Palliative care for Parkinson's disease: Patient and carer's perspectives explored through qualitative interview

Background: Palliative care is recommended for non-malignant illnesses, including Parkinson’s disease. However, past research with healthcare workers highlights unmet palliative needs in this population and referral rates to Specialist Palliative Care are low. Some healthcare workers perceive a ‘fear’ in their patients about introducing palliative care. However, less is known about the views of people with Parkinson’s disease and their carers about palliative care. Aim: (1) To explore the palliative care and related issues most affecting people with Parkinson’s disease and their families and (2) to examine perceptions about/understanding of palliative care. Design: This was a qualitative study; semi-structured interviews were conducted, transcribed and analysed using thematic analysis. Setting/participants: A total of 31 people participated, both people with Parkinson’s disease (n = 19) and carers (n = 12), across three Movement Disorder Clinics in the Republic of Ireland. Results: People with Parkinson’s disease and their carers were unfamiliar with the term palliative care. When informed of the role of palliative care, most felt that they would benefit from this input. People with Parkinson’s disease and carers experienced a high illness burden and wanted extra support. Crises requiring Specialist Palliative Care involvement may occur at diagnosis and later, with advancing illness. Participants wanted more information about palliative care and especially further supports to address their psychosocial needs. Conclusion: A holistic palliative care approach could address the complex physical and psychosocial symptoms experienced by people with Parkinson’s disease and their carers, and people with Parkinson’s disease and their carers are open to palliative care. Further research needs to explore how palliative care can be introduced into the routine care for people with Parkinson’s disease

Scotland's Budget Report 2023

When Deputy First Minister (DFM) and Finance Secretary Shona Robison rises next week to present her first Scottish Budget, she will do so against one of the most challenging fiscal backdrops in the history of Scottish devolution. The Scottish economy has not performed as badly as many had anticipated, with no recession this year, but growth has been essentially non-existent for the past two years. And with the Bank of England set to keep interest rates higher for longer than previously anticipated, the Scottish Fiscal Commission’s (SFC) forecasts are likely to follow the pattern presented by the Office for Budget Responsibility for the whole of the UK – slower growth and higher inflation than at their previous update. Between the Medium-Term Financial Strategy (MTFS) in May and the Autumn Budget Revision, spending pressures – mostly on pay – had increased by £930m. Since then, there have been £520m-worth of spending cuts announced; there is £380m in additional Barnett funding; and £260m in additional borrowing and use of the Scotland Reserve. This leaves the prospective position of the Scottish Government in 2023-24 at £232m, which might mean not all of the cuts announced by the DFM on the eve of the Autumn Statement are necessary. But the situation for 2024-25 is much more difficult. Part of it was already in the MTFS, with resource spending plans already outstripping funding by £1bn and capital plans £450m larger than projected funding. As the Scottish Government must balance funding sources with expenditures, this was clearly always unsustainable. More positive Income Tax net revenues in outturn and forecast are likely to add around £970m to funding available next year, and there are £310m of Barnett consequentials to add – plus an additional £180m additional funding to compensate for the devolution of winter fuel payments. In total, funding is £1,455m higher than expected in May. But spending pressures are also higher, with higher-than-budgeted-for pay awards creating ongoing difficulties. Assuming the higher scenario for pay this year and next from the MTFS – themselves probably too low for what actually happened – would add about £500m to spending. Adding in winter fuel payments expenditure brings spending plans to £646m above the MTFS – meaning a £780m improvement to the net funding position. This is before any of the additional spending commitments made by the Scottish Government, which have been numerous in recent months. First Minister Humza Yousaf said in October it would be ‘fully funded’ – which of course depends on what councils would have done in the absence of the freeze. If we assume they would have mirrored last year’s increases, we estimate compensation would run to £330m. The First Minister (FM) also announced so an additional £100m for NHS waiting list reduction. And at least £325m of the DFM’s ‘savings’ announced in Parliament on 21 November were actually reprofiling of spending into future years, when plans already exceeded projected funds using May’s forecasts. On the basis of announced policy and commitments, we estimate that the net funding gap is £1,465m for 2024-25: £799m on resource and £665m on capital. In the report, we also look at the outlook for spending and tax. We analyse how public sector employment has been evolving in Scotland relative to other areas of the UK; what capital borrowing plans using Scottish Government bonds might mean for capital spending; and how social security spending has been evolving. On the tax side, we have updated our analysis of how much proposed Income Tax policies would raise under our understanding of the SFC’s methodology; what reforms to smooth out marginal tax rates might look like; what the consequences of the council tax freeze are for the revenues and for households; the cost of matching reliefs on non-domestic rates; and the practical difficulties in introducing new taxes to combat short-term funding gaps

