The transition experience of rural older persons with advanced cancer and their families: a grounded theory study

BACKGROUND: Transitions often occur suddenly and can be traumatic to both patients with advanced disease and their families. The purpose of this study was to explore the transition experience of older rural persons with advanced cancer and their families from the perspective of palliative home care patients, bereaved family caregivers, and health care professionals. The specific aims were to: (1) describe the experience of significant transitions experienced by older rural persons who were receiving palliative home care and their families and (2) develop a substantive theory of transitions in this population. METHODS: Using a grounded theory approach, 27 open-ended individual audio-taped interviews were conducted with six older rural persons with advanced cancer and 10 bereaved family caregivers. Four focus group interviews were conducted with 12 palliative care health care professionals. All interviews were transcribed verbatim, coded, and analyzed using Charmaz\u27s constructivist grounded theory approach. RESULTS: Within a rural context of isolation, lack of information and limited accessibility to services, and values of individuality and community connectedness, older rural palliative patients and their families experienced multiple complex transitions in environment, roles/relationships, activities of daily living, and physical and mental health. Transitions disrupted the lives of palliative patients and their caregivers, resulting in distress and uncertainty. Rural palliative patients and their families adapted to transitions through the processes of Navigating Unknown Waters . This tentative theory includes processes of coming to terms with their situation, connecting, and redefining normal. Timely communication, provision of information and support networks facilitated the processes. CONCLUSION: The emerging theory provides a foundation for future research. Significant transitions identified in this study may serve as a focus for improving delivery of palliative and end of life care in rural areas. Improved understanding of the transitions experienced by advanced cancer palliative care patients and their families, as well as the psychological processes involved in adapting to the transitions, will help health care providers address the unique needs of this vulnerable population

The acute effect of intra-aortic balloon counterpulsation during extracorporeal life support: An experimental study

Hemodynamically unstable patients supported by an extracorporeal life support (ECLS) circuit often receive additional support by intra-aortic balloon pump (IABP). However, it is not established whether support of the failing heart is improved by adjunctive IABP in both peripheral cannulation (PC) and central cannulation (CC) settings. Seven sheep were supported by an IABP and an ECLS system which were cannulated centrally as well as peripherally. In each cannulation configuration, hemodynamic and cardiac function indices were measured at baseline, ECLS, and ECLS plus IABP. The primary variables were mean coronary artery flow (Qcor), diastolic pressure time index (DPTI), left ventricular (LV) pressure-volume area (PVA), and tension time index (TTI). Additional IABP with ECLS support (CC/PC) decreased LV afterload (LV systolic peak pressure -4%, P < 0.05/-8%, P < 0.02), as well as TTI -2%/-10% and PVA -10%/-12% (P < 0.03). Coronary perfusion was increased by additional IABP: CC, Qcor, +9%, and DPTI, +18% (P < 0.02); PC, Qcor,+6%, and DPTI, +11% (P < 0.05). IABP augmented the myocardial oxygen supply/demand ratios (CC/PC): Qcor/(PVA.heart rate) (+21%/+22%, P < 0.02) and DPTI/TTI (+27%/+24%, P < 0.03). In case of low arterial pressure (< 50 mm Hg) and reduced ECLS flow, the overall hemodynamic profile improved only with central cannulation. We conclude that in both central and peripheral ECLS cannulation settings, adjunctive IABP improves the myocardial oxygen supply demand balance. In case of low cardiac output and insufficient extracorporeal flow with PC, adjunctive IABP may be contraindicated

The acute effect of intra-aortic balloon counterpulsation during extracorporeal life support: an experimental study

