Ronald Chow

BACKGROUND: The aim of this review is to describe the challenges and barriers to conducting research in long-term care facilities. METHODS: A literature search was conducted in Ovid MEDLINE, Embase, Cochrane Central, PsycINFO and CINAHL. Keywords used included "long term care", "nursing home", "research", "trial", "challenge" and "barrier", etc. Resulting references were screened in order to identify relevant studies that reported on challenges derived from first-hand experience of empirical research studies. Challenges were summarized and synthesized. RESULTS: Of 1723 references, 39 articles were selected for inclusion. To facilitate understanding we proposed a classification framework of 8 main themes to categorize the research challenges presented in the 39 studies, relating to the characteristics of facility/owner/administrator, resident, staff caregiver, family caregiver, investigator, ethical or legal concerns, methodology, and budgetary considerations. CONCLUSIONS: Conducting research in long-term care facilities is full of challenges which can be categorized into 8 main themes. Investigators should be aware of all these challenges and specifically address them when planning their studies. Stakeholders should be involved from an early stage and flexibility should be built into both the methodology and research budget.

The process of formulating an accurate survival prediction is often difficult but important, as it influences the decisions of clinicians, patients, and their families. The current article aims to review the accuracy of clinicians' predictions of survival (CPS) in advanced cancer patients. A literature search of Cochrane CENTRAL, EMBASE, and MEDLINE was conducted to identify studies that reported clinicians' prediction of survival in advanced cancer patients. Studies were included if the subjects consisted of advanced cancer patients and the data reported on the ability of clinicians to predict survival, with both estimated and observed survival data present. Studies reporting on the ability of biological and molecular markers to predict survival were excluded. Fifteen studies that met the inclusion and exclusion criteria were identified. Clinicians in five studies underestimated patients' survival (estimated to observed survival ratio between 0.5 and 0.92). In contrast, 12 studies reported clinicians' overestimation of survival (ratio between 1.06 and 6). CPS in advanced cancer patients is often inaccurate and overestimated. Given these findings, clinicians should be aware of their tendency to be overoptimistic. Further investigation of predictive patient and clinician characteristics is warranted to improve clinicians' ability to predict survival.

The 2015 MASCC–ESMO guideline for the prevention of ChT- and RINV was updated based on a literature search from 1 June 2015 through 31 January 2023. Thirty-four multidisciplinary experts reviewed the literature. The most important updates were as follows:1)Recommendation to use olanzapine as part of the prophylaxis for patients receiving HEC;2)Recommendation of a 1-day DEX schedule in patients treated with AC, carboplatin or other MEC;3)Suggestion to include an NK1-RA in the antiemetic regimen for women aged ≤50 years receiving oxaliplatin;4)Suggestion to use olanzapine for breakthrough CINV;5)For the first time providing suggestions for the use of some integrative and non-pharmacological therapies; and6)Recommending aprepitant or fosaprepitant as part of the weekly antiemetic regimen in women treated with fractionated radiotherapy and concomitant weekly cisplatin.