A5088918376- Palliative Care and End-of-Life Issues
- Geriatric Care and Nursing Homes
- Grief, Bereavement, and Mental Health
- Neuroscience of respiration and sleep
- Family and Patient Care in Intensive Care Units
- Orthopaedic implants and arthroplasty
- Cardiac, Anesthesia and Surgical Outcomes
- Intensive Care Unit Cognitive Disorders
- Interprofessional Education and Collaboration
- Hip and Femur Fractures
- Dementia and Cognitive Impairment Research
- Venous Thromboembolism Diagnosis and Management
- High Altitude and Hypoxia
- Intergenerational Family Dynamics and Caregiving
- Trauma and Emergency Care Studies
- Patient-Provider Communication in Healthcare
- Smoking Behavior and Cessation
- Family Support in Illness
- Respiratory Support and Mechanisms
- Pain Management and Opioid Use
- Patient Satisfaction in Healthcare
- Anesthesia and Neurotoxicity Research
- Patient Dignity and Privacy
- Spinal Dysraphism and Malformations
- Injury Epidemiology and Prevention
University College London
2008-2021
Marie Curie
2011-2019
London Health Sciences Centre
2014-2015
Bridge University
2015
The Royal Free Hospital
2001-2011
Memorial Sloan Kettering Cancer Center
2011
UCL Australia
2009
The Behaviouralist (United Kingdom)
2009
Background: Increasing number of people are dying with advanced dementia. Comfort and quality life key goals care. Aims: To describe (1) physical psychological symptoms, (2) health social care service utilisation (3) at end in Design: 9-month prospective cohort study. Setting participants: Greater London, England, dementia (Functional Assessment Staging Scale 6e above) from 14 nursing homes or their own homes. Main outcome measures: At study entry monthly: prescriptions, Charlson Comorbidity...
Many people with dementia die in nursing homes, but quality of care may be suboptimal. We developed the theory-driven 'Compassion Intervention' to enhance end-of-life advanced dementia.To (1) understand how Intervention operated homes different health economies; (2) collect preliminary outcome data and costs an interdisciplinary leader (ICL) facilitate Intervention; (3) check caused no harm.A naturalistic feasibility study implementation for 6 months.Two northern London, UK.Thirty residents...
Many studies have examined the mental health of carers people with dementia. Few their experiences in advanced stages disease and into bereavement. We aimed to understand during dementia exploring links between end life care. Mixed methods longitudinal cohort study. Thirty-five family (6 at home, 29 care homes) were recruited assessed monthly for up nine months or until person died, then two seven Assessments included: Hospital Anxiety Depression Scale, Short Form 12 health–related quality...
Abstract Objective: Advance care planning (ACP) provides patients with an opportunity to consider, discuss, and plan their future health professionals. Numerous policy documents recommend that ACP should be available all life-limiting illness. Method: Forty recurrent progressive cancer completed one or more discussions a trained mediator using standardized topic guide. Fifty-two interviews were transcribed verbatim analyzed for qualitative thematic content. Results: Most had not spoken...
Most people with advanced dementia die in nursing homes where families may have to make decisions as death approaches. Discussions about end-of-life care between and home staff are uncommon, despite a range of potential benefits. In this study we aimed examine practices relating discussions family members residing explore strategies for improving practice. An ethnographic two the Compassion Intervention was delivered. The provides model engaging an Interdisciplinary Care Leader promote...
Little is known about the effectiveness of advance care planning in United Kingdom, although policy documents recommend that it should be available to all those with life-limiting illness.An exploratory patient preference randomized controlled trial discussions an independent mediator (maximum three sessions) was conducted London outpatient oncology clinics and a nearby hospice. Seventy-seven patients (mean age 62 years, 39 male) various forms recurrent progressive cancer participated, 68...
The majority of people with dementia in the UK die care homes. quality end life these environments is often suboptimal. aim present study was to explore context, mechanisms and outcomes for providing good palliative advanced residing homes from perspective health social providers.The design qualitative which involved purposive sampling professionals undertake interactive interviews within a realist framework. Interviews were completed between September 2012 October 2013 thematically analysed...
People with advanced dementia are frequently bed-bound, doubly incontinent and able to speak only a few words. Many reside in care homes may often have complex needs requiring efficient timely response by knowledgeable compassionate staff. The aim of this study is improve our understanding health professionals' attitudes knowledge the barriers integrated for people dementia. In-depth, interactive interviews conducted 14 professionals including commissioners, home managers, nurses assistants...
The prevalence of dementia is rising worldwide and many people will die with the disease. Symptoms towards end life may be inadequately managed informal professional carers poorly supported. There are few evidence-based interventions to improve end-of-life care in advanced dementia.To develop an integrated, whole systems, intervention that pragmatic feasible for support those close them.A realist-based approach which qualitative quantitative data assisted development statements. These were...
