Tailored Care Plan Research Articles

Supporting People and Their Caregivers Living with Advanced Cancer: From Individual Experience to a National Interdisciplinary Program.

To discuss the unmet needs of patients living with advanced cancer and their caregivers and to review strategies, including collaborating with community and non-profit organizations, to help improve the experience of living with, and beyond, advanced cancer. Published articles, first person experience (SB), community organization input, and survey data (Canadian Cancer Society). People living with advanced cancer face significant challenges, including persistent physical symptoms and psychosocial concerns, difficulties with coordination of care, and possible lack of available resources and supports if the person is no longer being followed by cancer health care professionals. More research is required to better understand the needs of patients and their caregivers living with advanced cancer. Existing resources and supports may be inadequate for this population, and delineation of the unique needs of this population may lead to tailored care plans and, ultimately, an improved experience for patients and caregivers alike. Oncology nurses are ideally suited to care for this population to help elucidate their unique unmet needs and collaborate with patients and other clinicians to develop interventions to address such unmet needs. Oncology nurses can liaise with community organizations to identify sources of support and resources for patients and their loved ones and advocate for improved care for patients affected by advanced cancer.

Bariatric surgery: Nutrition-related challenges and interventions in postoperative care

Abstract Bariatric surgery stands as a definitive treatment option for obesity, which is considered a chronic ailment. This review article outlines the various types of bariatric procedures and their associated complications, both early and late. It mainly focuses on the nutritional aspects and the significance of pre- and postoperative nutrition care in optimizing surgical and health outcomes, and addressing challenges faced by healthcare providers in managing bariatric patients. The article advocates for comprehensive support, education, and tailored care plans to improve patient outcomes and enhance their overall quality of life in the long term.

Health Promotion Behavior among Older Korean Family Caregivers of People with Dementia.

People adopt health promotion behaviors to promote their health as they interact within the environment. The purpose of this study was to examine factors influencing health promotion behaviors among older adults caring for family members with dementia. For this cross-sectional study, data from 135 older adults who were the main caregivers were collected at an outpatient clinic at a university hospital in the capital city of South Korea between September and October in 2020. Sociodemographic characteristics, caregiver-related characteristics, dementia knowledge, fear of dementia, and health promotion behaviors were measured. Univariate analysis revealed that the level of health promotion behaviors differed by age, sex, educational level, monthly income, relationship with the family member with dementia, and cohabitation with family members with dementia. In the multivariate analysis, a hierarchical multiple regression model explained 33.9% of the variance. Sex, duration of caregiving, use of long-term care service, and fear of dementia predicted health promotion behavior. A strategic tailored care plan for target population is needed to improve the health promotion behavior of older adults caring for family members with dementia.

The implementation of family nursing in a municipality of the Provence of Bolzano

. The implementation of Family Nursing in a municipality of the Provence of Bolzano. In the Province of Bolzano, 45 Family and Community Nurses have been trained to date with a 1250-hour course of which 400 hours of practical training. The working model adopted is the Calgary Assessment model, based on ithe relationship with families. The experience of the District of Bassa Atesina, which includes ten municipalities and about 40,000 inhabitants, is described, and in particular the assignment of three family nurses to a mountain municipality with a population of 1700 inhabitants, located with a considerable territorial dispersion. The FCNs cared for 48 families with tailored care plans. The model will be extended to other Districts.

Care partner-assisted intervention to improve oral health for older adults with cognitive impairment: A feasibility study.

Older adults with cognitive impairment often experience poor oral health outcomes due to inadequate oral hygiene practices. This pilot study aimed to evaluate the feasibility of a care partner-assisted intervention to improve the oral hygiene of community-dwelling older adults with cognitive impairment. The 6-month intervention included 25 older adults with mild dementia or mild cognitive impairment, who were randomly assigned to Treatment Group 1 or Treatment Group 2. Treatment Group 1 (n=7) received an educational booklet. Treatment Group 2 (n=18) received a booklet, a tailored care plan for the participants with cognitive impairment and the care partner received four coaching sessions to learn to facilitate good oral hygiene. Both groups received electric toothbrushes. The study consisted of a 3-month active intervention and 3-month maintenance phase. The outcomes of gingival index, plaque index and overall oral health status based on the Oral Health Assessment Tool were measured at baseline, 3months (end of active intervention) and 6months of the study. This study had very low dropout rate. Participants' oral hygiene improved in this study. In comparison to Treatment Group 1, participants in Treatment Group 2 had a greater reduction in plaque level and gingival inflammation, and greater improvement in overall oral health status. This study demonstrates the feasibility of this intervention designed to improve the oral health of persons with cognitive impairment and it lays the foundation for using this protocol in a future large randomised clinical trial.

