Amara Callistus Nwosu

Social media and palliative medicine: a retrospective 2-year analysis of global twitter data to evaluate the use of technology to communicate about issues at the end of life

Background Social media describes technological applications which are used to exchange information in a virtual environment. The use of social media is increasing, in professional and social contexts, on a variety of platforms such as Twitter; however, the scope and breadth of its use to discuss end-of-life care has not previously been reported. Aims To determine the frequency, sentiment and trend of Twitter ‘tweets’ containing palliative care-related identifiers (hashtags) and/or phrases sent by users over a 2-year period. Methods A 2-year retrospective analysis of Twitter posts (tweets), between the 1 August 2011 to 31 July 2013, using a social media analytics tool: TopsyPro. Thirteen search terms were identified and analysed for tweet volume, frequency, sentiment and acceleration. Results A total of 683.5K tweets containing a combination of 13 palliative care terms were analysed. The tweet volume for all terms increased by 62.3% between 2011–2012 (262.5K) and 2012–2013 (421K). The most popular terms include ‘end-of-life’ (210K), #hpm (114K) and ‘palliative care’ (93.8K). Sentiment was high with 89% of tweets rated more positive than all other tweets sent on Twitter during this period. The term ‘Liverpool Care Pathway’ experienced the highest percentage increase in tweets (55% increase) reaching a peak in July 2013. Conclusions A lot of discussion about palliative care is taking place on Twitter, and the majority of this is positive. Social media presents a novel opportunity for engagement and ongoing dialogue with public and professional groups.

Palliative medicine and smartphones: an opportunity for innovation?

Background The use of smartphones and their software applications (apps) provides health professionals with opportunities to integrate technology into clinical practice. Increasing numbers of work-related apps are available to health professionals, especially in certain specialties such as orthopaedics. However, so far the availability of apps specific to palliative medicine is limited. Objectives To review all smartphone apps targeted at health professionals within palliative medicine and available for the five most popular operating systems (iPhone, Blackberry, Android, Palm and Windows) . Methods Each smartphone app store was systematically searched with a combination of the following keywords: palliative, pain, cancer, symptoms, medicine. Identified apps were purchased and tested to determine if their title and/or description was relevant to palliative care. Results Six apps specific to palliative medicine were identified across all five operating systems. These consisted of blog orientated apps (Pallimed and Geripal), an app containing guidelines from eight cancer networks (PalliApp), an educational app (Palliative Care) and opioid dose converter apps (eOpioid and PalliCalc). Conclusions There is a lack of palliative medicine specific resources for smartphones and no studies have been published which examine the potential benefits of mobile technology for learning, clinical practice and professional development. This provides an opportunity for further research and development. Academic institutions could work with technological developers to improve access to, and dissemination of, key information for practice. Considered development of mobile technology has the potential to improve patient care, data sharing and education within the palliative medicine specialty.

Hydration in Advanced Cancer: Can Bioelectrical Impedance Analysis Improve the Evidence Base? A Systematic Review of the Literature

CONTEXT Decisions surrounding the administration of clinically assisted hydration to patients dying of cancer can be challenging because of the limited understanding of hydration in advanced cancer and a lack of evidence to guide health care professionals. Bioelectrical impedance analysis (BIA) has been used to assess hydration in various patient groupings, but evidence for its use in advanced cancer is limited. OBJECTIVES To critically appraise existing methods of hydration status assessment in advanced cancer and review the potential for BIA to assess hydration in advanced cancer. METHODS Searches were carried out in four electronic databases. A hand search of selected peer-reviewed journals and conference abstracts also was conducted. Studies reporting (de)hydration assessment (physical examination, biochemical measures, symptom assessment, and BIA) in patients with advanced cancer were included. RESULTS The results highlight how clinical examination and biochemical tests are standard methods of assessing hydration, but limitations exist with these methods in advanced cancer. Furthermore, there is disagreement over the evidence for some commonly associated symptoms with dehydration in cancer. Although there are limitations with using BIA alone to assess hydration in advanced cancer, analysis of BIA raw measurements through the method of bioelectrical impedance vector analysis may have a role in this population. CONCLUSION The benefits and burdens of providing clinically assisted hydration to patients dying of cancer are unclear. Bioelectrical impedance vector analysis shows promise as a hydration assessment tool but requires further study in advanced cancer. Innovative methodologies for research are required to add to the evidence base and ultimately improve the care for the dying.

