1230 PALLIATIVE CARE MOVEMENT DISORDERS MULTIDISCIPLINARY MEETING

Introduction

It is well recognised that patients with Parkinson’s disease (PD) have significant symptom burden in advanced stages of their disease. Integration of movement disorder and palliative care services has been limited by concerns about resource and sustainability. We present our experience of establishing a movement disorders palliative care multidisciplinary meeting.

Method

In 2019 we established a multidisciplinary virtual bimonthly meeting between movement disorders and palliative care specialists. Referrals were accepted from movement disorder specialists, community Parkinson’s practitioners and palliative care specialists. Referring clinicians all actively applied primary palliative care approaches within their existing services. Aims of the meeting were to facilitate holistic management of complex needs, support advance care planning (ACP) and consider referral to specialist palliative care services.

Result

37 patients in total were discussed over a 2-year period (although the service was limited for a time due to COVID pressures). On average 3 new patients were discussed per meeting. Reasons for referral included motor and non-motor symptoms, support with ACP, medication advice, caregiver concerns and emotional distress. Meeting outcomes included medication adjustments, expediting reviews, hospice support, carer support, and referral to other services. Since the meetings started 23 (62%) patients have died. Of these, 30% died in hospital compared with the national average of 43.4%. The average between discussion at the meeting and death was 139 days. The meeting has generated education opportunities, triggered joint assessments and a professionals’ framework for the palliative management of patients with a movement disorder.

Conclusions

We present the experience of an MDT embedded within an early integrated palliative care service for movement disorders. The MDT has strengthened partnership working and findings suggest that alongside active primary palliative care, specialist palliative care for PD can be sustainable and resource efficient in a UK setting.

Treadmill Velocity Best Predicts 5000-m Run Performance

In this study, we aimed to investigate physiological determinants of endurance performance that best predict 5000-m average run velocity before and after endurance training. Thirty-nine previously untrained participants completed a 5000-m run; a constant velocity test (measuring running economy); and an incremental treadmill test to determine maximal oxygen uptake, final treadmill velocity, and velocity and oxygen uptake at lactate threshold, before and after six weeks of endurance training. Maximal oxygen uptake, final treadmill velocity, and velocity and oxygen uptake at threshold all increased significantly after training (p < 0.05). Average velocity for 5000 m increased significantly (p < 0.05). Running economy was not significantly altered. Correlation analysis revealed final treadmill velocity was most strongly related to 5000-m performance, in both untrained and trained states (r = 0.89, 0.83). Lactate threshold velocity (r = 0.73, 0.76), maximal oxygen uptake (r = 0.55, 0.51) and oxygen uptake at threshold (r = 0.45, 0.45) also showed significant correlations. In contrast, running economy was not significantly related to performance. These results demonstrate that final treadmill velocity in an VO2max test is the single best predictor of 5000-m performance in untrained and trained states. Furthermore, stepwise regression analysis showed that only velocity at lactate threshold significantly improved the accuracy of prediction provided by final treadmill velocity alone.

Hepatitis C in Prince Edward Island: a descriptive review of reported cases, 1990-1995

INTRODUCTION

The prevalence of hepatitis C in Canada is not known. There is limited information on most small area populations such as Prince Edward Island.

METHODS

A retrospective approach was used to obtain detailed information on all cases of hepatitis C identified in Prince Edward Island from December 1990 to September 1995. Cases were reviewed for demographic, clinical and risk factor information, including blood donation and transfusion histories.

RESULTS

There were 54 RIBA confirmed cases of hepatitis C infection included in the Prince Edward Island Hepatitis C Database, of which 38 (70%) were males. Age ranged from 18 to 76 years, with a mean age of 38 years. Twenty-eight (52%) of the cases had a history of injection drug use, and 24 (44%) had received blood or blood products in the past. There were five cases with neither of these risk factors identified.

DISCUSSION

The results suggest that, in this small, primarily rural population, injection drug use is the most common means of hepatitis C transmission, followed by receipt of blood or blood products.

The epidemiology of Creutzfeldt-Jakob disease in Canada: a review of mortality data

Creutzfeldt-Jakob disease (CJD), and particularly its transmissibility through blood and blood products, has become a focus of concern in Canada. The recent identification of new variant CJD led to a review of the Canadian mortality database to identify any clustering of CJD by age, sex, or geographic location.

Changing epidemiology of AIDS

It has been 15 years since AIDS made its first appearance in North America, probably longer worldwide. In that time, our knowledge of the epidemiology of AIDS has grown and changed. This review highlights significant aspects of the epidemic with particular emphasis on the evolution of this disease in North America.