RESUMEN
BACKGROUND: Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) are the most common prostate disorders in the UK, which cause considerable ill health in older men. Transperineal template prostate biopsy (TTPB) has emerged as a reliable procedure for the histopathological diagnosis of PCa and BPH due to its higher cancer detection rates. Although antiseptic preparation and antibiotic prophylaxis are used to ensure safety in patients undergoing surgical intervention, post-operative complications, such as infection and bleeding are still unavoidable, resulting in re-admissions, with resource implications. Currently, there is no biomarker profile to predict outcomes or monitor patients during the post-operative course. The main aim of this single-centre observational clinical pilot-study was to investigate the role of inflammatory and infection biomarkers following TTPB and their association with post-operative complications. METHODS: Forty-five patients scheduled for elective TTPB were recruited after informed consent at the Wrexham Maelor and Glan Clwyd Hospitals, North Wales, UK (n = 45). Prior to surgery, venous blood samples were collected at baseline and subsequently at 30, 120, and 240 min post-operatively. Urine samples were collected before and 120 min after the procedure. Serum procalcitonin (PCT), serum ferritin, and urine B2MG analysis were done using enzyme-linked fluorescent assay (ELFA) and the magnetic Luminex® multiplex performance assay was used to analyse IL-6, IL-8, IL-10 and TNF-α plasma concentrations. Data on clinical outcomes were collected from patients' medical records. RESULTS: Following TTPB, significant (p ≤ 0.05) increases were observed in uB2MG, IL-6, IL-8, IL-10 and TNF-α. Significant decreases were observed in ferritin (p ≤ 0.05). No significant change was observed in PCT concentration (p ≥ 0.05). One patient developed an infection and severe haematuria post-operatively following TTPB. CONCLUSION: Although not confirmative, changes seen in biomarkers such as uB2MG, IL-10 and TNF-α in our observational clinical pilot-study may warrant further investigation, involving larger cohorts, to fully understand the role of these biomarkers and their potential association with post-operative complications such as infection and bleeding which can develop following TTPB for the diagnosis of PCa and BPH.
Asunto(s)
Antiinfecciosos Locales , Hiperplasia Prostática , Neoplasias de la Próstata , Anciano , Biomarcadores , Biopsia/métodos , Ferritinas , Humanos , Inflamación/patología , Interleucina-10 , Interleucina-6 , Interleucina-8 , Masculino , Proyectos Piloto , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Polipéptido alfa Relacionado con Calcitonina , Próstata/patología , Próstata/cirugía , Hiperplasia Prostática/patología , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Factor de Necrosis Tumoral alfaRESUMEN
OBJECTIVE: The study evaluated the effects of care consultation delivered through the Alzheimer's Association National Helpline - a free resource in which master's-level clinicians offer confidential support. The study compared the effectiveness of Helpline "Care Consultation" and "Care Consultation Plus" conditions on caller outcomes. METHODS: Four hundred and forty-five non-crisis callers were randomly assigned to the traditional Helpline "Care Consultation" or a "Care Consultation Plus" condition that included one additional booster call. RESULTS: While no differences were found between the two conditions, the study found that callers reported significantly improved caregiver mental health scores (27 % net improvement over baseline) and ability to manage emotions (29 % net improvement) at one week (p = .006). By one week, 70 % of callers had put action steps in place and by 1 month 80 % of callers had put action steps into place. Over 80 % of callers reported action steps were "helpful". CONCLUSION: A single call provided a measurable benefit to caregivers'mental health, ability to manage emotions and ability to engage in action planning and accessing resources. PRACTICE IMPLICATIONS: This pilot study demonstrated that the support provided via the Helpline can be effective at improving caregiver mental health and improving the ability of callers to "take action".
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Enfermedad de Alzheimer , Cuidadores , Enfermedad de Alzheimer/terapia , Líneas Directas , Humanos , Proyectos Piloto , Derivación y ConsultaRESUMEN
The use of robot companion pets for people in care homes has been extensively studied. The results are largely positive and suggest that they are valuable in enhancing wellbeing, communication and behavioural aspects. However, there has been little research in people's own homes, possibly due to the cost and complexity of some of the robot pets currently available. As dementia affects people in different ways, this study explores the effects of a robot cat for people in their own homes, without specifically investigating the effects on a particular symptom. We utilised a case study design to investigate the proposition that various factors influence the impact of a robot cat on the person living with dementia and their carer, including acceptability of the robot pet and acceptance of dementia and its symptoms. The qualitative analysis explores the similarities and differences within the data which were gathered during interviews with people with dementia and their families. This analysis revealed four themes: Distraction, Communication, Acceptance and rejection, and Connecting with the cat and connecting with others. These themes were synthesised into two overarching themes: the effect of the cat on mood and behaviour, and The interaction with the cat. We present the acceptability and impact of the robot cat on symptoms of dementia, with data presented across and within the group of participants. Our analysis suggests that benefits of the robot pet were evident, and although this was a small-scale study, where they were accepted, robot pets provided positive outcomes for the participants and their families.
