Neurologists' lived experiences of communicating the diagnosis of a motor neurodegenerative condition: an interpretative phenomenological analysis

BACKGROUND Receiving the diagnosis of a motor neurodegenerative condition (MNDC) can be a life-changing experience. Although several studies of individuals' experiences have indicated dissatisfaction with aspects of how an MNDC diagnosis was communicated, few studies have addressed doctors' experiences of breaking bad news for these conditions, especially from a qualitative perspective. This study explored UK neurologists' lived experience of delivering an MNDC diagnosis. METHODS Interpretative phenomenological analysis was used as the overarching method. Eight consultant neurologists working with patients with MNDCs took part in individual, semi-structured interviews. RESULTS Two themes were constructed from the data: 'Meeting patients' emotional and information needs at diagnosis: a balancing act between disease, patient and organization-related factors', and 'Empathy makes the job harder: the emotional impact and uncovered vulnerabilities associated with breaking bad news'. Breaking the news of an MNDC diagnosis was challenging for participants, both in terms of achieving a patient-centred approach and in terms of dealing with their own emotions during the process. CONCLUSIONS Based on the study's findings an attempt to explain sub-optimal diagnostic experiences documented in patient studies was made and how organizational changes can support neurologists with this demanding clinical task was discussed

Neurologists' current practice and perspectives on communicating the diagnosis of a motor neurodegenerative condition: a UK survey

Background The communication of a life-changing diagnosis can be a difficult task for doctors with potential long-term effects on patient outcomes. Although several studies have addressed the experiences of individuals with motor neurodegenerative diseases in receiving this diagnosis, a significant research gap exists regarding professionals’ perspectives, especially in the UK. This study aimed to assess UK neurologists’ current practice and perspectives on delivering the diagnosis of a motor neurodegenerative disease, explore different aspects of the process and detail the potential challenges professionals might face. Methods We conducted an anonymised online survey with 44 questions, grouped into four sections; basic demographic information, current practice, the experience of breaking bad news and education and training needs. Results Forty-nine professionals completed the survey. Overall, participants seemed to meet the setting-related standards of good practice; however, they also acknowledged the difficulty of this aspect of their clinical work, with about half of participants (46.5%) reporting moderate levels of stress while breaking bad news. Patients’ relatives were not always included in diagnostic consultations and participants were more reluctant to promote a sense of optimism to patients with poorer prognosis. Although professionals reported spending a mean of around 30–40 min for the communication of these diagnoses, a significant proportion of participants (21–39%) reported significantly shorter consultation times, highlighting organisational issues related to lack of capacity. Finally, the majority of participants (75.5%) reported not following any specific guidelines or protocols but indicated their interest in receiving further training in breaking bad news (78.5%). Conclusions This was the first UK survey to address neurologists’ practice and experiences in communicating these diagnoses. Although meeting basic standards of good practice was reported by most professionals, we identified several areas of improvement. These included spending enough time to deliver the diagnosis appropriately, including patients’ relatives as a standard, promoting a sense of hope and responding to professionals’ training needs regarding breaking bad news

Healthcare professionals’ involvement in breaking bad news to newly diagnosed patients with motor neurodegenerative conditions: a qualitative study

Purpose Research on breaking bad news (BBN) in healthcare has mostly focused on the doctor-patient interaction during a single consultation. However, it has been increasingly recognised that BBN is a wider process that also involves other healthcare professionals. This qualitative study explored non-medical1 healthcare professionals’ involvement in BBN to newly diagnosed patients with motor neurodegenerative conditions in the UK. Materials and methods 19 healthcare professionals working with people with motor neurone disease, multiple sclerosis, Parkinson’s disease or Huntington’s disease took part in individual, semi-structured interviews which were analysed using thematic analysis. Results Four themes were constructed: dealing with the diagnostic aftermath, unpacking the diagnosis, breaking bad news as a balancing act and empowering patients to regain control over their health and lives. Participants reported being broadly involved in BBN by supporting patients with negative diagnostic experiences, re-iterating diagnostic information and helping patients understand the impact of their condition. The challenges of effectively breaking bad news and how these difficult conversations could help empower patients were also emphasised. Conclusions BBN was a critical and challenging aspect of healthcare professionals’ clinical work with newly diagnosed patients with motor neurodegenerative conditions. Besides providing information, BBN was perceived as a way to educate patients, encourage them to make decisions and prepare for the future

Value relevance of accounting information in the pre- and post-IFRS accounting periods

