Five Weeks of Sprint Interval Training Improve Muscle Glycolytic Content and Activity But Not Time to Task Failure in Severe-Intensity Exercise.

PURPOSE: This study examined the impact of a 5-wk sprint interval training (SIT) intervention on time to task failure (TTF) during severe-intensity constant work rate (CWR) exercise, as well as in glycolytic enzymatic content and activity, and glycogen content. METHODS: Fourteen active males were randomized into either a SIT group ( n = 8) composed of 15 SIT sessions over 5 wk, or a control group ( n = 6). At pretraining period, participants performed i) ramp incremental test to measure the cardiorespiratory function; ii) CWR cycling TTF at 150% of the power output (PO) at the respiratory compensation point (RCP-PO) with muscle biopsies at rest and immediately following task failure. After 5 wk, the same evaluations were repeated (i.e., exercise intensities matched to current training status), and an additional cycling CWR matched to pretraining 150% RCP-PO was performed only for TTF evaluation. The content and enzymatic activity of glycogen phosphorylase (GPhos), hexokinase (HK), phosphofructokinase (PFK), and lactate dehydrogenase (LDH), as well as the glycogen content, were analyzed. Content of monocarboxylate transporter isoform 4 (MCT4) and muscle buffering capacity were also measured. RESULTS: Despite improvements in total work performed at CWR posttraining, no differences were observed for TTF. The GPhos, HK, PFK, and LDH content and activity, and glycogen content also improved after training only in the SIT group. Furthermore, the MCT4 concentrations and muscle buffering capacity were also improved only for the SIT group. However, no difference in glycogen depletion was observed between groups and time. CONCLUSIONS: Five weeks of SIT improved the glycolytic pathway parameters and total work performed; however, glycogen depletion was not altered during CWR severe-intensity exercise, and TTF remained similar.

Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017.

BACKGROUND: The anticipatory prescribing of injectable medications is recommended practice in controlling distressing symptoms in the last days of life. A 2017 systematic review found practice and guidance was based on inadequate evidence. Since then, there has been considerable additional research, warranting a new review. AIM: To review the evidence published since 2017 concerning anticipatory prescribing of injectable medications for adults at the end-of-life in the community, to inform practice and guidance. DESIGN: Systematic review and narrative synthesis. METHODS: Nine literature databases were searched from May 2017 to March 2022, alongside reference, citation and journal hand-searches. Gough's Weight of Evidence framework was used to appraise included studies. RESULTS: Twenty-eight papers were included in the synthesis. Evidence published since 2017 shows that standardised prescribing of four medications for anticipated symptoms is commonplace in the UK; evidence of practices in other countries is limited. There is limited data on how often medications are administered in the community. Prescriptions are 'accepted' by family caregivers despite inadequate explanations and they generally appreciate having access to medications. Robust evidence of the clinical and cost-effectiveness of anticipatory prescribing remains absent. CONCLUSION: The evidence underpinning anticipatory prescribing practice and policy remains based primarily on healthcare professionals' perceptions that the intervention is reassuring, provides effective, timely symptom relief in the community and prevents crisis hospital admissions. There is still inadequate evidence regarding optimal medications and dose ranges, and the effectiveness of these prescriptions. Patient and family caregiver experiences of anticipatory prescriptions warrant urgent investigation. PROSPERO REGISTRATION: CRD42016052108.

Ten weeks of Capsicum annuum L. extract supplementation did not change adipose tissue-derived hormones, appetite, body composition, and muscle strength when combined with resistance training in healthy untrained men: A clinical trial study.