Community-Engaged Approach to the Development and Implementation of a Student-Centered Return to Learn Care Plan After Concussion.

Current return to learn (RTL) after concussion guidelines lack specificity for individualized student care, limiting potential for adoption and implementation. We used a community-engaged research framework to develop and evaluate the implementation of a student-centered care plan that assists school personnel in facilitating RTL. We used best-practice RTL guidelines and input from administrators and medical experts to iteratively develop a flexible student-centered care plan. Thirteen schools participated. Coding completion of care plans indicated feasibility and fidelity; interviews with RTL coordinators indicated acceptability. The care plan includes educational materials, symptom checklists, and guidelines for classroom adjustments linked to student symptoms. Care plans were initiated for 24 (70.6%) of 34 students with concussions, indicating feasibility. Fidelity was high, with the following subsections completed: Action Checklist (90%), Symptom Evaluation (91%), Temporary Adjustment Recommendations (95%). Qualitative analysis of interviews suggested care plans were acceptable and facilitate consistent communication, prioritization of individual needs of students, and increased ability to delegate tasks to other school staff. Implementation of a student-centered, individually tailored care plan for RTL is feasible and acceptable in public high schools. Future research should examine how to expediently initiate student-centered concussion care plans after diagnosis to optimize recovery.

Perspectives of Afghan refugee mothers on the experience of caring for a child with cancer: a qualitative analysis.

Cancer in children causes many challenges for the family. When a refugee family experiences it, its impacts may be different and more specific considerations for care may be needed. This study aimed to explore the experiences of Afghan mothers living in the Islamic Republic of Iran who had a child with cancer. This was a qualitative study, conducted in 2017, of Afghan refugee women with children diagnosed with cancer and referred to a cancer referral hospital in Tehran; they were selected through purposive sampling. Face-to-face, semi-structured and in-depth interviews were conducted for data collection until data saturation was reached. Conventional content analysis was done. MAXQDA 10 was used for organizing the data. Nine Afghan mothers were interviewed. They were aged 24-44 years and the children were aged 2-9 years. A primary theme called "passive acceptor" was found with five subthemes: chronic suffering, health issues, lack of skills, maladaptive coping and enthusiasm. The mothers were struggling to cope with the challenges of caring for a child with cancer both financially, physically and emotionally. In spite of many issues in common with similar groups in other countries, Afghan mothers appear to need to greater assistance when it comes to seeking help and understanding for the care for their child with cancer, possibly because of cultural barriers to self-empowerment. Tailored care plans are recommended for Afghan refugee mothers in the Islamic Republic of Iran.

Supporting patients with long-term conditions in the community: Evaluation of the Greater Manchester Community Pharmacy Care Plan Service.

