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Context: A proportion of UK hospital inpatients have palliative care needs but do not access specialist services., Objectives: To contemporaneously evaluate the significance of unmet specialist palliative care needs within the hospital inpatient population., Methods: Prospective multi-centered service evaluation was conducted through 4 snapshots across 4 acute NHS hospital trusts. All patients identified as dying in each hospital were included. Data extraction included symptom burden, medications and completion of care plans., Results: End-of-life care plans were completed for 73%, symptom-focused prescribing present in 96%. Symptoms were not well managed for 22%, with 4% suffering moderate to severely. Specific intervention was triggered in 56% of patients, consisting of prescribing advice and holistic support., Conclusion: There are significant unmet specialist palliative care needs within the hospital inpatient population. Contemporaneous data collection coupled with an outreach approach helps palliative care services better understand the experiences of dying people, alongside where improvement is needed.

Early childhood is important for future cognitive and educational outcomes. Programs overcoming barriers to engagement in early education for Indigenous children must address family cultural needs and target developmental delays. This systematic review identifies culturally adapted programs to improve developmental delays among young children, in response to an identified priority of a remote Indigenous community. Five databases (the Cochrane Library, Embase, Medline, Scopus and CINAHL) were searched for English language papers in January 2018. Study quality was assessed, and findings were analysed thematically. Findings were presented to the community at an event with key stakeholders, to determine their inclusion and face validity. Seven relevant studies, published between 1997 and 2013, were identified by the researchers and each study was supported by the community for inclusion. Three studies included on Native American children and four studies included children from non-Indigenous disadvantaged backgrounds. Findings were reported narratively across four themes: storytelling to improve educational outcomes; family involvement improved development; culturally adapted cognitive behavioural therapy to reduce trauma; rewards-based teaching to improve child attention. Limited published research on culturally adapted and safe interventions for children with developmental delays exists but these four themes from seven studies identify useful components to guide the community and early childhood program development.

Background: Children with cystic fibrosis (CF) often have suboptimal adherence rates to nebulized medication. Adherence barriers cited include forgetting to take the nebulizers, due to busy home and social lives. Text message reminders have been shown to be effective at improving adherence rates in other chronic diseases such as asthma and diabetes., Objective: The objective of this study was to assess the feasibility and efficacy of sending text reminders for a prolonged period of time to children with CF., Materials and Methods: Children with CF aged 5-16 years taking at least one medication via a nebulizer with an electronic adherence monitor were consented for the study. Text message reminders were sent to participants and/or parents via the hospital's automated text service, up to twice a day, for 6 months. The adherence rates for the 6-month text period were compared to the previous 6 months before the study. Rates were calculated for weekdays, weekends, and school holidays., Results: Seventeen participants were recruited to the study, with a mean age of 12 years and a mean forced expiratory volume in 1 second (FEV1) of 81% predicted. Fifteen children completed the 6-month text period, and I-neb data were accurately analyzed for 13 participants. The mean adherence rate in the 6 months receiving texts was 80%, compared to 81% in the prior 6 months. Overall adherence rates on weekdays, weekends, and school holidays were equivalent during the 2 time periods. A subgroup of patients with moderate baseline adherence showed increased adherence during the text period, particularly at weekends., Conclusion: It is feasible to send text message reminders to children with CF, and they are amenable to this approach. Although text reminders do not increase rates in patients with existing optimal adherence, they may be of value in patients with more moderate baseline rates., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Given the increasing use of telephone consultation it is important to determine the factors which influence the length of a telephone consultation., Method: Analysis of 128717 telephone consultations during January to December 2011 to a National Health Service (NHS) out-of-hours primary care service provider in Shropshire and Telford and Powys, England, involving 102 General Practitioners (GPs) and 36 Nurse Practitioners (NPs). Telephone consultation conclude with one of three outcomes - advice only, the patient is invited to a face-to-face consultation with a GP or NP at a nearby health centre (known as a base visit) or the patient is visited at home by a GP or NP (known as home visit). Call length was analysed by these outcomes., Results: The overall mean call length was 7.78 minutes (standard deviation (SD) 4.77). Calls for advice only were longest (mean 8.11 minutes, SD 5.17), followed by calls which concluded with a base visit (mean 7.36 minutes, SD 4.08) or a home visit (mean 7.16 minutes, SD 4.53). Two primary factors influenced call length. Calls by GPs were shorter (mean 7.15 minutes, SD 4.41) than those by NPs (mean 8.74 minutes, SD 5.31) and calls designated as a mental health call were longer (mean 11.16 minutes, SD 4.75) than all other calls (mean 7.73 minutes, SD 7.7)., Conclusions: Telephone consultation length in the out-of-hours setting is influenced primarily by whether the clinician is a GP or a NP and whether the call is designated as a mental health call or not. These findings suggest that appropriate attempts to reduce the length of the telephone consultations should focus on these two areas, although the longer consultation length associated with NPs is offset to some extent by their lower employment costs compared to GPs. Nonetheless the extent to which the length of a telephone consultation impacts on subsequent use of the health service and correlates with quality and safety remains unclear.