Evaluation of Palliative Care Related Hospital Admissions in a Regional Centre.

OBJECTIVES: A significant proportion of adults admitted to hospital are in their last year of life. We evaluated admissions for these patients. METHODS: We identified ambulance callouts to patients known to the palliative care team. Data collected included admission outcome (e.g. discharge or death). RESULTS: There were 162 ambulance callouts between 126 patients known to the palliative care team. 8 patients (6%) died within 72 hours of admission. CONCLUSION: Our data suggests many palliative care patients can be appropriately treated in the community.

Seeking Excellence in End of Life Care UK (SEECare UK): a UK multi-centred service evaluation.

OBJECTIVE: To evaluate the care of patients dying in hospital without support from specialists in palliative care (SPC), better understand their needs and factors influencing their care. METHODS: Prospective UK-wide service evaluation including all dying adult inpatients unknown to SPC, excluding those in emergency departments/intensive care units. Holistic needs were assessed through a standardised proforma. RESULTS: 88 hospitals, 284 patients. 93% had unmet holistic needs, including physical symptoms (75%) and psycho-socio-spiritual needs (86%). People were more likely to have unmet needs and require SPC intervention at a district general hospital (DGH) than a teaching hospital/cancer centre (unmet need 98.1% vs 91.2% p0.02; intervention 70.9% vs 50.8% p0.001) and when end-of-life care plans (EOLCP) were not used (unmet need 98.3% vs 90.3% p0.006; intervention 67.2% vs 53.3% p0.02). Multivariable analyses demonstrated the independent influence of teaching/cancer hospitals (adjusted OR (aOR)0.44 CI 0.26 to 0.73) and increased SPC medical staffing (aOR1.69 CI 1.04 to 2.79) on need for intervention, however, integrating the use of EOLCP reduced the impact of SPC medical staffing. CONCLUSION: People dying in hospitals have significant and poorly identified unmet needs. Further evaluation is required to understand the relationships between patient, staff and service factors influencing this. The development, effective implementation and evaluation of structured individualised EOLCP should be a research funding priority.

Cancer centre supportive oncology service: health economic evaluation.

OBJECTIVES: There have been many models of providing oncology and palliative care to hospitals. Many patients will use the hospital non-electively or semielectively, and a large proportion are likely to be in the last years of life. We describe our multidisciplinary service to treatable but not curable cancer patients at University Hospitals Sussex. The team was a mixture of clinical nurse specialists and a clinical fellow supported by dedicated palliative medicine consultant time and oncology expertise. METHODS: We identified patients with cancer who had identifiable supportive care needs and record activity with clinical coding. We used a baseline 2019/2020 dataset of national (secondary uses service) data with discharge code 79 (patients who died during that year) to compare a dataset of patients seen by the service between September 2020 and September 2021 in order to compare outcomes. While this was during COVID-19 this was when the funding was available. RESULTS: We demonstrated a reduction in length of stay by an average of 1.43 days per admission and a reduction of 0.95 episodes of readmission rates. However, the costs of those admissions were found to be marginally higher. Even with the costs of the service, there is a clear return on investment with a benefit cost ratio of 1.4. CONCLUSIONS: A supportive oncology service alongside or allied to acute oncology but in conjunction with palliative care is feasible and cost-effective. This would support investment in such a service and should be nationally commissioned in conjunction with palliative care services seeing all conditions.

Hospital deaths dashboard: care indicators.

OBJECTIVES: We wanted to create a medical/nursing led data collection tool to allow for an ongoing audit of the quality of deaths in a teaching hospital. We wanted to be able to produce a visual summary to monitor our involvement, use of PRN medication, recognition of death, treatment escalation plans and communication aspects. We feel these are good surrogate indicators for quality end-of-life care. METHODS: We designed a purpose built spreadsheet which we have designed as an abbreviated version of the UK national audit tools. We involved a number of our core medical trainees to iterate the data collection so it could be done in a timely manner with a simple training guide. Our collective approach meant we have made this as straightforward as possible to roll out and maintain data collection. RESULTS: We collected 100 cases over a period of 6 months (August 2019 to January 2020). We created a dashboard looking at the core elements of end-of-life care and found bar treatment escalation planning all aspects were completed the majority of the time with near 100% communication to relevant family and friends. CONCLUSIONS: Our sample collection tool provides a useful ongoing indicator for the quality of end-of-life care in the trust and to provide a timely infographic quarterly to feedback to interested members of the trust. We hope to be able to continue over some years to collate themes and trends. We would encourage other hospital teams to adopt our approach.

Retrieval of aerosol refractive index from extinction spectra with a damped harmonic-oscillator band model.

A new method for the retrieval of the spectral refractive indices of micrometer-sized particles from infrared aerosol extinction spectra has been developed. With this method we use a classical damped harmonic-oscillator model of molecular absorption in conjunction with Mie scattering to model extinction spectra, which we then fit to the measurements using a numerical optimal estimation algorithm. The main advantage of this method over the more traditional Kramers-Kronig approach is that it allows the full complex refractive-index spectra, along with the parameters of the particle size distribution, to be retrieved from a single extinction spectrum. The retrieval scheme has been extensively characterized and has been found to provide refractive indices with a maximum uncertainty of approximately 10% (with a minimum of approximately 0.1%). Comparison of refractive indices calculated from measurements of a ternary solution of HNO3, H2SO4, and H2O with those published in J. Phys. Chem. A 104, 783 (2000) show similar differences as found by other authors.

Impactos de la certificación sobre los bosques, los grupos de interés y la cadena de abastecimiento

Contenido: La certificación - Su propósito y evolución.- Impactos y perspectivas de la certificación para las empresas de base comunitaria.- La cadena de abastecimiento y la certificación - catalizadoras del mejoramiento en el manejo forestal.- Madurando la certificación - progreso, desafíos y caminos a seguir.- Anexos

Impactos de la certificación sobre los bosques, los grupos de interés y la cadena de abastecimiento

Contenido: La certificación - Su propósito y evolución.- Impactos y perspectivas de la certificación para las empresas de base comunitaria.- La cadena de abastecimiento y la certificación - catalizadoras del mejoramiento en el manejo forestal.- Madurando la certificación - progreso, desafíos y caminos a seguir.- Anexos