Publications by authors named "Michael Bennett"

825 Publications

Community access to palliative care medicines-patient and professional experience: systematic review and narrative synthesis.

BMJ Support Palliat Care 2021 Mar 28. Epub 2021 Mar 28.

School of Health Sciences, University of Southampton, Southampton, Hampshire, UK

Background: Providing palliative care patients living at home with timely access to medicines is critical to enable effective symptom management, minimise burden and reduce unplanned use of healthcare services. Little is known about how diverse community-based palliative care models influence medicine access.

Objective: To produce a critical overview of research on experiences and outcomes of medicine access in community-based palliative care models of service delivery through a systematic review and narrative synthesis.

Methods: MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library databases and grey literature were systematically searched for all types of studies. Study quality was assessed using the Mixed Methods Appraisal Tool; a narrative synthesis was used to integrate and summarise findings.

Results: 3331 articles were screened; 10 studies were included in the final sample. Studies included a focus on community pharmacy (n=4), hospice emergency medication kits (HEMKs) in the home (n=3), specialist community nurse prescribers (n=1), general practice (n=1) and one study included multiple service delivery components. Community pharmacy was characterised by access delays due to lack of availability of medicine stock and communication difficulties between the pharmacy and other healthcare professionals. HEMKs were perceived to reduce medicine access time out of hours and speed symptom control. However, the majority of studies comprised small, local samples, largely limited to self-reports of health professionals. There was a lack of data on outcomes, and no comparisons between service delivery models.

Conclusions: Further research is required to understand which models facilitate rapid and efficient access to medicines for community-based palliative care patients.
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http://dx.doi.org/10.1136/bmjspcare-2020-002761DOI Listing
March 2021

Hyperbaric oxygen for sudden hearing loss: Influence of international guidelines on practice in Australia and New Zealand.

Diving Hyperb Med 2021 Mar;51(1):68-71

Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney Australia.

Introduction: Idiopathic sudden sensorineural hearing loss (ISSHL) is an otolaryngologic emergency. The Undersea and Hyperbaric Medicine Society (UHMS) revised practice guidelines in 2014 adding ISSHL to approved indications. This study investigated whether the UHMS guidelines influenced referral and practice in Australia and New Zealand.

Methods: Retrospective review of 319 patient referrals in two time periods (five years prior to addition of ISSHL to indications (T-PRE) and three years post (T-POST)).

Results: Seven of eight participating hyperbaric facilities provided data down to the level of the indication for HBOT for analysis. In T-PRE 136 patients were treated with HBOT for ISSHL, representing between 0% and 18% of the total cases to each facility. In the T-POST period 183 patients were treated for ISSHL, representing from 0.35% to 24.8% of the total patients in each facility. Comparison between the two periods shows the proportion of patients treated with ISSHL among all indications increased from 3.2% to 12.1% (P < 0.0009). One facility accounted for 74% (101/136) of ISSHL patients receiving HBOT in T-PRE and 63% (116/183) in T-POST. ISSHL case load at that facility increased from 18% to 24.8% (P = 0.009) after the UHMS guideline publication. Three of the seven units had a significant increase in referrals after the guideline change.

Conclusion: There remains equipoise regarding HBOT in the management of ISSHL. Only three out of seven units had a significant increase in ISSHL patients after the UHMS guidelines publication. Without well controlled RCTs to develop guidelines based on good evidence this is unlikely to change and practice variation will continue.
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http://dx.doi.org/10.28920/dhm51.1.68-71DOI Listing
March 2021

Adjunctive hyperbaric oxygen treatment for necrotising soft-tissue infections: A systematic review and meta-analysis.

Diving Hyperb Med 2021 Mar;51(1):34-43

Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark.

Introduction: Surgical intervention, broad-spectrum antibiotics and intensive care support are the standard of care in the treatment of necrotising soft-tissue infections (NSTI). Hyperbaric oxygen treatment (HBOT) may be a useful adjunctive treatment and has been used for almost 60 years, but its efficacy remains unknown and has not been systematically appraised. The aim was to systematically review and synthesise the highest level of clinical evidence available to support or refute the use of HBOT in the treatment of NSTI.

Methods: The review was prospectively registered (PROSPERO; CRD42020148706). MEDLINE, EMBASE, CENTRAL and CINAHL were searched for eligible studies that reported outcomes in both HBOT treated and non-HBOT treated individuals with NSTI. In-hospital mortality was the primary outcome. Odds ratio (ORs) were pooled using random-effects models.

Results: The search identified 486 papers of which 31 were included in the qualitative synthesis and 21 in the meta-analyses. Meta-analysis on 48,744 patients with NSTI (1,237 (2.5%) HBOT versus 47,507 (97.5%) non-HBOT) showed in-hospital mortality was 4,770 of 48,744 patients overall (9.8%) and the pooled OR was 0.44 (95% CI 0.33-0.58) in favour of HBOT. For major amputation the pooled OR was 0.60 (95% CI 0.28-1.28) in favour of HBOT. The dose of oxygen in these studies was incompletely reported.

Conclusions: Meta-analysis of the non-random comparative data indicates patients with NSTI treated with HBOT have reduced odds of dying during the sentinel event and may be less likely to require a major amputation. The most effective dose of oxygen remains unclear.
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http://dx.doi.org/10.28920/dhm51.1.34-43DOI Listing
March 2021

The effect of national public health measures on the characteristics of trauma presentations to a busy paediatric emergency service in Ireland: a longitudinal observational study.

Ir J Med Sci 2021 Mar 20. Epub 2021 Mar 20.

Department of Paediatric Emergency Medicine, Children's Health Ireland Crumlin, Dublin, Ireland.

Background: The SARS-CoV-2 pandemic and government-enforced restrictions have impacted medical practices.

Aims: The aim of our study was to investigate the impact SARS-CoV-2 and public health restrictions had on trauma presentations to a regional paediatric emergency service.