Capsiate (CAP) is a nonpungent capsaicin analog (Capsicum annuum L. extract) that has been studied as a potential antiobesity agent. However, the interaction between chronic CAP supplementation and resistance training is not clear. The purpose of this study was to examine the changes in adipose tissue-derived hormones, body composition, appetite, and muscle strength after 10 weeks of resistance training, combined with chronic CAP supplementation in healthy untrained men. We hypothesized that CAP could induce higher benefits when combined with resistance training after 10 weeks of intervention compared to resistance training alone. Twenty-four young men (age, 22.0 ± 2.9) were randomized to either capsiate supplementation (CAP = 12 mg/day) or placebo (PL), and both groups were assigned to resistance training. Body composition, leptin and adiponectin concentrations, subjective ratings of appetite, energy intake, and exercise performance were assessed at before and after 10 weeks of progressive resistance training. There was a significant increase in body mass (P < .001), fat-free mass (CAP: 58.0 ± 7.1 vs. post, 59.7 ± 7.1 kg; PL: pre, 58.4 ± 7.3 vs. post, 59.8 ± 7.1 kg; P < .001), resting metabolic rate (CAP: pre, 1782.9 ± 160.6 vs. post, 1796.3 ± 162.0 kcal; PL: pre, 1733.0 ± 148.9 vs. post, 1750.5 ± 149.8 kcal; P < .001), maximal strength at 45 leg press (P < .001) and bench press (P < .001) in both groups, but no significant (P > .05) supplementation by training period interaction nor fat mass was observed. For subjective ratings of appetite, energy intake, leptin, and adiponectin, no significant effect of supplementation by training period interaction was observed (P > .05). In conclusion, 10 weeks of resistance training increased total body weight, muscle mass, and maximum strength in healthy untrained men; however, CAP supplementation (12 mg, 7 days per week) failed to change adipose tissue-derived hormones, appetite, body composition and muscle strength in this population. Registered under Brazilian Registry of Clinical Trials (RBR-8cz9kfq).

Implementing patient-centred outcome measures in palliative care clinical practice for adults (IMPCOM): Protocol for an update systematic review of facilitators and barriers.

Background: Despite the development of patient-centred or patient-reported outcome measures (PCOMs or PROMs) in palliative and end-of-life care over recent years, their routine use in practice faces continuing challenges. Objective: To update a highly cited literature review, identify and synthesise new evidence on facilitators, barriers, lessons learned, PCOMs used, models of implementation, implementation outcomes, costs, and consequences of implementing PCOMs in palliative care clinical practice. Methods: We will search MEDLINE, PsycINFO, CINAHL, Embase, Emcare, SCI-Expanded, SSCI, ESCI, and BNI. The database search will be supplemented by a list of studies from the expert advisory committee, hand-searching of reference lists for included articles, and citations of the original review. We will include primary studies using a PCOM during clinical care of adult patients with advanced disease in palliative care settings and extract data on reported models of implementation, PCOMs, facilitators, barriers, lessons learned, costs, and implementation outcomes. Gough's Weight of Evidence Framework will be used to assess the robustness and relevance of the studies. We will narratively synthesise and tabulate the findings. This review will follow PRISMA, PRISMA-Abstract, PRISMA-P, and PRISMA-Search as the reporting guidelines. Source of funding: Marie Curie. The funder is not involved in designing or conducting this study. Protocol registration: CRD42023398653 (13/02/2023).

Impact of Breaking up of Sitting Time on Anti-inflammatory Response Induced by Extracellular Vesicles.

Physical inactivity and sedentary behaviors (SB) have promoted a dramatic increase in the incidence of a host of chronic disorders over the last century. The breaking up of sitting time (i.e., sitting to standing up transition) has been proposed as a promising solution in several epidemiological and clinical studies. In parallel to the large interest it initially created, there is a growing body of evidence indicating that breaking up prolonged sedentary time (i.e., > 7 h in sitting time) could reduce overall mortality risks by normalizing the inflammatory profile and cardiometabolic functions. Recent advances suggest that the latter health benefits, may be mediated through the immunomodulatory properties of extracellular vesicles. Primarily composed of miRNA, lipids, mRNA and proteins, these vesicles would influence metabolism and immune system functions by promoting M1 to M2 macrophage polarization (i.e., from a pro-inflammatory to anti-inflammatory phenotype) and improving endothelial function. The outcomes of interrupting prolonged sitting time may be attributed to molecular mechanisms induced by circulating angiogenic cells. Functionally, circulating angiogenic cells contribute to repair and remodel the vasculature. This effect is proposed to be mediated through the secretion of paracrine factors. The present review article intends to clarify the beneficial contributions of breaking up sitting time on extracellular vesicles formation and macrophage polarization (M1 and M2 phenotypes). Hence, it will highlight key mechanistic information regarding how breaking up sitting time protocols improves endothelial health by promoting antioxidant and anti-inflammatory responses in human organs and tissues.

