Women asylum seekers and refugees face persistent barriers to maternity care (antenatal, intrapartum and postnatal care) across high-income countries, yet the upstream governance shaping access remains under-examined. Although legally distinct, both groups share protection-seeking experiences and are addressed jointly in governance documents. This study examined and synthesised how international (macro), European regional (meso), and United Kingdom (UK, micro) governance documents frame and operationalise maternity service access. Sixty-four documents were analysed using the READ framework. Inductive analysis of macro and meso documents identified six access dimensions: universal coverage; cultural and linguistic adaptation; rights-based approaches; multi-agency collaboration; data, monitoring and accountability; and quality of care. These dimensions structured assessment of UK governance, with jurisdictions rated strong, moderate or weak. Alignment was fragmented: Wales, Scotland and Northern Ireland exempted asylum seekers from charging, whereas England retained charging provisions. Multi-agency collaboration was consistently articulated, yet none of the 35 UK government documents focused on maternity access for this population, and none required outcome monitoring disaggregated by asylum or refugee status. UK governance appears coordinated in form but fragmented in substance. UK-wide minimum standards and routine recording of these data, with safeguards against immigration-related use, could strengthen coherence and accountability and improve visibility of inequities.

AIMS:To identify, appraise and synthesise the current evidence relating to symptoms, experiences, management and impact of menopause on QoL among women with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) and to identify evidence gaps. METHODS:We conducted a scoping review guided by Arksey and O'Mally's framework by searching CINAHL, MEDLINE, EMBASE, PsychINFO and PubMed using an iterative approach to pre-specified eligibility criteria which were reviewed with increasing familiarity with the literature. Studies focusing on peri-menopausal and menopausal people assigned female at birth with a diagnosis of T1DM or T2DM were included. RESULTS:In total, 16,681 records were identified from which 77 papers were subjected to full review, with 22 eligible. Research focus and methodology varied: 16 observational studies, 2 expert consensus reviews, 2 interventional studies, 1 patient and public involvement paper and 1 qualitative grounded theory paper. PRISMA-ScR guidelines were followed for transparency of reporting. Findings indicate women with diabetes experience menopausal symptoms similar to those of women without diabetes; however, they may be at risk of increased severity of symptoms, HRT use was linked to lower HbA1c levels but is largely overlooked, limited research has been undertaken exploring women's experiences and awareness of support during the menopause; existing research evidence suggests they are ill-informed and lacking effective evidence based support. There is a particular dearth of evidence relating to women with T1DM. CONCLUSIONS:This review provides evidence that menopause has a negative influence upon quality of life for many women with diabetes. The impacts span managing diabetes and menopausal symptoms and seeking and receiving support. A hypothesised bidirectional relationship between diabetes and menopause may exist: whereby progression of one may be influenced by the other also resulting in a lower quality of life. While high-level evidence on this complex inter-relationship remains limited, particularly in T1DM populations, it suggests significant unmet need for those experiencing diabetes and menopause together.

Background While smart speakers are emerging as a novel health care technology, people with Parkinson's Disease (PwPD) and speech and language therapists (SaLTs) have reported difficulties using smart speakers with speech and voice impairments in research. To date, PwPD have identified frustration with having to repeat themselves to be understood, devices timing out before they had finished speaking, and being unable to have a conversation with smart speakers. SaLTs have reported technical and practical challenges in implementing voice-assisted technology tools. Both PwPD and SaLTs indicated a lack of knowledge about what smart speakers could do, as well as concerns about privacy and the listening nature of the devices. Objective This study aims to co-design solutions that support the use of smart speakers for speech and voice difficulties experienced by PwPD. Methods Based on the Design Thinking framework, a multistage design process was conducted, involving a lay steering group and 2 online co-design workshops. Twenty participants, including PwPD, carers, SaLTs, design and technology experts, and third-sector staff, collaborated during the co-design workshops. The ideate phase included brainstorming and ranking, and conventional content analysis was used to specify prototypes. Results Two main prototypes were created: (1) education and guidance, including privacy and therapeutic usage guides for PwPD and SaLTs to address troubleshooting and delivery considerations; and (2) new speech and language therapy (SLT)–specific features for smart speakers. Participants provided feedback on their experiences of co-design, highlighting feeling valued, the balance of perspectives, and making improvement suggestions. Feedback aligned with the UK standards for public involvement. Conclusions Smart speakers could enhance accessibility, therapy engagement, and long-term speech outcomes, offering scalable, cost-effective solutions to support SLT services, patient independence, and reduced service demand. Smart speaker solutions with a SLT focus enable PwPD to self-manage speech and voice difficulties at home and reinforce therapy gains between clinic visits. Co-designed with users, these prototypes are intended to address health disparities and relieve pressure on SLT services, offering a scalable and sustainable solution that enhances efficiency and supports ongoing rehabilitation within health care systems.

