The views of general practitioners 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 for patients with dementia is low. The disease’s
uncertain course and the inability to communicate with
the patient living with dementia are significant challenges for
GPs.
Aim The purpose of this study was to describe the attitudes and
practice preferences of GPs working within the UK’s National
Health System (NHS) regarding communication, and decisionmaking
for patients with dementia and their families
Methods A cross-sectional survey, using a purposive, cluster sample
of GPs across Northern Ireland with registered dementia
patients was used.
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
(39.8% in favour vs 45.8% disagreed). Interestingly, GPs who
were longer in practice placed greater importance on the presence
of an advance directive (F (2, 124) = 3.38, p = 0.037).
Discussion The timing of initiating ACP varies across individuals
requiring GPs to carefully consider strategies and receptiveness
of the patient and family carer.
Conclusion The findings promote both ongoing training in communication
and dementia management for GPs to meet the
needs of their patients living with dementia.

Planning Bill (3): Community Involvement

This paper looks at the Community Involvement provisions set out in the Planning Bill. It is one of four papers prepared for the Bill, which follow a common format that highlights: the key issues arising in the Bill; summarises the findings of the public consultation and the Government’s response; reviews comparable arrangements in comparable jurisdictions and highlights potential contentious issues that arise.

Planning Bill (4): Implementation, Performance and Decision making: Issues of Capacity, Delivery and Quality

This paper examines issues of capacity, delivery and quality in relation to the Planning Bill. It is one of four papers and follows a common format highlighting the key issues arising in the Bill; summarising the findings of the public consultation and the Government’s response; reviewing comparable arrangements in comparable jurisdictions and highlighting potential contentious issues.

Risk-aware Planning in BDI Agents

The ability of an autonomous agent to select rational actions is vital in enabling it to achieve its goals. To do so effectively in a high-stakes setting, the agent must be capable of considering the risk and potential reward of both immediate and future actions. In this paper we provide a novel method for calculating risk alongside utility in online planning algorithms. We integrate such a risk-aware planner with a BDI agent, allowing us to build agents that can set their risk aversion levels dynamically based on their changing beliefs about the environment. To guide the design of a risk-aware agent we propose a number of principles which such an agent should adhere to and show how our proposed framework satisfies these principles. Finally, we evaluate our approach and demonstrate that a dynamically risk-averse agent is capable of achieving a higher success rate than an agent that ignores risk, while obtaining a higher utility than an agent with a static risk attitude.

Wounded Spaces: When Planning Degraded Cairo’s Urban Memory

This paper examines the position of planning practices operated under precise guidelines for displaying modernity. Cultivating the spatial qualities of Cairo since the 1970s has unveiled centralised ideologies and systems of governance and economic incentives. I present a discussion of the wounds that result from the inadequate upgrading ventures in Cairo, which I argue, created scars as enduring evidence of unattainable planning methods and processes that undermined its locales. In this process, the paper focuses on the consequences of eviction rather than the planning methods in one of the city’s traditional districts. Empirical work is based on interdisciplinary research, public media reports and archival maps that document actions and procedures put in place to alter the visual, urban, and demographic characteristics of Cairo’s older neighbourhoods against a backdrop of decay to shift towards a global spectacular. The paper builds a conversation about the power and fate these spaces were subject to during hostile transformations that ended with their being disused. Their existence became associated with sores on the souls of its ex-inhabitants, as outward signs of inward scars showcasing a lack of equality and social justice in a context where it was much needed.