scholarly journals 133 Palliative care in the emergency department – a scoping review

2020 ◽  
Vol 37 (12) ◽  
pp. 822.3-823
Author(s):  
Ffion Barham ◽  
Samuel King ◽  
Jessica Hawksley
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Significant Proportion ◽  
Research Priorities ◽  
World Health Organisation ◽  
World Health ◽  
Electronic Systems ◽  
Ageing Population ◽  
Exit Block ◽  
Treatment Escalation

Aims/Objectives/BackgroundThe World Health Organisation (WHO) estimate that 40 million people a year globally require palliative care, and this need is expanding. The needs of palliative patients are not optimally met in the Emergency Department (ED), in part due to crowding and exit-block. This is further compounded in an ageing population with increasingly complex chronic diseases. Palliative care in the ED is one of the top five research priorities from the Royal College of Emergency Medicine and is often an underestimated part of the ED workload. These patients need to be recognised early and their care considered holistically. This project aims to define the scale of palliative care demand on EDs, describe the care these patients receive, and consider whether we provide truly palliative care for these patients.Methods/DesignData were collected from electronic and written ED records for all patients meeting the inclusion criteria who attended over a 14-day period. Patient records were identified by manually reviewing all electronic records and identifying coding that corresponded to the WHO list of palliative conditions. Demographic, attendance and clinical data were anonymised and analysed descriptively.Results/ConclusionsOver the study period, 5% (208/4126) of all ED attendances presented with palliative conditions. This figure is likely to be an underestimate, as electronic systems in this department are not linked to e-notes and written records accompany the patient’s hospital journey. Average time in department was 461 minutes (IQR 274.5 – 621.5). 77% (93/121) of these patients were admitted to hospital, with 96% of those admitted to the Medical Assessment Unit. Only 7% (8/121) left the department with a completed Treatment Escalation Plan (2 of these were pre-existing). This scoping data shows that a small but significant proportion of ED patients have incurable conditions and it may be worth targeting quality, not quantity, of life.

24 Understanding and management of terminal illness within tanzanian traditional medicine

2018 ◽  
Vol 8 (3) ◽  
pp. 368.3-369
Author(s):  
Naomi Higton ◽  
Emma Grace Lewis ◽  
Richard Walker ◽  
Richard Lee
Keyword(s):  
Palliative Care ◽  
Traditional Medicine ◽  
Terminal Illness ◽  
Healthcare Professionals ◽  
World Health Organisation ◽  
Traditional Healers ◽  
Explanatory Models ◽  
Sub Saharan Africa ◽  
World Health ◽  
List Type

BackgroundPalliative care (PC) need in Africa is projected to rise by 300% over the next 20 years.1 Late presentation and poor community awareness of services are recognised challenges to effective healthcare delivery.2 3Traditional and faith healers (TFH) hold cultural importance and provide a significant proportion of primary healthcare in Africa.4 5 This project sought to explore their understanding and management of terminal illness with the aim of improving PC delivery through collaborations between TFH and allopathic services.MethodologyData were collected through semi-structured qualitative interviews with traditional healers (n=11) and faith healers (n=8) working within the Kilimanjaro region of Tanzania. Participants were recruited through convenience and purposive sampling. Interviews were audio-recorded and translated transcripts analysed by thematic analysis.FindingsAll TFH had experience of terminally ill and dying patients. Participants had a holistic approach to healthcare with themes of biological psychological social and spiritual factors identified throughout conceptualisation and management of both terminal illness and death. This also informed opinions towards collaboration seeing healthcare professionals and TFH holding different roles within these areas.ConclusionsThe overlap with allopathic explanatory models of health (i.e. the BioPsychoSocial model) provides positive grounds for future collaborations. TFH could complement allopathic PC services through culturally acceptable spiritual care perceived to be lacking in hospitals. Joint dialogue and education between practitioners is necessary to begin collaboration. A significant challenge to this is mistrust between traditional healers and faith healers. The findings merit further research into patient’s preferences and experiences of TFHs in terminal illness.References. Grant L, Downing J, Namukwaya E. Palliative care in Africa since 2005: Good progress but much further to go. BMJ Supportive & Palliative Care2011;1(2).. Harding R, et al. Current HIV/AIDS end-of-life care in sub-Saharan Africa: A survey of models services challenges and priorities. BMC Public Health2003;3(33).. Lewis EG, Oates LL, Rogathi J, Duinmaijer A, Shayo A, Megiroo S, Bakari B, Dewhurst F, Walker RW, Dewhurst M, Urasa S. ‘We never speak about death.’ Healthcare professionals’ views on palliative care for inpatients in Tanzania: A qualitative study. Palliat Support CareAugust 2017;22:1–14.. World Health Organisation. WHO: Traditional medicine strategy: 2014–2023 2013. Geneva: World Health Organisation Geneva.. Stanifer JW, et al. The determinants of traditional medicine use in Northern Tanzania: A mixed-methods study. PLoS One2015;10(4):e0122638.

