Supportive Care Research Articles

The impact of cross disciplinary communication methods on the support needs, quality of life, and emotions of patients with advanced lung cancer

Background: The condition of advanced lung cancer patients is already quite severe. At this stage, the tumor has basically spread to other areas or caused multiple recurrent lesions, which not only increases the difficulty of treatment but also leads to a significant decrease in disease control rate. Aim: To analyze the impact of cross disciplinary communication methods on patients with advanced lung cancer. Methods: A comparative study involving 152 advanced lung cancer patients from January 2022 to January 2024 was conducted. Patients were randomly divided into an observation group (73 cases, using interdisciplinary communication) and a control group (79 cases, using routine nursing). An interdisciplinary team, including nurses, physicians, head nurses, and psychology experts, developed communication plans. The study compared emotional states (DASS-21), supportive care needs (SCNS-SF34), disease uncertainty (MUIS), quality of life (FACT-L), and compliance between the two groups. The study's limitation is the relatively single sample selection, potentially affecting result generalizability. Result: After intervention, the DASS-21 score, SCNS-SF34 score, and MUIS score in the observation group were lower than those in the control group, while the FACT-L score was higher than that in the control group (P < 0.05); the good compliance rate of the observation group was 97.26% (71/73), which was higher than that of the control group (86.08% (68/79) (P < 0.05). Conclusion: For patients with advanced lung cancer, adopting cross disciplinary communication for intervention can not only effectively alleviate their negative emotions and reduce their sense of disease uncertainty, but also maximize the satisfaction of their supportive care needs, ensure their quality of life, and to some extent, obtain good cooperation from patients.

Multifaceted impacts of double-aging neighborhood’s built environments on SAIP: a deep dive into Chinese rapidly aging urban society

IntroductionThe healthy aging of older adults in dual-older adult communities is influenced by multiple factors, and understanding its underlying mechanisms can promote healthy aging among the older adults in a wide range of developing countries. This comprehensive study delves into the intricate interplay between multifaceted built environmental factors, and their direct and indirect effects on the successful AIP residing in double-aging neighborhoods.MethodsApplying a series of HLM, the research meticulously explores the intricate links between SAIP and multi-scale aging spaces, including home space, community social participation, and built environments.ResultsThe results show that: (1) Older adults people’s need for spiritual comfort derived from home space exceed the need for financial support and family care, becoming a major positive factor for SAIP; (2) The neighborhood based on acquaintance society, partly replace the role of home-based care in influencing SAIP. Especially, community participation has a positive impact, serving as an extension of the home space, such as college for senior citizens and outdoor activity space; (3) The built environment of double-aging neighborhoods has a significant positive effect, with a sense of place identity replacing the reliance on family members and acquaintances to facilitate SAIP; (4) In high-density old district, the distribution of public facilities is saturated, and the proper utilizes of these facilities becomes an important factor affecting SAIP.DiscussionWe provide a multi-factorial perspective of SAIP, demonstrating the compensatory and substitutional roles of community-based older adults care services and friendly neighborhood relationships in fulfilling home-based older adults care functions. This approach better promotes the construction of age-friendly communities and supports SAIP.

Barriers and facilitators to implementing person-centred dementia care in long-term care facilities in Western and Asian countries: a scoping review

