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Delirium education priorities for healthcare professional students: a modified Delphi study
No full textBackgroundDelirium is frequently unrecognised, and healthcare professionals lack knowledge and confidence in recognition and management of the condition. Increased delirium education within pre-registration healthcare profession curricula may help to address this. A modified Delphi approach was utilised to develop a set of education priorities associated with delirium education for healthcare profession students.MethodsAn initial list of 72 education priorities were identified from a literature review, stakeholder focus groups, and a review of available clinical guidelines. Priorities were grouped into eight domains ‘assessment and diagnosis’, ‘aetiology and risk factors’, ‘pathophysiology’, ‘treatment of delirium’, ‘prevention’, ‘delirium and dementia’, ‘impact on people with delirium, informal caregivers and family’ and ‘health promotion and public education’. Academic experts and healthcare professionals were invited to rank each priority and each domain across two rounds. Round one consisted of a survey including the list of 72 potential education priorities which participants were asked to rank from one (not a priority) to five (essential priority). Items which did not reach consensus criteria following round one were re-distributed as round two of the survey and participants were asked to repeat this exercise for the shorter list of items. Additionally, in round two, participants were asked to rank the eight domains from most important to least important.ResultsEighty participants completed round one of the Delphi survey and 55 (68.75%) also completed round two. Following round one, 41 priorities were considered highly relevant and therefore met the criteria to be included in the final set of education priorities. An additional four items reached these criteria following round two and so the final set consists of 45 items. Priorities related to prevention, diagnosis, and treatment were consistently ranked highly whereas priorities related to pathophysiology and health promotion were consistently ranked lowest.DiscussionThis Delphi study identified areas of education viewed as the highest priorities for healthcare profession students’ delirium education, drawn from a range of academics and healthcare professionals. The final set may help to inform the development of delirium education reflecting these priorities.<br/
Wax-based sustained-release felodipine oral dosage forms manufactured using hot-melt extrusion and their resistance to alcohol-induced dose dumping
No full textBackground/Objectives: Hot-melt extrusion (HME) has gained prominence for the manufacture of sustained-release oral dosage forms, yet the application of wax-based matrices and their resilience to alcohol-induced dose dumping (AIDD) remains underexplored. This study aimed to develop and characterise wax-based sustained-release felodipine formulations, with a particular focus on excipient functionality and robustness against AIDD. Methods: Felodipine sustained-release formulations were prepared via HME using Syncrowax HGLC as a thermally processable wax matrix. Microcrystalline cellulose (MCC) and lactose monohydrate were incorporated as functional fillers and processing aids. The influence of wax content and filler type on mechanical properties, wettability, and drug release behaviour was systematically evaluated. Ethanol susceptibility testing was conducted under simulated co-ingestion conditions (4%, 20%, and 40% v/v ethanol) to assess AIDD risk. Results: MCC-containing tablets demonstrated superior sustained-release characteristics over 24 h, showing better wettability and disintegration. In contrast, tablets formulated with lactose monohydrate remained structurally intact during dissolution, overly restricting drug release. This limitation was effectively addressed through granulation, where reduced particle size significantly improved surface accessibility, with 0.5–1 mm granules achieving a satisfactory release profile. Ethanol susceptibility testing revealed divergent behaviours between the two filler systems. Unexpectedly, MCC-containing tablets showed suppressed drug release in ethanolic media, likely resulting from inhibitory effect of ethanol on filler swelling and disintegration. Conversely, formulations containing lactose monohydrate retained their release performance in up to 20% v/v ethanol, with only high concentrations (40% v/v) compromising matrix drug-retaining functionality and leading to remarkably increased drug release. Conclusions: This study highlights the pivotal role of excipient type and constitutional ratios in engineering wax-based sustained-release formulations. It further contributes to the understanding of AIDD risk through in vitro assessment and offers a rational design strategy for robust, alcohol-resistant oral delivery systems for felodipine.<br/
Ontological violence in the case of the ‘Paiter Suruí Carbon Credit REDD+ Project’
No full textSustainability initiatives are increasingly engaging with Indigenous realities across the world. Developed through a diversity of frameworks and supported by public and private actors, sustainability initiatives involve claims of conservation and development. However, such development notions often presume common ground between Indigenous realities and sustainability initiatives, neglecting foundational differences that can lead to contemporary forms of colonization and violence. In this paper, we explore how sustainability initiatives and Indigenous realities engage with each other by empirically engaging with the ‘Paiter Suruí Carbon Credit REDD+ Project’ in Rondônia - Brazil. Drawing from a political ontology lens, we examine ethical imposition and ontological violence over the life of this program, describing their mechanisms. We argue that despite the positive potentials of such programs, sustainability initiatives can lead to a process by which indigenous modes of life are disrupted by the imposition of external discourses and practices
The impact of palliative care consults on medicines optimisation for patients with cancer referred to hospice care at the end of life: a retrospective cohort study
No full textPurposeThis study evaluated the impact of Palliative Care Consults (PCC) on medicines optimisation in patients with cancer, focusing on deprescribing patterns and associated predictors.MethodsThis retrospective cohort study reviewed the medical records of patients with cancer admitted to an inpatient hospice unit between January 1 and December 31, 2022. Data were collected at hospice admission, first PCC assessment, and the day of death. Eligible patients had a life expectancy of ≤ six months, a Palliative Performance Scale (PPS) score ≤ 70%, and were prescribed at least one preventive medication at admission. Outcomes included medication burden (preventive medication use and polypharmacy), symptom control medication use, and potentially inappropriate medication (PIMs) use, assessed using OncPal criteria. PIM deprescribing patterns and predictors of successful deprescribing were analysed.ResultsAmong 321 patients (mean age 62.6 years; 60.1% female), the mean number of medications decreased from 7.87 at admission to 7.22 on the day of death (P < 0.001). Preventive medications decreased from 3.53 to 1.25, while symptom control medications increased from 4.34 to 5.98. PCC was associated with a significant PIM reduction (2.11 to 0.52; P < 0.001). Deprescribing was predominantly proactive at the first PCC assessment (61.3%) but reactive in later stages (89.6%). Male gender, absence of polypharmacy, and fewer than three PIMs at admission were significantly associated with successful deprescribing (P < 0.05).ConclusionsPCC was associated with improved medicines optimisation, though deprescribing remained reactive. Integration of structured, proactive deprescribing guidelines may enhance hospice care at the end of life.<br/
Transformation to integrated status: Principals’ lived experiences of barriers to transformation since 2022
No full textDifferential evolution for infeasible circumstances in network-assisted full-duplex Cell-Free Massive MIMO
No full textThis paper presents an application of differential evolution in optimizing the exploitation of full-duplex communication for Cell-Free Massive Multiple Input Multiple Output (CF-m MIMO), a potential candidate for 6G networks. This paper proposes a new dynamic network-assisted full-duplex CF-m MIMO network, where access points can operate in either half-duplex or full-duplex mode, and each full-duplex access point can serve uplink and downlink users simultaneously. A long-term total spectral efficiency maximization problem is formulated subject to a network operation model and individual spectral efficiency requirements with a limited power budget. Due to the intrinsic nonconvexity and infeasible circumstances where some users might not achieve the rate requirements, we adapt differential evolution to design a low computational complexity algorithm, attaining good power allocation and network operation mode in polynomial time. We further analytically investigate the number of generations required to reach the optimal solution. Numerical results demonstrate the effectiveness of our system design and proposed algorithm over state-of-the-art benchmarks. The network can offer satisfactory service to most users, although several may be unscheduled under harsh condition