Due to longer life expectancy, the incidence of frailty is increasing. Global healthcare services are responding to this demand by investing in services specialising in managing those living with frailty. Speech and Language Therapists (SLT) are an integral part of newly established multi-disciplinary teams targeting frailty however there is little to no existing evidence base in relation to this patient cohort. There is a need for further research into how SLTs manage this population and a research priority-setting exercise is most appropriate to target initial research priorities. Sequential mixed-methods consensus methodology using a Delphi study. Two rounds were completed with 80 statements provided for participants to rank covering a range of clinical and professional themes. Descriptive analysis will be used and consensus will be deemed to have been reached with >70% agreement. Participants were recruited from SLTs or SLT Managers who work or manage specialist frailty services within the Republic of Ireland. Fifteen experts were recruited and two rounds of the Delphi study were completed. Fifty-one statements, covering nine themes, reached consensus with highly important research priorities identified, including the SLT contribution to the overall model of care, impact of reduced SLT resources on MDTs, advocacy for the profession and identification of quality of life measures and self-management of care. Themes with the highest consensus agreement level included MDT Working, Scope of Practice and Leadership. This study is the first of its kind to establish research priorities as identified by a panel of expert SLTs working in the area of frailty. It is hoped that this initial priority-setting exercise in this novel area of practice will provide information to clinicians and policy makers by identifying the topics of most research need. Future research will benefit from the inclusion of a broader range of key stakeholders.

Background The first palliative day care program (PDCP) marks its 50th anniversary. Aim This study examined the distinctive features of PDCPs that have endured, as well as the changes they have undergone in the United Kingdom and Canada, to identify avenues for the development of these programs. Methods Using primary data from two qualitative studies, conducted in the United Kingdom and Canada, a thematic meta-synthesis was carried out using the expansive secondary analysis approach to identify similarities and distinctions between the PDCPs identified in the two original studies. Results The results were drawn from group and individual interviews with 19 participants in Canada, including 13 professionals and 6 managers across 6 PDCPs, and 35 participants in the United Kingdom, including 16 professionals and 18 managers from 3 PDCPs. The results indicate that the administrative structure of the PDCPs, the adoption of a palliative care philosophy, and the multidisciplinary nature of the professional and volunteer teams are the components of the programs that have endured. However, patient characteristics, care models, and institutionalization are constantly evolving. Conclusions As PDCPs continuously innovate to adapt to the needs of their patients, the evolution of their components is desirable. However, pressure to demonstrate the relevance of their services to justify financial resources could, while ensuring their sustainability, deprive them of the values and practices that are their most valuable asset and purpose: supporting people living with advanced diseases with palliative care while still remaining in their own homes.