Methods: We carried out a multisite retrospective longitudinal study of all paediatric ED attendances from 2018 including 13 March to 7 June 2020. This aligned with the initial government-enforced public health phases: delay phase, mitigation phase and reopening phase 1.

Results: There were 7975 total regional attendances during government-enforced restrictions. This represents 17.5% and 15.6% reductions in site attendances when compared with the two previous years. Regional attendances reduced by 52.5% in 2020 compared with 2018 and 50.9% compared with 2019. Following an initial reduction in injury attendances at the beginning of the 'lockdown' (p = 0.076), the number of injuries consistently grew as weeks progressed (p < 0.05), reaching a peak of 44.6% of all attendances. As restrictions eased, the most common location where injuries occurred moved to areas outside the home (p < 0.000). There was a significant change in injury type, final disposition and device-associated injury (p < 0.05). Wheeled recreational devices were associated with over 20% of all injuries by reopening phase 1.

Conclusions: This study reveals that total attendances and total injuries reduced during initial phases of the lockdown. This was followed by a significant increase in injury presentations, which reached a peak of 44.6% of all attendances. We identified potential modifiable characteristics of paediatric trauma which can be addressed by future public health strategies.
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http://dx.doi.org/10.1007/s11845-021-02593-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980126PMC
March 2021

Combinatorial glucose, nicotinic acid, and N-acetylcysteine therapy has synergistic effect in preclinical C. elegans and zebrafish models of mitochondrial complex I disease.

Hum Mol Genet 2021 Feb 27. Epub 2021 Feb 27.

Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.

Mitochondrial respiratory chain disorders are empirically managed with variable antioxidant, cofactor, and vitamin 'cocktails'. However, clinical trial validated and approved compounds, or doses, do not exist for any single or combinatorial mitochondrial disease therapy. Here, we sought to pre-clinically evaluate whether rationally-designed mitochondrial medicine combinatorial regimens might synergistically improve survival, health, and physiology in translational animal models of respiratory chain complex I disease. Having previously demonstrated that gas-1(fc21) complex I subunit NDUFS2-/-  C. elegans have short lifespan that can be significantly rescued with 17 different metabolic modifiers, signaling modifiers, or antioxidants, here we evaluated 11 random combinations of these 3 treatment classes on gas-1(fc21) lifespan. Synergistic rescue occurred only with glucose, nicotinic acid, and N-acetylcysteine (Glu + NA + NAC), yielding improved mitochondrial membrane potential that reflects integrated respiratory chain function, without exacerbating oxidative stress and while reducing mitochondrial stress (UPRmt) and improving intermediary metabolic disruptions at the levels of the transcriptome, steady-state metabolites, and intermediary metabolic flux. Equimolar Glu + NA + NAC dosing in a zebrafish vertebrate model of rotenone-based complex I inhibition synergistically rescued larval activity, brain death, lactate, ATP, and glutathione levels. Overall, these data provide objective preclinical evidence in two evolutionary-divergent animal models of mitochondrial complex I disease to demonstrate that combinatorial Glu + NA + NAC therapy significantly improved animal resiliency in the face of stressors that exacerbate their underlying metabolic deficiency, thereby preventing acute neurologic and biochemical decompensation. Clinical trials are warranted to evaluate the efficacy of this lead combinatorial therapy regimen to improve resiliency and health outcomes in human subjects with mitochondrial disease.
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http://dx.doi.org/10.1093/hmg/ddab059DOI Listing
February 2021

Malignant triton tumour (MTT) of the lung with metastasis to the proximal femur.

BMJ Case Rep 2021 Feb 4;14(2). Epub 2021 Feb 4.

Medical Oncology, Cork University Hospital Group, Cork, Ireland.

A 65-year-old female patient has a history of malignant triton tumour of the right upper lobe of the lung. She underwent right upper lobectomy and lymphadenectomy in May 2018. She presented in November 2019 with pathological fracture of the left proximal femur. It was not associated with neurofibromatosis. We decided to do an excisional biopsy of the mass and proximal femoral replacement followed by radiotherapy. Four months later, she presented with local recurrence. We organised a multidisciplinary team between the orthopaedic, histopathology and oncology teams. Then, we decided to treat her with chemotherapy. After 2 months of follow-up, she responded well to the chemotherapy with no further deterioration of her condition.
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http://dx.doi.org/10.1136/bcr-2020-237086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868192PMC
February 2021

Classification algorithm for the International Classification of Diseases-11 chronic pain classification: development and results from a preliminary pilot evaluation.

Pain 2021 Jan 20. Epub 2021 Jan 20.

Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, Newark, NJ, United States St Vincent's Clinical School, UNSW, Sydney, New South Wales, Australia Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany Department of Medicine, University of Münster, Münster, Germany Department of Medicine and Science of Aging, CAST, G D'Annunzio University of Chieti, Chieti, Italy European Palliative Care Research Centre (PRC),Department of Cancer Treatment, University Hospital Oslo, Oslo, Norway Department of Oncology, Oslo University Hospital, Oslo, Norway Institute of Cancer Research and Molecular Medicine, Department of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Clinical Neuroscience, Karolinska Institute, and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden Department of Surgical Sciences Uppsala University, Uppsala, Sweden Department of Anesthesiology, Acute Postoperative Pain Service, Saint Luc Hospital, Catholic University of Louvain, Brussels, Belgium Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, Sydney, Australia Pain Clinic, Cochin Hospital, Paris University, INSERM U987, Paris, France Department of Anaesthesiology and Pain Medicine, Medical School, University of Western Australia, Perth, Australia Division of Population Health and Genomics, University of Dundee, Dundee, Scotland Department of Dentistry and Oral Health, Section of Orofacial Pain and Jaw Function, Aarhus University, Aarhus, Denmark Research Group Health Psychology, Department of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium TRACE, Center for Translational Health Research, KU Leuven, Ziekenhuis Oost-Limburg, Genk, Belgium Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Brain Research Center and School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany, Division of Clinical and Biological Psychology, Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany, Université Paris Saclay, Versailles, France.

