Highlights • An overview of the history of melanoma treatment and the current targeted and immunotherapies. • Discussion of the future of melanoma treatment as we go beyond monotherapies to a ...combinatorial approach. • Combining older therapies with the new molecular and immunotherapies will be the most promising way forward for treatment of metastatic melanoma.
Advance Care Planning (ACP) enables healthcare professionals to embrace the important process where patients think about their values in life and goals for health care, and discuss their future ...health care preferences with family members for a time when they are not able to make health care decisions. Despite the promotion of ACP last two decades, and well-known benefits of ACP and a written Advance Care Directive (ACD), they are still underutilised in Australia and across the world. Previous studies have provided some insights, however, an uptake of ACP and prevalence of ACDs in community settings is rarely reported.
The aim of this study was to determine the uptake of ACP and prevalence of ACDs among people with chronic diseases in hospital and community settings. A retrospective medical record audit of eligible patients looking for evidence of ACP was conducted in 16 research sites in eight hospital and eight community care settings. Participants included those who were admitted to one of the research sites, and who were aged 18 years and over with at least one of nine nominated chronic diseases. The primary outcome measures included the number of patients with evidence of ACP through the following practices: completion of an ACD, appointment of an Enduring Guardian (EG), or completion of a resuscitation plan.
The overall prevalence of ACD was 2.8% (n = 28) out of 1006 audited records, and only 10 (1%) of them were legally binding. The number of EGs appointed was 39 (3.9%) across the sites. A total of 151 (15.4%) resuscitation plans were found across the eight hospital sites. 95% (n = 144) of the resuscitation plans indicated 'Not-for-resuscitation'.
The uptake of ACP is very low. Current medical recording system reveals the challenges in ACP lie in the process of storage, access and execution of the ACDs. Given that having an ACD or Enduring Guardian in place is only useful if the treating physician knows how and where to access the information, it has implications for policy, information system, and healthcare professionals' education.
The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246 ). The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The mode of ligand presentation has a fundamental role in organizing cell fate throughout development. We report a rapid and simple approach for immobilizing signaling ligands to maleic anhydride ...copolymer thin-film coatings, enabling stable signaling ligand presentation at interfaces at defined concentrations. We demonstrate the utility of this platform technology using leukemia inhibitory factor (LIF) and stem cell factor (SCF). Immobilized LIF supported mouse embryonic stem cell (mESC) pluripotency for at least 2 weeks in the absence of added diffusible LIF. Immobilized LIF activated signal transducer and activator of transcription 3 (STAT3) and mitogen-activated protein kinase (MAPK) signaling in a dose-dependent manner. The introduced method allows for the robust investigation of cell fate responses from interface-immobilized ligands.
Purpose - The purpose of this paper is to evaluate the evidence on the extent to which personal debt impacts on mental health, and mental health on personal debt.Design methodology approach - The ...paper systematically reviews the English-language, peer-reviewed literature, 1980-2009, drawing on 14 databases across the medical, business, legal, and social science fields.Findings - From 39,333 potential papers identified, 39,283 were excluded, and 50 were reviewed using a narrative analysis approach. Among nine longitudinal studies, three controlled for psychiatric morbidity or psychological wellbeing at baseline, income wealth, and other socio-economic variables. From these, two reported indebtedness or an increase in debt levels associated with subsequently poorer mental health, while one study found no such relationship. While methodological limitations make it difficult to definitively demonstrate whether indebtedness causes poorer mental health, plausible data exist which indicate that indebtedness may contribute to the development of mental health problems, and mediate accepted relationships between poverty, low income, and mental disorder.Research limitations implications - Existing research either uses definitions of "debt" which lack specificity, or definitions of "mental health" which are too broad-brushed. A more sensitive set of core questions is needed. Further longitudinal research is also a key priority.Practical implications - Those working with people with debt problems need to be aware of the potential risk of reduced mental wellbeing or mental disorder.Originality value - The mental health of individuals living with indebtedness has become a recent concern for the health and financial services sectors. However, no systematic reviews have so far been conducted.
Advance Care Planning (ACP) has emerged to improve end-of-life processes and experiences. However, the available evidence presents the gloomy picture of increasing number of older people living with ...chronic diseases and the mismatch between their preferences for and the actual place of death. The study aimed to investigate the efficacy of normalisation of an Advance Care Planning (NACP) service delivered by specially trained Registered Nurses (RNs) in hospital and community settings.
A quasi-experimental study was conducted involving 16 sites (eight hospital and eight community sites) in Australia. Patients who were aged ≥18 years, who had at least one of nine chronic conditions, and who did not have an Advance Care Directive (ACD) were offered the NACP service. ACP was normalised as part of routine service on admission. The intervention, NACP, was a series of facilitated conversations about the components of ACP. The primary outcomes which included the completion of ACDs, and/or appointment of an Enduring Guardian (EG), were assessed in both intervention and control sites at pre and post intervention stages. Numbers of patients who completed an ACD or appointed an EG were described by count (percentage). ACD completion was compared between intervention and control sites using a logistic mixed effects regression model. The model includes fixed effects for treatment group, period, and their interaction, as well as random site level intercepts. Secondary model included potentially confounding variables as covariates, including age, sex and chronic diseases.
