A comparison of four dementia palliative care services using the RE-AIM framework.

BACKGROUND: Living with a life-limiting illness, people with dementia benefit from palliative care which considers the holistic needs of the person and their family. However, little is known about how palliative care may be best provided to people living with dementia at home in the community. We examined four exemplary dementia palliative care services for people with dementia in the community, to see what activities they were providing, what were the commonalities and differences, and what lessons could be learned. METHODS: A long-list of dementia palliative care services in Ireland, Northern Ireland, England, Scotland, and Wales, was identified through a survey, and four exemplar services were chosen based on criteria including: in operation >six months; provides identifiable activities; availability of routinely collected service data; not exclusively for people with dementia in final hours or days of life. Mixed-methods of data collection included interviews, focus-groups and surveys with service staff, surveys of service users, and routinely collected service data. The RE-AIM framework was used to describe and understand the sample of dementia palliative care services. RESULTS: The four services had varied organisational structures and were led by different disciplines. However, they all provided common core activities including holistic and person-centred care, early advance care planning with service user involvement, carer support, integrated healthcare services, continuity of care, 24/7 support, bereavement support. All had needs-based referral criteria, accepting any age or dementia sub-type. All supported people with dementia to remain living at home and to have a comfortable, dignified death in their preferred place. CONCLUSIONS: An effective dementia palliative care service may take different forms. Whether the service is dementia-led or Specialist Palliative Care-led, efficacy is associated with providing a range of key activities and implementing them effectively. The data collected strongly suggests the benefits of the dementia palliative care services to a person with dementia and their families and offers valuable insight into the key factors for the establishment and successful running of such services.

How blogs support the transfer of knowledge into practice in the field of dementia palliative care: a survey of facilitators and barriers.

BACKGROUND: Blogging can help to maximise the impact of one's work in academia and beyond by making research findings accessible for multiple knowledge users, such as healthcare professionals and the public, as well as other researchers. As part of the knowledge exchange and dissemination activities of the Model for Dementia Palliative Care Project, this study explored stakeholders' views of blogs as a means to translate research findings. METHODS: A web-based survey was developed, piloted, and revised. It was distributed electronically via key dementia and palliative care organisations websites, newsletters, social media platforms, and within the staff mailing lists of five Universities in Ireland. Data were analysed using descriptive statistics and content analysis. RESULTS: Complete responses were received from 128 participants. The majority of respondents were healthcare researchers (n = 53), followed by healthcare providers (n = 46). The preferred methods of reviewing research findings were scientific papers, websites and news articles. Respondents read healthcare blogs "sometimes" (39.1%), with < 19% reading them "often" or "very often". Receiving an email notification might increase the likelihood of reading a new blog post for 83% of respondents. Barriers to engaging with blogs included lack of time, preference for other media, lack of awareness regarding available blogs, and concerns about the credibility and source of information. An appropriate length and the author of the blog were key features that encouraged engagement with a blog. CONCLUSIONS: Despite respondents choosing a scientific paper as their preferred method to consume research findings, many indicated an openness to reading blogs on their area of interest. Creating concise, relevant, and credible blogs, and suitably promoting them, could increase the impact and reach of healthcare research, such as in the emerging field of dementia palliative care, and thus promote translation of research findings into practice.

A scoping review of the evidence for community-based dementia palliative care services and their related service activities.

BACKGROUND: Palliative care is identified internationally as a priority for efficacious dementia care. Research into "effective models" of palliative care for people with dementia has been recommended by several European countries. To build an effective service-delivery model we must gain an understanding of existing models used in similar settings. The study aim is to identify core components of extant models of palliative care for people with dementia, and their families, who are living at home in the community. METHODS: A scoping review was employed. The search strategy was devised to identify all peer-reviewed research papers relating to the above aim. This process was iterative, and the search strategy was refined as evidence emerged and was reviewed. All types of study designs and both quantitative and qualitative studies of non-pharmacological interventions were considered for inclusion. RESULTS: The search identified 2,754 unique citations, of which 18 papers were deemed eligible for inclusion. Although a palliative care approach is recommended from early in the disease process, most evidence involves end-of-life care or advanced dementia and pertains to residential care. The majority of the research reviewed focused on the effects of advance care planning, and end-of-life care; specialist palliative care input, and/or generalist palliative care provided by dementia services to enable people to remain at home and to reduce costs of care. Community staff training in palliative care appeared to improve engagement with Specialist Palliative Care teams. Integration of dementia and palliative care services was found to improve care received for people with dementia and their carers. CONCLUSIONS: While the evidence for integration of dementia and palliative care services is promising, further high-quality research is necessary particularly to identify the key components of palliative care for people living with dementia. This is imperative to enable people with dementia to inform their own care, to stay living at home for as long as possible, and, where appropriate, to die at home.