Abstract: The International Classification of Diseases-11 (ICD-11) chronic pain classification includes about 100 chronic pain diagnoses on different diagnostic levels. Each of these diagnoses requires specific operationalized diagnostic criteria to be present. The classification comprises more than 200 diagnostic criteria. The aim of the Classification Algorithm for Chronic Pain in ICD-11 (CAL-CP) is to facilitate the use of the classification by guiding users through these diagnostic criteria. The diagnostic criteria were ordered hierarchically and visualized in accordance with the standards defined by the Society for Medical Decision Making Committee on Standardization of Clinical Algorithms. The resulting linear decision tree underwent several rounds of iterative checks and feedback by its developers, as well as other pain experts. A preliminary pilot evaluation was conducted in the context of an ecological implementation field study of the classification itself. The resulting algorithm consists of a linear decision tree, an introduction form, and an appendix. The initial decision trunk can be used as a standalone algorithm in primary care. Each diagnostic criterion is represented in a decision box. The user needs to decide for each criterion whether it is present or not, and then follow the respective yes or no arrows to arrive at the corresponding ICD-11 diagnosis. The results of the pilot evaluation showed good clinical utility of the algorithm. The CAL-CP can contribute to reliable diagnoses by structuring a way through the classification and by increasing adherence to the criteria. Future studies need to evaluate its utility further and analyze its impact on the accuracy of the assigned diagnoses.
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http://dx.doi.org/10.1097/j.pain.0000000000002208DOI Listing
January 2021

Megaloblastic Anaemia.

Authors:
Michael Bennett

J R Coll Physicians Edinb 2020 12;50(4):456-461

Retired Consultant Haematologist.

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http://dx.doi.org/10.4997/JRCPE.2020.430DOI Listing
December 2020

Palliative Care Needs and Integration of Palliative Care Support in COPD: A Qualitative Study.

Chest 2021 Jan 9. Epub 2021 Jan 9.

Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.

Background: The provision of palliative care for severe COPD remains low, resulting in unmet needs in patients and carers.

Research Questions: What are the palliative care needs of patients living with severe COPD and their caregivers? What views of accessing and providing palliative care and factors influence these experiences. To what extent have palliative care and COPD services been integrated?

Study Design And Methods: A multicentre qualitative study was undertaken in COPD services and specialist palliative care in the United Kingdom involving patients with severe COPD, their carers, and health professionals. Data were collected using semistructured interviews and were analyzed using framework analysis. Themes were integrated using the constant comparison process, enabling systematic data synthesis.

Results: Four themes were generated from interviews with 20 patients, six carers, and 25 health professionals: management of exacerbations, palliative care needs, access to palliative care and pathways, and integration of palliative care support. Uncertainty and fear were common in patients and carers, with identified needs for reassurance, rapid medical access, home care, and finance advice. Timely palliative care was perceived as important by health professionals. Palliative care was integrated into COPD services, although models of working varied across regions. Reliable screening tools and needs assessment, embedded psychological care, and enhanced training in palliative care and communication skills were perceived to be important by health professionals for timely palliative care referrals and optimized management.

Interpretation: Palliative care increasingly is being implemented for nonmalignant diseases including COPD throughout the United Kingdom, although models of working vary. A theoretical model was developed to illustrate the concept and pathway of the integration of palliative care support. A standardized screening and needs assessment tool is required to improve timely palliative care and to address the significant needs of this population.
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http://dx.doi.org/10.1016/j.chest.2020.12.055DOI Listing
January 2021

Stakeholder perspectives and requirements to guide the development of digital technology for palliative cancer services: a multi-country, cross-sectional, qualitative study in Nigeria, Uganda and Zimbabwe.

BMC Palliat Care 2021 Jan 4;20(1). Epub 2021 Jan 4.

Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.

Introduction: Coverage of palliative care in low and middle-income countries is very limited, and global projections suggest large increases in need. Novel approaches are needed to achieve the palliative care goals of Universal Health Coverage. This study aimed to identify stakeholders' data and information needs and the role of digital technologies to improve access to and delivery of palliative care for people with advanced cancer in Nigeria, Uganda and Zimbabwe.

Methods: We conducted a multi-country cross-sectional qualitative study in sub-Saharan Africa. In-depth qualitative stakeholder interviews were conducted with N = 195 participants across Nigeria, Uganda and Zimbabwe (advanced cancer patients n = 62, informal caregivers n = 48, health care professionals n = 59, policymakers n = 26). Verbatim transcripts were subjected to deductive and inductive framework analysis to identify stakeholders needs and their preferences for digital technology in supporting the capture, transfer and use of patient-level data to improve delivery of palliative care.

Results: Our coding framework identified four main themes: i) acceptability of digital technology; ii) current context of technology use; iii) current vision for digital technology to support health and palliative care, and; iv) digital technologies for the generation, reporting and receipt of data. Digital heath is an acceptable approach, stakeholders support the use of secure data systems, and patients welcome improved communication with providers. There are varying preferences for how and when digital technologies should be utilised as part of palliative cancer care provision, including for increasing timely patient access to trained palliative care providers and the triaging of contact from patients.

Conclusion: We identified design and practical challenges to optimise potential for success in developing digital health approaches to improve access to and enhance the delivery of palliative cancer care in Nigeria, Uganda and Zimbabwe. Synthesis of findings identified 15 requirements to guide the development of digital health approaches that can support the attainment of global health palliative care policy goals.
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http://dx.doi.org/10.1186/s12904-020-00694-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784352PMC
January 2021

IL-4/STAT6 signaling facilitates innate hematoma resolution and neurological recovery after hemorrhagic stroke in mice.

