Why is advance care planning underused in oncology settings? A systematic overview of reviews to identify the benefits, barriers, enablers, and interventions to improve uptake

BackgroundAdvance care planning (ACP) centres on supporting people to define and discuss their individual goals and preferences for future medical care, and to record and review these as appropriate. Despite recommendations from guidelines, rates of documentation for people with cancer are considerably low.AimTo systematically clarify and consolidate the evidence base of ACP in cancer care by exploring how it is defined; identifying benefits, and known barriers and enablers across patient, clinical and healthcare services levels; as well as interventions that improve advance care planning and are their effectiveness.MethodsA systematic overview of reviews was conducted and was prospectively registered on PROSPERO. PubMed, Medline, PsycInfo, CINAHL, and EMBASE were searched for review related to ACP in cancer. Content analysis and narrative synthesis were used for data analysis. The Theoretical Domains Framework (TDF) was used to code barriers and enablers of ACP as well as the implied barriers targeted by each of the interventions.ResultsEighteen reviews met the inclusion criteria. Definitions were inconsistent across reviews that defined ACP (n=16). Proposed benefits identified in 15/18 reviews were rarely empirically supported. Interventions reported in seven reviews tended to target the patient, even though more barriers were associated with healthcare providers (n=40 versus n=60, respectively).ConclusionTo improve ACP uptake in oncology settings; the definition should include key categories that clarify the utility and benefits. Interventions need to target healthcare providers and empirically identified barriers to be most effective in improving uptake.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42021288825

Neoliberalism as Liberation: The Statehood Program and the Remaking of the Palestinian National Movement

The Palestinian statehood-by-2011 program, framed through neoliberal institution building, redefines and diverts the Palestinian liberation struggle. Focusing on its economic aspects, and in particular the underlying neoliberal thought that goes beyond narrow economic policy applications, this essay argues that the program cannot succeed either as the midwife of independence or as a strategy for Palestinian economic development. Its weaknesses, the authors contend, derive not only from neoliberalism’s inability to deliver sustainable and equitable economic growth worldwide, but also because neoliberal “governance” under occupation, however “good,” cannot substitute for the broader struggle for national rights nor ensure the Palestinian right to development

Patients' perceived needs of osteoarthritis health information: A systematic scoping review

Background: Optimal management of osteoarthritis requires active patient participation. Understanding patients’ perceived health information needs is important in order to optimize health service delivery and health outcomes in osteoarthritis. We aimed to review the existing literature regarding patients’ perceived health information needs for OA. Methods: A systematic scoping review was performed of publications in MEDLINE, EMBASE, CINAHL and PsycINFO (1990–2016). Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Aggregates of patients’ perceived needs of osteoarthritis health information were categorized. Results: 30 studies from 2876 were included: 16 qualitative, 11 quantitative and 3 mixed-methods studies. Three areas of perceived need emerged: (1) Need for clear communication: terms used were misunderstood or had unintended connotations. Patients wanted clear explanations. (2) Need for information from various sources: patients wanted accessible health professionals with specialist knowledge of arthritis. The Internet, whilst a source of information, was acknowledged to have dubious reliability. Print media, television, support groups, family and friends were utilised to fulfil diverse information needs. (3) Needs of information content: patients desired more information about diagnosis, prognosis, management and prevention. Conclusions: Patients desire more information regarding the diagnosis of osteoarthritis, its impact on daily life and its long-term prognosis. They want more information not only about pharmacological management options, but also non-pharmacological options to help them manage their symptoms. Also, patients wanted this information to be delivered in a clear manner from multiple sources of health information. To address these gaps, more effective communication strategies are required. The use of a variety of sources and modes of delivery may enable the provision of complementary material to provide information more successfully, resulting in better patient adherence to guidelines and improved health outcomes

Walking endurance, muscle oxygen extraction, and perceived fatigability after overground locomotor training in incomplete spinal cord injury: A pilot study

The purpose of this study was to examine the effects of overground locomotor training (OLT) on walking endurance and gastrocnemius oxygen extraction in people with chronic cervical motor-incomplete spinal cord injury (SCI). Prospective single-arm pre-post pilot study. Human Performance Research Laboratory. Adult men with traumatic chronic cervical SCI ( = 6; age = 30.8 ± 12.5). Twenty-four sessions of structured OLT. Walking endurance was determined during a constant work-rate time-to-exhaustion treadmill test. Normalized perceived fatigability was calculated by dividing subjective ratings of tiredness by walking time. Cardiorespiratory outcomes and muscle oxygen extraction were analyzed using breath-by-breath gas-exchange and near-infrared spectroscopy. OLT resulted in large effects on walking endurance (1232 ± 446 s vs 1645 ± 255 s;  = 1.1;  = 0.045) and normalized perceived fatigability (5.3 ± 1.5 a.u. vs 3.6 ± 0.9 a.u.;  = 1.3;  = 0.033). Small-to-medium effects on absolute (2.8 ± 2.5 a.u. vs 4.2 ± 3.5 a.u.;  = 0.42;  = 0.035) and isotime (2.8 ± 2.5 a.u. vs 3.8 ± 3.0 a.u.;  = 0.33;  = 0.023) muscle oxygen extraction were also observed after OLT. These findings provide preliminary data supporting the potential for improved walking endurance, enhanced muscle O extraction, and reduced perceived fatigability in people with chronic cervical motor-incomplete SCI following the OLT program described in this study

