Kirkwood Hospice

<h3>Background</h3> Chorea is a prevalent feature of Huntington’s Disease, which significantly impairs quality of life (Sokol, Troost, Kluger, et al. Ann Clin Transl Neurol. 2021;8(8):1668-1679) and psychological wellbeing (Pérez-Pérez, García-López, Valle, et al. Neurol Ther. 2025;14(1):99-115). Virtual Reality (VR) has been implemented in early-stage Huntington’s Disease, demonstrating improvements in cognitive and motor impairment (Cellini, Paladina, Mascaro, et al. Medicina. 2022;58(7):919). However, the application of VR in advanced Huntington’s Disease remains underexplored. <h3>Aim</h3> To assess the impact of VR on the motor function and psychological wellbeing of a 35-year old female patient with Advanced Huntington’s Disease, focusing on chorea severity, anxiety and depression, and quality of life. <h3>Methods</h3> The patient was offered six fortnightly sessions of a VR experience of her choice within the Living Well Centre at John Eastwood Hospice. Chorea severity was measured using the Unified Huntington’s Disease Rating Scale (UHDRS), collected before, during and after each session. Psychological wellbeing was assessed using the Patient Health Questionnaire-4 (PHQ-4) before and after each session. The FACIT-PAL14 was used to collect quality of life data, completed at baseline and post intervention. <h3>Results</h3> The patient engaged in six sessions of VR, with clips lasting between 9-15 minutes. She chose to experience ‘Swimming with Dolphins’ for four sessions and an ‘Ocean Body Scan’ for two sessions. The patient enjoyed using VR every session, reporting feeling <i>‘relaxed’</i> and that it ‘<i>stopped the fidgeting</i>’. The UHDRS-Chorea scores decreased during the treatment phase, with an average reduction from 9.7 (pre-VR) to 3.2 (during-VR). After VR, UHDRS-Chorea scores increased slightly to an average of 7.2, but remained improved compared to baseline. The average PHQ-4 pre-score of 9 reduced to an average post-score of 2.3, a reliable and clinical improvement in symptoms of low mood and anxiety. The FACIT-PAL-14 score increased from 18 to 28, suggesting potential improvement in overall quality of life. <h3>Conclusion</h3> The use of VR for advanced Huntington’s Disease may provide immediate benefits for managing severe chorea and psychological distress. These preliminary findings support further exploration of VR interventions and their mechanisms, particularly for palliative patients with advanced disease, where conventional options such as ‘talking therapy’ may be limited.

Kirkwood Hospice’s Support and Therapy team have launched a new support service for male service users, patients, carers, and bereaved men, taking place as a drop-in group held weekly. This new initiative has drawn upon the wider multi-disciplinary (MDT) approach at Kirkwood, with input offered by our trained Counsellors and Specialist Palliative Care Social Workers. Working closely with MDT members, we hope to develop this group, along with the service users, so that it is truly meeting the needs identified by the group.Feedback from Kirkwood’s service and carer user forum had previously indicated a demand for a male-specific service at Kirkwood Hospice. This was alongside recognition of existing services offered perhaps not appealing to male patients. Given the national ‘Men’s Shed’ movement has been gaining momentum and demonstrating positive links with mental health and wellbeing, it has felt like the right opportunity to develop a Men’s Space session.With the aim to engage and support more male service users at Kirkwood, the ‘Men’s Space’ sessions have been developed and launched. The sessions are being envisaged as a developmental 12 week programme where service users, alongside Kirkwood Hospice staff, come together in a supportive manner with the option to plan and deliver a specific project such as gardening, creative activities or IT based projects. The activities undertaken by the group will be led by the group itself and supported and facilitated by staff from the Support and Therapy team, Family Care Team and IT team members. Users can attend for as long as they want to during a weekly four hour period.Initial feedback has been extremely positive and the service will be evaluated through the ‘Short Warwick-Edinburgh Wellbeing Scale’ at week 1, 6 and 12. The sessions are also being promoted to local stakeholders including other Men’s Sheds groups based in Kirklees.

