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

An Exploratory Study of Suboxone (Buprenorphine/ Naloxone) Film Splitting: Cutting Methods, Content Uniformity, and Stability

Suboxone films are U.S. Food and Drug Administration approved to treat opioid dependence. While the package insert states that films should not be cut, physicians often prescribe film fractions for treatment and tapering. There is no data to support this practice, and this study was initiated to evaluate cutting methods, content uniformity, and stability of split films. Suboxone 8-mg buprenorphine/2-mg naloxone films were split using four methods: 1) ruler/razor cut, 2) scissor cut, 3) fold/rip, and 4) fold/scissor cut. United States Pharmacopeia Chapter \u3c905\u3e was used to evaluate the weight variation and content uniformity of split films. The stability of split films stored in polybags was evaluated over 7 days. A stability-indicating high-performance liquid chromatography method was used for content uniformity and stability evaluation. The weight variation results were acceptable for the half films from all four cutting methods, but this was not true for the quarter films. The method of ruler/razor cut was determined most favorable and used for the content uniformity test. Based on the high-performance liquid chromatography results, the half films from the ruler/razor cut method met the passing criteria of United States Pharmacopeia Chapter \u3c905\u3e with acceptance values of 9.8 to 10.4 for buprenorphine and 8.4 to 11.5 for naloxone (≤15 is considered passing). The stability results indicated that both actives retained \u3e97.7% of initial strength. Four cutting methods were found to be acceptable for splitting Suboxone films into half but not quarter fractions. The half films from the ruler/razor cut method also passed United States Pharmacopeia Chapter \u3c905\u3e content uniformity test. Both actives remained stable for 7 days when the half films were stored in polybags at room temperature

Hormonal contraceptive methods and risk of HIV acquisition in women : a systematic review of epidemiological evidence

Peer reviewedPublisher PD

Being Motivated to Protect : The Influence of Sexual Communal Motivations on Sexual Risk Taking

College-aged students are a high-risk population for unplanned pregnancy with 40% of women between the ages of 18-20 experiencing an unplanned pregnancy. This can cause physical, mental, and emotional stress resulting in withdrawal from college for the student. Communal motivation (being oriented towards other’s needs) positively predicts condom use. WISE interventions, a simple yet impactful type of interventions targeted towards addressing a problem, have been shown to be successful. Participants completed a sexual risk behavior measure, sexual risk-taking measure and communal motivations (CM) measure following a sexual health video, and reflection activity were participants either applied the sexual health information to their relationship (experimental) or reflected on the sexual health material presented (control). CM was positively correlated with number of sexual partners in the past 3 months, r(262) = .162,

Learning about the complexity of humanised care: findings from a longitudinal study of nurse students’ perceptions

Background, including underpinning literature and, wherever possible, the international relevance of the research The rise in elderly populations with complex long-term conditions is a global phenomenon (World Health Organisation, 2011). However evidence has emerged internationally around concerns about quality of care, particularly for older people (Katz 2011; Organisation for Economic Cooperation and Development, 2013). It has been argued that in target-driven care environments, there is the potential for care professionals to lose sight of the person receiving the care and focuses on task-completion, resulting in dehumanising care cultures (Galvin and Todres 2013). Educating nurse students to effectively as well as compassionately deliver complex care to vulnerable people represents considerable challenges. Following a number of high profile examples of poor quality care in the United Kingdom (UK) (Francis 2013), health profession education providers now follow professional body guidelines that mandate that values for compassionate practice clearly underpin curricula. Limited evidence exists however, concerning the impact of this initiative over time. This paper reports on a study that evidences the impact on students of an education programme based on a humanising care philosophy in shaping the students’ value base as they progress through their education programmes. Aim(s) and/or research question(s)/research hypothesis(es) . This paper reports on a five-phase longitudinal study exploring the impact of an undergraduate-nursing curriculum based on a humanising care philosophy on the values of individual students. Research methodology/research design, any ethical issues, and methods of data collection and analysis The study uses a qualitative longitudinal approach to understanding the beliefs and values of student nurses from the day of entry, through their education programme to completion. Focusing on two cohorts of students one year apart, data were collected by individual interview at commencement and completion and by focus groups at the end of their first placement and at the end of their first and second years. This presentation reports up to the end of the programme for the first cohort and end of second year for the second cohort. Ethics approval was gained for the entire project. At each stage of the process, students were formally invited to participate and on-going individual consent was gained. The audio-recordings were transcribed verbatim and analysed thematically. Key findings and recommendations By the end of their first placement, both groups were very similar in the expression of their values and to some extent presented a rather negative view of their experiences. However students from both groups became more articulate in expressing their values particularly in relation to their placement experience, as they moved through their programme. Four on-going and developing themes emerged from the data: personal journey, impact of the curriculum, impact of practice and values development. Overall, although each cohort followed two distinct curricula, there were few differences between the groups at each stage. Reasons for this will be discussed. Both groups felt they had become less judgmental, that the curriculum had empowered them to challenge practice and enhanced their confidence. Students also reported that their mentors (placement supervisors) role modelled authentic compassionate care in practice. Over time students’ insight into the complexity of caring developed and their understanding of the importance of practice that respected patient individuality deepened. This study has evidenced the strong link between curriculum and its impact on the evolving values of nursing students. Whilst this paper reports on a local study from one university in the UK, transferability of findings to other settings can be judged; it is argued that the insights will have resonance for nurse educators more widely as well as other health professional disciplines. References Commissioning Board Chief Nursing Officer and Department of Health Chief Nurse Advisor (2012). Compassion in Practice: Nursing, Midwifery and Care Staff. Our vision and strategy. Retrieved 22nd January 2016 from: http://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf Francis Inquiry, (2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive summary. Crown Copyright: London. Galvin, K., Todres, L. (2013). Caring and Well-Being: A Lifeworld Approach. Routledge: Abingdon, Oxon. Katz, P.R. (2011). An International Perspective on Long Term Care: Focus on Nursing Homes. Journal of American Medical Directors Association. 12 (7): 487-492 OECD (2013) OECD Reviews of Health Care Quality: Denmark. Retrieved 7th Retrieved 22nd January 2016 from: http://www.oecd.org/els/health-systems/ReviewofHealthCareQualityDENMARK_ExecutiveSummary.pdf WHO (2011) Global Health and Ageing. Retrieved 22nd January 2016 from: http://www.who.int/ageing/publications/global_health.pdf Key words: (5) • Nurse education • Professional values • Humanising care • Curriculum • Longitudinal qualitative research 3 key points to indicate how your work contributes to knowledge development within the selected theme • Nursing students were able to clearly articulate values that underpin humanised care • This study provides evidence for the strong link between curriculum and its impact on the evolving values of nursing students • The curriculum is one factor in embedding humanised values in nursing students; further research is required

