The VOICE Study: Valuing Opinions, Individual Communication and Experience: Building the evidence base for undertaking patient-centred family meetings in palliative care - a mixed methods study

Background: Despite family meetings being widely used to facilitate discussion among patients, families, and clinicians in palliative care, there is limited evidence to support their use. This study aims to assess the acceptability and feasibility of Patient-Centred Family Meetings in specialist inpatient palliative care units for patients, families, and clinicians and determine the suitability and feasibility of validated outcome measures from the patient and family perspectives. Methods: The study is a mixed-methods quasi-experimental design with pre-planned Patient-Centred Family Meetings at the intervention site. The patient will set the meeting agenda a priori allowing an opportunity for their issues to be prioritised and addressed. At the control site, usual care will be maintained which may include a family meeting. Each site will recruit 20 dyads comprising a terminally ill inpatient and their nominated family member. Pre- and post-test administration of the Distress Thermometer, QUAL-EC, QUAL-E, and Patient Health Questionnaire-4 will assess patient and family distress and satisfaction with quality of life. Patient, family, and clinician interviews post-meeting will provide insights into the meeting feasibility and outcome measures. Recruitment percentages and outcome measure completion will also inform feasibility. Descriptive statistics will summarise pre- and post-meeting data generated by the outcome measures. SPSS will analyse the quantitative data. Grounded theory will guide the qualitative data analysis. Discussion: This study will determine whether planned Patient-Centred Family Meetings are feasible and acceptable and assess the suitability and feasibility of the outcome measures. It will inform a future phase III randomised controlled trial. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12616001083482 on 11 August 201

Developing targeted health service interventions using the PRECEDE-PROCEED model: two Australian case studies

 This paper provides an overview of the applicability of the PRECEDE-PROCEED Model to the development of targeted nursing led chronic illness interventions. Background. Changing health care practice is a complex and dynamic process that requires consideration of social, political, economic, and organisational factors. An understanding of the characteristics of the target population, health professionals, and organizations plus identification of the determinants for change are also required. Synthesizing this data to guide the development of an effective intervention is a challenging process. The PRECEDE-PROCEED Model has been used in global health care settings to guide the identification, planning, implementation, and evaluation of various health improvement initiatives. Design. Using a reflective case study approach, this paper examines the applicability of the PRECEDE-PROCEED Model to the development of targeted chronic care improvement interventions for two distinct Australian populations: a rapidly expanding and aging rural population with unmet palliative care needs and a disadvantaged urban community at higher risk of cardiovascular disease. Results. The PRECEDE-PROCEED Model approach demonstrated utility across diverse health settings in a systematic planning process. In environments characterized by increasing health care needs, limited resources, and growing community expectations, adopting planning tools such as PRECEDE-PROCEED Model at a local level can facilitate the development of the most effective interventions. Relevance to Clinical Practice. The PRECEDE-PROCEED Model is a strong theoretical model that guides the development of realistic nursing led interventions with the best chance of being successful in existing health care environments

NASA Kennedy Space Center: Contributions to Sea Turtle Science and Conservation

The National Aeronautics and Space Administration (NASA) is a United States (US) federal agency that oversees US space exploration and aeronautical research. NASA's primary launch site, Kennedy Space Center (KSC) is located along the east coast of Florida, on Cape Canaveral and the western Atlantic Ocean. The natural environment within KSC's large land boundaries, not only functions as an extensive safety buffer-area, it performs simultaneously as a wildlife refuge and a national seashore. In the early 1960s, NASA was developing KSC for rocket launches and the US was establishing an awareness of, and commitment to protecting the environment. The US began creating regulations that required the consideration of the environment when taking action on federal land or with federal funds. The timing of the US Endangered Species Act (1973), the US National Environmental Policy Act (1972), coincided with the planning and implementation of the US Space Shuttle Program. This resulted in the first efforts to evaluate the impacts of space launch operation operations on waterways, air quality, habitats, and wildlife. The first KSC fauna and flora baseline studies were predominantly performed by University of Central Florida (then Florida Technological University). Numerous species of relative importance were observed and sea turtles were receiving regulatory review and protection as surveys by Dr. L Ehrhart (UCF) from 1973-1978 described turtles nesting along the KSC beaches and foraging in the KSC lagoon systems. These data were used in the first NASA Environmental Impact Statement for the Space Transportation System (shuttle program) in 1980. In 1982, NASA began a long term ecological monitoring program with contracted scientists on site. This included efforts to track sea turtle status and trends at KSC and maintain protective measures for these species. Many studies and collaborations have occurred on KSC over these last 45 years with agencies (USFWS, NOAA, NAVY), students, and universities (UCF, University of Toronto, Texas A&M, UF). This presentation will review the various studies and collaborations on sea turtles at KSC that include: nest distributions and success, stranding network development, aerial survey testing for nest counts, predator control assessments, the earliest baseline blood chemistry health determinations on nesting females, stress hormones in nesting females, multi-year study of hatchling sex ratios, genetics, species composition, abundance and distribution of in-water juveniles, turtle cold stun response, exterior lighting impacts and control, and satellite tag tracking of post-nesting turtles in the vicinity of near shore shoals and sand mining sites. Through these studies, monitoring, and recommendations, KSC has provided excellent stewardship and protection of the local environment. While conducting its space program mission, KSC has also made significant contributions of information for agencies charged with the conservation and management of these specie

Integrating genomics into the care of people with palliative needs: A global scoping review of policy recommendations

