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Aims and objectives: To assess the impact of family health conversations (FamHC) as a supplement to conventional care on health‐related quality of life (HRQoL), family functioning (FFSS) and family hardiness or resilience (FHI) 4 and 14 weeks postoperatively among patients with glioblastoma multiforme and their family members. Background: There is a lack of knowledge about the efficiency of FamHC among families experiencing glioblastoma multiforme. Design: A quasi‐experimental pre‐ and post‐test design adhering to the STROBE (Strengthening the reporting of observational studies in epidemiology) guidelines for case–control studies. Patients and family members were included consecutively in the pretest period from November 2013–December 2014 for the control group (offered traditional care only), and in the post‐test period from January 2015–December 2015 for the intervention group (offered traditional care and FamHC). For both groups, 4 and 14 weeks postoperative measurement were obtained. Methods: Differences in outcomes were assessed using a difference‐in‐difference regression analysis approach measuring difference across pre and post groups and across 4 and 14 weeks measurements. Results: The study does not reveal significant effects of FamHC (all p‐values larger than 0.05) as measured by the three instruments WHOQOL‐BREF, FFSS and FHI. Conclusions: The present study was not able to show significant effects of FamHC. However, it cannot be left out that the intervention might be helpful and supportive at a later state of the illness trajectory. Relevance for clinical practice: The study adds to the growing evidence‐based knowledge on FamHC by questioning their potential use in different cultural contexts among families experiencing critical illness. Oncological nurses need to adapt this information to support their daily care for the patients and their close relatives. For future studies, it is recommended that the families themselves choose when the conversations should take place during the course of the illness. [ABSTRACT FROM AUTHOR]

It is important to monitor equity of access to health services in all countries. We assessed the levels of out-of-pocket (OOP) health spending in three European countries: Denmark, Germany and Poland. Using data from national databases (i.e., Statistics Denmark, German Socio-Economic Panel, and National Statistical Office of Poland) for the period 2000-2010, we applied common methods to assess the rate of households with 'catastrophic' OOP health spending and the concentration of health spending in income-ordered groups of citizens. 20.3 per cent of Polish households experienced 'catastrophic' expenditure defined by OOP health spending/income ratio >10 per cent, compared to 1.0 per cent of households in Germany and 3.2 per cent of households in Denmark. 8.8 per cent of Polish households experienced 'catastrophic' expenditure defined by OOP health spending/capacity to pay ratio >40 per cent, compared to 0.4 per cent of households in Germany and 0.8 per cent of households in Denmark. Concentration indexes for OOP on drugs in 2010 were 0.01978 and -0.114 for Denmark and Poland, respectively. The rate of households with 'catastrophic' OOP expenditure in Poland is much higher than in both Denmark and Germany; health spending in Poland is concentrated among the worst-off groups of citizens while in Denmark and Germany they are distributed more equitably. [ABSTRACT FROM AUTHOR]

Background: The effects of non-sedation on cognitive function in critically ill patients on mechanical ventilation are not yet certain. This trial is a substudy of the NONSEDA trial where critically ill patients are randomized to non-sedation or to sedation with a daily wake-up attempt during mechanical ventilation in the intensive care unit (ICU). The aim of this substudy is to assess the effects of non-sedation versus sedation with a daily wake-up attempt on long-term cognitive function.Methods: This is an investigator-initiated, randomized, clinical, parallel-group, superiority trial, including 200 patients. Inclusion criteria will be adult patients who are intubated and on mechanical ventilation with an expected duration of more than 24 hours. Exclusion criteria will be patients who are comatose at admission and patients with conditions requiring therapeutic coma (i.e., severe head trauma, status epilepticus, patients treated with therapeutic hypothermia and patients with severe hypoxia). The experimental intervention will be non-sedation supplemented with pain management during mechanical ventilation. The control intervention will be sedation with a daily wake-up attempt. The primary outcome will be cognitive function 3 months after discharge from intensive care. The secondary outcomes will be the results of seven specific cognitive tests, performed 3 months after discharge from intensive care, and the association between hypoactive and agitated delirium during ICU admission and long-term cognitive function.Discussion: If non-sedation can improve long-term cognitive function, it could be an approach worth considering for a larger group of critically ill patients.Trial Registration: The study has been approved by the relevant scientific ethics committee and is registered at ClinicalTrials.gov (ID: NCT02035436 , registered on 10 January 2014). [ABSTRACT FROM AUTHOR]

Background: In critically ill, mechanically ventilated patients, daily interruption of sedation has been shown to reduce the time on ventilation and the length of stay in the intensive care unit (ICU). Data on whether a plan of no sedation, as compared with a plan of light sedation, has an effect on mortality are lacking.Methods: In a multicenter, randomized, controlled trial, we assigned, in a 1:1 ratio, mechanically ventilated ICU patients to a plan of no sedation (nonsedation group) or to a plan of light sedation (i.e., to a level at which the patient was arousable, defined as a score of -2 to -3 on the Richmond Agitation and Sedation Scale [RASS], on which scores range from -5 [unresponsive] to +4 [combative]) (sedation group) with daily interruption. The primary outcome was mortality at 90 days. Secondary outcomes were the number of major thromboembolic events, the number of days free from coma or delirium, acute kidney injury according to severity, the number of ICU-free days, and the number of ventilator-free days. Between-group differences were calculated as the value in the nonsedation group minus the value in the sedation group.Results: A total of 710 patients underwent randomization, and 700 were included in the modified intention-to-treat analysis. The characteristics of the patients at baseline were similar in the two trial groups, except for the score on the Acute Physiology and Chronic Health Evaluation (APACHE) II, which was 1 point higher in the nonsedation group than in the sedation group, indicating a greater chance of in-hospital death. The mean RASS score in the nonsedation group increased from -1.3 on day 1 to -0.8 on day 7 and, in the sedation group, from -2.3 on day 1 to -1.8 on day 7. Mortality at 90 days was 42.4% in the nonsedation group and 37.0% in the sedated group (difference, 5.4 percentage points; 95% confidence interval [CI], -2.2 to 12.2; P = 0.65). The number of ICU-free days and of ventilator-free days did not differ significantly between the trial groups. The patients in the nonsedation group had a median of 27 days free from coma or delirium, and those in the sedation group had a median of 26 days free from coma or delirium. A major thromboembolic event occurred in 1 patient (0.3%) in the nonsedation group and in 10 patients (2.8%) in the sedation group (difference, -2.5 percentage points; 95% CI, -4.8 to -0.7 [unadjusted for multiple comparisons]).Conclusions: Among mechanically ventilated ICU patients, mortality at 90 days did not differ significantly between those assigned to a plan of no sedation and those assigned to a plan of light sedation with daily interruption. (Funded by the Danish Medical Research Council and others; NONSEDA ClinicalTrials.gov number, NCT01967680.). [ABSTRACT FROM AUTHOR]