BackgroundThere is a gap between the principles of person-centred dementia care and their actual implementation. However, scoping reviews of the barriers and facilitators to implementing person-centred dementia care in long-term care facilities for Western countries and Asian countries are lacking.ObjectiveTo identify and compare the barriers and facilitators to implementing person-centred dementia care in long-term care facilities between Western and Asian countries.MethodsIn line with Arksey and O’Malley’s methodology, a scoping review was conducted and is reported following PRISMA-ScR guidelines. Nine English language databases and three Chinese databases were searched to identify qualitative and quantitative research studies published in English and Chinese. Thematic analysis was used to summarise and characterize the barriers and facilitators to implementing person-centred dementia care in long-term care facilities for Western and Asian countries.ResultsThirty-three studies were included. Over half were conducted in Western countries (n =20). Barriers and facilitators were grouped under four high level themes: Nursing and care staff factors, people living with dementia and family factors, organizational factors, and resource factors. Inadequate knowledge of person-centred care, staffing shortages, time constraints, and low wages were the principal barriers to implementing person-centred dementia care in both Western and Asian countries.ConclusionsThe findings indicate that staff encounter numerous obstacles and needs in implementing person-centred care for people living with dementia in long-term care settings. Educational levels of nursing staff in Western countries were generally higher compared to Asian countries. Additionally, work-related injuries and stigma associated with dementia care presented unique challenges for nursing staff in Asia and were not cited in Western studies. Conversely, family-related factors were more frequently and elaborately cited as influencing person-centred dementia care in Western long-term care facilities. Moreover, Asian studies identified a significant lack of educational training support for person-centred dementia care, as well as shortages in staffing and poor availability of personalized, home-like environments

Navigating adulthood: Exploring the transition needs of adolescents and young adults affected by Duchenne or Becker muscular dystrophy.

For individuals with Duchenne or Becker muscular dystrophy (DMD and BMD, respectively), transitioning to adulthood presents significant challenges. Although considerable attention has been given to facilitating medical transitions due to the complexity of these conditions, less focus has been placed on other aspects of the transition, such as achieving independence. This study assessed the transition needs of people with DMD or BMD, exploring various domains including health, education, employment, living arrangements, transportation, daily activities, and independent personal life. Men with DMD or BMD participated in this cross-sectional study. Transition to adulthood was assessed using Transition Readiness Assessment for Young Adults with DMD. The questionnaire evaluates transitions in health care, education and employment, housing and transportation, activities of daily living, and independent life and autonomy. Factors associated with and predicting transition to adulthood were evaluated using Spearman's correlations and multiple regression analysis. Forty-two people with DMD or BMD (mean age: 24.3±5.3) participated in this study. The transition domains in which most participants needed help were education and employment (52.5%) and activities of daily living (57.0%). Transition needs that stood out included palliative care (66.6%), employment and education support (76.1%), social worker consultation for housing assistance (76.1%), and assistive device consultation (64.2%). Mobility and breathing function did not correlate with transition level. Number of siblings positively correlated with and predicted most transition domains. Older age predicted only education and employment status. In conclusion, the analysis showed that the most problematic transition domains among people with DMD or BMD were activities of daily living and education and employment. In most transition domains, help needed did not decrease with age and was not affected by function. However, adolescents and adults with more siblings typically reported being more ready to transit to adult life.

Impact on Mental Health Problems during Coxsackievirus Outbreak in the General Public: A Review

Coxsackievirus group B (CVB), a member of the Picornaviridae family and enterovirus genus, poses risks during pregnancy due to its potential to cause severe fetal and neonatal infections. Transmission primarily occurs through fecal–oral routes, with infections peaking mostly in warmer months. Vertical transmission to the fetus can lead to conditions such as myocarditis, encephalitis, and systemic neonatal disease, presenting clinically as severe myocardial syndromes and neurological deficits. Diagnostic challenges include detecting asymptomatic maternal infections and conducting in utero assessments using advanced techniques like RT-PCR from amniotic fluid samples should be encouraged. Morbidity and mortality associated with congenital CVB infections are notable. Current treatments are limited to supportive care, with emerging therapies showing promise but requiring further study for efficacy. Mental health impact due to this virus results in speech development failure and autistic feature. Future research should aim to fill knowledge gaps in epidemiology, improve diagnostic capabilities, and develop targeted interventions to enhance maternal and fetal outcomes and other health issues due to this virus.

