates that communication barriers and resources can be successfully assessed via a structured interview based on self-report and report of patients' relatives in practice and are reflected in neuroimaging specific for AD and FTD as well as in further clinical parameters specific for these neurodegenerative diseases. This can potentially open new treatment options for clinical practice and patient care.

Understanding adaptive tasks in cardiac rehabilitation among patients with acute myocardial infarction: a qualitative study

Background While Cardiac Rehabilitation (CR) programs have shown effectiveness in improving cardiac outcomes, there is limited understanding of how patients perceive and adapt to these interventions. Furthermore, alternative modes of delivering CR that have received positive evaluations from participants remain underexplored, yet they have the potential to enhance CR uptake. Objectives To explore the patient experience in CR programmes following Acute Myocardial Infarction (AMI) and describe their adaptive processing. Patients and Methods This qualitative study was conducted at a nationally certified centre in China between July 2021 and September 2022, encompassing three stages: in-hospital, centre-based, and home-based CR programs. Purposive sampling was used to select eligible AMI patients for in-depth semi-structured interviews. The interview outline and analytical framework were aligned with the key concepts derived from the middle-range theory of adaptation to chronic illness and the normalization process theory. The findings were reported following the Consolidated Criteria for Reporting Qualitative Research checklist. Results Forty AMI patients were recruited. Four main themes describing the process of AMI patients normalizing CR intervention were identified, including (1) experiencing CR service driving by role’s responsibilities, (2) engaging in collaborative relationship based on interpersonal trust, (3) exploring a personalized rehabilitation plan by complex integration, and (4) expecting a promised outcome to shape decision-making. Conclusion Integrated care interventions for AMI patients could benefit from a collaborative co-designed approach to ensure that CR interventions are normalized and fit into patients’ daily lives. Organizational-level CR services should align with the rehabilitation needs and expectations of patients.

Biomedical waste management and their effects on the Environment: A review

Biomedical waste has the potential to be hazardous and cause environmental pollution, therefore its proper management and disposal, especially in hospitals and healthcare facilities, plays an important role in protecting both the environment and public health. Biomedical waste encompasses a diverse array of materials originating from patient care, research activities, and medical interventions, and inadequate handling poses significant hazards. Common disposal methods, such as incineration, have been associated with environmental contamination and the emission of harmful fumes. Biomedical waste poses health risks through the spread of infectious diseases, particularly via sharps injuries, and the release of toxic compounds into the environment. The hazardous category includes infectious, potentially hazardous, and radioactive waste, with around 10% of hospital waste deemed infectious according to the World Health Organization. Various disposal techniques, including burning, autoclaving, microwaving, shredding, landfilling, and chemical treatments, are employed globally, each with its own benefits and limitations. In this review, a classification of the various categories of biomedical waste and its effects, treatment and disposal methods are discussed. In summary, the substantial impact of biomedical waste on the environment and public health necessitates careful handling and adherence to regulations. The implementation of sustainable waste management practices, promotion of recycling, and adoption of innovative technologies are essential for mitigating the adverse effects of biomedical waste on the environment and local communities.

The Value of Social Work to Health, Health Systems, and Interprofessional Teams: A Scoping Review

Abstract Social workers are an integral part of the U.S. healthcare system, yet specific contributions of social work to health and cost-containment outcomes is sparse. This scoping review describes and evaluates the state of the evidence on how social work interventions impact health and economic outcomes since the passage of the Patient Protection and Affordable Care Act. Three databases (PubMed, PsycINFO, and CINAHL) were searched using the convention [“social work” OR “social services”] AND “health” AND [“cost” OR “utilization” OR “readmission”] for studies published between 2010 and 2022. Unique records were evaluated on inclusion criteria (U.S.-based, reported social work, and cost or health outcomes) using a five-phase scoping review process. Methodological quality was assessed using two validated metrics. Of 1,655 unique records retrieved, 40 (2.4%) met inclusion criteria. Full-text review yielded 15 studies. Most (75%) studies described transitional care interventions for older patients and high utilizers of health services, with the majority (75%) led by social workers. While health and cost outcomes were generally positive, overall methodological quality of the sample was low. Social work intervention can improve health and cost outcomes. More robust economic analyses that inform policy, practice, and health service delivery are needed.