Background People with Parkinson disease (PD) often report low volume and reduced intelligibility of speech. Common household devices that use voice-assisted technology (VAT) require users to speak slowly, clearly, and loudly for the technology to function. For people with PD, this can be challenging, but this also suggests that VAT may have potential as a therapeutic tool. While VAT is an emerging health care technology, it is important to better understand the thoughts and experiences of people with PD who are already using it despite having speech and voice difficulties. Objective This study aimed to explore experiences of using VAT to address hypokinetic dysarthria secondary to PD, based on the perspectives of people with PD and family carers. Methods People with PD experiencing mild to moderate speech changes who were smart speaker users, and their carers, were invited to participate in 1 of 4 in-person focus groups. Between September and December 2024, focus groups were audiovisually recorded. A semistructured topic guide informed by published evidence was used to guide discussions. Results were transcribed and analyzed through a framework analysis approach (managed using NVivo software). Results A total of 15 participants, including 8 (53%) people with PD and 7 (47%) carers, participated in 4 in-person focus groups. Findings revealed shared experiences with VAT that were marked by its therapeutic potential and practical challenges. Five main themes were identified: (1) therapeutic potential for speech and voice, with subthemes of changes in volume, intelligibility, and clarity of speech; the role of VAT feedback; and VAT as an everyday device; (2) distrust of technology, with concerns surrounding data privacy, the listening nature of devices, and measures users take to protect themselves; (3) frustrations with devices, including devices not understanding, devices timing out, and the lack of conversation; (4) support needs, including the impact of a lack of knowledge and the need for education and guidance; and (5) design considerations for a future VAT tool in speech and language therapy (SLT). Conclusions This study extends on previous research findings, demonstrating that VAT may be acceptable to people with PD to create changes in volume, clarity, and intelligibility. However, attention must be given to users’ privacy concerns and frustrations with devices before VAT can used as a tool in SLT. Future research should design solutions to address current usability challenges with people with PD and professionals in three ways: (1) co-designing education and guidelines for people with PD, describing the use of VAT for speech and voice difficulties; (2) refining commercial VAT for use in SLT; and (3) establishing the feasibility of a therapeutic VAT intervention for people with PD with speech and voice difficulties.

BACKGROUND:People living with Parkinson disease (PD) often experience low speech volume and reduced intelligibility. Research suggests that common voice-assisted technology (VAT) devices, like Amazon Alexa and Google Home, can encourage individuals to modify their speech, speaking more clearly, slowly, and loudly. This highlights the potential of VAT as a therapeutic clinical tool in speech and language therapy (SLT). However, while VAT is emerging as a novel health care technology, gaps exist regarding understanding speech and language therapists' (SaLTs) experiences using these devices in clinical practice for PD-related speech and voice difficulties. OBJECTIVE:This research set out to explore various experiences of using VAT to address hypokinetic dysarthria, secondary to PD, from a range of stakeholder perspectives. This paper specifically focuses on clinical insights from SaLTs. METHODS:SaLTs with prior experience of using smart speakers in clinical practice with people with speech or voice difficulties were invited to participate in focus groups or interviews. Between September and December 2024, seven SaLTs participated in semistructured focus groups or interviews using a topic guide. Discussions were informed by published evidence. Results were transcribed and analyzed using a framework analysis approach and were managed through NVivo software (Lumivero). RESULTS:Four main themes were identified across the groups: (1) potential for VAT in SLT, (2) managing therapeutic beige flags, (3) empowering SaLTs to become digitally enabled practitioners, and (4) envisioning the future of VAT in SLT. CONCLUSIONS:This study recognizes VAT's potential as a therapeutic tool that may improve volume, clarity, intelligibility of speech, and facilitate at-home practice for people with PD. However, before VAT can be widely implemented, considerations around data privacy, device limitations, and practical integration into clinical care must be addressed. Future research is proposed to design solutions to address usability challenges for both clients and clinicians. Finally, this paper offers key clinical recommendations for the development of a therapeutic VAT tool for speech and voice difficulties in SLT.

