167 ASSISTED DECISION-MAKING (CAPACITY) ACT 2015: KNOWLEDGE AND ATTITUDES AMONG HOSPITAL DOCTORS

Background

Assessing capacity is part of our daily practice, and an important pillar of patient centred care. Assisted Decision-Making (Capacity) Act 2015, which is due to commence in June 2022, is an act to provide reform of the law to assist patients who require help in making decisions in a manner that will ensure their autonomy, dignity, and best interests. This study aimed to investigate the knowledge, attitudes, and confidence of hospital doctors regarding this act.

Methods

This study was conducted using an anonymous online survey completed by hospital doctors from all levels and specialties in a tertiary hospital. The survey contained two sections, the first asked questions on confidence and attitudes about capacity assessment. The second section contained practical scenarios to test knowledge around the new framework for decision support under the Act.

Results

Of the 670 consultants and non-consultant hospital doctors (NCHD) surveyed, an 11% response rate was achieved (75 respondents), 44% were consultants 56% were NCHD. 43% reported to lack confidence in assessing capacity. 92% felt that they needed more training regarding the act. Also, 80% agreed the act will have an impact on our practice. 80% thought capacity was carried out by a certain specialty (mostly Psychiatry and Geriatrics). In the decision support scenarios 18-27% of responders felt they did not know what the appropriate level of decision support was. In each scenario, with the exception of one, the most frequent response was the correct one but responses were widely distributed on most questions.

Conclusion

Despite the lack of a representative sample, doctors’ knowledge about capacity seems to have improved compared to previously carried out studies. However, our study appears to indicate a significant knowledge gap and further training is needed regarding the Assisted Decision-Making (Capacity) Act 2015 proposed to commence next month. Mandatory training on the act should be considered by HSE and the professional training bodies.

Design, synthesis, and antitumor activity of PLGA nanoparticles incorporating a discovered benzimidazole derivative as EZH2 inhibitor

PURPOSE

Targeting enhancer of zeste homolog 2 (EZH2) can represent a hopeful strategy for oncotherapy. Also, the use of PLGA-based nanoparticles as a novel and rate-controlling carrier system was of our concern.

METHODS

Benzimidazole derivatives were synthesized, and their structures were clarified. In vitro antitumor activity was evaluated. Then, a modeling study was performed to investigate the ability of the most active compounds to recognize EZH2 active sites. Compound 30 (Drug) was selected to conduct pre-formulation studies and then it was incorporated into polymeric PLGA nanoparticles (NPs). NPs were then fully characterized to select an optimized formula (NP₄) that subjected to further evaluation regarding antitumor activity and protein expression levels of EZH2 and EpCAM.

RESULTS

The results showed the antitumor activity of some synthesized derivatives. Docking outcomes demonstrated that Compound 30 was able to identify EZH2 active sites. NP₄ exhibited promising findings and proved to keep the antitumor activity of Compound 30. HEPG-2 was the most sensitive for both Drug and NP₄. Protein analysis indicated that Drug and NP₄ had targeted EZH2 and the downstream signaling pathway leading to the decline of EpCAM expression.

CONCLUSIONS

Targeting EZH2 by Compound 30 has potential use in the treatment of cancer especially hepatocellular carcinoma.