Background: Most people would prefer to die at home. Engaging citizens in end-of-life care may contribute to making home death possible for more people. Aims: To test the feasibility and acceptability of Last Aid Courses in different countries and to explore the views and experiences of participants with the course. Methods: International multi-centre study with a questionnaire based mixed methods design. 408 Last Aid Courses were held in three different countries. Of 6014 course participants, 5469 participated in the study accounting for a response rate of 91%. Results: The median age of participants was 56 years. 88% were female. 76% of participants rated the course "very good". 99% would recommend it to others.. Findings from the qualitative data revealed that participants found the atmosphere comfortable; instructors competent; appreciated the course format, duration, topics and discussions about life and death. Conclusions: Last Aid Courses are both feasible and accepted by citizens from different countries. They have a huge potential to inform citizens and to encourage them to engage in care at home. Future research should investigate the long-term effects of the course on the ability and willingness of participants to provide end-of-life care and the impact on the number of home-deaths.

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Identifying acute myocardial infarction in patients with renal disease is notoriously difficult, due to atypical presentation and chronically elevated troponin. The aim of this study was to identify a specific troponin T/troponin I cut-off value for diagnosis of acute myocardial infarction in patients with renal impairment via meta-analysis. Two investigators screened 2590 publications from MEDLINE, Embase, PubMed, Web of Science, and the Cochrane library. Only studies that investigated alternative cut-offs according to renal impairment were included. Fifteen articles fulfilled the inclusion criteria. Six studies were combined for meta-analysis. The manufacturer’s upper reference level for troponin T is 14 ng/L. Based on the meta-analyses, cut-off values for troponin in patients with renal impairment with myocardial infarction was 42 ng/L for troponin I and 48 ng/L for troponin T. For patients on dialysis the troponin T cut-off is even higher at 239 ng/L. A troponin I cut-off value for dialysis patients could not be established due to lack of data. The 15 studies analyzed showed considerable diversity in study design, study population, and the definition of myocardial infarction. Further studies are needed to define a reliable troponin cut-off value for patients with kidney disease, especially in dialysis patients, and to allow necessary subanalysis.

Background Data on the referral rate of chronic kidney disease (CKD) patients to specialists are sparse. Investigating referral rates and characterising patients with kidney disease not followed by a nephrologist is relevant for future measures in order to optimize public health and guideline implementation. Methods Data were extracted from the Kidney Disease Cohort of Southern Denmark (KidDiCo). Referral rates for all incident CKD patients below 60ml/min/1.73m² and referral rates according to the KDIGO guidelines based glomerular filtration rates below 30 ml/min/1.73m² were calculated. Information on contact with one of the nephrologist outpatient clinics in the Region of Southern Denmark was collected from the Danish National Patient Registry. The individual follow up time for nephrology contact was 12 months. Additional data was accessed via the respective national databases. CKD patients on dialysis and kidney transplanted patients were excluded. Result Three % of patients with an eGFR < 60 ml/min/1.73m² sixteen % of patients with an eGFR < 30 ml/min/1.73m² and thirty-five % of patients with an eGFR < 15 ml/min/1.73m² were in contact with a nephrologist in the outpatient settings. Younger age, male sex, diabetes, hypertension, higher education and proximity to a nephrology outpatient clinic increased the chance of nephrology follow up. Conclusion Only a small fraction of CKD patients are followed by a nephrologist. More studies should be performed in order to find out which patients will profit the most from renal referral and how to optimize the collaboration between nephrologists and general practitioners.