Proc Natl Acad Sci U S A 2020 12 8;117(51):32679-32690. Epub 2020 Dec 8.

Department of Neurology, Pittsburgh Institute of Brain Disorders & Recovery, University of Pittsburgh, Pittsburgh, PA 15213;

Intracerebral hemorrhage (ICH) is a devastating form of stroke affecting millions of people worldwide. Parenchymal hematoma triggers a series of reactions leading to primary and secondary brain injuries and permanent neurological deficits. Microglia and macrophages carry out hematoma clearance, thereby facilitating functional recovery after ICH. Here, we elucidate a pivotal role for the interleukin (IL)-4)/signal transducer and activator of transcription 6 (STAT6) axis in promoting long-term recovery in both blood- and collagenase-injection mouse models of ICH, through modulation of microglia/macrophage functions. In both ICH models, STAT6 was activated in microglia/macrophages (i.e., enhanced expression of phospho-STAT6 in Iba1 cells). Intranasal delivery of IL-4 nanoparticles after ICH hastened STAT6 activation and facilitated hematoma resolution. IL-4 treatment improved long-term functional recovery in young and aged male and young female mice. In contrast, STAT6 knockout (KO) mice exhibited worse outcomes than WT mice in both ICH models and were less responsive to IL-4 treatment. The construction of bone marrow chimera mice demonstrated that STAT6 KO in either the CNS or periphery exacerbated ICH outcomes. STAT6 KO impaired the capacity of phagocytes to engulf red blood cells in the ICH brain and in primary cultures. Transcriptional analyses identified lower level of IL-1 receptor-like 1 (ST2) expression in microglia/macrophages of STAT6 KO mice after ICH. ST2 KO diminished the beneficial effects of IL-4 after ICH. Collectively, these data confirm the importance of IL-4/STAT6/ST2 signaling in hematoma resolution and functional recovery after ICH. Intranasal IL-4 treatment warrants further investigation as a clinically feasible therapy for ICH.
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http://dx.doi.org/10.1073/pnas.2018497117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768771PMC
December 2020

Designing a clinical trial of non-steroidal anti-inflammatory drugs for cancer pain: a survey of UK palliative care physicians.

BMJ Support Palliat Care 2020 Dec 2. Epub 2020 Dec 2.

Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.

Objectives: Insufficient quality evidence exists to support or refute the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the management of cancer pain. We aimed to determine the most clinically pragmatic design of a future randominsed controlled trial (RCT), based on how NSAIDs are currently used and perceived efficacy.

Methods: An online survey was distributed to members of the Association for Palliative Medicine of Great Britain and Ireland examining NSAID use, indications and perceived efficacy, as well as duration of respondents' experience in palliative medicine.

Results: 23% of 968 members responded. A placebo-controlled trial of NSAIDs as a strong opioid adjunct in cancer-related bone pain was considered the most clinically pragmatic design. Concerning current practice, oral administration was the preferential route (79.4%), dosed regularly (79.5%). Selective cyclooxygenase-2 (COX-2) inhibitors and non-selective COX-2 inhibitors were considered similarly effective by 45% in cancer pain; ibuprofen being the first line oral NSAID of choice (42.6%). Treatment efficacy is generally determined within 1 week (94.3%). On a Likert scale, most physicians consider NSAIDs improve cancer pain either 'sometimes' (57.7%) or 'often' (40%). Years of specialist palliative care experience did not affect perception of efficacy (p=0.353).

Conclusions: A randomised controlled trial of NSAIDs as opioid adjuncts for cancer-related bone pain would be the most pragmatic design supported by palliative care clinicians to benefit clinical practice.
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http://dx.doi.org/10.1136/bmjspcare-2020-002792DOI Listing
December 2020

Implementing person-centred outcome measures in palliative care: An exploratory qualitative study using Normalisation Process Theory to understand processes and context.

Palliat Med 2021 Feb 29;35(2):397-407. Epub 2020 Nov 29.

Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.

Background: Despite evidence demonstrating the utility of using Person-Centred Outcome Measures within palliative care settings, implementing them into routine practice is challenging. Most research has described barriers to, without explaining the causal mechanisms underpinning, implementation. Implementation theories explain how, why, and in which contexts specific relationships between barriers/enablers might improve implementation effectiveness but have rarely been used in palliative care outcomes research.

Aim: To use Normalisation Process Theory to understand and explain the causal mechanisms that underpin successful implementation of Person-Centred Outcome Measures within palliative care.

Design: Exploratory qualitative study. Data collected through semi-structured interviews and analysed using a Framework approach.

Setting/participants: 63 healthcare professionals, across 11 specialist palliative care services, were purposefully sampled by role, experience, seniority, and settings (inpatient, outpatient/day therapy, home-based/community).

Results: Seven main themes were developed, representing the causal mechanisms and relationships underpinning successful implementation of outcome measures into routine practice. Themes were: Subjectivity of measures; Frequency and version of Integrated Palliative care Outcome Scale; Training, education, and peer support; Building and sustaining community engagement; Electronic system readiness; The art of communication; Reinforcing use through demonstrating value.

Conclusions: Relationships influencing implementation resided at individual and organisational levels. Addressing these factors is key to driving the implementation of outcome measures into routine practice so that those using palliative care services can benefit from the systematic identification, management, and measurement of their symptoms and concerns. We provide key questions that are essential for those implementing and using outcome measures to consider in order to facilitate the integration of outcome measures into routine palliative care practice.
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http://dx.doi.org/10.1177/0269216320972049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897789PMC
February 2021

Duration of palliative care before death in international routine practice: a systematic review and meta-analysis.

BMC Med 2020 11 26;18(1):368. Epub 2020 Nov 26.

Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.

Background: Early provision of palliative care, at least 3-4 months before death, can improve patient quality of life and reduce burdensome treatments and financial costs. However, there is wide variation in the duration of palliative care received before death reported across the research literature. This study aims to determine the duration of time from initiation of palliative care to death for adults receiving palliative care across the international literature.

