Informal caregivers are important in enabling palliative care patients to die at home, including their role in managing medications. Often these patients are taking multiple medications, imposing an unnecessary burden on those who are already struggling with oral intake. A literature review revealed that, while there are a number of qualitative studies published examining the experience of caregivers looking after patients at the end of life, there is a dearth of published studies specifically examining the impact of managing medications on caregivers. This study explores the experience of caregivers managing medications for patients dying at home, focusing on the impact of polypharmacy, the use of syringe drivers and the use of "as needed" medications for symptom control. Three focus groups were performed, involving bereaved caregivers of patients that had died at home, and were analysed using content thematic analysis. Themes that emerged include: the significant burden of polypharmacy; the positive impact of subcutaneous infusions; the value of being able to give medications as needed for symptom control; the importance of clear guidance to assist with medication management. Strategies are suggested that might ease the burden of medications at the end of life.

Total medication burden increases as time to death shortens, due to continuation of medications for CMCs, and addition of medications for symptom control. There is a need for research to demonstrate the impact of polypharmacy at the end of life, in order to formulate a framework to guide practice.

Evidence identified was mainly from uncontrolled observational studies, making causality difficult to establish. Studies were heterogeneous in methodology and outcome measures. There was a trend toward excess AEs using the RC method, in comparison to the AL and 3DS methods. The methodological quality of the AL studies was low. A direct comparison of AL and 3DS methods would be informative.

Escherichia coli can contaminate raw milk during the milking process or via environmental contamination in milk-processing facilities. Three bacteriophages, designated EC6, EC9, and EC11, were investigated for their ability to inhibit the growth of three strains of E. coli in ultrahigh-temperature (UHT) treated and raw bovine milk. A cocktail of the three phages completely inhibited E. coli ATCC 25922 and E. coli O127:H6 in UHT milk at 25 °C and under refrigeration temperatures (5-9 °C). The phage cocktail produced similar results in raw milk; however, E. coli ATCC 25922 and O127:H6 in raw milk controls also declined to below the level of detection at both temperatures. This observation indicated that competition by the raw milk microbiota might have contributed to the decline in viable E. coli cells. A cocktail containing EC6 and EC9 completely inhibited E. coli O5:H-, an enterohemorrhagic strain, in UHT milk at both temperatures. In raw milk, the phage cocktail initially inhibited growth of E. coli O5:H- but regrowth occurred following incubation for 9 h at 25 °C and 144 h at 5-9 °C. In contrast to the other E. coli strains, O5:H- was not inhibited in the raw milk controls. This study demonstrates that bacteriophages are effective biocontrol agents against E. coli host strains in UHT and raw bovine milk at various storage temperatures.

Although internet search query surveillance is a novel methodology, it is freely accessible and has significant potential to monitor health-seeking behaviour among the public. PC is rapidly growing in the USA, and the rapidly increasing public awareness of PC as demonstrated in this study, in comparison with the UK, where PC is relatively well established is encouraging in increasingly ensuring appropriate PC access for all.

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Consumption of raw cow’s milk (RCM) is increasing in popularity in developed countries despite the associated foodborne disease risks. While previous research has focused on consumer motivations for drinking RCM, there is limited research on how consumer handling practices may impact the microbiological safety of RCM. In this study, consumer handling practices associated with transport, storage, and freezing and thawing were simulated to investigate the impact of time and temperature variables on the concentrations of either Escherichia coli O157:H7 or Listeria monocytogenes in RCM. We found that the type of storage during simulated transport had a large (η2 = 0.70) and significant (p < 0.001) effect on both pathogens. The refrigeration temperature also had a large (η2 = 0.43) and significant (p < 0.001) effect on both pathogens during refrigerated storage. The interaction between pathogen species and initial pathogen inoculum level had a large (η2 = 0.20) and significant (p = 0.012) effect on the concentration of the pathogens during ambient temperature storage. We found that freezing and thawing practices did not have a significant effect on the pathogens (p > 0.05). However, we were able to recover L. monocytogenes, but not E. coli O157:H7, from RCM after freezing for 365 days. The results from this study highlight that consumer transport and storage practices can have significant effects on the growth of E. coli O157:H7 and L. monocytogenes in RCM. Consumer food handling practices should be considered when developing public health strategies aimed at reducing the risks of RCM consumption.

The study provides baseline data on the level of competence of PC of doctors working in Ireland. The study also offers a novel assessment tool that has the potential to be used for future research.