The Greater Manchester Community Pharmacy Care Plan (GMCPCP) service provided tailored care plans to help adults with one or more qualifying long-term condition (hypertension, asthma, diabetes and COPD) to achieve health goals and better self-management of their long-term conditions. The service ran between February and December 2017. The aim of this study was to investigate the impact of the service on patient activation, as measured by the PAM measure (primary outcome). Secondary outcomes included quality of life (EQ-5D-5L, EQ-VAS), medication adherence (MARS-5), NHS resource use and costs, systolic and diastolic blood pressure, HDL cholesterol ratio levels and body mass index (BMI). A before and after design was used, with follow-up at 6-months. A questionnaire was distributed at follow-up and telephone interviews with willing participants were used to investigate patient satisfaction with the service. The study was approved by the University of Manchester Research Ethics Committee. Quantitative data were analysed in SPSS v22 (IBM). A total of 382 patients were recruited to the service; 280 (73%) remained at follow-up. Ten patients were interviewed and 43 completed the questionnaire. A total of 613 goals were set; mean of 1.7 goals per patient. Fifty percent of goals were met at follow-up. There were significant improvements in PAM, EQ-5D-5L and EQ-VAS scores and significant reductions in systolic blood pressure, BMI and HDL cholesterol ratio at follow-up. Mean NHS service use costs were significantly lower at follow-up; with a mean decrease per patient of £236.43 (±SD £968.47). The mean cost per patient for providing the service was £203.10, resulting in potential cost-savings of £33.33 per patient (SD±874.65). Questionnaire respondents reported high levels of satisfaction with the service. This study suggests that the service is acceptable to patients and may lead to improvements in health outcomes and allows for modest cost savings. Limitations of the study included the low response rate to the patient questionnaire.

Assess frailty but avoid frailtyism.

The assessment of frailty in heart failure patients can help clinicians to build a tailored care plan, aimed at improving the selection of patients likely to benefit from one treatment vs. another, thereby improving outcomes. Although progress has been made in the ‘operationalization’ of frailty assessment, there is still the need to provide an improved instrument to assess frailty that is easy, quick and at the same time predictive within the setting of a busy clinical practice. Using such an ideal instrument, clinicians would be able to optimize the use of limited health care resources and avoid what has been termed ‘frailtyism’. This term, similar to ageism, can be defined as prejudice or discrimination based on the presence of frailty.

357 Utilizing a Health Information Exchange to Improve Care Transitions After an Emergency Department Visit

Improving care transitions for ambulatory sensitive conditions such as diabetes between the ED and primary care is important to patient safety. Health information exchanges (HIEs) may be useful tools in this process, although data demonstrating this impact is lacking. The primary objective of this study was to assess the feasibility of implementing a tailored care plan in the emergency department Information Exchange (EDIE), a statewide emergency department HIE and care coordination platform endorsed by the American College of Emergency Physicians. We hypothesize that patients who receive this intervention will have decreased ED visits and increased contacts with primary care providers after an ED visit compared to patients who did not receive the intervention. We performed a randomized parallel experimental study with a pre-post design. A total of 260 patients who were attributed to one of four primary care clinics within the University of Washington system, had a diagnosis of diabetes and had at least one ED visit were randomly assigned to the CARE (Coordination and Referral from Emergency) intervention or a control arm. CARE included a tailored care plan in the EDIE which is a care coordination HIE platform that is used in all EDs in Washington and across 22 states. The care plan included primary care clinic information, current diabetes medications, and HgA1c values and was pushed to emergency providers at the time a patient checked in to any ED that utilizes EDIE. Care plans were updated weekly. Measured outcomes included statewide ED visits and primary care clinic contacts within 10-days of an ED visit. These outcomes were compared using “differences in differences” models 12 months pre- and post-intervention. Overall, the number of ED visits decreased significantly in the post-intervention period (mean ratio: 0.75, p=0.002). The decrease was statistically significant in the intervention group (0.66, p=0.003) while the decrease in the control group was non-significant (0.83, p=0.10) over the same period. Similarly, the rate of primary care provider contacts after an ED visit decreased significantly overall (odds ratio: 0.76, p=0.048). In this case the decrease was statistically significantly in the control group (0.68, p=0.018) but not in intervention group (0.86, p=0.45). However, the difference in differences was not significant for either ED visits (p=0.11) or clinic contacts (p=0.37). Results were similar when adjusting for site, sex, age, and English as primary spoken language. Overall implementation of tailored care plans within a HIE care coordination platform is feasible. Patients with diabetes and previous ED visits with a tailored care plan in a statewide care coordination HIE had fewer ED visits after implementation. However, differences in post-period ED visits and clinic contacts were not statistically significant between experimental and control groups.

