Enhancing legacy in palliative care: study protocol for a randomized controlled trial of Dignity Therapy focused on positive outcomes.

BackgroundDignity Therapy is a brief psychotherapy that can enhance a sense of legacy while addressing the emotional and existential needs of patients receiving hospice or palliative care. In Dignity Therapy, patients create a formalized "legacy" document that records their most cherished memories, their lessons learned in life, as well as their hopes and dreams for loved ones in the future. To date, this treatment has been studied for its impact on mitigating distress within hospice and palliative care populations and has provided mixed results. This study will instead focus on whether Dignity Therapy enhances positive outcomes in this population.Methods/designIn this study, 90 patients with cancer receiving hospice or palliative care will complete a mixed-methods randomized controlled trial of Dignity Therapy (n = 45) versus Supportive Attention (n = 45). The patients will be enrolled in the study for 3 weeks, receiving a total of six study visits. The primary outcomes examine whether the treatment will quantitatively increase levels of positive affect and a sense of life closure. Secondary outcomes focus on gratitude, hope, life satisfaction, meaning in life, resilience, and self-efficacy. Using a fixed, embedded dataset design, this study will additionally use qualitative interviews to explore patients' perceptions regarding the use of positive outcome measures and whether these outcomes are appropriately matched to their experiences in therapy.DiscussionDignity Therapy has shown mixed results when evaluating its impact on distress, although no other study to date has solely focused on the potential positive aspects of this treatment. This study is novel in its use of mixed methods assessments to focus on positive outcomes, and will provide valuable information about patients' direct experiences in this area.Trial registrationISRCTN91389194

Using a stakeholder-engaged, iterative, and systematic approach to adapting collaborative decision skills training for implementation in VA psychosocial rehabilitation and recovery centers

Background: Adaptation of interventions is inevitable during translation to new populations or settings. Systematic approach to adaptation can ensure that fidelity to core functions of the intervention are preserved while optimizing implementation feasibility and effectiveness for the local context. In this study, we used an iterative, mixed methods, and stakeholder-engaged process to systematically adapt Collaborative Decision Skills Training for Veterans with psychosis currently participating in VA Psychosocial Rehabilitation and Recovery Centers. Methods: A modified approach to Intervention Mapping (IM-Adapt) guided the adaptation process. An Adaptation Resource Team of five Veterans, two VA clinicians, and four researchers was formed. The Adaptation Resource Team engaged in an iterative process of identifying and completing adaptations including individual qualitative interviews, group meetings, and post-meeting surveys. Qualitative interviews were analyzed using rapid matrix analysis. We used the modified, RE-AIM enriched expanded Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to document adaptations. Additional constructs included adaptation size and scope; implementation of planned adaptation (yes–no); rationale for non-implementation; and tailoring of adaptation for a specific population (e.g., Veterans). Results: Rapid matrix analysis of individual qualitative interviews resulted in 510 qualitative codes. Veterans and clinicians reported that the intervention was a generally good ft for VA Psychosocial Rehabilitation and Recovery Centers and for Veterans. Following group meetings to reach adaptation consensus, 158 adaptations were completed. Most commonly, adaptations added or extended a component; were small in size and scope; intended to improve the effectiveness of the intervention, and based on experience as a patient or working with patients. Few adaptations were targeted towards a specific group, including Veterans. Veteran and clinician stakeholders reported that these adaptations were important and would benefit Veterans, and that they felt heard and understood during the adaptation process. Conclusions: A stakeholder-engaged, iterative, and mixed methods approach was successful for adapting Collaborative Decision Skills Training for immediate clinical application to Veterans in a psychosocial rehabilitation center. The ongoing interactions among multiple stakeholders resulted in high quality, tailored adaptations which are likely to be generalizable to other populations or settings. We recommend the use of this stakeholder-engaged, iterative approach to guide adaptations

Análisis del Sistema de Frenos ABS: Funcionamiento y Efectividad en la Seguridad Vehicular

