Palliative and End of Life Care for Black, Asian, and Minority Ethnic Groups in the UK

This report marks the start of a programme of work by many partners. A better understanding of the nation's changing demographics, of the needs of individual ethnic and cultural groups and of the types of services which will best meet their end of life care needs must be early outputs from the partnership. There are many areas which researchers will investigate further and many opportunities for service providers to work together with local communities to develop care which is sensitive and responsive to their needs as well as on a scale which will be needed for the large numbers of people who could benefi

Local Preferences and Place of Death in Regions within England 2010

This report shows public preferences for place of death in the nine English Government Office Regions (GORs), obtained from a population-based telephone survey in 2010. It compares the results with a similar survey carried out in 2003 to understand how preferences are evolving over time. It goes on to contrast these preferences with actual place of death (as reported for that region) in order to shed light on how people's wishes relate to reality and to aid care planning so that preferences are more frequently met

The impact of the depressed economic condition of the area on the personnel practices in the textile industry in Fall River, Massachusetts

Thesis (M.B.A.)--Boston Universit

Synthesis and Coordination Chemistry of Ditopic Ligands Capable of Coordinating Metal Ions and Interacting with Anions

The aim of this research was to synthesise a series of novel organic multidentate ligands which contain N-donor domains for the coordination of metal ions and amide or amine hydrogen atoms which are capable of interaction with anions. It was envisaged that incorporation of these two binding units would produce a system where the metal ions would control the ability of the ligand to interact with anions or vice versa. Ligand 1 contains a tetradentate N-donor domain formed by a central bipyridine, two thaizole units and two amide units attached in the 4,4’-position of the bipyridine unit. Reaction of this with divalent metal ions results in a mono-nuclear complex where the metal is bound by the N-donor atoms and the amides interact with a variety of anions. Reaction with monovalent metal ions results in the formation of a dinuclear double helicate with the metal again coordinated by the N-donor domains and the anions interacting with the amide hydrogen atoms. This results in a polymeric assembly in the solid state. Ligand 2 contains an identical tetradentate domain comprised of the same N-donor units; however the single amides in the 4,4’-position have been removed and a diamide attached in the 3,3’-position of the bipyridine unit. Reaction of [L2 with divalent cations results in a similar mono-nuclear species. The metal centre is coordinated by the N-donor atoms and one of the acetyl units from two adjoining ligands with the counter ions undergoing interactions with the diamide hydrogen atoms. Coordination of the same ligand with a monovalent cation resulted in a di-nuclear double helicate, each metal centre is fulfilled by the N-donor atoms of the ligand strand and the hydrogen atoms of the diamide units interact with anions. This too results in a polymeric assembly in the solid state. Ligands 3 and 4 contain the iso-structural tetradentate N-donor domain seen in [L1] and [L2] but their functionality in the 3,3’-position differ. Ligand 3 contains a urea group while ligand 4 has a single amide group attatched to an indole unit. Coordination of [L3] and a divalent metal ion results in the formation of a mono-nuclear species with the metal ion bound by the central bipyridine and the N-donor of two thaizole units. Furthermore each of the urea groups in the 3,3’-position undergo favourable interactions with the perchlorate counter ions. A solid state structure of Ligand 4 was only successful with a monovalent cation resulting in the formation of a dinuclear double stranded species. Each metal centre exhibits a distorted trigonal planar geometry through coordination with a pyridine and thiazole ring of one strand and a single thiazole ring of another. The indole and amide of each ligand strand undergo two sets of interactions; anion interactions through the amide and indole hydrogen atoms as well as complementary intermolecular interactions between the indole N···H units of one ligand and the carbonyl C···O units of another complex. Both [L3] and [L4] exhibit long range order through favourable anion-NH interactions however [L4] also displays complimentary indole / acetyl interactions to develop a larger aggregate species. In all these cases the resultant complex is independent upon which anion is used. However, this is not the case with ligand 5. Reaction of [L5] with Cu(BF4)2 or Cu(ClO4)2 gave a dinuclear double helicate with a cleft within the helicate assembly in which an anion is bound. However, reaction of this with half an equivalent of either sulphate (SO4 2-) or dihydrogen phosphate (H2PO4 -) results in the formation of a different dinuclear double helicate whereby the cleft is occupied by either a dihydrogen phosphate or sulphate anion which bridges the metal centres. Further addition of sulphate results in no change of the ESI-MS indicating the dinuclear double helicate persist however addition of one equivalent of di-hydrogen phosphate leads to the formation of a pentanuclear circular helicate. Each metal centre is coordinated by the pyridine and thiazole units of two different ligand strands and a single Cu···O interaction from one of the dihydrogen phosphates. The inclusion of three dihydrogen phosphates into the centre of the assembly as well as a series of phosphate-ligand and phosphate-phosphate interactions leads to the dimerization of the structure with another set of phosphates from a second assembly. Further reaction of this dinuclear species with one equivalent of (Bu4N)NO3 resulted in the formation of a hexanuclear circular meso-helicate (or mesocate). In this structure each Ndonor domain of a thiazole and pyridine ring coordinate two different Cu2+ metal centres. Each metal centre exhibits a distorted octahedral arrangement with two ligand strands completing 4 of its 6 coordination sites, the remaining sites are occupied by two O-donors of a nitrate anion. In addition an amine of each ligand strand points into the centre of the complex creating a cavity capable of hosting two nitrate anions. Ligand 6 is made up of the same bis-bidentate donors as ligand 5 with the addition of a nitrogen atom into the central phenyl spacer. On reaction of [L6] with a divalent metal ion (e.g. Cu(II)) a simple mono-nuclear structure is observed. Although a mono-nuclear assembly is expected, it is interesting that even a simple change in the ligand strand can have a dramatic affect on the self-assembly process. When a central 1,3-phenylene spacer is employed (i.e. [L5]) a dinuclear double helicate is formed, however, when a 1,3-pyridine unit is contained within the ligand strand (i.e. [L6]) a simple mono-nuclear species is produced

