Patient-Reported Experiences of Supportive Cancer Care during the COVID-19 Pandemic

Background. During the COVID-19 pandemic, people affected by cancer were in need of information about the virus and about the (self-) management of cancer symptoms and treatment. It is important to understand how patients with cancer navigated through the pandemic and to explore their experience relating to their supportive care needs. Aim. This study aimed to describe the experience of Swiss oncological patients during the COVID-19 pandemic with additional supportive cancer care. Methods. A single-center study was conducted in 2021. Patients with melanoma, breast, lung, or colon cancer who received active systemic anticancer treatment at the time of the COVID-19 pandemic and who were additionally seeing either oncology clinical nurse specialists, integrative medicine physicians, or both were included. We conducted semistructured interviews alongside the patient-reported quantitative assessment of distress and resilience. Thematic analysis was performed for the qualitative data and descriptive statistics for the quantitative data. Results. Eighteen patients with cancer were interviewed. Patients seeing an integrative medicine physician highlighted that they positively felt being addressed as a whole person during the consultations. The oncology clinical nurse specialists were perceived as the first point of contact for the patients and had more time during the pandemic compared to what the patients normally received. In general, patients did not experience delays or disruptions in their cancer treatment. As immunosuppressed and fatigued patients with cancer, they felt supported by the restrictions and hygienic measures. Access to vaccination reassured patients against the risk of infection. These results were reflected in the quantitative data, as we found moderate distress levels (M = 4.1; SD = 2.5) and high resilience scores (M = 7.5; SD = 0.9) in this patient population. Conclusion. During the COVID-19 pandemic, patients with cancer felt particularly supported by integrative medicine and cancer nurse consultations. Secured resources for nursing consultations and integrative medicine services can help to address the supportive care needs of patients with cancer

Patient-reported experiences of cancer care related to the COVID-19 pandemic in Switzerland

Purpose This study aims to describe the experience of Swiss oncological patients during the COVID-19 pandemic. Methods A national multi-center study including five hospitals covering the three main language regions of Switzerland was conducted between March and July 2021. Patients with melanoma, breast, lung, or colon cancer receiving active systemic anti-cancer treatment at the time of the COVID-19 pandemic were included. We conducted semi-structured telephone or onsite interviews alongside the administration of distress and resilience-validated questionnaires. Thematic analysis was performed for the qualitative data and descriptive statistics for the quantitative data. Results Sixty-two cancer patients with a mean age of 61 (SD=14) (58% female) were interviewed. Based on the interviews, we identified that the experience of having cancer during the COVID-19 pandemic was related to five dimensions: psychological, social, support, healthcare, and vaccination. Three themes transverse the five dimensions: (a) needs, (b) positive changes, and (c) phases of the pandemic. In general, patients did not experience delays or disruptions in their cancer treatment nor felt additionally burdened by the pandemic. Lockdown and isolation were reported as mixed experiences (positive and negative), and access to vaccination reassured patients against the risk of infection and instilled hope to return to normalcy. Additionally, we found low distress levels (M=2.9; SD=2.5) and high resilience scores (M=7; SD=1.3) in these patients. Conclusion Swiss patients with cancer did not express major needs or disruptions in their care during this period of the COVID-19 pandemic. Results identify the mixed experiences of patients and highlight the high resilience levels

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Symptommanagement – pflegewissenschaftliche Modelle in der Theorie und Praxis

Hintergrund: Das Management von krankheits- und therapiebedingten Symptomen ist eine Kernaufgabe onkologischer Pflege. Neben eigener Beratung und Anbieten von Interventionen koordiniert Pflege das multidisziplinäre Team. Chronisch kranke Krebspatienten müssen lernen, ihre Symptome selbst zu managen. Fragestellung: Welche Faktoren müssen bei der Entwicklung maßgeschneiderter Symptommanagement-Interventionen besonders berücksichtigt werden? Methode: Die Fragestellung wird literaturgestützt und anhand von praktischen Erfahrungen aufgearbeitet. Ergebnisse: Das Modell von Dodd et al. stellt die Grundlage des pflegerischen Verständnisses von Symptommanagement dar. Ausgehend von der Symptomerfahrung der Patienten können individuelle Symptommanagement-Interventionen entwickelt werden. Leitend sind dabei die Fragen: Was? Wann? Wo? Warum? Wie viel? Für wen? Wie? Die Evaluation findet durch Erheben des funktionellen oder emotionalen Status, der Fähigkeit zur Selbstpflege, Kosten, Lebensqualität, sowie Morbidität und Mortalität statt. Schlussfolgerung: Für eine erfolgreiche Symptommanagement-Intervention ist multidisziplinäres Zusammenarbeiten erforderlich. Dabei müssen Symptome, die zu einer intensiven Symptomerfahrung führen, zunächst identifiziert und verstanden werden. Auf dieser Basis können Interventionen entwickelt und evaluiert werde