The following document presents a detailed analysis of publications related to the Anti-lock Braking System (ABS). To conduct this bibliographic research, Google Scholar's search engine was utilized, employing appropriate and relevant terms related to the topic's focus. The primary purpose of this investigation is to describe the operation and effectiveness of the Anti-lock Braking System (ABS). ABS utilizes wheel speed sensors to measure their rotation, and in the event of detecting wheel lock, it sends this information to the electronic control unit. This unit, in turn, signals the electro-pump to release pressure in the braking circuit, allowing the wheel to rotate and regain traction on the road. The electro-pump intervenes again to restore pressure. While the figures presented in research may not be entirely clear, certain studies suggest a greater reduction in accidents for motorcycles compared to automobiles. This does not imply that the system does not contribute to safety in automobiles, as the benefits of the system are clearly observed in conducted tests, leading to improved vehicle performance in situations requiring emergency braking.El siguiente documento presenta un análisis detallado de las publicaciones relacionadas con el sistema antibloqueo de frenos (ABS). Para llevar a cabo esta investigación bibliográfica, se utilizó el motor de búsqueda de Google Académico, empleando términos adecuados y pertinentes al enfoque del tema. El propósito principal de esta investigación es describir el funcionamiento y la efectividad del sistema antibloqueo de frenos. El ABS utiliza sensores de velocidad en las ruedas para medir el giro de estas y en el caso de detectar el bloqueo, envía esta información a la unidad de control electrónico para que está mande a su vez la señal a la electrobomba y libere presión en el circuito de frenado permitiéndole a la rueda girar y adherirse a la calzada, para recuperar presión nuevamente interviene la electrobomba. Las cifras presentadas en investigaciones no son muy claras pero ciertos estudios indican que existe mayor reducción de accidentes en motocicletas que en automóviles, esto no significa que no exista un aporte en la seguridad ya que se observa claramente en pruebas realizadas de los beneficios que aporta el sistema y esto se traduce en mejorar el desempeño del vehículo ante situaciones que requieran un frenado emergente

Anxiety and depression in inpatients in two hospitals of Arequipa, Perú

Marco teórico: Las personas durante su hospitalización tienden a presentar problemas emocionales como ansiedad y depresión. El objetivo de la investigación fue comparar los niveles de ansiedad y depresión en los pacientes internados en dos hospitales de Arequipa, Perú. Por otro lado, se buscó comparar los niveles de ansiedad y depresión entre hombres y mujeres y entre ambos hospitales. Métodos: Para el presente estudio se aplicó la escala hospitalaria de ansiedad y depresión a 50 pacientes internados en dos hospitales de la ciudad, uno del Ministerio de Salud y otro del Seguro Social. Resultados: Los resultados indican que no existen diferencias estadísticamente significativas entre hospitales respecto a la ansiedad y la depresión (p=.451; p=.468). Se observó también que existe diferencia estadísticamente significativa entre hombres y mujeres respecto a la ansiedad (p=.009)en la muestra en general. Se observó que existe una diferencia estadísticamente significativa entre hombres y mujeres respecto a la ansiedad en solo uno de los hospitales evaluados (p=.022). Conclusiones: Se concluye que los pacientes internados tienden a presentar problemas de ansiedad y depresión, sin diferenciar el tipo de hospitalTheoretical Framework:People during their hospitalization tend tohave emotional problems such as anxiety and depression. The objective of the research was to compare the levels of anxiety and depression in inpatients in two hospitals in Arequipa, Peru. The study also sought to compare levels of anxiety and depression among men and women in general and both hospitals.Methods:The hospital scale of anxiety and depression wasapplied to 50 inpatientsintwo hospitals in the city, one from the health ministry and another from social insurance.Results:The results indicate that there are no statistically significant differences between hospitals respect to anxiety and depression (p = .451; p = .468). It was observed that there is a statistically significant difference between men and women respect to anxiety (p = .009)in the entire sample.It was found that there is a statistically significant difference between men and women regarding anxiety in only one of the hospitals evaluated (p = .022). Conclusions:We concludedthat hospitalized patients tend to present anxiety and depression problems, withoutdifferentiating thetype of hospita

Enhancing legacy in palliative care: study protocol for a randomized controlled trial of Dignity Therapy focused on positive outcomes

