AMRC open research最新文献

{"title":"Research Evaluating Staff Training Online for Resilience (RESTORE):  Protocol for a single-arm feasibility study of an online Acceptance and Commitment Therapy intervention to improve staff wellbeing in palliative care settings","authors":"A. Finucane, N. Hulbert-Williams, Brooke Swash, J. Spiller, Brigid Lydon, D. Gillanders","doi":"10.12688/amrcopenres.13035.1","DOIUrl":"https://doi.org/10.12688/amrcopenres.13035.1","url":null,"abstract":"Background Palliative care workers commonly experience workplace stress and distress. General stressors include unmanageable workloads and staff shortages.  Stressors specific to palliative care include regular exposure to death, loss and grief.  The COVID pandemic exacerbated exhaustion and burnout across the healthcare system, including for those providing palliative care.  Evidence based psychological support interventions, tailored to the needs and context of palliative care workers, are needed.  Acceptance and Commitment Therapy (ACT) is an established form of cognitive behavioural therapy which uses behavioural psychology, values, acceptance, and mindfulness techniques to improve mental health and wellbeing. ACT is effective in improving workplace wellbeing in many occupational settings.  Our study examines the acceptability and feasibility of an online ACT-based intervention to improve mental health and wellbeing in staff caring for people with an advanced progressive illness. Methods A single-arm feasibility trial.  We will seek to recruit 30 participants to take part in an 8- week online ACT-based intervention, consisting of three synchronous facilitated group sessions and five asynchronous self-directed learning modules.  We will use convergent mixed methods to evaluate the feasibility of the intervention. Quantitative feasibility outcomes will include participant recruitment and retention rates, alongside completion rates of measures assessing stress, quality of life, wellbeing, and psychological flexibility.  Focus groups and interviews will explore participant perspectives on the intervention. We will run a stakeholder workshop to further refine the intervention and identify outcomes for use in a future evaluation. Results We will describe participant perspectives on intervention acceptability, format, content, and perceived impact alongside rates of intervention recruitment, retention, and outcome measure completion. Conclusion We will show whether a brief, online ACT intervention is acceptable to, and feasible for palliative care workers.  Findings will be used to further refine the intervention and provide essential information on outcome assessment prior to a full-scale evaluation.","PeriodicalId":72183,"journal":{"name":"AMRC open research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45403622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What do we know about the impact of the Covid-19 pandemic on hospices? A collaborative multi-stakeholder knowledge synthesis.","authors":"John MacArtney, Abi Eccles, Joanna Fleming, Catherine Grimley, Jeremy Dale, Kathryn Almack, Catriona Mayland, Sarah Mitchell, Ruth Driscoll, Rebecca Hammond, Lynn Tatnell, Lesley Roberts","doi":"10.12688/amrcopenres.13023.1","DOIUrl":"10.12688/amrcopenres.13023.1","url":null,"abstract":"<p><strong>Background: </strong>Prior to undertaking a study looking at the effects of the COVID-19 pandemic upon lived experiences of hospice services in the West Midlands, we sought to identify the range of issues that hospice service users and providers faced between March 2020 and July 2021, and to provide a report that can be accessed and understood by all interested stakeholders.</p><p><strong>Methods: </strong>We undertook a collaborative multi-stakeholder approach for scoping the range of potential issues and synthesising knowledge. This involved a review of available literature; a focus group with hospice stakeholders; and a collaborative knowledge exchange panel.</p><p><strong>Results: </strong>The literature on the effects of the COVID-19 pandemic on hospices remains limited, but it is developing a picture of a service that has had to rapidly adapt the way it provides care and support to its service users, during a period when it faced many fundamental challenges to established ways of providing these services.</p><p><strong>Results: </strong>The impacts of many of the changes on hospices have not been fully assessed. It is also not known what the effects upon the quality of care and support are for those with life-limiting conditions and those that care for them. We found that the pandemic has presented a new normative and service context in which quality of care and life itself was valued that is, as yet, poorly understood.