Community nursing quality indicators for end-of-life care in England: Identification, preparation, and coordination

High-quality community nursing is essential to ensure that end-of-life care can be provided in community settings in line with patient preferences. This article examines the quality priorities commissioners sought to incentivise in end-of-life care, by reviewing a survey of Commissioning for Quality and Innovation (CQUIN) indicators for community nursing conducted in England in 2014-2015. Findings from the survey suggest that end-of-life care was not given a high priority with the CQUIN indicators for community nursing. Vigorous quality standards, including training and development, need to be in place to make sure that the potential of community nursing is being used to sensitively engage with people nearing the end of their lives and support them to plan their future care, if they so wish

Medication decision making and patient outcomes in GP, nurse and pharmacist prescriber consultations

UNLABELLED: Aim The aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy.BACKGROUND: There are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups.METHODS: Analysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation. Findings A total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patient's treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patient's preference about their treatment regimen (χ 2=6.6, P=0.036, Cramer's V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit

Live‐cell super‐resolution imaging of actin using LifeAct‐14 with a PAINT‐based approach

We present direct‐LIVE‐PAINT, an easy‐to‐implement approach for the nanoscopic imaging of protein structures in live cells using labeled binding peptides. We demonstrate the feasibility of direct‐LIVE‐PAINT with an actin‐binding peptide fused to EGFP, the location of which can be accurately determined as it transiently binds to actin filaments. We show that direct‐LIVE‐PAINT can be used to image actin structures below the diffraction‐limit of light and have used it to observe the dynamic nature of actin in live cells. We envisage a similar approach could be applied to imaging other proteins within live mammalian cells

Adapted Dynamic Cycling for children and young people with Cerebral Palsy: a pilot study

This is an overview of the three year funded pilot study. 35 children took part, 17 in the cycling group and 18 in the non cycling group. Children kept diaries about their cycling experiences and took part in an interview. Strength changes in quadriceps and hamstrings were demonstrated in the adapted cycling group, the non cycling group got weaker. Changes between the 2 groups were not significant. The children enjoyed the cycling experinces and those who had not tried it explored this and 11 of the 18 children took part in cycling during or after the study was completed. The numbers were small and the cycling took place for a short period. Further study is needed on a larger sample size to measure if this change continues

Children with cerebral palsy’s participation in physical activities, including adapted cycling: Interview and diary data

Children and Young People (C & YP) with Cerebral Palsy (CP) have limited opportunities to participate in physical activities that have health benefits. Cycling is one activity that can be adapted but such trikes are expensive. This three year mixed methods study explored the effect of participation in adapted cycling with C & YP with CP. 35 C & YP (2-18 years) participated: a cycling group (n=17) and a non-cycling control group (n=18). The cycle group participated in 6 outdoor cycling sessions, using hired adapted trikes. Interviews were conducted with families, C & YP, and physical activity diaries were kept. The data were managed by NVivo and analysed for emergent themes. In total 43 interviews and 23 diaries were collected. Data analysis showed that many families, C & YP perceived improvements in pedalling skills, control of cycling speed and steering. Many felt this was good for their muscle strength, balance and endurance. This outdoor participatory opportunity had opened up a new community environment, which enhanced their choice of activities. The cycle hire facility made this an affordable, accessible activity. All the C & YP enjoyed their cycling experiences, expressing this in a variety of communication styles. This was represented by their diverse range of verbal and non verbal means of expression. The C & YP in the non-cycling control group reported different opportunities for participation in physical activities. These included steel drumming, ball and computer games, animal care, swimming, horse riding and trampolining. The majority of these C & YP were considering adapted cycling, two children did not like cycling. The facility to hire an adapted trike was not available in all the regions where these C & YP were recruited from. Therapists, educators and policy makers should consider providing adapted cycle hire facilities for C & YP with disabilities

Cycling participation for children and young people with cerebral palsy

Introduction: Children and Young People (C&YP) with Cerebral Palsy(CP) have limited opportunities for movement. Physiotherapists can adapt cycling and this may reduce the muscle weakness present in C&YP with CP. This mixed methods study explored cycling participation in C&YP with CP. Participants and Methods: Cardiff University School of Healthcare Studies Ethics Committee provided ethical approval. Thirty five C&YP (2–17y) participated: non-cycling control group (n=18) and cycling group (n=17). The cycle group participated in six outdoor cycling sessions, using individually adapted trikes. Families and C&YP were interviewed and cycling diaries kept and thematically analysed with NVivo. Bilateral quadriceps and hamstrings strength measures were taken before and after the intervention period for both groups using the Hand-Held Dynamometer. Results were analysed using analysis of covariance. Results: Thematic analysis revealed perceived improvements in participation, pedalling skills, cycling speed and steering. Strength analysis revealed no statistically significant difference between groups, although increased strength trends were observed for the cycling group: (Quadriceps increased by: Right: 12.14 Newton(N)± 6.5; Left:15.56_ 13.87N; Hamstrings by: Right:5.19_3.5N; Left:4.23_5.94N). Trends of decreased strength were observed in the control group. Conclusion: Adapted cycling has potential social and physical health benefits. Observed improvements in cycling skills and strength trends deserve further investigation with larger sample sizes over longer terms. C&YP without freedom to move lack access to outdoor activities. Physiotherapists can advocate cycling transition, as it reduces dependency on physiotherapy provision and is perceived to improve quality of life

‘Every picture tells a story’: Interviews with children with cerebral palsy about adapted cycling

Children with Cerebral Palsy have a variety of communication styles, verbal and non verbal, augmented by aids, signs, symbols and gestures. Twenty five children with Cerebral Palsy (2-17 years) were interviewed about their experiences of adapted cycling. The objective was to analyse their response to their experiences of adapted cycling by including the use of pictures and photographs. This method was developed from an understanding of Mosaic methods. Pictures of cycling in different environments were displayed for the child to see. The interview questions were phrased in a closed way to enable a simple yes/ no response. These could be indicated by eye pointing or hand gesture as well as their usual form of communication. Pictures of happy and sad faces were also used to ask the child to describe how cycling made them feel. Some children had photographs of themselves cycling in the diary they were keeping, which were also used. The two researchers carrying out the interviews were confident to deal with alternate forms of communication, but reflected that it was hard not to lead the interview. The interview data was transcribed then sent back to the participants and their parents for verification. The interviews were analysed using a template approach by highlighting pertinent quotes. The emerging themes related to the benefits to the children in terms of learning new skills, social participation and the impact on their wider family and friends. Adapted cycling has given them an opportunity to enjoy a physical activity that has health benefits