The prevalence of legally binding ACDs in intervention sites has increased from five to 85 (from 0.85% in pre to 17.6% in post), whereas it has slightly decreased from five to 2 (from 1.2% in pre and to 0.49% in post) in control sites (the difference in these changes being statistically significant p < 0.001). ACD completion rate was 3.6% (n = 4) in LHD1 and 1.2% (n = 3) in LHD2 in hospital whereas it was 53% (n = 26) in LHD1 and 80% (n = 52) in LHD2 in community.
The study demonstrated that NACP service delivered by ACP RNs was effective in increasing completion of ACDs (interaction odds ratio = 50) and was more effective in community than hospital settings. Involvement of various healthcare professionals are warranted to ensure concordance of care.
The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246 ) on 03/10/2018. The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A growing body of international literature concurs that comprehensive and complex Advance Care Planning (ACP) programs involving specially qualified or trained healthcare professionals are effective ...in increasing documentation of Advance Care Directives (ACDs), improving compliance with patients' wishes and satisfaction with care, and quality of care for patients and their families. Economic analyses of ACDs and ACP have been more sporadic and inconclusive. This study aimed to contribute to the evidence on resource use associated with implementation of ACP and to inform key decision-makers of the resource implications through the conduct of a cost-consequence analysis of the Normalised Advance Care Planning (NACP) trial.
The outcomes for the economic evaluation included the number of completed "legally binding" ACDs and the number of completed Conversation Cards (CC). The cost analysis assessed the incremental difference in resource utilisation between Usual Practice and the Intervention. Costs have been categorised into: 1) Contract staff costs; 2) Costs associated with the development of the intervention; 3) Implementation costs; 4) Intervention (delivery) costs; and 5) Research costs.
The cost incurred for each completed ACD was A$13,980 in the hospital setting and A$1248 in the community setting. The cost incurred for each completed Conversation Card was A$7528 in the hospital setting and A$910 in the community setting.
The cost-consequence analysis does not support generalisation of the specified intervention within the hospital setting. The trial realised an estimated incremental cost per completed ACD of $1248, within the community setting. This estimate provides an additional benchmark against which decision-makers can assess the value of either 1) this approach towards the realisation of additional completed ACDs; and/or 2) the value of ACP and ACDs more broadly, when this estimate is positioned within the potential health outcomes and downstream health service implications that may arise for people with or without a completed ACD.
The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246 ). The URL of the trial registry record.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•The hope accompanying debt can be one of avoiding legal enforcement despite being behind with repayments.•This optimism involves a struggle over the proximity or distance of the material ...manifestations of debt.•Over-indebted optimism is spatially constituted.•It is scenic in that it involves imaginative projections onto one’s surroundings.
Studies of the hopes that accompany personal debt have highlighted the aspirations it generates for upward mobility. Yet working-class debtors living on a housing estate in southern England expressed little faith that their socio-economic situation could improve. The optimism accompanying their indebtedness was of avoiding legal enforcement despite being behind with repayments. This optimism involved a spatial politics of debt, where debtors expelled threats of enforcement from their immediate sensory environment. Home entertainment was another key source of repose for my interlocutors. The suspension of disbelief required for entertaining the on-screen fictions of video games and films relied on setting a scene free from distractions. Likewise, debtors’ capacity to believe in the possibility of avoiding enforcement relied on crafting a sensory environment for their optimism, by focusing on desired sensory stimuli like their home, family and possessions and putting the portents of dispossession out of sight. Accordingly, I identify “mise en scène” as a description of over-indebted optimism. In spatial terms, it involved re-asserting conventional Euclidean space in the face of creditors’ topological power-plays. Its scenic quality derived from “make-believe” practices that could bring into being the possibility they simulated: debtors acted as if, by hanging up the phone on creditors and leaving their letters unopened, it were possible to stop enforcement from happening. Highlighting the spatial basis of over-indebted optimism, these scenes were spaces in which debtors could undertake a political struggle over the possibility or impossibility of avoiding enforcement.
The power asymmetries operating through debt include not only the domination of conduct and the extraction of wealth but also unequal struggles to define value. Long-term ethnographic fieldwork on a ...low-income housing estate in southern England revealed a 'suspensory' approach to debt, in which those who cannot afford to comply with their creditors' debt repayment demands suspend both the temporal point at which debts will end through repayment or enforcement and the dominant morality of repayment through amoral humour about being a bad debtor. This shows that the form of power asymmetry that debtors experience, if any, hinges on their relation to both the morality and temporality of repayment.
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