Disseminated intravascular coagulation: cause, molecular mechanism, diagnosis, and therapy

AbstractDisseminated intravascular coagulation (DIC) is a complex and serious condition characterized by widespread activation of the coagulation cascade, resulting in both thrombosis and bleeding. This review aims to provide a comprehensive overview of DIC, emphasizing its clinical significance and the need for improved management strategies. We explore the primary causes of DIC, including sepsis, trauma, malignancies, and obstetric complications, which trigger an overactive coagulation response. At the molecular level, DIC is marked by excessive thrombin generation, leading to platelet and fibrinogen activation while simultaneously depleting clotting factors, creating a paradoxical bleeding tendency. Diagnosing DIC is challenging and relies on a combination of existing diagnostic criteria and laboratory tests. Treatment strategies focus on addressing the underlying causes and may involve supportive care, anticoagulation therapy, and other supportive measures. Recent advances in understanding the pathophysiology of DIC are paving the way for more targeted therapeutic approaches. This review highlights the critical need for ongoing research to enhance diagnostic accuracy and treatment efficacy, ultimately improving patient outcomes in those affected by DIC.

Impact of Psychological Factors on Survival in Metastatic Esophagogastric Cancer: Secondary Analysis of a Randomized Controlled Trial.

Early interdisciplinary supportive care (ESC), including psychological interventions, can improve the survival of patients with metastatic esophagogastric cancer (EGC). The purpose of the study was to evaluate the association between psychological factors and survival in patients with metastatic EGC. A secondary analysis was conducted for an open-label randomized controlled trial of ESC, in which 246 patients with EGC completed a distress measure (the distress thermometer) and a depression symptom measure (the Patient Health Questionnaire-9 [PHQ-9]) at baseline before cancer treatments. Cox regression was applied to explore the influence of psychological distress and depressive symptoms on overall survival (OS) and progression-free survival (PFS). Patients with moderate depressive symptoms (PHQ-9 ≥8) had shorter PFS (3.5 v 6.0 months, P < .001) and shorter OS (10.7 v 15.0 months, P = .001) than those without. Patients with significant psychological distress had worse PFS (4.8 v 6.3 months, P = .035) and worse OS (13.4 v 15.5 months, P = .039) than those without. After controlling for performance status, group, sex, primary tumor site, tumor histology, and age, only depressive symptoms remained associated with worse PFS (adjusted hazard ratio [HR], 2.02 [95% CI, 1.41 to 2.91]; P < .001) and worse OS (adjusted HR, 1.70 [95% CI, 1.17 to 2.47]; P = .006). This study shows that depressive symptoms at baseline were associated with poor survival in patients with newly diagnosed metastatic EGC. Therefore, screening and preventive intervention for depression should be integrated into routine cancer care for this population.

Service delivery and the role of clinical pharmacists in UK primary care for older people, including people with dementia: a scoping review

ObjectiveAs populations age globally, there is increasing prevalence of multiple long-term conditions, such as dementia, leading to many challenges. The burden on health and care services, economic pressures, and the necessity for innovative policies to better support older people and people with dementia becomes paramount. This review explores how clinical pharmacists working in UK primary care support older people and people with dementia.DesignScoping review.MethodThis review was conducted following the framework for scoping reviews in accordance with the Joanna Briggs Institute (JBI) methodology. The search of Scopus, EMBASE, CINAHL, Web of Science, PsycINFO, and Cochrane was initially conducted in September 2022, and updated in August 2024. Searches included literature exploring the landscape of clinical pharmacy services for older people in the UK, focusing on roles and services delivered, perceptions, and experiences.ResultsA total of 30 articles were included. These detail the multifaceted responsibilities of clinical pharmacists in primary care for older people. Stakeholder perspectives, including healthcare professionals and patients, emphasised the positive outcomes of clinical pharmacist involvement, from reducing other practitioners’ workloads to improving patient safety. However, communication gaps, concerns about competence from other healthcare professionals, and the need for clear role definitions emerged as challenges. Research focused on the experiences of underserved groups, such as people with dementia or from minority ethnic backgrounds, is lacking.Conclusions and implicationsThe review enhances our understanding of the primary care clinical pharmacist service in the UK and identifies gaps in evidence, emphasising the need for empirical studies on the experiences of older people with cognitive impairment and those from minority ethnic backgrounds. It provides insights into what makes an effective clinical pharmacist service, such as training and communication, which may help to inform international policy and practice and improve service provision globally.

