Amara Nwosu

MBCHB MRCP PhD


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Digital health priorities for palliative care research

We have deposited our paper “Technology in Palliative Care (TIP): the identification of digital priorities for palliative care research using a modified Delphi method” on the medRxiv preprint server (ahead for formal peer reviewed publication)

The aim of this study was to identify research priority areas for digital health in palliative care.

This is first study to identify digital health research priorities for palliative care and provides guidance for researchers, funders and policy makers to consider areas for future research and development. 

We identified 16 research priority areas for technology in palliative care, representing 8 themes of big data, mobile devices, telehealth, virtual reality, artificial intelligence, the smart home, biotechnology and digital legacy.  Our findings will support researchers, clinicians and policy makers to improve the evidence base in these areas, through further research and development. This work is timely and important, as global palliative care need is increasing but there is a lack of evidence of how digital health can be meaningfully used to support care needs of people with advanced illness.  Therefore, it is important that the risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely and safely and do not cause unintentional harm

The pre-print is freely available from the following link. Please note, that this has not been peer reviewed so should not yet be used to guide clinical practice.

Nwosu AC, McGlinchey T, Sanders J, Stanley S, Palfrey J, Lubbers P, Chapman L, Finucane A, Mason S. Technology in Palliative Care (TIP): the identification of digital priorities for palliative care research using a modified Delphi method. Medrxiv 2021. https://doi.org/10.1101/2021.06.24.21259307

health technology design, vector illustration eps10 graphic


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How can technology be used to support communication in palliative care beyond the COVID19 pandemic?

Can we use technology better to support communication in palliative care?

  • We are looking for palliative care healthcare professionals to share their experience of using technology to communicate during the COVID19 pandemic.
  • The study is funded by Marie Curie is led by Sarah Stanley (research nurse at Marie Curie Liverpool Hospice). The study has ethical approval and is sponsored by Lancaster University.
  • We are seeking the opinions of Palliative Care healthcare professionals who have worked in the UK during the COVID19 pandemic. 
  • This a short electronic survey (takes roughly 10 -15 minutes to complete) can be completed from a smartphone, laptop or desktop computer.
  • We will identify how technology have been used in palliative care, been used to support communication during the COVID19 pandemic. 
  • We will use the outcomes of this work to inform policy, to identify how technologies can be used to improve palliative access beyond the COVID19 pandemic.

  All the participant information, consent form and survey can be assessed from the link below.

Click here to access the survey

health technology design, vector illustration eps10 graphic


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Investigation and management of iron deficiency anaemia in a specialist palliative care setting and the role of intravenous iron: a descriptive analysis of hospice data

Anaemia is common in hospice populations and associated with significant symptom burden. Guidelines recommend investigating for and treating iron deficiency (ID), but there is little evidence of this practice in palliative care populations. Our paper (published in AMRC Open Research) describes the results of investigations for and subsequent management of ID in Marie Curie Hospice Liverpool.

Our data demonstrates that iron deficiency is common and can be safely treated with intravenous iron replacement, within current guidelines, in a hospice setting. Further research should define the optimum use of this approach in palliative care patients.

More information can be found here:

Steele T, Bonwick H, Nwosu AC and Chapman L. Investigation and management of iron deficiency anaemia in a specialist palliative care setting and the role of intravenous iron: a descriptive analysis of hospice data [version 1; peer review: awaiting peer review]. AMRC Open Res 2021, 3:6 (https://doi.org/10.12688/amrcopenres.12963.1)

Medical photo created by rawpixel.com – www.freepik.com


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Implantable cardioverter defibrillator (ICD) deactivation in palliative care – a case involving best interest decisions for someone lacking capacity at the end of life

The use of implantable cardioverter-defibrillators (ICD) has increased due to benefits of preventing death from cardiac arrhythmia. However, the increasing use of ICDs has created new challenges for how to proactively manage deactivation of these devices in people who are dying, especially for those who lack capacity to make decisions about their care. The aim of this case report is to discuss the challenges of planning for deactivation of an ICD for a patient who lacked capacity at the end of life.


In this case report (published on AMRC Open Research) we describe the challenges of managing ICD deactivation in a dying patient with fluctuating capacity who had previously expressed a wish for the ICD to remain active. Although it is preferable to use advance care planning (ACP), to provide care in-line with patient-identified care preferences, we demonstrate how a best interest process can be used to make decisions about ICD deactivation at the end of life.

More information can be found in our case report here:

https://amrcopenresearch.org/articles/3-4


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Improving Palliative Care Through Digital Health Technology

I’m delighted to write a geust blog for BMJ Supportive and Palliative Care about how palliative care care be improved through use of digital health technology. I also reflect on how this presents an opportunity to learn from the COVID19 pandemic. Specifically, I reference an article by Clabburn and colleagues, which describes the novel use of ‘Ivy Street’, a Virtual Learning Environment to support palliative and end of life care education. 

