Purpose:
Cancer treatment for those nearing death has become increasingly aggressive over time despite evidence that less aggressive approaches are associated with better quality of life and ...sometimes longer survival. Chemotherapy administration in the last 14 days of life is one of the proposed benchmarks for quality of cancer care. The purpose of our study is to evaluate factors associated with aggressive cancer treatment in patients who died within 2 weeks of receiving chemotherapy.
Methods:
This retrospective cohort study evaluated adult patients who died between 1 February 2018 and 1 March 2019 after receiving cancer treatment in the preceding 14 days at the Prisma Health Cancer Institute. This project was approved by our institutional review board. Data was obtained by review of electronic medical records and analyzed using commercial software.
Results:
We identified 92 patients who met inclusion criteria for the study. Of those who were staged, 57% had metastatic disease. A majority received treatments with only palliative intent (54%). These patients overwhelmingly died in the hospital (62%). Few had documented advanced directives (28%) or dedicated palliative care for longer than 1 week (28%). Overall, this cohort reflects a rate of 11.7% of patients who received cancer treatment during the study time period.
Significance of Results:
Patients receiving aggressive cancer treatment at the end of life elucidate significant gaps in quality cancer care, particularly the early involvement of dedicated palliative care. Systematic review helped identify multiple gaps and assisted in implementing interventions to improve this outcome.
Improving outcomes of telebehavioral psychoeducation requires rethinking program design when delivered wholly or partially for self-directed participation. Discussion forum participation often ...follows the "90-9-1 Rule" where 90% of participants lurk, rather than contribute content. A theoretical perspective on the behavior can help explain its adaptive functions, as well as the threats that this behavior poses to the lurker. Implications for practice require program redesign that actively links individual skills training and group-based discussion. The proposed linking design can synergize individual and group participation to support the development of mutual aid, as well as greater interaction with psychoeducation content and materials.
Student technology uncertainty was investigated in an introductory e-Social Work (e-SW) practice course. e-SW practice includes technology-mediated advocacy, research, and services delivery. A ...convergent parallel mixed methods design included pre- and post-test e-SW self-efficacy surveys and student reflections. There were significant measurable changes in the practice self efficacy scale and sub-scales. Thematic analysis demonstrated the course addressed student needs for increasing their knowledge and confidence prior to engaging in e-SW practice. Privacy and security regulation compliance showed the least increase in self-efficacy and should be an area for further development in future e-SW courses. The findings contribute to a growing literature supporting the need for investment in harnessing technology for future growth in the field of social work.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Summary
FliC is a natural antigen recognized by the innate and adaptive immune systems during Salmonella infection in mice and humans; however, the regulatory mechanisms governing its expression in ...vivo are incompletely understood. Here, we use flow cytometry to quantify fliC gene expression in single bacteria. In vitro, fliC transcription was not uniformly positive; a viable fliC‐negative subpopulation was also identified. Intracellular Salmonella repressed transcription of fliC and its positive regulator fliA, but constitutively transcribed the master regulator flhD; fliC repression required ClpXP protease, known to degrade FlhD. In orally infected mice, fliC transcription was anatomically restricted: Salmonella transcribed fliC in the Peyer's Patches (PP) but not in the mesenteric lymph nodes and spleen. The intracellularly transcribed pagC promoter was upregulated by Salmonella in all tissues, defining the infected PP as a unique environment that initiates expression of intracellularly induced genes and yet permits transcription of fliC. Because a single bacterium can escape the GI tract to colonize deeper tissues, heterogeneous gene expression may have important implications for Salmonella pathogenesis: FliC‐positive bacteria in the PP could stimulate inflammation and facilitate the priming of FliC‐specific immune responses, while FliC‐negative bacteria escape host detection in the gut and spread to systemic sites of replication.
