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

Art therapy for PTSD and TBI: A senior active duty military service member’s therapeutic journey

AbstractArt therapy is increasingly being accepted as a form of complementary and integrative care for military veterans affected by trauma and injuries in the line of duty. Less is known, however, about the applications of art therapy for co-morbid traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). In addition, most studies to date have focused on art therapy with veterans (former military service members) rather than with active duty service members; furthermore, there are no studies that have examined the unique context of PTSD in senior military personnel. This case study presents the therapeutic process through art therapy in the case of a senior active duty military service member (with chronic PTSD and TBI), in the context of an integrated model of care that included medical and complementary therapies

Dependence of Ice-Core Relative Trace-Element Concentration on Acidification

To assess the role of methodological differences on measured trace-element concentrations in ice cores, we developed an experiment to test the effects of acidification strength and time on dust dissolution using snow samples collected in West Antarctica and Alaska. We leached Antarctic samples for 3 months at room temperature using nitric acid at concentrations of 0.1, 1.0 and 10.0% (v/v). At selected intervals (20 min, 24 hours, 5 days, 14 days, 28 days, 56 days, 91 days) we analyzed 23 trace elements using inductively coupled plasma mass spectrometry. Concentrations of lithogenic elements scaled with acid strength and increased by 100–1380% in 3 months. Incongruent elemental dissolution caused significant variability in calculated crustal enrichment factors through time (factor of 1.3 (Pb) to 8.0 (Cs)). Using snow samples collected in Alaska and acidified at 1% (v/v) for 383 days, we found that the increase in lithogenic element concentration with time depends strongly on initial concentration, and varies by element (e.g. Fe linear regression slope =1.66; r = 0.98). Our results demonstrate that relative trace-element concentrations measured in ice cores depend on the acidification method used

Accuracy of clinical predictions of prognosis at the end-of-life: evidence from routinely collected data in urgent care records

BACKGROUND: The accuracy of prognostication has important implications for patients, families, and health services since it may be linked to clinical decision-making, patient experience and outcomes and resource allocation. Study aim is to evaluate the accuracy of temporal predictions of survival in patients with cancer, dementia, heart, or respiratory disease. METHODS: Accuracy of clinical prediction was evaluated using retrospective, observational cohort study of 98,187 individuals with a Coordinate My Care record, the Electronic Palliative Care Coordination System serving London, 2010-2020. The survival times of patients were summarised using median and interquartile ranges. Kaplan Meier survival curves were created to describe and compare survival across prognostic categories and disease trajectories. The extent of agreement between estimated and actual prognosis was quantified using linear weighted Kappa statistic. RESULTS: Overall, 3% were predicted to live "days"; 13% "weeks"; 28% "months"; and 56% "year/years". The agreement between estimated and actual prognosis using linear weighted Kappa statistic was highest for patients with dementia/frailty (0.75) and cancer (0.73). Clinicians' estimates were able to discriminate (log-rank p < 0.001) between groups of patients with differing survival prospects. Across all disease groups, the accuracy of survival estimates was high for patients who were likely to live for fewer than 14 days (74% accuracy) or for more than one year (83% accuracy), but less accurate at predicting survival of "weeks" or "months" (32% accuracy). CONCLUSION: Clinicians are good at identifying individuals who will die imminently and those who will live for much longer. The accuracy of prognostication for these time frames differs across major disease categories, but remains acceptable even in non-cancer patients, including patients with dementia. Advance Care Planning and timely access to palliative care based on individual patient needs may be beneficial for those where there is significant prognostic uncertainty; those who are neither imminently dying nor expected to live for "years"

Appraisal of literature reviews on end-of-life care for minority ethnic groups in the UK and a critical comparison with policy recommendations from the UK end-of-life care strategy

<p>Abstract</p> <p>Background</p> <p>Evidence of low end-of-life (EoL) care service use by minority ethnic groups in the UK has given rise to a body of research and a number of reviews of the literature. This article aims to review and evaluate literature reviews on minority ethnic groups and EoL care in the UK and assess their suitability as an evidence base for policy.</p> <p>Methods</p> <p>Systematic review. Searches were carried out in thirteen electronic databases, eight journals, reference lists, and grey literature. Reviews were included if they concerned minority ethnic groups and EoL care in the UK. Reviews were graded for quality and key themes identified.</p> <p>Results</p> <p>Thirteen reviews (2001-2009) met inclusion criteria. Seven took a systematic approach, of which four scored highly for methodological quality (a mean score of six, median seven). The majority of systematic reviews were therefore of a reasonable methodological quality. Most reviews were restricted by ethnic group, aspect of EoL care, or were broader reviews which reported relevant findings. Six key themes were identified.</p> <p>Conclusions</p> <p>A number of reviews were systematic and scored highly for methodological quality. These reviews provide a good reflection of the primary evidence and could be used to inform policy. The complexity and inter-relatedness of factors leading to low service use was recognised and reflected in reviews' recommendations for service improvement. Recommendations made in the UK End-of-Life Care Strategy were limited in comparison, and the Strategy's evidence base concerning minority ethnic groups was found to be narrow. Future policy should be embedded strongly in the evidence base to reflect the current literature and minimise bias.</p

