Conectar
Head and neck cancer (HNC) affects the mouth, throat, salivary glands, voice box, nose or sinuses. Every year, over 12 000 people in the UK are diagnosed with HNC. Neck dissection is a key, surgical component of patient care. However, many people experience postoperative restriction in shoulder and neck movements, pain, fatigue and low mood, with only half ever returning to work.
Getting Recovery Right After Neck Dissection (GRRAND) is a two-arm, multicentre, pragmatic randomised controlled trial. The trial aims to compare clinical and cost-effectiveness of a personalised physiotherapy programme (GRRAND programme) versus usual practice, National Health Service (NHS), postdischarge care.
The planned sample size is 390 participants. Participants will be recruited from across UK sites and followed up for 12 months. The primary outcome is the shoulder pain and disability index at 12 months. Economic evaluation will be conducted from a healthcare system and personal social services perspective. Secondary outcome data, including pain, function, health-related quality of life, mental well-being, health resource use and adverse events, will be collected at 6 weeks, 3, 6 and 12 months, with exercise adherence at 6 weeks. A process evaluation will determine how GRRAND is implemented, delivered and received across clinical settings, exploring what works, for whom and under what conditions. Analysis will be on an intention-to-treat basis and reported inline with the Consolidated Standards of Reporting Trials statement.
The trial was approved by the London-Brent Research Ethics Committee (ref: 24/LO/0722) on 15 October 2024. Trial results will be disseminated via peer-reviewed publications, presentations at national and international conferences, in lay summaries and social media. This protocol adheres to the recommended Standard Protocol Items: Recommendations for Interventional Trials checklist.
To explore the healthcare experiences and needs of older adults living with HIV in Sweden.
A phenomenological study using qualitative thematic analysis.
Data were gathered through semistructured qualitative interviews and analysed using thematic analysis. A purposive sample of individuals ageing and living with HIV was recruited for this study.
A total of 22 participants aged 65 years and older, with a mean age of 75 years, participated in the study. Living with HIV meant a need to rely on consistent healthcare and treatment over the course of one's lifetime. The experiences of older adults were described under four themes: relying on access to health care, desiring involvement and shared decision-making, the importance of trust and confidentiality and experiences of stigma in healthcare visits.
Living and ageing with HIV involved recurring exposure and vulnerability in healthcare encounters, and experiences of being exposed to HIV-related stigma, especially outside HIV clinics. Continuity and being seen as a person in healthcare encounters were important. Enhancing HIV knowledge alongside fostering supportive attitudes and approaches of healthcare professionals is critical for ensuring high-quality and nondiscriminating health care.
Meeting the needs of older adults living with HIV requires a person-centred approach, including active involvement and shared decision-making between patients and healthcare providers.
This study describes the healthcare experiences and needs of older adults, aged 65 years and older, living with HIV, a population that is not typically investigated in qualitative research. Living and ageing with HIV means a vulnerability where the attitudes of professionals and the active involvement of the patient become significant for quality care. The findings can help with the implementation of policies and practices for the care of older adults living with HIV.
The Consolidated Criteria for Reporting Qualitative Studies (COREQ) was used.
Patient representatives were involved in discussions on data collection and the development of the interview guide.
To evaluate the impact of nurse care changes in implementing a blood pressure management protocol on achieving rapid, intensive and sustained blood pressure reduction in acute intracerebral haemorrhage patients.
Retrospective cohort study of prospectively collected data over 6 years.
Intracerebral haemorrhage patients within 6 h and systolic blood pressure ≥ 150 mmHg followed a rapid (starting treatment at computed tomography suite with a target achievement goal of ≤60 min), intensive (target systolic blood pressure < 140 mmHg) and sustained (maintaining target stability for 24 h) blood pressure management plan. We differentiated six periods: P1, stroke nurse at computed tomography suite (baseline period); P2, antihypertensive titration by stroke nurse; P3, retraining by neurologists; P4, integration of a stroke advanced practice nurse; P5, after COVID-19 impact; and P6, retraining by stroke advanced practice nurse. Outcomes included first-hour target achievement (primary outcome), tomography-to-treatment and treatment-to-target times, first-hour maximum dose of antihypertensive treatment and 6-h and 24-h systolic blood pressure variability.
Compared to P1, antihypertensive titration by stroke nurses (P2) reduced treatment-to-target time and increased the rate of first-hour target achievement, retraining of stroke nurses by neurologists (P3) maintained a higher rate of first-hour target achievement and the integration of a stroke advanced practice nurse (P4) reduced both 6-h and 24-h systolic blood pressure variability. However, 6-h systolic blood pressure variability increased from P4 to P5 following the impact of the COVID-19 pandemic. Finally, compared to P1, retraining of stroke nurses by stroke advanced practice nurse (P6) reduced tomography-to-treatment time and increased the first-hour maximum dose of antihypertensive treatment.
Changes in nursing care and continuous education can significantly enhance the time metrics and blood pressure outcomes in acute intracerebral haemorrhage patients.
STROBE guidelines.
No Patient or Public Contribution.
FreshRSS 