Palliative care in severe mental illnesses.

In this editorial, we highlight the interaction between patients who are diagnosed with severe mental illness and their treatment within palliative care, a clinical area of specialized focus which has a multitude of complex impacts on affected patients, their (chosen) family members and caregivers, as well as the healthcare professionals who are caring for them.

Impact of surgical checklists on the time of surgical processes: a cross-sectional study.

OBJECTIVES: to analyze the impact of the use of checklists on the mean time of the operative processes of patients undergoing hip and knee arthroplasties. METHOD: cross-sectional and analytical research conducted between November/2020 and March/2022 with retrospective consultation in a simple random sample of 291 medical records, distributed in three periods (2010/2013/2016). Descriptive and inferential statistics were used for data analysis; p=0.05 values indicated significance. RESULTS: there was a reduction in the time of entry-exit from the operating room (p=0.002), surgery (p<0.001) and between the onset-anesthesia and the beginning-incision (p=0.021). There was no difference in time between patients with and without the use of checklists (p=0.05) in relation to the variables onset-anesthesia, onset-incision, time of anesthesia and surgery. CONCLUSION: the implementation of checklists potentially contributed to reduce the time of use of the operating room. The nonassociation of its use with the increase in the mean time of the processes in the operating room shows that its application does not interfere negatively in this indicator.

The European Portuguese Posthumous Dignity Therapy Schedule of Questions: Initial development and validation.

OBJECTIVE: Dignity therapy (DT) is a brief psychotherapeutic intervention with beneficial effects in the end-of-life experience. Since it provides a continuing bond between the bereaved and their loved ones, we speculated that it could be offered as a novel bereavement intervention following the patient's death. We aimed to develop, translate, and validate the Posthumous DT Schedule of Questions (p-DT-SQ), for administration with bereaved relatives or friends. METHOD: The original DT-SQ was adapted for application with bereaved relatives or friends. It was translated and back-translated to European Portuguese and revised by an expert committee. Content validity was assessed by the Content Validity Coefficient (CVC). The instrument was tested in a sample of 50 individuals from a large Senior Residence in Lisbon (10 elderly people and 40 healthcare professionals), who assessed face validity. RESULTS: The p-DT-SQ showed very good CVC (0.94) and face validity: it was considered clear, easy to understand, reasonable in length, and not difficult to answer. Participants felt comfortable answering the p-DT-SQ and felt it could positively affect the way themselves or others would remember their loved ones, allowing an understanding of the deceased's concerns, interests, and values. SIGNIFICANCE OF RESULTS: We created and validated an adapted version of the DT-SQ to be used posthumously by bereaved family and friends. The European Portuguese version of the p-DT-SQ is clear, comprehensible, and aligned with the fundamentals of DT. While our data suggest its beneficial effects for those who are bereft, future research is needed to examine the impact of p-DT-SQ for those who are grieving.

Impact of surgical checklists on the time of surgical processes: a cross-sectional study / Impacto de checklists cirúrgicos no tempo dos processos operatórios: um estudo transversal

ABSTRACT Objectives: to analyze the impact of the use of checklists on the mean time of the operative processes of patients undergoing hip and knee arthroplasties. Method: cross-sectional and analytical research conducted between November/2020 and March/2022 with retrospective consultation in a simple random sample of 291 medical records, distributed in three periods (2010/2013/2016). Descriptive and inferential statistics were used for data analysis; p=0.05 values indicated significance. Results: there was a reduction in the time of entry-exit from the operating room (p=0.002), surgery (p<0.001) and between the onset-anesthesia and the beginning-incision (p=0.021). There was no difference in time between patients with and without the use of checklists (p=0.05) in relation to the variables onset-anesthesia, onset-incision, time of anesthesia and surgery. Conclusion: the implementation of checklists potentially contributed to reduce the time of use of the operating room. The nonassociation of its use with the increase in the mean time of the processes in the operating room shows that its application does not interfere negatively in this indicator.