Pharmacogenomics and symptom management in palliative and supportive care: A scoping review

ContextPharmacogenomics (PGx) is an area of expanding research, which could indicate whether an individual is likely to benefit from a symptom control medication. Palliative and supportive care (PSC) could be...

Haemophagocytic lymphohistiocytosis in pregnancy.

Dengue infection is emerging as one of the most common tropical diseases globally. It manifests in varying severity from asymptomatic to the most severe forms of the disease, characterized by coagulopathy, increased vascular fragility, and permeability (dengue haemorrhagic fever) that may progress to hypovolaemic shock (dengue shock syndrome). For atypical manifestations, a new terminology known as expanded dengue syndrome (EDS) was introduced. Haemophagocytic lymphohistiocytosis (HLH), is considered a spectrum of EDS, which is a rare, potentially fatal hyperinflammatory condition. A case of a pregnant woman with dengue fever diagnosed as secondary HLH is reported here. It was successfully managed with intravenous dexamethasone and supportive care. A high index of suspicion is paramount in diagnosing HLH when a patient deteriorates even after giving appropriate care for dengue infection. Early recognition and prompt treatment with immuno-suppressive therapy can bring a successful response.

COVID-19 Impact On Black and Latina Women: Pregnancy and Parenting.

The coronavirus-19 (COVID-19) pandemic presented unique challenges for pregnant women and birthing individuals, particularly those from Black and Latino communities. Understanding the impact of the pandemic on their experiences is crucial for providing adequate support and care during vulnerable times. This research delves into the specific effects of COVID-19 on maternal stress and resilience. We conducted in-depth interviews with a subsample of 19 women from a larger study examining the effects of maternal stress and anxiety, racism, and resilience and coping on pregnancy among Black and Latina pregnant women in the San Francisco Bay Area, a diverse region where nearly two-thirds of residents are people of color. Using thematic analysis, we identified three dominant themes that illuminate the impact of the COVID-19 pandemic on participants' pregnancy, birth, and postpartum experiences. Firstly, the pandemic shifted participants' focus away from their pregnancy and birth experiences, compelling them to prioritize safety measures against COVID-19 infection. Secondly, the study highlighted the profound value of high-quality, supportive care from healthcare providers during the pandemic, which significantly impacted participants' well-being. Lastly, we uncovered various resilience-building strategies employed by participants to navigate the challenges of pregnancy and parenting during the pandemic. This research provides essential insights into the lived experiences of Black and Latina pregnant women in the San Francisco Bay Area during the COVID-19 pandemic. The findings underscore the need for targeted support and interventions to address the unique stressors faced by these communities. By understanding the personal lived experience of Black and Latina participants' pregnancy, birth, and postpartum during the pandemic, healthcare providers and policymakers can develop more tailored and effective approaches to assist and empower Black and Latina pregnant individuals.

Determinants of Prolonged Hospitalization in Children and Adolescents: A Retrospective Observational Study.

