Palliative and end-of-life care conversations in COPD: A systematic literature review

Chronic obstructive pulmonary disease (COPD) is a chronic life-limiting disorder characterised by persistent airflow obstruction and progressive breathlessness. Discussions/conversations between patients and clinicians ensure palliative care plans are grounded in patients’ preferences. This systematic review aimed to explore what is known about palliative care conversations between clinicians and COPD patients.  A comprehensive search of all major healthcare-related databases and websites was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were quality assessed, employing widely used quality-assessment tools, with only papers scoring moderate-to-high quality included. All relevant data were extracted. A narrative synthesis was used to analyse, process and present the final data.  The findings indicated that the frequency and quality of palliative care conversations is generally poor. Patients and physicians identified many barriers and important topics were not discussed. Patients and clinicians reported tension between remaining hopeful and the reality of the patients’ condition. When discussions did happen, they often occurred at an advanced stage of illness and in respiratory wards and intensive care units.  In conclusion, current care practices do not facilitate satisfactory conversations about palliative care between COPD patients and clinicians. This impacts upon the fulfilment of patients’ preferences at the end of life

Barlean\u27s Organic Oils: rezone & expansion: environmental impact assessment

In the spring of 2010 Barlean\u27s Organic Oils, LLC. applied to Whatcom County to rezone 35 acres on their 40 acre property from rural-5 (R5A) to Light Impact Industrial (LII). The purpose the rezone is to expand their processing facilities and warehousing storage capacity. Barlean\u27s is a fish oil and flax seed oil processing plant located in Whatcom County, WA. Specifically, Barlean\u27s Organic Oils, LLC. headquarters and processing facilities are located on the southwest 10-acres of their 40-acre square property, northeast of the Slater Road and Lake Terrell Road junction. Barlean\u27s is adjacent to ConocoPhillips\u27 crude oil refinery to the west, privately owned rural county residents on the north and east, and the Lummi Nation Reservation to the south. In February of 2011, Whatcom County approved the rezone of 35 acres of the Barlean\u27s property. Before the rezone, Barleans\u27 processing facilities were operating under conditional use permits (CUP1993-0036, CUP1997-00002 and CUP2000-00024) and were restricted to the southwest 10 acres. The rezone changed 35 acres of Barleans\u27 property from a R5A zone to a LII zoning designation. The zoning has been approved by the county but the buildings that Barlean\u27s intends to construct on the rezoned land have yet to be permitted. There are four 20,000 square foot buildings Barlean\u27s plans to add outside the originally developed 10-acre area as well as two additional pre-approved 20,000 and 5,000 square foot facilities on the existing 10 acres. These buildings will house a protein plant, dry boat storage, seed storage, packing plant, material warehousing and office space. In addition, Barlean\u27s plans to build a 27,000 square foot, four-foot deep drainage pond on the southeast corner of the property to account for impervious surface water runoff. The drainage pond will be located within the new LII zone between a category IV wetland area and the proposed material warehousing building (Figure 4). An employee nature walk and a 25-foot wide quick growing native plant buffer is planned to the north and east sides of the rezone area to mitigate encroaching expansion toward the neighbors (Figure 4) In all, the new operational LII zone will include 35 acres, leaving a five acre triangular plot on the northeast corner of the property that will remain a R5A zone for future residential use (Figure 2)

An exploration of family members’ roles in the context of breast cancer: A narrative study in Malaysia

Introduction: Breast cancer is a significant health problem that affects patients and their family members. Family members are often key to supporting the patient. However, there is an inadequate understanding of the role of female breast cancer patients’ family members in Malaysia. This study aimed to explore the roles of family members of female breast cancer patients from symptom appraisal until the patient treatment commences. Methods: Snowball sampling was applied and 14 participants were recruited through the nomination of the female breast cancer patients. The participants took part in in-depth, face-to-face, and audio-recorded one-time interviews. All of the interviews were subsequently transcribed verbatim and analysed using narrative analysis. Results: Five themes were identified with regard to the roles of family members: 1) confirming breast changes; 2) managing personal emotions; 3) seeking the information; 4) seeking alternative forms of treatment; and 5) advocating for conventional treatment. Conclusion: This study discovered that family members play an important role in the journey of women with breast cancer from the time an abnormality is discovered to the time the patient receives treatment. During this time, many of them suppressed their emotions in order to focus on the women suffering from breast cancer. Healthcare professionals working with breast cancer should recognise and support the key role of family members in supporting women to get treatment. It is important to take a proactive approach in recognising the early signs of stress for family members and, when appropriate, offering them additional sources of support

