Jennifer McGaughey

An evaluation of palliative care services for cancer patients in the Southern Health and Social Services Board of Northern Ireland

An interview study of 55 lay carers of people who died from cancer in the Southern Board of Northern Ireland was undertaken using a combination of closed-format and open-ended questions. The aim of the study was to evaluate palliative care services delivered in the last six months of their lives to cancer patients who died either at home or in hospital. Two-thirds of the deaths (36) occurred in the domestic home, 45 of the deceased were admitted as hospital inpatients, and the great majority were in receipt of community nursing (53) and general practitioner (54) services. Open-ended questions were used to allow respondents to give their views about services in some detail and their views about good and bad aspects of services were sought. While they were generally satisfied with services specific areas of difficulty were identified in each aspect of care addressed by the study. The most favourable assessments were made of community nursing with the greatest number of negative comments being made about inpatient hospital care. Differing interests between some of those who were dying and their lay carers were found in two areas: the receipt of help from nonfamily members and the information that the deceased received about their terminal status.

Impact of non-pharmacological interventions on prevention and treatment of delirium in critically ill patients: protocol for a systematic review of quantitative and qualitative research

BackgroundCritically ill patients have an increased risk of developing delirium during their intensive care stay. To date, pharmacological interventions have not been shown to be effective for delirium management but non-pharmacological interventions have shown some promise. The aim of this systematic review is to identify effective non-pharmacological interventions for reducing the incidence or the duration of delirium in critically ill patients.MethodsWe will search MEDLINE, EMBASE, CINAHL, Web of Science, AMED, psycINFO and the Cochrane Library. We will include studies of critically ill adults and children. We will include randomised trials and controlled trials which measure the effectiveness of one or more non-pharmacological interventions in reducing incidence or duration of delirium in critically ill patients. We will also include qualitative studies that provide an insight into patients and their families’ experiences of delirium and non-pharmacological interventions. Two independent reviewers will assess studies for eligibility, extract data and appraise quality. We will conduct meta-analyses if possible or present results narratively. Qualitative studies will also be reviewed by two independent reviewers, and a specially designed quality assessment tool incorporating the CASP framework and the POPAY framework will be used to assess quality.DiscussionAlthough non-pharmacological interventions have been studied in populations outside of intensive care units and multicomponent interventions have successfully reduced incidence and duration of delirium, no systematic review of non-pharmacological interventions specifically targeting delirium in critically ill patients have been undertaken to date. This systematic review will provide evidence for the development of a multicomponent intervention for delirium management of critically ill patients that can be tested in a subsequent multicentre randomised trial.Systematic review registrationPROSPERO CRD42015016625

Early warning systems and rapid response to the deteriorating patient in hospital: a systematic realist review.

AIM To determine the Rapid Response System programme theory and investigate how the mechanisms of implementation and the characteristics of context combine to enable or constrain the implementation of Rapid Response Systems and the achievement of desired outcomes. BACKGROUND Rapid Response Systems have been implemented internationally to improve the recognition and management of patient deterioration, reduce the need for cardiopulmonary resuscitation and improve patient outcomes. DESIGN Realist review. DATA SOURCES We searched DARE, CENTRAL, NHSEED, MEDLINE, Medline In Process, EMBASE, CINAHL, PubMed, Scopus, The Web of Science and PychInfo databases from 1997 - 2017 in addition to purposively searching the grey literature looking for articles supporting, refuting or explaining Rapid Response System programme theories. REVIEW METHODS Included studies were critically appraised and graded using the Critical Appraisal Skills Programme tool. Data extraction and synthesis investigated the Rapid Response System theoretical propositions against the empirical evidence to refine Rapid Response System programme theories. RESULTS The review found that the Rapid Response System programme theory achieved desired outcomes when there were sufficient skills mix of experienced staff, EWS protocols were used flexibly alongside clinical judgement and staff had access to ongoing, multiprofessional, competency-based education. However, ward cultures, hierarchical referral systems, workload and staffing resources had a negative impact on the implementation of the Rapid Response System. CONCLUSION To improve the recognition and management of patient deterioration, policymakers need to address those cultural, educational and organizational factors that have an impact on the successful implementation of Rapid Response Systems in practice.

Exploring parental reasons for attendance at emergency departments for children with minor illness: A mixed methods systematic review

C cystic adenomatoid malformation (CCAM), also called congenital pulmonary adenomatoid malformation (CPAM), is a rare hamartomatous cystic lesion. Our previous study noted that the occurrence is approximately 4.01:10,000 in China. Open fetal surgery currently provides a potential therapeutic option for management of the fetus with CCAM diagnosis. A 22-year-old G2P0 female presented at 211/7 weeks’ gestation for evaluation of a fetus with a left lung lesion and diagnosed as CCAM at 283/7 weeks’ gestation. Open fetal surgery was performed to resection the lesion at 292/7 weeks’ gestation under deep maternal general anesthesia. The mother presented at 35/7 weeks after open fetal surgery with preterm premature rupture of membranes (PPROM) and underwent cesarean delivery at 326/7 weeks’ gestation. A vigorous female infant of 1955 g, with good Apgar score, was delivered. At one month, 4 years, and present, 6 years after birth, she has continued to do well without any obvious deficit and both respiration and circulation were well maintained. Complex care undergoing fetal surgery requires a well-coordinated multidisciplinary team. Nurses in many roles are essential members of the team that cares for this woman across the continuum. A basic maternal medical, obstetric history, information about family support, family’s anxiety level, and their understanding of the diagnosis are obtained during the initial screening. The surgical procedure and potential risks and benefits are reviewed, informed consent obtained, and any remaining questions the family may have been answered before the surgery. After discharge, psychosocial support of the women and her family is extremely important throughout this experience. Follow-up assessments continue for the child each year and long term follow-up will continue at 10 and 15 years. The nursing care undergoing fetal surgery is complex and provides an essential thread of continuity through the process.