Spiritual Care in Patient with Cancer Pain: Literature Review

Spiritual care for cancer pain is an intervention to address the spiritual needs of patients with cancer in managing pain. Despite numerous studies conducted in this area, the diversity of spiritual care interventions for cancer pain remains a challenge. Objective: This literature review aimed to identify spiritual care interventions for cancer patients in managing pain. Method: The database used Scopus, Pubmed, Proquest, Science Direct, and Google Scholar. The keywords used were “spiritual care” OR “spiritual therapies” OR “spiritual healing” OR “faith healing” OR “spiritual intervention” OR “religious intervention” AND “cancer pain” OR “cancer-related pain” OR “neoplasm-related pain” OR “oncology pain. The search was limited to articles published between 2011 and 2021, resulting in the identification of 6642 articles, which only 10 met the inclusion criteria. The selected articles underwent critical appraisal using JBI tools. Results: This literature review showed that the types of spiritual care interventions consist of yoga, psychoreligious intervention, mindfulness, music therapy, and therapeutic touch, and the primary outcomes of spiritual care are pain levels. Conclusions: This literature review showed the interventions were very diverse in all types of cancer. Therefore, a spiritual care intervention study on managing pain with a specific type of cancer is needed.

Nurse-Led, Telephone-Based Primary Palliative Care Intervention for Patients With Lung Cancer: Domains of Quality Care.

Palliative care is traditionally delivered by specialty-trained palliative care teams. Because of a national workforce shortage of palliative care specialists, there is an urgent need to explore alternative models of palliative care delivery to meet the needs of patients living with serious illness. As part of a multisite randomized controlled trial, 2 registered nurses without previous palliative care experience were trained to deliver a primary palliative care intervention to patients with newly diagnosed lung cancer. The intervention focused on assessing and managing symptoms, psychosocial needs, education, and initiating goals-of-care discussions. The primary outcome, improved symptom burden and quality of life, was not statistically significant. Despite this finding, nurses addressed 5 of the 8 National Consensus Project Guidelines domains of quality palliative care: structure and processes of care; physical, psychological, and social aspects of care; and ethical and legal aspects. Patients' engagement in goals-of-care discussions, a measure of high-quality palliative care, increased. Clinical recommendations offered by the nurses to the patients' clinicians were addressed and accepted on a timely basis. Most patients rated satisfaction with the intervention as "very or extremely" satisfied. These findings may inform future nurse-led palliative care interventions on the specific quality domains of palliative care.

Coping in Patients with Hematologic Malignancies Undergoing Hematopoietic Cell Transplantation

Background Patients undergoing hematopoietic cell transplantation (HCT) must cope with immense physical and psychological symptoms during HCT hospitalization, which contribute to a dramatic deterioration in quality of life (QOL). Yet, studies examining pre-HCT coping strategies are limited. We aimed to characterize use of pre-HCT coping strategies, to identify sociodemographic and clinical factors associated with coping strategy use, and to investigate the association of coping strategy use with pre-HCT QOL and psychological distress. Methods We conducted a secondary analysis of baseline data from a multi-site randomized controlled trial evaluating a supportive care intervention for patients with hematologic malignancies undergoing allogeneic or autologous HCT (NCT#03641378). From 10/2018 - 07/2022, the trial enrolled consecutive adults (age ≥ 18) with hematologic cancers undergoing HCT at three tertiary care academic centers. Prior to HCT, we assessed QOL (Functional Assessment of Cancer Therapy - Bone Marrow Transplant), psychological symptoms (Hospital Anxiety and Depression Scale and Post Traumatic Stress Disorder (PTSD) - Civilian Version), and coping (Brief COPE). We categorized coping as either “approach-oriented” (active coping, use of emotional support, positive reframing, acceptance) or “avoidant” (behavioral disengagement, denial, and self-blame). We used the median split method to categorize high and low use of approach-oriented and avoidant coping. Univariate logistic regression was used to identify sociodemographic and clinical factors associated with high use of coping strategies. Multivariate linear regression was used to measure associations of coping strategy use with QOL and psychological distress. Results Of pre-HCT patients (n=360), the majority were male (62.8%), identified as White (77.5%), were younger than 65 (73.6%), and had received at least some college education (78.9%). A minority were unemployed due to disability from illness (29.2%). Approximately half received autologous HCT (n=178, 49.4%). Figure 1 displays the proportion of patients scoring as high utilizers of individual coping strategies. While 31.3% were high utilizers of avoidant coping, 43.5% were high utilizers of approach-oriented coping. Notably, 43 (11.9%) patients identified as high utilizers of both approach-oriented and avoidant coping. No sociodemographic or clinical factors were associated with use of approach-oriented coping. Older age (&amp;gt;65 years, OR=0.9, p=0.01) and higher income (&amp;gt;$100K, OR=0.90, p=0.04) were associated with less frequent use of avoidant coping. Female gender (OR=1.11, p=0.03) and disabled employment status (OR=1.11, p=0.05) were associated with increased likelihood of high use of avoidant coping. Table 1 displays adjusted associations between approach-oriented and avoidant coping strategies and patient-reported outcomes. High use of approach-oriented coping was associated with better pre-HCT QOL (B=6.4, p&amp;lt;0.001) and lower depression (B=-1.1, p=0.001) and anxiety (B=-0.9, p=0.02) symptoms. High use of avoidant coping was associated with worse pre-HCT QOL (B=-11.7, p&amp;lt;0.001) and symptoms of depression (B=1.9, p&amp;lt;0.001), anxiety (B=3.1, p&amp;lt;0.001), and PTSD (B=8.1, p&amp;lt;0.001). Conclusions Prior to HCT, patients frequently employ approach-oriented and avoidant coping strategies. Key sociodemographic factors including age, gender, income level, and employment status were associated with avoidant coping. Patients with high use of approach-oriented coping reported higher baseline QOL and lower psychological distress, while those with high use of avoidant coping strategies reported worse QOL and psychological distress. These data suggest that supportive care interventions which enhance approach-oriented coping and mitigate avoidant coping in pre-HCT populations may improve QOL and reduce psychological distress

