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Kids Along Malady as well as Obstructive Sleep Apnea: Outcomes Following Tonsillectomy.
CONTEXT Previous studies from the US and Canada report deficiencies in informed decision-making and a need to improve end-of-life (EoL) care in dialysis patients. However, there is a paucity of literature on these issues in Pakistani dialysis patients, who differ from Western patients in culture, religion, and available healthcare services. METHODS We used convenience sampling to collect 522 surveys (90% response rate) from patients in 7 different dialysis units in Pakistan. We used an existing dialysis survey tool, translated into Urdu, and back-translated to English. A facilitator distributed the survey, explained questions, and orally administered it to patients unable to read. RESULTS Less than one-fourth of the respondents (23%) felt informed about their medical condition and 45% were hopeful that their condition would improve in future. More than half (54%) wished to know their prognosis and 80% reported having no prognostic discussion. Almost 63% deemed EoL planning important, but only 5% recalled discussing EoL decisions with a doctor during the last 12 months. Nearly 62% of the patients regretted their decision to start dialysis. Patients' self -reported knowledge of hospice (5%) and palliative care (7.9%) services was very limited, yet 46% preferred a treatment plan focused on comfort and symptom management rather than life extension. CONCLUSION Pakistani patients reported a need for better informed dialysis decision-making and EoL care and better access to palliative care services. These findings underscore the need for palliative care training of Pakistani physicians and in other developing countries, to help address communication and EoL needs of their dialysis patients. CONTEXT Supplementary support services in palliative care for older people are increasingly common, but with no recommended tools to measure outcomes, nor reviews synthesising anticipated outcomes. Common clinically focussed tools may be less appropriate. OBJECTIVE To identify stakeholder perceptions of key outcomes from supplementary palliative care support services, then map these onto outcome measurement tools to assess relevance and item redundancy. METHODS A scoping review using Arksey and O'Malley's design. EMBASE, CINAHL, MEDLINE and PSYCHinfo searched using terms relating to palliative care, qualitative research and supplementary support interventions. Papers imported into Endnote™, and Covidence™ used by two reviewers to assess against inclusion criteria. Included papers were imported into NVivo™, and thematically coded to identify key concepts underpinning outcomes. Olprinone nmr Each item within contender outcome measurement tools was assessed against each concept. RESULTS 60 included papers focused on advance care planning, guided conversations, and volunteer befriending services. Four concepts were identified enriching relationships; greater autonomy and perceived control; knowing more; and improved mental health. Mapping concepts to contender tool items revealed issues of relevance and redundancy. Some tools had no redundant items, but mapped only to two of four outcome themes, others mapped to all concepts, but with many redundant questions. Tools such as ICECAP-SCM and McGill Quality of Life had high relevance and low redundancy. CONCLUSIONS Pertinent outcome concepts for these services and population are not well represented in commonly used outcome measurement tools, and this may have implications in appropriately measuring outcomes. This review and mapping method may have utility in fields where selecting appropriate outcome tools can be challenging. BACKGROUND We designed group coaching calls to reinforce communication skill acquisition and Serious Illness Care Program (SICP) uptake in adult primary care. MEASURES Percentage of primary care physicians who have documented a Serious Illness Conversation in the electronic health record (EHR) approximately 3 and 6 months after the coaching intervention. Participant feedback surveys to better understand provider attitudes toward the coaching intervention. INTERVENTION We offered 60-minute group coaching calls to internal medicine primary care physicians, previously trained in serious illness conversation skills, as part of an institutional quality incentive program. The calls addressed communication challenges common to serious illness care and instructed participants about how to document and bill for conversations. OUTCOMES We completed 31 coaching calls over three months in which 170 of 228 primary care physicians attended in groups of 2-9 participants per call (74.6% penetration rate). The percentage of primary care physicians who documented at least one Serious Illness Conversation in the electronic health record increased from 18.4% to 41.2% six months after the intervention. Primary care internal medicine physicians found the one-hour coaching calls to be highly valuable, with 86.9% of respondents attesting they would recommend the calls to their colleagues. Content analysis of participant feedback identified the most useful coaching content elements to be self-reflection around the impact of prior conversation skills training, instruction around using the EHR to find and document ACP discussions, the opportunity to share individual challenges and successes with peers, and feedback/advice from communication experts in palliative care. CONCLUSIONS/LESSONS LEARNED Group coaching of primary care physicians resulted in more than a two-fold increase in documented serious illness conversations. Delivery of hydrophobic drugs is a significant challenge due to poor solubility and formulation difficulty. Here, we describe the potential of ionic liquids, in particular choline and geranic acid (CAGE), for oral delivery of a hydrophobic drug, sorafenib (SRF). CAGE provided excellent apparent solubility of SRF tosylate (> 500 mg/mL). Upon oral dosing in rats, CAGE increased peak blood concentrations of SRF by 2.2-fold. The elimination half-life of SRF was also increased by 2-fold and the mean absorption time was extended by 1.6-fold. Furthermore, SRF delivered by CAGE exhibited significantly different biodistribution compared to control formulations. Specifically, accumulation in lungs and kidneys improved 4.4-fold and 6.2-fold, respectively compared to control formulations. Mechanistic studies revealed that SRF-CAGE solution spontaneously formed a self-assembled structure (427 ± 41 nm), which is likely responsible for altered biodistribution in vivo. UPLC-MS studies confirmed the presence of choline-geranate species in blood indicative of micellar/emulsion structures which eventually dissociated into choline and geranic acid molecular species.
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