No / Laura Middleton-Green, lecturer and researcher in palliative and end of life care, writes about how attitudes to death influence care of the dying.

No / Dementia is a global concern. Although effort is being put toward finding a cure, many advances have been made in ensuring excellence in dementia care. In the United Kingdom, the concept of person-centered dementia care has transformed what is expected for individuals with dementia. Now embraced in national policy in the United Kingdom, it was pioneered by Thomas Kitwood and Kathleen Bredin and driven by a con-cern for the quality of care for indi-viduals with dementia in care homes. The purpose of the current article is to describe key concepts of Kitwood’s pioneering work in person-centered dementia care and to use them to inform current community-based supports and services for individuals with dementia in their own homes, whether alone or with family carers. / Full text is unavailable due to publisher copyright restrictions.

Yes / Many intervention studies lack an investigation and description of the factors that are relevant to its success or failure, despite its relevance to inform future interventions. This study aimed to explore the facilitators and barriers to the implementation of a psycho‐educational intervention for care assistants caring for people with dementia in aged‐care facilities. A process evaluation was carried out alongside a pretest/post‐test controlled study conducted in aged‐care facilities. Seven focus‐group interviews involving 21 care assistants (female; mean age 43.37 ± 10.0) and individual semi‐structured interviews with two managers (female; mean age 45.5 ± 10.26) were conducted 2 weeks and 6 months after the intervention, in two aged‐care facilities. Interviews were recorded, transcribed and submitted to content analysis by two independent researchers. Results were organised into implementer, participant and organisation level hindered and facilitator factors. Findings enable the interpretation of the experimental results and underscore the importance of collecting the perception of different grades of staff to obtain information relevant to plan effective interventions. / Foundation for Science and Technology (FCT). Grant Number: SFRH/BD/72460/2010 and RIPD/CIF/109464/2009

No description available.

Equity of access to healthcare services is a concept which underpins current UK health policy. However evidence suggests that this is not achieved within community palliative care. Referrals can be tardy or not made at all. Most literature describes inequality in service utilisation, but does not aid understanding of why such inequalities exist. There is little research exploring the processes underpinning referral making rather than the outcomes of referrals such as service utilisation. The aim of this research was to investigate the influences on referral decisions made within community palliative care services. A qualitative case study strategy was chosen as the research approach as it provided a framework for facilitating the incorporation of multiple perspectives in a complex context, in a field where there has been little previous research, and where there is little theory to guide the investigation. Three cases (Primary Care Trusts) were studied. Data collection used multiple methods (interviews, observation and documentary analysis, as well as mapping and profiling the palliative care services provided within the cases) from multiple perspectives (general and specialist palliative care professionals, managers, commissioners and patients). Detailed data analysis followed a framework approach, comparing and contrasting patterns within and across cases with existing and developing theoretical propositions. Two core influences on the way health care professionals made referral decisions were found. First, their perception of their own role in providing palliative care. Autonomous professionals made independent judgements about referrals, influenced by their expertise, workload, the special nature of palliative care and the relationship they developed with patients. Second, their perception about those to whom they may refer. Professionals needed to know about services to refer, and then made a complex judgement about the professionals involved and what they could offer the referrer as well as the patient. These findings indicate that many more factors than an assessment of patients' clinical need affect referrals within community palliative care services. It appears that personal, inter-personal and inter-professional factors have the potential to shape referral practices. It may be that the combination of these factors has an influence on equitable access to community palliative care services. Practitioners could be more explicit about referral or non-referral rationales, and policy makers take account of these complex influences on referrals rather than just mandating change.

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

No description available.

Type 2 diabetes mellitus is a chronic disease that is associated with substantial morbidity, mortality, and health care cost. All patients with diabetes require a high level of clinical care to prevent the development of diabetic complications. The aim of this study was to compare the impact of a pharmaceutical care diabetic clinic within a primary care setting to standard care on clinical, humanistic and process outcomes in Type 2 diabetes patients. A randomised controlled trial was conducted in 9 general practices in Greater Glasgow Health Board. All patients with Type 2 diabetes, aged 18 years or over, taking an oral antidiabetic drug were recruited and stratified by practice, age, and gender, and then randomised into an active or control group. The patients in both groups were invited to a pharmaceutical care diabetic clinic within their general practice for three visits at three-monthly intervals. Active patients received review and allocated intervention by the pharmacist while control patients received review only without intervention by the pharmacist. Allocation remained blind until after the first evaluation. The pharmacist evaluated the appropriateness of the medication for the individual and their overall diabetic care. The pharmacist prepared a list of drug-related problems and a referral where appropriate. GP referrals were actioned in the active group but held back until after the conclusion of the study in the control group. Patient outcome measures include changes in HbA 1 c value, systolic blood pressure, health related quality of life (HRQOL), and drug related problems (DRPs) from baseline to the end of the study for both groups.