Insights into the epidemiology and clinical aspects of post-COVID-19 conditions in adult

Objectives While most individuals infected with COVID-19 recover completely within a few weeks, some continue to experience lingering symptoms. This study was conducted to identify and describe the clinical and subclinical manifestations of adult patients from the long-term effects of COVID-19. Methods The study analyzed 205 medical records of inpatients (age ≥ 16 years, ≥ 4 weeks post-COVID-19 recovery, and a negative SARS-CoV-2 status at enrollment) at Thong Nhat Hospital, Vietnam, from 6 September 2021 to 26 August 2022, using R language software. Results The majority of patients hospitalized with long COVID-19 symptoms (92.68%) had normal consciousness. The most common symptoms on admission were fatigue (59.02%), dyspnea (52.68%), and cough (42.93%). In total, 80% of patients observed respiratory symptoms, primarily dyspnea, while 42.44% reported neurological symptoms, with sleep disturbance being the most common. Noticeably, 42.93% of patients experienced respiratory failure in the post-COVID-19 period, resembling acute respiratory distress syndrome. Discussion These findings provide crucial insights into the epidemiology, clinical, and subclinical aspects of post-COVID-19 conditions, shedding light on the prevalence of common symptoms and the demographic distribution of affected patients. Understanding these manifestations is vital for patient well-being, improved clinical practice, and targeted healthcare planning, potentially leading to better patient care, management, and future interventions.

Study the Serum Levels of IL-17, IL-23, TLR-4, and TLR-7 Role in Immunopathogenesis in Patients with Moderate and Severe Psoriasis

Objective: Psoriasis is an immune-mediated disease* (a disease with an unclear cause that is characterized by inflammation caused by dysfunction of the immune system) that causes inflammation in the body. This study examined the relationship between immunological markers (IL-17 and TLR-4) and several socio-demographic parameters, including age, sex, disease severity, stress, smoking behaviours, BMI classification, and dietary preferences, in patients with psoriasis. Methods: Psoriasis on patients at the Imam Al-Hussein City Hospital in Karbala Province, Iraq, psoriasis from December 2022 to April 2023. The participants were healthy individuals and newly diagnosed, untreated psoriasis patients. Pregnant women, those with chronic conditions, and those receiving psoriasis medication were excluded. A case-control observational study was conducted, using convenience sampling to select participants. The PASI scoring method was used to evaluate four body areas, and the sandwich ELISA method was used for immunomarker analysis. Results: The study found significant dispirited in the severity of psoriasis among individuals, with 54.44% presenting with intermediate symptoms and 45.56% showed severe manifestations. The moderate and severe psoriasis patients were classified into five age cohorts. The severity of psoriasis correlates with age, with those with severe psoriasis being older. Socio-demographic features revealed a greater prevalence of moderate patients than those with severe psoriasis. The study also found a significant association between greater BMI values and severe symptoms, smoking behaviours, elevated stress levels, and higher consumption of processed foods. Immunological markers such as IL-17, IL-23, TLR-4, and TLR-7 were also examined, showed significant variations between control participants and those with moderate and severe forms of the condition. These findings contributed to understanding the determinants impacting psoriasis severity and its clinical implications for patient care and therapeutic interventions. Conclusion: Psoriasis patients make up a significant part of the study population, with higher smoking, stress, and healthy food habits. There was no significant difference in BMI, disease severity. of immunological markers IL-17, IL-23, TLR-4, and TLR-7 showed a significantly increase.