RESUMO Objetivo: analisar o impacto do uso de checklists no tempo médio dos processos operatórios de pacientes submetidos a artroplastias de quadril e joelho. Método: pesquisa transversal e analítica realizada entre novembro/2020 e março/2022 com consulta retrospectiva em amostra aleatória simples de 291 prontuários, distribuídos em três períodos (2010/2013/2016). Utilizou-se estatística descritiva e inferencial para análise dos dados; valores de p=0,05 indicaram significância. Resultados: houve redução do tempo de entrada-saída da sala cirúrgica (p=0,002), de cirurgia (p<0,001) e entre o início-anestesia e início-incisão (p=0,021). Não houve diferença no tempo entre os pacientes com e sem o uso dos checklists (p=0,05) com relação às variáveis início-anestesia, início-incisão, tempo de anestesia e de cirurgia. Conclusão: a implantação de checklists potencialmente contribuiu para reduzir o tempo de uso da sala cirúrgica. A não associação de seu uso ao aumento do tempo médio dos processos no centro cirúrgico mostra que sua aplicação não interfere negativamente nesse indicador.

Remote, Whole-Body Interval Training Improves Muscular Endurance and Cardiac Autonomic Control in Young Adults.

High-intensity interval training (HIIT) is an exercise modality acknowledged to maintain physical fitness with more engagement in an active lifestyle compared with other traditional exercise models. Nevertheless, its effects on cardiac control and physical performance in an online-guided setting are not yet clarified. The present work assessed physical fitness and heart rate variability (HRV) before and after an online, home-based HIIT program in college-age students while pandemic lockdowns were in effect. Twenty university students (age: 21.9 ± 2.4 years.) that were solely enrolled in online classes were distributed into three groups: control-CON-(n = 6), 14 min of HIIT-HIIT-14-(n = 8), and 21 min of HIIT-HIIT-21-(n = 6). A maximal push-up test was employed to assess muscular endurance and performance, and resting HRV signals were collected with wireless heart rate monitors and were processed in Kubios HRV Std. (Kubios Oy, Finland). There was an increase in total push-up capacity compared to CON (p < 0.05 HIIT-21 vs. CON; p < 0.001 HIIT-14 vs. CON) after 8 weeks. A significant interaction was observed in high-frequency and low-frequency spectra ratios after the HIIT-21 intervention (p < 0.05). The current work demonstrated that either short- or mid-volume online, whole-body HIIT improves muscle strength, whereas mid-volume HIIT (HIIT-21) was the only intervention that developed a sympathovagal adaptation. This study showed promising results on muscular endurance and cardiac autonomic modulation through whole-body HIIT practice at home.

Characterizing palliative care needs in people with or at risk of developing diabetic foot ulcers.

Aims: Diabetic foot ulcers (DFUs) have a significant impact on a patient's quality of life and life expectancy, with mortality rates comparable with malignant diseases. However, there is a lack of data regarding palliative care needs in this population. We aimed to characterize palliative care needs in people under diabetic foot surveillance using the Integrated Palliative care Outcome Scale (IPOS) and EuroQol-5D three-level version (EQ-5D-3L) and to assess differences between those with and without a DFU. Methods: We conducted a cross-sectional study with consecutive sampling inclusion of patients followed in a tertiary hospital's Diabetic Foot Clinic between February and October 2019 with (n = 20) and without (n = 42) active DFU. Results: The most frequent symptoms encountered were pain, weakness or lack of energy, sore or dry mouth and drowsiness. Patients with an active DFU were significantly more likely to report feeling anxious or worried in comparison with those without (95% versus 55%, p = 0.002). Only 10% of the participants with an active DFU said that they were always able to share how they felt with family and friends as much as they wanted in comparison with 45% of those without (p = 0.006). Conclusion: Our study identified palliative care needs in patients under diabetic foot surveillance with and without DFU, including a significant presence of physical symptoms. Patients in both groups showed signs of emotional/psychological distress, with a higher manifestation in patients with DFU. To the best of our knowledge, this is the first study addressing and characterizing palliative care needs in this population.