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Demencia , Mascotas , Robótica , Animales , Cuidadores , Gatos , Humanos , Investigación CualitativaRESUMEN
In April, 2019, the Alzheimer's Association Dementia Care Provider Roundtable convened to discuss common challenges faced when implementing person-centered, non-pharmacological practices in long-term care and other settings that provide care and programs for persons living with dementia, and to develop relevant, specific guidance from the perspective of administrative leaders from 23 long-term and community-based care provider organizations (representing home, community-based, and residential care). Guidance related to 5 practice areas emerged from the facilitated discussion: having a foundational person-centered culture, conceptualizing behaviors as expressions and focusing on behavioral support, identifying antecedents and placing person-centeredness before protocols, modifying training to promote person-centered culture, and valuing implementation flexibility. In developing the practice guidance, a related list of priority areas for research and policy were also identified.
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Enfermedad de Alzheimer , Demencia , Enfermedad de Alzheimer/terapia , Demencia/terapia , Humanos , Cuidados a Largo Plazo , Atención Dirigida al Paciente , AutocuidadoRESUMEN
UNLABELLED: Spirituality in nursing care has been discussed for many years in the nursing press. There has been no literature review that explores only UK literature, and this article updates a literature review carried out in 2006 (Ross, 2006). aIM: The review was designed to investigate the current nursing evidence underpinning the concept of spirituality and its application. METHOD: A systematic review of the literature was undertaken and a thematic analysis performed following a search for literature using defined dates, databases and search terms. RESULTS: Four major themes emerged from the literature: concept clarification; spiritual care-giving; religion and spirituality; and nurse education. CONCLUSION: Definitions of spiritual care vary, and the concept of spirituality in nursing is still under development. However, until a common language of spirituality is developed, models of spiritual care developed through research involving mainly nursing staff will be difficult for nurses to apply.
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Rol de la Enfermera/psicología , Enfermería , Espiritualidad , Medicina Estatal , Humanos , Reino UnidoRESUMEN
OBJECTIVE: Recent national surveys have documented that the majority of adults in the United States do not meet the recommended levels of healthy lifestyle-related behaviors. The Nutrition and Physical Activity (NuPA) study was designed to promote fruit and vegetable consumption, physical activity, and weight management for a working population. METHOD: Data were collected nationwide, USA, from 2005 to 2007 and analyzed in 2008. A total of 2470 employed participants were randomized into the self-help (SH: n=1191) or self-help plus telephone counseling (SH+C: n=1279) group. The SH+C group received nine structured telephone counseling sessions in addition to the print materials. RESULTS: A series of hierarchical regression analyses for each of the health behavior outcomes in the present-at-follow-up subsample (n=1098-1148) revealed that the SH+C was effective in increasing fruit and vegetable consumption. Among the overweight and obese participants, weight loss was significant in both the SH and SH+C groups. CONCLUSION: Using a theory-based behavioral change counseling technique and targeting multiple health behaviors among employed individuals, our findings demonstrate that the addition of telephone counseling to mailed self-help materials is effective in promoting healthy diet and weight management.
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Peso Corporal , Conductas Relacionadas con la Salud , Teléfono , Consejo , Ejercicio Físico , Frutas , Promoción de la Salud , Humanos , Conducta de Reducción del Riesgo , Encuestas y Cuestionarios , Estados Unidos , VerdurasRESUMEN
OBJECTIVE: Although the rate of smoking among women giving birth in the United States has declined steadily from 19.5% in 1989 to 11.4% in 2002, it still far exceeds the Healthy People 2010 goal of 1%. The objective of this study was to estimate the costs of a recommended five-step smoking cessation counseling intervention for pregnant women. METHODS: Costs were compared across three settings: a clinical trial, a quit line, and a rural managed care organization. Cost data were collected from August 2002 to September 2003. Intervention costs were compared with potential neonatal cost savings from averted adverse outcomes using data from the Centers for Disease Control and Prevention's Maternal and Child Health Smoking-Attributable Mortality, Morbidity, and Economics Costs software. RESULTS: The costs of implementing the intervention ranged from dollar 24 to dollar 34 per pregnant smoker counseled across the three settings. Potential neonatal cost savings that could be accrued from women who quit smoking during pregnancy were estimated at dollar 881 per maternal smoker. Assuming a 30% to 70% increase over baseline quit rates, interventions could net savings up to dollar 8 million within the range of costs per pregnant smoker. CONCLUSIONS: Costs may vary depending on the intensity and nature of the intervention; however, this analysis found a surprisingly narrow range across three disparate settings. Cost estimates presented here are shown to be low compared with potential cost savings that could be accrued across the quit rates that could be achieved through use of the 5A's smoking cessation counseling intervention.