Components of palliative care interventions addressing the needs of people with dementia living in long term care: a systematic review

© The Author(s) 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).Background: People with dementia requiring palliative care havemultiple needs that require complex, multicomponent interventions. Thisneed is amplified in the long term care setting. The European Associationfor Palliative Care (EAPC) White Paper offers recommendations forpalliative care in dementia and highlights domains of care integral forthis population, thus providing useful guidance to developing suchinterventions. This review maps components of palliative careinterventions for people with dementia in LTCFs, with a particular focuson shared decision-making.Peer reviewe

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

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The provision of nutritional advice and care for cancer patients: a UK national survey of healthcare professionals.

PURPOSE: People living with and beyond cancer often experience nutrition-related issues and should receive appropriate advice on nutrition that is consistent and evidence based. The aim of this study was to investigate current practice for the provision of nutritional care by healthcare professionals (HCPs) from a UK national survey produced by the National Institute for Health Research (NIHR) Cancer and Nutrition Collaboration. METHODS: An online survey sent to professional groups and networks included questions on discussing nutrition, providing information, awareness of guidelines, confidence in providing nutritional advice, training and strategies for improving nutritional management. RESULTS: There were 610 HCPs who responded including nurses (31%), dietitians (25%), doctors (31%) and speech and language therapists (9%). The majority of HCPs discusses nutrition (94%) and provides information on nutrition (77%). However, only 39% of HCPs reported being aware of nutritional guidelines, and just 20% were completely confident in providing nutritional advice. Awareness of guidelines varied between the different professional groups with most but not all dietitians reporting the greatest awareness of guidelines and GPs the least (p = 0.001). Those HCPs with a greater awareness of guidelines had received training (p = 0.001) and were more likely to report complete confidence in providing nutritional advice (p = 0.001). CONCLUSION: Whilst HCPs discuss nutrition with cancer patients and may provide information, many lack an awareness of guidelines and confidence in providing nutritional advice. To ensure consistency of practice and improvements in patient care, there is scope for enhancing the provision of appropriate nutrition education and training

Impact of ‘DEALTS2’ education intervention on trainer dementia knowledge and confidence to utilise innovative training approaches: A national pre-test – post-test survey

Background Gaps in acute care staff knowledge, skills, and attitudes towards dementia exist. Innovative training approaches that improve the delivery of care for people with dementia are needed. We were commissioned by Health Education England to develop and evaluate a new dementia education intervention ‘Dementia Education And Learning Through Simulation 2’ (DEALTS2), a simulation toolkit to enhance delivery of dementia training nationally across England. Objectives Evaluate differences in trainer dementia knowledge scores pre and post training, satisfaction with DEALTS2 Train-The-Trainer (TTT) workshops and simulation toolkit, confidence to use training approaches, and spread of implementation. Design A questionnaire survey using a pre-test – post-test design with measures completed: before (pre-test); after (T1); and 12 months post training (T2). Setting Twelve one-day DEALTS2 TTT workshops delivered across England in 2017. Participants National Health Service Trust staff employed in dementia training roles (n=199 trainers). Methods Trainers attended DEALTS2 TTT workshops and received the simulation toolkit. Data were collected between 2017 and 2018 using a questionnaire capturing differences in dementia knowledge scores, Likert scales and closed-ended questions measured satisfaction, confidence and implementation. Data were analysed using quantitative methods. Results Response rate was 92% (n=183) at pre-test/T1 and 26% (n=51) at T2. Trainer dementia knowledge scores increased from pre-test to T1 (p < 0.001) and were retained after 12 months in 5 of the 6 areas measured (pre-test to T2, p < 0.002); largest gains in ‘humanised approaches to dementia care’. 96% (n=176/183) were satisfied with DEALTS2 TTT workshops and simulation toolkit; 66.7% (n=34/51) felt confident to deliver dementia training informed by DEALTS2. Adherence rates were good with 45% (n=23/51) using the innovative training approaches within twelve months. Conclusions The results show DEALTS2 effectively increased trainer dementia knowledge and confidence to utilise innovative dementia training approaches. Implementation of DEALTS2 varied across organisations, therefore further research should explore factors determining successful implementation

Long‐Chain Polyunsaturated Fatty Acids and Lipid Peroxidation Products in Donor Human Milk in the United Kingdom: Results From the LIMIT 2‐Centre Cross‐Sectional Study

