Background: Pressure injury is a common problem. Its prevention and treatment is predominantly focussed on views, perceptions and knowledge of healthcare staff rather than on patient experience, particularly those patients living in their own homes.Aim: This paper reports findings on patients experiences and perceptions of loss associated with PI.These findings are drawn from a larger study of pressure injury patients living and receiving care in the community.Methods: Qualitative interviews with 12 participants with pressure injury and five carers. Data was audio recorded and thematically analysed. The study is reported in accordance with the COREQ guidelines.Findings: Having a pressure injury negatively affected many aspects of life for our participants resulting in multiple losses. These losses included loss of mobility and independence, privacy and dignity, and social engagement and ability to engage in preferred activities.Discussion: Although the effects of a pressure injury may be similar for many people, the most important issues will differ from person-to-person thus treatment and prevention of pressure injury requires a multidisciplinary team having a holistic care approach. Some patients' pressure injury will never heal and it is increasingly important to involve the patient to find out what matters most to them and how their wound is impacting on them, to jointly develop a holistic, person-centred plan.Conclusion: Policy and practice should recognise and reflect that patients living with a pressure injury at home have different challenges and needs to those in acute or long term care. Pragmatic solutions in the delivery of pressure injury care are needed to compliment the drive to move healthcare from the hospital-to-home.
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SUMMARY OF RELEVANCE:
IssueLittle is known about the impact of pressure injuries on the lives of patients living in their own homes, especially from the patient's perspective.
Background and purposeNelfinavir can enhance intrinsic radiosensitivity, reduce hypoxia and improve vascularity. We conducted a phase II trial combining nelfinavir with chemoradiotherapy (CRT) for locally advanced inoperable pancreatic cancer (LAPC).Materials and methodsRadiotherapy (50.4 Gy/28 fractions; boost to 59.4 Gy/33 fractions) was administered with weekly gemcitabine and cisplatin. Nelfinavir started 3–10 days before and was continued during CRT. The primary end-point was 1-year overall survival (OS). Secondary end-points included histological downstaging, radiological response, 1-year progression free survival (PFS), overall survival (OS) and treatment toxicity. An imaging sub-study (n = 6) evaluated hypoxia (18F-Fluoromisonidazole-PET) and perfusion (perfusion CT) during induction nelfinavir.ResultsThe study closed after recruiting 23 patients, due to non-availability of Nelfinavir in Europe. The 1-year OS was 73.4% (90% CI: 54.5–85.5%) and median OS was 17.4 months (90% CI: 12.8–18.8). The 1-year PFS was 21.8% (90% CI: 8.9–38.3%) and median PFS was 5.5 months (90% CI: 4.1–8.3). All patients experienced Grade 3/4 toxicity, but many were asymptomatic laboratory abnormalities. Four of 6 patients on the imaging sub-study demonstrated reduced hypoxia and increased perfusion post-nelfinavir.ConclusionsCRT combined with nelfinavir showed acceptable toxicity and promising survival in pancreatic cancer.
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