Journal of Palliative MedicineVol. 23, No. 8 Personal ReflectionFree AccessA Wish and a Worry: From a Doctor in Palliative Medicine to the Families of Those Dying from COVID-19Amy Grace Stephanie TaylorAmy Grace Stephanie TaylorAddress correspondence to: Amy Grace Stephanie Taylor, MBChB, MRCP, Northern Ireland Postgraduate Medical Training Scheme in Palliative Medicine, Northern Ireland Medical and Dental Training Agency, Belfast, Northern Ireland BT8 7RL, United Kingdom E-mail Address: [email protected]Northern Ireland Postgraduate Medical Training Scheme in Palliative Medicine, Northern Ireland Medical and Dental Training Agency, Northern Ireland, United Kingdom.Search for more papers by this authorPublished Online:15 Jul 2020https://doi.org/10.1089/jpm.2020.0269AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail I wish that things were different.I wish you could be here too.I wish that this hard thing wasn't being made harder.I wish I could change this part for you.I worry that what I can tell youKeeps changing from day to day.I worry I am uncertain, unsure of the answers.I worry you see this in what I say.I wish I could sit down beside youAnd talk with you face to face.You see my eyes as I tell you we really do careAnd I'm sorry you are both in this place.I worry that you will ask, “what if?”More often than you normally would.I worry accepting that it is what it isWill be unexpectedly harder than it should.I wish I could tell you what to expect.I wish I had that crystal ball.I wish there was an understanding, a vaccine,I wish we knew enough, not even it all.I worry that even though I'm speakingCarefully chosen and thoughtful words,After “COVID,” they lose all their meaning,That you just hear panic, fear, the worst.I wish I could let you say goodbyeIn the way that you thought you would.I worry that if the rules change againWe took away the chance that you could.So I use a wish and a worryTo say that I'm sorry and I'm sad too.And I wish that these times would pass quickly,But I worry that wishes don't come true.FiguresReferencesRelatedDetails Volume 23Issue 8Aug 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Amy Grace Stephanie Taylor.A Wish and a Worry: From a Doctor in Palliative Medicine to the Families of Those Dying from COVID-19.Journal of Palliative Medicine.Aug 2020.1133-1133.http://doi.org/10.1089/jpm.2020.0269Published in Volume: 23 Issue 8: July 15, 2020Online Ahead of Print:May 18, 2020 TopicsCOVID-19Palliative carePalliative therapy PDF download
Background: Cognitive behavioral therapy (CBT) is a goal-oriented intervention that aims to improve detrimental emotional or behavioral distress by modifying individuals’ thought processes. This review evaluates the efficacy and specific adaptations of CBT in persons with mild cognitive impairment and dementia. Methods: A literature search of PubMed, Embase, and PsycINFO was conducted up to March 2020. Study quality was assessed using the Cochrane risk of bias criteria. Results: Twelve publications were identified. Seven of the studies demonstrated CBT efficacy to improve depression, anxiety, and/or quality of life. One study’s positive postintervention outcome became insignificant with longer term follow up. Two of the studies improved sleep outcomes. Four studies integrated caregivers into intervention delivery. Three studies utilized content, memory, and adherence adaptations aimed to improve intervention efficacy. Two studies included adaptations to address caregiver burden and depression. Conclusion: There is strong evidence to suggest that CBT is associated with improvements in anxiety, depression, and quality of life in persons with mild cognitive impairment and dementia. CBT showed a reduction in insomnia and improvements in sleep quality. However, there is insufficient evidence to draw conclusions on the effects of CBT on insomnia. These results suggest that further investigation into insomnia outcomes is needed.
Motor neurons (MNs) are highly energetic cells and recent studies suggest that altered energy metabolism precede MN loss in amyotrophic lateral sclerosis (ALS), an age-onset neurodegenerative disease. However, clear mechanistic insights linking altered metabolism and MN death are still missing. In this study, induced pluripotent stem cells from healthy controls, familial ALS, and sporadic ALS patients were differentiated toward spinal MNs, cortical neurons, and cardiomyocytes. Metabolic flux analyses reveal an MN-specific deficiency in mitochondrial respiration in ALS. Intriguingly, all forms of familial and sporadic ALS MNs tested in our study exhibited similar defective metabolic profiles, which were attributed to hyper-acetylation of mitochondrial proteins. In the mitochondria, Sirtuin-3 (SIRT3) functions as a mitochondrial deacetylase to maintain mitochondrial function and integrity. We found that activating SIRT3 using nicotinamide or a small molecule activator reversed the defective metabolic profiles in all our ALS MNs, as well as correct a constellation of ALS-associated phenotypes.
Junior doctors undertake holistic patient assessments on hospice admission. Although physical and psychosocial needs are frequently comprehensively evaluated, medical staff often lack confidence and training in the assessment and management of spiritual issues. This quality improvement project aimed to improve medical staff confidence in the assessment and documentation of patients' spiritual needs upon hospice admission.
Methods
An anonymous survey evaluated hospice medical staff opinion on spiritual care. A chart review examined the spiritual assessments documented at baseline and monthly (February to June 2018). Using the 'HOPE' tool, factors assessed were: identification of source of Hope; Organisation/spiritual community; spiritual Practices; desired Effects on healthcare. Interventions included dissemination of a spiritual care journal article, integration of 'HOPE', a spiritual assessment tool, into the admission proforma and junior doctor education by the hospice chaplain. Descriptive statistics were generated using Microsoft Excel.
Results
Eight medical staff (junior doctors and consultants) completed the survey. Spiritual care was identified as important but often forgotten. 63% believed religious leaders should direct spiritual care, but that all staff should have relevant skills. Over 50% lacked confidence in spiritual aspects, particularly regarding religious minorities. Completion of spiritual assessment improved from 83% to 94%. Identification of source of hope increased from 50% to 78%, which was sustained. Identification of a spiritual community improved from 6% to 67%, but this was not maintained. Identification of spiritual practices improved from 28% to 75% and discussing effects on healthcare rose from 17% to 67%. These were sustained.
Conclusions
Introducing a spiritual assessment tool improves identification of spiritual needs on admission, particularly source of hope and spiritual practices. Ongoing targeted education would ensure continuous improvement. Use of this tool across inpatient and community palliative care settings could improve spiritual care by clinicians.
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