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Multiple organ failure (MOF) is accompanied by muscle wasting, but changes in body composition are frequently obscured by fluid retention (edema), mainly in superficial and visceral tissue. There is a need to assess body composition and changes in body composition in these circumstances independently of edema. A relation was sought between fat-free (lean tissue) mass [calculated from body weight and skinfold thicknesses and measured by using dual-energy X-ray absorptiometry (DXA)] and muscle thickness (measured using ultrasound at a variety of sites accessible in an unconscious supine subject) to determine which sites correlated best with lean body mass. The three best sites were midbiceps, midforearm anteriorly, and midthigh anteriorly: [R.sup.2] for the simple sum of the three sites correlated with fat-free mass from skinfold thicknesses was 71.1%, and with lean tissue mass from DXA was 76.1%. Serial measurements of both muscle thickness and midupper-arm circumference in nine patients with MOF showed a complete dissociation; in all nine there was a significant negative correlation of muscle thickness with time (P < 0.05) but changes in arm circumference were random. Only one patient showed a significant negative correlation with time, seven showed no change, and one other showed a significant increase. The muscle thicknesses that correlate best with lean body mass are measured over the biceps, anterior forearm, and anterior thigh. Monitoring muscle thicknesses at these three sites identifies wasting in edematous patients as it is happening.

BackgroundWhen the Liverpool Care Pathway was removed, a range of materials and guidance required review; furthermore, revised practice needed a platform in order to be shared. We decided that our new approach to care might be supported by a novel on-line resource.MethodsA suite of tools that could be used by different providers across Derbyshire at different stages in a patient‘s end of life journey were collected together. Initially, these documents were held on a webpage hosted by a local community healthcare provider. An accompanying webpage contained details of upcoming educational events and contacts. In the first 6 months the pages were used regularly. However, feedback stated they were not easily accessible to all staff and were clumsy to use. Funding was obtained to build a more ‘user friendly’ resource. An improved platform (www.derbyshire.eolcare.uk) was launched in October 2015. As well as a library of resources, the website offers users the option to create an individualised learning portfolio. This can be linked to existing accredited resources (eELCA) as well as signposting to local face to face educational events.ResultsIn the period 1.10.2016–30.9.2017, 9862 sessions were conducted on our website, by 5842 users. The average number of pages viewed per session was 3.6 with an average session duration being 3’34 ‘More than 50% of users in this period were new to the website and our low bounce rate suggests that people who came to us found what they were looking for. The most popular resource was symptom management guidance.ConclusionsThis novel website is a well-used platform for a suite of resources, as well a means of educational support for those engaging in end of life care.

BackgroundThe Hospital Palliative Care Team (HPCT) at Royal Derby Hospital identified a number of circumstances where previously known patients were readmitted, but not promptly re-referred, to HPCT. The average length of time between admission to hospital and referral to HPCT was 8 days. We believed earlier HPCT intervention might reduce length of stay.MethodsThrough our electronic hospital database we attach an e-alert to a patient‘s clinical details which generates an email on each re-admission. HPCT apply e-alerts to the records of patients who have stated they would not want further hospital admissions or to those complex patients for whom we feel early involvement in future would be advantageous. We check the e-alert inbox daily and respond by telephoning the ward to ascertain whether HPCT input is required.ResultsWe report on data collected over 30 months relating to 627 unique patients with e-alerts. 213 patients had unplanned re-admissions to hospital. A total of 294 emails were received, on average 2.25 emails per week – which did not present an excessive new workload. HPCT response time to an e-alert averaged 0.6 days. For those patients whose preference was to be discharged, the use of an e-alert was associated with a reduced time in hospital of 7 days. When the patient died in hospital, the average length of stay was 15 days.ConclusionAdmit alerts allow HPCT to make a more prompt assessment of patients previously known to the service. For patients who go on to be discharged home, this is associated with a decreased length of hospital stay. We suggest this may improve patient experience.