Assessment of quality of life for frail, elderly patients post-ICU discharge: a protocol for a scoping review.

INTRODUCTION: Rises in average life expectancy, increased comorbidities and frailty among older patients lead to higher admission rates to intensive care units (ICU). During an ICU stay, loss of physical and cognitive functions may occur, causing prolonged rehabilitation. Some functions may be lost permanently, affecting quality of life (QoL). There is a lack of understanding regarding how many variables are relevant to health-related outcomes and which outcomes are significant for the QoL of frail, elderly patients following discharge from the ICU. Therefore, this scoping review aims to identify reported variables for health-related outcomes and explore perspectives regarding QoL for this patient group. METHODS AND ANALYSIS: The Joanna Briggs Institute guidelines for scoping reviews will be employed and original, peer-reviewed studies in English and Scandinavian languages published from 2013 to 2023 will be included. The search will be conducted from July 2023 to December 2023, according to the inclusion criteria in Embase, MEDLINE, PsycINFO and CINAHL. References to identified studies will be hand-searched, along with backward and forward citation searching for systematic reviews. A librarian will support and qualify the search strategy. Two reviewers will independently screen eligible studies and perform data extraction according to predefined headings. In the event of disagreements, a third reviewer will adjudicate until consensus is achieved. Results will be presented narratively and in table form and discussed in relation to relevant literature. ETHICS AND DISSEMINATION: Ethical approval is unnecessary, as the review synthesises existing research. The results will be disseminated through a peer-reviewed publication in a scientific journal.

Feasibility and First Experiences from an Online Kidney School for Patients with Chronic Kidney Disease.

Objectives: To examine patients' and relatives' experiences with participation in an online kidney school (OKS) and its influence on their choice of treatment modality; furthermore, to report on healthcare professionals' (HCPs) first experiences with OKS. Methods: A mixed-methods design with parallel data collection involving two questionnaires for participants, including patients and relatives and a focus group discussion (FGD) with HCPs. Results: The OKS was feasible, and overall, patients and relatives were satisfied. Participation in the OKS increased the percentage of those who felt ready to make a decision regarding treatment. One over-arching theme (evolvement of the online kidney school over time) and three sub-themes (concerns and perceived barriers, facilitators, and benefits and future possibilities) emerged from the FGD. Conclusions: The OKS proved feasible, was well-accepted, and increased participants' abilities to choose a preferred treatment modality. HCPs displayed initial concerns regarding the quality of the OKS and worried about the practicality of conducting the OKS. They experienced a feeling of something being lost. However, over time, HCPs developed strategies to tackle initial concerns and discovered that patients were more capable of participating than they had anticipated.

[Christmas article: Christmas music might just be the secret behind the peace of Christmas ].

INTRODUCTION: Christmas, which is just around the corner, is associated with stress in Danish homes. Therefore, it is important to find interventions that reduce stress levels. Classical music is known to have a soothing effect as it reduces systolic blood pressure and increases quality of life. However, whether or not Christmas music can bring about the same effect is unknown. Therefore, the purpose of this study was to examine whether or not Christmas music has a calming effect. METHODS: The design was a classical intervention study, in which participants were subjected to Christmas music. Blood pressure was measured prior to, and after, the intervention, and a questionnaire was completed regarding demographical questions and questions about one's attitude to Christmas and Christmas spirit. We used a paired t-test to test the primary outcome and a p-value ≤ 0.05 was considered statistically significant. RESULTS: Ten participants took part in the study, of whom 8 were female (and 1 unknown). The systolic blood pressure fell by 3.5 mmHg (p = 0.12) and the Christmas mood which was on an average of 5 at the beginning of the study rose by 0.8 point following the intervention. CONCLUSION: In this study, we displayed that Christmas music has the potential to reduce blood pressure and increase the Christmas spirit. Therefore, we recommend that one plays Christmas music throughout the month of December to reduce stress levels and bring us whole skinned and in high spirits through the Christmas season. FUNDING: none. TRIAL REGISTRATION: none.

Time to End-of-Life of Patients Starting Specialised Palliative Care in Denmark: A Descriptive Register-Based Cohort Study.

Increasing numbers of patients are being referred to specialised palliative care (SPC) which, in order to be beneficial, is recommended to last more than three months. This cohort study aimed to describe time to end-of-life after initiating SPC treatment and to explore potential regional variations. We used national register data from all Danish hospital SPC teams. We included patients who started SPC treatment from 2015-2018 to explore if time to end-of-life was longer than three months. Descriptive statistics were used to summarise the data and a generalised linear model was used to assess variations among the five Danish regions. A total of 27,724 patients were included, of whom 36.7% (95% CI 36.2-37.1%) had over three months to end-of-life. In the Capital Region of Denmark, 40.1% (95% CI 39.0-41.3%) had over three months to end-of-life versus 32.5% (95% CI 30.9-34.0%) in North Denmark Region. We conclude that most patients live for a shorter period of time than the recommended three months after initiating SPC treatment. This is neither optimal for patient care, nor the healthcare system. A geographical variation between regions was shown indicating different practices, patient groups or resources. These results warrant further investigation to promote optimal SPC treatment.

mHealth education for patients with chronic kidney disease: protocol for a scoping review.