Cumulative mutagenesis of the basic residues in the 201-218 region of insulin-like growth factor (IGF)-binding protein-5 results in progressive loss of both IGF-I binding and inhibition of IGF-I biological action

We have reported previously that mutation of two conserved nonbasic amino acids (G203 and Q209) within the highly basic 201–218 region in the C-terminal domain of IGF-binding protein-5 (IGFBP-5) decreases binding to IGFs. This study reveals that cumulative mutagenesis of the 10 basic residues in this region, to create the C-Term series of mutants, ultimately results in a 15-fold decrease in the affinity for IGF-I and a major loss in heparin binding. We examined the ability of mutants to inhibit IGF-mediated survival of MCF-7 cells and were able to demonstrate that this depended not only upon the affinity for IGF-I, but also the kinetics of this interaction, because IGFBP-5 mutants with similar affinity constants (KD) values, but with different association (Ka) and dissociation (Kd) rate values, had markedly different inhibitory properties. In contrast, the affinity for IGF-I provided no predictive value in terms of the ability of these mutants to enhance IGF action when bound to the substratum. Instead, these C-Term mutants appeared to enhance the actions of IGF-I by a combination of increased dissociation of IGF-IGFBP complexes from the substratum, together with dissociation of IGF-I from IGFBP-5 bound to the substratum. These effects of the IGFBPs were dependent upon binding to IGF-I, because a non-IGF binding mutant (N-Term) was unable to inhibit or enhance the actions of IGF-I. These results emphasize the importance of the kinetics of association/dissociation in determining the enhancing or inhibiting effects of IGFBP-5 and demonstrate the ability to generate an IGFBP-5 mutant with exclusively IGF-enhancing activity

The effect of self-selected complementary therapies on cancer patients\u27 quality of life and symptom distress: A prospective cohort study in an integrative oncology setting

Objective: To examine the effectiveness of a multifaceted complementary therapies intervention, delivered in a systematic manner within an Australian public hospital setting, on quality of life and symptom distress outcomes for cancer patients. Methods: Adults receiving treatment for any form of cancer were eligible to participate in this study. Self-referred participants were offered a course of six complementary therapy sessions. Measures were administered at baseline, and at the third and sixth visit. The primary outcomes were quality of life and symptom distress. Linear mixed models were used to assess change in the primary outcomes. Results: In total, 1376 cancer patients participated in this study. The linear mixed models demonstrated that there were significant improvements in quality of life and significant reductions in symptom distress over six sessions. Body-based therapies demonstrated significantly superior improvement in quality of life over counselling, but no other differences between therapies were identified. Reduced symptom distress was not significantly associated with any particular type of therapy. Conclusion: A self-selected complementary therapies intervention, provided in an Australian public hospital by accredited therapists, for cancer patients significantly mproved quality of life and reduced symptom distress. The effect of this intervention on quality of life has particular salience, since cancer impacts on many areas of people’s lives and impairs quality of life

Age-related variation in non-breeding foraging behaviour and carry-over effects on fitness in an extremely long-lived bird

Senescence has been widely documented in wild vertebrate populations, yet the proximate drivers of age‐related declines in breeding success, including allocation trade‐offs and links with foraging performance, are poorly understood. For long‐lived, migratory species, the non‐breeding period represents a critical time for investment in self‐maintenance and restoration of body condition, which in many species is linked to fitness. However, the relationships between age, non‐breeding foraging behaviour and fitness remain largely unexplored. We performed a cross‐sectional study, investigating age‐related variation in the foraging activity, distribution and diet of an extremely long‐lived seabird, the wandering albatross Diomedea exulans, during the non‐breeding period. Eighty‐two adults aged 8–33 years were tracked with geolocator‐immersion loggers, and body feathers were sampled for stable isotope analysis. We tested for variation in metrics of foraging behaviour and linked age‐related trends to subsequent reproductive performance. There was an age‐related decline in the number of landings (a proxy of foraging effort) during daylight hours, and a decrease in body feather δ¹³C values in older males but not females, yet this did not accompany an age‐related shift in distributions. Males conducted fewer landings than females, and the sexes showed some spatial segregation, with males foraging further south, likely due to their differential utilization of winds. Although younger (<20 years) birds had higher foraging effort, they all went on to breed successfully the following season. In contrast, among older (20+ years) birds, individuals that landed more often were more likely to defer breeding or fail during incubation, suggesting they have lower foraging success. As far as we are aware, this is the first demonstration of an age‐specific carry‐over effect of foraging behaviour in the non‐breeding period on subsequent reproductive performance. This link between foraging behaviour and fitness in late but not early adulthood indicates that the ability of individuals to forage efficiently outside the breeding period may be an important driver of fitness differences in old age. A plain language summary is available for this article