scholarly journals COVID-19 vaccine hesitancy and resistance: Correlates in a nationally representative longitudinal survey of the Australian population

2020 ◽  
Author(s):  
Ben Edwards ◽  
Nicholas Biddle ◽  
Matthew Gray ◽  
Kate Sollis
Keyword(s):  
Vaccination Coverage ◽  
Online Survey ◽  
Significant Proportion ◽  
World Health Organisation ◽  
World Health ◽  
Vaccine Hesitancy ◽  
Policy Measures ◽  
Low Levels ◽  
Nationally Representative ◽  
Territory Government

AbstractBackgroundHigh levels of vaccination coverage in populations will be required even with vaccines that have high levels of effectiveness to prevent and stop outbreaks of coronavirus. The World Health Organisation has suggested that governments take a proactive response to vaccine hesitancy ‘hotspots’ based on social and behavioural insights.MethodsRepresentative longitudinal online survey of over 3000 adults from Australia that examines the demographic, attitudinal, political and social attitudes and COVID-19 health behavior correlates of vaccine hesitance and resistance to a COVID-19 vaccine.ResultsOverall, 59% would definitely get the vaccine, 29% had low levels of hesitancy, 7% had high levels of hesitancy and 6% were resistant. Females, those living in disadvantaged areas, those who reported that risks of COVID-19 was overstated, those who had more populist views and higher levels of religiosity were more likely to be hesitant or resistant while those who had higher levels of household income, those who had higher levels of social distancing, who downloaded the COVID-Safe App, who had more confidence in their state or territory government or confidence in their hospitals, or were more supportive of migration were more likely to intend to get vaccinated.ConclusionsOur findings suggest that vaccine hesitancy, which accounts for a significant proportion of the population can be addressed by public health messaging but for a significant minority of the population with strongly held beliefs, alternative policy measures may well be needed to achieve sufficient vaccination coverage to end the pandemic.

scholarly journals Smart and Age-Friendly Cities in Russia: An Exploratory Study of Attitudes, Perceptions, Quality of Life and Health Information Needs

2020 ◽  
Vol 17 (24) ◽  
pp. 9212
Author(s):  
Liliya Eugenevna Ziganshina ◽  
Ekaterina V. Yudina ◽  
Liliya I. Talipova ◽  
Guzel N. Sharafutdinova ◽  
Rustem N. Khairullin
Keyword(s):  
Quality Of Life ◽  
Health Information ◽  
Exploratory Study ◽  
Information Needs ◽  
World Health Organisation ◽  
Healthy Ageing ◽  
World Health ◽  
Evidence Based ◽  
Ageing Population

In Russia, initiatives for healthy ageing have been growing over the last two decades; however, none use an evidence-based (EB) approach. It is proposed that Kazan, a city with a population of over a million in the European part of Russia, has good chances of moving towards age-friendliness and contributing to raising awareness about healthy ageing through Cochrane evidence. One of the eight essential features of age-friendly cities by the World Health Organisation (WHO) directly points to health services. This exploratory study assesses the health information needs of the ageing population of Kazan and the challenges people face in improving their health and longevity. Survey data were used from 134 participants, patients, caregivers and healthcare providers of the Interregional Clinical Diagnostic Centre (ICDC), aged from 30 to over 80 years, and potential associations of the studied parameters with age, gender, quality of life and other characteristics were analysed. Older people (60+) were less positive about their quality of life, took medicines more often on a daily basis (10/16 compared to 29/117 of people under 60), encountered problems with ageing (9/16 compared to 21/117 of people under 60) and rated their quality of life as unsatisfactory (4/14 compared to 9/107 of people under 60). Awareness of EB approaches and Cochrane was higher within health professions (evidence-based medicine: 42/86 vs. 13/48; Cochrane: 32/86 vs. 2/48), and health information needs did not differ between age or gender groups or people with a satisfactory and unsatisfactory quality of life. The minority (10%—13/134) were aware of ageism without age or gender differences. The low awareness calls for the need of Cochrane intervention both for consumers and those in the health profession to raise awareness to contribute to Kazan moving towards an age-friendly city.

scholarly journals The remaining unknowns: A determination of the current research priorities for COVID-19 by the global health research community

2020 ◽  
Author(s):  
Alice Norton ◽  
Arancha De La Horra Gozalo ◽  
Nicole Feune de Colombi ◽  
Moses Alobo ◽  
Juliette Mutheu Asego ◽  
...  
Keyword(s):  
Public Health ◽  
Virus Transmission ◽  
Research Priorities ◽  
World Health Organisation ◽  
Research Community ◽  
Global Perspective ◽  
World Health ◽  
Global Health Research ◽  
The World ◽  
Global Research