The Grizzly, April 26, 2001

Watson Foundation Considers Ursinus for Membership • Dining Committee Addresses Rising Number of Student Complaints • Senior Student Young Named Ursinus Valedictorian • CAB, RHA, USGA, and Class Officer Elections Being Held • Opinions: Berg on Bush: First 100 Days of W a Comedy of Errors; Wismer: Taking a Turn for the Worse?; Awards Assembly Hot, Boring, Uninspired • Annual Student Art Exhibition now in Berman • Track: Men and Women Accelerate Toward Penn Relays • Baseball: Close to the .500 Mark, Third in Conference • Women\u27s LAX #1 Seed in Conference • Softball Squad Holding Steady in Third Place • Men\u27s and Women\u27s Tennis Look to end Season at CCC • Complications Lead to Delay in Field House Openinghttps://digitalcommons.ursinus.edu/grizzlynews/1489/thumbnail.jp

Economic commentary [March 2024]

Poor but improving: economy slowly recovers in line with expectations Economic data in early 2024 is showing that the economy is likely to be recovering hesitantly as expected, following the contractions in growth in the final part of 2023. This comes in the latest economic assessment from the Fraser of Allander Institute at Strathclyde University. The Institute’s quarterly Economic Commentary, which includes an assessment of all the latest key data on the UK and Scottish economies, is published today. In the Deloitte-sponsored Economic Commentary, the University of Strathclyde researchers have set out their latest forecasts for the Scottish Economy. The economists are forecasting growth of 0.6% in 2024, 1.1% in 2025 and 1.2% in 2026. These forecasts are unchanged from the previous assessment. Bright spots for the UK as a whole can be seen in the inflation data, with the latest showing that Consumer Price Inflation fell to 3.4% in February, adding to hopes that interest rate cuts are likely to be coming over the course of 2024. January GDP data for the UK also shows growth after a poor end to 2024. In Scotland, consumer sentiment has risen 4.8 points over the last quarter and 23 points over the year, indicating a significant improvement in sentiment across Scotland. However, most indicators remain in negative territory (i.e. more people being negative than positive about their circumstances) reflecting the challenging economic and financial pressures facing households. The latest assessment from the Fraser of Allander includes a real-time earnings tracker, a focus on the implications of the changes to the national minimum wage being introduced in April 2024, and an analysis of the major public policy priorities for citizens in Scotland. These include health care and the NHS, inequality & poverty, housing and cost of living. Professor Mairi Spowage, Director of the Institute, said “The mixed bag of economic news we are seeing for both Scotland and the UK at the moment could give reasons for either pessimism or optimism. “On the one hand, the economy returning to growth in January and inflation falling faster than expected support our view that we will return to growth in 2024 overall. On the other hand, this growth is fragile and may be blown off course by events, particularly given geopolitical uncertainty this year. “Our report chimes with other data released today by the Scottish Chambers of Commerce, which also shows businesses displaying confidence and resilience in the face of challenges.” Douglas Farish, Head of Tax for Scotland at Deloitte, said “Although it’s encouraging that Scotland avoided a technical recession in the latter half of last year, this quarter’s Economic Commentary still paints an ambivalent view of the nation’s current economic position, with overall growth lacklustre in 2023.” “The cost-of-living crisis continues to take a toll on household finances, and our latest State of the State report found that 60 per cent of the Scottish public believe the crisis will get worse still, albeit dropping from 75 per cent last year.“ The Institute’s quarterly commentary also includes analysis of implications of the UK Budget on 6th March for Scotland, including the second National Insurance cut, the impact of the overall tax burden, and the impact of UK Government spending decisions on the Scottish Government’s Budget. João Sousa, Deputy Director of the Institute, said: “The lack of significant changes on resource and capital departmental spending further confirms the tough fiscal environment for the Scottish Government, and this will become apparent again when Deputy First Minister Shona Robison presents the Medium-Term Financial Strategy (MTFS) on 30 May. “The 2023 MTFS had a £2.4 billion shortfall in funding built in for 2025-26, and with so much of the £1.5 billion shortfall in 2024-25 being filled by delaying projects, more difficult decisions are likely to be on the way. “This is not to say that the Scottish Government will not receive any additional spending consequentials from the UK Budget on 6th March. £295m in Barnett consequentials was generated for 2024-25 from the chancellor’s announcements.

