Family carers' administration of injectable medications at the end of life: a service evaluation of a novel intervention.

Timely and safe administration of injectable medications for patients at home is vital in optimally managing distressing symptoms in the final days of life. This article discusses a service evaluation of family carers' (including close friends) administrating subcutaneous end-of-life medications. The procedure was not intended to become normal care, rather the exception when appropriate and needed, with 24/7 skilled support from community nursing and palliative care services. A service evaluation of the procedure was undertaken in rural and urban areas in the South East of England. The procedure ran over 6 months and used detailed processes with recruitment criteria to mitigate risk of harm. In total, 11 patients participated with their family carers, including five carers with experience in healthcare roles. Of the 11 family carers, 10 were able to administer injections safely with structured training and support in place. Patients received timely symptom relief and their family carers were able to support loved ones by administering injectable medications rapidly without waiting for a nurse to arrive. This was particularly welcomed in more rural areas where waiting times were greater due to the large geographical area covered and limited staff availability during out-of-hours periods. The findings informed a carefully monitored wider rollout and ongoing evaluation in adult community nursing services in the NHS Trust.

The impact of body condition after calving on metabolism and milk progesterone profiles in two breeds of dairy cows.

BACKGROUND: Optimal body condition in early lactation is generally accepted as a prerequisite for good reproductive performance. Examination of milk progesterone profiles offers an objective method for characterization of postpartum ovarian activity in dairy cows. The present study investigated the relationship between body condition after calving, some metabolic parameters in blood plasma, and fertility, as reflected by milk progesterone profiles in the two dairy breeds Swedish Red (SR) and Swedish Holstein (SH). RESULTS: Multiparous dairy cows (n = 73) of SR and SH breeds were selected and divided into three groups based on their body condition score (BCS) after parturition. Selected plasma metabolites were determined, milk progesterone profiles were identified and body condition was scored. Over-conditioned cows and atypical progesterone profiles were more common among SR cows. Insulin sensitivity was lower and IGF 1 higher among SR cows. Insulin was positively related to body condition, but not related to breed. CONCLUSIONS: Atypical progesterone profiles were more common and insulin sensitivity lower in SR than in SH cows, but the SR breed had a higher proportion of over-conditioned SR cows. It is reasonable to assume that breed differences in body condition contributed to these results.

An assessment of the diagnosis and management of dementia in nursing homes.

OBJECTIVES: The purpose of this study was to evaluate the diagnosis and management of dementia in the nursing home setting through use of the Mini-Mental State Examination (MMSE) and monitoring of acetylcholinesterase-inhibitor (ACHEI) therapy. DESIGN: Longitudinal cross-sectional study. SETTING: Long-term care facilities in Indiana. PATIENTS: Residents in long-term care facilities were included. MAIN OUTCOME MEASURES: The number of residents with MMSE scores indicative of dementia, the presence of a dementia diagnosis, and receipt of ACHEI therapy. RESULTS: Data were collected on 782 residents. An MMSE score was available within the past 12 months in 456 (58.3%) of residents. The median MMSE score was 17 and ranged from 0 to 30 points. Out of the total population, ACHEI therapy was prescribed in 165 (21.1%) residents. Seventy-five (29.2%) of the residents with mild-moderate dementia (MMSE = 10-26) were prescribed ACHEI therapy. The most frequently prescribed ACHEI was donepezil 10 mg/day prescribed in 98 (59.4%) of the residents receiving ACHEI therapy. Average length of ACHEI therapy was 9.0 months. CONCLUSION: MMSE scores were not available in a large proportion of this nursing home population (41.7%). Of those residents with an available MMSE score, a significant number of them had scores indicative of dementia. Despite having scores indicative of dementia, 182 (70.8%) residents were not receiving AChEI therapy. An assessment to determine why residents were not receiving therapy is needed. Opportunities exist to improve the screening, diagnosis, and treatment of dementia in the nursing home setting.

Prophylaxis of cerebrovascular events in dementia patients receiving risperidone.

OBJECTIVE: To determine if differences exist in prescribing for cerebrovascular adverse event (CAE) prophylaxis between residents receiving risperidone therapy and those with no antipsychotic therapy. DESIGN: Retrospective, multicentered, cross-sectional study. SETTING: Ten long-term care facilities. PARTICIPANTS: A total of 200 residents residing in skilled nursing facilities. The study group (n = 95) included residents with a risk factor for a CAE receiving risperidone. The control group (n = 105) consisted of residents with a risk factor for a CAE and not receiving antipsychotic therapy. MEASUREMENTS: Data collected included patient age, gender, risk factor for CAE, and CAE prophylaxis. Statistics were performed using Chi-squared tests. RESULTS: Fifty-six percent of the study group was not on an agent for CAE prophylaxis, compared with 36% of the control group. CONCLUSION: This study demonstrated with statistical significance that CAE prophylaxis was less likely in the risperidone group. We are implementing a pharmacist-driven initiative to add antiplatelet therapies in all patients who have at least one risk factor for CAE.