Colman Hospital

ABSTRACT Introduction Families of individuals who require inpatient neurorehabilitation following brain injury often have expectations of recovery that differ from treating healthcare professionals. This can hinder collaboration and create tension. This study aimed to explore healthcare professionals’ experiences of family expectations and identify ways to improve practice. Methods Semi-structured interviews were conducted with healthcare professionals at a Level 1 neurorehabilitation unit in England. This National Health Service unit is commissioned to see patients with highly complex needs following a brain injury. Data were analyzed using reflexive thematic analysis. Results Eighteen healthcare professionals from a range of disciplines participated, with physiotherapists most highly represented (n = 5). Analysis generated three key themes: ‘the promise of rehabilitation,’ ‘confidence with complexity,’ and ‘developing mutual understanding.’ Participants described differing expectations as a common and emotionally demanding aspect of their work, often complicated by prognostic uncertainty. Healthcare professionals recognized hope as a valid and often protective response to a life-altering brain injury. Discussion Improved mutual understanding may require a multi-component intervention to aid communication pre-admission, identify family support needs, support patients requiring disability management, provide emotional support to HCPs, and to address uncertainty. It is critical to first deepen understanding of family and patient perspectives on this topic.

Abstract Efficacy of 2nd line treatment in advanced gastric or gastro-esophageal junction (GEJ) adenocarcinoma remains limited with no identified strong predictor of treatment efficacy. We evaluated the prognostic value of circulating tumor DNA (ctDNA) in predicting the efficacy of immune checkpoint inhibitors plus chemotherapy in the randomized PRODIGE 59-FFCD 1707-DURIGAST trial. ctDNA was evaluated before treatment (baseline) and at 4 weeks (before the third cycle of treatment, C3) using droplet-digital PCR assays based on the detection of CpG methylation. Progression-free survival (PFS) and overall survival (OS) were shorter in patients with a high (> 1.1 ng/mL) versus low (< 1.1 ng/mL) ctDNA concentration at baseline (2.3 vs. 5.8 months; HR = 2.19; 95% CI, 1.09–4.41; p = 0.03 and 4.5 vs. 12.9 months; HR = 2.73; 95% CI, 1.29–5.75; p < 0.01), respectively, after adjustment for identified prognostic variables. Patients with a ctDNA decrease ≤ 75% between baseline and C3 versus a ctDNA decrease > 75% had a worse objective response rate (p = 0.007), shorter PFS (2.2 vs. 7.4 months, HR = 1.90; 95% CI, 1.03–3.51; p = 0.04) and OS (6.6 vs 16.0 months; HR = 2.18; 95% CI, 1.09–4.37; p = 0.03). To conclude, an early decrease in ctDNA concentration is a strong predictor of the therapeutic efficacy of ICI plus chemotherapy in advanced gastric/GEJ adenocarcinoma. CLINICAL TRIAL INFORMATION NCT03959293 (DURIGAST)

With an increasing prison population and rising numbers of life sentences in the UK, many older prisoners have chronic medical conditions requiring palliative interventions. The healthcare unit within HMP Norwich is the only unit in Europe providing a service specialising in the care of such prisoners. This paper describes innovative liaison work designed to develop a high-quality palliative care and end-of-life …

This article describes the development of a palliative care outreach service by two nurse practitioners into ten community hospitals. The service was designed to improve equity of service delivery in the area and to meet national initiatives aimed at developing palliative care services. It involved responding to direct referrals while developing an educational programme for staff members. The results of a survey, which identified achievements for patient care and staff development, are discussed.