The VOICE Study: Valuing Opinions, Individual Communication and Experience: Building the evidence base for undertaking patient-centred family meetings in palliative care - a mixed methods study

Background: Despite family meetings being widely used to facilitate discussion among patients, families, and clinicians in palliative care, there is limited evidence to support their use. This study aims to assess the acceptability and feasibility of Patient-Centred Family Meetings in specialist inpatient palliative care units for patients, families, and clinicians and determine the suitability and feasibility of validated outcome measures from the patient and family perspectives. Methods: The study is a mixed-methods quasi-experimental design with pre-planned Patient-Centred Family Meetings at the intervention site. The patient will set the meeting agenda a priori allowing an opportunity for their issues to be prioritised and addressed. At the control site, usual care will be maintained which may include a family meeting. Each site will recruit 20 dyads comprising a terminally ill inpatient and their nominated family member. Pre- and post-test administration of the Distress Thermometer, QUAL-EC, QUAL-E, and Patient Health Questionnaire-4 will assess patient and family distress and satisfaction with quality of life. Patient, family, and clinician interviews post-meeting will provide insights into the meeting feasibility and outcome measures. Recruitment percentages and outcome measure completion will also inform feasibility. Descriptive statistics will summarise pre- and post-meeting data generated by the outcome measures. SPSS will analyse the quantitative data. Grounded theory will guide the qualitative data analysis. Discussion: This study will determine whether planned Patient-Centred Family Meetings are feasible and acceptable and assess the suitability and feasibility of the outcome measures. It will inform a future phase III randomised controlled trial. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12616001083482 on 11 August 201

Michelson-Morley experiments revisited and the cosmic background radiation preferred frame

Canad

The Human Right to Water and Its Application in the Occupied Palestinian Territories.

A human right to water has been determined at the international level. However, the legal status of this right and its normative content are unclear. This thesis discusses the development of the concept of a legal human right to water and examines its present codification under international human rights law, in particular under the UN Committee on Economic, Social and Cultural Rights General Comment 15. Subsequently the scope and core content of the right are analysed, highlighting the limitations in provision and identifying other problematic elements. Furthermore, the correlative obligations concerning the right to water are discussed within the wider context of legal obligations and economic, social and cultural rights and strengths and weaknesses considered. The second part of the thesis applies the legal basis for a human right to water to a particular context to better understand the implications of the ambiguous legal status of the right. The case study used is the Palestinians' right to water in the Occupied Palestinian Territories. Therefore, due to the ongoing occupation, in addition to investigation of applicable human rights law, the relevant international humanitarian law providing for a right to water is also examined. In addition, provisions for a right to water in applicable domestic and bilateral law are evaluated. Subsequently, the enjoyment of the right to water 'on the ground' is investigated through a small-scale qualitative research project based in the southern West Bank. Using a violations approach and focusing on core obligations, interview material was gathered. The findings illustrate that there are violations of the right to water under both human rights law and humanitarian law. Finally in conclusion the thesis addresses what can be done to improve the enjoyment of the right both specifically in relation to the case study and more broadly. There are several mechanisms by which the right to water could be strengthened in terms of implementation through improving existing codification and through more effective remedies at both international and domestic levels

Reclaiming the peacebuilding agenda:economic and social rights as a legal framework for building positive peace : a human security plus approach to peace-building

This article examines the exclusion of economic and social rights from peacebuilding. The peacebuilding process has become dominated by a liberal agenda resulting in a ‘one size fits all’ model of peacebuilding. As a consequence, the inclusion of human rights within the mandate of peacebuilding has also been limited to a liberal conception of human rights constituting only civil and political rights. It is argued that an alternative approach is required which refocuses the peacebuilding agenda on human security: a hybrid ‘human security plus’ approach to peacebuilding (or a ‘inclusive’ human rights approach) will ensure the protection and promotion of economic, social and cultural rights, while maintaining protection of civil and political rights, throughout the whole peacebuilding process: from peace agreements to post-conflict reconstruction. The result will be a reclaiming of the peacebuilding agenda to improve its effectiveness and provide a legal framework for building positive peace

