ABSTRACT
BackgroundResearch is essential to improving outcomes for patients with life-threatening illness and it is vital that hospices are at the centre of this (Payne, Preston, Turner et al, 2013). Journal clubs have been identified as a way of sharing evidence amongst hospice teams, developing staff research skills and contributing to hospice research culture but they are not widespread in hospices, with barriers often encountered in their development and sustainability (Turner & Payne, 2019. Eur J Palliat Care. 19:34).AimsThis project aims to develop a toolkit to support hospices in establishing and sustaining multidisciplinary journal clubs.MethodsAt Marie Curie Hospice, Liverpool, a new model of journal club was implemented in January 2019 with a focus on promoting reflection of the relevance of research to clinical practice (Steele, Stanley & Nwosu, 2019. BMJ Support Palliat Care. 9:A50). Attendance, and contributions to presenting, come from across the multidisciplinary team and palliative care service sites in the locality. A toolkit to allow this to be replicated was developed by the research team, informed by participant feedback and the successes and challenges of setting up the journal club from scratch then surviving, growing and thriving in a semi-virtual model despite the COVID-19 pandemic (Stanley, Nwosu & Finney, 2021. BMJ Support Palliat Care. 11:A4).ResultsThe toolkit consists of a practical guide to both setting up and running the journal club, with flexibility to be individualised to diverse hospices across the UK. In addition, it includes resources such as presenter templates and certificates. The toolkit is being piloted in two palliative care centres so that facilitators and barriers to its use can be identified.ConclusionsThis work will lead to the development of a freely available toolkit that any hospice can use to support their implementation of a journal club, thus promoting a research culture and evidence-based practice.
ABSTRACT
INTRODUCTION: The COVID-19 vaccination programme is under way worldwide. Anecdotal evidence is increasing that some people with type 1 diabetes mellitus (T1DM) experience temporary instability of blood glucose (BG) levels post-vaccination which normally settles within 2-3 days. We report an analysis of BG profiles of 20 individuals before/after vaccination. METHODS: We examined the BG profile of 20 consecutive adults (18 years of age or more) with T1DM using the FreeStyle Libre flash glucose monitor in the period immediately before and after COVID-19 vaccination. The primary outcome measure was percentage (%) BG readings in the designated target range 3.9-10 mmmol/L as reported on the LibreView portal for 7 days prior to the vaccination (week -1) and the 7 days after the vaccination (week +1). RESULTS: There was a significant decrease in the %BG on target following the COVID-vaccination for the 7 days following vaccination (mean 45.2% ± SE 4.2%) vs pre-COVID-19 vaccination (mean 52.6% ± SE 4.5%). This was mirrored by an increase in the proportion of readings in other BG categories 10.1%-13.9%/≥14%. There was no significant change in BG variability in the 7days post-COVID-19 vaccination. This change in BG proportion on target in the week following vaccination was most pronounced for people taking Metformin/Dapagliflozin+basal-bolus insulin (-23%) vs no oral hypoglycaemic agents (-4%), and median age <53 vs ≥53 years (greater reduction in %BG in target for older individuals (-18% vs -9%)). CONCLUSION: In T1DM, we have shown that COVID-19 vaccination can cause temporary perturbation of BG, with this effect more pronounced in patients talking oral hypoglycaemic medication plus insulin, and in older individuals. This may also have consequences for patients with T2DM who are currently not supported by flash glucose monitoring.