Identifying the need for specialized palliative care in adult cancer patients – development and validation of a screening procedure based on proxy assessment by physicians and filter questions

Background One challenge in caring for cancer patients with incurable disease is the adequate identification of those in need for specialized palliative care (SPC). The study’s aim was to validate an easy to use phenomenological screening tool. Methods The German tool is based on the National Comprehensive Cancer Network (NCCN) Palliative Care guidelines and contains ten items in five domains that focus e.g. on diagnosis, functional status, complications, comorbidities, and palliative care relevant problems such as symptom management, distress, and support of family and team members. Sum score ranges from 0 to 14 (no need to great need). Assessment to identify SPC needs was done in university hospital wards between 1 and 08/2017 by health care professionals on admission of the patient if the disease was incurable and expected prognosis < 12 months. The Integrated Palliative Outcome Scale (IPOS, staff version), an outcome assessment instrument for palliative care that consists of ten items, served as external criterion; in sub samples inter-rater/test-retest were performed. Results Data from 208 patients with incurable disease and life expectancy < 12 months (54.8% female; average age 63.5 years, range 21–96) were assessed using the tool. The tool has good convergent validity; the correlation between the sum scores of IPOS and our tool showed a significant and substantial effect. The sum score was independent of the patient’s age, gender and primary diagnosis. Patients who already were in contact with SPC had significantly higher screening scores than patients without. With a cut point of  ≥ 5, 80.8% of the screened patients were in need for SPC. Cronbach’s alpha was α = .600. Rater agreement (inter-rater, test-retest) varied between single items. Correlation coefficients showed significant substantial effects. Conclusions This is the first validation of a screening procedure in German language identifying SPC needs of adult patients with advanced cancer and the first using filter questions as a pre-screening. Proxy assessment of SPC needs by physicians in cancer care settings is feasible and the suggested tool presents a valid instrument to trigger a PC consultation. Trial registration The study was not registered

ON THE USE OF DISCRETE EVENT SIMULATION IN GREEN IS RESEARCH - DEVELOPING A CONCEPTUAL FRAMEWORK

Discrete event simulation is a widely established approach in research on supply chain structures. However, discrete event simulation is rarely used within the context of environmental sustainability. A conceptual framework is suggested to discuss the valu of discrete event simulation in Green IS research. The content of the framework is based on a systematic literature review and the structure builds upon the belief-action-outcome model. The framework contains research issus for the use of discrete event simulation in Green IS research and illustrates the causal relations between organizational, social and physical structures, individual objects as well as the outcomes in their interaction. A methodological toolkit is included to provide a starting point for the development of suitable research methodologies within the field. Du to the interdisciplinary approach of this work, the framework may be restrictive in its view on information systems. Therefore, the results do not claim to be deterministic or constrictive. Scientists and practitioners are encouraged to enter the discourse on discrete event simulation to enhance Green IS research

Life Cycle Assessments als Instrument zur Messung der ökologischen Auswirkungen von Informationssystemen