AbstractBackgroundIn March 2020 the World Health Organisation (WHO) released a Global Research Roadmap in an effort to coordinate and accelerate the global research response to combat COVID-19 based on deliberations of 400 experts across the world. Three months on, the disease and our understanding have both evolved significantly. As we now tackle a pandemic in very different contexts and with increased knowledge, we sought to build on the work of the WHO to gain a more current and global perspective on these initial priorities.Methods and findingsWe undertook a mixed methods study seeking the views of the global research community to i) assess which of the early WHO roadmap priorities are still most pressing; ii) understand whether they are still valid in different settings, regions or countries; and iii) identify any new emerging priorities.Thematic analysis of the significant body of combined data shows the WHO roadmap is globally relevant, however, new important priorities have emerged, in particular, pertinent to low and lower-middle income countries (less resourced countries), where health systems are under significant competing pressures. We also found a shift from prioritising vaccine and therapeutic development towards a focus on assessing the effectiveness, risks, benefits and trust in the variety of public health interventions and measures. Our findings also provide insight into temporal nature of these research priorities, highlighting the urgency of research that can only be undertaken within the period of virus transmission, as well as other important research questions but which can be answered outside the transmission period. Both types of studies are key to help combat this pandemic but also importantly to ensure we are better prepared for the future.ConclusionsWe hope these findings will help guide decision making across the broad research system including the multi-lateral partners, research funders, public health practitioners, clinicians and civil society.

What is palliative care?

2020 ◽  
Vol 14 (1) ◽  
pp. 19-26
Author(s):  
Francis Odukwe ◽  
Francis Ezeh
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
World Health Organisation ◽  
World Health ◽  
Care Services ◽  
Care Specialist ◽  
The World ◽  
Palliative Care Services ◽  
Serious Injuries

In 1990, the World Health Organisation (WHO) recognised palliative care as a distinct specialty dedicated to relieving suffering and improving quality of life for patients with life-limiting illnesses or serious injuries. Fourteen years later, the WHO in its publication ‘ Global Atlas of Palliative Care at the End of Life’, projected that, ‘each year in the world, around 377 per 100,000 of the adult (over 15 years of age) population and 63 per 100,000 of the child population (under 15 years of age) will require “palliative care at the end of life’. This article will discuss what constitutes palliative care, the different elements of palliative care, the approaches to palliative care, specialist palliative care services, end of life care and where GPs fit into this area. We will also be sharing tips on providing palliative care as a GP and for GP trainees.

scholarly journals COVID-19 vaccine hesitancy and resistance: Correlates in a nationally representative longitudinal survey of the Australian population

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248892
Author(s):  
Ben Edwards ◽  
Nicholas Biddle ◽  
Matthew Gray ◽  
Kate Sollis
Keyword(s):  
Vaccination Coverage ◽  
Online Survey ◽  
Significant Proportion ◽  
World Health Organisation ◽  
World Health ◽  
Vaccine Hesitancy ◽  
Policy Measures ◽  
Low Levels ◽  
Nationally Representative ◽  
Territory Government

Background High levels of vaccination coverage in populations will be required even with vaccines that have high levels of effectiveness to prevent and stop outbreaks of coronavirus. The World Health Organisation has suggested that governments take a proactive response to vaccine hesitancy ‘hotspots’ based on social and behavioural insights. Methods Representative longitudinal online survey of over 3000 adults from Australia that examines the demographic, attitudinal, political and social attitudes and COVID-19 health behavior correlates of vaccine hesitance and resistance to a COVID-19 vaccine. Results Overall, 59% would definitely get the vaccine, 29% had low levels of hesitancy, 7% had high levels of hesitancy and 6% were resistant. Females, those living in disadvantaged areas, those who reported that risks of COVID-19 was overstated, those who had more populist views and higher levels of religiosity were more likely to be hesitant or resistant while those who had higher levels of household income, those who had higher levels of social distancing, who downloaded the COVID-Safe App, who had more confidence in their state or territory government or confidence in their hospitals, or were more supportive of migration were more likely to intend to get vaccinated. Conclusions Our findings suggest that vaccine hesitancy, which accounts for a significant proportion of the population can be addressed by public health messaging but for a significant minority of the population with strongly held beliefs, alternative policy measures may well be needed to achieve sufficient vaccination coverage to end the pandemic.

scholarly journals Technology in Palliative Care (TIP): the identification of digital priorities for palliative care research using a modified Delphi method