BackgroundPeople with Parkinson disease (PD) often report low volume and reduced intelligibility of speech. Common household devices that use voice-assisted technology (VAT) require users to speak slowly, clearly, and loudly for the technology to function. For people with PD, this can be challenging, but this also suggests that VAT may have potential as a therapeutic tool. While VAT is an emerging health care technology, it is important to better understand the thoughts and experiences of people with PD who are already using it despite having speech and voice difficulties. ObjectiveThis study aimed to explore experiences of using VAT to address hypokinetic dysarthria secondary to PD, based on the perspectives of people with PD and family carers. MethodsPeople with PD experiencing mild to moderate speech changes who were smart speaker users, and their carers, were invited to participate in 1 of 4 in-person focus groups. Between September and December 2024, focus groups were audiovisually recorded. A semistructured topic guide informed by published evidence was used to guide discussions. Results were transcribed and analyzed through a framework analysis approach (managed using NVivo software). ResultsA total of 15 participants, including 8 (53%) people with PD and 7 (47%) carers, participated in 4 in-person focus groups. Findings revealed shared experiences with VAT that were marked by its therapeutic potential and practical challenges. Five main themes were identified: (1) therapeutic potential for speech and voice, with subthemes of changes in volume, intelligibility, and clarity of speech; the role of VAT feedback; and VAT as an everyday device; (2) distrust of technology, with concerns surrounding data privacy, the listening nature of devices, and measures users take to protect themselves; (3) frustrations with devices, including devices not understanding, devices timing out, and the lack of conversation; (4) support needs, including the impact of a lack of knowledge and the need for education and guidance; and (5) design considerations for a future VAT tool in speech and language therapy (SLT). ConclusionsThis study extends on previous research findings, demonstrating that VAT may be acceptable to people with PD to create changes in volume, clarity, and intelligibility. However, attention must be given to users’ privacy concerns and frustrations with devices before VAT can used as a tool in SLT. Future research should design solutions to address current usability challenges with people with PD and professionals in three ways: (1) co-designing education and guidelines for people with PD, describing the use of VAT for speech and voice difficulties; (2) refining commercial VAT for use in SLT; and (3) establishing the feasibility of a therapeutic VAT intervention for people with PD with speech and voice difficulties.

There is a reported high prevalence of anxiety in people with autism spectrum disorder. This mini review appraises existing research investigating heart rate variability biofeedback to help manage symptoms of anxiety in people with autism spectrum disorder. A thorough search of electronic databases was conducted to find relevant literature. Consultation with experts and a librarian helped develop search terms following the PICO framework. Five databases were searched, and screening was undertaken using Covidence software, with the process outlined in a PRISMA flowchart. The latest review showed positive short-term effects but there is a need for long-term follow-up. Future investigations should consider device type, training settings, and control interventions. Accurate heart rate variability assessment independent of biofeedback devices is crucial. Additional measures like cortisol assessment and user feedback are recommended for comprehensive evaluation. The findings highlight progress in the evidence base and offer insight to future directions.

Background Myanmar has a high maternal mortality rate. Evidence about pregnancy and antenatal care experiences of women in more remote areas, where Covid and conflict have increased poverty and restricted travel, is limited. Understanding how women in a camp for internally displaced persons (IDP) navigate pregnancy and antenatal care may inform strategies to improve pregnancy outcomes in remote and fragile contexts. Aim To explore how women living as IDPs experience pregnancy and antenatal care in a remote setting. Methods A case study approach with an exploratory and descriptive design will be employed using qualitative data collection methods with women in one settled IDP camp. Thematic interviews will be undertaken with internally displaced women, members of a local women's support network and local data collectors who have been working in women's health and development. Due to travel restrictions, a pragmatic decision was taken to work online with local data collectors experienced in qualitative research. This arrangement should increase richness of data, strengthen research capacity and reduce the impact of cross-cultural communication in the interview setting. Transcripts will be translated to English and data will be analysed thematically. Expected Results Pandemic restrictions and disruption to services have increased challenges for displaced women in relation to pregnancy and antenatal care. The study is likely to develop themes related to access difficulties, traditional beliefs and practices, the role of cultural factors in pregnancy and the value of social support networks in women's experiences of pregnancy in displacement. Current Stage of Work Ethical approval has been granted by Ulster University. A systematic review of qualitative evidence on pregnancy experiences of displaced women is underway. Interview guides have been translated, local language data collectors have been engaged, a site identified and local permissions secured.