</p>","PeriodicalId":72183,"journal":{"name":"AMRC open research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11064980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48148582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prior elicitation of the efficacy and tolerability of Methotrexate and Mycophenolate Mofetil in Juvenile Localised Scleroderma.","authors":"Yasin Desai, Thomas Jaki, Michael W Beresford, Thomas Burnett, Despina Eleftheriou, Heidi Jacobe, Valentina Leone, Suzanne Li, Pavel Mozgunov, Athimalaipet V Ramanan, Kathryn S Torok, Marina E Anderson, Jordi Anton, Tadej Avcin, Jessie Felton, Ivan Foeldvari, Bisola Laguda, Flora McErlane, Lindsay Shaw, Francesco Zulian, Clare E Pain","doi":"10.12688/amrcopenres.13008.1","DOIUrl":"10.12688/amrcopenres.13008.1","url":null,"abstract":"<p><strong>Background: </strong>Evidence is lacking for safe and effective treatments for juvenile localised scleroderma (JLS). Methotrexate (MTX) is commonly used first line and mycophenolate mofetil (MMF) second line, despite a limited evidence base. A head to head trial of these two medications would provide data on relative efficacy and tolerability. However, a frequentist approach is difficult to deliver in JLS, because of the numbers needed to sufficiently power a trial. A Bayesian approach could be considered.</p><p><strong>Methods: </strong>An international consensus meeting was convened including an elicitation exercise where opinion was sought on the relative efficacy and tolerability of MTX compared to MMF to produce prior distributions for a future Bayesian trial. Secondary aims were to achieve consensus agreement on critical aspects of a future trial.</p><p><strong>Results: </strong>An international group of 12 clinical experts participated. Opinion suggested superior efficacy and tolerability of MMF compared to MTX; where most likely value of efficacy of MMF was 0.70 (95% confidence interval (CI) 0.34-0.90) and of MTX was 0.68 (95% CI 0.41-0.8). The most likely value of tolerability of MMF was 0.77 (95% CI 0.3-0.94) and of MTX was 0.62 (95% CI 0.32-0.84). The wider CI for MMF highlights that experts were less sure about relative efficacy and tolerability of MMF compared to MTX. Despite using a Bayesian approach, power calculations still produced a total sample size of 240 participants, reflecting the uncertainty amongst experts about the performance of MMF.</p><p><strong>Conclusions: </strong>Key factors have been defined regarding the design of a future Bayesian approach clinical trial including elicitation of prior opinion of the efficacy and tolerability of MTX and MMF in JLS. Combining further efficacy data on MTX and MMF with prior opinion could potentially reduce the pre-trial uncertainty so that, when combined with smaller trial sample sizes a compelling evidence base is available.</p>","PeriodicalId":72183,"journal":{"name":"AMRC open research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11064983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41349820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A feasibility pilot study of the effects of neurostimulation on dysphagia recovery in Parkinson’s Disease","authors":"A. Sasegbon, U. Hammerbeck, E. Michou, Ivy Cheng, Mengqing Zhang, C. James, S. Hamdy","doi":"10.12688/amrcopenres.13007.1","DOIUrl":"https://doi.org/10.12688/amrcopenres.13007.1","url":null,"abstract":"Introduction: Dysphagia often occurs during Parkinson’s disease (PD) and can have severe consequences. Recently, neuromodulatory techniques have been used to treat neurogenic dysphagia. Here we aimed to compare the neurophysiological and swallowing effects of three different types of neurostimulation, 5 Hertz (Hz) repetitive transcranial magnetic stimulation (rTMS), 1 Hz rTMS and pharyngeal electrical stimulation (PES).   Method: 12 PD patients with dysphagia were randomised to receive either 5 Hz rTMS, 1 Hz rTMS, or PES. In a cross-over design, patients were assigned to one intervention and received both real and sham stimulation. Patients received a baseline videofluoroscopic (VFS) assessment of their swallowing, enabling penetration aspiration scores (PAs) to be calculated for: thin fluids, paste, solids and cup drinking. Swallowing timing measurements were also performed on thin fluid swallows only. They then had baseline recordings of motor evoked potentials (MEPs) from both pharyngeal and (as a control) abductor pollicis brevis (APB) cortical areas using single-pulse TMS. Subsequently, the intervention was administered and post interventional TMS recordings were taken at 0 and 30 minutes followed by a repeat VFS within 60 minutes of intervention. Results: All interventions were well tolerated. Due to lower than expected recruitment, statistical analysis of the data was not undertaken. However, with respect to PAs swallowing timings and MEP amplitudes, there was visual separation in a positive direction between active and sham groups for all interventions. Conclusion: PES, 5 Hz rTMS and 1 Hz rTMS are tolerable interventions in PD related dysphagia. Due to small patient numbers no definitive conclusions could be drawn from the data with respect to individual interventions improving swallowing function and comparative effectiveness between interventions. Larger future studies are needed to further explore the efficacy of these neuromodulatory treatments in Parkinson’s Disease