Publishing during a pandemic: Resilience and change.

The scholarly publishing industry must be prepared to step back, consider our value, reset our relationships, and be prepared to accept and embrace real change.Three areas of focus during these times should be (1) the importance of community; (2) racism, bias, and structural inequities; and (3) openness, transparency, and trust.We need to recognize the importance of the humanities and social sciences, as well as of science, technology, and medicine in addressing the impacts of the pandemic.

Publishing peer review materials.

Publishing peer review materials alongside research articles promises to make the peer review process more transparent as well as making it easier to recognise these contributions and give credit to peer reviewers. Traditionally, the peer review reports, editors letters and author responses are only shared between the small number of people in those roles prior to publication, but there is a growing interest in making some or all of these materials available. A small number of journals have been publishing peer review materials for some time, others have begun this practice more recently, and significantly more are now considering how they might begin. This article outlines the outcomes from a recent workshop among journals with experience in publishing peer review materials, in which the specific operation of these workflows, and the challenges, were discussed. Here, we provide a draft as to how to represent these materials in the JATS and Crossref data models to facilitate the coordination and discoverability of peer review materials, and seek feedback on these initial recommendations.

Examining Clinical Utility of Imaging for Inpatient Palliative Care.

BACKGROUND: Medicine in the final months of life is increasingly interventional, both in the manner by which life may be prolonged and symptoms may be reduced. Radiology is frequently utilized to provide diagnostic clarity and improve symptom control. As with any intervention, examining the benefit and potential harms of a procedure is required to establish its role in ongoing clinical care. METHODS: This retrospective cohort study involved patients admitted to an inpatient palliative care unit between October 2013 and September 2014. Data were collected using clinical databases manually searched by the researchers. RESULTS: Of 388 admissions, there were a total of 154 imaging events completed in 85 patients. Patients who had imaging performed had longer mean length of stays, more likely to be discharged home, and male. Very few imaging events (4%) occurred in the 3 days prior to death and none on the day of death. In total, 43% of imaging confirmed the clinical suspicion and management changed 42% of times. Limbs X-rays and computed tomography brain had low rates of confirming clinical suspicion (21% and 17%) and changing management (21% and 33%). There were a total of 7 complications resulting from imaging, the majority due to interventional procedures. CONCLUSION: The use of imaging in inpatient palliative care seems to be of substantive utility, prompting alterations in management in >40% of instances. The majority of imaging occurred prior to the terminal phase of the disease and with few complications.

Simultaneous Liquid Chromatographic Determination of 10 Ultra-Violet Filters in Sunscreens.

A rapid HPLC method was developed for the simultaneous determination of 10 UV filters found in sunscreen. The following UV filters were analyzed in this method; 2-phenylbenzimidazole-5-sulfonic acid, benzophenone-3, isoamyl p-methoxycinnamate, 4-methylbenzylidene camphor, octocrylene, ethylhexyl dimethyl 4-aminobenzoic acid, ethylhexyl methoxycinnamate, butyl methoxydibenzoylmethane, ethylhexyl salicylate and homosalate. The method was developed on two columns; a Thermo Hypersil C18 BDS, 3 µm column (4.6 × 100 mm) and a Chromolith RP-18e Monolithic column (4.6 × 100 mm). The same mobile phase of ethanol and 1% acetic acid (70:30, v/v) was employed for both columns. The separation of the 10 UV filters was carried out successfully on both columns; the optimal resolution was obtained on the Thermo Scientific Hypersil column in a time frame of 7 min. An isocratic elution utilizing ethanol and acetic acid (70:30, v/v) at a temperature of 35°C was employed. The method was applied to a number of commercial samples of sunscreen and lotions and was validated according to International Conference on Harmonisation guidelines for selectivity, linearity, accuracy, precision and robustness. A comparison of the performances of both columns was also carried out.

Rapid liquid chromatographic determination of itraconazole and its production impurities.

A simple, rapid ultra-performance liquid chromatography (UPLC) method was developed for the analysis of itraconazole and its associated production impurities. The optimum chromatographic conditions were achieved using an Agilent Zorbax Eclipse XDB C18 column, 1.8 µm (4.6 × 50 mm) installed in a column oven heater utilizing a gradient mobile phase of 0.08M tetrabutylammonium hydrogen sulfate buffer-acetonitrile (80:20, v/v), with ultraviolet detection at 235 nm. An Agilent 1200 RRLC Series was used for the UPLC analysis. UPLC is a technology that greatly reduces analysis time by utilizing columns packed with sub-2 µm particles. The method was validated according to International Conference on Harmonization guidelines with respect to precision, accuracy, linearity, robustness and limits of detection and quantification. All parameters were found to be well within the stated guidelines. The total analysis time was reduced by two-thirds, from over 30 min (the current European Pharmacopeia method) to under 10 min, and the method is applicable for assay and related substance determination. A method utilizing the sub-2 µm column on a conventional high-performance liquid chromatography system was also developed and validated, resulting in substantial time and solvent savings.