The good and the bad of neuroinflammation in multiple sclerosis

Multiple sclerosis (MS) is the most common inflammatory, demyelinating, neurodegenerative disorder of the central nervous system (CNS). It is widely considered a T-cell mediated autoimmune disease that develops in genetically susceptible individuals, possibly under the influence of certain environmental trigger factors. The invasion of autoreactive CD4+ T-cells into the CNS is thought to be a central step that initiates the disease. Several other cell types, including CD8+ T-cells, B-cells and phagocytes appear to be involved in causing inflammation and eventually neurodegeneration. But inflammation is not entirely deleterious in MS. Evidence has accumulated in the recent years that show the importance of regulatory immune mechanisms which restrain tissue damage and initiate regeneration. More insight into the beneficial aspects of neuroinflammation might allow us to develop new treatment strategies for this enigmatic disease

Assessments im pflegerischen Erstgespräch : Ausgangspunkt für interprofessionelle Zusammenarbeit in der Onkologie

Hintergrund Die meisten onkologischen Patient*innen werden während des Aufnahmeprozesses nicht ausreichend auf Symptome gescreent. Das führt dazu, dass die Bedarfe und Bedürfnisse von ihnen nicht richtig erfasst und mit in die Behandlung einbezogen werden. Ziel der Arbeit Es wurde untersucht, welche Assessments bereits durch verschiedene pflegerische, medizinische und soziale Dienste an onkologischen Zentren zum Einsatz kommen und wie diese zentralisiert werden könnten, um auf Grundlage dessen die unterschiedlichen Dienste gebündelt in die Betreuung der Patient*innen einbeziehen zu können. Material und Methoden Dazu wurden Gespräche mit pflegerischen, medizinischen und sozialen Diensten eines onkologischen Zentrums geführt. Hierbei wurde ein Hauptaugenmerk auf deren individuelle Screenings gelegt. Ferner wurden die Besonderheiten der Dienste für onkologische Patient*innen herausgearbeitet. Ergebnisse und Schlussfolgerung Assessments werden momentan nur durchgeführt, wenn der betreffende pflegerische, medizinische oder soziale Dienst aktiv in die Betreuung der Patient*innen eingebunden ist. Dies geschieht in der Regel erst, wenn ein Problem auftritt. Dem könnte durch eine in den Aufnahmeprozess eingebundene Bedarfs- und Bedürfnisanalyse, in dem die Assessments gebündelt zum Einsatz kommen, entgegengewirkt werden. So könnte schon vor der Entstehung eines Problems ein umfassendes Bild von den Betreffenden geschaffen werden. Auf Grundlage der Analyse durch Pflegeexpert*innen könnten dann die unterschiedlichen pflegerischen, medizinischen und sozialen Dienste direkt zu Beginn der Behandlung in die Betreuung der Patient*innen involviert werden. So kann sich die Versorgungsqualität der Patient*innen maßgeblich steigern

Medical therapy of heart failure with reduced ejection fraction: current evidence and new developments

Heart failure with reduced ejection fraction (HFrEF) is a common cardiovascular condition with a significant individual and societal burden. Although it was previously known as a palliative condition, medical drug therapies that were developed in the last four decades significantly reduced morbidity and mortality of the disease. The cornerstone of HFrEF therapy remains the blockade of the renin-angiotensin-aldosterone and the β-adrenergic systems. This review aims to give an overview and update on established disease-modifying therapies in HFrEF, discuss advances and setbacks in the treatment of selected comorbidities and provide an outlook on upcoming therapies including the new concept of dual angiotensin receptor and neprilysin inhibition