Background: Donor human milk is increasingly used as alternative to mother’s own milk to feed preterm infants, however, it may provide less long-chain polyunsaturated fatty acid (LCPUFA), and more oxidised lipids, which may be detrimental for preterm infant health and development. Levels have not been reported for donor human milk in the U.K. Methods: Donor human milk (n=19) from two neonatal units, milk from preterm mothers from a neonatal unit (n=10), and term mothers from the community (n=11) were analysed for fatty acid, malondialdehyde, 4-hydroxy-2-nonenal, and hexanal content. Study registration: NCT03573531 Results: Donor human milk had significantly lower absolute LCPUFA content compared to term milk (P<0.001) and significantly lower omega-3 PUFAs than preterm milk (P<0.05), although relative LCPUFA composition did not differ. Exclusive donor human milk feeding leads to significantly lower fat (3.7 vs. 6.7 g/d) and LCPUFA (DHA: 10.6 vs. 16.8 mg/d; ARA: 17.4 vs. 25.2 mg/d) intake than recommended by ESPGHAN, and provides only 17.3% and 43.1% of the in utero accreted ARA and DHA. Donor human milk also had the highest proportion of lipid peroxidation. Conclusions: This study confirms that donor human milk in the U.K. has insufficient levels of LCPUFAs for preterm infants. It demonstrates for the first time that donor human milk has the highest level of lipid peroxidation, compared to preterm or term milk. This has important implications for preterm infant nutrition, as exclusive donor human milk feeding might not be suitable long-term, and may contribute to the development of major preterm neonatal morbidities

Systematic realist synthesis of health-related and lifestyle interventions designed to decrease overweight, obesity and unemployment in adults.

BACKGROUND: Obesity and unemployment are complex social and health issues with underlying causes that are interconnected. While a clear link has been established, there is lack of evidence on the underlying causal pathways and how health-related interventions could reduce obesity and unemployment using a holistic approach. OBJECTIVES: The aim of this realist synthesis was to identify the common strategies used by health-related interventions to reduce obesity, overweight and unemployment and to determine for whom and under what circumstances these interventions were successful or unsuccessful and why. METHODS: A realist synthesis approach was used. Systematic literature searches were conducted in Cochrane library, Medline, SocIndex, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and PsychInfo. The evidence from included studies were synthesised into Context-Mechanism-Outcome configurations (CMOcs) to better understand when and how programmes work, for which participants and to refine the final programme theory. RESULTS: A total of 83 articles met the inclusion criteria. 8 CMOcs elucidating the contexts of the health-related interventions, underlying mechanisms and outcomes were identified. Interventions that were tailored to the target population using multiple strategies, addressing different aspects of individual and external environments led to positive outcomes for reemployment and reduction of obesity. CONCLUSION: This realist synthesis presents a broad array of contexts, mechanisms underlying the success of health-related interventions to reduce obesity and unemployment. It provides novel insights and key factors that influence the success of such interventions and highlights a need for participatory and holistic approaches to maximise the effectiveness of programmes designed to reduce obesity and unemployment. TRIAL REGISTRATION: PROSPERO 2020 CRD42020219897

Towards an improved dementia care experience in clinical radiography practice: A state-of-the-art review.

INTRODUCTION: The increasing global incidence rate of dementia and associated co/multimorbidity has consequently led to a rise in the number of people with dementia (PwD) requiring clinical radiography care services. This review aims to explore and integrate findings from diverse settings with a focus on the experiences of PwD and stakeholders, towards the development of a holistic approach for dementia care and management within the context of radiography services. METHOD: An electronic search was performed across the following databases: PUBMED, CINAHL, Medline, SCOPUS, and ScienceDirect for articles published from January 2009 and June 2023. Articles were included if they fulfilled a predefined criteria mainly focused on experiences of PwD and/or other stakeholders when using the radiography services. Data obtained from the included studies were analysed using a result-based convergent synthesis. RESULT: Eleven studies from diverse settings met the inclusion criteria. A mix of both positive and negative experiences of PwD and stakeholders were reported following visits to radiology and radiotherapy departments were highlighted across settings. The findings were themed around the need for: person-centred care, effective communication, attitudinal changes of staff, specialised and improved clinical environment and inclusion of caregivers for the care of PwD. DISCUSSION: This study emphasise the critical importance of adopting holistic approaches to caring for PwD. This involves adopting a person-centred approach, actively involving caregivers, effective communication, and adequate training for radiographers to provide quality services, all in dementia-friendly environments. CONCLUSION: The experiences of various stakeholders highlight the need for a more holistic approach and strategy for the care and management of PwD within the context of the radiography services. This calls for an urgent need for a comprehensive strategy that includes awareness creation of staff to enhance the quality of care and the overall experience for PwD using the radiography services