Impact of a hospice rapid response service on preferred place of death,and costs

Background

Many people with a terminal illness would prefer to die at home. A new palliative rapid response service (RRS) provided by a large hospice provider in South East England was evaluated (2010) to provide evidence of impact on achieving preferred place of death and costs. The RRS was delivered by a team of trained health care assistants and available 24/7. The purpose of this study was to (i) compare the characteristics of RRS users and non-users, (ii) explore differences in the proportions of users and non-users dying in the place of their choice, (iii) monitor the whole system service utilisation of users and non-users, and compare costs.

Methods

All hospice patients who died with a preferred place of death recorded during an 18 month period were included. Data (demographic, preferences for place of death) were obtained from hospice records. Dying in preferred place was modelled using stepwise logistic regression analysis. Service use data (period between referral to hospice and death) were obtained from general practitioners, community providers, hospitals, social services, hospice, and costs calculated using validated national tariffs.

Results

Of 688 patients referred to the hospice when the RRS was operational, 247 (35.9 %) used it. Higher proportions of RRS users than non-users lived in their own homes with a co-resident carer (40.3 % vs. 23.7 %); more non-users lived alone or in residential care (58.8 % vs. 76.3 %). Chances of dying in the preferred place were enhanced 2.1 times by being a RRS user, compared to a non-user, and 1.5 times by having a co-resident carer, compared to living at home alone or in a care home. Total service costs did not differ between users and non-users, except when referred to hospice very close to death (users had higher costs).

Conclusions

Use of the RRS was associated with increased likelihood of dying in the preferred place. The RRS is cost neutral.

Trial registration

Current controlled trials ISRCTN32119670, 22 June 2012.

     

First episode psychosis and the trail to secondary care: help-seeking and health-system delays

Background  

People experience delays in receiving effective treatment for many illnesses including psychosis. These delays have adverse consequences in heart disease and cancer, and their causes have been the subject of much research but only in recent years have pathways to care in psychosis received such attention. We sought to establish if, when and where people seek help in the early phase of psychosis in a representative sample.     

Early intervention service for psychosis: views from primary care

Aim: Although General Practitioners (GPs) have a pivotal role in early detection and treatment of psychosis, there is sparse information on their views of early intervention (EI) services and how information related to EI should be delivered. Method: Since inception, DETECT (Dublin East Treatment and Early Care Team), Ireland's pilot EI project, mailed information packs and provided information through the local GP continuing medical education (CME) network. After 1 year, we surveyed GPs within DETECT's catchment area for their views on the service being provided. Results: One hundred and twenty‐six (36%) responded and 80% found the EI service very/extremely useful. GPs reported that the combination of CME session and information packs were more useful than information packs alone. Those who attended CME meetings were significantly more likely to refer suspected cases (P < 0.01) and more likely to find the service useful (P < 0.001). Conclusion: The EI service for psychosis is well‐received among GPs. Information about EI delivered through CME appears to have a greater impact on referral rates and satisfaction levels than mailed information.     

Fetal human cortical neurons grown in culture: morphological differentiation, biochemical correlates and development of electrical activity

Cultured fetal human cortical neurons derived from second trimester human fetal cortex were analyzed with regard to their morphological differentiation and expression of cell-specific markers. The culture method was adapted from standardized protocols originally developed for the isolation and culture of rodent oligodendrocytes and astrocytes. This technique takes advantage of the different adhesive properties and stratification of central nervous system cells in vitro. Under these culture conditions fetal human cortical neurons underwent morphological differentiation, expressed neuron-specific markers and voltage- and ligand-gated ion channels. Highly enriched cultures of microglia and astrocytes generated from the same starting material also expressed cell-type specific markers. These cultures serve as a valuable tool for the establishment of normative data and as experimental models for neurodevelopmental and neurodegenerative studies.     

Diverticulitis of the jejunum: Clinical and radiological features

This article describes three cases of jejunal diverticulitis in elderly women, who had presented with pain and tenderness in the periumbilical region or the left side of the abdomen, lowgrade fever, anemia, and weight loss. The findings were initially attributed to possible inflammatory or neoplastic lesions of the colon. However, gastrointestinal barium studies and computed tomography (CT) of the abdomen proved crucial in establishing the preoperative diagnosis of jejunal diverticulitis and its associated abscess in the adjacent mesentery or abdominal wall. The clinical and radiological manifestations of this uncommon entity are herein presented along with a brief review of the pertinent literature.     

Executive functioning in adults and children with developmental dyslexia

The performance of developmentally dyslexic children and adults was studied upon a range of tasks that involved executive functioning. Both adult and child samples of dyslexics were found to under-perform on the group-embedded figures test. This test required the identification of constituent parts from within complex visual arrays, with good performance necessitating the inhibition of the processing of the surrounding context. A general deficit on visual-spatial tasks was eliminated as an explanation as dyslexics performed normally upon a range of other non-verbal assessments. The dyslexics consistently demonstrated a deficit in digit span tasks, a decrement that was increased with distractors, again suggesting difficulties in inhibiting the processing of the surrounding context. A deficit was also identified upon a verbal fluency task without a deficit in vocabulary level. Additionally, a specific deficit in the recollection of the temporal order of the presentation of items was in evidence, without a deficit in the recognition of the items themselves. The findings taken as a whole suggest that dyslexic individuals show deficiencies in executive functions relating to inhibition of distractors and to sequencing of events, a set of tasks associated with left prefrontal cortex functioning in the acquired neuropsychology literature.     

Infantile cortical hyperostosis,Caffey's disease,involving two cousins

Two cases of infantile cortical hyperostosis are presented in the hope of eliciting word of increased incidence seen by others. These two children are cousins born within 24 h of each other in separate cities, and their disease followed similar clinical courses. Their 14-year-old maternal uncle appeared to have had symptoms identical to those of Caffey's disease at three months of age. The apparent immunity of premature infants to infantile cortical hyperostosis is a previously unnoticed feature that we have come across in reviewing the literature. In analyzing the many theories proposed by different investigators as the pathogenesis of Caffey's disease, the following conclusions are reached.

1. Multiple causal factors may have to combine to produce Caffey's disease.
2. There may be a spectrum of Caffey's diseases with different pathogeneses.
3. Should the incidence of infantile cortical hyperstosis increase, all the previously suspected causal factors must be reexamined.