Ensuring an appropriate length of stay (LOS) is a primary goal for hospitals, as prolonged LOS poses clinical risks and organizational challenges. Children and adolescents are particularly susceptible to prolonged LOS due to frequent hospitalizations and unique vulnerabilities, including developmental disabilities that may necessitate additional care and monitoring. This study aims to describe the LOS of children and adolescent patients and identify the sociodemographic, organizational, clinical, and nursing care factors contributing to prolonged LOS in this population. Observational, retrospective, monocentric study. A sequential sampling approach was used to select the clinical records of 1538 children and adolescent patients admitted to an Italian university hospital in 2022. The study included all children and adolescents aged 3-18 who were hospitalized for a minimum of 2 days. Patients from outpatient units and those with LOS shorter than 2 days were excluded. The Neonatal Pediatric Professional Assessment Instrument (PAIped) and the Hospital Discharge Register were used to collect sociodemographic, organizational, clinical, and nursing care patient data, including nursing diagnoses (NDs) and nursing actions (NAs). A forward stepwise regression approach was used to identify predictors of LOS among the selected variables. A mediation analysis was conducted to explore the role of nursing predictors, identified in the stepwise regression, as mediators between the number of medical diagnoses and LOS. Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (rs = 0.262, p = < 0.001; rs = 0.114, p = < 0.001; rs = 0.384, p = < 0.001, respectively). Longer hospital stays were associated with an increased number of medical diagnoses, NDs, and NAs. The number of NAs emerged as an independent predictor of LOS (β = 0.516; p < 0.001). Other significant determinants of LOS included a higher number of NAs and medical diagnoses, the presence of a medical DRG category, increased DRG weight, emergency admissions, residency in rural areas, and older age (F = 122.222, p < 0.001, R2 = 0.361, adjusted R2 = 0.358). The mediation analysis showed that the number of medical diagnoses positively predicted the number of NAs (β = 2.774, p < 0.001), which, in turn, positively affected LOS (β = 0.162, p < 0.001). A significant indirect effect of the number of medical diagnoses on LOS through NAs was observed (β = 0.448, 95% CI [0.34, 0.55]), along with a significant direct effect of medical diagnoses on LOS, even with the mediator in the model (β = 0.633, p < 0.001), indicating partial mediation (F = 321.6892; R2 = 0.295; p < 0.001). These results highlight the influence of medical diagnoses on LOS through the mediating role of NAs. Our study highlights the significant interplay between determinants of LOS in children and adolescent patients, emphasizing the need for targeted interventions, resource planning, and the integration of clinical nursing information systems to enhance care quality and support evidence-based practices. Optimizing resource distribution and implementing specific interventions for patients at risk of prolonged LOS could help mitigate this negative outcome and enhance the quality of care. Incorporating nursing data into DRG systems could improve reimbursement accuracy and benefit the nursing profession, which may result in better patient outcomes and lower hospital expanses.

Supportive care needs of the family caregivers of urostomy patients: a qualitative study

Family caregivers play a vital role during the home care of urostomy patients by providing direct care and support. The role of family caregivers may extend to several years, even over ten years, in certain cases. In this process, the caregivers are impacted in various ways due to the patient’s conditions and may not be able to identify and address their own needs, which often get ignored and remain unfulfilled. The present study aimed to explore the supportive care needs of such family caregivers of urostomy patients. The method of qualitative research with the aid of purposive sampling was adopted in the present study. A semi-structured interview was conducted with 22 family caregivers of urostomy patients. Each interview lasted 60 min. Data analysis was conducted by employing the NVivo software for qualitative research and using a thematic approach. Four themes were identified: (i) Strong psychological and physical needs; (ii) Eagerness for information regarding the patient’s diseases; (iii) Need for social support; (iv) Necessity of spiritual support. Further, within these four themes, eight sub-themes were constructed using coders. The respondents reported that they felt equally under pressure as the urostomy patients they were caring for, although the medical staff appeared to be paying little attention to them. The medical staff paid greater attention to the patients, while the caregivers also required their help and support. The need for supportive care is quite common among the family caregivers of patients with urostomy. Medical staff should comprehensively understand the needs of the family caregivers of urostomy patients and then actively provide targeted psychological/physical/information/social/spiritual support to these caregivers. This would result in enhanced caregiving skills and reduced burden among these caregivers.

Induced pluripotent stem-cell-derived CD19-directed chimeric antigen receptor natural killer cells in B-cell lymphoma: a phase 1, first-in-human trial.