Acute mountain sickness (AMS) occurs when there is failure of acclimatisation to high altitude. The aim this study was describe the relationship between physiological variables and incidence AMS during ascent 5300 m. A total 332 lowland-dwelling volunteers followed an identical profile on staggered treks. Self-reported symptoms were recorded daily using Lake Louise score (mild 3-4; moderate-severe ≥5), alongside measurements (heart rate, respiratory rate (RR), peripheral oxygen saturation (SpO
A COMMUNICATION between the subarachnoid space and middle ear cavity produces a serious potentially lethal problem. The presence of fistula in petrous portion temporal bone may lead to otorrhea, pneumocephalus, meningitis, or abscess formation. It is obvious that diagnosis surgical correction should be initiated promptly prevent irreversible changes. Dandy1 has classified causes cerebrospinal fluid otorrhea into four groups: (1) fracture, (2) openings created by operative procedures, (3)...
Background The neuropsychological consequences of exposure to environmental hypobaric hypoxia (EHH) remain unclear. We thus investigated them in a large group healthy volunteers who trekked Mount Everest base camp (5,300 m). Methods A (NP) test battery assessing memory, language, attention, and executive function was administered 198 participants (age 44.5±13.7 years; 60% male). These were studied at baseline (sea level), 3,500 m (Namche Bazaar), 5,300 (Everest Base Camp) on return 1,300...
In Brief BACKGROUND: Postoperative cognitive dysfunction occurs in a proportion of patients after noncardiac surgery. Older are particularly vulnerable. We hypothesized that dehydration, common perioperative problem the elderly, may provoke dysfunction. used clinical scenario free surgical/anesthetic intervention to determine whether dehydration caused by bowel preparation results changes. METHODS: Thirty-eight an age associated with significant incidence postoperative were recruited...
Approximately 700 000 people in the UK have dementia, rising to 1.2 million by 2050; one-third of aged over 65 will die with dementia. Good end-of-life care is often neglected, and detailed UK-based research on symptom burden needs lacking. Our project examines these issues from multiple perspectives using a rigorous innovative design, collecting data which inform development pragmatic interventions improve care.To define detail burden, service provision factors affecting pathways we shall...
In the UK approximately 700,000 people are living with, and a third of aged over 65 will die dementia. People with dementia may receive poor quality care towards end life. We applied realist approach used mixed methods to develop complex intervention improve for advanced their family carers. Consensus on content was achieved using RAND UCLA appropriateness method mapped sociological theories process impact. Core components are: (1) facilitation integrated care, (2) education, training...
Little research has explored the detail of practice when using sedative medications at end life. One work package I-CAN-CARE programme investigates this in UK palliative care.To investigate current practices medication life London, UK, by (1) qualitatively exploring understandings care clinicians, (2) examining documented use patient records and (3) comparing findings from both investigations.We conducted focus groups with experienced physicians nurses, simultaneously reviewed deceased...
Intraoperative cerebral microembolization occurs in a substantial proportion of patients undergoing THA. Historically, postoperative cognitive dysfunction has been attributed to different factors, including anesthesia, but the influence surgery not thoroughly examined.We conducted prospective, controlled clinical trial assess intraoperative during THA and neuropsychologic outcome.The presence patent foramen ovale (PFO) also was investigated, using transcranial Doppler, determine whether this...
Abstract Background Keeping people living with advanced dementia in their usual place of residence is becoming a key governmental goal but to achieve this, family carers and health care professionals must negotiate how provide optimal care. Previously, we reported realist analysis the professional perspective. Here, report on carer perspectives. We aimed understand similarities differences between two perspectives, gain insights into interdependent roles HCPs can be optimised, make...
This study compared the occurrence of intraoperative microemboli and postoperative changes in neuropsychological performance 195 patients undergoing coronary artery bypass grafting who were randomized to intermittent crossclamp fibrillation or cardioplegic arrest. Cerebral recorded from cannulation 15 min after decannulation, using transcranial Doppler 166 patients. Microemboli relation 9 surgical events also noted. Neuropsychological change scores obtained by comparing cognitive...
The Impact program is an adolescent, injury prevention with both school- and hospital-based components aimed at decreasing high-risk behaviors preventing injury. objective of this study was to obtain student input on the school-based component Impact, as part evaluation redesign process, ensure that content format were optimal relevant, addressing injury-related issues important for youth in our region.Secondary schools selected various geographic regions students varying language, religion,...
Introduction In line with the National Dementia Strategy (2009), a mixed methods programme was designed to develop and pilot complex intervention improve end of life care for people advanced dementia. A facilitation-based model provided education, training support health professionals (HCPs) creating an integrated, individualised holistic service. Aim(s) method(s) To inform development, we conducted series qualitative interviews examine HCPs attitudes knowledge regarding integrated care....
Introduction Discussion about care preferences and end of life wishes between family staff on entry to a home is an important predictor satisfaction with for residents advanced dementia. Aim(s) method(s) This paper aims examine issues relating discussions members Data were collected during piloting the Compassion intervention that engaged Interdisciplinary Care Leader (ICL) in two homes aimed improve included ICL's reflective diary, time record interviews carers, staff, GPs other health...