Methods: We conducted a systematic review and meta-analysis that was registered with PROSPERO (CRD42018094718). Six databases were searched for articles published between Jan 1, 2013, and Dec 31, 2018: MEDLINE, Embase, CINAHL, Global Health, Web of Science and The Cochrane Library, as well undertaking citation list searches. Following PRISMA guidelines, articles were screened using inclusion (any study design reporting duration from initiation to death in adults palliative care services) and exclusion (paediatric/non-English language studies, trials influencing the timing of palliative care) criteria. Quality appraisal was completed using Hawker's criteria and the main outcome was the duration of palliative care (median/mean days from initiation to death).

Results: One hundred sixty-nine studies from 23 countries were included, involving 11,996,479 patients. Prior to death, the median duration from initiation of palliative care to death was 18.9 days (IQR 0.1), weighted by the number of participants. Significant differences between duration were found by disease type (15 days for cancer vs 6 days for non-cancer conditions), service type (19 days for specialist palliative care unit, 20 days for community/home care, and 6 days for general hospital ward) and development index of countries (18.91 days for very high development vs 34 days for all other levels of development). Forty-three per cent of studies were rated as 'good' quality. Limitations include a preponderance of data from high-income countries, with unclear implications for low- and middle-income countries.

Conclusions: Duration of palliative care is much shorter than the 3-4 months of input by a multidisciplinary team necessary in order for the full benefits of palliative care to be realised. Furthermore, the findings highlight inequity in access across patient, service and country characteristics. We welcome more consistent terminology and methodology in the assessment of duration of palliative care from all countries, alongside increased reporting from less-developed settings, to inform benchmarking, service evaluation and quality improvement.
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http://dx.doi.org/10.1186/s12916-020-01829-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690105PMC
November 2020

From Preproduction to Coproduction: COVID-19, whiteness, and making black mental health matter.

Lancet Psychiatry 2021 02 12;8(2):93-95. Epub 2020 Nov 12.

Department of Philosophy, University of Oxford, Oxford OX1 2JD, UK.

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http://dx.doi.org/10.1016/S2215-0366(20)30458-2DOI Listing
February 2021

Mitochondrial dysfunction in inflammatory bowel disease alters intestinal epithelial metabolism of hepatic acylcarnitines.

J Clin Invest 2021 Jan;131(1)

Department of Medicine, Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

As the interface between the gut microbiota and the mucosal immune system, there has been great interest in the maintenance of colonic epithelial integrity through mitochondrial oxidation of butyrate, a short-chain fatty acid produced by the gut microbiota. Herein, we showed that the intestinal epithelium could also oxidize long-chain fatty acids, and that luminally delivered acylcarnitines in bile could be consumed via apical absorption by the intestinal epithelium, resulting in mitochondrial oxidation. Finally, intestinal inflammation led to mitochondrial dysfunction in the apical domain of the surface epithelium that may reduce the consumption of fatty acids, contributing to higher concentrations of fecal acylcarnitines in murine Citrobacter rodentium-induced colitis and human inflammatory bowel disease. These results emphasized the importance of both the gut microbiota and the liver in the delivery of energy substrates for mitochondrial metabolism by the intestinal epithelium.
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http://dx.doi.org/10.1172/JCI133371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773399PMC
January 2021

Patient and professional experiences of palliative care referral discussions from cancer services: A qualitative interview study.

Eur J Cancer Care (Engl) 2021 Jan 13;30(1):e13340. Epub 2020 Oct 13.

Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.

Objectives: The aim of this paper was to identify current barriers, facilitators and experiences of raising and discussing palliative care with people with advanced cancer.

Methods: Semi-structured interviews were conducted with patients with advanced cancer and healthcare professionals (HCPs). Patients were included who had and had not been referred to palliative care. Transcripts were analysed using framework analysis.

Results: Twenty-four patients and eight HCPs participated. Two overarching themes and five sub-themes emerged: Theme one-referral process: timing and triggers, responsibility. Theme two-engagement: perception of treatment, prognosis and palliative care, psychological and emotional preparedness for discussion, and understanding how palliative care could benefit present and future care.

Conclusion: There is a need to identify suitable patients earlier in their cancer trajectory, address misconceptions about palliative care, treatment and prognosis, and better prepare patients and HCPs to have meaningful conversations about palliative care. Patients and HCPs need to establish and communicate the relevance of palliative care to the patient's current and future care, and be clear about the referral process.
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http://dx.doi.org/10.1111/ecc.13340DOI Listing
January 2021

Behind the mask: demedicalising race and mental health in professional football.

Authors:
Michael Bennett

Lancet Psychiatry 2021 04 9;8(4):264-266. Epub 2020 Oct 9.

The Professional Footballers Association, London EC3M 8AA, UK. Electronic address:

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http://dx.doi.org/10.1016/S2215-0366(20)30418-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546649PMC
April 2021

Is hospitalization a risk factor for cognitive decline in older age adults?

Int Psychogeriatr 2020 Sep 28:1-18. Epub 2020 Sep 28.

Centre for Healthy Brain and Ageing, University of New South Wales, Sydney, New South Wales, Australia.

Objectives: Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD).

Methods: We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle-Ottawa Scale.

Results: The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen's d = -0.25, 95% CI [-0.02, -0.49] I2 35%).

Conclusions: There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization.
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http://dx.doi.org/10.1017/S1041610220001763DOI Listing
September 2020

Supporting patient access to medicines in community palliative care: on-line survey of health professionals' practice, perceived effectiveness and influencing factors.

BMC Palliat Care 2020 Sep 24;19(1):148. Epub 2020 Sep 24.

Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, England.

Background: Patient access to medicines at home during the last year of life is critical for symptom control, but is thought to be problematic. Little is known about healthcare professionals' practices in supporting timely medicines access and what influences their effectiveness. The purpose of the study was to evaluate health professionals' medicines access practices, perceived effectiveness and influencing factors.

