(2016) Patient, nursing and medical staff experiences and perceptions of the care of people with palliative esophagogastric cancer. JBI Executive summary Background Esophago-gastric cancer is the fifth most common malignancy and its incidence is increasing. The disease is fast paced and five year survival rates are poor. Treatment with palliative intent is provided for the majority of patients but there remains a lack of empirical evidence into the most effective service models to support esophago-gastric cancer patients. Objectives The overall objective of this systematic review was to synthesize the best available evidence on the experiences and perceptions of patients and health professionals with regard to the care of people diagnosed with palliative esophago-gastric cancer. Inclusion Criteria Types of participants This review considered studies that included patients diagnosed with palliative esophago-gastric cancer and any health professionals involved in the delivery of palliative care to this patient group in a hospital, home or community setting. Phenomena of interest Studies that investigated the experience and perceptions of people diagnosed with palliative esophago-gastric cancer, and staff working with these people were considered. Context Studies that were carried out in any setting, including in-patient and outpatient areas, specialist cancer and non-specialist palliative care services and any patient in receipt or with experience of palliative care services were considered. All types of health practitioners delivering palliative care to esophago-gastric cancer patients were considered. Types of studies Studies that focussed on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, feminist research and narrative approaches were considered. Mixed methods studies were considered in the review only if qualitative findings were reported separately. A three step search strategy was utilised. Eleven databases were searched for papers from 2000 onwards, followed by hand searching of reference lists. Methodological quality Methodological quality was assessed using the Qualitative Assessment and Review Instrument critical appraisal tool (JBI-QARI) developed by the Joanna Briggs Institute. Data extraction Qualitative findings were extracted using the Joanna Briggs Institute-Qualitative Assessment and Review data extraction Instrument (JBI-QARI). Data synthesis Qualitative research findings were pooled using a pragmatic meta-aggregative approach. Results This review included two publications. There were 46 findings which were aggregated into four categories and one overall synthesized finding: In addition to support for physical needs, patients needed support taking into account changing life situations to achieve the best quality of life. Conclusions This review shows that patients value services and support that addresses their complex, fluctuating and highly individual needs. No evidence was uncovered regarding how these services shou...
Background: Elvitegravir/cobicistat/emtricitabine/tenofovir DF (STRIBILD, STB), can be used for antiretroviral (ARV) treatment simplification and tolerability in HIV-1 infected patients who are virologically suppressed without prior virologic failure (VF). Week (W) 96 results of STRATEGY-PI (Study 115) are reported, the first phase 3b, open-label, study examining simplification from ritonavir (RTV)-boosted protease inhibitor (PI+RTV) plus emtricitabine/ tenofovir DF (FTC/TDF) regimens to an integrase inhibitor-containing single tablet regimen. Methods: HIV-1 infected, virologically suppressed subjects on PI+RTV + FTC/ TDF regimens for ≥ 6 months either switched to STB or remained on their PI+RTV regimen (2:1 randomization). Eligibility included estimated creatinine (Cr) clearance ≥ 70 mL/min, ≤2 prior ARV regimens, no prior VF and no resistance to FTC/TDF. The primary endpoint was the proportion of subjects who maintained HIV-1 RNA < 50 c/mL at W48 (snapshot algorithm, 12% noninferiority margin); W96 was the final endpoint. If noninferiority was established, superiority was tested (prespecified). Results: At randomization, subjects (n=433, 293 STB; 140 PI+RTV) were mostly male (86%), white (80%) and age < 50 yr (82%). ATV+RTV (40%) or DRV+RTV (40%) were the most common PIs. Median time since first ARV use was 3 yrs; 19% were on their 2nd ARV regimen. At W96, 86% STB vs 69% PI+RTV maintained HIV-RNA < 50 c/mL (difference 16.5%, 95% CI: +7.8% to +25.4%; p<0.001). The difference favouring STB was mainly due to nonvirologic reasons. VF was lower on STB (1% STB vs 5% PI+RTV), but with no emergent resistance in either group. Grade 3-4 adverse events (AE) occurred in 6% STB vs 8% PI+RTV. AEs leading to discontinuation occurred in 3% STB vs 2% PI+RTV. Median changes in serum Cr (lmol/L) were STB, +6.2, and RI+RTV, +0.9, similar to W48. One STB subject discontinued due to a renal AE after W48 (blood Cr increased). No case of proximal renal tubulopathy (PRT) occurred in either group. Conclusions: Switching to STB from PI+RTV+FTC/TDF regimens resulted in significantly higher virologic success by snapshot at W96. VF was lower on STB with no emergent resistance in either group. The difference favouring STB was mainly due to non-virologic reasons. STB was well-tolerated, and no case of PRT occurred. Simplification to STB from a multi-tablet, PI+RTV regimen is effective, durable and safe in HIV-1 infected, virologically suppressed patients without history of VF. P2 SINGLE W144: Greater changes in bone turnover markers in antiretroviral therapy-na€ ıve individuals initiating efavirenz/ emtricitabine/tenofovir disoproxil fumarate compared with dolutegravir plus abacavir/lamivudine GlaxoSmithKline Research Triangle Park, North Carolina, USA Background: Changes in bone mineral density (BMD) have been reported after initiation of antiretroviral therapy (ART), and the degree of change in BMD may differ among various regimens. Biomarkers of bone turnover were assessed over 144 weeks in the SINGLE study, a clinical trial which demonst...
Background An extended role being explored globally is that of the advanced clinical practitioner (ACP). In England this is an extended role for allied health professions, nurses and midwives. ACP education is organised by Health Education England (HEE) who organise an accredited training programme for ACPs alongside a multi-professional framework. This paper draws on research commissioned to evaluate the national implementation of the ACP role to inform the development of a Centre for Advancing Practice in the UK but has implications for others considering their ACP provision. This paper focuses on three key research questions: 1) What is the role of ACPs in England? 2) What are the barriers and facilitators to implementing the role? and 3) What is the contribution of ACPs to health services in England? Methods Semi-structured interviews were conducted in 2020 with 63 participants across a range of stakeholder groups and clinical areas. A purposive snowball sampling technique was used to identify participants meeting the inclusion criteria. Interviews were recorded and transcribed verbatim, anonymised and thematically analysed. Results We report on three aspects as highlighted from the data (1) The role of ACPs, (2) Barriers to and facilitators of the ACP role implementation (3) Contribution of ACPs to health services in England. The ACP role in England was undertaken in a broad range of clinical contexts. ACPs worked towards being an autonomous practitioner and most were independent prescribers. In England ‘advanced clinical practitioner’ was not a protected title. There were high levels of variability and ambiguity of understanding and deployment of the ACP role in England. Conclusions This study outlines the contribution that ACPs make to health services and contributing factors to the success of the ACP role in England. We demonstrated the range in which the role is successful in England. We identified key barriers and facilitators to implementing this role. Finally, the work showed the positive contribution that ACPs can make to service redesign and workforce development as well as patient outcomes, whilst accepting that there is much work to do to ensure protected status and parity across all professions and clinical contexts.
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