Hemodynamically unstable patients supported by an extracorporeal life support (ECLS) circuit often receive additional support by intra-aortic balloon pump (IABP). However, it is not established whether support of the failing heart is improved by adjunctive IABP in both peripheral cannulation (PC) and central cannulation (CC) settings. Seven sheep were supported by an IABP and an ECLS system which were cannulated centrally as well as peripherally. In each cannulation configuration, hemodynamic and cardiac function indices were measured at baseline, ECLS, and ECLS plus IABP. The primary variables were mean coronary artery flow (Qcor), diastolic pressure time index (DPTI), left ventricular (LV) pressure-volume area (PVA), and tension time index (TTI). Additional IABP with ECLS support (CC/PC) decreased LV afterload (LV systolic peak pressure -4%, P < 0.05/-8%, P < 0.02), as well as TTI -2%/-10% and PVA -10%/-12% (P < 0.03). Coronary perfusion was increased by additional IABP: CC, Qcor, +9%, and DPTI, +18% (P < 0.02); PC, Qcor,+6%, and DPTI, +11% (P < 0.05). IABP augmented the myocardial oxygen supply/demand ratios (CC/PC): Qcor/(PVA.heart rate) (+21%/+22%, P < 0.02) and DPTI/TTI (+27%/+24%, P < 0.03). In case of low arterial pressure (< 50 mm Hg) and reduced ECLS flow, the overall hemodynamic profile improved only with central cannulation. We conclude that in both central and peripheral ECLS cannulation settings, adjunctive IABP improves the myocardial oxygen supply demand balance. In case of low cardiac output and insufficient extracorporeal flow with PC, adjunctive IABP may be contraindicated

Qualit&auml;tsstandards f&uuml;r epidemiologische Kohortenstudien. Ein bewerteter Anforderungskatalog zur Studienvorbereitung und Studiendurchf&uuml;hrung. &nbsp;

Hintergrund Kohortenstudien sind prospektive Beobachtungsstudien. Sie sind in der Epidemiologie zum Studium von Krankheitsverl&auml;ufen und Risikofaktoren fest etabliert. Hinsichtlich der Beschreibung und Bewertung von Qualit&auml;tsmerkmalen epidemiologischer Kohortenstudien existieren jedoch keine Standards. Ziel der Arbeit Im TMF(Technologie- und Methodenplattform f&uuml;r die vernetzte medizinische Forschung e.&thinsp;V.)-Projekt &bdquo;Qualit&auml;tsmanagementstandards in Kohortenstudien&ldquo; sollte unter Beteiligung von Vertretern epidemiologischer Kohortenstudien ein Anforderungskatalog f&uuml;r Qualit&auml;tsmerkmale der Studienvorbereitung und Studiendurchf&uuml;hrung zusammengestellt und bewertet werden. Material und Methoden Der Anforderungskatalog wurde auf Basis eines Konsensprozesses von Vertretern aus sieben deutschen epidemiologischen Kohortenstudien erstellt. Um die Struktur und Elemente einer Anforderungsliste zu definieren, fanden Expertentreffen statt. In drei Bewertungswellen wurden Wichtigkeit und Implementierungsgrad aller Anforderungen bewertet. Ergebnisse Konsentiert wurde ein Anforderungskatalog mit 138 Anforderungen, die in 10&nbsp;Bereiche gegliedert sind: 1.&nbsp;Studiendokumente, 2.&nbsp;Instrumentenauswahl, 3.&nbsp;Untersuchungsplanung, 4.&nbsp;Organisationsstruktur, 5.&nbsp;Qualifizierung und Zertifizierung, 6.&nbsp;Probandenrekrutierung, 7.&nbsp;Untersuchungsvorbereitung und -durchf&uuml;hrung, 8.&nbsp;Logistik und Instandhaltung, 9.&nbsp;Datenerfassung und Datenmanagement sowie 10.&nbsp;Reporting und Monitoring. Insgesamt 41&nbsp;Anforderungen wurden als essenziell, 91&nbsp;als wichtig und 6&nbsp;als weniger wichtig bewertet. Diskussion Der Anforderungskatalog liefert Kohortenstudien Orientierungspunkte bei der Konzeption und Umsetzung, um eine m&ouml;glichst hohe Struktur‑, Prozess- und Ergebnisqualit&auml;t zu erzielen. Die Bewertung der Wichtigkeit und des Implementationsgrades einzelner Anforderungen h&auml;ngt vom Studiendesign ab. Die Ergebnisse k&ouml;nnen mit Anpassungen auch f&uuml;r andere Studientypen relevant sein. &nbsp