Views of Care at End of Life: A Secondary Analysis of Online Feedback Using Care Opinion.

Although there are studies on the use of social media and palliative and end-of-life care (PEOLC), there are no studies specifically investigating the content of online public feedback about PEOLC services. This study sought to understand experiences of end-of-life care provided in hospitals in the West of Scotland by exploring the main themes within the content of stories posted on a nationally endorsed nonprofit feedback online platform, Care Opinion, within a 2-year period. We used "Appreciative Inquiry" as a theoretical framework for this study to determine what works well in end-of-life care, while also identifying areas for further improvement. Of the 1428 stories published on "Care Opinion" from March 2019 to 2021 regarding hospitals in the West of Scotland, 48 (3.36%) were related to end-of-life care, of which all were included in data analysis. Using the software package NVivo and thematic analysis, we identified 4 key themes. We found that people overwhelmingly posted positive feedback about their experiences with end-of-life care. People reported positively about staff professionalism in providing compassionate and person-centered care to meet their loved ones needs at end of life. Other experiences of care related to challenges facing healthcare services, particularly during the COVID-19 pandemic. Quality appraisal of staff responses highlighted areas for improving feedback. This study can add to the aim of improving staff response to people's concerns about end-of-life care. This study has provided a novel perspective of patients' experiences of end-of-life care in hospitals in the West of Scotland. Novel insights were the appreciation of quality of care, staff professionalism, effective communication, and meeting patient's needs at end-of-life particularly by nursing staff.

The rate of usage of electroconvulsive therapy in the city of Edinburgh, 1993-2005.

BACKGROUND: In May 2003, the National Institute for Clinical Excellence published controversial clinical guidelines that intended to restrict the indications for the use of electroconvulsive therapy (ECT) in the United Kingdom. OBJECTIVE: We investigated whether the guideline had affected the rate of usage of ECT in the City of Edinburgh and set this in the context of ECT usage in the City since 1993. METHOD: We calculated the annual rate of ECT usage using a case register and contemporaneous and coterminous population data, reporting separately rates for young people (younger than 18 years), the general adult population, and older adults (aged 65 years of age and older). RESULTS: No young person was treated after 1998. There were similar significant falls in the rates of usage in both the general adult and older age population (-60%). There was no suggestion that the fall had accelerated after May 2003. CONCLUSIONS: No early effect of the guidance was found in the rate of ECT usage in the City of Edinburgh, but the passage of time will be required to assess any longer term effect.

The prevalence of prolonged cerebral seizures at the first treatment in a course of electroconvulsive therapy.

BACKGROUND: It has been suggested that prolonged cerebral seizures are more prevalent in contemporary practice than realized partly because they may go undetected in the absence of monitoring by electroencephalogram (EEG). The previous report on this topic from Scotland concerned only patients taking part in research and may not be generalizable to routine clinical practice; moreover, the EEG monitoring was not all carried out at a standardized point in the course of treatment. OBJECTIVE: We sought to establish the prevalence of prolonged cerebral seizures in a representative sample from routine clinical practice in Edinburgh and do so at the first treatment, when the risk is greatest. METHOD: Two-channel EEG monitoring was conducted at the first treatment in a new course given to 100 individual consecutive patients. RESULTS: The titration had to be curtailed for anesthetic reasons in 2 patients, and no cerebral seizure was induced. Electroencephalogram measurement of seizure duration was practicable in only 95 of the remaining patients. Two cerebral seizures longer than 120 seconds were detected. One seizure ended spontaneously after 158 seconds and was associated with a generalized convulsion lasting 77 seconds. One was medically terminated after 180 seconds and was associated with a generalized convulsion lasting 122 seconds; this patient had an encephalopathy during the index illness. CONCLUSIONS: The prevalence of prolonged seizures in our routine clinical practice was 1% to 2%, depending on the definition of prolonged cerebral seizure activity.