BACKGROUND: Genomics has growing relevance to palliative care, where testing largely benefits relatives. Integration of genomics into the care of patients with palliative care needs has not received the critical attention it requires, and health professionals report a lack of policy guidance to support them to overcome practice barriers. SUMMARY: To identify policy recommendations related to: (1) integrating genomics into the care of patients with palliative care needs and their families, and (2) care of the family unit, we performed a scoping review of palliative care and genomic policies. Two of 78 policies recommended integrating genomics into palliative care. Six palliative care policies mentioned genomics in background information but were without relevant recommendations. No genomics policies mentioned palliative care in the background information. Across all policies, guidance related to “Delivering Family-Centred Care” was the most frequent recommendation related to care of the family unit, (n=62/78, 79.5%). KEY MESSAGES: We identified a policy gap related to integrating genomics into palliative care. Without policy guidance, health services are less likely to commit funding towards supporting health professionals, reducing the personal and clinical benefits of genomics to patients and relatives. Framing genomic information as family-centred care enables policy makers to communicate the value of genomics to palliative care that will resonate with genomic and palliative care stakeholders. These findings increase awareness among policy makers of the benefits of genomic information to patients with palliative care needs and their families and call for incorporation of appropriate recommendations into palliative care and genomic policy

Design Principles of Length Control of Cytoskeletal Structures

Cells contain elaborate and interconnected networks of protein polymers which make up the cytoskeleton. The cytoskeleton governs the internal positioning and movement of vesicles and organelles, and controls dynamic changes in cell polarity, shape and movement. Many of these processes require tight control of the size and shape of cytoskeletal structures, which is achieved despite rapid turnover of their molecular components. Here we review mechanisms by which cells control the size of filamentous cytoskeletal structures from the point of view of simple quantitative models that take into account stochastic dynamics of their assembly and disassembly. Significantly, these models make experimentally testable predictions that distinguish different mechanisms of length-control. While the primary focus of this review is on cytoskeletal structures, we believe that the broader principles and mechanisms discussed herein will apply to a range of other subcellular structures whose sizes are tightly controlled and are linked to their functions.Comment: 61 pages, 11 figure

\u27Through the eyes of the dying\u27 - Identifying who may benefit from bereavement follow-up: A qualitative study

Introduction: Bereavement support is an integral element of palliative care. Emerging evidence stipulates that bereavement support should be reserved for those most at risk of poor outcomes. While this evidence makes identifying those at risk of experiencing a complex bereavement a necessary first step, it has been difficult to arrive at a consensus as to whom that should be. Aim: To explore whether palliative care in-patients with advanced disease are concerned about the bereavement needs of others and, if so, is it their next-of-kin. Design: A qualitative study using semi-structured interviews, and thematic analysis using a constant comparative method. Setting/participants: Patients identified by their physicians as being aware of their limited prognosis (n = 19) in a specialist palliative care service in Sydney, Australia. Findings: Three key themes emerged: 1) Families considered close and supportive may not require bereavement follow-up; 2) Families with previous significant losses or who have more complex lives are perceived by patients as having greater risk; and 3) Asking palliative care patients about whom they are most concerned in their network after their death is difficult but possible. Conclusions: There are potentially people in the palliative patients’ networks who may be in need of bereavement support, but who are unlikely to be informed about available bereavement services. New strategies are needed to identify people who may benefit from bereavement support

Components of palliative care interventions addressing the needs of people with dementia living in long term care: a systematic review

© The Author(s) 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).Background: People with dementia requiring palliative care havemultiple needs that require complex, multicomponent interventions. Thisneed is amplified in the long term care setting. The European Associationfor Palliative Care (EAPC) White Paper offers recommendations forpalliative care in dementia and highlights domains of care integral forthis population, thus providing useful guidance to developing suchinterventions. This review maps components of palliative careinterventions for people with dementia in LTCFs, with a particular focuson shared decision-making.Peer reviewe

Characterization of wild and captive baboon gut microbiota and their antibiotic resistomes

Antibiotic exposure results in acute and persistent shifts in the composition and function of microbial communities associated with vertebrate hosts. However, little is known about the state of these communities in the era before the widespread introduction of antibiotics into clinical and agricultural practice. We characterized the fecal microbiota and antibiotic resistomes of wild and captive baboon populations to understand the effect of human exposure and to understand how the primate microbiota may have been altered during the antibiotic era. We used culture-independent and bioinformatics methods to identify functional resistance genes in the guts of wild and captive baboons and show that exposure to humans is associated with changes in microbiota composition and resistome expansion compared to wild baboon groups. Our results suggest that captivity and lifestyle changes associated with human contact can lead to marked changes in the ecology of primate gut communities.Environmental microbes have harbored the capacity for antibiotic production for millions of years, spanning the evolution of humans and other vertebrates. However, the industrial-scale use of antibiotics in clinical and agricultural practice over the past century has led to a substantial increase in exposure of these agents to human and environmental microbiota. This perturbation is predicted to alter the ecology of microbial communities and to promote the evolution and transfer of antibiotic resistance (AR) genes. We studied wild and captive baboon populations to understand the effects of exposure to humans and human activities (e.g., antibiotic therapy) on the composition of the primate fecal microbiota and the antibiotic-resistant genes that it collectively harbors (the “resistome”). Using a culture-independent metagenomic approach, we identified functional antibiotic resistance genes in the gut microbiota of wild and captive baboon groups and saw marked variation in microbiota architecture and resistomes across habitats and lifeways. Our results support the view that antibiotic resistance is an ancient feature of gut microbial communities and that sharing habitats with humans may have important effects on the structure and function of the primate microbiota

Integrating the PCC4U Modules into a New Undergraduate Nursing Curriculum: The UNDA –Sydney Experience

Introduction (from Power Point Presentation) Why integrate palliative care concepts into an undergraduate nursing course? - Do generalist nurses need this specialist knowledge? - Why not a single, discreet palliative care unit? - When should these concepts be introduced