The importance of sources of meaning in life of community dwelling psychologically frail older people

Purpose Psychological frailty adds most to overall feelings of frailty, but is often neglected, although meaning in life is important for psychological well-being. The purpose of this paper is to explore the sources of meaning in life within psychologically frail older people. Design/methodology/approach Data (n= 16,872) generated from the Belgian Ageing Studies were collected, using the Comprehensive Frailty Assessment Instrument and the Sources of Meaning Profile (SOMP-R) instrument. Psychometric properties of the SOMP-R were explored using factor and reliability analysis and one-way-ANOVA analysis were used to asses mean differences. Findings Financial security, meeting basic needs and personal relations play an important role as sources of meaning in life. Moreover, the SOMP-R showed excellent psychometric properties. Research limitations/implications Due to the cross-sectional design of this study, evolution in time and causal links could not be assessed. Practical implications The findings of this study emphasize that sources of meaning in life are relevant and can be assessed using the SOMP-R upon which individually tailored care plans can be developed. The results show that, meaning in life as such plays an important role for psychologically frail older people. As a consequence, this offers insights to support these older people. Caregivers and policymakers might therefore take these results into account. Guarantee and/or follow up a frail individual’s financial security, assessing and enabling one’s personal relationships and meeting their basic needs are very important when taking care of psychologically frail older individuals. Social implications Besides the practical implications, the social inclusion of psychologically frail older people seems to be relevant. Originality/value To the best of the authors’ knowledge, the association between meaning in life and psychological frailty in later life is not yet investigated. Further the findings of this study emphasize that sources of meaning in life are relevant and can be assessed using the SOMP-R upon which individually tailored care plans can be developed.

Using Temporal Features to Provide Data-Driven Clinical Early Warnings for Chronic Obstructive Pulmonary Disease and Asthma Care Management: Protocol for a Secondary Analysis.

BackgroundBoth chronic obstructive pulmonary disease (COPD) and asthma incur heavy health care burdens. To support tailored preventive care for these 2 diseases, predictive modeling is widely used to give warnings and to identify patients for care management. However, 3 gaps exist in current modeling methods owing to rarely factoring in temporal aspects showing trends and early health change: (1) existing models seldom use temporal features and often give late warnings, making care reactive. A health risk is often found at a relatively late stage of declining health, when the risk of a poor outcome is high and resolving the issue is difficult and costly. A typical model predicts patient outcomes in the next 12 months. This often does not warn early enough. If a patient will actually be hospitalized for COPD next week, intervening now could be too late to avoid the hospitalization. If temporal features were used, this patient could potentially be identified a few weeks earlier to institute preventive therapy; (2) existing models often miss many temporal features with high predictive power and have low accuracy. This makes care management enroll many patients not needing it and overlook over half of the patients needing it the most; (3) existing models often give no information on why a patient is at high risk nor about possible interventions to mitigate risk, causing busy care managers to spend more time reviewing charts and to miss suited interventions. Typical automatic explanation methods cannot handle longitudinal attributes and fully address these issues.ObjectiveTo fill these gaps so that more COPD and asthma patients will receive more appropriate and timely care, we will develop comprehensible data-driven methods to provide accurate early warnings of poor outcomes and to suggest tailored interventions, making care more proactive, efficient, and effective.MethodsBy conducting a secondary data analysis and surveys, the study will: (1) use temporal features to provide accurate early warnings of poor outcomes and assess the potential impact on prediction accuracy, risk warning timeliness, and outcomes; (2) automatically identify actionable temporal risk factors for each patient at high risk for future hospital use and assess the impact on prediction accuracy and outcomes; and (3) assess the impact of actionable information on clinicians’ acceptance of early warnings and on perceived care plan quality.ResultsWe are obtaining clinical and administrative datasets from 3 leading health care systems’ enterprise data warehouses. We plan to start data analysis in 2020 and finish our study in 2025.ConclusionsTechniques to be developed in this study can boost risk warning timeliness, model accuracy, and generalizability; improve patient finding for preventive care; help form tailored care plans; advance machine learning for many clinical applications; and be generalized for many other chronic diseases.International Registered Report Identifier (IRRID)PRR1-10.2196/13783