This paper examines the value relevance of accounting information in the pre- and post-periods of International Financial Reporting Standards implementation using the models of Easton and Harris (1991) and Feltham and Ohlson (1995) for a sample of Greek companies. The results of the paper indicate that the effects of the IFRS reduced the incremental information content of book values of equity for stock prices. However, earnings’ incremental information content increased for the post-IFRS period. The results can be explained by the introduction of the fair value principle under the IFRS that brought major changes in book value but not in earnings.peer-reviewe

Dairy foods and body mass index over 10-year: evidence from the Caerphilly Prospective Cohort Study

The association between dairy product consumption and body mass index (BMI) remains controversial. The aim of the present study was to investigate the association between total dairy, milk, cheese, cream and butter consumption and BMI change over a 10-year follow-up by using long-term follow-up cohort data from the Caerphilly Prospective Cohort Study (CAPS). The CAPS included 2512 men aged 45⁻59 years at baseline, who were followed up at 5-year intervals for over 20-year. A semi-quantitative food frequency questionnaire estimated the intake of dairy consumption, including milk, cheese, cream and butter at baseline, 5-year and 10-year follow-up. In total, men free of cardiovascular disease, diabetes and cancer ( = 1690) were included in current analysis. General linear regression and logistic regression were used for data analysis. The results showed higher cheese consumption was associated with lower BMI at the 5-year follow-up ( = 0.013). There was no evidence that higher consumption of total dairy, milk, cream and butter were significantly associated with BMI during the over the 10-year following-up. This study suggest that cheese consumption have beneficial effects on lowering BMI, which needs further investigation

Mycophenolate mofetil and intravenous cyclophosphamide are similar as induction therapy for class V lupus nephritis

Class V lupus nephritis (LN) occurs in one-fifth of biopsy-proven cases of systemic lupus erythematosus. To study the effectiveness of treatments in this group of patients, we pooled analysis of two large randomized controlled multicenter trials of patients with diverse ethnic and racial background who had pure class V disease. These patients received mycophenolate mofetil (MMF) or intravenous cyclophosphamide (IVC) as induction therapy for 24 weeks, with percentage change in proteinuria and serum creatinine as end points. Weighted mean differences, pooled odds ratios, and confidence intervals were calculated by using a random-effects model. A total of 84 patients with class V disease were divided into equal groups, each group had comparable entry variables but one received MMF and one received IVC. Within these groups, 33 patients on MMF and 32 patients on IVC completed 24 weeks of treatment. There were no differences between the groups in mean values for the measured end points. Similarly, no difference was found regarding the number of patients who did not complete the study or who died. In patients with nephrotic syndrome, no difference was noted between those treated with MMF and IVC regarding partial remission or change in urine protein. Hence we found that the response to MMF as induction treatment of patients with class V LN appears to be no different from that to IVC

Metal foam recuperators on micro gas turbines: Multi-objective optimisation of efficiency, power and weight

Small size and high efficiency of micro gas turbines require a higher surface-to-volume ratio of recuperators. Conventional recuperators can achieve a range of 250–3600 m2/m3. Advances in materials and manufacturing, such as metal foams, can increase significantly the exchange surface and improve compactness ranging approximately from 500 to over 10,000 m2/m3, due to their exceptional micro geometry. The main advantage is that the increase of surface area does not impact the cost of the heat exchanger as much as conventional recuperators due to their easy manufacturing. This work addresses the optimisation of the recuperator using multiple objectives satisfying efficiency, power output and weight criteria, offering a holistic approach that takes into account the entire system rather than individual components or channels. A model is developed to represent the performance of a compact heat exchanger in micro gas turbines. The recuperator is an annular heat exchanger with involute profile filled with porous media in a counterflow arrangement on the hot and cold sides. The model allows the evaluation of the effect of the recuperator geometry features on the electrical efficiency, power output and weight savings in a micro gas turbine. Existing models for the global heat transfer coefficient, effective thermal conductivity, surface area and pressure drop of porous media are selected and implemented. The design variables of multi-objective are the pore density, porosity and number of channels, whilst the objectives are the overall electrical efficiency, power output and recuperator weight. The problem is solved using the Non-Dominated Sorting Genetic Algorithm (NSGA-II) to determine an approximation of the Pareto front, whilst the accuracy of the approximation is assessed against the solution obtained by an exhaustive search. The comparison shows that NSGA-II outperforms an exhaustive search by at least 90 % in terms of computational efficiency. These results allow the quantification of the impact of metal foam technology on performance metrics of the recuperator as well as the entire system. This quantitative analysis provides valuable insights into the behaviour of metal foam recuperators in micro gas turbines. An optimal design with 30 % efficiency and 28 kW power output appears in pore densities of approximately 10 and 20 pores per inch (PPI) for the air and gas side respectively, and a porosity of 85 %, which leads to a state-of-the-art recuperator weight of 48 kg. The efficiency improvement over the industry standard is 15 %, with only a 2.5 % reduction in power output

