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52. Advance care planning in patients with advanced cancer : a 6-country, cluster-randomised clinical trialIda Joanna Korfage, Giulia Carreras, Caroline M. Arnfeldt Christiansen, Pascalle Billekens, Louise Bramley, Linda Briggs, Francesco Bulli, Glenys Caswell, Branka Červ, Johannes JM van Delden, Hana Kodba Čeh, Urška Lunder, Alenka Mimič, Polona Ozbič, Anja Simonič, 2020, review article Abstract: Background. Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. Methods and findings. To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015–2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0–3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients’ age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients’ quality of life did not differ between intervention and control groups (T-score −1.8 versus −0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. Conclusions. Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed.
Keywords: advanced care planning, medical treatment, advanced cancer, palliative care
Published in DiRROS: 14.12.2020; Views: 1308; Downloads: 1267
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53. Platformne storitveAna Robnik, Andrej Ciglič, Aleš Balanč, Dušan Gabrijelčič, Jan Porekar, Arso Savanović, Polona Škraba, Roman Kužnar, Ignac Zupan, 2015, published scientific conference contribution Published in DiRROS: 08.12.2020; Views: 1278; Downloads: 385
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55. Timeline of leaf and cambial phenology in relation to development of initial conduits in xylem and phloem in three coexisting sub-Mediterranean deciduous tree speciesJožica Gričar, Andreja Vedenik, Gregor Skoberne, Polona Hafner, Peter Prislan, 2020, original scientific article Abstract: It is unclear how the anticipated climate change will affect the timing of phenology of different tree organs/tissues and thus the whole-tree functioning. We examined the timing of leaf phenology and secondary growth in three coexisting deciduous tree species (Quercus pubescens Willd., Fraxinus ornus L. and Ostrya carpinifolia Scop) from a sub-Mediterranean region in 2019. In addition, we investigated the relationship between leaf and cambial phenology and the onset of the potential functioning of initial conduits, as determined by the completed differentiation process (vessels) or final size (sieve tubes). For this purpose, leaf development was monitored and the microcores of cambium and the youngest phloem and xylem increments were repeatedly collected at 7-10-day intervals during the growing season. The results revealed differences in the timing of leaf development and seasonal radial growth patterns in spring among the studied tree species, depending on wood porosity. We found that cambial cell production started in all cases in the first half of March. However, in ring-porous Q. pubescens and F. ornus, radial growth in the stem occurred more than a month before buds were swollen, whereas in diffuse-porous O. carpinifolia, these two events were detected at almost the same time. The end of cambial cell production occurred earliest in F. ornus (mid-July) and two weeks later also in the other two species. The widest initial earlywood vessels and early phloem sieve tubes were found in Q. pubescens, the narrowest initial earlywood vessels in O. carpinifolia and the narrowest early phloem sieve tubes in F. ornus. This indicates differences in the e%ciency of conducting systems among the studied species. This novel approach of studying phloem phenology and anatomy in relation to leaf and xylem development contributes to a better understanding of how different tree species adapt their structure of secondary vascular tissues in response to environmental change.
Keywords: Quercus pubescens, Fraxinus ornus, Ostrya carpinifolia, earlywood, early phloem, vessel, sieve tube, radial growth
Published in DiRROS: 21.10.2020; Views: 1225; Downloads: 907
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56. Je mogoče pripisati vrednost vsem ekosistemskim storitvam, ki jih nudi gozd?Mitja Skudnik, Polona Hafner, 2020, preface, editorial, afterword Keywords: ekosistemske storitve, gozdovi, posredni pomen gozdov, vrednotenje
Published in DiRROS: 10.10.2020; Views: 1341; Downloads: 424
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57. Trained facilitators' experiences with structured advance care planning conversations in oncology : an international focus group study within the ACTION trialK. Pollock, Marieke Zwakman, Francesco Bulli, Glenys Caswell, Branka Červ, Johannes JM van Delden, Luc Deliens, Agnes van der Heide, Lea J. Jabbarian, Hana Kodba Čeh, Urška Lunder, Anja Simonič, 2019, original scientific article Abstract: Background: In oncology, health care professionals often experience conducting advance care planning (ACP) conversations as difficult and are hesitant to start them. A structured approach could help to overcome this. In the ACTION trial, a Phase III multi-center cluster-randomized clinical trial in six European countries (Belgium, Denmark, Italy, the Netherlands, Slovenia, United Kingdom), patients with advanced lung or colorectal cancer are invited to have one or two structured ACP conversations with a trained facilitator. It is unclear how trained facilitators experience conducting structured ACP conversations. This study aims to understand how facilitators experience delivering the ACTION Respecting Choices (RC) ACP conversation. Methods: A qualitative study involving focus groups with RC facilitators. Focus group interviews were recorded, transcribed, anonymized, translated into English, and thematically analysed, supported by NVivo 11. The international research team was involved in data analysis from initial coding and discussion towards final themes. Results: Seven focus groups were conducted, involving 28 of in total 39 trained facilitators, with different professional backgrounds from all participating countries. Alongside some cultural differences, six themes were identified. These reflect that most facilitators welcomed the opportunity to participate in the ACTION trial, seeing it as a means of learning new skills in an important area. The RC script was seen as supportive to ask questions, including those perceived as difficult to ask, but was also experienced as a barrier to a spontaneous conversation. Facilitators noticed that most patients were positive about their ACTION RC ACP conversation, which had prompted them to become aware of their wishes and to share these with others. The facilitators observed that it took patients substantial effort to have these conversations. In response, facilitators took responsibility for enabling patients to experience a conversation from which they could benefit. Facilitators emphasized the need for training, support and advanced communication skills to be able to work with the script. Conclusions: Facilitators experienced benefits and challenges in conducting scripted ACP conversations. They mentioned the importance of being skilled and experienced in carrying out ACP conversations in order to be able to explore the patients' preferences while staying attuned to patients' needs.
Keywords: ACTION study, cancer, facilitator, patients, respecting choices, experience
Published in DiRROS: 23.09.2020; Views: 1289; Downloads: 905
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58. Meritve gostote lesa v slovenskih gozdovihLuka Krajnc, Polona Hafner, Andreja Vedenik, Jožica Gričar, Primož Simončič, 2020, professional article Abstract: V prispevku je predstavljen primer raziskave o variabilnosti kakovosti lesa različnih drevesnih vrst v slovenskih gozdovih. Meritve gostote, ki je eden glavnih pokazateljev kakovosti lesa, bodo služile za izdelavo podatkovne baze za oceno prostorske variabilnosti kakovosti lesa v Sloveniji. Zanesljivih in objektivnih podatkov o kakovosti lesa v naših gozdovih je relativno malo. Takšne baze so na ravni Slovenije izjemno pomembne, saj omogočajo vpogled v kakovost lesa, ki bo v prihodnje na voljo kot surovina na trgu za domačo lesno industrijo. Podobne baze bodo pomembne za izračun količine vezanega ogljika v nadzemni in podzemni biomasi za Slovenijo, hkrati pa bodo zbrani podatki služili tudi kot izhodišče za nadaljnje analize kakovosti lesa, zlasti mehanske lastnosti, ki so ključne pri uporabi lesa za konstrukcijske namene. Lastnosti in razpoložljivost lesa ekonomsko pomembnih drevesnih vrst so osnova za razvoj gozdno-lesne verige glede novih tehnologij, razvoja novih biomaterialov in potenciala rabe lesa različnih kakovosti z optimalnimi izkoristki.
Keywords: rezistograf, gostota lesa, kakovost lesa, listavci, iglavci
Published in DiRROS: 09.08.2020; Views: 1954; Downloads: 543
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