̽��ֱ�� of Cambridge - Marie Curie Foundation

Study reveals ‘patchy and inconsistent’ end-of-life care

cjb250 — Tue, 03 Sep 2024 08:00:57 +0000

These are among the conclusions of Time to Care: findings from a nationally representative survey of experiences at the end of life in England and Wales, a new report funded by end-of-life charity Marie Curie and produced by King’s College London’s Cicely Saunders Institute, Hull York Medical School at ̽��ֱ�� of Hull, and the ̽��ֱ�� of Cambridge.

Time to Care aims to describe the outcomes, experiences, and use of care services by people affected by dying, death, and bereavement in England and Wales. It is the final report from the Marie Curie Better End of life programme.

̽��ֱ��report found one in five dying people had no contact with their GP in the last three months of life.

Half of people surveyed (49%) said their dying loved one visited A&E at least once in their final three months of life, and one in eight people who died in hospital had been there less than 24 hours.

Half of respondents (49%) in the study were also unhappy with at least one aspect of the care the person who died received and of those one in eight people made a formal complaint. Fewer than half of respondents said they had a key contact person to co-ordinate their care. This meant responsibility for care fell on informal carers (family and friends), who often felt unprepared and unsupported.

Professor Stephen Barclay, from the Department of Public Health & Primary Care at the ̽��ֱ�� of Cambridge, a researcher on the project and a practicing GP, said: “GPs, Community Nurses and the wider Primary Care Team have a central and often under-recognised role in the care of people approaching and at the end of their lives. But they are under enormous pressure with increasing workloads, diminishing workforces and inadequate investment over recent years.

“Increasing numbers of people have been dying in the community during and following the COVID-19 pandemic, at home or in care homes. This important survey, undertaken at a time when the NHS was beginning to recover from the worst of the pandemic, reveals how clinical teams in all settings are struggling to meet the needs of this vulnerable patient group.

“ ̽��ֱ��out-of-hours period, which comprises two-thirds of the week, is particularly difficult for patients and their families. Across the UK, GPs and Community Nurses want to provide excellent palliative and end of life care, but the necessary ‘time to care’ is currently often squeezed. ̽��ֱ��new UK Government’s focus on care close to home is welcome. This report highlights the need for a radical repurposing of NHS funding to resource primary care for that ambition to be achieved.”

̽��ֱ��research report is based on a survey sent by the Office for National Statistics in 2023 to a nationally representative sample of people who had registered the death of a family member in the prior six to 10 months. Only non-sudden causes of death were included. Responses were received from 1179 people, making this the largest nationally representative post-bereavement survey in England and Wales for a decade.

Professor Katherine Sleeman, from King’s College London and lead researcher on the project, said: “This study reveals patchy and inconsistent provision of care for people approaching the end of life. While there were examples of excellent care - including in the community, in care homes, and in hospitals - the overall picture is of services that are overstretched, and of health and care staff lacking the time they need to consistently provide high-quality care. This means that dying people miss out on treatment and care for their symptoms, and families are left feeling unprepared and unsupported which has lasting emotional repercussions into bereavement.

̽��ֱ��researchers say the findings are concerning, considering the ageing population and the expected increase in palliative care needs across the UK. By 2048, there will be an additional 147,000 people in the UK who need palliative care before they die, an increase of 25%.

“Without a corresponding increase in capacity of primary and community care teams to support these people as they approach the end of life, the quality of care is likely to further suffer,” said Professor Sleeman. “It has never been more important to ensure high-quality palliative care for all who need it.”

Annette Weatherley, Marie Curie Chief Nursing Officer, added: “ ̽��ֱ��findings are shocking. Too many people are dying in avoidable pain, struggling with breathlessness and other debilitating symptoms because of the difficulties they face accessing the end-of-life care they need from overstretched GPs and other health and care workers.

“Without urgent action, gaps in access to palliative and end of life care will only grow.

“It is a critical time to improve palliative and end of life care. People at the end of life should be able to have the very best possible care. There is only one chance to get it right at the end of life. Yet, as the evidence shows, too many people are being failed by a system faced with extreme financial and workforce pressures. It’s time for Governments to step up and fix care of the dying.”

Professor Stephen Barclay is a fellow at Emmmanuel College, Cambridge.

Adapted from a press release by Marie Curie

One in three dying people in England and Wales was severely or overwhelmingly affected by pain in the last week of life, with bereaved people reporting how difficult it was to get joined-up support from health and care professionals at home.

This report highlights the need for a radical repurposing of NHS funding to resource primary care for that ambition to be achieved

Stephen Barclay

Alexander Grey

Experimental coloured image of two hands touching

̽��ֱ��text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Low-cost plastic sensors could monitor a range of health conditions

sc604 — Fri, 22 Jun 2018 18:00:00 +0000

̽��ֱ��sensor can measure the amount of critical metabolites, such as lactate or glucose, that are present in sweat, tears, saliva or blood, and, when incorporated into a diagnostic device, could allow health conditions to be monitored quickly, cheaply and accurately. ̽��ֱ��new device has a far simpler design than existing sensors, and opens up a wide range of new possibilities for health monitoring down to the cellular level. ̽��ֱ��results are reported in the journal Science Advances.

̽��ֱ��device was developed by a team led by the ̽��ֱ�� of Cambridge and King Abdullah ̽��ֱ�� of Science and Technology (KAUST) in Saudi Arabia. Semiconducting plastics such as those used in the current work are being developed for use in solar cells and flexible electronics, but have not yet seen widespread use in biological applications.