Healing from Childhood Sexual Abuse: A Meta-Synthesis of Qualitative Studies

ABSTRACTAlthough the global prevalence of childhood sexual abuse (CSA) is very high, the experience of healing after such abuse has not been well documented. The goal of this study was to characterize the healing experience among CSA survivors presented in the literature. Metaethnography was used to synthesize an integrative literature review. The CINAHL, PubMed, PsycINFO, and Web of Science databases were used as data sources. Eight articles that explored healing experiences from CSA, published between 2007 and 2017, were included in the analysis. After performing a quality assessment, line-of-argument synthesis was used to construct the integrating scheme of healing experiences from CSA. CSA healing experiences included dissociating oneself from the memories of CSA, finding peace by creating a comfort zone, disclosure as the start of healing, attempting to establish identity through ongoing self-reflective activities, feeling comfort by sharing experiences and connecting with CSA survivors, and accepting CSA as part of the life history and stepping forward. Healing experiences from CSA synthesized from the analysis focused on personal growth, supporting previous theory on CSA health in the broader literature. A tailored care plan could be developed for CSA survivors who are at varying stages of healing.

Development of an Instrument to Assess Stroke Caregivers' Readiness for the Transition Home.

The study purpose was to develop a measure to assess stroke caregivers' commitment and capacity to assume the caregiving role prior to discharge. Participants were caregivers of stroke survivors in an inpatient rehabilitation facility. A sequential, multimethod approach, which included item generation from qualitative data, review of items by expert clinicians, cognitive interviews to determine response format (n = 22), and item clarity (n = 20), and an analysis of pilot data were utilized. Cognitive interviewing provided information to improve item clarity. This instrument development approach resulted in the Preparedness Assessment for the Transition Home After Stroke (PATH-s), a 26-item self-report instrument. The PATH-s represents the domains of the Model of Caregiver Readiness, upon which the instrument was developed. The PATH-s, once further validated, may guide healthcare providers in the development of tailored care plans to address identified gaps and better prepare caregivers for the transition home.

Evaluation of a survivorship needs assessment planning tool for head and neck cancer survivor-caregiver dyads.

The objectives of this study were to test the acceptability and feasibility of a survivorship needs assessment planning (SNAP) tool for head and neck cancer (HNC) survivors and caregivers, evaluate short-term changes in psychosocial outcomes after completing the SNAP session, and develop strategies for system refinement. We used a prospective one-group design and mixed methods with HNC survivors and caregivers (N = 25 dyads). Participants completed baseline and 6-week surveys before and after completing a SNAP clinic visit to assess psychosocial outcomes and acceptability. Intervention sessions included tablet-based needs assessments driving tailored care plans. Dyads' open-ended feedback and clinician interviews (N = 12) evaluated acceptability and feasibility. SNAP data collection time burden and technology challenges were minimal, and care plans included messages (M= 19), educational materials (M = 13), and referrals (M = 4.5; 86% behavioral medicine, 77% nutrition, 65% physical therapy). Participants reported high satisfaction with the session and care plan, highlighting the key strengths of pulling complex medical information together and the focus on caregiver well-being, with multiple suggestions to facilitate clinic workflow. Depression and unmet needs decreased and survivorship knowledge increased significantly in survivors and caregivers (p < .05) over the 6-week period. The SNAP tool is an innovative technology-based survivor-centered strategy to assess and manage needs in HNC survivors and caregivers. Results support its acceptability and ability to address dyads' needs; the tool merits further testing in a clinical trial. Technology-enabled care planning may be a productive way to assess and address HNC dyads' dynamic needs after treatment.