BACKGROUND: Dignity Therapy is a brief psychotherapy that can enhance a sense of legacy while addressing the emotional and existential needs of patients receiving hospice or palliative care. In Dignity Therapy, patients create a formalized “legacy” document that records their most cherished memories, their lessons learned in life, as well as their hopes and dreams for loved ones in the future. To date, this treatment has been studied for its impact on mitigating distress within hospice and palliative care populations and has provided mixed results. This study will instead focus on whether Dignity Therapy enhances positive outcomes in this population. METHODS/DESIGN: In this study, 90 patients with cancer receiving hospice or palliative care will complete a mixed-methods randomized controlled trial of Dignity Therapy (n = 45) versus Supportive Attention (n = 45). The patients will be enrolled in the study for 3 weeks, receiving a total of six study visits. The primary outcomes examine whether the treatment will quantitatively increase levels of positive affect and a sense of life closure. Secondary outcomes focus on gratitude, hope, life satisfaction, meaning in life, resilience, and self-efficacy. Using a fixed, embedded dataset design, this study will additionally use qualitative interviews to explore patients’ perceptions regarding the use of positive outcome measures and whether these outcomes are appropriately matched to their experiences in therapy. DISCUSSION: Dignity Therapy has shown mixed results when evaluating its impact on distress, although no other study to date has solely focused on the potential positive aspects of this treatment. This study is novel in its use of mixed methods assessments to focus on positive outcomes, and will provide valuable information about patients’ direct experiences in this area. TRIAL REGISTRATION: ISRCTN9138919

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

Sistematización de la Experiencia Programa de Estrategias de Sensibilización y Prevención de la Violencia Física y Psicológica en Mujeres de entre 25 y 40 años del Centro de Salud tipo C Martha de Roldós en el periodo Mayo – Agosto del 2022

La sistematización de experiencias responde a un proyecto que se encuentra centrado en las mujeres víctimas de violencia física y psicológica, del Centro de Salud Tipo C ·Martha de Roldós, en el periodo comprendido de Mayo a Agosto del 2022. Debido a la naturaleza del presente proyecto, se tuvo experiencia práctica que permitió el recabar información sustancial de las circunstancias vividas por las pacientes, el modelo utilizado parte desde la TREC, el cual se estructura como un sistema de creencias que trabaja desde los pensamientos, centrándose en la detención de ideas irracionales, consecuencias emocionales y conductuales que tienen estos procesos disfuncionales, para su modificación. Mientras se sensibiliza sobre temáticas focalizadas hacia la vulnerabilidad presente en las participantes generando talleres de psicoeducación, ocasionando métodos de afrontamiento, que reorientan los pensamientos irracionales hacia un discurso racional que produzca conductas funcionales, identificando la eficacia de este método y recabando información utilizable para posibles estudios.The systematization of experiences responds to a project that is focused on women victims of physical and psychological violence, of the Centro de Salud Tipo C ·Martha de Roldos, in the period of time from May to August 2022. Due to the nature of the present project, practical experience was had that allowed the collection of substantial information on the circumstances experienced by the patients, the model used starts from the TREC, which is structured as a belief system that works from the thoughts, focusing on the arrest of irrational ideas, emotional and behavioral consequences that these dysfunctional processes have, for their modification. While raising awareness on topics focused on the vulnerability present in the participants, generating psychoeducation workshops, causing coping methods, which redirect irrational thoughts towards a rational discourse that produces functional behaviors, identifying the effectiveness of this method and gathering information that can be used for possible studies

A five year review of client attendance and satisfaction at a student-led university nutrition and dietetics clinic

University health clinics provide work integrated learning experiences, increase student placement capacity and deliver affordable client services. Client attendance and satisfaction with student interaction are essential to ensure their viability. The aim of this review was to evaluate client attendance and satisfaction for the Queensland University of Technology (QUT) Nutrition and Dietetics Clinic from 2013 to 2017

Use of a Health Advocacy Model for Survivors of Interpersonal Violence

This article examines the implementation of a health advocacy model designed for survivors of interpersonal violence (IPV) in a metropolitan area of North Texas. Using a framework influenced by motivational interviewing, solution-focused therapy, and trauma-informed care, this program engaged IPV survivors in creating health and safety goals. Goal attainment scaling was used to track progress after each health advocacy encounter. Clients could set their own goals for healthcare, self-care, and safety. The program served 419 clients and 648 goals were set by clients at the first visit. Among all goals, 89% selected goals focused on healthcare, with 47% of those selecting obtaining health insurance or coverage as a need. These results demonstrate the need for an enhanced healthcare response for this population. The remaining goals selected were self-care (7%) and safety (3%). The design of the health advocacy intervention shows promise towards filling the gaps between IPV and healthcare service delivery systems