associated dysphagia.","PeriodicalId":72183,"journal":{"name":"AMRC open research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44895459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rapid review of the overuse of antibiotics during the COVID-19 pandemic: lessons learned and recommendations for the future","authors":"W. Cherry, M. Brown, C. Garner","doi":"10.12688/AMRCOPENRES.12998.1","DOIUrl":"https://doi.org/10.12688/AMRCOPENRES.12998.1","url":null,"abstract":"The coronavirus disease 2019 (COVID-19) pandemic has had severe implications on healthcare systems and the patients affected by this infectious disease. To improve outcomes for patients with COVID-19 and limit future antimicrobial resistance, there is continued urgency to improve our understanding of the rates and causative agents of secondary bacterial infections in patients with COVID‑19, and recognise whether antibiotics are being overused in patients prior to and following COVID-19 diagnosis. This article presents the results of a rapid review comparing reported rates of secondary bacterial infections with rates of antibiotic use in patients with COVID-19 predominantly in a hospital setting, within the context of treatment guidelines and recommendations. The review revealed rates of antibiotic use in patients with COVID-19 of 37–100%, far outweighing rates of secondary bacterial infections which were typically below 20%. There was a lack of consistent reporting of causative microorganisms of secondary infections, and the distinction between bacterially- and virally-induced sepsis was rarely made. Early in the pandemic, healthcare agencies published treatment guidelines recognising the importance of antimicrobial stewardship. However, many are yet to provide updated guidance detailing the most appropriate antibiotics to treat patients with concurrent COVID-19 and secondary bacterial infections in a way which limits the emergence of drug-resistant infections and does not negatively impact patient outcomes. Without significant improvements to the testing and reporting of causative organisms and corresponding updates to antimicrobial treatment guidelines, there is a risk of worsened clinical outcomes and increased burden on healthcare systems from antimicrobial resistance during the remainder of the COVID-19 pandemic and beyond.","PeriodicalId":72183,"journal":{"name":"AMRC open research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43801071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the 4AT tool for delirium assessment in specialist palliative care settings: protocol of a prospective diagnostic test accuracy study [version 1; peer review: 2 approved].","authors":"Elizabeth Arnold,&nbsp;Anne M Finucane,&nbsp;Juliet A Spiller,&nbsp;Zoë Tieges,&nbsp;Alasdair M J MacLullich","doi":"10.12688/amrcopenres.12973.1","DOIUrl":"https://doi.org/10.12688/amrcopenres.12973.1","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a serious and distressing neuropsychiatric condition, which is prevalent across all palliative care settings. Hypoactive delirium is particularly common, but difficult to recognize, partly due to overlapping symptoms with depression and dementia. Delirium screening tools can lead to earlier identification and hence better management of patients. The 4AT (4 'A's Test) is a brief tool for delirium detection, designed for use in clinical practice. It has been validated in 17 studies in over 3,700 patients. The test is currently used in specialist palliative care units, but has not been validated in this setting. The aim of the study is to determine the diagnostic accuracy of the 4AT for delirium detection against a reference standard, in hospice inpatients.</p><p><strong>Methods: </strong>240 participants will be recruited from the inpatient units of two hospices in Scotland. If a patient lacks capacity to consent, agreement will be sought from a legal proxy. Each participant will complete the 4AT and a reference standard assessment based on the diagnostic delirium criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This will be supplemented by tests of cognition and attention, including reverse days of the week, counting down from 20 to 1, Vigilance 'A', the Observational Scale for Level of Arousal, the modified Richmond Agitation Sedation Scale and the Delirium Rating Scale-Revised-98. The assessments will be conducted in a randomized order by two independent clinicians, who will be blinded to the results until both are complete. Primary outcomes will be the sensitivity and specificity of the 4AT in detecting delirium.</p><p><strong>Discussion: </strong>The findings will inform clinical practice regarding delirium assessment in palliative care settings.</p><p><strong>Trial registration: </strong>ISRCTN ISRCTN97417474 (21/02/2020).