Use of podcast technology to facilitate education, communication and dissemination in palliative care: the development of the AmiPal podcast

Objectives Podcasts have the potential to facilitate communication about palliative care with researchers, policymakers and the public. Some podcasts about palliative care are available; however, this is not reflected in the academic literature. Further study is needed to evaluate the utility of podcasts to facilitate knowledge-transfer about subjects related to palliative care. The aims of this paper are to (1) describe the development of a palliative care podcast according to international recommendations for podcast quality and (2) conduct an analysis of podcast listenership over a 14-month period. Methods The podcast was designed according to internationally agreed quality indicators for medical education podcasts. The podcast was published on SoundCloud and was promoted via social media. Data were analysed for frequency of plays and geographical location between January 2015 and February 2016. Results 20 podcasts were developed which were listened to 3036 times (an average of 217 monthly plays). The Rich Site Summary feed was the most popular way to access the podcast (n=1937; 64%). The mean duration of each podcast was 10 min (range 3–21 min). The podcast was listened to in 68 different countries and was most popular in English-speaking areas, of which the USA (n=1372, 45.2%), UK (n=661, 21.8%) and Canada (n=221, 7.3%) were most common. Conclusions A palliative care podcast is a method to facilitate palliative care discussion with global audience. Podcasts offer the potential to develop educational content and promote research dissemination. Future work should focus on content development, quality metrics and impact analysis, as this form of digital communication is likely to increase and engage wider society.

Longitudinal bioimpedance assessments to evaluate hydration in POEMS syndrome

Polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes (POEMS) syndrome is a rare paraneoplastic disorder associated with an underlying plasma cell dyscrasia and multiorgan failure. POEMS syndrome is potentially fatal and adversely affects quality of life. Oedema is common with many patients affected by pleural effusions, ascites and lower limb oedema. Bioelectrical impedance vector analysis (BIVA) is a non-invasive assessment tool, which enables rapid bedside assessments of nutrition and hydration. This paper describes the use of sequential BIVA assessments to evaluate the response to diuretic therapy in a woman aged 52 years with POEMS syndrome. This case illustrates the potential to use BIVA to conduct longitudinal assessments of hydration status. This provides opportunities for further research using BIVA to monitor hydration and response to interventions. This may be useful in specific situations, for example at the end of life.

Patients want to be involved in end-of-life care research

Advances in multimodal cancer-directed treatment have improved survival for metastatic cancer patients. In the Western world the combination of various demographic, health-related and sociological factors will contribute to increased comorbidities and mortality over the next decade. A careful, evidence-based approach is necessary to address the inevitable challenges, which will be posed by an increasingly aged population that will require supportive care towards the end of their lives.1 Further investment in palliative care research is required to generate the evidence which will improve the care delivered to patients approaching death.2 Currently, funding for end-of-life and palliative care research is inadequate. Data on UK research funding by National Cancer Research Institute partners in …

Palliative Care and Obesity: Are We Prepared?

Obesity is a major public health problem which can result in premature death due to its association with serious chronic conditions, such as type 2 diabetes, hypertension, and cancer. The World Health Organisation (WHO) indicates that obesity is the fifth leading risk factor for global deaths, with 2.8 million adults dying each year as a result of being overweight or obese. WHO projects a worldwide disease burden of 2.5 billion overweight adults and 700 million obese adults by 2015. The prevalence of obesity is increasing in England with 24.5% of adults classified as obese. If current trends of obesity continue it is predicted approximately one third of adults in England will be obese by 2012. Obesity creates significant challenges to palliative medicine with premature death and adverse quality of life. These difficulties are likely to increase due to an aging population, increasing prevalence of obesity, and improved access to palliative care services. There are no published studies around the topic of obesity and palliative care, with the exception of one letter highlighting the potential classification of moribund obesity as a palliative care diagnosis. We would like to present a case in which obesity was a key factor in affecting delivery of palliative care to a patient in a large university teaching hospital.

Big Data analysis to improve care for people living with serious illness: The potential to use new emerging technology in palliative care.

We read with interest the editorial by Peter Tanuesputro,1 which describes how Big Data analysis of linked data has the potential to support palliative care by improving identification of patient needs. The editorial described how the use of predictive algorithms (built using routinely collected data) could help to personalise care for people with palliative care needs. However, it is necessary to address the potential barriers that may prevent the full potential of Big Data from being realised.2 Some of these challenges (highlighted in the editorial) include the inadequate capture of certain information, such as nonhospital and mortality data, patient experience information and available familial/social support. In addition to these challenges, we discuss five additional issues that need to be considered in order to make meaningful use of Big Data analysis in palliative care.

The evaluation of a peer‐led question‐writing task

Background:  Novel studies have previously highlighted the educational benefits of peer‐led learning and peer marking of examinations. Limited data exist about the educational value of students writing their own exam questions and sharing these with other students.

Wearable smartwatch technology to monitor symptoms in advanced illness

The development of sensor-based technologies has led to the creation of wearable health monitoring systems to provide real-time feedback information to support health.1 This technology has the potential to assist the monitoring and management of symptoms in advanced disease, such as pain management.2 Within our university, we have developed a partnership between Computer Science and Palliative Medicine to examine the potential to use technology to support care for people living with …