A narrative study of Malaysian women with breast cancer sharing their experiences

Diagnostic pathway is important period for early detection of breast cancer to improve its prognosis. In developed country such as England had introduced faster diagnosis standard to ensure that patients should receive a definitive diagnosis or ruling out of cancer within 28 days of referral. However, there is lack of evidence regarding the patients with breast cancer’s experiences during the diagnostic interval in Malaysia. This study aims to explore what happened to the women during the diagnostic phase before they were diagnosed with breast cancer. 14 participants were recruited from two government hospitals using purposeful sampling. The participants took part in in-depth, face-to-face, one-time, and audio-recorded interviews. All the interviews were subsequently transcribed verbatim and analysed using narrative analysis. Four themes were identified regarding the diagnostic phase: 1) Women who has suspected having breast cancer; 2) Women who experienced false reassurance; 3) Woman who experienced delayed referral; and 4) Women who experienced unconfirmed investigation results. The findings in this study suggest that alert symptoms may prompt immediate action from doctors. However, unexpected delayed may happened due to healthcare workers and system itself. Therefore, healthcare workers should actively refer patients with alert symptoms and actively follow-up patients with non-alert symptoms in the community. Continuing education for healthcare workers might be necessary to improve diagnostic and referral procedures

The networks of care surrounding cancer palliative care patients

Objectives: This paper explicates the nature and extent of the networks of care surrounding patients with cancer palliative care needs. Method: Twenty-four patients with 15 different types/sites of cancer were recruited in one city in England, UK. During one in-depth interview patients identified who was ‘involved in their care’ and any known pathways of communication between them. One hundred of these people (35 doctors, 32 nurses, 17 professions allied to medicine, 8 family members and 8 others) were also interviewed. Maps of people/teams and the connections between them for each patient were then reconstructed using social networking software (PAJEK). Results: The 24 patients identified a total of 619 people or teams (mean 26, median 22, range 9–45 per patient) contributing to their care. Selected care network maps are displayed, illustrating the extent and nature of the care networks supporting palliative care patients. Common members of care networks for patients with palliative care needs are revealed, but their individual and unique nature is also apparent. Conclusions: The possible clinical utility and challenges of mapping care networks are discussed. Exploring the care networks surrounding individual patients can be useful for illuminating the extent and complexity of individual patient's care networks; clarifying who is involved and who they communicate with; providing opportunities to see interaction routes that may otherwise be hidden, revealing potentially missing or weak connections; and highlighting overlaps or gaps in provision

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Scaling-up Health-Arts Programmes : the largest study in the world bringing arts-based mental health interventions into a national health service

The Scaling-up Health-Arts Programme: Implementation and Effectiveness Research (SHAPER) project is the world's largest hybrid study on the impact of the arts on mental health embedded into a national healthcare system. This programme, funded by the Wellcome Trust, aims to study the impact and the scalability of the arts as an intervention for mental health. The programme will be delivered by a team of clinicians, research scientists, charities, artists, patients and healthcare professionals in the UK's National Health Service (NHS) and the community, spanning academia, the NHS and the charity sector. SHAPER consists of three studies - Melodies for Mums, Dance for Parkinson's, and Stroke Odysseys - which will recruit over 800 participants, deliver the interventions and draw conclusions on their clinical impact, implementation effectiveness and cost-effectiveness. We hope that this work will inspire organisations and commissioners in the NHS and around the world to expand the remit of social prescribing to include evidence-based arts interventions

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity.

Global dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention