Amara Nwosu

MBCHB MRCP PhD


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Palliative Care, Architecture & Design Symposium (#PADS2018), 12th November, University of Liverpool

The inaugural Palliative Care, Architecture & Design Symposium (#PADS2018) will take place on the 12th November, University of Liverpool, Foresight Centre, 0900 – 1700.

By 2040 the UK need for palliative care is likely to increase by 40%; however, by then the most likely place of death will be nursing homes. Consequently, this symposium asks what work can to done now to re-design palliative care to meet the needs of people over the next 20 years or so. This redesign includes how be develop services, build homes and other buildings, how we use technology, design hospice and hospital services.

This symposium will bring together researchers from different backgrounds to develop research methodology, to explore how architecture, design and technology can improve quality of life for people with palliative care needs. Several speakers across a range of disciplines have been confirmed (see attached programme).

The event is supported by a number of organisations, including: Engage Liverpool (University of Liverpool), the Centre for Humanities and Social Sciences of Health Medicine and Technology (CHSSoHMT), the Global Digital Exemplar Programme, Royal Liverpool & Broadgreen University Hospitals NHS Trust and the National Institute for Health Research (NIHR) North West Clinical Research Network (CRN).

The event is free. A lunch will be provided. It will offer a wonderful opportunity for collaborative research and networking. ALL WELCOME!

Further information can be found from:
https://www.liverpool.ac.uk/engage/events/2018-2019/palliative-care-architecture-design-technology/

or by contacting Dr Amara Nwosu: anwosu@liverpool.ac.uk

To register please click the link(s) below


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Caring robots: UK robotics week (24th – 30th June)

Next week is UK robotics week (24th – 30th June). Personally, I have interest about how developments in robotic technology will affect the world that we live in. On the Monday 19th June I participated in events at the University of Liverpool. The ‘Robots who care’ seminar was jointly organised by The Centre for Humanities and Social Sciences of Health, Medicine, and Technology (https://www.liverpool.ac.uk/humanities-social-sciences-health-medicine-technology/) and the Centre for Autonomous Systems Technology (CAST – https://www.liverpool.ac.uk/autonomous-systems/) and consisted of a variety of speakers, presenting different technological, ethical and practical issues concerning the use of robots in a ‘caring’ capacity. This included deep and meaningful questions, such as whether a robot (or ayny artifical intelligent system) can ‘care’ and, fundamentally, what we mean by ‘care’.
I presented a piece of work (on behalf of my co-authors), a collaborative with Computer science. This was an exploratory piece of work to program a robot to exhibit emotional responses in response to posed questions. The idea was to determine whether such applications could potentially be useful in palliative care education, through use of clinical stimulation scenarios.
An abstract describing the work can be found here:
A poster describing the work is available here:
The evening was concluded with a public lecture from  Professor Kerstin Dautenhahn, University of Hertfordshire (http://homepages.herts.ac.uk/~comqkd/). Her talk was entitled ‘A fatal attraction’ and explored the fascination that humans have with robots. Further information can be found here.
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Improving the approach to end of life care

The following article is reproduced from the University of Liverpool Website:

Improving the approach to end of life care

In a UK first, researchers from the Marie Curie Palliative Care Institute Liverpool, based at the University of Liverpool, have utilised a novel assessment tool to help monitor the hydration levels of a critically ill patient with POEMS syndrome to improve care.

Hydration in critically ill patients is important and the accurate assessment of their fluid status can be challenging. For example, many people with advanced cancer may have less desire to drink as their condition worsens and we understand little of the effects of this both physiologically and clinically.

Currently, there is a lack of evidence to guide health professionals’ management of (de)hydration of critically ill patients and current methods for monitoring hydration status can be invasive. In addition, current methods can provide a flawed measurement of hydration as they provide no information about extravascular or intracellular fluid status.

Feasibility and validity

The study, which took place in the Royal Liverpool University Hospital in collaboration withProfessor Andrew Pettitt, aimed to use bioelectrical impedance vector analysis (BIVA) to assist in guiding the care of a symptomatic patient with POEMS syndrome. Bioelectrical impedance vector analysis is a simple, safe, bedside method to measure body water content.

POEMS syndrome is an extremely rare multisystem disorder. POEMS stands for (P)olyneuropathy, disease affecting many nerves; (O)rganomegaly, abnormal enlargement of an organ; (E)ndocrinopathy, disease affecting certain hormone-producing glands that help to regulate sexual function, and certain metabolic functions; (M)onoclonal gammopathy or M proteins; and (S)kin abnormalities. The exact cause of POEMS syndrome is not known.

The researchers examined and evaluated the response of a 52-year-old female patient with POEMS syndrome to diuretic therapy. This therapy helps rid the body of salt (sodium) and water. Diuretics work by making the kidneys put more sodium into the urine. The sodium, in turn, takes water with it from the blood.

The patient was observed repeatedly over a period of a month and data was gathered as part of the assessment. The results of the study have been published in the British Medical Journal (BMJ) Supportive & Palliative Care.

Overcoming limitations

Dr Amara Nwosu, said: “This is the first study to use BIVA to evaluate hydration in POEMS syndrome. Furthermore, the evaluation of long term change in hydration in POEMS syndrome using BIVA, following intervention with diuretics, is novel.

“The advantage of BIVA is that it allows information to be obtained simultaneously about changes in tissue hydration or soft tissue mass, independent of regression equations, or body weight. This allows for accurate interpretation of BIVA readings even if patients are at extremes of weight or volume distribution.

Professor John Ellershaw, Director of the Marie Curie Palliative Care Institute Liverpool, said: “This case report highlights the potential to use BIVA to monitor hydration states over time in response to interventions. More research is needed to determine the potential of BIVA to improve the evaluation and management of hydration states in advanced cancer and chronic disease.”

The Marie Curie Palliative Care Institute Liverpool is a partnership between the University of Liverpool, the Royal Liverpool and Broadgreen University Hospitals NHS Trust and Marie Curie Cancer Care. The Institute aims to make a real and sustained difference to care at the end of life from bedside to policy through service innovation and improvement, research and development and knowledge transfer to inform clinical excellence.

The full paper, entitled ‘Longitudinal bioimpedance assessments to evaluate hydration in POEMS syndrome. BMJ Supportive and Palliative Care‘, can be found here.


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AmiPal podcast: A comparison between studies: research, audit and service evaluation – episode 20

In this episode I will provide an overview between the differences between research, audit and service evaluation. This is important to distinguish as research studies require ethical approval before they commence, whereas the other project types do not.

Is your project research, evaluation or audit? (Avon Primary Care Research Collaborative website)
www.apcrc.nhs.uk/governance/is_it_research.htm

NRES Defining Research leaflet.
www.hra.nhs.uk/documents/2013/09…ning-research.pdf

Copyright Dr Amara Nwosu, AmiPal Media 2016. www.amaranwosu.com

Music by Purple Planet
www.purple-planet.com


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AmiPal Podcast: Renal Medicine and Palliative Care – Interview with Dr Hannah Sammut – episode 19

In this episode of AmiPal I talk with Dr Hannah Sammut (Renal Physician and Royal College of Physicians post-CCT fellow in Palliative Medicine) about the importance of palliative medicine and palliative care.

 

The prevalence of symptoms in end-stage renal disease: a systematic review. Murtagh FE et al. Adv Chronic Kidney Dis. 2007 Jan;14(1):82-99.
www.ncbi.nlm.nih.gov/pubmed/17200048

 

Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease?Carson RC et al.Clin J Am Soc Nephrol. 2009 Oct;4(10):1611-9. doi: 10.2215/CJN.00510109
www.ncbi.nlm.nih.gov/pubmed/19808244

 

AmiPal and it’s content is copyright of Dr Amara Nwosu, KingAmi Media 2016. www.amaranwosu.com

Music by Bensound
www.bensound.com/royalty-free-music


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MyPal Podcast: What makes a good Case Based Discussion (CBD)? Interview with Dr Laura Chapman & Dr Daniel Monnery

In this episode of MyPal I interview Dr Laura Chapman (Palliative Medicine Consultant and Training Programme Director for Palliative Medicine in Health Education North West- Mersey) and Dr Daniel Monney (Specility Trainee in Palliative Medicine) about the Eportfolios’ Case Based Discussion (CBD) supervised learning events (SLEs). We discuss practical tips for educational supervisors to help conduct these SLEs.

Copyright Dr Amara Nwosu, KingAmi Media 2015.

www.amaranwosu.com

Music by Bensound

www.bensound.com/royalty-free-music


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MyPal podcast: Technology in the delivery of healthcare: patient power in medicine – Episode 16

In this episode of MyPal Dr Amara Nwosu provides an overview of the health secretary’s recent speech to the Health Service Journal which outlined the potential role of technology in healthcare.

There is the potential to use technology to help patients self management their conditions and facilitate more personalised proactive management of there health.

However 4 potential pitfalls were highlighted.

1. The issue of Bureaucracy, where technology is used as a means to a end where the systems detract from patient care.

2. A lack of accountability, where shared computer systems bewteen different healthcare providers remove accountability from anyone taking overall responsibility for care.

3. The problem of cost. Investment in expensive systems that cost too much and cannot be maintained long term.

4. Data security issues. The concern that the NHS can keep data safe.

Despite the potential barriers technology can be used to improve patient outcomes but should not be an end itself; it must aim to improve patient care. This is a good starting point to evaluate the role technology has in healthcare.

References

Patient power: threat or opportunity? Health Secretary’s speech on the opportunities offered by the shift to a patient-powered, technologically advanced health service.
Department of Health and The Rt Hon Jeremy Hunt MP
Health Service Journal, Barber-Surgeons‘ Hall, London
https://www.gov.uk/government/speeches/patient-power-threat-or-opportunity

Smart patients
Emma Hill, Lancet Volume 15, No. 2, p140–141, February 2014.
http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70044-0/abstract

The Patient Will See You Now: The Future of Medicine is in Your Hands by Eric Topol
http://www.amazon.com/The-Patient-Will-See-You/dp/0465054749

Patient reported outcomes
http://sites.duke.edu/rethinkingclinicaltrials/patient-reported-outcomes/

Use of an electronic patient-reported outcome measurement system to improve distress management in oncology
Palliat Support Care. 2014 Feb; 12(1): 69–73.
Sophia K. Smith, Krista Rowe, Amy P. Abernethy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066540/

Copyright Dr Amara Nwosu, KingAmi Media 2015.
http://www.amaranwosu.com

Music by Bensound
http://www.bensound.com/royalty-free-music


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Coming full circle: Thoughts on winning the European Association for Palliative Care Early Researcher Award

Last month I received joint 3rd place for the Early Research Award of the European Association of Palliative Care (EAPC) at their 14th World Congress in Copenhagen. I have written a blog about my reflections of winning this award which can be found through the following link.

 https://eapcnet.wordpress.com/2015/06/17/coming-full-circle-thoughts-on-winning-the-european-association-for-palliative-care-early-researcher-award/