Background: Advance care planning has been shown to improve end of life decision-making for people with dementia. However, the impact of goals of care conversations between people with dementia and their caregivers has not been characterized. Objective: In this study, we evaluate the association between goals of care conversations and advance care planning outcomes. Methods: Retrospective advance care planning measures were collected via a questionnaire administered to 166 caregivers after the death of the person with dementia for whom they provided care. Results: At time of death, the majority of decedents with dementia had advance directives, health care agents, and previous goals of care conversations with their caregiver. Goals of care conversations were significantly associated with the perceived usefulness of advance directives, the perceived adherence to advance directives, and decedent dying at their desired place of death, but not with disagreements around end-of-life care. Conclusion: Our findings suggest that goals of care conversations are an important component of advance care planning. These findings support the development of interventions that facilitate such conversations between people with dementia and their caregivers.

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Chronic itch is a prevalent and debilitating symptom in atopic dermatitis (AD) patients causing ongoing demand in finding effective treatments. Recent research has advanced our understanding how inflammatory immune dysregulation and neuronal dysfunction drive the pathophysiology of itch in AD. Type 2 cytokines, including IL-13, IL-4, IL-5 and IL-31 are upregulated in AD skin lesions. IL-31 was shown to directly activate dorsal root ganglia (DRG) to elicit itch. Recently, IL-4, another well-described cytokine in the pathophysiology of AD, was reported to activate mouse and human neurons. The objective of this study was to test the effects of IL-13 in human DRG to mediate itch. Human DRGs were treated with IL-13 alone or in combination with different pruritogens that represent histaminergic and nonhistaminergic itch. Live cell imaging with calcium measurement via fluorescence detection was used to measure activation of neurons. Our data showed direct activation of hDRGs by IL-13 and additionally an extensive enhancement of serotonin-induced responses. A similar sensitization effect was observed for histamine-induced activation when neurons were incubated with IL-13. Lebrikizumab, a high affinity antibody against IL-13, significantly reduced sensitization of serotonin-triggered neuronal responses. In conclusion, our data suggests that IL-13 is a neuronal enhancer in different itch pathways and is potentially involved in chronic itch in AD.

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