Enhancing Palliative Care for Patients With Advanced Heart Failure Through Simple Prognostication Tools: A Comparison of the Surprise Question, the Number of Previous Heart Failure Hospitalizations, and the Seattle Heart Failure Model for Predicting 1-Year Survival

Background: Score-based survival prediction in patients with advanced heart failure (HF) is complicated. Easy-to-use prognostication tools could inform clinical decision-making and palliative care delivery. Objective: To compare the prognostic utility of the Seattle HF model (SHFM), the surprise question (SQ), and the number of HF hospitalizations (NoH) within the last 12 months for predicting 1-year survival in patients with advanced HF. Methods: We retrospectively analyzed data from a cluster-randomized controlled trial of advanced HF patients, predominantly with reduced ejection fraction. Primary outcome was the prognostic discrimination of SHFM, SQ (“Would you be surprised if this patient were to die within 1 year?”) answered by HF cardiologists, and NoH, assessed by receiver operating characteristic (ROC) curve analysis. Optimal cut-offs were calculated using Youden’s index (SHFM: <86% predicted 1-year survival; NoH ≥ 2). Results: Of 535 subjects, 82 (15.3%) had died after 1-year of follow-up. SHFM, SQ, and NoH yielded a similar area under the ROC curve [SHFM: 0.65 (0.60–0.71 95% CI); SQ: 0.58 (0.54–0.63 95% CI); NoH: 0.56 (0.50–0.62 95% CI)] and similar sensitivity [SHFM: 0.76 (0.65–0.84 95% CI); SQ: 0.84 (0.74–0.91 95% CI); NoH: 0.56 (0.45–0.67 95% CI)]. As compared to SHFM, SQ had lower specificity [SQ: 0.33 (0.28–0.37 95% CI) vs. SHFM: 0.55 (0.50–0.60 95% CI)] while NoH had similar specificity [0.56 (0.51–0.61 95% CI)]. SQ combined with NoH showed significantly higher specificity [0.68 (0.64–0.73 95% CI)]. Conclusion: SQ and NoH yielded comparable utility to SHFM for 1-year survival prediction among advanced HF patients, are easy-to-use and could inform bedside decision-making

2H and 27Al Solid-State NMR Study of the Local Environments in Al-Doped 2-Line Ferrihydrite, Goethite, and Lepidocrocite.

Although substitution of aluminum into iron oxides and oxyhydroxides has been extensively studied, it is difficult to obtain accurate incorporation levels. Assessing the distribution of dopants within these materials has proven especially challenging because bulk analytical techniques cannot typically determine whether dopants are substituted directly into the bulk iron oxide or oxyhydroxide phase or if they form separate, minor phase impurities. These differences have important implications for the chemistry of these iron-containing materials, which are ubiquitous in the environment. In this work, 27Al and 2H NMR experiments are performed on series of Al-substituted goethite, lepidocrocite, and 2-line ferrihydrite in order to develop an NMR method to track Al substitution. The extent of Al substitution into the structural frameworks of each compound is quantified by comparing quantitative 27Al MAS NMR results with those from elemental analysis. Magnetic measurements are performed for the goethite series to compare with NMR measurements. Static 27Al spin-echo mapping experiments are used to probe the local environments around the Al substituents, providing clear evidence that they are incorporated into the bulk iron phases. Predictions of the 2H and 27Al NMR hyperfine contact shifts in Al-doped goethite and lepidocrocite, obtained from a combined first-principles and empirical magnetic scaling approach, give further insight into the distribution of the dopants within these phases.J.K., A.J.I., D.M. and N.P. were supported by an NSF grant collaborative research grant in chemistry CHE0714183. An allocation of time upon the NANO computer cluster at the Center for Functional Nanomaterials, Brookhaven National Laboratory, U.S.A., which is supported by the U.S. Department of Energy (DOE), Office of Basic Energy Sciences, under Contract No. DE-AC02-98CH10886 is also acknowledged. D.S.M. and C.P.G. thank the EPSRC and the EU-ERC for support.This is the final version of the article. It first appeared from the American Chemical Society via http://dx.doi.org/10.1021/acs.chemmater.5b0085

Putting together the data jigsaw: The extent of the linking of administrative datasets on children by local authorities in England. Responses to a Freedom of Information request

Across England, administrative data is routinely collected by the NHS, education and social care services. Multiple national reviews have advocated for better sharing of data by local agencies to improve outcomes for children and their families. The aim of the research was to investigate the extent of data linkage of children and young people’s data in Local Authorities (LAs) across England. The research questions were explored using a Freedom of Information (FOI) request submitted to LAs, including, Metropolitan Districts (36), London boroughs (32), City of London (1), Unitary authorities (55), and County Councils (24). The response rate was 91/148 requests. The results show that there is limited linking of health, educational and social care data on children by LAs in England. This policy briefing presents interim findings, which will be updated when results from a similar request to integrated care systems (ICS) and outstanding responses from LAs are received. Local research is also underway to explore barriers to data linkage and enabling factors. The research team are also exploring policy solutions with local and national officials; initial recommendations, informed by this research, are shown at the end of this briefing

Putting together the data jigsaw: Linking administrative data sets on children with SEND - Learning from local area experience