The Therapeutic Potential of Carnosine as an Antidote against Drug-Induced Cardiotoxicity and Neurotoxicity: Focus on Nrf2 Pathway.

Different drug classes such as antineoplastic drugs (anthracyclines, cyclophosphamide, 5-fluorouracil, taxanes, tyrosine kinase inhibitors), antiretroviral drugs, antipsychotic, and immunosuppressant drugs are known to induce cardiotoxic and neurotoxic effects. Recent studies have demonstrated that the impairment of the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway is a primary event in the pathophysiology of drug-induced cardiotoxicity and neurotoxicity. The Nrf2 pathway regulates the expression of different genes whose products are involved in antioxidant and inflammatory responses and the detoxification of toxic species. Cardiotoxic drugs, such as the anthracycline doxorubicin, or neurotoxic drugs, such as paclitaxel, suppress or impair the Nrf2 pathway, whereas the rescue of this pathway counteracts both the oxidative stress and inflammation that are related to drug-induced cardiotoxicity and neurotoxicity. Therefore Nrf2 represents a novel pharmacological target to develop new antidotes in the field of clinical toxicology. Interestingly, carnosine (ß-alanyl-l-histidine), an endogenous dipeptide that is characterized by strong antioxidant, anti-inflammatory, and neuroprotective properties is able to rescue/activate the Nrf2 pathway, as demonstrated by different preclinical studies and preliminary clinical evidence. Starting from these new data, in the present review, we examined the evidence on the therapeutic potential of carnosine as an endogenous antidote that is able to rescue the Nrf2 pathway and then counteract drug-induced cardiotoxicity and neurotoxicity.

End-of-life care quality measures: beyond place of death.

BACKGROUND: How quality in healthcare is measured shapes care provision, including how and what care is delivered. In end-of-life care, appropriate measurement can facilitate effective care and research, and when used in policy, highlight deficits and developments in provision and endorse the discipline necessity. The most prevalent end-of-life quality metric, place of death, is not a quality measure: it gives no indication of the quality of care or patient experience in the place of death. AIM: To evaluate alternative measures to place of death for assessing quality of care in end-of-life provision in all settings. METHOD: We examine current end-of-life care quality measures for use as metrics for quality in end-of-life care. We categorise approaches to measurement as either: clinical instruments, mortality follow-back surveys or organisational data. We review each category using four criteria: care setting, patient population, measure feasibility, care quality. RESULTS: While many of the measure types were highly developed for their specific use, each had limitations for measuring quality of care for a population. Measures were deficient because they lacked potential for reporting end-of-life care for patients not in receipt of specialist palliative care, were reliant on patient-proxy accounts, or were not feasible across all care settings. CONCLUSION: None of the current end-of-life care metric categories can currently be feasibly used to compare the quality of end-of-life care provision for all patients in all care settings. We recommend the development of a bespoke measure or judicious selection and combination of existing measures for reviewing end-of-life care quality.

Is BDNF related to spatial-temporal gait parameters in people with multiple sclerosis? An observational study.