“In our work, we’ve overcome many of the limitations of conventional electrochemical biosensors that incorporate enzymes as the sensing material,” said lead author Dr Anna-Maria Pappa, a postdoctoral researcher in Cambridge’s Department of Chemical Engineering and Biotechnology. “In conventional biosensors, the communication between the sensor’s electrode and the sensing material is not very efficient, so it’s been necessary to add molecular wires to facilitate and ‘boost’ the signal.”

To build their sensor, Pappa and her colleagues used a newly-synthesised polymer developed at Imperial College that acts as a molecular wire, directly accepting the electrons produced during electrochemical reactions. When the material comes into contact with a liquid such as sweat, tears or blood, it absorbs ions and swells, becoming merged with the liquid. This leads to significantly higher sensitivity compared to traditional sensors made of metal electrodes.

Additionally, when the sensors are incorporated into more complex circuits, such as transistors, the signal can be amplified and respond to tiny fluctuations in metabolite concentration, despite the tiny size of the devices.

Initial tests of the sensors were used to measure levels of lactate, which is useful in fitness applications or to monitor patients following surgery. However, according to the researchers, the sensor can be easily modified to detect other metabolites, such as glucose or cholesterol by incorporating the appropriate enzyme, and the concentration range that the sensor can detect can be adjusted by changing the device’s geometry.

“This is the first time that it’s been possible to use an electron accepting polymer that can be tailored to improve communication with the enzymes, which allows for the direct detection of a metabolite: this hasn’t been straightforward until now,” said Pappa. “It opens up new directions in biosensing, where materials can be designed to interact with a specific metabolite, resulting in far more sensitive and selective sensors.”

Since the sensor does not consist of metals such as gold or platinum, it can be manufactured at a lower cost and can be easily incorporated in flexible and stretchable substrates, enabling their implementation in wearable or implantable sensing applications.

“An implantable device could allow us to monitor the metabolic activity of the brain in real time under stress conditions, such as during or immediately before a seizure and could be used to predict seizures or to assess treatment,” said Pappa.

̽��ֱ��researchers now plan to develop the sensor to monitor metabolic activity of human cells in real time outside the body. ̽��ֱ��Bioelectronic Systems and Technologies group where Pappa is based is focused on developing models that can closely mimic our organs, along with technologies that can accurately assess them in real-time. ̽��ֱ��developed sensor technology can be used with these models to test the potency or toxicity of drugs.

̽��ֱ��research was funded by the Marie Curie Foundation, the KAUST Office of Sponsored Research, and the Engineering and Physical Sciences Research Council.

Reference:
A.M. Pappa et al. ‘Direct metabolite detection with an n-type accumulation mode organic electrochemical transistor.’ Science Advances (2018). DOI: 10.1126/sciadv.aat0911

An international team of researchers have developed a low-cost sensor made from semiconducting plastic that can be used to diagnose or monitor a wide range of health conditions, such as surgical complications or neurodegenerative diseases.

This work opens up new directions in biosensing, where materials can be designed to interact with a specific metabolite, resulting in far more sensitive and selective sensors.

Anna-Maria Pappa

KAUST

Polymer biosensor

Researcher profile: Anna Maria Pappa

I strongly believe that through diversity comes creativity, comes progress. I qualified as an engineer, and later earned my Master’s degree at Aristotle ̽��ֱ�� of Thessaloniki in Greece. My PhD is in Bioelectronics from École des Mines de Saint-Étienne in France and leaving my comfort zone to study abroad proved to be an invaluable experience. I met people from different cultures and mindsets from all over the world, stretched my mind and expanded my horizons.

Now, I always look for those with different views. I travel frequently for conferences and visit other laboratories across Europe, the United States and Saudi Arabia. When you work in a multidisciplinary field it is essential to establish and keep good collaborations: this is the only way to achieve the desired outcome.

Being part of a ̽��ֱ�� where some of the world's most brilliant scientists studied and worked is a great privilege. Cambridge combines a historic and traditional atmosphere with cutting-edge research in an open, multicultural society. ̽��ֱ��state-of-the-art facilities, the openness in innovation and strong collaborations provide a unique combination that can only lead to excellence.

As an engineer, creating solutions to important yet unresolved issues for healthcare is what truly motivates me. I’m working on a drug discovery platform using bioelectronics, and my work sets out to improve and accelerate drug discovery by providing novel technological solutions for drug screening and disease management. I hope my research will lead to a product that will impact healthcare. In the future, I imagine a healthcare system where the standard one-size-fits-all approach shifts to a more personalised and tailored model.

I’m a strong advocate for Women in STEMM, and in October 2017 I was awarded a L'Oréal-UNESCO For Women in Science Fellowship, an award that honours the contributions of women in science. For me, the award not only represents a scientific distinction but also gives me the unique opportunity, as an ambassador of science, to inspire and motivate young girls to follow the career they desire.

I think it’s absolutely vital, at every opportunity, for all of us to honour and promote girls and women in science. Unfortunately, women still struggle when it comes to joining male-dominated fields, and even to establish themselves later at senior roles. We still face stereotypes and social restrictions, even if it is not as obvious today as it was in the past. A question I always ask girls during my outreach activities at schools, is, ‘do I look like a scientist?’, and the answer I most often get is no! I think this misperception of what STEMM professionals look like, or of what they actually do on a daily basis is what discourages girls early on to follow STEMM careers. This needs to change.

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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