Challenges in the implementation and evaluation of a transmural palliative care pathway for acutely hospitalized older adults; lessons from the PalliSupport program: A qualitative process evaluation study

Objectives: To improve transmural palliative care for acutely admitted older patients, the PalliSupport transmural care pathway was developed. Implementation of this care pathway was challenging. The aim of this study was to improve understanding why the implementation partly failed. Design: A qualitative process evaluation study. Setting/participants:: 17 professionals who were involved in the PalliSupport program were interviewed. Methods: Online semi-structured interviews. Thematic analysis to create themes according to the implementation framework of Grol & Wensing. Results: From this study, themes within four levels of implementation emerged: 1) The innovation: challenges in current palliative care, the setting of the pathway and boost for improvement; 2) Individual professional: feeling (un)involved and motivation; 3) Organizational level: project management; 4) Political and economic level: project plan and evaluation. Conclusion and implications: We learned that the challenges involved in implementing a transmural care pathway in palliative care should not be underestimated. For successful implementation, we emphasize the importance of creating a program that fits the complexity of transmural palliative care. We suggest starting on a small scale and invest in project management. This could help to involve all stakeholders and anticipate current challenges in palliative care. To increase acceptance, create one care pathway that can start and be used in all care settings. Make sure that there is sufficient flexibility in time and room to adjust the project plan, so that a second pilot study can possibly be performed, and choose a scientific evaluation with both rigor and practical usefulness to evaluate effectiveness

Preparation and Solid-State Characterization of Inclusion Complexes Formed Between Miconazole and Methyl-β-Cyclodextrin

The aim of this study is to confirm the formation of inclusion complexes between miconazole (MCZ) and two derivatives of beta-cyclodextrin, methyl-beta-cyclodextrin (MβCD) and 2-hydroxypropyl-beta-cyclodextrin (HPβCD) in aqueous solution by phase solubility studies. Inclusion complexes with MβCD in the solid state were then prepared by different methods, i.e., kneading, coevaporation (COE), spray-drying (SD), and lyophilization (LPh). The physicochemical properties of these complexes were subsequently studied by means of differential scanning calorimetry, Fourier transform infrared spectroscopy, scanning electron microscopy, and X-ray diffraction techniques. Phase solubility diagrams with MβCD and HPβCD were classified as AP type, indicating the formation of 1:1 and 1:2 stoichiometric inclusion complexes. The apparent stability constants (KS) calculated from the phase solubility diagram were 145.69 M−1 (K1:1) and 11.11 M−1 (K1:2) for MβCD and 126.94 M−1 (K1:1) and 2.20 M−1 (K1:2) for HPβCD. The method of preparation of the inclusion complexes in the solid state was shown to greatly affect the properties of the formed complex. Hence, the LPh, SD, and COE methods produce true inclusion complexes between MCZ and MβCD. In contrast, crystalline drug was still clearly detectable in the kneaded (KN) product

Exploring dress, identity and performance in contemporary dance music culture

Electronic dance music and its associated cultures have experienced significant growth and diversification in recent decades, evolving from their origins in the warehouse, acid house and rave ‘scenes’. The myriad of interrelated scenes under the umbrella term ‘dance culture’ provides a range of aesthetic and social event experiences, where participants can experiment with and perform multiple identities. This paper explores the significance of dress and identity within dance culture, drawing on an autoethnographic study which included participant observation, field trips, online research, focus groups and interviews. It investigates performance and presentation of identity within these commodified places, in particular how participants negotiate and traverse various credible roles. It suggests that the performance metaphor is useful in conceptualising event spaces and demonstrates the hugely significant role that dress and identity play in the construction and consumption of these events