Are digital health interventions valuable to support patients with cancer and caregivers? An umbrella review of web-based and app-based supportive care interventions.

Digital health technologies have expanded tremendously in the last two decades, creating an emerging research and clinical field. They are regarded as cost-effective, and their use in healthcare is prioritized by many countries. However, the constant evolution of these technologies has led to an abundance of related literature. Thus, we conducted an umbrella review to identify and characterize digital supportive care interventions for patients with cancer and their relatives. A preregistered umbrella review was conducted (PROSPERO registration number CRD42022333110). Five databases were searched (Embase, PsycINFO, PubMed, CINAHL, and the Cochrane Library). To be considered, studies had to be systematic reviews or meta-analyses, be performed on pediatric or adult patients with cancer or survivors or their relatives, report results on web-based or app-based supportive care interventions, and measure psychological, functional, or behavioral variables or quality of life related to cancer. The methodological quality of the studies was assessed using the AMSTAR-2 tool. Twenty eligible studies were identified. Most of the included studies reported results from adult patients with cancer. Globally, digital interventions were shown to be effective for physical activity in patients with cancer but had mixed results regarding emotional outcomes and quality of life. Additionally, a lack of methodological quality was noted for most of the included reviews. Digital supportive care interventions could be an effective tool in cancer care for some outcomes. Recommendations have been formulated for further research in this field using adapted methodologies for the development of digital health interventions.

The PaCES Study: Cost effectiveness of an early palliative care intervention in patients with advanced colorectal cancer.

20 Background: An early palliative care (PC) pragmatic trial conducted in outpatient cancer clinics for patients living with advanced colorectal cancer (CRC), led to a 17% increase in early referrals (more than 3 months before death). This study evaluates the cost effectiveness of this trial. A lack of timely palliative care is associated with poorer quality of life, poorer symptom control and fewer days spent at home. Improving on this time toxicity is an important part of early palliative care. Methods: This pragmatic controlled before-and-after study was performed in 18 outpatient cancer clinics in two tertiary cancer centers in neighboring metropolitan cities. Baseline phase was from April 2017 to December 2018 with intervention phase only occurring in 1 of the cities, from April 2019 to December 2020. Intervention consisted of systematically screening patients for unmet PC needs, adding a community-based PC nurse specialist and templated ‘shared care’ letters sent from oncologists to primary care providers. Effectiveness was defined as the number of days spent at home in the last 90 days of life, by subtracting days in hospital, residential hospice, emergency department and clinic. A healthcare system perspective was used to calculate total costs in all sectors including hospital, cancer care, home care, palliative care and physician visits. Healthcare outcomes and costs were analysed using a difference-in-differences (DID) method, while accounting for geographic variations and other covariates. Results: A total of 695 decedents were included. There was a 15% decrease in hospital stay and 18% decrease in chemotherapy days in last 90 days of life. The intervention was cost dominant with an overall DID increase of 2.3 community days with an average cost reduction of C$1,942.17 per patient day in the community. Adjusted analysis showed that this difference was not statistically significant. A non-parametric random resampling of the population with 1,000 reiterations (bootstrapping) showed that the likelihood of the program remaining dominant was 69%. The biggest cost contributors were inpatient acute care (53.6%) and residential hospice (33.6%). Conclusions: Integrating early palliative care services into the care of CRC patients’ shows potential for cost savings and more days spent in the community in the last 90 days of life. Measuring time toxicity is a potentially important outcome in early palliative care trials while examining impact on cost.