Implementing an integrated pathway to care for the dying: is your organisation ready?

BACKGROUND: Integrated pathways for care of the dying aim to promote the delivery of high-quality palliative care, regardless of access to specialist services. AIM: To produce a heuristic technique to assist with planning and evaluating the integration of the care of the dying pathway into everyday work. METHODS: Electronic databases were searched to identify research papers focused on the implementation of integrated pathways for care of the dying in acute hospital settings. RESULTS: A total of 13 articles were reviewed using the four elements of normalisation process theory-coherence, cognitive participation, collective action and reflexive monitoring. These results informed the development of a heuristic for organisational readiness. CONCLUSION: The organisational readiness heuristic provides an evidence-based checklist for organisational leaders who are planning to introduce new, or evaluate current, integrated pathways for care of the dying. The next step is to trial the heuristic for feasibility in practice.

Validation of a three-frequency bioimpedance spectroscopic method for body composition analysis.

OBJECTIVE: We assessed whether whole-body multiple frequency impedance (MFBIA) data obtained at a few discrete frequencies could be used to estimate accurately resistance at 0 (R(0)) and infinite (R(infinity)) frequencies required for prediction of body composition by mixture theory. METHODS: Fat-free mass (FFM) was measured in 157 subjects (77 males, 80 females; body mass index [BMI] 17.8-41.7 kg/m(2)) by dual X-ray absorptiometry (DXA). Whole-body impedance was measured and R(0) and R(infinity) were calculated by three different methods. FFM predicted using the different values of R(0) and R(infinity) were compared with each other and with the reference DXA values for all subjects stratified according to BMI band (BMI <24.9 kg/m(2), normal weight; BMI 25-29.9 kg/m(2), overweight; BMI >30 kg/m(2), obese). RESULTS: All BIA procedures predicted an FFM that was slightly but significantly different from DXA-derived values, underestimating by 0.24 to 1.4 kg in the normal-weight subjects and overestimating by 5.3 to 7.1 kg in the obese subjects. Although statistically significant, the different impedance procedures were highly correlated (r > 0.98), with small limits of agreement (approximately +/-2%) when used to predict FFM. Predictive power was associated with BMI, worsening as BMI increased. CONCLUSION: MFBIA can be used to estimate impedance parameters required for mixture theory prediction of body composition, but this approach requires adjustment for BMI to be accurate.