Warfarin prevalence, indications for use and haemorrhagic events

Warfarin, the standard oral anticoagulant drug used in Ireland, is a widely prescribed medication, particularly in the elderly. A HSE Mid-Western Area wide audit was undertaken over a 12-month period to examine the prevalence and indications for warfarin use and haemorrhagic complications associated with the drug. Every patient receiving warfarin therapy over a 13-week period was included (2564). The age standardised rate varied from 0.09% of 35-39 year olds to 6.1% of 80-84 year olds. Atrial fibrillation was the most common indication (54%) in patients attending the Mid-Western Regional Hospital anticoagulation clinic. The annual cumulative incidence of adverse haemorrhagic events in patients with a recorded INR > or = 5.0 episode was 16.6%. The incidence of major and minor haemorrhagic events per INR > or = 5.0 episode was 1.3% and 15.3% respectively. The most common sites of haemorrhage were genitourinary (39%) and gastrointestinal (27%). No fatal or intracranial haemorrhage relating to episodes of over-anticoagulation were reported during the audit period. The most frequent reason for over-anticoagulation was drug interaction (43%). In 74% of patients, the elevated INR was reversed by omitting or reducing warfarin dose. In 17% of cases, vitamin K was administered. Only 3% of incidents were treated with fresh frozen plasma or prothrombin complex concentrates.Warfarin, the standard oral anticoagulant drug used in Ireland, is a widely prescribed medication, particularly in the elderly. A HSE Mid-Western Area wide audit was undertaken over a 12-month period to examine the prevalence and indications for warfarin use and haemorrhagic complications associated with the drug. Every patient receiving warfarin therapy over a 13-week period was included (2564). The age standardised rate varied from 0.09% of 35-39 year olds to 6.1% of 80-84 year olds. Atrial fibrillation was the most common indication (54%) in patients attending the Mid-Western Regional Hospital anticoagulation clinic. The annual cumulative incidence of adverse haemorrhagic events in patients with a recorded INR > or = 5.0 episode was 16.6%. The incidence of major and minor haemorrhagic events per INR > or = 5.0 episode was 1.3% and 15.3% respectively. The most common sites of haemorrhage were genitourinary (39%) and gastrointestinal (27%). No fatal or intracranial haemorrhage relating to episodes of over-anticoagulation were reported during the audit period. The most frequent reason for over-anticoagulation was drug interaction (43%). In 74% of patients, the elevated INR was reversed by omitting or reducing warfarin dose. In 17% of cases, vitamin K was administered. Only 3% of incidents were treated with fresh frozen plasma or prothrombin complex concentrates

The effectiveness of web-based interventions designed to decrease alcohol consumption – a systematic review

OBJECTIVE To review the published literature on the effectiveness of web-based interventions designed to decrease consumption of alcohol and/or prevent alcohol abuse. METHOD Relevant articles published up to, and including, May 2006 were identified through electronic searches of Medline, PsycInfo, Embase, Cochrane Library, ASSIA, Web of Science and Science Direct. Reference lists of all articles identified for inclusion were checked for articles of relevance. An article was included if its stated or implied purpose was to evaluate a web-based intervention designed to decrease consumption of alcohol and/or to prevent alcohol abuse. Studies were reliably selected and quality-assessed, and data were independently extracted and interpreted by two authors. RESULTS Initial searches identified 191 articles of which 10 were eligible for inclusion. Of these, five provided a process evaluation only, with the remaining five providing some pre-to post-intervention measure of effectiveness. In general the percentage quality criteria met was relatively low and only one of the 10 articles selected was a randomized control trial. CONCLUSION The current review provides inconsistent evidence on the effectiveness of eIectronic screening and brief intervention (eSBI) for alcohol use. Process research suggests that web-based interventions are generally well received. However further controlled trials are needed to fully investigate their efficacy, to determine which elements are keys to outcome and to understand if different elements are required in order to engage low- and high-risk drinkers