Vaccination reduces the risks related to infectious disease, especially among more vulnerable groups, such as older adults. The vaccines available to older adults in the UK through the government-funded programme currently include influenza, pneumococcal, shingles and COVID-19 vaccines. The purpose of the programme is disease prevention and improving wellbeing among the ageing population. Yet, the target population’s views of the programme remain unknown. This paper aims to increase the understanding of older adults’ perceptions of the vaccination programme available in the UK. A total of 13 online focus groups (56 informants) were carried out for this qualitative study. The findings indicate that getting vaccinated involves personal decision-making processes, which are influenced by previous experiences and interpersonal interactions. Factors related to the wider community and culture are less prominent in explaining vaccination decisions. However, opportunistic vaccination offers, a lack of information and a lack of opportunities to discuss vaccines, especially with healthcare professionals, are prominent factors. The study provides in-depth data about the rationale behind older adults’ vaccination decisions in the UK. We recommend that the provision of information and opportunities to discuss vaccines and infectious disease be improved to enable older adults’ to make better informed decisions regarding the vaccines available to them.

Glaucoma patients are currently undergoing monitoring by community based optometrists as part of a randomised controlled trial of shared care. As part of this trial, the costs of monitoring these patients by community optometrists are being calculated. Data were obtained from eight practices for the 1993-1994 financial year. The average 'full' cost of a 40 min appointment was calculated as epsilon 31.56 pounds. The average number of unbooked appointments for the month of October 1994 was 16 per practice, which equated to 12, 40 min appointments. Once the number of unbooked appointments was surpassed for each practice, an average opportunity cost of epsilon 54.00 pounds was experienced per appointment. The participating optometrists were willing to accept a minimum fee of epsilon 26.03 pounds for a small number of patient assessments but this rose to epsilon 43.16 pounds for up to 100 glaucoma patients seen per annum.

IntroductionConstipation is one of the most common symptoms in patients in specialist palliative care (SPC) settings and can cause considerable physical psychological and social suffering for the patient and their family. Due to the high variability in constipation assessment and management in SPC settings questions exist around how to implement an educational program in practice to address this clinical gap.AimTo develop and test the feasibility and acceptability of a novel educational intervention for HCPs to manage constipation experienced by people in SPC settings.MethodUsing the MRC framework for complex interventions and guided by the consolidated framework for implementation research an online resource was developed considering the content context and processes for implementation.ResultsAssessment prevention and management were identified as the core aspects. Six sessions with theoretical content application to practice and reflection through interacting with colleagues were developed in line with the best available evidence. Incentives including an educational bursary and alignment with revalidation and support from senior management champions and the research team were identified as key elements needed successful implementation. Funding IT infrastructure and attitudes to the content have been flagged as potential barriers to success.ConclusionA six week blended program covering the key concepts for assessment and management of constipation in palliative care has been created. Content evidence from the literature and empirical data on the preferred structure and method of delivery as well as key considerations of the contextual factors have been identified as key factors for implementation.References. Craig P, et al.Developing and evaluating complex interventions: The new medical research council guidance. BMJ Clinical Research Ed2008;337(October):a1655. Available at: http://discovery.ucl.ac.uk/168426/. Damschroder LJ, et al. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science2009;4(50).. Friedrichsen M, Erichsen E. The lived experience of constipation in cancer patients in palliative hospital-based home care. Int J Palliat Nurs [Internet] 2004;10(7):321–5. Available from: http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl?=13576321&AN=13991056&h=XKMF4r08srZuhDY0j7C95oLLyYKNHUcvoeEuhyXNnsIM2BI%2BEhmcY1pPP%2BN1pvrMzQ9Bn9b5j45X6WzyBRydEA%3D%3D&crl=c [Accessed: 2017 August 21]. Tvistholm N, Munch L, Danielsen AK. Constipation is casting a shadow over everyday life? A systematic review on older people’s experience of living with constipation [Internet]. Journal of Clinical Nursing2017;26:902–14. Available from: http://doi.wiley.com/10.1111/jocn.13422 [Accessed: 2017 August 21]

IntroductionMarie Curie Palliative Care Day Services have been developed to support people with life-limiting illness who live in their own home. Patients attend on a regular basis, typically receiving a mix of clinical and social care. Despite their popularity and general satisfaction (Kernohan et al, 2006), there is ambiguity concerning the content.AimTo provide in-depth knowledge of day services by mapping services at three Marie Curie Hospice sites.MethodsWe: reviewed the records of a 25% random stratified sample of new patients attending in 2015, providing evidence on the content of care; undertook focus groups with staff, focusing on their knowledge and experience of providing Day Services.ResultsThe three services are characterised by:• wide-ranging care that spans physical, psychological, emotional and social domains;• care for both patients and their informal carers;• the development of patient-patient and patient-professional therapeutic relationships• extremely proactive care, based on regular assessment and follow-up;• being able to respond to a majority of identified needs ‘in-house’;• where such response in unavailable, ensuring onward referral and follow-up;• extensive liaison with other health and social care providers.ConclusionFindings contribute to the limited evidence base on the organisation and content of day services. They highlight how these services are firmly rooted in, but extend beyond, their immediate context to promote holistic, patient-centred care. This care is premised on meaningful therapeutic relationships, which form between patients themselves and between patients and day services staff.Reference. Kernohan WG, Hasson F, Hutchinson P, Cochrane B. Patient satisfaction with hospice day care. Support Care Cancer2006;14(5):462–8.

IntroductionConstipation causes considerable suffering, either as a direct result of physical symptoms or due to related social and psychological problems. Despite this, uncertainty persists about the best management within hospice settings.AimTo synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a hospice setting.MethodsA systematic search of MEDLINE, Embase, Cinahl, Scopus, and Cochrane databases was undertaken in April 2017 for empirical studies, written in English, on the assessment and management of constipation in the hospice, between 2007 and 2017. Two researchers independently reviewed and critically appraised all studies, conducted data extraction and undertook a thematic analysis.ResultsFourteen studies were included in the review including randomised trials (n=3), observational (n=5), and descriptive studies (n=6). The majority of the research was conducted in palliative care units and targeted either healthcare professionals or patients. The analysis highlighted a lack of standard definition of constipation. Clinicians experienced challenges in constipation assessment, with a need to combine patient reports with physical examination. Clinicians focused on pharmacological management, however, consideration around non-pharmacological aspects is also essential. Finally, the need to assess current practice for the management of constipation in light of changing priorities of care at end of life was emphasised.DiscussionSupporting clinicians to more effectively assess and manage the complexities of constipation in this setting is essential in improving overall symptom management. Gaps in the evidence base included defining constipation, constipation prevention, non-pharmacological management, and management in the dying patient.