BackgroundDysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is associated with diverse adverse health outcomes, making it an important therapeutic target. Measurement of the diurnal rhythm of cortisol secretion provides a window into this system. At present, no guidelines exist for the optimal use of this biomarker within randomised controlled trials (RCTs).PurposeThe aim of this study is to describe the ways in which salivary diurnal cortisol has been measured within RCTs of health or behavioural interventions in adults.MethodsSix electronic databases (up to May 21, 2015) were systematically searched for RCTs which used salivary diurnal cortisol as an outcome measure to evaluate health or behavioural interventions in adults. A narrative synthesis was undertaken of the findings in relation to salivary cortisol methodology and outcomes.ResultsFrom 78 studies that fulfilled the inclusion criteria, 30 included healthy participants (38.5 %), 27 included patients with physical disease (34.6 %) and 21 included patients with psychiatric disease (26.9 %). Psychological therapies were most commonly evaluated (n = 33, 42.3 %). There was substantial heterogeneity across studies in relation to saliva collection protocols and reported cortisol parameters. Only 39 studies (50 %) calculated a rhythm parameter such as the diurnal slope or the cortisol awakening response (CAR). Patterns of change in cortisol parameters were inconsistent both within and across studies and there was low agreement with clinical findings.ConclusionsSalivary diurnal cortisol is measured inconsistently across RCTs, which is limiting the interpretation of findings within and across studies. This indicates a need for more validation work, along with consensus guidelines.Electronic supplementary materialThe online version of this article (doi:10.1007/s12160-015-9753-9) contains supplementary material, which is available to authorized users.
There is a need to identify additional routes of supply for ophthalmic tissue in the UK. This paper reports the findings from a national study exploring the potential for eye donation (ED) from three Hospice Care (HC) and three Hospital Palliative Care Services (HPC) in England. The objectives addressed in this paper are i.) to establish the size and describe the clinical characteristics of the potential eye donor population across six clinical sites; ii.) to identify challenges for clinicians in applying the standard ED criteria for assessing patient eligibility. Retrospective assessment of 1199 deceased patient case notes, 601 Hospice Care and 598 Hospital Palliative Care services, against current eye donation criteria. Clinicians’ assessments were then evaluated against the same criteria. by specialists based at the National Health Service Blood and Transplant Tissue Services division (NHSBT-TS). Results of the assessment and evaluation are reported as descriptive statistics (numerical data). Free-text comment boxes facilitated clarification and/or justification of review and evaluation decisions. 46% (n = 553) of 1199 deceased patients’ notes were agreed as eligible for eye donation (Hospice care settings = 56% (n = 337); Palliative care settings = 36% (n = 216). For all eligible cases (n = 553) the option of ED was recorded as being raised with family members in only 14 cases (3%). Significant potential exists for eye donation from the clinical sites in this study. This potential is not currently being realised.
Findings will help develop criteria to objectively and proactively define complex patients and improve care through greater team collaboration. Results Before the teaching programme, 26/30 respondents (87%) wished for further palliative care education. Key concerns included pain and symptom management, and a need for a key point of regular contact for advice. After the programme a second staff survey was conducted. 13/17 respondents were keen for more palliative care education. Their main concerns were pain (10), end of life care (10), advance planning and DNACPR (6), care of relatives (1). Of note, this was not the same group that received education or who replied to the first survey. Programme attendees who gave feedback reported increased awareness of palliative care. Following the training programme, relatives (n=10) felt care in Biggart was 'always good' (10/10), pain/symptoms 'always' or 'usually' well managed (5/10; 5/10 respectively); sufficiently supportive both emotionally (8/10) and spiritually (4/10). Conclusions Joint working improved relationships, skills and confidence. ANP visits consolidated this new approach. Education programme was valued by attendees albeit numbers were small. Education programmes need learner and management commitment to support attendance. Pain, spiritual support and care of relatives remain key areas for ongoing education. 121
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