The conceptual models and mechanisms of action that underpin advance care planning for cancer patients: A systematic review of randomised controlled trials

Background: No systematic review has focused on conceptual models underpinning advance care planning for patients with advancedcancer, and the mechanisms of action in relation to the intended outcomes.Aim: To appraise conceptual models and develop a logic model of advance care planning for advanced cancer patients, examining thecomponents, processes, theoretical underpinning, mechanisms of action and linkage with intended outcomes.Design: A systematic review of randomised controlled trials was conducted, and was prospectively registered on PROSPERO. Narrativesynthesis was used for data analysis.Data sources: The data sources were MEDLINE, CINAHL, PsycINFO, EMBASE, CENTRAL, PROSPERO, CareSearch, and OpenGreywith reference chaining and hand-searching from inception to 31 March 2017, including all randomised controlled trials withadvance care planning for cancer patients in the last 12 months of life. Cochrane quality assessment tool was used for qualityappraisal.Results: Nine randomised controlled trials were included, with only four articulated conceptual models. Mechanisms through whichadvance care planning improved outcomes comprised (1) increasing patients’ knowledge of end-of-life care, (2) strengtheningpatients’ autonomous motivation, (3) building patients’ competence to undertake end-of-life discussions and (4) enhancing shareddecision-making in a trustful relationship. Samples were largely highly educated Caucasian.Conclusion: The use of conceptual models underpinning the development of advance care planning is uncommon. When used, theyidentify the individual behavioural change. Strengthening patients’ motivation and competence in participating advance care planningdiscussions are key mechanisms of change. Understanding cultural feasibility of the logic model for different educational levels andethnicities in non-Western countries should be a research priority

Centennial-scale variability of the Southern Hemisphere westerly wind belt in the eastern Pacific over the past two millennia

We present the first high-resolution (sub-annual) dust particle data set from West Antarctica, developed from the West Antarctic Ice Sheet (WAIS) Divide deep ice core (79.468° S, 112.086° W), and use it to reconstruct changes in atmospheric circulation over the past 2400 years. We find a background dust flux of ~4 mg m−2 year−1 and a mode particle size of 5–8 μm diameter. Through comparing the WAIS Divide record with other Antarctic ice core particle records, we observe that coastal and lower-elevation sites have higher dust fluxes and coarser particle size distributions (PSDs) than sites on the East Antarctic plateau, suggesting input from local dust sources at these lower-elevation sites. In order to explore the use of the WAIS Divide dust PSD as a proxy for past atmospheric circulation, we make quantitative comparisons between both mid-latitude zonal wind speed and West Antarctic meridional wind speed and the dust size record, finding significant positive interannual relationships. We find that the dust PSD is related to mid-latitude zonal wind speed via cyclonic activity in the Amundsen Sea region. Using our PSD record, and through comparison with spatially distributed climate reconstructions from the Southern Hemisphere (SH) middle and high latitudes, we infer that the SH westerlies occupied a more southerly position from circa 1050 to 1400 CE (Common Era), coinciding with the Medieval Climate Anomaly (MCA). Subsequently, at ca. 1430 CE, the wind belt shifted equatorward, where it remained until the mid-to-late twentieth century. We find covariability between reconstructions of El Niño–Southern Oscillation (ENSO) and the mid-latitude westerly winds in the eastern Pacific, suggesting that centennial-scale circulation changes in this region are strongly influenced by the tropical Pacific. Further, we observe increased coarse particle deposition over the past 50 years, consistent with observations that the SH westerlies have been shifting southward and intensifying in recent decades

Policy and Environmental Indicators for Heart Disease and Stroke Prevention: Data Sources in Two States

INTRODUCTION: Investigators in South Carolina and Alabama assessed the availability of data for measuring 31 policy and environmental indicators for heart disease and stroke prevention. The indicators were intended to determine policy and environmental support for adopting heart disease and stroke prevention guidelines and selected risk factors in 4 settings: community, school, work site, and health care. METHODS: Research teams used literature searches and key informant interviews to explore the availability of data sources for each indicator. Investigators documented the following 5 qualities for each data source identified: 1) the degree to which the data fit the indicator; 2) the frequency and regularity with which data were collected; 3) the consistency of data collected across time; 4) the costs (time, money, personnel) associated with data collection or access; and 5) the accessibility of data. RESULTS: Among the 31 indicators, 11 (35%) have readily available data sources and 4 (13%) have sources that could provide partial measurement. Data sources are available for most indicators in the school setting and for tobacco control policies in all settings. CONCLUSION: Data sources for measuring policy and environmental indicators for heart disease and stroke prevention are limited in availability. Effort and resources are required to develop and implement mechanisms for collecting state and local data on policy and environmental indicators in different settings. The level of work needed to expand data sources is comparable to the extensive work already completed in the school setting and for tobacco control

Ohne Titel

Kartoffelausgabe im Hof des städtischen Ernährungamte