BackgroundThe use of virtual reality (VR) is increasing in palliative care. However, despite increasing interest in VR, there is little evidence of how this technology can be implemented into practice.AimsThis paper aims to: (1) explore the feasibility of implementing VR therapy, for patients and caregivers, in a hospital specialist inpatient palliative care unit and a hospice, and (2) to identify questions for organisations, to support VR adoption in palliative care.MethodsThe Samsung Gear VR system was used in a hospital specialist palliative inpatient unit and a hospice. Patients and caregivers received VR distraction therapy and provided feedback of their experience. Staff completed a feedback questionnaire to explore their opinion of the usefulness of VR in palliative care. A public engagement event was conducted, to identify questions to support implementation of VR in palliative care settings.ResultsFifteen individuals (12 (80%) patients and 3 (20%) caregivers) participated. All had a positive experience. No adverse effects were reported. Ten items were identified for organisations to consider ahead of adoption of VR in palliative care. These were questions about: the purpose of VR; intended population; supporting evidence; session duration; equipment choice; infection control issues; content choice; setting of VR; person(s) responsible for delivery and the maintenance plan.ConclusionsIt is feasible to use VR therapy in palliative care; however, further evidence about its efficacy and effectiveness is needed. Palliative care practitioners considering VR use should carefully consider several factors, to ensure that this technology can be used safely and effectively in clinical practice.
reviewed by Palliative Care team and compare the results with best practice guidance and the Gosport. Methods The audit cohort was consisted of all patients who died in CCC between July 2018 and December 2018. 29 deaths were identified. Electronical medical records and paper prescription charts were reviewed regarding opiates and sedatives. Results 84% of patients reviewed was not opioid na¯ve on admission. 80% of patients were commenced on syringe driver during admission. Commencement of syringe driver was justified in 96%. In the remaining 4%, syringe driver use was appropriate, but it was not justified. Starting and finishing doses of opiates in syringe drivers were variable, whereas PRN opiate prescription was appropriately dosed in all cases. In 2 cases where the conversion was not according to the guidelines, rationale was given. Similar results were retrieved regarding midazolam prescription. Midazolam was prescribed in 90% cases in patients with syringe driver. Doses of midazolam in syringe driver ranged from 5 mg to 60 mg with appropriate justification of doses. There was no direct correlation between commencement of syringe driver and death. In 100% of cases, clear adherence to the clinical guidelines was shown. Conclusion Current practice in prescribing opiates/sedatives and commencement of syringe driver is according to the clinical guidelines and dosing is appropriate. Results of this audit compared with results produced by the Gosport Independent Panel provide assurance about current use of these medications at CCC. Nevertheless, continuous training is necessary for prescribers in order to maintain the reassuring results.
evaluate cost-effectiveness studies of PR programmes worldwide. Methods A systematic review was conducted in accordance with PRISMA guidelines. A thorough literature search strategy was employed across PubMed, the Cost-Effectiveness Analysis Registry (CEA Registry), National Health Service Economic Evaluation Database (NHS EED), Physiotherapy Evidence Database (PEDro) and Google Scholar from inception to October 2019 for studies comparing the cost-effectiveness of PR programmes with that of usual care. Included studies had to meet the Cochrane definition of PR; at minimum, exercise training for at least 4 weeks. Cost-effectiveness measures included cost per quality-adjusted life year (QALY), cost per clinically significant outcome, incremental cost-effectiveness ratio (ICER) and/or cost savings to the healthcare system involved. These findings were then narratively synthesised. Results 8 studies consisting of 1437 patients were included. Settings for the PR programmes were UK, Ireland, France, Netherlands, Canada and Australia. 7 studies included COPD patients only. 1 study assessing the uncertainties around the cost and outcome found that the cost per QALY was below £17000, below the willingness to pay threshold suggested by the NICE. Evidence from the studies suggests that PR is cost-effective with savings for the healthcare provider involved. Conclusion PR is a cost-effective intervention with potential savings for the service providers. Future studies should examine whether cost-effectiveness varies with the age of patients undergoing PR.
range 0-14) and twice in their last twenty-four hours (range 0-5). Hyperglycaemic episodes were recorded on two occasions and a hypoglycaemic episode was recorded once. Of those patients on oral agents (five) these were stopped between 48-120 hours before death. Of patients on insulin (four) all patients had injections in their last 24 hours of life. Conclusion Patients with diabetes make up a significant proportion of palliative populations. We currently are not discussing with patients about how best to manage their diabetes, resulting in numerous blood sugars tests, high and low blood sugars and a significant medication burden.
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