Relationship between three palliative care outcome scales

BACKGROUND: Various scales have been used to assess palliative outcomes. But measurement can still be problematic and core components of measures have not been identified. This study aimed to determine the relationships between, and factorial structure of, three widely used scales among advanced cancer patients. METHODS: Patients were recruited who received home or hospital palliative care services in the south of England. Hope, quality of life and palliative outcomes were assessed by patients in face to face interviews, using three previously established scales – a generic measure (EQoL), a palliative care specific measure (POS) and a measure of hope (Herth Hope Index). Analysis comprised: exploratory factor analysis of each individual scale, and all scales combined, and confirmatory factor analysis for model building and validation. RESULTS: Of 171 patients identified, 140 (81%) consented and completed first interviews; mean age was 71 years, 54% were women, 132 had cancer. In exploratory analysis of individual means, three out of the five factors in the EQoL explained 75% of its variability, four out of the 10 factors in POS explained 63% of its variability, and in the Hope Index, nine out of the 12 items explained 69% of its variability. When exploring the relative factorial structure of all three scales, five factors explained 56% of total combined variability. Confirmatory analysis reduced this to a model with four factors – self-sufficiency, positivity, symptoms and spiritual. Removal of the spiritual factor left a model with an improved goodness of fit and a measure with 11 items. CONCLUSION: We identified three factors which are important outcomes and would be simple to measure in clinical practice and research

Development of a patient-reported palliative care-specific health classification system: the POS-E

BackgroundGeneric preference-based measures are commonly used to estimate quality-adjusted life-years (QALYs) to inform resource-allocation decisions. However, concerns have been raised that generic measures may be inappropriate in palliative care.ObjectiveOur objective was to derive a health-state classification system that is amenable to valuation from the ten-item Palliative Care Outcome Scale (POS), a widely used patient-reported outcome measure in palliative care.MethodsThe dimensional structure of the original POS was assessed using factor analysis. Item performance was assessed, using Rasch analysis and psychometric criteria, to enable the selection of items that represent the dimensions covered by the POS. Data from six studies of patients receiving palliative care were combined (N = 1011) and randomly split into two halves for development and validation. Analysis was undertaken on the development data, and results were validated by repeating the analysis with the validation dataset.ResultsFollowing Rasch and factor analyses, a classification system of seven items was derived. Each item had two to three levels. Rasch threshold map helped identify a set of 14 plausible health states that can be used for the valuation of the instrument to derive a preference-based index.ConclusionCombining factor analysis and Rasch analysis with psychometric criteria provides a valid method of constructing a classification system for a palliative care-specific preference-based measure. The next stage is to obtain preference weights so the measure can be used in economic evaluations in palliative care

Current and Future Needs for Hospice Care: An Evidence Based Approach

This report provides evidence on what is known and still needs to be known about patients' and families' needs for hospice care towards the end of life. We focus on crucial factors for hospice care planning for the future in the UK, including the most recent data on actual and projected number of deaths in England, Wales, Scotland and Northern Ireland. This is followed by evidence on people's preferences for place of care and place of death. Finally, we present available evidence on the effectiveness and cost-effectiveness of hospice care and discuss the need for further research. Evidence-based recommendations are provided throughout the report