No abstract

The human foot provides an ideal environment for the colonization and growth of bacteria and subsequently is a body site associated with the liberation of odour. This study aimed to enumerate and spatially map bacterial populations' resident across the foot to understand any association with odour production. Culture-based analysis confirmed that Staphylococci were present in higher numbers than aerobic corynebacteria and Gram-positive aerobic cocci, with all species being present at much higher levels on the plantar sites compared to dorsal sites. Microbiomic analysis supported these findings demonstrating that Staphylococcus spp. were dominant across different foot sites and comprised almost the entire bacterial population on the plantar surface. The levels of volatile fatty acids, including the key foot odour compound isovaleric acid, that contribute to foot odour were significantly increased at the plantar skin site compared to the dorsal surface. The fact that isovaleric acid was not detected on the dorsal surface but was present on the plantar surface is probably attributable to the high numbers of Staphylococcus spp. residing at this site. Variations in the spatial distribution of these microbes appear to be responsible for the localized production of odour across the foot.

Carers perceived external tunnelled intrathecal drug delivery as most valuable when it improved quality of life towards the end of life, by reducing pain and side effects of conventional systemic analgesia to enable individuals 'to be themselves'. Under these circumstances, the carers judged significant side effects to be acceptable.

No abstract

Deborah Stevens talks to Lucy Jolin about why it is never to late to move forward in your career

BackgroundEarly Specialist Palliative Care (SPC) introduced to patients with advanced lung cancer has recently been proven to enhance quality-of-life and improve survival. Combined Oncology and Palliative Care Clinics (COPCC) have been carried at Royal Cornwall Hospital Trust for over two decades, to enable patients to be reviewed by palliative care consultants (PCC) whilst attending the Oncology Centre; enabling the two specialities to run in parallel to improve patient care. The aims of this project were to explore the types of patients seen and content of consultations.MethodsA retrospective review of the current PCC consultation letter of 150 consecutive patients reviewed between 01/2016–06/2016. Data collected by three medical students.ResultsOf the 150 patients, 49% had on-going/planned palliative oncological options (POO), 20% optimal supportive/symptom control (SSC), 18% radical treatment and 13% treated with curative intent. 75% had stable disease, 23% deteriorating and 2% in their last month of life. The main focus of the consultation was symptom control (95%), followed by discussions around aims of palliative/oncological treatment (71%). For patients who were considered POO or SSC (n=104), 66% were referred/known to the community SPC nursing team. The median number of consultations per patient was 2.9, and patients were known to the service for up to five years and two months.ConclusionCOPCCs appears to facilitate collaborative working between disciplines to enable optimal symptom control, information sharing and forward planning to patients attending oncology clinics. Unsurprisingly, PCC focus on symptom control and early referral to SPC services in the community. Many patients are seen when they are ‘stable’ suggesting the service is proactive in approach. COPCCs remove the need for a ‘referral’ to SPC, and allows patients to be seen who perhaps wouldn’t otherwise be referred to SPC.

BackgroundNationally, there is awareness of the need to improve symptom control for patients at end of life (National VOICES survey).AimDissemination of unified Anticipatory Prescribing Guidance (APG) (incorporating opioid conversion chart, and Hospice 24 hour/7-days-a-week-advice-line-number) to all healthcare settings across Cornwall, backed by a programme of education.MethodsAPG developed and rolled out with teaching by specialist palliative care (SPC) teams throughout the county and incorporating attendees’ experience to inform the evolution of the project, using Quality Improvement (QI) methodology. Participants were asked to complete a paper questionnaire at the time of teaching to assess changes in knowledge, and an electronic questionnaire 12 weeks after the teaching to capture the impact of such teaching on care of the dying. Quantitative data was analysed using the non-parametric-Wilcoxon-Matched-Pairs. Qualitative data was analysed using thematic analysis until saturation was achieved.SettingsAll healthcare sectors; acute and community hospitals, hospices, nursing homes, GPs, district nursing services, secure dementia units and ambulance service.Results990 healthcare professionals (HCPs) were taught. There was a statistically significant shift in median knowledge scores (p value<0.001). HCP perceived there was an improvement of symptom control for the dying in clinical practice. Five main themes emerged from the qualitative data; common guidance, improved knowledge and assessment of symptom-control and opioid conversions, advice 24/7-feeling safe, recognising dying and considering what is important to patients, and confidence building.ConclusionIt has been possible to roll out unified APG to a wide range of HCPs to improve their knowledge and confidence. In clinical practice, HCPs perceive it enables improved care to patients in the dying phase by improving symptom control. HCPs described their practice as safer and more efficient. Healthcare professionals formally and informally described the positive impact of having specialist palliative care/hospice-advice-24/7 to back up the guidance on the ground.

used to identify the number of non-elective hospital admissions, reason and length of admission. Results In JOPCC there were 45 non-elective hospital admissions compared to 70 admissions in SOC. The main reason for admission in both groups was for new complications of diagnosis: JOPCC 84.4%; SOC 85.5%. Complications of treatment were more common in the SOC patients; JOPCC 10.5%; SOC 26.7%. The average length of admission was significantly shorter (p=0.0015) in the JOPCC (4.8 days). Conclusions JOPCC appear to reduce both the number and length of non-elective admissions. This may be partly attributed to fewer patients actually receiving treatment or having previous access to palliative care teams; resulting in fewer admissions. Further research comparing non-elective admissions within 12 months from first consultation with a larger sample size, confining data to a single site-specific cancer diagnosis will allow further conclusions to be made.