A qualitative study of the use of a supportive care pathway for end of life care in an intensive care unit

Background: Providing palliative care support in intensive care settings is beneficial, however, barriers to delivering high-quality end-of-life care remain. To address this, pathways have been used to improve the quality of palliative care in generalist settings. This study describes the views of health professionals using a supportive care pathway in intensive care. Design: Qualitative semi-structured interviews were conducted with ten health professionals working in a surgical intensive care unit. The data were analysed thematically. Results: Participants were positive about the effect of the supportive care pathway on patient care, particularly in enabling consensus in care planning. Some expressed concerns including the difficulty of identifying the ‘correct patients’ for the pathway, the risk of it becoming a ‘self-fulfilling prophecy’, and a euphemism for dying. Conclusion: Pathways are one potential mechanism for guiding care planning and communicating the goals of care to colleagues, patients and families, thus contributing to improvements in palliative care. </jats:sec

Proposing a plausible molecular structure for Ice XI: A coupled study using Rietveld refinement and Density Functional Theory

A plausible molecular structure for fully ordered Ice XI is proposed. A range of structures were generated by varying the lattice parameters along the trajectory of the observed Ice Ih/Ice XI phase transition and recording the energy-minimised Density Functional Theory structure (using the Perdew–Wang 1991 functional) for each set of lattice parameters. These proposed structures were then fitted to the neutron data using GSAS-II to extract the goodness-of-fit. It is shown that the Rietveld refinement was insensitive to the OH bond length and the HOH bond angle. The refinement with the lowest value of Rw=6.038% gave OH bond lengths of 0.997(7)Å, 0.999(2)Å, 0.997(5)Å, HOH bond angles of 107.5 and 106.0, and OH...O hydrogen bond lengths of 1.77(4),1.75(2) and 1.75(1)Å. It is therefore apparent that the two crystallographically distinct water molecules have very similar molecular hydrogen bond parameters, which are close to that predicted by previous CASTEP PW91 DFT modelling