Methods: On-line questionnaire survey of health care professionals (General Practitioners, Community Pharmacists, community-based Clinical Nurse Specialists and Community Nurses) delivering end-of-life care in primary and community care settings in England. Quantitative data were analysed using descriptive statistics.

Results: One thousand three hundred twenty-seven responses were received. All health professional groups are engaged in supporting access to prescriptions, using a number of different methods. GPs remain a predominant route for patients to access new prescriptions in working hours. However, nurses and, increasingly, primary care-based pharmacists are also actively contributing. However, only 42% (160) of Clinical Nurse Specialists and 27% (27) of Community Nurses were trained as prescribers. The majority (58% 142) of prescribing nurses and pharmacists did not have access to an electronic prescribing system. Satisfaction with access to shared patient records to facilitate medicines access was low: 39% (507) were either Not At All or only Slightly satisfied. Out-of-hours specialist cover was reported by less than half (49%; 656) and many General Practitioners and pharmacists lacked confidence advising about out-of-hours services. Respondents perceived there would be a significant improvement in pain control if access to medicines was greater. Those with shared records access reported significantly lower pain estimates for their caseload patients.

Conclusions: Action is required to support a greater number of nurses and pharmacists to prescribe end-of-life medicines. Solutions are also required to enable shared access to patient records across health professional groups. Coverage and awareness of out-of-hours services to access medicines needs to be improved.
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http://dx.doi.org/10.1186/s12904-020-00649-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517636PMC
September 2020

South Pacific Underwater Medicine Society guidelines for cardiovascular risk assessment of divers.

Diving Hyperb Med 2020 Sep;50(3):273-277

Bristol Heart Institute, Bristol, United Kingdom.

The South Pacific Underwater Medicine Society (SPUMS) diving medical for recreational scuba divers was last reviewed in 2011. From 2011 to 2019, considerable advancements have occurred in cardiovascular risk assessment relevant to divers. The SPUMS 48th (2019) Annual Scientific Meeting theme was cardiovascular risk assessment in diving. The meeting had multiple presentations updating scientific information about assessing cardiovascular risk. These were distilled into a new set of guidelines at the final conference workshop. SPUMS guidelines for medical risk assessment in recreational diving have subsequently been updated and modified including a new Appendix C: Suggested evaluation of the cardiovascular system for divers. The revised evaluation of the cardiovascular system for divers covers the following topics: 1. Background information on the relevance of cardiovascular risk and diving; 2. Defining which divers with cardiovascular problems should not dive, or whom require treatment interventions before further review; 3. Recommended screening procedures (flowchart) for divers aged 45 and over; 4. Assessment of divers with known or symptomatic cardiovascular disease, including guidance on assessing divers with specific diagnoses such as hypertension, atrial fibrillation, cardiac pacemaker, immersion pulmonary oedema, takotsubo cardiomyopathy, hypertrophic cardiomyopathy and persistent (patent) foramen ovale; 5. Additional cardiovascular health questions included in the SPUMS guidelines for medical risk assessment in recreational diving; 6. Updated general cardiovascular medical risk assessment advice; 7. Referencing of relevant literature. The essential elements of this guideline are presented in this paper.
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http://dx.doi.org/10.28920/dhm50.3.273-277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819720PMC
September 2020

An observational trial to establish the effect of hyperbaric oxygen treatment on pelvic late radiation tissue injury due to radiotherapy.

Diving Hyperb Med 2020 Sep;50(3):250-255

Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney, Australia.

Introduction: Rates of pelvic cancer are growing globally with around half of these patients receiving radiotherapy. In a small proportion, radiotherapy results in significant late radiation tissue injury (LRTI) to surrounding tissue, most commonly affecting the bladder and bowel mucosa. We conducted a combined prospective and retrospective observational trial to establish the effectiveness of hyperbaric oxygen treatment (HBOT) in improving the symptoms and signs of LRTI in these patients.

Methods: Fifty-two patients were included after receiving radiotherapy for cancers of the bowel, bladder, cervix, prostate or vulva. They received HBOT at 203-243 kPa (2.0-2.4 atmospheres absolute (atm abs)) for 90 minutes with the median number of treatments being 30 (IQR 1). Late effects normal tissues - subjective, objective, management, analytic (LENT-SOMA) scores were recorded before and after treatment.

Results: The mean LENT-SOMA scores before and after HBOT were 11.7 (SD 5.3) and 8.1 (5.1) respectively. This reduction in score of 3.7 (95% CI 2.6 to 4.8) was statistically significant (P < 0.001). For radiation cystitis the mean reduction was 3.7 (95% CI 2.4 to 5.0, P < 0.001) and for radiation proctitis was 3.8 (95% CI 1.4 to 6.1, P = 0.004). There were no significant adverse effects recorded.

Conclusions: Hyperbaric oxygen treatment may be an effective and safe treatment for pelvic late tissue radiation injury.
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http://dx.doi.org/10.28920/dhm50.3.250-255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819726PMC
September 2020

Factors affecting cost and patient choice of travel insurance in cardiac disease: a web-based case-control study.

J R Coll Physicians Edinb 2020 Sep;50(3):233-240

Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK.

Background: The aim of this study was to explore variations in cost and choice of travel insurance in patients with cardiac disease.

Methods: Clinical data from patients with myocardial infarction (MI, n = 20), Marfan syndrome (MFS, n = 10) and dilated cardiomyopathy (DCM, n = 10) were input to insurance websites for a proposed ten-day holiday and data for premium cost (£) and choice of quotes (n) collated for each condition. Age-matched healthy individuals were used as controls.