Dairy foods and body mass index over 20-years: evidence from Caerphilly Prospective Study

The prevalence of obesity has reached epidemic proportions with more than 600 million adults worldwide classified as clinically obese (body mass index (BMI) ⩾ 30 kg/m2)(1). Among the various approaches to tackle obesity and its comorbidities, a heathy diet is one of the key determinants for reducing obesity(2). Given that dairy products are naturally rich in protein and essential micronutrients, including calcium, potassium and vitamin A(3), they are recommended as an integral part of a healthy diet by many countries(4). However, dairy is also a major contributor to saturated fatty acids (SFA) and energy intake(5), thus their role in development of obes- ity has been questioned and explored by several studies(6). We investigated the association between total dairy, milk, cheese, cream and butter consumption and BMI change over a 20-year follow-up using the Caerphilly prospective study (CAPS). The CAPS included 2512 men aged 45–59 years, who were followed up at 5-year intervals for over 20-years. The associations of total dairy, milk, cheese, cream and butter consumption with BMI were examined cross-sectionally at baseline and longitudinally at 5, 10, 15 and 20-years follow-ups. General linear regression and logistic regression were used for data analysis. Men free of cardiovascular disease and diabetes (n = 1704) were included in the current analysis. Higher cheese consumption was associated with lower BMI at the 5-year follow-up (P = 0·008) but not at later follow-ups. There was no evidence that higher consumption of dairy products was associated with increased BMI during the over 20-years follow-up, although total dairy (P = 0·002) and milk consumption (P < 0·001) were inversely associated with BMI at baseline. For the future studies, the association between cheese consumption and BMI requires further investigation

Sampling with poling-based flux balance analysis: optimal versus sub-optimal flux space analysis of Actinobacillus succinogenes

Flux balance analysis is traditionally implemented to identify the maximum theoretical flux for some specified reaction and a single distribution of flux values for all the reactions present which achieve this maximum value. However it is well known that the uncertainty in reaction networks due to branches, cycles and experimental errors results in a large number of combinations of internal reaction fluxes which can achieve the same optimal flux value. In this work, we have modified the applied linear objective of flux balance analysis to include a poling penalty function, which pushes each new set of reaction fluxes away from previous solutions generated. Repeated poling-based flux balance analysis generates a sample of different solutions (a characteristic set), which represents all the possible functionality of the reaction network. Compared to existing sampling methods, for the purpose of generating a relatively ¿small¿ characteristic set, our new method is shown to obtain a higher coverage than competing methods under most conditions. The influence of the linear objective function on the sampling (the linear bias) constrains optimisation results to a subspace of optimal solutions all producing the same maximal fluxes. Visualisation of reaction fluxes plotted against each other in 2 dimensions with and without the linear bias indicates the existence of correlations between fluxes. This method of sampling is applied to the organism Actinobacillus succinogenes for the production of succinic acid from glycerol. A new method of sampling for the generation of different flux distributions (sets of individual fluxes satisfying constraints on the steady-state mass balances of intermediates) has been developed using a relatively simple modification of flux balance analysis to include a poling penalty function inside the resulting optimisation objective function. This new methodology can achieve a high coverage of the possible flux space and can be used with and without linear bias to show optimal versus sub-optimal solution spaces. Basic analysis of the Actinobacillus succinogenes system using sampling shows that in order to achieve the maximal succinic acid production CO2 must be taken into the system. Solutions involving release of CO2 all give sub-optimal succinic acid production

Retinoic Acid Accelerates the Specification of Enteric Neural Progenitors from In-Vitro-Derived Neural Crest

The enteric nervous system (ENS) is derived primarily from the vagal neural crest, a migratory multipotent cell population emerging from the dorsal neural tube between somites 1 and 7. Defects in the development and function of the ENS cause a range of enteric neuropathies, including Hirschsprung disease. Little is known about the signals that specify early ENS progenitors, limiting progress in the generation of enteric neurons from human pluripotent stem cells (hPSCs) to provide tools for disease modeling and regenerative medicine for enteric neuropathies. We describe the efficient and accelerated generation of ENS progenitors from hPSCs, revealing that retinoic acid is critical for the acquisition of vagal axial identity and early ENS progenitor specification. These ENS progenitors generate enteric neurons in vitro and, following in vivo transplantation, achieved long-term colonization of the ENS in adult mice. Thus, hPSC-derived ENS progenitors may provide the basis for cell therapy for defects in the ENS. In this article, Frith and colleagues show that retinoic acid (RA) signaling alters the axial identity of hPSC-derived neural crest cells in a time- and dose-dependent manner. They utilized this to derive enteric nervous system (ENS) proge