</p>","PeriodicalId":72183,"journal":{"name":"AMRC open research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7613285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A collaborative approach to exercise provision for people with Parkinson's - a feasibility and acceptability study of the PDConnect programme [version 2; peer review: 2 approved].","authors":"Julie Jones, Lyndsay Alexander, Elizabeth Hancock, Kay Cooper","doi":"10.12688/amrcopenres.12936.2","DOIUrl":"10.12688/amrcopenres.12936.2","url":null,"abstract":"<p><strong>Background: </strong>Exercise has been shown to be beneficial for people with Parkinson's (PwP), slowing the rate of decline of motor and nonmotor symptoms, with emerging evidence associating exercise with a neuroprotective effect. Current exercise provision is time-limited, and delivered in the absence of strategies to support long-term adherence to exercise. With a growing Parkinson's population, there is a need to develop long-term sustainable approaches to exercise delivery. The primary aim of this study is to assess the feasibility and acceptability of a multicomponent intervention (PDConnect) aimed at promoting physical activity, and self-management for PwP.</p><p><strong>Methods: </strong>A convergent fixed parallel mixed methods design study will be undertaken. The study aims to recruit 30 PwP, who will be randomly allocated into two groups: (i) the usual care group will receive physiotherapy once a week for six weeks delivered via Microsoft Teams. (ii) The PDConnect group will receive physiotherapy once a week for six weeks which combines exercise, education and behaviour change interventions delivered by NHS Parkinson's specialist physiotherapists via Microsoft Teams. This will be followed by 12 weekly sessions of group exercise delivered on Microsoft Teams by fitness instructors specially trained in Parkinson's. Participants will be then contacted by the fitness instructors once per month for three months by video conferencing to support exercise engagement. Primary feasibility data will be collected during the study, with acceptability assessed via semi-structured interviews at the end. Secondary outcomes encompassing motor, non-motor and health and well-being measures will be assessed at baseline, at six, 18, and 30 weeks.</p><p><strong>Discussion: </strong>This pilot study will establish whether PDConnect is feasible and acceptable to PwP. This will provide a platform for a larger evaluation to assess the effectiveness of PDConnect at increasing exercise participation and self-management within the Parkinson's Community.</p><p><strong>Trial registration: </strong>Registered on ISRCTN (ISRCTN11672329, 4^th June 2020).</p>","PeriodicalId":72183,"journal":{"name":"AMRC open research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39239029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating process and effectiveness of a low-intensity CBT intervention for women with gynaecological cancer (the EPELIT Trial).","authors":"Nicholas J Hulbert-Williams, Lee Hulbert-Williams, Ryan James Flynn, Rosina Pendrous, Carey MacDonald-Smith, Anna Mullard, Brooke Swash, Gemma Evans, Annabel Price","doi":"10.12688/amrcopenres.12971.1","DOIUrl":"10.12688/amrcopenres.12971.1","url":null,"abstract":"<p><strong>Background: </strong>Improving survival from gynaecological cancers is creating an increasing clinical challenge for long-term distress management. Psychologist-led interventions for cancer survivors can be beneficial, but are often costly. The rise of the Psychological Wellbeing Practitioner (PWP) workforce in the UK might offer a cheaper, but equally effective, intervention delivery method that is more sustainable and accessible. We aimed to test the effectiveness of a PWP co-facilitated intervention for reducing depression and anxiety, quality of life and unmet needs.</p><p><strong>Methods: </strong>We planned this trial using a pragmatic, non-randomised controlled design, recruiting a comparator sample from a second clinical site. The intervention was delivered over six-weekly sessions; data were collected from participants at baseline, weekly during the intervention, and at one-week and three-month follow-up. Logistical challenges meant that we only recruited 8 participants to the intervention group, and 26 participants to the control group.</p><p><strong>Results: </strong>We did not find significant, between-group differences for depression, quality of life or unmet needs, though some differences at follow-up were found for anxiety ( <i>p</i><.001). Analysis of potential intervention mediator processes indicated the potential importance of self-management self-efficacy. Low uptake into the psychological intervention raises questions about (a) patient-driven needs for group-based support, and (b) the sustainability of this intervention programme.</p><p><strong>Conclusions: </strong>This study failed to recruit to target; the under-powered analysis likely explains the lack of significant effects reported, though some trends in the data are of interest. Retention in the intervention group, and low attrition in the control group indicate acceptability of the intervention content and trial design; however a small baseline population rendered this trial infeasible in its current design. Further work is required to answer our research questions, but also, importantly, to address low uptake for psychological interventions in this group of cancer survivors.