Similar to cancer, dementia is a complex, life-limiting condition, incidence also increasing with age. Both conditions require skilled care by professionals who understand the significant impact upon physical, emotional and social well-being for whole families. Recent work by Hospice UK (2015) resulted in guidance for hospices in embracing dementia care, partnership and collaboration being identified as key to success. Kirklees has a diverse population, approximately 4600 people currently live with dementia, a figure predicted to rise to 7000 by 2030. A number of these will be living with multi-morbidities necessitating support from different agencies and professionals as end of life approaches. The Kirkwood Admiral Nurse will ensure increasing numbers of families affected by dementia are supported to access skilled, competent, compassionate care. <h3>Aims</h3> Support people with dementia and carers make future plans for advancing illness and end of life care. Enable and facilitate workforce development, internal and external. Provide an expert resource for people with dementia, carers, hospice staff and external organisations. Develop new collaborations and partnerships extending role of hospice in dementia care. Promote role of hospice in dementia care amongst local community. Support both local and national agendas from dementia and end of life care perspectives. <h3>Service description</h3> This innovative service is a collaboration between Kirkwood Hospice, Kirklees Council and Dementia UK. An open referral system is in place with referrals accepted from people with dementia, carers and professionals. The Admiral Nurse has a caseload of complex cases, works in an advisory, consultancy capacity and focuses on workforce development via education. This paper describes how aims of the service have been implemented along with successes over a two-year pilot leading to a future substantive End of Life Care Admiral Nurse post at Kirkwood Hospice.

Share and Care is an innovative project developed within the hospice setting run in collaboration with a carers charity and the local authority to improve support, knowledge and education for carers of individuals with life- limiting illnesses. The course was designed to deliver specialist support to carers, an area for development identified within the hospice User Forum. Share and Care provides sessions on a variety of topics including: Helping people to move safely Protecting vulnerable skin and preventing pressure sores Nutritional needs and eating on a budget Fatigue management Developing coping skills. Having a carer specific group allows the sharing of practical ideas and personal experience, as well as hospice staff being able to promote good practice, providing a forum for carers to engage with hospice services earlier for them and their families. The three-week course is run every third month; each session lasting 90 minutes, enabling delivery to five cohorts per year. Between 2015 and 2016 the course was delivered to 70 carers. Feedback gained following sessions suggested that the support and advice delivered was specific to their needs and delivered at the correct time to enhance confidence in their caring role when supporting their loved ones at the end of their lives. The course has been commissioned for a further 12 months by the Local Authority. We have developed the scope of the Share and Care service to include a more informal drop-in service for carers supported by local carer support agencies known as “Carers’ Retreat”, supporting 85 carers in the last 12 months. Carers play a vital role in managing issues for patients with life-limiting illnesses and the group provides practical support with this. Additionally it allows earlier access to more traditional hospice services whilst challenging stigma around the role of hospice care.

BackgroundWithin the last decade, numerous white papers have been published to improve care for palliative care patients. The principle of effective communication is at the heart of clinical practice and professional codes. Often communication training programmes are expensive, elitist or inaccessible. It is a challenge to develop a workforce in the current climate and demands of biological and sociological developments.The more complex healthcare becomes, the more important it becomes to keep it simple.AimTo improve the confidence and competence of the workforce who will communicate with palliative care patients.ApproachDesign & delivery of innovative, accessible, multi-professional education. The two day programme includes pre and post training interviews in order to provide meaningful, individual assessment and feedback. The teaching styles are both negotiated and didactic. The programme provides an opportunity for professionals to observe and participate in scenarios which demonstrate key and difficult issues involved in communication. The teaching team consists of ‘Jobbing experts’ who have undergone advanced communication skills training, specialist clinicians who share the many and various scripts that lie in their memories. Formative assessments include a reflective essay, which fits well with portfolio learning/evidence for all professionals including General practitioners.OutcomesThe evaluations have been excellent from all professionals in all clinical arenas. Funding has been secured for further education and collaboration in education is essential to future delivery. The practical element of ensuring information follows the patient, and how to start, support and close conversations were particularly appreciated.Application to hospice practiceExciting innovative education can embrace key contemporary issues and develop and inspire a workforce Clinical education in the 21st Century must be in partnership and make the complex simple. Negotiated learning by ‘telling the story’ is both authentic and inspirational. Our stories are worthwhile, inspiring future practitioners – crucial.

We would like to outline our experience of setting up a shared patient database. In palliative care, patients commonly move between one care setting and another, encountering different palliative care teams. Sharing clinical information between professionals in separate agencies may be difficult or subject to delay. Sheffield has two major providers of palliative …

In this paper, the vertical diffusion was measured from line source injector under neutral boundary condition over rib-roughened wall in a water channel. The variation in gap distance between the rib-roughened wall characterized skimming flow (ribs closely spaced), wake interference flow and isolated roughness flow (ribs widely spaced). The effect of change in local bed geometry was noticed with the increase in turbulence energy production, which was correlated with the vertical diffusion.