General practitioners perceptions on advance care planning for patients living with dementia

BACKGROUND: Advance care planning (ACP) facilitates communication and understanding of preferences, nevertheless the use of ACPs in primary care is low. The uncertain course of dementia and the inability to communicate with the patient living with dementia are significant challenges for GPs to initiate discussions on goals of care.

METHODS: A cross-sectional survey, using a purposive, cluster sample of GPs across Northern Ireland with registered dementia patients was used. GPs at selected practices received the survey instrument and up to four mail contacts was implemented.

RESULTS: One hundred and thirty-three GPs (40.6%) participated in the survey, representing 60.9% of surveyed practices. While most respondents regarded dementia as a terminal disease (96.2%) only 37.6% felt that palliative care applied equally from the time of diagnosis to severe dementia. While most respondents thought that early discussions would facilitate decision-making during advanced dementia (61%), respondents were divided on whether ACP should be initiated at the time of diagnoses. While most respondents felt that GPs should take the initiative to introduce and encourage ACP, most survey participants acknowledged the need for improved knowledge to involve families in caring for patients with dementia at the end of life and that a standard format for ACP documentation was needed.

CONCLUSION: Optimal timing of ACP discussions should be determined by the readiness of the patient and family carer to face to face end of life. ACP discussions can be enhanced by educational strategies directed towards the patient and family carer that enable shared decision-making with their GP when considering options in future care.

Aesthetic Perceptions - Is There a Difference?

Introduction: In recent times, the demand for aesthetic dentistry has increased, with patients presenting for treatment expecting an improvement in their aesthetics. Therefore, it is increasingly important for the dental profession to appreciate perceptions of dental aesthetics in order to provide a patient-centred service.

Objectives: The aim of this study is to quantify perceptions of aesthetics using a cross-sectional survey design. The hypotheses being tested were that differences exist in aesthetic perceptions of 1) dentists and dental students, 2) different age ranges and 3) gender.

Methods: A questionnaire was distributed to dental staff and students in the Cork University Dental School and Hospital. The questionnaire sought information relating to aesthetic perceptions by asking participants to compare photographs of smiles.

Results: 100 questionnaires were returned. It was found that differences existed in perceptions of dentists and dental students when certain aspects of a smile were evaluated, in particular when a minor flaw was present in a smile in addition to the major flaw being tested. Assuming that flaws were detected, more dental students (34%) than dentists (26%) were found to prioritise colour above more subtle flaws, such as a centreline shift. However, most results between the two groups are comparable in terms of their prioritising of importance of particular aspects of a smile, with no large significant differences.

Conclusion: Differences exist in aesthetic perceptions of dentists and dental students, especially with regard to tooth colour.

Traditions and transitions: teenagers’ perceptions of parading in Belfast

The purpose of this article is to explore and illuminate teenagers' experiences of, and attitudes to, parades in Belfast. The research draws on responses from 125 teenagers located in interface areas (areas where Catholics and Protestants live side by side but apart) to government supported attempts to rebrand Orangefest (traditional parade associated with Protestant/Unionist/Loyalist community) and St Patrick's Day (traditional parade associated with Catholic/Nationalist/Republican community) as all-inclusive community events. For the most part, young people access these parades in pre-existing, single identity peer groups and view these parades as either inclusive or exclusive calling into question the extent to which Belfast's city centre can be viewed as shared space.

Parents' perceptions of microneedle-mediated monitoring as an alternative to blood sampling in the monitoring of their infants

OBJECTIVES: Microneedle (MN) arrays could offer a pain-free, minimally invasive approach to monitoring. This is envisaged to be particularly beneficial for younger patients, but parents' views to date are unknown. The aim of this study was to explore parental perceptions of MN-mediated ISF monitoring, as an alternative to the use of conventional blood sampling, and to understand the important factors for technique approval.

METHODS: Semi-structured interviews were conducted with parents with recent experience of a premature birth. Recruitment was through the Northern Ireland premature infant charity, Tinylife. Interviews progressed until data saturation was reached and thematic analysis employed.

KEY FINDINGS: The study included 16 parents. Parental support for MN-mediated monitoring was evident, alongside the unpopularity of traditional blood sampling in neonates. Factors facilitating MN approval included the opportunity for pain reduction, the simplicity of the procedure, the potential for increased parental involvement and the more favourable appearance, owing to the minute size of MNs and similarities with a sticking plaster. Confirmation of correct application, a pain-free patch removal and endorsement from trusted healthcare professionals were important.

CONCLUSION: These findings will inform researchers in the field of MN development and enlighten practitioners regarding parental distress resulting from conventional blood sampling. Further work is necessary to understand MN acceptability among practitioners. This work should assist in the development of an acceptable MN device and facilitate the reduction of parental distress.

Perceptions of therapist responses to shame disclosures by clients: A quasi-experimental investigation with non-clinical participants

Background
Therapist responses to initial shame disclosure in therapy have received little empirical attention.

Aim
This study explored different therapeutic responses to shame disclosures in terms of their perceived helpfulness. Responses ranged from complete withdrawal from the feeling (withdrawal) to completely tuning into it (non-withdrawal). Given the tendency of shame to evoke avoidance, participants higher on shame-proneness (as measured by The Experience of Shame Scale) were expected to perceive withdrawal responses to shame as more helpful than non-withdrawal responses.

Methodology
Fifty-five non-clinical participants were assessed for shame-proneness before viewing videos of mock therapy sessions showing clients either disclosing shame (two videos) or shock (control condition). Participants then rated the helpfulness of different therapist responses. The responses differed in the degree they allowed the client to withdraw from their emotions.

Results
High shame proneness was associated with rating withdrawal responses to shame as least helpful. Overall, neither the withdrawal response nor the non-withdrawal response were rated as particularly helpful. The therapeutic response which addressed management strategies when shame is initially experienced in therapy was deemed most helpful.

Conclusion
Despite the tendency to withdraw from shame feelings, this response is not deemed helpful in therapy.