Social Work's Grand Challenge to Harness Technology for Social Good calls for educators to reevaluate their role and its significance for the future of social work. Information and communication ...technology (ICT)-mediated practice methods like artificial intelligence, virtual reality, gamification, and big data, among others, represent a new arena for social work practice. However, educators have been mostly inactive in developing curricula that support student knowledge, training, and decision-making on the adoption of technology for practice. In the United States, the Council on Social Work Education Futures Task Force highlighted this inaction as a matter of critical uncertainty for the field's future. In contrast, this paper describes how a school of social work rapidly deployed a free, CE training program on the basics of telebehavioral health practice to the social work community to aid their response to COVID-19. The rapid deployment of that training has been distilled as 'lessons learned' for those wanting to join in efforts to address the field's critical uncertainty regarding the adoption of technology. Information is presented about the reach of this training and includes feedback from participants. Additionally, the authors discuss whether COVID-19 can influence social work's future rate of technology adoption.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This research piloted an e-health intervention that used social media to friendsource peer support for Alzheimer's disease (AD) caregivers. Friendsourcing is a variant of crowdsourcing. Crowdsourcing ...recruits online participants who share a characteristic that makes their volunteerism meaningful when they join to achieve an outcome. Friendsourcing recruits online participants who share membership in a social network that makes their volunteerism meaningful when they join to achieve an outcome. This article introduces our friendsourcing intervention research and examines the effects on the psychological well-being of AD caregivers. After a 6-week intervention, caregivers were found to have significantly decreased burden (Z = −2.01, p < .05) and perceived stress (Z = −2.95, p < .01). Emotional and informational support scores were significantly increased (Z = −2.32, p < .05). Qualitative data analysis of the intervention identified positive effects in new caregiving knowledge acquisition and application and reduced stress in the acceptance of the caregiving role. Joining social networks in support groups through friendsourcing was feasible for AD caregivers who were familiar with social media, and can provide another means of guiding the development of their personal support networks.
Psychoeducation is an empirically based intervention that is increasingly delivered online to individuals and groups. Low participation has been a problem for online designs that include peer ...support. New technology designs have been called for, and in response, we developed a model that synchronized the delivery of individual and group‐based psychoeducational activities for parent management training. We used a problem‐based learning strategy delivered to caregivers of youth demonstrating oppositional behaviours to encourage the development of helping processes and peer support. This mixed methods intervention study had high rates of participant retention and positive measurable changes for two of its three psychoeducational outcome measures. When we merged the study data, we observed that mutual aid—a frequently sought goal of group‐based interventions—contributed to participant outcomes.
Children’s and adolescents’ capacity to provide valid informed consent is one of the key ethical concerns in pediatric research. This review of adolescent vulnerability is presented to highlight the ...complex interplay between capacity and other forms of vulnerability. This review is offered as an interdisciplinary analysis to better understand why the study of vulnerable populations is critical to the ethical advancement of clinical research. Results from this analysis suggest the need for enhanced screening techniques as well as the utilization of specialized staff to identify and reduce the impact of different forms of vulnerability. These findings also provide insights into ways to ethically involve youth in complex biomedical research.
Children's and adolescents' capacity to provide valid informed consent is one of the key ethical concerns in pediatric research. This review of adolescent vulnerability is presented to highlight the ...complex interplay between capacity and other forms of vulnerability. This review is offered as an interdisciplinary analysis to better understand why the study of vulnerable populations is critical to the ethical advancement of clinical research. Results from this analysis suggest the need for enhanced screening techniques as well as the utilization of specialized staff to identify and reduce the impact of different forms of vulnerability. These findings also provide insights into ways to ethically involve youth in complex biomedical research.
Teachers’ experiences with parent involvement were compared at an inner-city high school and a suburban high school. Parent involvement has been described as underutilized by teachers, due to either ...ideological barriers or cultural biases against parents of lower socio-economic status. A sample of 62 teachers found no significant group differences between teachers at the two schools for either problematic or collaborative parent involvement. There was a significant difference for beliefs about parent competency. Results may suggest that the ideological barrier of a “protective model” for home/school relations devalues parent involvement for teachers. Parent involvement may be further devalued for inner-city teachers, who hold beliefs that parent competence is reduced by socioeconomic challenges.
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