To describe and assess the overall results of the La Caixa Foundation and the ICO/UVIC Chair of Palliative Care (Former WHO Collaborating Centre) Program “Comprehensive Care of People with Advanced Chronic Conditions” at 15 years (2008–2023).

We used qualitative and quantitative methods, such as prospective, quasi-experimental, and pre-post test designs, to evaluate the effectiveness of the interventions led by psychosocial teams providing support to existing healthcare services. Data were collected from the Program’s unique shared online information system, retrieving output and outcomes information, including data obtained from validated psychosocial evaluation instruments and semi-structured interviews with patients, relatives, professionals and other stakeholders, focusing on effectiveness, satisfaction, and perceived quality of different aspects of the Program, as well as outputs.

From 2008 to 2022, the Program implemented 65 teams in Spain and 11 in Portugal across all the provinces, with 379 full-time professionals. They saw 286,644 patients and 371,023 relatives, with a median intervention duration of 2.3 weeks. Patients’ mean (SD) age was 73.2 (14.9) years; 52.3% were women, and most had a cancer diagnosis (60.1%). After 3 consecutive interventions, patients showed significantly improved psychosocial parameters, according to the Assessment of PSS Needs (ENP-E) and Existential Loneliness Detection Scale (EDSOL). Patients, relatives, and stakeholders were highly satisfied. The Program has developed a Master’s degree that has trained over 250 professionals and conducted 371 courses/workshops and 302 lectures. The Program developed tools, manuals, and protocols that were published, available, and common to all professionals involved. It also developed innovative approaches responding to special settings and needs.

A care program within a collaborative framework between public health services and non-profit foundations is an effective, efficient, and feasible model for organizing the psychosocial and spiritual dimension of care for patients with advanced chronic conditions and their relatives.

Understanding post-stroke spasticity (PSS) treatment in everyday clinical practice may guide improvements in patient care.

This was a retrospective cohort study that used population-level administrative data. Adults (aged ≥18 years) who initiated PSS treatment (defined by the first PSS clinic visit, focal botulinum toxin injection, or anti-spasticity medication dispensation [baclofen, dantrolene and tizanidine] with none of these treatments occurring during the 2 years before the stroke) were identified between 2012 and 2019 in Alberta, Canada. Spasticity treatment use, time to treatment start and type of prescribing/treating physician were measured. Descriptive statistics were performed.

Within the cohort (n = 1,079), the most common PSS treatment was oral baclofen (initial treatment: 60.9%; received on/after the initial treatment date up to March 31, 2020: 69.0%), largely prescribed by primary care physicians (77.6%) and started a median of 348 (IQR 741) days after the stroke. Focal botulinum toxin (23.3%; 37.7%) was largely prescribed by physiatrists (72.2%) and started 311 (IQR 446) days after the stroke; spasticity clinic visits (18.6%; 23.8%) were also common.

We found evidence of gaps in provision of spasticity management in persons with PSS including overuse of systemic oral baclofen (that has common adverse side effects and lacks evidence of effectiveness in PSS) and potential underuse of focal botulinum toxin injections. Further investigation and strategies should be pursued to improve alignment of PSS treatment with guideline recommendations that in turn will support better outcomes for those with PSS.

Tightly connected symptom networks have previously been linked to treatment resistance, but most findings come from small-sample studies comparing single responder v. non-responder networks. We aimed to estimate the association between baseline network connectivity and treatment response in a large sample and benchmark its prognostic value against baseline symptom severity and variance.

N = 40 518 patients receiving treatment for depression in routine care in England from 2015–2020 were analysed. Cross-sectional networks were constructed using the Patient Health Questionnaire-9 (PHQ-9) for responders and non-responders (N = 20 259 each). To conduct parametric tests investigating the contribution of PHQ-9 sum score mean and variance to connectivity differences, networks were constructed for 160 independent subsamples of responders and non-responders (80 each, n = 250 per sample).

The baseline non-responder network was more connected than responders (3.15 v. 2.70, S = 0.44, p < 0.001), but effects were small, requiring n = 750 per group to have 85% power. Parametric analyses revealed baseline network connectivity, PHQ-9 sum score mean, and PHQ-9 sum score variance were correlated (r = 0.20–0.58, all p < 0.001). Both PHQ-9 sum score mean (β = −1.79, s.e. = 0.07, p < 0.001), and PHQ-9 sum score variance (β = −1.67, s.e. = 0.09, p < 0.001) had larger effect sizes for predicting response than connectivity (β = −1.35, s.e. = 0.12, p < 0.001). The association between connectivity and response disappeared when PHQ-9 sum score variance was accounted for (β = −0.28, s.e. = 0.19, p = 0.14). We replicated these results in patients completing longer treatment (8–12 weeks, N = 22 952) and using anxiety symptom networks (N = 70 620).

The association between baseline network connectivity and treatment response may be largely due to differences in baseline score variance.

Rapid diagnosis of dementia is essential to ensure optimum patient care. This study used real-world data to quantify the dementia diagnostic pathway in Australia.

A real-world, cross-sectional survey of physicians and patients.

Clinical practice.

Primary care or specialist physicians managing patients with cognitive impairment (CI).

Descriptive analyses focused on key events in the diagnostic pathway. Regression modeling compared the duration between first consultation and formal diagnosis with various factors.

Data for 600 patients were provided by 60 physicians. Mean time from initial symptoms to first consultation was 6.1 ± 4.4 months; 20% of patients had moderate or severe CI at first consultation. Mean time from first consultation to formal diagnosis was 4.0 ± 7.4 months (1.2 ± 3.6 months if not referred to a secondary physician, and 5.3 ± 8.3 months if referred). Time from first consultation to diagnosis was significantly associated with CI severity at first consultation; time was shorter with more severe CI. There was no association of disease severity and referral to a secondary physician; 69.5% of patients were referred, the majority (57.1%) to a geriatrician. The highest proportion of patients were diagnosed by geriatricians (47.4%). Some form of test or scale was used to aid diagnosis in 98.8% of patients.

A substantial number of Australians experience cognitive decline and behavioral changes some time before consulting a physician or being diagnosed with dementia. Increasing public awareness of the importance of early diagnosis is essential to improve the proportion of patients receiving comprehensive support prior to disease progression.