Comprehensive geriatric assessment in integrated care for older people living at home: a systematic review

Introduction : Older people living at home may experience problems in the physical, cognitive, psychological, social and/or environmental life domains, leading to complex care needs. Integration of health and social care is widely acknowledged as an adequate way to address these complex needs. An important component of integrated care programs is a comprehensive geriatric assessment CGA which helps to identify older people’s care needs and preferences. A CGA provides the basis for a tailored care plan, consisting of specific actions to support older people in their homes. In the wide range of integrated care programs for frail older people, different CGA tools are being used. To the best of our knowledge, a comprehensive overview of the characteristics of the different CGA tools is currently lacking. The aim of our study was therefore to describe and compare different CGA tools and procedures for conducting them. Methods : A systematic literature search in the electronic databases Embase/Medline and Scopus was conducted to search for papers describing CGAs in integrated care programs for older people living at home. Our search yielded 814 potentially relevant publications. Two researchers independently assessed eligibility based on title and abstract and full text screening. In total, 26 integrated care programs were included in our review. The identified integrated care programs were reviewed as to their main characteristics: country, program objective, target group, setting and involved professionals. Data extraction for information about the CGAs included: CGA tool/instruments, comprehensiveness i.e. life domains being addressed, multidisciplinarity i.e. extent to which professionals from different disciplines are involved, person-centredness i.e. extent to which older people and informal carers are involved and procedures to conduct a CGA. Results : Included studies shows a great variety of CGAs used in integrated care programs. Most integrated care programs were implemented in the Netherlands and the United States. The majority of CGAs seemed to address comprehensiveness, multidisciplinarity and person-centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. Furthermore, some identified instruments are broadly used in different countries e.g. RAI-CHA, whereas others e.g. [G]OLD instrument are developed and used exclusively in one specific program. Discussion/conclusion : This study shows that integrated care programs, in different settings and for different target groups, have different ways of conducting a CGA. Due to this heterogeneity, older people’s needs and preferences are being assessed and addressed in different ways. It is still unclear what works best in conducting a CGA in the context of integrated care and whether the existing range of CGAs is adequate. Limitations/suggestions for future research : We did not include the entire range of existing CGAs in this review, as several papers did not adequately describe the CGA tool and procedures used. A more thorough description of CGAs as a component of an integrated care program is recommended to complement the current overview of CGAs. Further research is recommended to develop guidance on how older people’s problems and care needs should best be assessed and to prevent researchers and professionals from reinventing the wheel.

What do nursing home residents with mental-physical multimorbidity need and who actually knows this? A cross-sectional cohort study

ObjectiveAging societies will bring an increase in the number of long-term care residents with mental-physical multimorbidity. To optimize care for these residents, it is important to study their care needs, since unmet needs lower quality of life. To date, knowledge about care needs of residents with mental-physical multimorbidity is limited. The aim of this study was to explore (un)met care needs of residents with mental-physical multimorbidity and determinants of unmet needs. MethodsCross-sectional cohort study among 141 residents with mental-physical multimorbidity without dementia living in 17 geronto-psychiatric nursing home units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. The Camberwell Assessment of Need for the Elderly (CANE) was used to rate (un)met care needs from residents’ and nursing staff’s perceptions. Descriptive and multivariate regression analyses were conducted. ResultsResidents reported a mean number of 11.89 needs (SD 2.88) of which 24.2% (n = 2.88, SD 2.48) were unmet. Nursing staff indicated a mean number of 14.73 needs (SD 2.32) of which 10.8% (n = 1.59, SD 1.61) were unmet. According to the residents, most unmet needs were found in the social domain as opposed to the psychological domain as reported by the nursing staff. Different opinions between resident and nursing staff about unmet needs was most common in the areas accommodation, company, and daytime activities. Further, nearly half of the residents indicated ‘no need’ regarding behavior while the nursing staff supposed that the resident did require some kind of support. Depression, anxiety and less care dependency were the most important determinants of unmet needs. ConclusionsSystematic assessment of care needs showed differences between the perspectives of resident and nursing staff. These should be the starting point of a dialogue between them about needs, wishes and expectations regarding care. This dialogue can subsequently lead to the most optimal individually tailored care plan. To achieve this, nurses with effective communication and negotiation skills, are indispensable.