FT596 is an induced pluripotent stem-cell (iPSC)-derived chimeric antigen receptor (CAR) natural killer (NK) cell therapy with three antitumour modalities: a CD19 CAR; a high-affinity, non-cleavable CD16 Fc receptor; and interleukin-15-interleukin-15 receptor fusion. In this study, we aimed to determine the recommended phase 2 dose (RP2D) and evaluate the safety and tolerability of FT596 as monotherapy and in combination with rituximab. We also aimed to evaluate the antitumour activity and characterise the pharmacokinetics of FT596 as monotherapy and in combination with rituximab. In this phase 1, first-in-human trial, we evaluated FT596 in patients with relapsed or refractory B-cell lymphoma at nine sites in the USA. Patients who had received at least one previous systemic therapy and had no curative treatment options were eligible for inclusion. FT596 was administered after conditioning chemotherapy without rituximab (regimen A) or combined with rituximab (regimen B). The study consisted of a dose-escalation phase using a 3 + 3 design, with dose escalation commencing at 3 × 107 viable cells as a single dose on day 1 and done independently for individual regimens. A treatment cycle consisted of conditioning chemotherapy with cyclophosphamide (500 mg/m2) and fludarabine (30 mg/m2) intravenously on days -5 to -3, followed by FT596 administered at various doses and schedules, without (regimen A) or with (regimen B) a single dose of rituximab (375 mg/m2) intravenously on day -4. Supportive care was determined by the treating investigator. Patients were observed for dose-limiting adverse events for 28 days. Patients who tolerated therapy and derived clinical benefit could receive subsequent cycles of study treatment, with modification of conditioning chemotherapy dose if clinically indicated. The dose-expansion phase evaluated additional patients at selected doses and dosing schedules that had been found to be tolerable. The primary endpoints of the study were the incidence and nature of dose-limiting toxicities within each dose-escalation cohort to determine the maximum tolerated dose or maximum assessed dose to establish the RP2D and the incidence, nature, and severity of adverse events, with severity determined according to National Cancer Institute Common Toxicity Criteria and Adverse Events version 5·0. The trial was registered with ClinicalTrials.gov, NCT04245722. Between March 19, 2020, and Jan 12, 2023, 86 patients with B-cell lymphoma received FT596 on regimen A (n=18) or regimen B (n=68). 22 (26%) of 86 patients were female and 72 (84%) of 86 patients were White. Patients had received a median of four previous lines of therapy (range 1-11) and 33 (38%) of 86 patients had received previous CAR T-cell therapy. The maximum tolerated dose was not reached. Cytokine release syndrome was reported in one (6%) of 18 patients (maximum grade 1) on regimen A and nine (13%) of 68 patients on regimen B (six with maximum grade 1 and three with grade 2). Neurotoxicity was not observed. FT596 was well tolerated as monotherapy or with rituximab and induced deep and durable responses in patients with indolent and aggressive lymphomas and the RP2D was preliminarily identified to be 1·8 × 109 cells for three doses per cycle. This study supports that cell therapy using iPSC-derived, gene-modified NK cells is a potent platform for cancer treatment and suggests that such a platform might address limitations of currently available immune cell therapies, including manufacturing time, heterogeneity, access, and cost. Fate Therapeutics.

Patient Acceptability of the First Integrative Pediatric Oncology Unit in Spain—The Pediatric Cancer Center Barcelona Experience: A Retrospective Study

