Barriers to collaboration between health care, social services and schools

<p class="MsoNormal" style="margin: 0cm 0cm 0pt; line-height: 150%;"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt; line-height: 150%; font-family: " lang="EN-US">Background: </span></strong><span style="font-size: 11pt; line-height: 150%; font-family: " lang="EN-US">It is essential for professionals from different organizations to collaborate when handling matters concerning children, adolescents, and their families in order to enable society to provide holistic health care and social services. </span></p><p class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11pt; font-family: " lang="EN-US"> </span></p><p class="MsoNormal" style="margin: 0cm 0cm 0pt; line-height: 150%;"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt; line-height: 150%; font-family: " lang="EN-US">Objective: </span></strong><span style="font-size: 11pt; line-height: 150%; font-family: " lang="EN-US">This paper reports perceptions of obstacles to collaboration among professionals in health care (county council), social services (municipality), and schools in an administrative district of the city of Stockholm, Sweden. </span></p><p class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11pt; font-family: " lang="EN-US"> </span></p><p class="MsoNormal" style="margin: 0cm 0cm 0pt;"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt; font-family: " lang="EN-US">Methods: </span></strong><span style="font-size: 11pt; font-family: " lang="EN-US">Data were collected in focus group interviews with unit managers and employees. </span></p><p class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-size: 11pt; font-family: " lang="EN-US"> </span></p><p class="MsoNormal" style="margin: 0cm 0cm 0pt; line-height: 150%;"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt; line-height: 150%; font-family: " lang="EN-US">Results and discussion: </span></strong><span style="font-size: 11pt; line-height: 150%; font-family: " lang="EN-US">Our results show that the responsibility for collaboration fell largely on the professionals. Also, there was a <em style="mso-bidi-font-style: normal;">lack of clarity</em> regarding differences in mission and regulations, allocation of responsibilities, competence, explanatory models, and working approach. We conclude that a <em style="mso-bidi-font-style: normal;">holding environment</em> and a <em style="mso-bidi-font-style: normal;">committed management</em> would support these professionals in their efforts to collaborate.</span></p

Survivorship and improving quality of life in men with prostate cancer

Context: Long-term survival following a diagnosis of cancer is improving in developed nations. However, living longer does not necessarily equate to living well. Objective: To search systematically and synthesise narratively the evidence from randomised controlled trials (RCTs) of supportive interventions designed to improve prostate cancer (PCa)-specific quality of life (QoL). Evidence acquisition: A systematic search of Medline and Embase was carried out from inception to July 2014 to identify interventions targeting PCa QoL outcomes. We did not include nonrandomised studies or trials of mixed cancer groups. In addition to database searches, citations from included papers were hand-searched for any potentially eligible trials. Evidence synthesis: A total of 2654 PCa survivors from 20 eligible RCTs were identified from our database searches and reference checks. Disease-specific QoL was assessed most frequently by the Functional Assessment of Cancer Therapy-Prostate questionnaire. Included studies involved men across all stages of disease. Supportive interventions that featured individually tailored approaches and supportive interaction with dedicated staff produced the most convincing evidence of a benefit for PCa-specific QoL. Much of these data come from lifestyle interventions. Our review found little supportive evidence for simple literature provision (either in booklets or via online platforms) or cognitive behavioural approaches. Conclusions: Physical and psychological health problems can have a serious negative impact on QoL in PCa survivors. Individually tailored supportive interventions such as exercise prescription/referral should be considered by multidisciplinary clinical teams where available. Cost-effectiveness data and an understanding of how to sustain benefits over the long term are important areas for future research. Patient summary: This review of supportive interventions for improving quality of life in prostate cancer survivors found that supervised and individually tailored patient-centred interventions such as lifestyle programmes are of benefit.</p

Issues in applying multi-arm multi-stage methodology to a clinical trial in prostate cancer: the MRC STAMPEDE trial

Background: The multi-arm multi-stage (MAMS) trial is a new paradigm for conducting randomised controlled trials that allows the simultaneous assessment of a number of research treatments against a single control arm. MAMS trials provide earlier answers and are potentially more cost-effective than a series of traditionally designed trials. Prostate cancer is the most common tumour in men and there is a need to improve outcomes for men with hormone-sensitive, advanced disease as quickly as possible. The MAMS design will potentially facilitate evaluation and testing of new therapies in this and other diseases.Methods: STAMPEDE is an open-label, 5-stage, 6-arm randomised controlled trial using MAMS methodology for men with prostate cancer. It is the first trial of this design to use multiple arms and stages synchronously.Results: The practical and statistical issues faced by STAMPEDE in implementing MAMS methodology are discussed and contrasted with those for traditional trials. These issues include the choice of intermediate and final outcome measures, sample size calculations and the impact of varying the assumptions, the process for moving between trial stages, stopping accrual to each trial arm and overall, and issues around perceived trial complexity.Conclusion: It is possible to use the MAMS design to initiate and undertake large scale cancer trials. The results from STAMPEDE will not be known for some years but the lessons learned from running a MAMS trial are shared in the hope that other researchers will use this exciting and efficient method to perform further randomised controlled trials

Niraparib in patients with metastatic castration-resistant prostate cancer and DNA repair gene defects (GALAHAD): a multicentre, open-label, phase 2 trial

