Development of an online palliative care medicines training series for health and social care staff

Aim or goal of work: Frontline support staff working in General Practice (GP) (i.e. receptionists), Community Pharmacies (CP) and Care Homes are likely to face issues concerning palliative care medicines amongst their patient group. Previous service evaluations by the authors found a need for sustainable and accessible palliative care training for these staff. A national online training resource on palliative medicines for health and social care staff was subsequently developed and is currently being evaluated. Design, methods & approach taken: Various education and training materials for these staff groups were consolidated and re-developed into one interactive course, comprised of Core sessions for all staff (e.g. Introduction to Palliative Care) and discipline specific sessions i.e. Pharmacy (e.g. Dispensing Opioids) and Care Home (e.g. Palliative Medicines & Risk of Falls) staff. User feedback was obtained via a questionnaire measuring satisfaction, usefulness and impact. Results: All 50 participants (11 staff from GP Practices, Community Pharmacies (n=9) and Care Homes (n=30)) agreed that the training was useful and with the correct degree of difficulty. Participants liked the delivery format and felt the training was “informative” and “easy to access”. Staff also reported that managers were supportive of them undertaking the training. The training provided a good introduction and, for some, a refresher to palliative care. Some participants provided real-life examples of how the training had been beneficial to (and applied by) them in the workplace. Conclusions and lessons learned: This new training resource provides education in an engaging, accessible format to frontline health and social care multi-disciplinary teams. It will be available nationally from November 2016 to support the provision of palliative care by frontline staff at the point of need

Development of the NES online palliative care medicines training series for health and social care support staff

Previous Macmillan Cancer Support and Health Board funded palliative care pharmacy service evaluations in NHS Greater Glasgow & Clyde (urban) and NHS Highland (rural) (1-4) observed a steady integration of the community pharmacy team into local palliative care services. Frontline staff in General Practice, Community Pharmacies and Care Homes in these areas were found to lack knowledge about palliative care medicines amongst their patient group. Both evaluations resulted in the development and testing of training materials in a variety of face-to-face and online formats and for different support staff

National trends and local delivery in old age mental health services: towards an evidence base: a mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Background The rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models. Aims The programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups. Methods The programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award. Results BoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training. Limitations Limitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored. Conclusions BoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental healt

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

A user-centred approach to developing bWell, a mobile app for arm and shoulder exercises after breast cancer treatment

Purpose: The study aim was to develop a mobile application (app) supported by user preferences to optimise self-management of arm and shoulder exercises for upper-limb dysfunction (ULD) after breast cancer treatment. Methods: Focus groups with breast cancer patients were held to identify user needs and requirements. Behaviour change techniques were explored by researchers and discussed during the focus groups. Concepts for content were identified by thematic analysis. A rapid review was conducted to inform the exercise programme. Preliminary testing was carried out to obtain user feedback from breast cancer patients who used the app for 8 weeks post-surgery. Results: Breast cancer patients’ experiences with ULD and exercise advice and routines varied widely. They identified and prioritised several app features: tailored information, video demonstrations of the exercises, push notifications, and tracking and progress features. An evidence-based programme was developed with a physiotherapist with progressive exercises for passive and active mobilisation, stretching and strengthening. The exercise demonstration videos were filmed with a breast cancer patient. Early user testing demonstrated ease of use, and clear and motivating app content. Conclusions: bWell, a novel app for arm and shoulder exercises was developed by breast cancer patients, health care professionals and academics. Further research is warranted to confirm its clinical effectiveness. Implications for Cancer Survivors: Mobile health has great potential to provide patients with information specific to their needs. bWell is a promising way to support breast cancer patients with exercise routines after treatment and may improve future self-management of clinical care

Photochemically produced SO2 in the atmosphere of WASP-39b

S.-M.T. is supported by the European Research Council advanced grant EXOCONDENSE (no. 740963; principal investigator: R. T. Pierrehumbert). E.K.H.L. is supported by the SNSF Ambizione Fellowship grant (no. 193448). X.Z. is supported by NASA Exoplanet Research grant 80NSSC22K0236. O.V. acknowledges funding from the ANR project ‘EXACT’ (ANR-21-CE49-0008-01), from the Centre National d’Études Spatiales (CNES) and from the CNRS/INSU Programme National de Planétologie (PNP). L.D. acknowledges support from the European Union H2020-MSCA-ITN-2109 under grant no. 860470 (CHAMELEON) and the KU Leuven IDN/19/028 grant Escher. This work benefited from the 2022 Exoplanet Summer Program at the Other Worlds Laboratory (OWL) at the University of California, Santa Cruz, a programme financed by the Heising-Simons Foundation. T.D. is an LSSTC Catalyst Fellow. J.K. is an Imperial College Research Fellow. B.V.R. is a 51 Pegasi b Fellow. L.W. is an NHFP Sagan Fellow. A.D.F. is an NSF Graduate Research Fellow.Photochemistry is a fundamental process of planetary atmospheres that regulates the atmospheric composition and stability1. However, no unambiguous photochemical products have been detected in exoplanet atmospheres so far. Recent observations from the JWST Transiting Exoplanet Community Early Release Science Program2,3 found a spectral absorption feature at 4.05 μm arising from sulfur dioxide (SO2) in the atmosphere of WASP-39b. WASP-39b is a 1.27-Jupiter-radii, Saturn-mass (0.28 MJ) gas giant exoplanet orbiting a Sun-like star with an equilibrium temperature of around 1,100 K (ref. 4). The most plausible way of generating SO2 in such an atmosphere is through photochemical processes5,6. Here we show that the SO2 distribution computed by a suite of photochemical models robustly explains the 4.05-μm spectral feature identified by JWST transmission observations7 with NIRSpec PRISM (2.7σ)8 and G395H (4.5σ)9. SO2 is produced by successive oxidation of sulfur radicals freed when hydrogen sulfide (H2S) is destroyed. The sensitivity of the SO2 feature to the enrichment of the atmosphere by heavy elements (metallicity) suggests that it can be used as a tracer of atmospheric properties, with WASP-39b exhibiting an inferred metallicity of about 10× solar. We further point out that SO2 also shows observable features at ultraviolet and thermal infrared wavelengths not available from the existing observations.Publisher PDFPeer reviewe

Identification of carbon dioxide in an exoplanet atmosphere

Carbon dioxide (CO2) is a key chemical species that is found in a wide range of planetary atmospheres. In the context of exoplanets, CO2 is an indicator of the metal enrichment (that is, elements heavier than helium, also called ‘metallicity’)1–3, and thus the formation processes of the primary atmospheres of hot gas giants4–6. It is also one of the most promising species to detect in the secondary atmospheres of terrestrial exoplanets7–9. Previous photometric measurements of transiting planets with the Spitzer Space Telescope have given hints of the presence of CO2, but have not yielded definitive detections owing to the lack of unambiguous spectroscopic identification10–12. Here we present the detection of CO2 in the atmosphere of the gas giant exoplanet WASP-39b from transmission spectroscopy observations obtained with JWST as part of the Early Release Science programme13,14. The data used in this study span 3.0–5.5 micrometres in wavelength and show a prominent CO2 absorption feature at 4.3 micrometres (26-sigma significance). The overall spectrum is well matched by one-dimensional, ten-times solar metallicity models that assume radiative–convective–thermochemical equilibrium and have moderate cloud opacity. These models predict that the atmosphere should have water, carbon monoxide and hydrogen sulfide in addition to CO2, but little methane. Furthermore, we also tentatively detect a small absorption feature near 4.0 micrometres that is not reproduced by these models