Risultati per: Linee guida sulle cure palliative nei pazienti affetti da cancro

Oncologa, ‘ipotesi difficili’. Il decorso varia, non sempre è lento

Comunicato del 04/02/2024 n°7

Stroke, Volume 55, Issue Suppl_1, Page AWP143-AWP143, February 1, 2024. Introduction:AHA Guidelines call for utilization of Palliative Care (PC) for all patients with serious, life-threatening stroke. The purpose of this study was to assess factors associated with change in Code Status and PC utilization for patients with large vessel occlusion undergoing EVT.Methods:We retrospectively reviewed prospectively collected data in an IRB-approved stroke registry at two large, academic Comprehensive Stroke Centers. Subjects who received EVT for acute ischemic stroke (AIS) between 2014-2022 were included. Patients were grouped by change in code status during hospitalization. Baseline demographics were compared between groups with frequencies, chi-squared or t-test as appropriate. A correlation matrix was constructed and regression was performed.Results:Of the 411 included patients, 88 had code status changes. There was a significant difference in age, history of diabetes, last known well to hospital arrival, groin puncture to recanalization, and sICH within 36 hours between groups (Table 1). Goals of care (GOC) discussion was documented in only 36% of patients, with a mean of 4 days from stroke onset to code status change. Code status change was significantly associated with female sex (p=0.04), history of diabetes (p=0.01), sICH at 36 hours post rt-PA (p

Objective
Integrating a palliative approach to care into primary care is an emerging evidence-based practice. Despite the evidence, this type of care has not been widely adopted into primary care settings. The objective of this study was to examine the barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices by applying an implementation science framework.

Design
This convergent mixed methods study analysed semistructured interviews and expression of interest forms to evaluate the implementation of a protocol, linked to implementation strategies, for a palliative approach to care called Early Palliation through Integrated Care (EPIC) in three primary care practices. This study assessed barriers to and facilitators of implementation of EPIC and was guided by the Consolidated Framework for Implementation Research (CFIR). A framework analysis approach was used during the study to determine the applicability of CFIR constructs and domains.

Setting
Primary care practices in Canada. Interviews were conducted between September 2020 and November 2021.

Participants
10 individuals were interviewed, who were involved in implementing EPIC. Three individuals from each practice were reinterviewed to clarify emerging themes.

Results
Overall, there were implementation barriers at multiple levels that caused some practices to struggle. However, barriers were mitigated when practices had the following facilitators: (1) a high level of intra-practice collaboration, (2) established practices with organisational structures that enhanced communications, (3) effective leveraging of EPIC project supports to transition care, (4) perceptions that EPIC was an opportunity to make a long-term change in their approach to care as opposed to a limited term project and (5) strong practice champions.

Conclusions
Future implementation work should consider assessing facilitators identified in our results to better gauge primary care pre-implementation readiness. In addition, providing primary care practices with support to help offset the additional work of implementing innovations and networking opportunities where they can share strategies may improve implementation success.

Comunicato del 29/01/2024 n°5

In video-collegamento dalla Stazione Spaziale Internazionale

Colpa di obesità e alcol. Esperti: “Anticipare lo screening”

Presidente Perrone, ‘Difendere l’universalismo delle cure’

Rappresenta le aziende a capitale europeo e nipponico

Background
Due to the recognition that people experiencing homelessness (PEH) often die young and unsupported, a growing number of initiatives focusing on palliative care and homelessness are emerging across the UK. However, there has been no systematic exploration of the nature and landscape of this work.

Aims
To understand the range, aims, successes and challenges of current initiatives within the field of palliative care and homelessness in the UK, by exploring existing projects and initiatives.

Method
An online survey was distributed to members of an Extension for Community Healthcare Outcomes network focusing on palliative care and homelessness for a mixed professional audience. The survey collated the aims, successes and challenges of initiatives aiming to improve palliative care for PEH. Responses were summarised using descriptive statistics, and free-text responses were analysed using thematic analysis.

Results
162 professionals completed the survey. Of these, 62% reported involvement in at least one palliative care and homelessness initiative. Initiatives focused on service delivery (59%), training (28%) and research (28%). Themes for success included improved service engagement, relationship formation, housing provision, honouring end-of-life wishes, upskilling staff and enabling safe hospital discharge. The main challenges included stigma around substance misuse, securing funding, staff capacity, equipment and facilities, and engaging communities.

Conclusion
The number and scope of initiatives aiming to support PEH with advanced ill health and palliative care needs across the UK is growing, with a range of professionals engaging in the field. Future research may benefit from exploring initiatives in more detail to understand the specific drivers of impact on PEH and the staff and services supporting them.

Inadeguatezza risorse pubbliche stanziate e disparità regionali

Presidente Perrone: ‘Difendere l’universalismo delle cure’

Sono 224mila i casi diagnosticati, ma si stimano circa 600mila