Quality of death educational programme in a national reference palliative care unit

OBJECTIVE

To report the experience of offering the Quality End of Life Care for All (QELCA) Programme, highlighting the distinct methodology for the training of health professionals.

DEVELOPMENT

The QELCA Programme, intellectual property of St Christopher's Hospice, was offered to seven health professionals working in the hospital palliative care unit at the National Cancer Institute, between June and December 2022, with the support of Premier Institute. The programme, which originates in the UK, has been evaluated there and is currently being evaluated in Hong Kong, and is delivered in two phases: (1) a 5-day immersion programme; (2) monthly sessions of Action Learning for 6 months. Participants realised that communication between members of the multidisciplinary team, as well as between health professionals and patients/loved ones, was one of the key challenges for achieving quality of death in the hospital palliative care unit. This insight empowered them to drive forward significant changes in practice that promise to improve quality of care.

CONCLUSION

The QELCA Programme enabled participants to engage in active problem-solving to promote the relief of suffering of patients and their families in end-of-life care.

Genotypic analysis of clinical and environmental Cryptococcus neoformans isolates from Brazil reveals the presence of VNB isolates and a correlation with biological factors

Cryptococcal infections are mainly caused by members of the Cryptococcus neoformans species complex (molecular types VNI, VNII, VNB, VNIV and the AD hybrid VNIII). PCR of the mating type loci and MLST typing using the ISHAM-MLST consensus scheme were used to evaluate the genetic relationship of 102 (63 clinical and 39 environmental) C. neoformans isolates from Uberaba, Brazil and to correlate the obtained genotypes with clinical, antifungal susceptibility and virulence factor data. All isolates were mating type alpha. MLST identified 12 known and five new sequence types (ST). Fourteen STs were identified within the VNI isolates, with ST93 (57/102, 56%) and ST77 (19/102, 19%) being the most prevalent. From the nine VNII isolates previously identify by URA5-RFLP only four (ST40) were confirmed by MLST. The remaining five grouped within the VNB clade in the phylogenetic analysis corresponding to the sequence type ST504. Other two environmental isolates also grouped within VNB clade with the new sequence type ST527. The four VNII/ST40 isolates were isolated from CSF. The two VNIV sequence types (ST11 and ST160) were isolated from blood cultures. Two of six patients evaluated with more than one isolates had mixed infections. Amongst the VNI isolates 4 populations were identified, which showed differences in their susceptibility profiles, clinical outcome and virulence factors. These results reinforce that ST93 is the most prevalent ST in HIV-infected patients in the Southeastern region of Brazil. The finding of the VNB molecular type amongst environmental Brazilian isolates highlights that this genotype is not restricted to the African continent.

Effect of lectin (ScLL) on fibroblasts stimulated with LPS - an in vitro study

The lectin (ScLL) extracted from the Synadenium carinatum plant has been evaluated as an immunomodulator in diseases such as asthma, neosporosis and leishmaniasis. However, it has not yet been evaluated in the oral cavity. This study evaluated the effect of ScLL on viability, proliferation and release of IL-10 in human gingival fibroblasts (HGF) stimulated with lipopolysaccharide (LPS). HGF were stimulated with LPS 1 µg/ml and treated with ScLL in concentrations of 10, 5 and 2 µg/ml for 1 and 5 h, and evaluated by flow cytometry for viability, apoptosis (initial/advanced) and necrosis. The supernatant was collected to detect release of IL-10 by ELISA. The proliferation was assessed with the BrdU assay. Positive control consisted of cells maintained in Dulbecco's Modified Eagles Medium (DMEM), and the negative control, of those kept in tap water. Data were analyzed by ANOVA and Dunnett's test (α = 0.05). No significant difference was found for ScLL concentrations regarding viability or initial and advanced apoptosis (p=0.455). All the groups, including the positive control, had a significantly lower necrosis parameter than negative control at 5 h (p < 0.001). No difference was found for proliferation among the experimental groups (p = 0.832). ScLL at 5 and 2 µg/ml resulted in a lower release of IL-10 than positive and negative controls at 5 h (p = 0.047). The results indicated that ScLL concentrations tested were not cytotoxic, and had no effect on proliferation and release of IL-10 parameters. A thorough understanding of ScLL, regarding its immunomodulatory potential, may open the door to new perspectives for dentistry.

Mudanças no desenvolvimento temporal da força em mulheres de diferentes faixas etárias

INTRODUÇÃO: redução na força e na velocidade da contração muscular são duas das maiores causas de debilidade funcional em idosos.OBJETIVO: analisar as mudanças relacionadas à idade no desenvolvimento temporal da força de preensão manual e dos extensores do joelho em mulheres.MÉTODOS: a amostra foi constituída por 52 mulheres subdivididas em três grupos (JO. n=24, 25,2±3,7 anos; MI. n=13, 58±4,2 anos; ID. n=15, 71,3±3,9 anos). Os testes realizados foram o de preensão manual e o de extensão do joelho. Foram executadas três tentativas de esforço isométrico máximo em cada teste, e a curva com o valor máximo de força foi selecionada para análise por meio de um algoritmo desenvolvido em linguagem Matlab(r). A massa livre de gordura (MLG) foi avaliada por meio da absortometria radiológica de dupla energia.RESULTADOS: foram observados entre os grupos valores semelhantes de força (p=0,831) e MLG do membro superior (p=0,207). A taxa de desenvolvimento da força (TDF) foi menor nos intervalos iniciais da contração muscular (0-50 e 0-100ms) nos grupos MI (p=0,005 e p=0,000, para 50ms e 100ms, respectivamente) e ID (p=0,003 e p=0,000, para 50ms e 100ms, respectivamente). A MLG e a força do membro inferior foram menores nos grupos MI (p=0,006, p=0,014, respectivamente) e ID (p<0,000, p=0,000, respectivamente) em comparação ao JO. Já a TDF dos extensores do joelho foi semelhante no grupo MI (p>0,05), porém, menor no grupo ID (p<0,05) em comparação ao JO, em todos os intervalos analisados.CONCLUSÃO: os resultados deste estudo sugerem que os grupos musculares dos membros superiores e inferiores possam ser afetados em diferentes magnitudes pelo envelhecimento. As diferenças entre os membros podem estar relacionadas à quantidade e qualidade das atividades físicas realizadas.