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT03553784 (registered 14 June 2018).</p>","PeriodicalId":72183,"journal":{"name":"AMRC open research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11064984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66399916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population attributable risk for colorectal and breast cancer in England, Wales, Scotland, Northern Ireland, and the United Kingdom","authors":"Shatabdi Goon, Hanseul Kim, E. Giovannucci","doi":"10.12688/AMRCOPENRES.12980.1","DOIUrl":"https://doi.org/10.12688/AMRCOPENRES.12980.1","url":null,"abstract":"Background: The population attributable risk (PAR) is a statistic commonly used for quantifying preventability of cancer. We report here PAR estimates for the United Kingdom (UK) along with its constituent countries for up-to-date risk factor-attributable colorectal cancer (CRC) and breast cancer (BC), focusing on diet and nutrition related factors and tobacco (CRC) using representative national surveys. Methods: The PAR was calculated using established, modifiable risk factors by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR): physical activity, body mass index (BMI), alcoholic drinks, red meat, processed meat, dietary fiber, dietary calcium, as well as cigarette smoking for CRC, and physical activity, BMI, alcoholic drinks, and fruits and vegetable consumption for BC. National prevalence estimates and relative risks (RRs) for CRC and BC were obtained from meta-analyses or large pooled analyses. Results: Based on eight dietary and lifestyle risk factors, the estimates for attributable cases of CRC for males and females, respectively, were as follows: England: 67% and 60%; Scotland: 68% and 59%, Wales: 66% and 61%; Northern Ireland: 67% and 61%; and UK: 67% and 60%. Excluding smoking, the PAR for the UK was 61% for men and 52% for women. Based on four dietary and lifestyle risk factors, the estimates for BC were as follows: England: 26%, Scotland: 27%; Wales: 25%; Northern Ireland: 26%; and UK: 27%. Conclusion: Up to 67% for CRC and 27% of BC were attributable to modifiable dietary and lifestyle factors in the UK. Moderate differences in PAR are observed between countries due to different prevalence of exposure to risk factors.","PeriodicalId":72183,"journal":{"name":"AMRC open research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47094220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation and management of iron deficiency anaemia in a specialist palliative care setting and the role of intravenous iron: a descriptive analysis of hospice data.","authors":"Thomas Steele, Helen Bonwick, Amara Callistus Nwosu, Laura Chapman","doi":"10.12688/amrcopenres.12963.2","DOIUrl":"10.12688/amrcopenres.12963.2","url":null,"abstract":"<p><strong>Background: </strong>Anaemia is common in hospice populations and associated with significant symptom burden. Guidelines recommend investigating for and treating iron deficiency (ID), but there is little evidence of this practice in palliative care populations. This report describes the results of investigations for and subsequent management of ID in a UK hospice.</p><p><strong>Methods: </strong>This is a descriptive study of routine clinical data. Laboratory and clinical records were reviewed retrospectively for 12 months following the implementation, in August 2018, of routine investigation for ID amongst patients with clinically relevant anaemia in whom treatment would be considered. Absolute (AID) and functional iron deficiency (FID) were diagnosed using established definitions and treatments recorded.</p><p><strong>Results: </strong>Iron status was evaluated in 112 cases, representing 25/110 (22.7%) of those with mild, 46/76 (60.5%) moderate and 41/54 (75.9%) severe anaemia. Twenty-eight (25%) were defined as having AID, 48 (42.8%) FID and 36 (32%) no ID. There was a significant difference between groups in symptoms triggering haemoglobin check and diagnosis, with a higher proportion of patients with classic symptoms of anaemia and gastrointestinal malignancy in those with AID. Intravenous iron was given on 12 occasions in the hospice with no major adverse events. Subjective symptom benefit in 7 cases and a statistically significant increase in overall mean haemoglobin were observed.</p><p><strong>Conclusions: </strong>This report describes the outcome of investigations for iron deficiency in patients with clinically significant anaemia in a UK hospice. Results indicate iron deficiency is common and can be safely treated with intravenous iron replacement, within current guidelines, in a hospice setting. Further research should define the optimum use of this approach in palliative care patients.</p>","PeriodicalId":72183,"journal":{"name":"AMRC open research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11064982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44509013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}