Background/Objectives: Pediatric cancer patients and their families are increasingly combining conventional treatment with complementary therapies. These therapies are not covered by most public healthcare systems, and Spain is not an exception. To address this need, the Pediatric Cancer Center Barcelona, at the Hospital Sant Joan de Déu (Spain), established the first integrative pediatric oncology unit in 2019. The objective of this study is to describe the feasibility of implementing a pediatric integrative oncology unit, in terms of the acceptance of the interventions, as well as to present initial data on the care activities; Methods: This is a retrospective single-center study, conducted in the Pediatric Cancer Center Barcelona, at the Hospital Sant Joan de Déu. Data from patients during a two-year period were collected by reviewing medical records in a pseudonymous manner; Results: From 1 September 2019 to 30 September 2021, the unit was visited by 433 patients. The median age of patients was 9 years [range 0–34 years], with 266 boys (61.4%) and 167 girls (38.6%). Of these patients, 90.1% were in active treatment, 7.6% were survivors, and 2.3% were at the end of life. Acupuncture was recommended to 227 patients, with a 94.7% acceptance rate. Aromatherapy was recommended to 114 patients, with a 100% acceptance. The reflexology team visited 129 patients, delivering a total of 414 sessions, with a 96.1% acceptance.; Conclusions: The findings of our study support the feasibility of implementing an Integrative Pediatric Oncology Unit within a patient-centered care model in a comprehensive pediatric cancer center. The high acceptance rates of various complementary therapies highlight their potential role in enhancing supportive care for pediatric oncology patients.

Development of a brief screening measure of unmet supportive care needs (SCNS-P&C-6) in caregivers of people with high-grade glioma

PurposeInformal caregivers of people with high grade glioma (HGG) often have high levels of unmet support needs. Routine screening for unmet needs can facilitate appropriate and timely access to supportive care. We aimed to develop a brief screening tool for HGG caregiver unmet needs, based on the Supportive Care Needs Survey—Partners & Caregivers (SCNS-P&C).MethodsSecondary analysis was performed on responses to the SCNS-P&C from 188 HGG caregivers, who participated in the Care-IS trial. SCNS-P&C items were assessed against four criteria: factor loadings; prevalence; variation in domain score; diagnostic accuracy. Supplementary analysis was conducted at two timepoints (T1 & T2) on the final selected items to identify caregivers indicating no needs on the screening items but reported a need on the original SCNS-P&C, suggesting they would be “missed” by the screening items.ResultsSix items performed best against psychometric criteria, capturing two domains: Cancer impact needs and Information and communication needs. Supplementary analysis showed screening items failed to identify only 7.4% (14/188) of caregivers with other unmet needs at T1 and 11.4% (18/158) at T2. Of those missed at T1, only four were missed again at T2.ConclusionsWe identified six-items for inclusion in a brief screening tool, the SCNS-P&C-6, demonstrating good sensitivity in detecting unmet needs of caregivers of people with HGG. Use of this tool in clinical practice has the potential to improve access to care and the cancer experience for both the caregiver and person with brain tumor.

Treatment of metastatic urothelial carcinoma in the United Kingdom, France, Germany, Italy, and Spain.

The treatment landscape of metastatic urothelial carcinoma (mUC) has evolved with the emergence of programmed cell death protein 1/ligand 1 (PD-1/L1) inhibitors. This study assessed mUC treatment patterns in Europe. Data were derived from the Adelphi mUC Disease Specific Programme™ (November 2020 to April 2021), a large, cross-sectional, patient record-based survey of physicians in France, Germany, Italy, Spain, and the United Kingdom. Patient characteristics, treatment patterns across lines of therapy, and treatment durations were assessed. Physicians (N = 232) provided data for 1922 patients with mUC. Mean (SD) patient age at the time of data collection was 69.1 (7.9) years, and 81% presented with bladder tumors. Most patients received platinum-based chemotherapy in first-line (cisplatin plus gemcitabine, 43%; carboplatin plus gemcitabine, 28%), followed by PD-1/L1 inhibitors in second-line (pembrolizumab, 35%; atezolizumab, 19%). In third-line, 41% received best supportive care and 36% received single-agent chemotherapies. Mean treatment duration was longer in second-line than first-line (6.1 vs 4.8 months). Most patients received platinum-based chemotherapy in first-line, followed by a PD-1/L1 inhibitor. A substantial proportion received best supportive care after second-line. Findings indicate unmet need for the later-line treatment of mUC and provide important context for the emergence of novel therapies.