Abstract WMP111: Assessing Caregiver Commitment and Capacity

Care transitions for individuals with disabling conditions, such as stroke, are often ineffective and inefficient, resulting in unmet patient and caregiver (CG) needs, increased safety risks, high rates of preventable readmissions, and increased health care costs. This is particularly problematic for stroke patients transitioning from an inpatient rehabilitation facility (IRF) to home. There is no assessment instrument specifically designed to evaluate a family member’s commitment and capacity to assume the caregiving role following a stroke survivor (SS) discharge from an IRF or sub-acute facility. This is critically needed to facilitate the development of tailored care plans and interventions to mitigate risks associated with the crisis of stroke and the associated health effects on the CG and SS. The purpose of this study is determine the psychometric properties of the Preparedness Assessment for the Transition Home after Stroke (PATH-s) instrument. The PATH-s instrument is a 25-item, 4-point scale based on the foundational work of B. Lutz (Co-Investigator). A prospective cohort study was conducted to establish the psychometric properties of the PATH-s instrument using a convenience sample of 184 SSs and their family caregivers during IRF admission. Data collection from SSs and CGs at IRF admission was conducted to determine the quality of the items, internal consistency, reliability, construct validity, and criterion-related validity. We will describe the characteristics of CG responses on the PATH-s instrument during IRF in addition to correlation with other measures (general health, perceived stress, depression). This novel instrument can support a primary prevention strategy to identify gaps in preparedness for stroke survivor-caregiver dyads following the complex transition from IRF to home, with the long-range goal to mitigate the effects of suboptimal preparation and the associated adverse effects associated with this transition on the health of CGs and SSs. Once gaps are identified, care plans can be tailored to address gaps and better prepare caregivers for the transition home.

Management of diabetes in older adults

Type 2 diabetes prevalence is high in older adults and is expected to rise in the next decades. Diabetes in the population of frail older adults is accompanied by functional disability, several comorbidities, and premature mortality. A comprehensive geriatric assessment, including functional, cognitive, mental and social status, is advisable for identifying the glycemic targets and glucose-lowering therapies, focused on patient preferences, needs, and risks. The therapeutic options for older adults with diabetes are like those for the adult population. However, the pharmacological treatments must be carefully prescribed and monitored, taking into consideration the patient cognitive capacities, the potentially life-threatening drug–drug interactions, the cardiovascular risk, and with the main goal of avoiding hypoglycemia. Also, a careful nutritional evaluation with appropriate tools, as well as a balanced and periodically monitored physical activity, contribute to an effective tailored care plan, as needed by older adults with diabetes. This review evaluates the currently available hypoglycemic drugs and the current indications to the Italian diabetology community, specifically with regard to the treatment of adults aged 75 years or older with diabetes, including the unmet needs by the guidelines.

Sleep quality of endometrial cancer survivors and the effect of treatments.

Objective:Sleep disorders affect 54.9% of gynaecologic cancer survivors. The effect of treatment methods on sleep quality is not clear. This study evaluated the sleep quality of survivors of endometrial cancer and compared the effects of different treatments on sleep quality.Materials and Methods:Patients were categorised as surgery (group 1), surgery + brachytherapy (BRT) (group 2), surgery + external beam radiation therapy (EBRT) (group 3), and surgery + EBRT + BRT + chemotherapy (group 4). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The PSQI was completed by the participants before surgery, 1, 3, and 6 months after each treatment was completed. The PSQI scores were compared between the different measurement times and different study groups.Results:This study enrolled 114 patients with a mean age of 58.1±11 years. The number of participants in each group was 53 (46.5%), 14 (12.3%), 12 (10.5%), and 35 (30.7%), respectively. At baseline, 28 (24.6%) patients reported poor sleep quality. The mean PSQI score reached the maximum level at the second measurement and decreased slightly during follow-up and the change in the PSQI score was significant (p=0.001). Group 3 and group 4 had significantly higher scores from baseline (p<0.008). At time point 3, the differences between the groups were significant. At time point 4, the most prominent effect of treatment on sleep quality was observed in patients with combined chemo-radiotherapy when compared with the other study groups.Conclusion:Most survivors of endometrial cancer are affected by poor sleep quality during their treatment. To improve these patients’ quality of life, this disorder must be considered at each visit and tailored care plans should be developed to meet the women’s needs. Further studies are needed to evaluate the long-term results of sleep quality on patients with endometrial cancer.