Defining the supportive care needs and psychological morbidity of patients with functioning versus nonfunctioning neuroendocrine tumors: Protocol for a phase 1 trial of a nurse-led online and phone-based intervention

© 2019 Journal of Medical Internet Research. All rights reserved. Background: Online information resources and support have been demonstrated to positively influence the well-being of people diagnosed with cancer. This has been explored in past literature for more common cancers; however, for rare cancers, such as neuroendocrine tumors (NETs), there are little to no support or resources available. Despite relatively good prognoses, the quality of life (QoL) of patients with NETs is significantly lower compared with samples of mixed cancer patients and the general population. Patients with NETs also typically report unclear and difficult pathways of disease management and treatment, given the heterogeneity of the diagnosis. There is a vital need to improve the availability of disease-specific information for this patient group and provide supportive care that is tailored to the unique needs of the NET patient population. Objective: This study described the protocol of a study aimed to better understand the outcomes and experiences of patients diagnosed with NETs and to develop and pilot test a nurse-led online and phone-based intervention that will provide tailored supportive care targeted to NET subgroups (functioning vs nonfunctioning). Methods: This is a multisite cohort with 3 phases, incorporating both quantitative and qualitative data collection. Phase 1 is a mixed methods prospective cohort study of NET patients identifying differences in patient experiences and priority of needs between NET subgroups. Phase 2 utilizes results from phase 1 to develop an online and nurse-led phone-based intervention. Phase 3 is to pilot test and evaluate the intervention\u27s acceptability, appropriateness, and feasibility. Results: Currently, the project is progressing through phase 1 and has completed recruitment. A total of 138 participants have been recruited to the study. To date, patient-reported outcome data from 123 participants at baseline and 87 participants at 6-month follow-up have been collected. Of these, qualitative data from semistructured interviews from 35 participants have also been obtained. Phase 2 and phase 3 of the project are yet to be completed. Conclusions: Limited research for patients with NETs suggests that QoL and patient experiences are significantly impaired compared with the general population. Furthermore, past research has failed to delineate how the clinical variability between those with functioning and nonfunctioning NETs impacts patient supportive care needs. This study will improve on the availability of disease-specific information as well as informing the design of a nurse-led online and phone-based supportive care intervention tailored for the unique needs of the NET patient population. International Registered Report Identifier (IRRID): DERR1-10.2196/14361

Optimal Configuration of Omega-Kappa FF-SAR Processing for Specular and Non-Specular Targets in Altimetric Data: The Sentinel-6 Michael Freilich Study Case

In this study, the full-focusing (FF) algorithm is reviewed with the objective of optimizing it for processing data from different types of surfaces probed in altimetry. In particular, this work aims to provide a set of optimal FF processing parameters for the Sentinel-6 Michael Freilich (S6-MF) mission. The S6-MF satellite carries an advanced radar altimeter offering a wide range of potential FF-based applications which are just beginning to be explored and require prior optimization of this processing. In S6-MF, the Synthetic Aperture Radar (SAR) altimeter acquisitions are known to be aliased in the along-track direction. Depending on the target, aliasing can be tolerated or may be a severe impairment to provide the level of performance expected from FF processing. Another key aspect to consider in this optimization study is the unprecedented resolution of the FF processing, which results in a higher posting rate than the standard SAR processing. This work investigates the relationship between posting rate and noise levels and provides recommendations for optimal algorithm configurations in various scenarios, including transponder, open ocean, and specular targets like sea-ice and inland water scenes. The Omega–Kappa (WK) algorithm, which has demonstrated superior CPU efficiency compared to the back-projection (BP) algorithm, is considered for this study. But, unlike BP, it operates in the Doppler frequency domain, necessitating further precise spectral and time domain settings. Based on the results of this work, real case studies using S6-MF acquisitions are presented. We first compare S6-MF FF radargrams with Sentinel-1 (S1) images to showcase the potential of optimally configured FF processing. For highly specular surfaces such as sea-ice, distinct techniques are employed for lead signature identification. S1 relies on image-based lineic reconstruction, while S6-MF utilizes phase coherency of focalized pulses for lead detection. The study also delves into two-dimensional wave spectra derived from the amplitude modulation of image/radargrams, with a focus on a coastal example. This case is especially intriguing, as it vividly illustrates different sea states characterized by varying spectral peak positions over time.Astrodynamics & Space Mission

Dossier 7. The lockdown of the projects

Atti del convegno internazionale "The lockdown of the projects" 16, 23 e 30 settembre 202