Minimal research has explored the personal experience of burnout in doctors from any medical speciality. Consequently, we aimed to provide a relatable description and understanding of this globally recognised problem. We employed an interpretative phenomenological analysis (IPA) of face-to-face interviews with seven general practitioners (GPs) in Northern Ireland, having selected interviewees best able to speak about burnout. We sought to understand how these GPs understood their burnout experiences. Our participants’ continuous work involved more than their busy weekdays and also working on supposedly off evenings and weekends. In addition, draining intrusive thoughts of work filled most, if not all, of their other waking moments. There was no respite. Work was ‘always there.’ Being constantly busy, they had no time to think or attend to patients as doctors. Instead, participants were going through the motions like GP automatons. Their effectiveness, efficiency, and caring were failing, while their interactions with patients had changed as they tried to conserve their now-drained energy and empathy. There was no time left for their families or themselves. They now “existed” to continuously work rather than “living” their previous, more balanced lives that at one time included enjoying being a doctor. Worryingly, participants were struggling, isolated, and vulnerable, yet unwilling to speak to someone they trusted. We intend our burnout narrative to promote discussion between medical colleagues and assist in its recognition by GPs and other doctors. Our findings warn against working excessively, prioritising work ahead of family and oneself, and self-isolation rather than seeking necessary support.

BACKGROUND:Jordanian pregnant women report high prevalence of antenatal depressive symptoms, compared to their counterparts internationally. One potential nonpharmacological intervention is Interpersonal Psychotherapy (IPT), accessed by telephone.AIM:The aim of this study is to compare the depressive symptom level(s) among Jordanian pregnant women who received IPT treatment with those who received routine antenatal care.METHODS:A prospective randomized controlled trial design was used. Following ethical approval, a sample of 100 pregnant women (50 in each group) at 24 to 37 weeks gestation, was drawn from one governmental public hospital. Seven sessions (each half an hour) of telephone-based IPT were offered twice weekly to those assigned to the intervention arm: one pretherapy orientation, five intermediates, and one closing session. The Edinburgh Postnatal Depression Scale was administered before and after the intervention. Analysis of covariance was used to detect the intervention effect. The two groups were matched based on demographic and health characteristics.RESULTS:Compared to the control group, pregnant women who received the intervention reported fewer depressive symptoms.CONCLUSIONS:Midwives and general nurses should screen all pregnant women for symptoms of depression. The effectiveness of IPT treatment in alleviating depressive symptoms indicates the importance of using such supportive interventions by midwives and general nurses, who are trained in psycho-educational counseling techniques. Moreover, data provided by this study may encourage policymakers to legislate policies that make psychotherapists available and accessible in antenatal care units and ensure that staff have adequate training via continuing education programs to screen for antenatal depressive symptoms.

INTRODUCTION:A palliative care approach can improve quality-of-life for people with dementia. It is the preference of many people with dementia to remain living at home until death, with the appropriate care. To develop a successful model for dementia palliative care in the community, it is essential to assimilate the perspectives and experiences of those affected. The guiding research question for this study was: What are people with dementia and family carers' views on a model for dementia palliative care?. METHODS:Focus groups (n = 3) were conducted with bereaved or current family carers (n = 11), and people with dementia (n = 2). Discussions centred around a proposed model of dementia palliative care. These were transcribed and analysed using thematic analysis. RESULTS:Three main themes were identified: living and dying well with dementia; reducing carer burden to fulfil the wish for home care; and lack of faith in the healthcare system. One statement which summarised the analysis was: "Dementia palliative care is a dream, but not a reality." This reflected participants' repeated "wish" for this "ideal" model of care, but simultaneous scepticism regarding its implementation, based on their prior experiences of healthcare services. CONCLUSION:All participants were welcoming of the proposed model for dementia palliative care and were generally positive about palliative care as a concept relating to dementia. There was consensus that the model would allow people to live and die well with dementia, and reducing the carer burden would fulfil the wish to remain at home. However systemic changes in the healthcare system will be needed to facilitate a truly person-centred, holistic, individualised and flexible model of care.

