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A hematopoietic stem cell transplant (HSCT) is an intense treatment approach for patients with a hematologic malignancy and brings a significant risk for morbidity and mortality. HSCT brings hope of cure for patients; however, treatments are lengthy and burdensome from both a physical and psychosocial perspective. As the culture of HSCT has traditionally been cure-oriented, it leaves little room for a potential partnership with palliative care services, and when palliative care services are introduced, it is often too late for significant benefit. The need to standardize palliative care involvement for patients with hematologic malignancies receiving a HSCT has become necessary, yet there are challenges with the best way to create such a partnership. Nurse practitioners are a steadily growing professional body possessing the knowledge and skill necessary to fill the gap in palliative care delivery for HSCT patients. The proposed Nurse Practitioner Early Palliative Care for HSCT patients (NEST) algorithm will seek to provide a pathway in which to foster a partnership between hematology/HSCT teams and palliative services to yield the best care possible for patients.

The Royal Melbourne Hospital (RMH) GEM (Geriatric Evaluation Management) Wound Ward round model was developed in response to workflow changes during the COVID-19 pandemic.

Background Foot problems are common in older adults and associated with poorer physical function, falls, frailty and reduced quality of life. Comprehensive Geriatric Assessment (CGA), a multidisciplinary process that is considered the gold standard of care for older adults, does not routinely include podiatry assessment and intervention in hospitalized older adults. Aims To introduce foot assessment to inpatient CGA to determine prevalence of foot disease, foot disease risk factors and inappropriate footwear use, assess inter-rater reliability of foot assessments, determine current podiatry input and examine associations between patient characteristics and foot disease risks. Methods Prospective, observational cohort study of older adults on geriatric rehabilitation wards. Foot assessment completed using the Queensland Foot Disease Form (QFDF) in addition to routine CGA. Results Fifty-two patients (median age [inter-quartile range] 86.4 [79.2–90.3] years, 54% female) were included. Six patients (12%) had foot disease and 13 (25%) had a ‘high risk’ or ‘at risk’ foot. Foot disease risk factor prevalence was peripheral arterial disease 9 (17%); neuropathy 10 (19%) and foot deformity 11 (22%). Forty-one patients (85%) wore inappropriate footwear. Inter-rater agreement was substantial on presence of foot disease and arterial disease, fair to moderate on foot deformity and fair on neuropathy and inappropriate footwear. Eight patients (15%) saw a podiatrist during admission: 5 with foot disease, 1 ‘at risk’ and 2 ‘low risk’ for foot disease. Patients with an at risk foot or foot disease had significantly longer median length of hospital stay (25 [13.7–32.1] vs 15.2 [8–22.1] days, p  = 0.01) and higher median Malnutrition Screening Test scores (2 [0–3] vs 0 [0–2], p  = 0.03) than the low-risk group. Patients with foot disease were most likely to see a podiatrist ( p  < 0.001). Conclusion Foot disease, foot disease risk factors and inappropriate footwear are common in hospitalized older adults, however podiatry assessment and intervention is mostly limited to patients with foot disease. Addition of routine podiatry assessment to the multidisciplinary CGA team should be considered. Examination for arterial disease and risk of malnutrition may be useful to identify at risk patients for podiatry review.

La greffe de cellules souches hématopoà¯étiques (GCSH) est une approche thérapeutique intensive des hémopathies malignes qui s'accompagne d'un important risque de morbidité et de mortalité. Malgré la lueur d'espoir qu'elle apporte aux patients, les traitements sont longs et pénibles, tant du point de vue physique que psychosocial. Habituellement, la greffe de cellules souches hématopoà¯étiques a une visée curative qui laisse peu de place à un partenariat éventuel avec les services de soins palliatifs et, lorsque ces derniers sont proposés, il est souvent trop tard pour en tirer un bénéfice notable. Il faudrait donc systématiser le recours aux soins palliatifs pour les patients atteints d'hémopathie maligne qui reçoivent une GCSH; cependant, il demeure difficile de trouver la meilleure voie pour établir un tel partenariat. Les infirmières praticiennes, qui sont de plus en plus nombreuses, possèdent les connaissances et les compétences requises pour combler les lacunes dans la prestation de soins palliatifs aux patients recevant une GCSH. L'algorithme de soins palliatifs précoces dispensés par les infirmières praticiennes aux patients recevant une GCSH (dit NEST en anglais, pour « Nurse-Practitioner-Delivered Early Palliative Care for Stem Cell Transplant ») vise justement à faire le pont entre les services palliatifs et les équipes d'hématologie et de greffe afin d'offrir aux patients les meilleurs soins possible.