Across England, administrative data is routinely reported by NHS, education and social care services. Multiple policy reviews have advocated for the sharing of data between local agencies to provide richer information to improve policy, service delivery and outcomes. The aim of this rapid research, carried out between March and July 2023, was to gather evidence from six local areas that link health, education and social care administrative data on children and young people with SEND, or who are working towards this. The research aimed to explore what difference this made, barriers to data linkage and enabling factors. Semi-structured interviews were conducted online, recorded and analysed thematically. The interviews were anonymous and non-attributable, so findings are reported without naming the local areas, except for in the case studies they shared. This policy brief also draws on evidence gathered through a Freedom of Information (FOI) request to local authorities (LAs) and Integrated Care Boards (ICBs) across England, between February and April 2023. This is reported in policy briefs 1* and 2* from this project. The conclusion includes recommendations to policy makers, drawing together suggestions from the local areas involved in this research, solutions discussed at a national policy workshop in May 2023 and recommendations emerging from the FOI analysis

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Putting together the data jigsaw: The extent of the linking of administrative datasets on children by Integrated Care Boards (ICBs) in England. Responses to a Freedom of Information request

The aim of this research was to investigate the extent of data linkage of children and young people’s data in Integrated Care Boards (ICBs) across England. The research questions were explored using a Freedom of Information (FOI) request submitted to all 42 ICBs in England. 31 of 42 ICBs responded to the FOI request (73.8%). The ICBs reported that they were frequently engaging in data linkage between health datasets. Secondary Uses Services (SUS), Accident and Emergency (A&E), Primary care, and Community Services Datasets (CSDS) were the most frequently linked health datasets. However consistent with the authors’ previous publication on local authority (LA) data linkage practices, ICBs were rarely linking their health data with LA datasets (social care and education). Primarily, if ICBs were linking data, they were doing so for all children and young people in their area. However, some suggested they could not specifically undertake data linkage for certain groups of children, such as those with Special Educational Needs and Disabilities (SEND) and Looked after children, because these vulnerabilities were not always flagged in their health datasets. ICBs were most likely to be using linked data to undertake strategic planning and populate data dashboards. This echoes the findings from the publication on LA data linkage practices, however the ICBs were also often using the linked data for population health management. This study suggests that ICBs, similar to LAs, frequently link internal datasets, but face greater challenges with regards to external data linkage. This barrier between healthcare data and LA data on social care and education is a hinderance to multi-agency efforts to meet the needs of disabled children and their families as mandated by the Children and Families Act. Recommendations informed by this research are presented at the end of this briefing

²H and ²⁷Al Solid-State NMR Study of the Local Environments in Al-Doped 2‑Line Ferrihydrite, Goethite, and Lepidocrocite

Although substitution of aluminum into iron oxides and oxyhydroxides has been extensively studied, it is difficult to obtain accurate incorporation levels. Assessing the distribution of dopants within these materials has proven especially challenging because bulk analytical techniques cannot typically determine whether dopants are substituted directly into the bulk iron oxide or oxyhydroxide phase or if they form separate, minor phase impurities. These differences have important implications for the chemistry of these iron-containing materials, which are ubiquitous in the environment. In this work, ²⁷Al and ²H NMR experiments are performed on series of Al-substituted goethite, lepidocrocite, and 2-line ferrihydrite in order to develop an NMR method to track Al substitution. The extent of Al substitution into the structural frameworks of each compound is quantified by comparing quantitative ²⁷Al MAS NMR results with those from elemental analysis. Magnetic measurements are performed for the goethite series to compare with NMR measurements. Static ²⁷Al spin–echo mapping experiments are used to probe the local environments around the Al substituents, providing clear evidence that they are incorporated into the bulk iron phases. Predictions of the ²H and ²⁷Al NMR hyperfine contact shifts in Al-doped goethite and lepidocrocite, obtained from a combined first-principles and empirical magnetic scaling approach, give further insight into the distribution of the dopants within these phases

Prognostic Awareness and Goals of Care Discussions Among Patients With Advanced Heart Failure

BackgroundPrognostic awareness (PA)-the understanding of limited life expectancy-is critical for effective goals of care discussions (GOCD) in which patients discuss their goals and values in the context of their illness. Yet little is known about PA and GOCD in patients with advanced heart failure (HF). This study aims to determine the prevalence of PA among patients with advanced HF and patient characteristics associated with PA and GOCD.MethodsWe assessed the prevalence of self-reported PA and GOCD using data from a multisite communication intervention trial among patients with advanced HF with an implantable cardiac defibrillator at high risk of death.ResultsOf 377 patients (mean age 62 years, 30% female, 42% nonwhite), 78% had PA. Increasing age was a negative predictor of PA (odds ratio, 0.95 [95% CI, 0.92-0.97]; P&lt;0.01). No other patient characteristics were associated with PA. Of those with PA, 26% had a GOCD. Higher comorbidities and prior advance directives were associated with GOCD but were of only borderline statistical significance in a fully adjusted model. Symptom severity (odds ratio, 1.77 [95% CI, 1.19-2.64]; P=0.005) remained a robust and statistically significant positive predictor of having a GOCD in the fully adjusted model.ConclusionsIn a sample of patients with advanced HF, the frequency of PA was high, but fewer patients with PA discussed their end-of-life care preferences with their physician. Improved efforts are needed to ensure all patients with advanced HF have an opportunity to have GOCD with their doctors. Clinicians may need to target older patients with HF and continue to focus on those with signs of worsening illness (higher symptoms). Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01459744