Burnout in family doctors (FDs) affects their well-being, patient care, and healthcare organizations, and is considered common worldwide. However, its measurement has been so inconsistent that whether the widely divergent prevalence figures can be meaningfully interpreted has been questioned. Our aim was to go further than previous systematic reviews to explore the meaning contribution and usefulness of FD-burnout prevalence estimates. Worldwide literature was systematically reviewed using Levac's scoping framework, with 249 papers undergoing full-text review. Of 176 studies measuring burnout, 78% used the Maslach Burnout Inventory (MBI), which measures burnout as now defined by the World Health Organization. We, therefore, concentrated on the MBI. Its burnout measurement was markedly inconsistent, with prevalence estimates ranging from 2.8% to 85.7%. Researchers made prevalence claims relating to burnout severity and implied diagnoses based on participants' MBI scores, even though the MBI has not been validated as a clinical or diagnostic tool. Except when comparisons were possible between certain studies, prevalence figures provided limited meaning and added little to the understanding of burnout in FDs. Our review revealed a lack of research-supported meaningful information about the prevalence of FD burnout and that care is required to avoid drawing unsubstantiated conclusions from prevalence results. This paper's overall purpose is to propose how obtaining meaningful prevalence estimates can begin, which are recognized as key to developing improved prevention policies and interventions. Researchers must adopt a consistent means to measure burnout, use the MBI as its authors intended, and explore making progress through quantitative and qualitative collaboration.

BACKGROUND The prevalence of dementia is increasing, bringing a range of challenges, such as eating, drinking and swallowing (EDS) difficulties, that are associated with aspiration, which can be fatal. Early identification of EDS difficulty in early-stage dementia could prevent complications, but reliable indicators are needed to help develop pathways to support the diagnosis. Previous reviews of this area require updating. AIMS To identify reliable and clinically measurable indicators of EDS difficulty used in early-stage dementia. METHODS & PROCEDURES A systematic search was conducted using common databases (MEDLINE, EMBASE and PsychInfo). Articles reporting indicators of EDS difficulty in early-stage dementia or mild cognitive impairment were included. The reliability of included studies was critically appraised using the risk of bias tools. Study outcomes were narratively reviewed by considering the reliability, clinical measurability and applicability of EDS indicators to early-stage dementia. OUTCOMES & RESULTS Initial searches returned 2443 articles. After removing duplicates, limiting to English language and human studies, 1589 articles remained. After reviewing titles, 60 abstracts were reviewed, yielding 18 full-text articles. A total of 12 articles were excluded that did not report at least one indicator of EDS difficulty in early-stage dementia, or where the reported association was not strong. Six included studies that reported eight indicators of EDS difficulty in early-stage dementia (four studies including people with Alzheimer's disease). On the balance of measurability, reliability and applicability, the most promising indicators of EDS difficulty were: delayed oral transit, rinsing ability, sarcopenia and polypharmacy. Additional, less reliable and applicable indicators included: always opened lips and non-amnestic mild cognitive impairment, especially in men. The delayed pharyngeal response is subjectively measured when instrumental assessment is not available and the 'candy sucking test' cannot be recommended because there is an inherent choking risk. CONCLUSIONS & IMPLICATIONS EDS difficulty in early-stage dementia can be highlighted by indicators that could be combined to create enhanced pathways to support the early identification of EDS difficulties for people living with early-stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration. Exploring the experiences of people living with dementia and their families' perspectives on potential indicators of EDS difficulty may add to the existing evidence base. WHAT THIS PAPER ADDS What is already known on the subject Early identification of EDS difficulty in early-stage dementia may prevent complications, but more reliable and clinically measurable indicators of EDS difficulty are needed to help develop pathways to support diagnosis. What this paper adds to existing knowledge A comprehensive range of studies related to EDS identification in early-stage dementia have been selected and reviewed. Across six included studies, the most promising indicators of EDS difficulty in early-stage dementia included delayed oral transit, poor rinsing ability, presence of sarcopenia and polypharmacy. What are the potential or actual clinical implications of this work? This study could help to develop pathways to support the early identification of EDS difficulties for people living with early-stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration.