Results: Median cost of insurance was significantly higher for MI (£233.07; interquartile range (IQR) = £222.95-£245.47 versus £24.29; IQR = £11.9-£34.09, p = < 0.001), MFS (£37.43; IQR = £23.61-58.83 versus £19.20; IQR = £9.09-£27.31, p = 0.0378)) and DCM (£166.87; IQR = £129.71-£198.62 versus £23.96; IQR = £11.99-£32.44, p = <0.001) compared to controls. Choice of quotes was also significantly reduced for MI (5; IQR = 5-14 versus 89; IQR = 26-110, p = <0.001) MFS (61; IQR = 26-83 versus 105; 26-105, p = <0.001) and DCM (19; IQR = 16-28 versus 89; IQR = 26-106, p = <0.001) compared to controls. Modifiable factors, such as time after cardiac event or awaiting further investigations, and clinical factors, such as persistent symptoms and disease severity, lead to a significant increase in cost.

Conclusion: This study provides insight into the factors affecting cost and choice of travel insurance for patients with cardiac disease. The findings highlight ways in which healthcare professionals can support patients to obtain travel insurance.
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http://dx.doi.org/10.4997/JRCPE.2020.305DOI Listing
September 2020

State of the science: opioids and survival in cancer pain management.

BMJ Support Palliat Care 2020 12 11;10(4):379-380. Epub 2020 Sep 11.

Academic Unit of Palliative Care, University of Leeds, Leeds, UK.

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http://dx.doi.org/10.1136/bmjspcare-2020-002624DOI Listing
December 2020

Interleukin-4 improves white matter integrity and functional recovery after murine traumatic brain injury via oligodendroglial PPARγ.

J Cereb Blood Flow Metab 2021 Mar 5;41(3):511-529. Epub 2020 Aug 5.

Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA, USA.

Long-term neurological recovery after severe traumatic brain injury (TBI) is strongly linked to the repair and functional restoration of injured white matter. Emerging evidence suggests that the anti-inflammatory cytokine interleukin-4 (IL-4) plays an important role in promoting white matter integrity after cerebral ischemic injury. Here, we report that delayed intranasal delivery of nanoparticle-packed IL-4 boosted sensorimotor neurological recovery in a murine model of controlled cortical impact, as assessed by a battery of neurobehavioral tests for up to five weeks. Post-injury IL-4 treatment failed to reduce macroscopic brain lesions after TBI, but preserved the structural and functional integrity of white matter, at least in part through oligodendrogenesis. IL-4 directly facilitated the differentiation of oligodendrocyte progenitor cells (OPCs) into mature myelin-producing oligodendrocytes in primary cultures, an effect that was attenuated by selective PPARγ inhibition. IL-4 treatment after TBI in vivo also failed to stimulate oligodendrogenesis or improve white matter integrity in OPC-specific PPARγ conditional knockout (cKO) mice. Accordingly, IL-4-afforded improvements in sensorimotor neurological recovery after TBI were markedly impaired in the PPARγ cKO mice compared to wildtype controls. These results support IL-4 as a potential novel neurorestorative therapy to improve white matter functionality and mitigate the long-term neurological consequences of TBI.
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http://dx.doi.org/10.1177/0271678X20941393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922743PMC
March 2021

Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium.

Ann Intensive Care 2020 Aug 3;10(1):104. Epub 2020 Aug 3.

Australian National University Medical School, Canberra, Australia.

Objective: Delirium is common in intensive care patients and is associated with short- and long-term adverse outcomes. We investigated the long-term risk of cognitive impairment and post-traumatic stress disorder (PTSD) in intensive care patients with and without delirium.

Methods: This is a prospective cohort study in ICUs in two Australian university-affiliated hospitals. Patients were eligible if they were older than 18 years, mechanically ventilated for more than 24 h and did not meet exclusion criteria. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Variables assessing cognitive function and PTSD symptoms were collected at ICU discharge, after 6 and 12 months: Mini-Mental State Examination, Telephone Interview for Cognitive Status, Impact of Events Scale-Revised and Informant Questionnaire for Cognitive Decline (caregiver).

Results: 103 participants were included of which 36% developed delirium in ICU. Patients with delirium were sicker and had longer duration of mechanical ventilation and ICU length of stay. After 12 months, 41/60 (68.3%) evaluable patients were cognitively impaired, with 11.6% representing the presence of symptoms consistent with dementia. When evaluated by the patient's caregiver, the patient's cognitive function was found to be severely impaired in a larger proportion of patients (14/60, 23.3%). Delirium was associated with worse cognitive function at ICU discharge, but not with long-term cognitive function. IES-R scores, measuring PTSD symptoms, were significantly higher in patients who had delirium compared to patients without delirium. In regression analysis, delirium was independently associated with cognitive function at ICU discharge and PTSD symptoms at 12 months.

Conclusions: Intensive care survivors have significant rates of long-term cognitive decline and PTSD symptoms. Delirium in ICU was independently associated with short-term but not long-term cognitive function, and with long-term PTSD symptoms. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616001116415, 15/8/2016 retrospectively registered, https://www.anzctr.org.au.
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http://dx.doi.org/10.1186/s13613-020-00723-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399009PMC
August 2020

Quantitative Assessment of Regional Mucociliary Clearance in Smokers with Mild-to-Moderate Chronic Obstructive Pulmonary Disease and Chronic Bronchitis from Planar Radionuclide Imaging.

J Aerosol Med Pulm Drug Deliv 2020 12 8;33(6):342-356. Epub 2020 Jul 8.

Active Biotech, Lund, Sweden.