BACKGROUND: It has been suggested that the protein Brain-derived Neurotrophic Factor (BDNF) plays a neuroprotective role in people with multiple sclerosis (pwMS). Also, BDNF seems to play a role in cognition performance. In the same line, gait in pwMS requires a higher cognitive resource, mainly during complex walking. Thus, maybe BDNF could be related to gait in pwMS. OBJECTIVE: To investigate the relationship between BDNF and gait spatial-temporal parameters during unobstructed and obstructed conditions and the Timed Up and Go (TUG) in pwMS and healthy controls (HC). METHODS: The study included 20 pwMS (11F/9M, 33.1±7.5 years, Expanded Disability Status Scale- EDSS 2.2±1.2) and 18 HC (13F/5M, 35.5±5.9 years). Both groups performed 20 gait attempts in two conditions: unobstructed walking (10 trials) and avoiding an obstacle. The obstacle was 15 cm in height and made of foam material. The BDNF serum concentration was collected with participants in fasting and completed before the clinical, gait, and mobility assessments. Clinical variables included the Symbol Digit Modality Test (SDMT), the Fatigue Severity Scale (FSS), and the International Physical Activity Questionnaire (IPAQ- short version). Associations between BDNF and spatial-temporal gait parameters, clinical variables, and TUG were determined by Pearson/Spearman correlations with Bonferroni's correction being applied (p<0.0013). Gait was compared by a two-way, repeated-measures ANOVA (group and condition) to characterize our cohort. RESULTS: Reduced BDNF was observed for pwMS (41.66±4.45 ng/ml) in comparison with HC (61.67±7.07, p<0.001). However, although some correlations presented a moderate correlation between BDNF with gait variables, the correlations didn't reach a significant p-value after Bonferroni's correction. Lastly, pwMS presented shorter step length and slower step velocity for both gait conditions, with more evidence for obstacle conditions. Only pwMS changed gait behavior from unobstructed walking to obstacle avoidance conditions (i.e., reduced step length and velocity and increased step duration). CONCLUSION: BDNF is not related to either clinical (i.e., EDSS, SDMT, FSS, or IPAQ) or gait parameters in pwMS and HC, even in a condition involving higher cognitive demand. These results may suggest that BDNF does not play a role in these parameters' performance.

Community-based anticipatory prescribing during COVID-19: a qualitative study.

OBJECTIVES: To understand healthcare professionals' experiences of delivering anticipatory prescribing (AP) during the first wave of the UK COVID-19 pandemic. METHODS: Semistructured qualitative interviews were conducted with a purposive sample of 16 healthcare professionals involved in community palliative care. Data were analysed inductively using thematic analysis. RESULTS: Some of practitioners' fears about the pandemic's impact on delivering AP had not been realised during the first wave. Among patients with COVID-19 for whom community end-of-life care was deemed appropriate, deaths were perceived to be relatively easy to palliate with standard medications. These deaths were typically too rapid for AP to be appropriate or feasible. For non-COVID deaths, providing timely AP was more challenging: although community nurses and some palliative specialists continued to visit patients regularly, general practitioners did many fewer visits, moving abruptly to mainly remote consultations. This left some community nurses feeling undersupported, and prompted some palliative specialists to increase their direct involvement in AP. Several other changes were widely welcomed: collaboration to maintain drug supplies, adoption of online meetings and paperless practice, enhanced specialist helplines and a new policy allowing reuse of medication in care homes. The inclusion of more non-injectable options in AP protocols allowed clinicians to offer selected patients more choice, but few had yet done this in practice. No participants reported changing their prepandemic practice regarding administration of AP by lay caregivers. CONCLUSIONS: Accomplishing AP during a pandemic was challenging, requiring healthcare professionals to make rapid changes to their systems and practices. Some changes may produce lasting improvements.

Short-Term High-Intensity Circuit Training Does Not Modify Resting Heart Rate Variability in Adults during the COVID-19 Confinement.

BACKGROUND/OBJECTIVE: The quarantine caused by the COVID-19 pandemic increased sedentary behavior, psychological stress, and sleep disturbances in the population favoring the installation of alterations in the cardiovascular system. In this sense, physical exercise has widely been suggested as an efficient treatment to improve health. The current study determined the impact of short-term high-intensity circuit training (HICT) on resting heart rate variability (HRV) in adults. METHODS: Nine healthy participants (age: 31.9 ± 4.4 yr.) performed 36 HICT sessions (3 times per day; 3 days per week) and four participants (age: 29.5 ± 1.7 yr.) were assigned to a control group. The HICT consisted of 12 min of whole-body exercises performed during a workout. Twenty-four hours before and after the exercise program, HRV parameters were recorded. RESULTS: The heart rate exercise during the last session trended to be lower when compared with the first HICT session (p = 0.07, d = 0.39, 95% CI = -13.50, 0.72). The interval training did not modify the HRV time (Mean NN, SDNN, RMSSD, NN50, pNN50) and frequency (LF, HF, LF/HF ratio, total power) domain parameters. CONCLUSION: Thirty-six HICT sessions did not provide enough stimuli to modify the resting HRV in adults during social isolation elicited by the COVID-19 pandemic. However, the data suggested that exercise protocol did not induce cardio-vagal adaptations.