Economic Commentary [October 2023]

Growth in the economy has been faltering and pretty muted over 2023, with a high interest rate environment and wider economic uncertainty leading to many businesses choosing to delay or cancel investments. Whilst not in the recession that many economists were predicting at the end of 2022, monthly economic figures have been very mixed, which means growth overall for 2023 is likely to be pretty poor. The most recent data on inflation, which held steady at 6.7% in September, shows that the high inflationary and interest rate environment is likely to persist for longer than previously thought – therefore it is likely that there are more risks to the downside for our forecasts numbers than in the previous quarter. We are now forecasting growth of 0.2% in 2023, 0.7% in 2024 and 1.2% in 2025. For 2023, this is a revision down from our previous set of forecasts in June, as data for 2023 to date has been much weaker than expected. The forecasts for 2024 and 2025 have not changed since June. Analysis in the Commentary this quarter includes a detailed look at the hospitality sector in Scotland. This sector, one of the hardest hit over the period of the pandemic, is a large employer in Scotland and the institute has been carrying out research with employers and employees into how pay and conditions in the sector can be improved. The Commentary also looks ahead to the Autumn Statement, which will be presented by the UK Chancellor on 22nd November. This will be important to set the scene – and indeed broadly the spending envelope - for the Scottish Budget on 19th December. The outlook for the public finances continues to be challenging, with slow growth translating into weak tax revenue forecasts. Despite recent positive revisions to UK growth, this is unlikely to translate into more fiscal headroom for the Chancellor. This will mean that the spending envelope remains tight, which will put further pressure on the Scottish Government’s finances in the run-up to the Scottish Budget. There have been a number of spending commitments made by the Scottish Government in recent weeks that are likely to make the situation more challenging

From abstract to impact in cardiovascular research: factors predicting publication and citation

Aims Through a 4-year follow-up of the abstracts submitted to the European Society of Cardiology Congress in 2006, we aimed at identifying factors predicting high-quality research, appraising the quality of the peer review and editorial processes, and thereby revealing potential ways to improve future research, peer review, and editorial work. Methods and results All abstracts submitted in 2006 were assessed for acceptance, presentation format, and average reviewer rating. Accepted and rejected studies were followed for 4 years. Multivariate regression analyses of a representative selection of 10% of all abstracts (n= 1002) were performed to identify factors predicting acceptance, subsequent publication, and citation. A total of 10 020 abstracts were submitted, 3104 (31%) were accepted for poster, and 701 (7%) for oral presentation. At Congress level, basic research, a patient number ≥ 100, and prospective study design were identified as independent predictors of acceptance. These factors differed from those predicting full-text publication, which included academic affiliation. The single parameter predicting frequent citation was study design with randomized controlled trials reaching the highest citation rates. The publication rate of accepted studies was 38%, whereas only 24% of rejected studies were published. Among published studies, those accepted at the Congress received higher citation rates than rejected ones. Conclusions Research of high quality was determined by study design and largely identified at Congress level through blinded peer review. The scientometric follow-up revealed a marked disparity between predictors of full-text publication and those predicting citation or acceptance at the Congres

Interviews with Irish healthcare workers from different disciplines about palliative care for people with Parkinson’s disease: a definite role but uncertainty around terminology and timing

Background: An integrated palliative care approach is recommended in all life-limiting diseases, including Parkinson’s disease (PD). However research shows that people with PD have unmet palliative care needs. The study aimed to explore multidisciplinary healthcare workers’ (HCWs) views on palliative care for people with PD, identifying perceived barriers and facilitators. Methods: A qualitative design was used; data was analysed using Thematic Analysis. Semi-structured interviews were conducted with 30 HCWs, working either with people with PD or in a palliative care setting in Ireland. Results: A number of perceived barriers were evident helping to account for the previously reported unmet palliative care needs in PD. A lack of education about PD and palliative care meant that HCWs were unsure of the appropriateness of referral, and patients and carers weren’t equipped with information to seek palliative care. A lack of communication between PD and palliative care specialists was seen to impede collaboration between the disciplines. Uncertainty about the timing of palliative care meant that it was often not introduced until a crisis point, despite the recognised need for early planning due to increased prevalence of dementia. Conclusions: Most HCWs recognised a need for palliative care for people with PD; however several barriers to implementing a palliative care approach in this population need to be addressed. Implications for clinical practice and policy include the need for an integrated model of care, and education for all HCWs, patients, carers, and the public on both the nature of advanced PD, and the potential of palliative care in support of patients and their family members