BackgroundThe value of cardiac rehabilitation (CR) after a transient ischaemic attack (TIA) or minor stroke is untested despite these conditions sharing similar pathology and risk factors to coronary heart disease. We aimed to evaluate the feasibility of conducting a trial of an adapted home-based CR programme, ‘The Healthy Brain Rehabilitation Manual’, for patients following a TIA/minor stroke, participants’ views on the intervention and, to identify the behaviour change techniques (BCTs) used.MethodsClinicians were asked to identify patients attending the Ulster Hospital, Belfast within 4 weeks of a first TIA or minor stroke. Those who agreed to participate underwent assessments of physical fitness, cardiovascular risk, quality of life and mental health, before random allocation to: Group (1) standard/usual care; (2) rehabilitation manual or (3) manual plus pedometer. All participants received telephone support at 1 and 4 weeks, reassessment at 6 weeks and an invitation to a focus group exploring views regarding the study. Two trained review authors independently assessed the manual to identify the BCTs used.ResultsTwenty-eight patients were invited to participate, with 15 (10 men, 5 women; 9 TIA, 6 minor stroke; mean age 69 years) consenting and completing the study. Mean time to enrolment from the TIA/stroke was 20.5 days. Participants completed all assessment measures except VO2max testing, which all declined. The manual and telephone contact were viewed positively, as credible sources of advice. Pedometers were valued highly, particularly for goal-setting. Overall, 36 individual BCTs were used, the commonest being centred around setting goals and planning as well as social support.ConclusionRecruitment and retention rates suggest that a trial to evaluate the effectiveness of a novel home-based CR programme, implemented within 4 weeks of a first TIA/minor stroke is feasible. The commonest BCTs used within the manual revolve around goals, planning and social support, in keeping with UK national guidelines. The findings from this feasibility work have been used to further refine the next stage of the intervention’s development, a pilot study.Trial registrationClinicalTrials.gov Identifier: NCT02712385. This study was registered prospectively on 18/03/2016.Electronic supplementary materialThe online version of this article (10.1186/s12872-017-0717-9) contains supplementary material, which is available to authorized users.

We studied the use of the do not resuscitate (DNR) order among general medical patients. During the six-month study period, of 2431 admissions there were 95 patients (3.9%) declared DNR. Of 105 deaths, 69 (66%) occurred among DNR patients. Twenty-seven percent of the DNR patients left the hospital alive. In 90% of the cases the medical intern initiated the DNR discussion, and in 60% of the cases a decision was reached in less than 24 hours. Two-thirds of the DNR orders were consented to by family members, and one-third of all DNR orders had a discernible impact on nonresuscitative care. Less aggressive therapy accounted for 60% of these restrictions, whereas the remainder involved limitations in diagnostic evaluations. When compared with age- and sex-matched general adult inpatient control subjects, DNR patients were found to have longer hospitalizations (P = .01), be more likely to reside in a nursing home (RR = 4.2), have a metastatic neoplasm (RR = 3.6), and be admitted with an abnormal mental status (RR = 6.1) or urinary incontinence (RR = 2.9). These differences remained significant when we controlled for the presence of a metastatic neoplasm. Despite a high in-hospital mortality rate (73%), DNR patients were not admitted more frequently than controls to the intensive care unit. We conclude that the DNR decision is based on clinical prognostic indexes and that once established, this order serves to modify the allocation of medical resources.

Background: Most patients with cancer want to die at home and will spend most of the final year of life there. Primary care staff will, therefore, provide the bulk of palliative care at home. Yet, palliative care training for staff is fragmented and ad hoc. Some feel inadequately trained for the tasks they are expected to perform. Aim:The aim of this study was to carry out an educational needs assessment in palliative care of general practitioners and community nurses in Northern Ireland. Method: A semi-structured postal questionnaire was sent to 1018 GPs and 750 community nurses with a reminder approximately one month later. Results: 611 GPs and 497 nurses replied giving a response rate of 60% for the doctors and 66% for nurses. 52% of doctors and 94% of nurses expressed a special interest in palliative care. Though the majority of both groups felt confident in their palliative care skills, 83% of doctors and 95% of nurses said they would be likely to undertake further training in palliative care. Preferences for the topics and type of further training were similar for the two groups. The most popular topics for further training for both groups were pain and symptom control, bereavement care and research and audit methods. Preferred methods of further training included specialist lectures, discussion with specialists, hands-on experience in a hospice and multidisciplinary team meetings. Perceived barriers to further training were lack of time, lack of locally available courses, expense of providing locums or of self-funding courses and lack of recognition from management. Conclusion:Primary care staff have expressed a keenness to provide community palliative care and provide it well. It now rests with managers and educationalists in the field to recognise and support staff in their needs. EurJ Gen Pruct 2001;7:99-103.Keywords: palliative care, primary care, educational needs Aim The aim of this study was to carry out a comprehensive educational needs assessment in palliative care of all

SynopsisA study of psychotropic drug prescribing, derived from the computerized pricing data in Northern Ireland from 1966, showed that the use of these drugs reached a peak in 1975, when about 12·5% of the adult population were estimated to have been receiving them, and declined in the following 5 years. Benzodioazepines accounted for three-quarters of all psychotropic drugs prescribed in 1980. Benzodiazepine tranquillizer prescribing was consistently 20–30% higher than in the rest of the United Kindom, in contrast to hypnotic and antidepressant prescribing which has been consistently lower. The rate of increase in benzodiazepine tranquillizer prescribing was greater than in other European countries, but the level remains lower than in Iceland and Denmark. The influence of a number of demographic and socioeconomic variables was studied in an intra-regional analysis of the 1978 data for the 17 health districts in the province, using multivariate and multiple regression statistics. The prescribing of benzodiazepine hypnotics was almost entirely accounted for by the proportion of elderly (over 65 years) and women aged 45–59 years; neuroleptic prescribing was largely a function of factors associated with rural areas (overcrowding and unemployment) and the proportion of elderly; but neither tranquillizer, antidepressant, barbiturate hypnotic nor psychostimulant prescribing were satisfactorily explained by these variables.