Medical, cognitive and academic outcomes of very low birth weight infants at age 10-14 years in Ireland.

BACKGROUND: Low birth weight (LBW) is a leading cause of infant mortality and morbidity, and a specific risk for the development of neuro-developmental and academic problems. AIM: To examine the medical, cognitive and academic outcomes of VLBW (<1,500 g) children, born in one maternity hospital in Dublin between 1995 and 1997. METHODS: The study employed a prospective/cohort design, with semi-structured, and standardised measures, along with the completion of a study-specific questionnaire. Ratings were obtained from parents and teachers. RESULTS: Of the 127 surviving VLBW cohort, 64 (50 %) consented to assessment at a mean age of 11.6 years (SD 1.0) along with a matched-weight and gender control sample of 51. VLBW children had an increased risk of chronic medical problems and neuro-sensory deficits, but without any increased use in services. Similarly, they had lower IQ (mean 89.7 compared to NBW 101.3, p < 0.001) and more were identified by teachers to have special education needs (33 % VLBW vs. 7 % NBW, p < 0.005). With regard to academic attainments, birth weight had a significant [t(98) = -4.54, p < 0.001] and robust effect (η(2) = 0.17) on mathematical attainment scores. Those with lower SES fared least well off. CONCLUSIONS: Although significant advances have been made in reducing infant mortality, there is a recognised increased risk of subsequent disability especially with decreasing gestational age, and when coupled with low SES. Having facilitated the survival of vulnerable infants, services must be available for the necessary on-going medical and educational support and treatment that they require throughout adolescent years.

The use of complementary and alternative medicine by irish pediatric cancer patients.

INTRODUCTION: The use of complementary and alternative medicine (CAM) in the Irish pediatric cancer setting has not previously been established. METHODS: To investigate the prevalence and predictors of CAM use in this group of patients, an anonymous cross-sectional survey was offered to all carers of patients either on or off treatment for malignancy at a single pediatric cancer center over an 8-week period. RESULTS: Of a total of 220 questionnaires distributed, 98 (43%) were returned. Six were excluded because of inadequate data. A total of 58% of children were male and the mean age was 9 years. The most common cancer diagnosis was leukemia (45%). Fifty-two respondents (57%) said their child had used or was using CAM, and 55% of whom had started since their cancer diagnosis. The most common types of CAM used were vitamins and minerals (18%), reflexology (11%), dietary supplements (11%), faith healers (9%), and energy therapies (9%). The most common reason for CAM use was to improve physical well-being (31%). A total of 65% of CAM users had not told their doctor that they were doing so. Of the 52 CAM users, 30 (58%) were using oral CAM medication. A total of 86% of CAM users reported benefit from the treatment, and no respondent reported side effects.There was no significant relationship between sex, tumor type, age, income, previous treatment, and CAM use. Where parents had a higher level of education, children were more likely to use CAM (P=0.035.) There was a statistically significant relationship between respondents rating of conventional therapy and CAM use (P=0.007). Interestingly, parents who were satisfied with conventional therapy were more likely to use CAM. CONCLUSION: The high prevalence of CAM use demonstrated in this study and particularly the high use of CAM medication therapies underlines the importance of physicians asking routinely about CAM use in this population.

Development and validation of a rapid chromatographic method for the analysis of flunarizine and its main production impurities.

A rapid selective method for the analysis of flunarizine and its associated impurities was developed and validated according to ICH guidelines. The separation was carried out using a Thermo Scientific Hypersil Gold C18 column (50 mm×4.6 mm i.d., 1.9 µm particle size) with a gradient mobile phase of acetonitrile-ammonium acetate-tetrabutylammoniumhydrogen sulfate buffer, at a flow rate of 1.8 mL/min and UV detection at 230 nm. Naturally aged samples were also tested to determine sample stability. A profile of sample and impurity breakdown was also presented.

Psychiatrists in their eyes: Children's drawings of what a psychiatrist looks like.

Drawings can be used as an important tool to measure children's perception and emotions. Using a qualitative design, we asked a group of 24 school children (10 boys and 14 girls) aged 11-12 to draw their impressions of psychiatrists. In the majority of drawings, psychiatrists were portrayed as a friendly or kind figure. The art work was analysed by the coordinator of the Arts Initiative in Mental Health, Niamh O'Connor. Psychiatrists were portrayed positively by this group of young people. This reflects a strong influence of the media on children's perception.