Vor dem Hintergrund demographischer Entwicklungen, der zunehmenden Nutzung von Informationstechnologien in unserem Alltag (Stichwort „Digitales Leben“) und einem begrenzten Maß natürlicher Ressourcen ist die Wissenschaft zunehmend gefordert, das Verhältnis aus Informationstechnologie, menschlichem Verhalten und unserer Umwelt neu zu hinterfragen. Gegenstand des Dissertationsvorhabens ist daher die Untersuchung von Informationssystemen im Hinblick auf deren ökologische Nachhaltigkeit. Dabei zeigt sich auf der einen Seite, dass Informationssysteme aufgrund der genutzten physischen IT-Infrastruktur (PCs, Server, Mobiltelefone etc.) als Ursache von Umweltproblematiken in Erscheinung treten können. Neben dem Stromverbrauch bei der Nutzung von IT steht dabei vor allem der Verbrauch seltener Metalle wie Gold, Palladium und Tantal sowie das Problem der Entsorgung von Altgeräten im Fokus. Auf der anderen Seite werden Informationssysteme zunehmend auch als Mittel zur Lösung von Umweltproblematiken gesehen. So können Informationssysteme dazu beitragen, Geschäftsprozesse effizienter und damit umweltfreundlicher zu gestalten, Konsumenten von Produkten und Dienstleistungen sowie Entscheider im Unternehmen für Umweltprobleme zu sensibilisieren oder neue umweltfreundliche Produktinnovationen zu unterstützen. Zur Untersuchung des Themenkomplexes werden etablierte Ansätze zur Untersuchung physischer Systeme auf Informationssysteme übertragen. Zum einen werden Methoden und Softwaretools aus dem Bereich ereignisdiskreter Simulationen (Materialflusssimulationen, Simulation von Supply Chains, Produktionsabläufen etc.) genutzt. Ereignisdiskrete Simulationen erlauben es, die Auswirkungen von Informationssystemen auf ein physisches System (z. B. eine Fabrik oder ein öffentliches Transportsystem) realitätsnah in einem Simulationsmodell abzubilden. Hierdurch ist es möglich eine Verbindung zwischen virtuellen Informationen und physischen Prozessen (z. B. Entstehung von CO2-Emission) herzustellen. Zum anderen werden Methoden und Softwaretools aus dem Bereich Ökobilanzierung (engl. Life Cycle Assessment) eingesetzt, um die ökologischen Auswirkungen von Informationssystemen messbar zu machen. Dabei wird der Einfluss physischer Prozesse, die durch Informationssysteme beeinflusst werden, auf ein ökologisches System (z. B. das Klima) abgeschätzt

Analysis of Transition of Patients with Parkinson’s Disease into Institutional Care: A Retrospective Pilot Study

Parkinson’s disease (PD) is a neurodegenerative disease which gives a person a high risk of becoming care-dependent. During disease progression, the amount of care concerning activities of daily living can increase, possibly resulting in transition of the people with Parkinson’s disease (PwP) to a care facility. However, there is a lack of knowledge concerning the factors leading to institutionalization of PwP and the consequences for them and their informal caregivers. The aim of this cross-sectional retrospective study was to investigate reasons leading to the transition into an institutional care facility, the process of decision-making and its effects on PwP symptoms and caregiver burden. Participating PwP had to be institutionalized for at most one year after transition at study inclusion. Participants completed a range of semiquantitative questionnaires as well as the caregiving tasks questionnaire. Fourteen patient–caregiver pairs were included. PwP suffered from late-stage PD symptoms with high dependence on help, experiencing several hospitalizations before transition. Analyses revealed a significant decrease in caregiver burden and depressive symptoms of the caregivers after PwP institutionalization. Factors influencing the transition were, e.g., fear of PwP health issues and concerns about caregivers’ health. This study presents new insights into the process of institutionalization and its influence on caregiver burden, including aspects for discussions of physicians with PwP and their caregivers for counselling the decision to move to institutional care

One Year Trajectory of Caregiver Burden in Parkinson’s Disease and Analysis of Gender-Specific Aspects

Parkinson’s disease (PD) is a slowly progressive neurodegenerative movement disorder that leads to impairments in activities of daily living. In addition to reducing patients’ quality of life, this disease also affects caregivers’ well-being. Until recently, caregiver burden was mainly assessed by generic questionnaires, which do not take the characteristics of the chronic disease into consideration. In the case of PD, this issue has been addressed by the introduction of the “Parkinson’s disease caregiver burden” questionnaire (PDCB). Data on longitudinal trajectories of caregiver burden are still missing in the literature. In this study, we assessed the one-year trajectory of caregiver burden by the PDCB as a disease-specific questionnaire. Further, gender-specific aspects of caregiver burden were analyzed by applying a caregiver task questionnaire. PDCB total score (n = 84 patients and caregivers) did not significantly change from baseline (30.4) to one year at follow-up (31.5). No significant difference was detected between female and male caregivers in global burden and-specific caregiver tasks. Our data showed only a mild increase of caregiver burden in the timeframe of one year. Gender-specific differences do not seem to impact-specific caregiver tasks in the presented study population

Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial

International audienceAbstract Background Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants. Methods Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. Results Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49–69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI − 0.1% [− 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (− 3.2% [− 9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities. Conclusion This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu ( 2022-500385-99-00 )