2021 ◽  
Author(s):  
Amara Callistus Nwosu ◽  
Tamsin McGlinchey ◽  
Justin Sanders ◽  
Sarah Stanley ◽  
Jennifer Palfrey ◽  
...  
Keyword(s):  
Palliative Care ◽  
Data Science ◽  
Digital Health ◽  
Personalised Medicine ◽  
Research Priorities ◽  
Consensus Meeting ◽  
Ageing Population ◽  
Modified Delphi ◽  
Health And Social Care ◽  
Wide Range

Background Developments in digital health (describing technologies which use computing platforms, connectivity, software, and sensors for health care and related purposes) has the potential to transform the delivery of health and social care to help citizens manage their own health. Currently, we lack consensus about digital health research priorities in palliative care and lack theories about how these technologies might improve care outcomes. Global palliative care need is expected to increase due to the consequences of an ageing population; therefore, it is important for healthcare leaders to identify innovations to ensure that an increasingly frail population have appropriate access to palliative care services. Consequently, it is important to articulate research priorities as the first step to determine how we should allocate finite research resources to a field saturated with rapidly developing innovations. Aims To identify research priority areas for digital health in palliative care. Methods We selected the digital health trends, most relevant to palliative care, from a list of emerging trends reported by the Future Today Institute. We conducted a modified Delphi process and consensus meeting with palliative care experts to identify research priorities. We used the views of public representatives to gain their perspectives of the agreed priorities. Results One hundred and three experts (representing 11 countries) participated in the 1st Delphi round. Fifty-five participated in the 2nd round (53% of 1st round). Eleven experts attended the final consensus meeting. We identified 16 priorities areas, which were summarised into eight themes. These themes were: big data, mobile devices, telehealth and telemedicine, virtual reality, artificial intelligence, the smart home, biotechnology and digital legacy. Conclusions The identified priorities in this paper represent a wide range of important emerging areas in field of digital health, personalised medicine, and data science. Human-centred design and robust governance systems should be considered in future research. It is important that the barriers and risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely and safely and that do not cause unintentional harm.

A Collaborative Study to Establish the Second International Standard for Streptokinase

1990 ◽  
Vol 64 (02) ◽  
pp. 267-269 ◽  
Author(s):  
A B Heath ◽  
P J Gaffney
Keyword(s):  
High Purity ◽  
Collaborative Study ◽  
World Health Organisation ◽  
World Health ◽  
Clot Lysis ◽  
Current Standard ◽  
International Standard ◽  
Accelerated Degradation ◽  
The World ◽  
International Collaborative Study

SummaryAn International Standard for Streptokinase - Streptodomase (62/7) has been used to calibrate high purity clinical batches of SK since 1965. An international collaborative study, involving six laboratories, was undertaken to replace this standard with a high purity standard for SK. Two candidate preparations (88/826 and 88/824) were compared by a clot lysis assay with the current standard (62/7). Potencies of 671 i.u. and 461 i.u. were established for preparations A (88/826) and B (88/824), respectively.Either preparation appeared suitable to serve as a standard for SK. However, each ampoule of preparation A (88/826) contains a more appropriate amount of SK activity for potency testing, and is therefore preferred. Accelerated degradation tests indicate that preparation A (88/826) is very stable.The high purity streptokinase preparation, coded 88/826, has been established by the World Health Organisation as the 2nd International Standard for Streptokinase, with an assigned potency of 700 i.u. per ampoule.

A Collaborative Study to Establish an International Standard for Alpha-Thrombin

1992 ◽  
Vol 67 (04) ◽  
pp. 424-427 ◽  
Author(s):  
P J Gaffney ◽  
A B Heath ◽  
J W Fenton II
Keyword(s):  
Elevated Temperatures ◽  
Collaborative Study ◽  
World Health Organisation ◽  
Significant Loss ◽  
Thrombin Inhibitors ◽  
World Health ◽  
Expert Committee ◽  
International Standard ◽  
Assay Procedure ◽  
And Control

SummarySince 1975 an International Standard for Thrombin of low purity has been used. While this standard was stable and of value for calibrating thrombins of unknown potency the need for a pure a-thrombin standard arose both for accurate calibration and for precise measurement of thrombin inhibitors, notably hirudin. An international collaborative study was undertaken to establish the potency and stability of an ampouled pure a-thrombin preparation. A potency of 97.5 international units (95% confidence limits 86.5-98.5) was established for the new a-thrombin standard (89/ 588) using a clotting-assay procedure. Stability data at various elevated temperatures indicated that the standard could be transported and stored with no significant loss of potency.Ampoules of lyophilised a-thrombin (coded 89/588) have been recommended as an International Standard for a-thrombin with an assigned potency of 100 international units per ampoule by the International Society for Thrombosis and Haemostasis (Thrombin and its Inhibitors Sub-Committee) in Barcelona, Spain in July 1990 while the Expert Committee on Biological Standardisation and Control of the World Health Organisation will consider its status at its next meeting in Geneva in 1991.

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