INTRODUCTION: More than 10% of the population worldwide is affected by chronic kidney disease (CKD). Despite many promising indications regarding the use of mHealth education for patients with CKD, there is still little evidence regarding the feasibility, effectiveness outcomes and outcome measures. Therefore, we will conduct a scoping review to examine the currently available evidence on mHealth education for patients with CKD and, thus, explore the existing evidence regarding feasibility, effectiveness outcomes and outcome measures, patient and/or provider perception and implementation challenges. METHODS AND ANALYSIS: A scoping review will be conducted in accordance with Joanna Briggs Institute Manual for Evidence Synthesis chapter on scoping reviews.MEDLINE, Embase, CINAHL and PsycINFO will be searched. The search strategy will consist of blocks, which have been adopted and modified from former Cochrane reviews. Two independent reviewers will screen studies. Characteristics of the included studies, both quantitative and qualitative, will be reported using quantitative descriptive statistics. Quantitative results will be grouped by objectives (feasibility, effectiveness outcomes and outcome measures, patient perception and implementation challenges), types of intervention and characteristics of participants. Qualitative results will be organised into categories using an iterative process, as suggested by Pollock et al. ETHICS AND DISSEMINATION: As this scoping review does not involve primary data collection, ethical permission is unnecessary. Results of the scoping review will be published in an international peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: Open Science Framework (https://osf.io/gxkeh/).

Protocol for an integrative review: patient and families' perspectives on telehealth in palliative care.

INTRODUCTION: Increases in the use of telehealth in palliative care (telepalliative care) prior to, and during, the COVID-19 pandemic have resulted in a proliferation of studies on the topic. While knowledge is building on how providers and recipients adapt to telepalliative care, no reviews have, as of yet, examined telepalliative care from a patient and family perspective. Therefore, the aim of this integrative review is to explore patients and families' perspectives on telepalliative. METHODS AND ANALYSIS: An integrative review will be performed inspired by the methodology of Remmington and Toronto from March 2022 to December 2022. Medline, Embase, PsycINFO and CINAHL will be searched for primary peer-reviewed studies that describe telepalliative care from patient and families' perspectives. Limiters will be used for age; 18 years+, time; 10 years, and language; English and Danish. Hand searches of authors of included articles and reference lists of included articles will be performed. Two reviewers will independently screen and appraise selected articles using the Mixed Method Appraisal Tool. Conflicts will be resolved through discussions with a third reviewer. Data will be extracted independently by two reviewers into a data matrix with predefined headings and analysed using thematic analysis. Findings will be reported thematically, summarised into a thematic synthesis and discussed in relation to relevant literature. ETHICS AND DISSEMINATION: Ethical approval is not required for this review. Results will be published in an international peer-reviewed journal and presented at a relevant international conference. Reporting of this protocol was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocol checklist and prospectively reported to PROSPERO (CRD42022301206).

Last Aid Courses as measure for public palliative care education for adults and children-a narrative review.

OBJECTIVE: To provide a narrative overview of the current knowledge on Last Aid Courses (LAC) and experiences from the implementation process in different countries. BACKGROUND: Major challenges for public health palliative care include supporting all people who wish to die at home and educating the public about death, dying and palliative care. LAC commenced in 2015 in order to educate and empower citizens to participate in end-of-life care and to improve the public debate about death and dying. The International Last Aid project and the International Last Aid working group were established to provide and evaluate public palliative care education (PPCE) using LAC. METHODS: A literature search in PubMed/Medline was performed and a narrative overview of the existing literature on LAC and PPCE is provided. In addition, experiences from the implementation process are presented. CONCLUSIONS: An International Last Aid working group was established with representatives from different countries and national organisations. This group revises the curriculum and contents of LAC in regular intervals with the latest revision in October 2020. Scientific evaluation of LAC is coordinated by the international Last Aid Research Group Europe (LARGE). Work on LAC has commenced in 18 countries. The overall results show that LAC are feasible and very well accepted in many different countries and cultures. Adults, children, and other groups, such as hospital employees and police officers, have participated in LAC. LAC for citizens is also possible in an online course format that was established and tested during the COVID-19 pandemic. Scientific work on the effects of LAC and cultural issues connected to LAC are ongoing in a number of countries. LAC are feasible and well accepted by citizens in different countries. The courses can contribute to a public debate on death, dying and palliative care and may contribute to empowering citizens in providing end-of-life care.

District nurses' views on and experiences with a telemedicine educational programme in palliative care.

BACKGROUND: Medical advancements, limited resources and shifting demographics have increased the number of patients with palliative care needs in primary care. To address educational needs, the specialised palliative care team of South Jutland, Denmark, created a telemedicine educational programme in palliative care to empower district nurses. AIM: The study aimed to explore district nurses' views on and experiences with a telemedicine educational programme in palliative care. RESEARCH METHODS: A qualitative explorative study based on interpretive description was conducted. Data collection consisted of four focus group interviews with district nurses from three municipalities, supplemented by participant observations and a focus group interview with teachers from the specialised palliative care team. Data were analysed using predominately inductive thematic analysis. RESULTS: District nurses (n = 15) who participated in the programme and members of the specialised palliative care team (n = 6) who taught the programme were included. Analysis revealed the following advantages: reaffirming and updating existing knowledge, reduced professional isolation and creation of a forum to promote knowledge dissemination. A disadvantage was limited interaction between teachers and district nurses, questioning suitability for teaching complex palliative care. Initial technical problems affected motivation to participate. Organisational support differed between participating municipalities resulting in varying degrees of programme integration. Despite advantages of IT-expert-led sessions, key-nurse-led sessions in smaller groups proved more beneficial, suggesting a combination of IT support and key-nurse management to maximise benefits. CONCLUSION: The use of an inter-professional telemedicine educational programme to teach palliative care to district nurses is beneficial. However, programmes should be designed for interactivity and address varying educational needs. Key-nurse roles require managerial and IT support to optimise knowledge dissemination. Further research on implementation of telemedicine education in palliative care is needed.