Abstract Severe acute respiratory syndrome coronavirus (SARS-CoV2) and associated COVID-19 infection continue to impact patients globally. Patients with underlying health conditions are at heightened risk of adverse outcomes from COVID-19; however, research involving patients with rare health conditions remains scarce. The amyloidoses are a rare grouping of protein deposition diseases. Light-chain and transthyretin amyloidosis are the most common disease forms, often present with systemic involvement of vital organs including the heart, nerves, kidneys, and GI tracts of affected individuals. The Amyloidosis Program of Calgary examined 152 ATTR patients and 103 AL patients analyzing rates of vaccination, COVID-19 testing, infection outcomes, influence referrals, and excess deaths. Results showed 15 total PCR-confirmed COVID-19 infections in the tested population of amyloid patients, with a higher frequency of infections among patient with AL compared to the ATTR cohort (26.2% vs 5.1%). Four patients (26.6%) required hospital admission for COVID-19 infection, 2 ATTR, and 2 AL patients. Of the confirmed cases, 1 (0.07%) unvaccinated ATTR patient died of a COVID-19 infection. An excess of deaths was found in both the ATTR and AL cohorts when comparing pre-pandemic years 2018 and 2019 to the pandemic years of 2020 and 2021. The finding suggests that amyloidosis patients are likely at a high risk for severe COVID-19 infection and mortality, especially those of advanced age, those on an active treatment with chemotherapy, and those with concomitant B-cell or plasma cell disorder. The impact of virtual healthcare visits and pandemic measures on the excess of deaths observed requires further research.

Any discussion of the Three-Fifths Clause sooner or later leads to a discussion of women, but never in or of themselves, always in relationship to slaves, or, rather, the institution of slavery. Women’s assumed political incapacity was used to anchor a system of representation that rested on enslavement.

A cavity was made in the brain (entorhinal cortex) of developing or adult rats, and a small piece of Gelfoam was emplaced to collect fluid secreted into the wound. The neuronotrophic activity of the fluid was assayed with sympathetic and parasympathetic neurons in culture. The results show that wounds in the brain of developing or adult rats stimulate the accumulation of neuronotrophic factors and that the activity of these factors increases over the first few days after infliction of the damage.

Systemic intervention (Midgley, 2000) and Feminist Systems Thinking (Stephens, 2013a), both branches of Critical Systems Thinking, have been used widely to improve social and organisational systems. According to Midgley (2000), a systemic intervention can be defined as a “…purposeful action by an agent to create change” (113, emphasis original). Building on Midgley’s work, Stephens (2013a) created a non-hierarchical “… framework for feminist systems thinking, as a set of five principles that provide common sense guidelines for applied research and social action…” (8, emaphsis added). Presently, the small amount of gendered systemic research is troubling in a world where no country has achieved gender equality. The purpose of this research is to conduct a participatory systemic intervention working in partnership with a U.S. non-governmental agency in Washington D.C. in the United States, and Nicaragua in Central America, I conducted a feminist systemic intervention in an international development organisation. This study found that a more structured systemic intervention method, currently named Gendered Systemic Analysis, was needed to support stakeholders in identifying potential improvements in their businesses: previous work on Feminist Systems Thinking left too much of a gap between theory and practice. In this research, I follow Midgley’s (2011:11-12) use of ‘method’ as: “as a set of techniques operated in a sequence (or sometimes iteratively) to achieve a given purpose. GSA uses a boundary critique process, which concentrates attention on gender, nature and voices from the margin as a means to create social change. The contribution of this research deepened the understanding of how to empower individuals and groups to engage with systemic thinking and contextualise its theoretical and methodological underpinnings into a local knowledge generating systems leading to more sustainable change.