ObjectivesThe majority of people would prefer to die at home and the stated intentions of both statutory and voluntary healthcare providers aim to support this. This service evaluation compared the preferred and actual place of death of patients known to a specialist community palliative care service.DesignAll deaths of patients (n=2176) known to the specialist palliative care service over a 5-year period were examined through service evaluation to compare the actual place of death with the preferred place of death previously identified by the patient. Triggers for admission were established when the patients did not achieve this preference.ResultsBetween 2009 and 2013, 73% of patients who expressed a choice about their preferred place of death and 69.3% who wanted to die at home were able to achieve their preferences. During the course of their illness, 9.5% of patients changed their preference for place of death. 30% of patients either refused to discuss or no preference was elicited for place of death.ConclusionsDirect enquiry and identification of preferences for end-of-life care is associated with patients achieving their preference for place of death. Patients whose preferred place of death was unknown were more likely to be admitted to hospital for end-of-life care.
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A 75-year-old woman was admitted with sepsis and treated with broad-spectrum antibiotics until examination of her lower limbs noted necrotising wounds. Surgical intervention was advised by the plastic surgeons; however, she was deemed unsuitable for intensive care. She underwent incision and drainage of the necrotic area and biopsies were taken. She deteriorated clinically and the decision was made for best supportive care and was therefore transferred to the inpatient palliative care unit for end-of-life care. However, she stabilised, and based on culture sensitivities, antibiotics were restarted. It was also noted that the patient had a 3-month history of loose stools, which had not been addressed previously. The biopsies were suggestive of pyoderma gangrenosum, prompting a dermatology review, and prednisolone and doxycycline were started. The wounds and her loose stools improved, and with ongoing rehabilitation, she made a full recovery. Referral to gastroenterology was made.
The aim of the study was to determine the effects of immobilization on the gross morphology of rats’ intervertebral disc (IVD) and observe the ameliorating effects of Omega 3 fatty acids and Co-enzyme Q 10 (CoQ10). Forty Sprague Dawley rats weighing 250-300 g were procured from NIH Islamabad. The animals were randomly selected and were divided into four groups of 10 animals in each. Group-A rats served as control group. Each rat of Group B was disc immobilized by using an Illizarov-type apparatus, which was applied for 60 days. Group-C and -D rats after disc immobilization were administrated with Omega 3 fatty acids (260 mg/kg/day) and CoQ10 (150mg/kg/day) through oral gavage respectively. Gross examination of IVD was done using the Thompson grading scale and the disc alterations were scored from grade 1 to 5 in increasing order of IVD alterations. Gross examination of the sections of IVD’s of the control group showed normal healthy morphology, falling in Thompson grade I degeneration. The frequency of disc alteration was statistically significant in disc-immobilized group B when compared to control group A (p-value=0.000), group C (p-value=0.000) and group D (p value=0.002). Group C in which n-3 fatty acid was given along with disc immobilization, showed significant improvement in disc degenerative changes. On comparison with group B, p-value<0.001 was statistically significant. In experimental Group D, where CoQ10 was given along with disc immobilization, the degenerative changes were significantly reduced as compared to Group B (p = 0.002). In this study, gross morphological changes were induced by immobilization in IVDs of the experimental rats and its reversal by omega 3 and CoQ10 was proven. Co-administration of Omega 3 and CoQ10 significantly minimized degenerative changes in IVDs induced by immobilization.
Method Semi-structured interviews were conducted with registered nurses working in hospital (n=6) and hospice (n=29) settings. The roles and experiences of nurses when meeting the psychological needs of patients receiving palliative care were explored. Interviews were audio recorded, transcribed verbatim and analysed thematically. Result Four themes were generated after analysis of the data collected. These are: assessing, observing, intuition and experience; trust and managing uncertainties; little things that have great impacts; maintaining professionalism when grieving. Conclusion Nurses are well placed to detect, assess and manage psychological problems experienced by patients receiving palliative care, with frequent contact being a key factor. Nurses are faced with emotional stress when caring for patients at the end of life and coping mechanisms and strategies are needed to enable them to continue to function well as a compassionate carer.
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