Unhealthy Dieting During the COVID-19 Pandemic: An Opinion Regarding the Harmful Effects on Brain Health.

Since 2020, the world has been suffering from a pandemic that has affected thousands of people regardless of socio-economic conditions, forcing the population to adopt different strategies to prevent and control the advance of the disease, one of which is social distancing. Even though social distancing is a safe strategy to reduce the spread of COVID-19, it is also the cause of a rising sedentary behavior. This behavior develops an excess of fat tissue that leads to metabolic and inflammatory disruption related to chronic diseases and mental health disorders, such as anxiety, depression, and sleep issues. Furthermore, the adoption of dietary patterns involving the consumption of ultra-processed foods, higher in fats and sugars, and the reduction of fresh and healthy foods may play a role in the progress of the disease. In this perspective, we will discuss how an unhealthy diet can affect brain function and, consequently, be a risk factor for mental health diseases.

Medical communication and decision-making about assisted hydration in the last days of life: A qualitative study of doctors experienced with end of life care.

BACKGROUND: The impact of assisted hydration on symptoms and survival at the end of life is unclear. Little is known about optimal strategies for communicating and decision-making about this ethically complex topic. Hydration near end of life is known to be an important topic for family members, but conversations about assisted hydration occur infrequently despite guidance suggesting these should occur with all dying people. AIM: To explore the views and experiences of doctors experienced in end-of-life care regarding communicating with patients and families and making decisions about assisted hydration at the end of life. DESIGN: Qualitative study involving framework analysis of data from semi-structured interviews. SETTING/PARTICIPANTS: Sixteen UK-based Geriatrics and Palliative Medicine doctors were recruited from hospitals, hospices and community services from October 2019 to October 2020. RESULTS: Participants reported clinical, practical and ethical challenges associated with this topic. The hospital setting provides barriers to high-quality communication with dying patients and their families about assisted hydration, which may contribute to the low incidence of documented assisted hydration-related conversations. Workplace culture in some hospices may make truly individualised decision-making about this topic more difficult. Lack of inclusion of patients in decision-making about assisted hydration appears to be common practice. CONCLUSIONS: Proactive, routine discussion with dying people about hydration-related issues is indicated in all cases. There is room for debate regarding the limits of shared decision-making and the benefits of routine discussion of assisted hydration with all dying people. Clinicians have to navigate multiple barriers as they strive to provide individualised care.

Immunometabolism-fit: How exercise and training can modify T cell and macrophage metabolism in health and disease.

BACKGROUND: The term immunometabolism describes cellular and molecular metabolic processes that control the immune system and the associated immune responses. Acute exercise and regular physical activity have a substantial influence on the metabolism and the immune system, so that both processes are closely associated and influence each other bidirectionally. SCOPE OF REVIEW: We limit the review here to focus on metabolic phenotypes and metabolic plasticity of T cells and macrophages to describe the complex role of acute exercise stress and regular physical activity on these cell types. The metabolic and immunological consequences of the social problem of inactivity and how, conversely, an active lifestyle can break this vicious circle, are then described. Finally, these aspects are evaluated against the background of an aging society. MAJOR CONCLUSIONS: T cells and macrophages show high sensitivity to changes in their metabolic environment, which indirectly or directly affects their central functions. Physical activity and sedentary behaviour have an important influence on metabolic status, thereby modifying immune cell phenotypes and influencing immunological plasticity. A detailed understanding of the interactions between acute and chronic physical activity, sedentary behaviour, and the metabolic status of immune cells, can help to target the dysregulated immune system of people who live in a much too inactive society.