28 research outputs found
Social inequality in cancer survivorship:Educational differences in healthârelated quality of life among 27,857 cancer survivors in Denmark
BackgroundWith a growing population of cancer survivors in Denmark, the evaluation of health-related quality of life (HRQoL) has become increasingly important. We describe variations in HRQoL between educational groups in a national population of cancer survivors.MethodsWe conducted a cross-sectional questionnaire study among breast, prostate, lung, and colon cancer survivors diagnosed in 2010â2019 in Denmark. We used the EORTC QLQ-C30 to assess HRQoL including physical, role, emotional, cognitive, social functioning, and symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Information on educational level and clinical data were extracted from national registers and clinical databases. Levels of impaired functioning and severe symptoms were identified using newly established thresholds for clinical importance. Multivariate logistic regression was used to examine associations between education and HRQoL. All statistical tests were 2-sided.ResultsIn total, 27,857 (42%) participated in the study. Up to 72% and 75% of cancer survivors with short education (â€9âyears) reported impaired functioning and severe symptoms, respectively. Cancer survivors with short compared to long education (>12âyears) were more likely to report impaired functioning and severe symptoms, with for example significantly higher odds ratios (ORs) for impaired physical function (breast ORâ=â2.41, 99% CIâ=â2.01â2.89; prostate ORâ=â1.81, 99% CIâ=â1.48â2.21; lung ORâ=â2.97, 99% CIâ=â1.95â4.57; and colon cancer ORâ=â1.69, 99% CIâ=â1.28â2.24).ConclusionsCancer survivors with short education are at greater risk of impaired HRQoL than survivors with long education 2â12âyears after diagnosis. This underscores the need for systematic screening and symptom management in cancer aftercare, in order to reach all cancer survivors, also cancer survivors with short education
A Model-Based Methodology for Spray-Drying Process Development
Solid amorphous dispersions are frequently used to improve the solubility and, thus, the bioavailability of poorly soluble active pharmaceutical ingredients (APIs). Spray-drying, a well-characterized pharmaceutical unit operation, is ideally suited to producing solid amorphous dispersions due to its rapid drying kinetics. This paper describes a novel flowchart methodology based on fundamental engineering models and state-of-the-art process characterization techniques that ensure that spray-drying process development and scale-up are efficient and require minimal time and API. This methodology offers substantive advantages over traditional process-development methods, which are often empirical and require large quantities of API and long development times. This approach is also in alignment with the current guidance on Pharmaceutical Development Q8(R1). The methodology is used from early formulation-screening activities (involving milligrams of API) through process development and scale-up for early clinical supplies (involving kilograms of API) to commercial manufacturing (involving metric tons of API). It has been used to progress numerous spray-dried dispersion formulations, increasing bioavailability of formulations at preclinical through commercial scales
'Same, but different' : a mixed methods realist evaluation of a cluster-randomized controlled participatory organizational intervention
Participatory organizational interventions are a recommended approach to improve the psychosocial work environment. As interventions of this type are shaped by employees and managers, their implementation can vary considerably, making evaluation challenging. This study contributes to our understanding of interventions by focusing on how the intervention mechanisms and the organizational context interact. In a mixed-methods design, we use multi-group structural equation modelling of pre-and post-intervention survey data (N = 204) to test multiple mediational mechanisms in three different contexts. We then analyse interviews (N = 67) and field observations of workshops to identify the role of contextual factors. The findings suggest that participatory organizational interventions do not produce one-size-fits-all results; on the contrary, intervention results are better understood as products of multiple intervention mechanisms interacting with the specific organizational contexts
Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU
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Identification of a functional hepatocyte nuclear factor 4 binding site in the neutral ceramidase promoter
Effect of Healthcare System information on healthcare-seeking behaviour among immigrants
Effect of Healthcare system information on immigrants' knowledge of the healthcare system
Patient-controlled hospital admission for patients with severe mental disorders:a nationwide prospective multicentre study
Objective
To assess whether implementing patientâcontrolled admission (PCA) can reduce coercion and improve other clinical outcomes for psychiatric inâpatients.
Methods
During 2013â2016, 422 patients in the PCA group were propensity score matched 1:5 with a control group (n = 2110) that received treatment as usual (TAU). Patients were followed up for at least one year using the intention to treat principle utilising nationwide registers. In a paired design, the outcomes of PCA patients during the year after signing a contract were compared with the year before.
Results
No reduction in coercion (risk difference = 0.001; 95% CI: â0.038; 0.040) or selfâharming behaviour (risk difference = 0.005; 95% CI: â0.008; 0.018) was observed in the PCA group compared with the TAU group. The PCA group had more inâpatient bed days (mean difference = 28.4; 95% CI: 21.3; 35.5) and more medication use (P < 0.0001) than the TAU group. Before and after analyses showed reduction in coercion (P = 0.0001) and inâpatient bed days (P = 0.0003).
Conclusion
Implementing PCA did not reduce coercion, service use or selfâharm behaviour when compared with TAU. Beneficial effects of PCA were observed only in the before and after PCA comparisons. Further research should investigate whether PCA affects other outcomes to better establish its clinical value