Background Metastatic castration-resistant prostate cancers are enriched for DNA repair gene defects (DRDs) that can be susceptible to synthetic lethality through inhibition of PARP proteins. We evaluated the anti-tumour activity and safety of the PARP inhibitor niraparib in patients with metastatic castration-resistant prostate cancers and DRDs who progressed on previous treatment with an androgen signalling inhibitor and a taxane. Methods In this multicentre, open-label, single-arm, phase 2 study, patients aged at least 18 years with histologically confirmed metastatic castration-resistant prostate cancer (mixed histology accepted, with the exception of the small cell pure phenotype) and DRDs (assessed in blood, tumour tissue, or saliva), with progression on a previous next-generation androgen signalling inhibitor and a taxane per Response Evaluation Criteria in Solid Tumors 1.1 or Prostate Cancer Working Group 3 criteria and an Eastern Cooperative Oncology Group performance status of 0–2, were eligible. Enrolled patients received niraparib 300 mg orally once daily until treatment discontinuation, death, or study termination. For the final study analysis, all patients who received at least one dose of study drug were included in the safety analysis population; patients with germline pathogenic or somatic biallelic pathogenic alterations in BRCA1 or BRCA2 (BRCA cohort) or biallelic alterations in other prespecified DRDs (non-BRCA cohort) were included in the efficacy analysis population. The primary endpoint was objective response rate in patients with BRCA alterations and measurable disease (measurable BRCA cohort). This study is registered with ClinicalTrials.gov, NCT02854436. Findings Between Sept 28, 2016, and June 26, 2020, 289 patients were enrolled, of whom 182 (63%) had received three or more systemic therapies for prostate cancer. 223 (77%) of 289 patients were included in the overall efficacy analysis population, which included BRCA (n=142) and non-BRCA (n=81) cohorts. At final analysis, with a median follow-up of 10·0 months (IQR 6·6–13·3), the objective response rate in the measurable BRCA cohort (n=76) was 34·2% (95% CI 23·7–46·0). In the safety analysis population, the most common treatment-emergent adverse events of any grade were nausea (169 [58%] of 289), anaemia (156 [54%]), and vomiting (111 [38%]); the most common grade 3 or worse events were haematological (anaemia in 95 [33%] of 289; thrombocytopenia in 47 [16%]; and neutropenia in 28 [10%]). Of 134 (46%) of 289 patients with at least one serious treatment-emergent adverse event, the most common were also haematological (thrombocytopenia in 17 [6%] and anaemia in 13 [4%]). Two adverse events with fatal outcome (one patient with urosepsis in the BRCA cohort and one patient with sepsis in the non-BRCA cohort) were deemed possibly related to niraparib treatment. Interpretation Niraparib is tolerable and shows anti-tumour activity in heavily pretreated patients with metastatic castration-resistant prostate cancer and DRDs, particularly in those with BRCA alterations

Celebrity endorsement, motives and risks : case study of Skånemejerier

Many of today's companies use celebrities in marketing campaigns in order to on a more effective way, reach out with the message to the target group. Those celebrities that are used as endorsers of the product/the service are mostly movie stars or athletes. This type of marketing has become very popular but also involves certain risks. This leads to our aim with this thesis where through research we aim to gaining a deeper understanding of the reasons for using celebrities as promotion tools in marketing and how the risks that arise can be described and prevented. The thesis has been limited to a case study of a specific Swedish company within the dairy sector, Skånemejerier, that use celebrities in their marketing. Telephone interviews with manager responsible for sponsoring at Skånemejerier was the source of empirical data for this thesis. Collected data are analyzed and conclusions are drawn as following: Skånemejerier uses celebrities in their marketing in order to take benefits from the athlete’s positive properties and to provide these along with the product's properties. The choice of celebrities is based more on the celebrities' trustworthiness rather than attractiveness. The biggest risk with the use of celebrities in marketing are the risk of using illegal substances. In order to avoid this risk and other risks, Skånemejerier is very selective in its choice of celebrities to collaborate with. Another important factor is that Skånemejerier only collaborates with celebrities that already use products from the company before any cooperation is initiated.Validerat; 20101217 (root

Parents’ experiences of collaboration between welfare professionals regarding children and adolescents with anxiety or depression - an explorative study

Introduction: Well-functioning collaboration between professionals in the welfare sector has a strong influence on the contact with parents of children and adolescents with mental illness, and it is a precondition for the availability of support for these parents. This paper reports how such parents experience collaboration between professionals in mental health care, social services, and schools.Methods: Data were collected by in-depth interviews with seven parents of children and adolescents diagnosed with anxiety and depression. The families were selected from the Child and Adolescent Mental Health (CAMH) patient records kept by the Stockholm County Council (Sweden), and they all lived in a catchment area for CAMH outpatient services in Stockholm.Results and discussion: We conclude that when the encounter between parents and professionals is characterized by structure and trust, it is supportive and serves as a holding environment. Coordination and communication links are needed in the collaboration between the professionals, along with appropriately scheduled and well-performed network meetings to create structure in the parent-professional encounter. Indeed, establishment of trust in this interaction is promoted if individual professionals are available, provide the parents with adequate information, are skilled, and show empathy and commitment.