The impact of covid-19 on out-of-hours adult hospice care: an online survey

BACKGROUND: Globally COVID-19 has had a profound impact on the provision of healthcare, including palliative care. However, there is little evidence about the impact of COVID-19 on delivery of out-of-hours specialist palliative care services in the United Kingdom. The aim of the study is to investigate the impact of the COVID-19 pandemic on the delivery of out-of-hours community-based palliative care services. METHODS: A national online census survey of managers of adult hospices in the United Kingdom was undertaken. Survey were emailed to managers of adult hospices (n = 150) who provided out-of-hours community palliative care services. Fifteen questions related specifically to the impact of COVID-19. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using descriptive content analysis. RESULTS: Eighty-one responses to the survey were returned (54% response rate); 59 were complete of which 47 contained COVID-19 data. Findings indicated that COVID-19 impacted on out-of-hours community-based palliative care. To meet increased patient need, hospices reconfigured services; redeployed staff; and introduced new policies and procedures to minimize virus transmission. Lack of integration between charitably and state funded palliative care providers was reported. The interconnected issues of the use and availability of Personal Protective Equipment (n = 21) and infection control screening (n = 12) resulted in changes in nursing practices due to fear of contagion for patients, carers and staff. CONCLUSIONS: Survey findings suggest that due to increased demand for community palliative care services, hospices had to rapidly adapt and reconfigure services. Even though this response to the pandemic led to some service improvements, in the main, out-of-hours service reconfiguration resulted in challenges for hospices, including workforce issues, and availability of resources such as Personal Protective Equipment. These challenges were exacerbated by lack of integration with wider healthcare services. More research is required to fully understand the implications of such changes on the quality of care provided. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12904-022-00985-6

Novel Approaches to Monitor and Manipulate Single Neurons In Vivo

The complexity of the vertebrate brain poses an enormous challenge to experimental neuroscience. One way of dealing with this complexity has been to investigate different aspects of brain function in widely different preparations, each best suited to address a particular question. Accordingly, cellular questions are typically addressed with intracellular recordings in in vitro preparations such as brain slices or neuronal cultures, whereas network behavior and sensory or motor response properties are analyzed in vivo, often with extracellular recordings. This division of labor has proved to be an experimentally effective strategy. However, although there seems to be no limit to the wealth of data that can be generated in this way, integrating results derived in different preparations comes with its own set of challenges. The enormous difficulties encountered when one attempts to link cellular phenomena such as synaptic plasticity to systems properties such as spatial memory (Martin et al., 2000) have shown us that close collaboration between molecular−cellular and systems neuroscience is required (Tonegawa et al., 2003) and that we need more convergence of experimental techniques to analyze the cellular basis of neural function under more natural conditions. Studying neurons under naturalistic conditions is, however, easier said than done. A return to in vivo preparations will only be successful if we are able to solve the technical problems that led previous researchers to abandon the study of intact brains in the first place. Thus, studying neurons at the cellular level in vertebrate brains is today first and foremost a technological challenge. Here we highlight recent efforts to improve our ability to analyze functions of single neurons in vivo. Given th

Development of a root caries prediction model in a population of dental attenders

Acknowledgement This study was conducted as part of the doctoral thesis of P.A.F. We would like to thank the participating dental practice teams and patients without whose valuable contribution this study could not have taken place. We would like to thank our colleagues in the INTERVAL Trial team Funding INTERVAL was funded by the NIHR HTA programme [project numbers 06/35/05 (Phase I) and 06/35/99 (Phase II)]. No additional funding was obtained to conduct the prediction study presented in this paper. The views expressed are those of the author(s) and not necessarily those of NIHR, the NHS or the Department of Health and Social Care.Peer reviewedPublisher PD

The Effects of Cognitive Behavioral Therapy for Insomnia on Multidimensional Perfectionism

Perfectionism is related to insomnia and objective markers of disturbed sleep. This study examined whether multidimensional perfectionism is related to dysfunctional beliefs about sleep, sleep-effort, pre-sleep arousal, and polysomnography-determined markers of sleep amongst individuals with insomnia. The effects of cognitive behavioral therapy for insomnia (CBT-I) on perfectionism was also examined. This was a secondary analysis of a randomized controlled trial on CBT-I. Forty-three insomnia patients were randomized to treatment (receiving CBT-I) or waitlist control groups. Sleep was recorded using polysomnography at baseline. Participants completed measures of perfectionism, dysfunctional beliefs about sleep, sleep-effort and pre-sleep arousal at baseline and post-treatment. Total perfectionism scores and doubts about action, concern over mistakes and personal standards were each significantly related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep at baseline. Patients receiving treatment displayed increased total perfectionism scores post-treatment d=.49. In those receiving treatment, levels of organization d=.49 and parental expectations d=.47 were significantly increased post-treatment, relative to baseline. In line with the literature, our results confirm that perfectionism is related to insomnia. Here, insomnia was related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep. The propensity to maintain a high standard of order and organization may be elevated following CBT-I, considering the treatment protocol expects patients to strictly adhere to a set of clearly defined rules. Levels of parental expectations may be increased following CBT-I since the patient-therapist-relationship may trigger implicitly expectations in the patients which are reminiscent of their relationship to their parents

A constraint on antigravity of antimatter from precision spectroscopy of simple atoms

Consideration of antigravity for antiparticles is an attractive target for various experimental projects. There are a number of theoretical arguments against it but it is not quite clear what kind of experimental data and theoretical suggestions are involved. In this paper we present straightforward arguments against a possibility of antigravity based on a few simple theoretical suggestions and some experimental data. The data are: astrophysical data on rotation of the Solar System in respect to the center of our galaxy and precision spectroscopy data on hydrogen and positronium. The theoretical suggestions for the case of absence of the gravitational field are: equality of electron and positron mass and equality of proton and positron charge. We also assume that QED is correct at the level of accuracy where it is clearly confirmed experimentally