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Adolescent sociable seclusion brought on alterations in nucleus accumbens glutamate signalling.
CONCLUSIONS Palliative care needs strengthening in rural areas, and increased competence for all healthcare professionals is vital to increase equality in care. Geographical conditions require locally adapted solutions. Access to guidelines and interprofessional collaboration are essential. IMPLICATIONS FOR PRACTICE Rural palliative care needs in Norway are improving, as exemplified by at least 1 cancer nurse assigned to each local authority, and access to guidelines and palliative tools and interprofessional collaboration.BACKGROUND Patients with cancer have high symptom burden and unmet needs and therefore can benefit from palliative care. Oncology nurses are consistent providers of care to patients with cancer and can provide palliative care to these patients. However, oncology nurses' knowledge on palliative care has not been systematically evaluated. OBJECTIVE To synthesize the current state of the science of oncology nurses' knowledge on palliative care. METHODS A systematic literature search was completed using PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO databases using the following key words (oncology nurs*) AND (knowledge OR attitude OR belief OR perception) and (palliative care OR supportive care OR terminal care OR end-of-life care OR hospice). The quality of identified studies was rated on a 7-point scale using Fineout-Overholt's hierarchy of evidence. RESULTS Twenty studies from 10 different countries were identified and synthesized for this review. Seventeen studies were quantitative, whereas 3 were qualitative studies. Results revealed that oncology nurses lacked knowledge on several aspects of palliative care. CONCLUSIONS Overall oncology nurses did not possess adequate knowledge on palliative care. Factors influencing oncology nurses' knowledge on palliative care included nurses' sociodemographic factors, educational status, years of experience, palliative care education/training, and clinical setting. IMPLICATIONS FOR PRACTICE This review provides evidence on gaps of oncology nurses' knowledge on palliative care and helps inform the design of interventions targeted toward enhancing oncology nurses' knowledge on palliative care.BACKGROUND Application of patient-reported outcome measures (PROM) seems to be a step toward person-centered care and identifying patients' unmet needs. OBJECTIVE To investigate the experiences of nurses when PROMs were introduced in a hematological clinical practice as part of a multimethod intervention study. METHODS The qualitative framework was guided by the interpretive description (ID) methodology, including a focused ethnographic approach with participant observations and interviews. The instruments introduced were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Outcomes and Experiences Questionnaire. Analysis was inspired by Habermas' critical theory. RESULTS The analysis revealed 2 predominant themes of nurses' experiences "PROMs are only used when there is time-which there rarely is" and "PROMs cannot be used without a strategy, just because they are present." CONCLUSIONS Nurses' experiences with PROMs depended on the systems' rationale, resulting in limited capacity to use and explore PROMs. Nurses believed that PROMs might have the potential to support clinical practice, as PROMs added new information about patients' conditions but also identified needs within supportive care, leaving the potential of PROMs uncertain. Simply introducing PROMs to practice does not necessarily actuate their potential because use of PROMs is dependent on institutional conditions and mandatory tasks are prioritized. IMPLICATIONS FOR PRACTICE This study contributes knowledge of nurses' experiences when introducing PROMs in a hematological outpatient clinical practice. Findings can guide future PROMs research within the field of nursing.BACKGROUND Difficult weaning frequently develops in ventilated patients and is associated with poor outcome. In neurally adjusted ventilatory assist, the ventilator is controlled by diaphragm electrical activity, which has been shown to improve patient-ventilator interaction. The objective of this study was to compare neurally adjusted ventilatory assist and pressure support ventilation in patients difficult to wean from mechanical ventilation. METHODS In this nonblinded randomized clinical trial, difficult-to-wean patients (n = 99) were randomly assigned to neurally adjusted ventilatory assist or pressure support ventilation mode. The primary outcome was the duration of weaning. Secondary outcomes included the proportion of successful weaning, patient-ventilator asynchrony, ventilator-free days, and mortality. Weaning duration was calculated as 28 days for patients under mechanical ventilation at day 28 or deceased before day 28 without successful weaning. RESULTS Weaning duration in all patients was statistf stay in the intensive care unit and in the hospital were similar among groups. CONCLUSIONS In patients difficult to wean, neurally adjusted ventilatory assist decreased the duration of weaning and increased ventilator-free days. WHAT WE ALREADY KNOW ABOUT THIS TOPIC Neurally adjusted ventilatory assist is safe and well tolerated by patientsIt improves patient-ventilator interaction WHAT THIS ARTICLE TELLS US THAT IS NEW In selected patients difficult to wean from mechanical ventilation, neurally adjusted ventilatory assist improves patient outcome indicated by reduction in duration of weaningSuch a benefit seems most prominent in tracheostomized patients.OBJECTIVES The treatment of Parkinson disease (PD) psychosis remains a challenge. Only a few treatments eliciting significant relief of psychotic symptoms have passed the test of randomized controlled trials. METHODS Here, we conducted a review of the literature on the effect of antidepressants on PD psychosis. Because there is no randomized controlled trial that assessed the antipsychotic effects of antidepressants in PD, only case reports, case series, and open-label trials were available to review. Because of the scarce literature, statistical analysis could not be performed. RESULTS The following antidepressants alleviated hallucinations in PD amoxapine, citalopram, clomipramine, escitalopram, mianserin, mirtazapine, and venlafaxine. Repertaxin The antidepressants were generally well tolerated, with the exception of amoxapine, which exacerbated parkinsonism. CONCLUSIONS Whereas the conclusions that can be drawn on the efficacy of antidepressants at reducing PD psychosis are limited because of the poor quality of the reported studies, it is encouraging to notice that there are positive anecdotal reports.
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