Read my guest blog here:


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Big Data and Palliative Care

 

I was delighted that our letter about Big Data and palliative medicine was published in ‘Palliative Medicine’. This was in response to an editorial by Peter Tanuesputro which described how Big Data analysis of linked data has the potential to support care by indentifying patient needs. Our letter describes five challenges which need to be considered in order to make meaningful use of Big Data analysis in palliative care.

The letter is freely available in full from the link below.

Nwosu AC, Collins B, Mason S. Big Data analysis to improve care for people living with serious illness: the potential to use new emerging technology in palliative care. Palliative Medicine 2017; doi:10.1177/0269216317726250.


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Learning through listening: The development of the ‘SAGE Palliative Medicine & Chronic Care’ podcast

I was delighted to be invited to write a guest blog for the European Association of Palliative Care (EAPC) website, about my role in developing podcasts for ‘Palliative Medicine’ in my role Digital Editor for the journal.

The full blog post can be found here:

Learning through listening EAPC guest blog

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How to access the ‘SAGE Palliative Medicine & Chronic Care’ podcasts

  • Subscribe to the podcasts from iTunes here.

 


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Poster about the ‘Palliative Medicine’ podcasts presented at the 2017 North West Annual Medical Leadership and Management Conference

I am currently the Digital Editor of the Palliative Medicine journal (the world’s highest ranked journal, peer reviewed scholarly journal dedicated to improving knowledge and clinical practice in the palliative care of patients with far advanced disease: http://journals.sagepub.com/home/pmj ). In this role I lead the development of podcasts to enable dissemination of the journals’ work to a wider audience. Essentially this work follows on from my foray into the podcast world through my AmiPal podcasts (https://soundcloud.com/mypal), which are podcasts about palliative care, technology and innovation.

On the 14th June I was delighted to present a poster about the development of these Palliative Medicine podcasts at the 2017 North West Annual Medical Leadership and Management Conference which took place in the AJ Bell stadium. The poster featured some initial data on the popularity of the podcasts and some download data. Essentially the podcasts are doing very well with many authors getting into the process of recording podcasts which have been well received.

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A link to the ‘SAGE Palliative Medicine & Chronic Care’ podcasts can be found through the Palliative Medicine site here: http://journals.sagepub.com/page/pmj/podcasts

You can subscribe to the podcasts from iTunes here: https://itunes.apple.com/gb/podcast/sage-palliative-medicine-chronic/id1179036261?mt=2

The podcasts are available from most podcast app services by simply searching for ‘Palliative Medicine’. However, if you need the RSS feed to subscribe to can do find that here: http://sagepalliativemedicine.sage-publications.libsynpro.com/rss

If you’re an author of a paper published in Palliative Medicine are interested in recording a podcast, please feel free to contact me.


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Sensor City: Connected cows and better mousetraps

This evening I had the pleasure to attend a networking event at ‘Sensor City’ Liverpool. Sensor City is a Liverpool-based technical innovation centre and University Enterprise Zone; it aims to support the creation, development, production and promotion of cutting edge sensor technologies for use in a wide range of sectors.

http://www.sensorcity.co.uk/

Sensor City

The event was entitled ‘Connected cows and better mousetraps’ and detailed myriad potential  ‘use-cases’ for the application of Internet of Things (IoT) technology in industry.

http://www.sensorcity.co.uk/event/connected-cows-better-mousetraps/

The session was led by Mark Maidman, a representative from Actility (https://www.actility.com/) a company specialising in IoT devices.

As a palliative care doctor interested in technology my immediate thoughts are about the potential uses of IoT to support care of people with advanced disease and complex needs. Events like these are excellent in fostering cross-disciplinary collaboration which will hopefully lead to innovation through sharing expertise and resources.

Further information about sensor cities events can be found here:

http://www.sensorcity.co.uk/events/

Are you interested in the role of emerging technologies in facilitating supportive and palliative care for individuals and populations? If so, please free to comment and get in touch with me.


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AmiPal podcast – Assessing hydration in POEMS syndrome using bioimpedance analysis – episode 21

In this episode I provide an overview of the use of bioimpedance analysis to assess hydration over time in a patient with POEMS syndrome. This was published in the BMJ Supportive and Palliative Care journal and can be found through the link provided below.

Nwosu AC, Morris L, Mayland C, Mason S, Pettitt A, Ellershaw J.

Longitudinal bioimpedance assessments to evaluate hydration in POEMS syndrome. BMJ Supportive and Palliative Care doi:10.1136/bmjspcare-2015-000991
spcare.bmj.com/content/early/201…-2015-000991.full

Nwosu AC, Mayland CR, Mason S, Khodabukus AF, Varro A, Ellershaw JE. Hydration in advanced cancer: can bioelectrical impedance analysis improve the evidence base? A systematic review of the literature. Journal of Pain and Symptom Management 2013; 46(3):433-446.e6
www.jpsmjournal.com/article/S0885-3…0499-X/abstract

Researchgate link: www.researchgate.net/publication/23…the_Literature

Nwosu AC, Mayland CR, Mason SR, Varro A, Ellershaw JE. Patients want to be involved in end-of-life care research. BMJ Support Palliat Care 2013, Dec;3(4):45.
spcare.bmj.com/content/early/201…13-000537.extract

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

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

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