Going for gold: Sports and exercise groups for people with dementia and carers contribute to their well-being.

Background: Interventions involving exercise appear to have positive effects, both for people with dementia and for their carers. Quality of life and well-being are especially important outcomes. This study investigated how a sports and exercise group for people with dementia and their carers could contribute to the well-being of those attending the group. Methods: The study was a qualitative investigation, comprising semi-structured interviews, a focus group and observations. Participants included people with dementia and carers attending the group sessions, as well as staff providing the programme. The group sessions were provided weekly by the charitable trust of a leading sports venue. Data were analysed using thematic analysis. Results: A total of 16 participants were interviewed, including four people with dementia, eight carers, and four members of staff. Five main themes were identified: "Support to keep active and engaged is highly valued by people with dementia and carers"; "The challenges of being a carer are significant but sharing the experience really helps"; "People with dementia can have flourishing social lives"; "The group helps to maintain identity despite physical and role changes"; and "There are practical aspects of the group that make it appealing". Discussion: People with dementia enjoy physical activity and experience the benefits of it. The sports and exercise group had an important role in providing access to activities that people with dementia and their carers value and enjoy, but would be difficult to undertake without a facilitated and safe environment. The group benefited the well-being of both people with dementia and carers in various ways, with peer support being of particular importance for carers.

Blunt splenic injury in children: haemodynamic status key to guiding management, a 5-year review of practice in a UK major trauma centre.

PURPOSE: To review the management of children and adolescents (0-18 years), with blunt splenic injury treated at a single UK major trauma centre over a 5-year period, focusing upon efficacy of non-operative management and the use of haemodynamic stability as a guide to planning treatment strategy, rather than radiological injury grading. To produce a treatment pathway for management of blunt splenic injury in children. METHODS: Retrospective, cross-sectional study of all paediatric patients admitted with radiologically proven blunt splenic injury between January 2011 and March 2016. Penetrating injuries were excluded. Follow up was for at least 30 days. RESULTS: 30 Patients were included, mean age was 14.5 (SD 3.6), median injury severity score was 16 (IQR 10-31). 6 Patients (20%) had a splenectomy, whilst 22 patients (73%) were successfully treated non-operatively with 100% efficacy at index admission. 5/8 (63%) patients with radiological grade V injuries were managed non-operatively, injury grade was not associated with surgical intervention (p = 1.57). Haemodynamic instability was initially treated with fluid resuscitation leading to successful non-operative management in 5/11 (45%) patients. However, haemodynamic instability is a significant predictor of requirement for surgical intervention (p = 0.03), admission to critical care (p = 0.017), presence of additional injuries (p = 0.015) and increased length of stay (p = 0.038). No such relationships were found to be associated with increased radiological injury grade. CONCLUSIONS: Non-operative management should be first-line treatment in the haemodynamically stable child with a blunt splenic injury and may be carried out with a high degree of efficacy. It may also be successfully implemented in those initially showing signs of haemodynamic instability that respond to fluid resuscitation. Radiological injury grade does not predict definitive management, level of care, or length of stay; however, haemodynamic stability may be utilised to produce a treatment algorithm and is key to guiding management.

Cycling related traumatic brain injury requiring intensive care: association with non-helmet wearing in young people.

INTRODUCTION: Traumatic injury is the leading cause of death in children after infancy. Almost 25% of all cyclists killed in the UK are children, and two thirds of these will die because of their head injuries. We compared the population of young people wearing helmets whilst cycling, to those admitted with serious post cycling head injuries to our paediatric critical care unit. METHOD: All children aged 0-18 years admitted to our intensive care following a bicycle accident between the years January 2011-June 2018 were identified and information on the mechanism of injury, and both immediate and long term clinical data were collected. For comparison data, helmet wearing on a random morning was observed from six schools. All pupils arriving at school by bicycle were observed. Data collected included the school year and sex of the child, and whether each child was wearing a helmet or not. RESULTS: Of 28 cases, 22 were admitted due to head injuries. None wore a helmet. 23/133 school pupils wore a helmet. The intensive care population were significantly less likely to be wearing helmets than the general population (p = 0.044, Fisher's exact test). A Chi-Square test for helmet wearing by school year showed a reduction in helmet wearing with increasing school year with a p value of 0.0026. There was no association between helmet wearing and abdominal injury. CONCLUSION: Young people admitted to a Critical Care Unit with cycling related head trauma are statistically significantly less likely to wear a helmet than the general, age matched cycling population. Helmet wearing decreases as children get older. Outcomes were mixed, but in the head trauma group only 3/18 recovered with no neurological deficit.

Organ and tissue donation in a regional paediatric intensive care unit: evaluation of practice.

Approximately 2% of those on the organ transplant list in the UK are children. Early identification of donors and referral to organ donation teams (ODT) has proven to increase both the success rate of gaining consent and the number of organs actually retrieved. To evaluate the practice relating to organ donation for children receiving end-of-life care on a paediatric intensive care unit (PICU) measured against the National Guidelines. All children 0-18 who received their end-of-life care and died on the PICU. A retrospective cohort study of organ donation patterns including referral, approach, consent and donation. This involved a review of case notes on PICU between the years 2009 and 2014. One hundred five deaths were identified and 100 notes were examined and data analysed to ascertain if religion, age and length of stay on PICU impacted on practice. Eighty-six children met the early identification criteria for potential donors, 40 (46.5%) children were referred to the ODT and 33 (38.3%) families were approached regarding donation. Twenty-one (24.4%) families consented to donation. Seventeen donations took place with a total of 41 sets of organs/tissues retrieved. Despite the majority of children meeting early identification for potential donors, many were not being referred. CONCLUSIONS: All children on end-of-life care should be referred for potential organ donation. Organ donation needs to be seen as a priority for hospitals as a part of routine end-of-life care to help increase referral rates and give families the opportunity to donate. Many paediatric deaths are not referred for consideration of organ donation, despite guidelines stating that this process should be standard of care. Further optimization of referral rates may aid in increasing the number of organs available for donation. What is Known: • Shortage of organs continues to be a national problem. • NICE guidelines state that all patients who are on end-of-life care should have the option of organ donation explored. • Required referral both increases the number of donors and organs donated. What is New: • The process of identifying and referring children for paediatric organ donation. • Identifies that children are still not being referred for organ donation. • Organ donation is still not a priority for hospitals.

Spironolactone.

Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

Furosemide.

Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

Football and dementia: A qualitative investigation of a community based sports group for men with early onset dementia.

This study investigates the impact of a weekly group providing sport and physical activities for men with early onset dementia established by Notts County Football in the Community (NCFC). There were three aims: to investigate the effect of early onset dementia on individuals with the condition and their carers; to examine the perceptions of current levels of service provision for people with early onset dementia; and to analyse the impact of the group. Men with dementia (n = 5) attending the sessions, their carers (n = 5), NCFC coaching staff (n = 5) and people organizing/facilitating the sessions (n = 5) were interviewed. Semi-structured interviews explored the participants' experiences of dementia, their opinions on current service provisions and on the sessions. Data were analysed using thematic analysis. Four main themes were found: loss related to the condition of dementia and its impact on relationships ('Loss'); lack of age-appropriate services for people with early onset dementia ('Lack of Resources'); enjoyment and positive anticipation related to the group for all involved ('Enjoyment and Anticipation'); and 'the Notts County Effect' which attributed the success of the sessions to the strong brand of the football club, and to personalized service in a "dementia-free" environment. The NCFC sessions provided a safe low-cost intervention with positive effects upon quality of life for both people with early onset dementia, their carers and the staff involved. This suggests that the service may be valuable to a wider range of people living in different areas.