Doctors' and nurses' views and experience of transferring patients from critical care home to die: a qualitative exploratory study.

BACKGROUND: Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. AIM: To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. DESIGN: Exploratory two-stage qualitative study SETTING/PARTICIPANTS: Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. FINDINGS: The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. CONCLUSION: There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting

The Impact of Sodium Alginate Hydrogel on Exogenous Glucose Oxidation Rate and Gastrointestinal Comfort in Well-Trained Runners

Purpose: The purpose of this study is to quantify the effect of adding sodium alginate and pectin to a carbohydrate (CHO) beverage on exogenous glucose (ExGluc) oxidation rate compared with an isocaloric CHO beverage. Methods: Following familiarization, eight well-trained endurance athletes performed four bouts of prolonged running (105 min; 71 ± 4% of VO2max) while ingesting 175 mL of one of the experimental beverages every 15 min. In randomized order, participants consumed either 70 g.h−1 of maltodextrin and fructose (10% CHO; NORM), 70 g.h−1 of maltodextrin, fructose, sodium alginate, and pectin (10% CHO; ENCAP), 180 g.h−1 of maltodextrin, fructose, sodium alginate, and pectin (26% CHO; HiENCAP), or water (WAT). All CHO beverages had a maltodextrin:fructose ratio of 1:0.7 and contained 1.5 g.L−1 of sodium chloride. Total substrate oxidation, ExGluc oxidation rate, blood glucose, blood lactate, serum non-esterified fatty acid (NEFA) concentration, and RPE were measured for every 15 min. Every 30 min participants provided information regarding their gastrointestinal discomfort (GID). Results: There was no significant difference in peak ExGluc oxidation between NORM and ENCAP (0.63 ± 0.07 and 0.64 ± 0.11 g.min−1, respectively; p > 0.5), both of which were significantly lower than HiENCAP (1.13 ± 0.13 g.min−1, p < 0.01). Both NORM and HiENCAP demonstrated higher total CHO oxidation than WAT from 60 and 75 min, respectively, until the end of exercise, with no differences between CHO trials. During the first 60 min, blood glucose was significantly lower in WAT compared with NORM and HiENCAP, but no differences were found between CHO beverages. Both ENCAP and HiENCAP demonstrated a higher blood glucose concentration from 60–105 min than WAT, and ENCAP was significantly higher than HiENCAP. There were no significant differences in reported GID symptoms between the trials. Conclusions: At moderate ingestion rates (i.e., 70 g.h−1), the addition of sodium alginate and pectin did not influence the ExGluc oxidation rate compared with an isocaloric CHO beverage. At very high ingestion rates (i.e., 180 g.h−1), high rates of ExGluc oxidation were achieved in line with the literature

Commentaries on viewpoint : physiology and fast marathons

Q2Q1N/

A systematic review evaluating the psychometric properties of measures of social inclusion

Introduction: Improving social inclusion opportunities for population health has been identified as a priority area for international policy. There is a need to comprehensively examine and evaluate the quality of psychometric properties of measures of social inclusion that are used to guide social policy and outcomes. Objective: To conduct a systematic review of the literature on all current measures of social inclusion for any population group, to evaluate the quality of the psychometric properties of identified measures, and to evaluate if they capture the construct of social inclusion. Methods: A systematic search was performed using five electronic databases: CINAHL, PsycINFO, Embase, ERIC and Pubmed and grey literature were sourced to identify measures of social inclusion. The psychometric properties of the social inclusion measures were evaluated against the COSMIN taxonomy of measurement properties using pre-set psychometric criteria. Results: Of the 109 measures identified, twenty-five measures, involving twenty-five studies and one manual met the inclusion criteria. The overall quality of the reviewed measures was variable, with the Social and Community Opportunities Profile-Short, Social Connectedness Scale and the Social Inclusion Scale demonstrating the strongest evidence for sound psychometric quality. The most common domain included in the measures was connectedness (21), followed by participation (19); the domain of citizenship was covered by the least number of measures (10). No single instrument measured all aspects within the three domains of social inclusion. Of the measures with sound psychometric evidence, the Social and Community Opportunities Profile-Short captured the construct of social inclusion best. Conclusions: The overall quality of the psychometric properties demonstrate that the current suite of available instruments for the measurement of social inclusion are promising but need further refinement. There is a need for a universal working definition of social inclusion as an overarching construct for ongoing research in the area of the psychometric properties of social inclusion instruments

Addition of an Alginate Hydrogel to a Carbohydrate Beverage Enhances Gastric Emptying

PURPOSE: To examine the effect of altering osmolality or adding sodium alginate and pectin to a concentrated carbohydrate (CHO) beverage on gastric emptying (GE) rate. METHODS: 500 mL boluses of three drinks were instilled double-blind in eight healthy males while seated and GE measured using the double sampling method for 90 min and blood samples collected regularly. Drinks consisted of glucose and fructose (MON, 1392 mOsmol/kg), maltodextrin and fructose (POLY, 727 mOsmol/kg) and maltodextrin, fructose, sodium alginate and pectin (ENCAP, 732 mOsmol/kg) with each providing 180 g/L CHO (CHO ratio of 1:0.7 maltodextrin/glucose:fructose). RESULTS: Time to empty half of the ingested bolus was faster for ENCAP (21±9 min) than POLY (37±8 min), both were faster than MON (51±15 min). There were main effects for time and drink in addition to an interaction effect for the volume of test drink remaining in the stomach. There were no differences between MON or POLY at any timepoint. ENCAP had a smaller volume of the test drink in the stomach than MON at 30 min (193±62 vs 323±54 mL), which remained less up to 60 min (93±37 vs 210±88 mL). There was a smaller volume of the drink remaining in the stomach in ENCAP compared with POLY 20 min (242±73 vs 318±47 mL) and 30 min (193±62 vs 304±40 mL) after ingestion. Although there was a main effect of time, there was no effect of drink or an interaction effect on serum glucose, insulin or non-esterified fatty acid (NEFA) concentrations. CONCLUSION: The addition of sodium alginate and pectin to a CHO beverage enhances early GE rate but did not affect serum glucose, insulin or NEFA concentration at rest

The validity and reliability of a novel isotope ratio infrared spectrometer to quantify 13C enrichment of expired breath samples in exercise

Rationale: The traditional method to measure 13CO2 enrichment in breath involves isotope ratio mass spectrometry (IRMS) and has several limitations such as cost, extensive training and large space requirements. Here we present the validity and reliability data of an isotope ratio infrared spectrometer (IRIS) based method developed to combat these limitations. Methods: Eight healthy male runners performed 105 min of continuous running on a motorised treadmill while ingesting various carbohydrate beverages enriched with 13C and expired breath samples obtained every 15 min in triplicate. A total of 213 breath samples were analysed using both methods, while 212 samples were repeated using IRIS to determine test-retest reliability. Bland-Altman analysis was performed to determine systematic and proportional bias, and intraclass correlation coefficient (ICC) and coefficient of variation (CV) to assess level of agreement and magnitude of error. Results: The IRIS method demonstrated a small but significant systematic bias to overestimate δ13CO2 (0.18‰; p < 0.05) compared with IRMS, without any proportional bias or heteroscedasticity and a small CV% (0.5%). There was a small systematic bias during the test-retest of the IRIS method (-0.07‰; p < 0.05), no proportional bias, an excellent ICC (1.00) and small CV% (0.4%). Conclusions. The use of the Delta Ray IRIS to determine 13C enrichment in expired breath samples captured during exercise has excellent validity and reliability when compared with the gold standard IRMS