1. Some properties of the triphosphoinositide phosphomonoesterase from the homogenates of guinea-pig brain were studied. The enzyme has an optimum pH range 6.7-7.3, is stimulated with KCl at a concentration of 0.1m, and under these conditions has K(m)1.43x10(-4)m. 2. A factor from the ;pH5 supernatant' of guinea-pig brain stimulates the enzyme activity over and above the stimulation produced by KCl. Subcellular fractions of guinea-pig brain varied in their response to the ;pH5 supernatant'. Maximum stimulation was observed with the P(1) fraction, containing myelin and nuclei. 3. An assay system for the enzyme was developed that contained optimum concentrations of both KCl and the ;pH5 supernatant'. Acid phosphatases were inhibited by NaF, but, in contrast with previous work, no EDTA was added to the assay system to inhibit the alkaline phosphatases. This reagent inhibited the triphosphoinositide phosphomonoesterase. It was estimated that the remaining fraction of non-specific phosphatases can account for only 14% of the observed triphosphoinositide phosphomonoesterase activity. 4. Subcellular fractions of guinea-pig brain were characterized by electron microscopy and subcellular markers. The triphosphoinositide phosphomonoesterase exhibited a distribution between the fractions similar to that of 5'-nucleotidase, but different from that of alkaline phosphatase.

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BackgroundLeeds have benefited from a bespoke palliative care ambulance service since 2007 when work done with Marie Curie and the “Delivering Choice” programme highlighted the need for the service.Early consultation with stakeholders identified that a lack of appropriate ambulance transport can be one of the factors that restricts or prevents the fulfilment of a patient's previously expressed wish to die in the place of their choice.AimThe aim of the dedicated palliative care ambulance service is to provide flexible, prompt, safe and comfortable transport to patients moving to a place of their choice towards the end of life and to those needing palliative treatments and investigations.MethodThe Hospital Specialist Palliative Care Team, Leeds Commissioners, Yorkshire Ambulance Service (YAS) Leeds Hospices and Leeds Community Health worked closely together at a local level to improve the present palliative care ambulance service.Leeds commissioners have now funded a second ambulance to run on weekdays, covering the busiest times and new dedicated crews have been recruited and trained by the local hospice.ResultsThis service will benefit patients, carers, healthcare professionals and healthcare providers by:Helping patients achieve their choice for place of care by reducing delays in discharge caused by restrictions to transportEnsuring appropriately trained ambulance personnel will provide quality care services to patients at the end of life during transportationProviding effective ways of working with professionalsProviding better coordination and connectivity between hospital, hospice, community and ambulance servicesConclusionIn providing patients with choice in place of care at the end of life, whilst improving service provision, it is expected that the number of patients dying at home will increase. Future plans are to monitor present demand with a view to expanding the service further to support the transfer of palliative patients in Leeds.

BackgroundHospital teams must plan a safe and effective transfer of care for patients returning home in the last days of life. To support this Leeds Teaching Hospitals NHS Trust (LTHT) launched a revised Rapid Discharge Plan (RDP) in January 2014.AimTo assess the quality of transfer of care (ToC) for patients returning home from LTHT who died within a week of discharge (June 2014 – May 2015).MethodsA convenience sample of 45 patients was selected from a database of 228. Clinical notes were reviewed for recognition of dying (prognosis days) pre-discharge, RDP use, and evidence of eight key interventions necessary for a successful ToC.ResultsMedian survival from discharge was 4 (1–7) days. Thirty-one (69%) had a progressive life-limiting illness and 12 (27%) had multi-morbidity/frailty.Twenty-five patients (56%) were recognised to be dying. Key interventions took place for the majority, including: advance care planning (ACP) (96%), Fast Track discharge (92%), anticipatory prescribing (88%) and do not attempt cardiopulmonary resuscitation form (DNACPR) (84%).The RDP was used in 11 (44%) of those recognised to be dying. The RDP patients had a median of six (5–8) key interventions compared to four (1–5) for those without an RDP.Eight (18%) were perceived to be in the last weeks to months of life and twelve (27%) were not recognised to be approaching the EoL at all. Ten (83%) of those not recognised to be near the EoL had multi-morbidity/frailty, whereas 29 (87%) of patients in the other two groups had a life-limiting illness. The majority (73%) of those not recognised had two or more markers of deteriorating health.ConclusionAppropriate planning occurred for the majority of patients recognised to be dying. This was enhanced by use of the RDP. Recognition is a barrier to planning; particularly in those with multi-morbidity and frailty.