Mucociliary clearance (MCC) rate from the lung has been shown to be reduced in chronic obstructive pulmonary disease (COPD). This study investigates the value of regional clearance measurements in assessing MCC in mild-to-moderate disease. Measurement of lung MCC using planar gamma camera imaging was performed in three groups: (i) healthy nonsmoking controls (NSCs) ( = 9), (ii) smoking controls (SCs) who were current smokers with normal lung function ( = 10), and (iii) current smokers with mild-to-moderate COPD and bronchitis ( = 15). The mean (±standard deviation) forced expiratory volumes at 1 second (FEV1) for the three groups were 109 (± 18), 94 (± 5), and 78 (± 12), respectively. After inhalation of a technetium-99m labeled aerosol, planar imaging was performed over 4 hours and then at 24 hours. Both lung clearance and tracheobronchial clearance (TBC) (normalized to 24 hours clearance) were calculated for inner and outer lung zones. Inner zone clearance was corrected for input from the outer zone. A novel parameter, the bronchial airways clearance index (BACI), which combined clearance data from both zones, was also evaluated. Regional results were compared with whole lung clearance in the same subjects. Corrected inner zone clearance at 3 hours was not reduced compared with NSC in either SCs or COPD. Outer zone clearance was higher in COPD than in the other groups. Corrected inner zone TBC showed significant reductions in SC and COPD compared with NSC. BACI was significantly reduced in COPD compared with NSC and also correlated with FEV1. The mean BACI for SC was also reduced compared with NSC, but the distribution of results was bimodal, with a significant proportion of subjects having values in the NSC range. Regional MCC demonstrated differences between NSCs, SCs, and subjects with mild-to-moderate COPD, which were not apparent with whole lung measurements.
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http://dx.doi.org/10.1089/jamp.2019.1551DOI Listing
December 2020

Barriers to Efficient Foliar Uptake of dsRNA and Molecular Barriers to dsRNA Activity in Plant Cells.

Front Plant Sci 2020 12;11:816. Epub 2020 Jun 12.

Bayer AG, Woodland, CA, United States.

Foliar application of dsRNA to elicit an RNA interference (RNAi) response is currently under consideration as a crop protection strategy. To access the RNAi machinery of a plant, foliarly applied dsRNAs must traverse the plant cuticle, avoid nuclease degradation, and penetrate the cell wall and plasma membrane. Application methods and co-formulants have been identified by Bayer Crop Science researchers and others that can help bypass barriers to dsRNA uptake in plants leading to an RNAi response in greenhouse grown, young plants and cell cultures. However, these advances in dsRNA delivery have yet to yield systemic RNAi silencing of an endogenous gene target required for product concepts such as weed control. Systemic RNAi silencing in plants has only been observed with the transgene in . Because biologically meaningful whole plant RNAi has not been observed for endogenous gene products in or in other plant species tested, under growing conditions including field production, the regulatory risk assessment of foliarly applied dsRNA-based products should not consider exposure scenarios that include systemic response to small RNAs in treated plants.
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http://dx.doi.org/10.3389/fpls.2020.00816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304407PMC
June 2020

Identification of patients with potential palliative care needs: A systematic review of screening tools in primary care.

Palliat Med 2020 09 7;34(8):989-1005. Epub 2020 Jun 7.

Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK.

Background: Despite increasing evidence of the benefits of early access to palliative care, many patients do not receive palliative care in a timely manner. A systematic approach in primary care can facilitate earlier identification of patients with potential palliative care needs and prompt further assessment.

Aim: To identify existing screening tools for identification of patients with advanced progressive diseases who are likely to have palliative care needs in primary healthcare and evaluate their accuracy.

Design: Systematic review (PROSPERO registration number CRD42019111568).

Data Sources: Cochrane, MEDLINE, Embase and CINAHL were searched from inception to March 2019.

Results: From 4,127 unique articles screened, 25 reported the use or development of 10 screening tools. Most tools use prediction of death and/or deterioration as a proxy for the identification of people with potential palliative care needs. The tools are based on a wide range of general and disease-specific indicators. The accuracy of five tools was assessed in eight studies; these tools differed significantly in their ability to identify patients with potential palliative care needs with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99%.

Conclusion: The ability of current screening tools to identify patients with advanced progressive diseases who are likely to have palliative care needs in primary care is limited. Further research is needed to identify standardised screening processes that are based not only on predicting mortality and deterioration but also on anticipating the palliative care needs and predicting the rate and course of functional decline. This would prompt a comprehensive assessment to identify and meet their needs on time.
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http://dx.doi.org/10.1177/0269216320929552DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388141PMC
September 2020

Short- and long-term diets of the threatened longhorned pygmy devil ray, Mobula eregoodoo determined using stable isotopes.

J Fish Biol 2020 Aug 16;97(2):424-434. Epub 2020 Jun 16.

School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia.

Most mobulids are listed as near threatened to endangered. Nonetheless, effective conservation measures are hindered by knowledge gaps in their ecology and behaviour. In particular, few studies have assessed diets and trophic ecologies that could inform methods to avoid fishing mortality. Here, a shortfall in data for the longhorned pygmy devil ray, Mobula eregoodoo was addressed by describing temporal variability in dietary preferences using stable isotope analysis. During summer and autumn in 2017, five bather-protection gillnets were deployed off eastern Australia (29° S, 153.5° E). From the catches of these gillnets, 35 adult M. eregoodoo had liver, muscle and stomach contents sampled to determine δ C and δ N profiles. Analyses revealed that surface zooplankton and zooplanktivorous teleosts were important dietary components across short- and long-term temporal scales. Large quantities of undigested sandy sprat, Hyperlophus vittatus, in the stomachs of some specimens unequivocally confirm feeding on teleosts. A narrow isotopic niche and minimal isotopic overlap with reef manta rays, Mobula alfredi from the same geographic region in eastern Australia implies M. eregoodoo has unique and highly specialised resource use relative to other mobulids in the area. The species is clearly vulnerable to capture during inshore migrations, presumably where they feed on shallow-water shoaling teleosts. Female M. eregoodoo likely have a low annual reproductive output, so population recoveries from fishing-induced declines are likely to be slow. Measures to reduce the by catch of M. eregoodoo in local bather-protection gillnets, and artisanal fisheries more broadly, should be given priority.
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http://dx.doi.org/10.1111/jfb.14381DOI Listing
August 2020