Characteristics of individuals using an integrated intensive support team within an adult community learning disability team

Purpose This paper aims to describe characteristics of individuals known to an integrated intensive support team (IST) for adults with intellectual disabilities (age, sex, ethnicity, level of intellectual disability, diagnoses). This paper also aims to report on community service input, the use of Dynamic Support Database-Clinical Support Tool, Care and Treatment Reviews and admissions and discharges from mental health hospitals. Design/methodology/approach A retrospective cohort study using routinely collected data over a two-year period. Findings Around 90 individuals aged 19–73 years were rated as at risk of admission to mental health hospital, using the Dynamic Support Database-Clinical Support Tool. There were more men (62%) than women. Almost half (47%) had a mild intellectual disability, and around a third (37%) were autistic. Of the 63 individuals known to the team who were rated red (imminent risk of admission), three individuals were admitted to hospital. Therefore, 95% of potential admissions were avoided. Practical implications This adds to the emerging evidence of the utility of ISTs integrated within community learning disability teams in reducing admissions to hospital. Originality/value To the best of the authors’ knowledge, this study is the first to evaluate IST outcomes using the Dynamic Support Database-Clinical Support Tool.

Hematological and Serum Chemistry of Canine Parvoviral Enteritis in Diverse Breeds of Dogs

Canine Parvovirus enteritis (CPV-2) is a highly infectious viral disease occurring in puppies resulting in high mortality with a myriad of clinical signs, hematological and biochemical changes during the progression of the disease. This study investigated hematological and biochemical changes in 30 CPV-positive dogs in Ibadan, Nigeria. Severe non-regenerative anemia (35.71%) and leukopenia (22 cases) were prevalent. Thrombocytopenia was severe in 73.33% of cases. Further analysis revealed normocytic hypochromic anemia in 42.86%, microcytic hypochromic anemia in 28.57%, and leukopenia categorized as mild (5), moderate (12), or severe (5). Biochemical changes included hyperproteinemia (26.7%), hyperalbuminemia, hyperglobulinemia, and elevated liver enzymes in some cases. Renal dysfunction was evident in 16.7% of dogs with elevated creatinine. Significant differences (p&lt;0.05) were observed between infected and healthy dogs. These findings underscore the critical impact of CPV on hematological and biochemical profiles, necessitating supportive care and emphasizing the crucial role of vaccination in disease prevention.

Learning from experience: does providing end-of-life care support for relatives boost personal end-of-life health literacy?

BackgroundDespite the critical role of health literacy in utilizing palliative care and engaging in advance care planning, limited research exists on the determinants of end-of-life health literacy. This study investigates the association between individuals’ experiences with end-of-life care support to relatives and their end-of-life health literacy among a population-based sample of adults aged 58 and older.MethodWe used data from 1,548 respondents in Switzerland to Wave 8 (2019/2020) of the Survey on Health, Ageing, and Retirement in Europe. Their ability to understand medical jargon, find information, communicate, and make decisions about end-of-life care options was measured with the validated Subjective End-of-Life Health Literacy Scale. Experiences with end-of-life care support include having made medical decisions as healthcare proxy, accompanied, or cared for relatives at the end of life. Associations were estimated using ordinary least squares regressions, controlling for socio-demographic, health, and regional characteristics.ResultsRespondents who experienced being a healthcare proxy (p < 0.001), who accompanied (p < 0.001), or who cared for a relative at the end of life (p < 0.001) tended to have higher levels of end-of-life health literacy. These results remained significant when the three variables were simultaneously included in the multivariable model (p < 0.001, p < 0.001 and p < 0.05).ConclusionsOur findings suggest that providing end-of-life care support to relatives is associated with higher end-of-life health literacy. Thus, as caregivers gain experience caring for others, targeted interventions could leverage their skills and encourage them to think of engaging in end-of-life planning for themselves.