ObjectiveThe COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities.DesignQualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework.SettingResidential long-term care.Participants23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians.ResultsMotivation barriers include families’ lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population.ConclusionFindings reveal that validating families’ concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.

Background Optimal supportive end of life care for frail, older adults in long term care (LTC) homes involves symptom management, family participation, advance care plans, and organizational support. This 2-phase study aimed to combine multi-disciplinary opinions, build group consensus, and identify the top interventions needed to develop a supportive end of life care strategy for LTC. Methods A consensus-building approach was undertaken in 2 Phases. The first phase deployed modified Delphi questionnaires to address and transform diverse opinions into group consensus. The second phase explored and prioritized the interventions needed to develop a supportive end of life care strategy for LTC. Development of the Delphi questionnaire was based on findings from published results of physician perspectives of barriers and facilitators to optimal supportive end of life care in LTC, a literature search of palliative care models in LTC, and published results of patient, family and nursing perspectives of supportive end of life care in long term care. The second phase involved World Café Style workshop discussions. A multi-disciplinary purposive sample of individuals inclusive of physicians; staff, administrators, residents, family members, and content experts in palliative care, and researchers in geriatrics and gerontology participated in round one of the modified Delphi questionnaire. A second purposive sample derived from round one participants completed the second round of the modified Delphi questionnaire. A third purposive sample (including participants from the Delphi panel) then convened to identify the top priorities needed to develop a supportive end-of-life care strategy for LTC. Results 19 participants rated 75 statements on a 9-point Likert scale during the first round of the modified Delphi questionnaire. 11 participants (participation rate 58 %) completed the second round of the modified Delphi questionnaire and reached consensus on the inclusion of 71candidate statements. 35 multidisciplinary participants discussed the 71 statements remaining and prioritized the top clinical practice, communication, and policy interventions needed to develop a supportive end of life strategy for LTC. Conclusions Multi-disciplinary stakeholders identified and prioritized the top interventions needed to develop a 5-point supportive end of life care strategy for LTC.

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There are over 200 distinct forms of cancer, and all are diagnosed and treated differently. According to the WHO Global Cancer Observatory, 19,292,789 cases new cases of cancer were diagnosed in 2020, with breast (11.7% cases), lung (11.4%), and Colorectum (10% cases) becoming the three most common. Lung cancer is one of the most often diagnosed malignancies and the biggest cause of cancer-related deaths globally, with an estimated 220 million new cases and 179 million deaths every year. It is extremely invasive, quickly spreading, and cause death in both sexes. In light of both core genetic abnormalities and therapy response, lung cancer is a highly diverse ailment. WDR74 protein predominantly controls WNT signaling pathways in lung cancer. Wnt-responsive genes such as c-myc and cyclin D1 have been linked to cell proliferation, whereas caspase 3, caspase 9, and MDR1 have been linked to chemo-resistance and death. WDR74 had regulatory impacts on these genes. In lung cancer cells, WDR74 influenced several biological processes in lung cancer cells by modulating these genes. Abnormal activation of the Wnt/-catenin signalling pathway promotes a number of cellular functions such as proliferation, cell cycle progression, aggressiveness, and chemoresistance, specifically in Lung cancer. Our study uses local alignment to establish WDR74 sequence similarity, and then uses multiple sequence alignment to compare homologous sequences. We then used software to scan the sequence for open reading frames (ORFs) to see if WDR74 had main mutations. The study's findings include a brief summary of the top five protein matches from well-studied reference species in the database, as well as a graphical summary and phylogenetic tree development. The study also suggested the open reading frame with the primary mutation, as well as the start and stop codon positions. Keyword: Lung cancer, WDR74, ORF, Local alignment, Multiple sequence alignment, BLAST, CLUSTAL OMEGA, COBALT, SMART BLAST.

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