Living with a life-limiting illness, people with dementia benefit from palliative care which considers the holistic needs of the person and their family. However, little is known about how palliative care may be best provided to people living with dementia at home in the community. We examined four exemplary dementia palliative care services for people with dementia in the community, to see what activities they were providing, what were the commonalities and differences, and what lessons could be learned. A long-list of dementia palliative care services in Ireland, Northern Ireland, England, Scotland, and Wales, was identified through a survey, and four exemplar services were chosen based on criteria including: in operation >six months; provides identifiable activities; availability of routinely collected service data; not exclusively for people with dementia in final hours or days of life. Mixed-methods of data collection included interviews, focus-groups and surveys with service staff, surveys of service users, and routinely collected service data. The RE-AIM framework was used to describe and understand the sample of dementia palliative care services. The four services had varied organisational structures and were led by different disciplines. However, they all provided common core activities including holistic and person-centred care, early advance care planning with service user involvement, carer support, integrated healthcare services, continuity of care, 24/7 support, bereavement support. All had needs-based referral criteria, accepting any age or dementia sub-type. All supported people with dementia to remain living at home and to have a comfortable, dignified death in their preferred place. An effective dementia palliative care service may take different forms. Whether the service is dementia-led or Specialist Palliative Care-led, efficacy is associated with providing a range of key activities and implementing them effectively. The data collected strongly suggests the benefits of the dementia palliative care services to a person with dementia and their families and offers valuable insight into the key factors for the establishment and successful running of such services.

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial Fibrillation (AF) affects 30% of the world’s population and accounts for 3 million deaths annually, and current management pathways often result in poor outcomes in recurrence of AF with up to 50% reoccurring post pulmonary vein isolation cardiac ablation (PVICA). Epicardial Adipose Tissue (EAT) is a metabolically active substrate implicated in the pathogenesis of AF. Increased levels of EAT thickness have been associated with the risk of developing AF and has also been associated with poorer outcomes and increased likelihood of AF recurrence after PVICA. The aim of this work was to explore current knowledge on levels of EAT in people with AF, post cardiac ablation, taking account of physical activity (PA). Objectives: Three research questions were set: · Does volume of EAT contribute to the pathogenesis and severity of AF? · Does any kind of PA modify EAT volumes? · Does PA improve outcomes in patients with AF who have undergone PVICA? Methods An umbrella review format was adopted with eligible studies from PubMed, EMBASE, the Cochrane Central Register of controlled trials (CENTRAL), Ovid MEDLINE, CINAHL, and Scopus and registered on Prospero. All results were reported adhering to Preferred Reporting items for Systematic Reviews and Meta-Analysis (PRISMA). Quality assessment evaluation involved the AMSTAR 2 tool and risk of bias evaluated using the ROBIS tool. No ethical considerations were identified for this review. Results Ten reviews were eligible for inclusion in the analysis. Five examined the relationship between EAT and AF occurrence, three examined EAT modifications with PA and two examined the effect of PA on AF outcomes. The quality of the studies was high, with a low risk of bias. Increased EAT volumes were associated with a large effect size for the development of AF Hedges’ g=0.86[0.79,0.92] for Total EAT volume and g=1.31[1.16,1.47] for Left Atrial (LA) EAT volume, and AF severity also had a large effect size for both Total and LA EAT volumes with g=0.87[0.71,1.02] and 0.99[0.69,1.3] respectively. EAT also showed a large effect on recurrence of AF post PVICA in both the Total and LA EAT groups 1.15[0.88,1.43] and 0.92[0.65,1.2]. The overall impact of PA showed a small to medium effect in reducing EAT volumes g=0.23[0,0.46]. Despite this PA was shown to significantly improve outcomes in reducing AF frequency, duration and severity and risk of mortality and serious adverse events in the intervention groups Conclusion Higher levels of EAT are associated with AF after PVICA but the influence of PA is unclear. This review highlights the need for further research evaluating the impact that physical activity has on EAT volume reduction and recurrence of AF post PVICA.