CELPI: Trial protocol for a randomised controlled trial of a Carer End of Life Planning Intervention in people dying with dementia

Background: Dementia is a leading cause of death in developed nations. Despite an often distressing and symptom laden end of life, there are systematic barriers to accessing palliative care in older people dying of dementia. Evidence exists that 70% of people living with severe dementia attend an emergency department (ED) in their last year of life. The aim of this trial is to test whether a Carer End of Life Planning Intervention (CELPI), co-designed by consumers, clinicians and content specialists, improves access to end of life care for older people with severe dementia, using an ED visit as a catalyst for recognising unmet needs and specialist palliative care referral where indicated. Methods: A randomised controlled trial (RCT) enrolling at six EDs across three states in Australia will be conducted, enrolling four hundred and forty dyads comprising a person with severe dementia aged ≥ 65 years, and their primary carer. Participants will be randomly allocated to CELPI or the control group. CELPI incorporates a structured carer needs assessment and referral to specialist palliative care services where indicated by patient symptom burden and needs assessment. The primary outcome measure is death of the person with dementia in the carer-nominated preferred location. Secondary outcomes include carer reported quality of life of the person dying of dementia, hospital bed day occupancy in the last 12 months of life, and carer stress. An economic evaluation from the perspective of a health funder will be conducted. Discussion: CELPI seeks to support carers and provide optimal end of life care for the person dying of dementia. This trial will provide high level evidence as to the clinical and cost effectiveness of this intervention. Trial registration: ACTRN12622000611729 registered 22/04/2022

CELPI: trial protocol for a randomised controlled trial of a Carer End of Life Planning Intervention in people dying with dementia.

BACKGROUND: Dementia is a leading cause of death in developed nations. Despite an often distressing and symptom laden end of life, there are systematic barriers to accessing palliative care in older people dying of dementia. Evidence exists that 70% of people living with severe dementia attend an emergency department (ED) in their last year of life. The aim of this trial is to test whether a Carer End of Life Planning Intervention (CELPI), co-designed by consumers, clinicians and content specialists, improves access to end of life care for older people with severe dementia, using an ED visit as a catalyst for recognising unmet needs and specialist palliative care referral where indicated. METHODS: A randomised controlled trial (RCT) enrolling at six EDs across three states in Australia will be conducted, enrolling four hundred and forty dyads comprising a person with severe dementia aged ≥ 65 years, and their primary carer. Participants will be randomly allocated to CELPI or the control group. CELPI incorporates a structured carer needs assessment and referral to specialist palliative care services where indicated by patient symptom burden and needs assessment. The primary outcome measure is death of the person with dementia in the carer-nominated preferred location. Secondary outcomes include carer reported quality of life of the person dying of dementia, hospital bed day occupancy in the last 12 months of life, and carer stress. An economic evaluation from the perspective of a health funder will be conducted. DISCUSSION: CELPI seeks to support carers and provide optimal end of life care for the person dying of dementia. This trial will provide high level evidence as to the clinical and cost effectiveness of this intervention. TRIAL REGISTRATION: ACTRN12622000611729 registered 22/04/2022

Oxygen consumption and ammonia excretion of the searobin Prionotus punctatus (Scorpaeniformes, Triglidae) at two different temperatures

Routine oxygen consumption and ammonia excretion were measured at 20ºC and 25ºC in the searobin Prionotus punctatus collected in Ubatuba region (22º30'S), SP, Brazil, in western South Atlantic, to investigate energy expenditure and losses through metabolic processes. IndividuaIs ranging from 1.00g to 88.47g and from 1.79g to 56.50g were used in experiments at 20ºC and 25ºC, respectively. At 20ºC and 25ºC, the averages of weight-specific oxygen consumption for the weight class of 1.00 - 10.00g, common to both temperatures, were 162.46µ 39.51 µ.10z/g/h and 200.47µ 92.46 µ.10z/g/h, respectively; for the weight class of 50.01 - 60.00g these values were 112.30 µ 22.84 µ.10z/g/h and 114.60 µ 20.36 µ.10zlg/h. At 20ºC and 25ºC, the averages of weight-specific ammonia excretion for the weight class of 1.00 to 1O.00g were 1.03 µ 0.37 fJ.M/g/h and 1.21 µ 0.65 µ.M/g/h, respectively; for the weight class of 50.01 -60.00g these values were 0.68 µ 0.13 fJ.M/g/h and 0.60 µ 0.22 µ.M/g/h. The energy budget for the species was calculated at both temperatures using the experimental data and a model for marine teleosts proposed in the literature.<br>O consumo de oxigênio de rotina e a excreção de amônia de Prionotus punctatus coletados na região de Ubatuba (22º30'S), SP, Brasil, foram medidos a 20ºC e 25ºC, para avaliar os gastos e perdas de energia com os processos metabólicos. Foram utilizados indivíduos variando de 1,00g a 88,47g e de 1,79g a 56,50g, em experimentos a 20ºC e 25ºC, respectivamente. As médias de consumo específico de oxigênio a 20ºC e 25ºC para a classe de peso de 1,00 - 10,00g, comum a ambas as temperaturas, foram 162,46µ 39,51 µ.10z/g/h e 200,47 µ 92,46 µ.10z/g/h, respectivamente; para a classe de peso de 50,01 - 60,00g esses valores foram 112,30 µ 22,84 µ.10z/g/h e 114,60 µ 20,36 µ.10z/g/h. A 20ºC e 25ºC, as médias de excreção específica de amônia para a classe de peso de 1,00 a 10,00g foram 1,03 µ 0,37 e 1,21 µ 0,65 µ.M/g/h, respectivamente; para a classe de peso de 50,01 - 60,00g esses valores foram 0,68 µ 0,13 µ.M/g/h e 0,60 µ 0,22 µ.M/g/h. O orçamento energético para a espécie foi calculado para cada temperatura utilizando-se os da.dos experimentais e modelo proposto na literatura