bluuebunny/crossref_metadata_2025 huggingface dataset:
Common questions in veterinary toxicology
Authors: Bates N. , Rawson‐Harris P. , Edwards N.
Published: February 2015

Toxicology is a vast subject. Animals are exposed to numerous drugs, household products, plants, chemicals, pesticides and venomous animals. In addition to the individual toxicity of the various potential poisons, there is also the question of individual response and, more importantly, of species differences in toxicity. This review serves to address some of the common questions asked when dealing with animals with possible poisoning, providing evidence where available. The role of emetics, activated charcoal and lipid infusion in the management of poisoning in animals, the toxic dose of chocolate, grapes and dried fruit in dogs, the use of antidotes in paracetamol poisoning, timing of antidotal therapy in ethylene glycol toxicosis and whether lilies are toxic to dogs are discussed.
Use of posaconazole delayed‐release tablets for treatment of invasive aspergillosis
Authors: Conant Marjorie M. , Sha Beverly E. , Proia Laurie A.
Published: February 2015

A 65‐year‐old man developed Aspergillus brain abscesses following surgical resection of a sinus aspergilloma. He was treated with voriconazole for 1 year but infection recurred. We elected to treat with posaconazole delayed‐release tablets, currently only indicated as antifungal prophylaxis in high‐risk patients. A maintenance dose of 300 mg Q24 h resulted in a therapeutic serum concentration and appears safe and clinically effective thus far. This is the first report of successful use of posaconazole tablets for treatment of invasive aspergillosis.
Ketamine as a promising prototype for a new generation of rapid‐acting antidepressants
Authors: Abdallah Chadi G. , Averill Lynnette A. , Krystal John H.
Published: February 2015

The discovery of ketamine's rapid and robust antidepressant effects opened a window into a new generation of antidepressants. Multiple controlled trials and open‐label studies have demonstrated these effects across a variety of patient populations known to often achieve little to no response from traditional antidepressants. Ketamine has been generally well tolerated across patient groups, with transient mild‐to‐moderate adverse effects during infusion. However, the optimal dosing and route of administration and the safety of chronic treatment are not fully known. This review summarizes the clinical effects of ketamine and its neurobiological underpinnings and mechanisms of action, which may provide insight into the neurobiology of depression, relevant biomarkers, and treatment targets. Moreover, we offer suggestions for future research that may continue to advance the field forward and ultimately improve the psychopharmacologic interventions available for those individuals struggling with depressive and trauma‐related disorders.
Modulation of the host response by probiotic Lactobacillus brevisCD2 in experimental gingivitis
Authors: Lee J‐K , Kim S‐J , Ko S‐H , Ouwehand AC , Ma DS
Published: February 2015

Objective

Probiotic Lactobacillus brevisCD2 (CD2) exerts anti‐inflammatory properties by preventing nitric oxide synthesis. It is hypothesized that oral application of CD2 can inhibit naturally occurring gingival inflammation.

Materials and Methods

Thirty‐four healthy adults were randomized to receive L. brevisCD2 lozenges or placebo, three times daily for 14 days. The subjects refrained from oral hygiene, the extent of which was determined at various time points.

Results

In both groups, bleeding on probing scores increased continuously throughout the study except on day 3. In the placebo group, scores increased significantly from 9.50 at baseline to 14.75 and 14.81 on days 10 and 14, respectively (P < 0.05). No significant change from baseline was observed in the CD2 group. However, scores were consistently higher with placebo, and significant intergroup differences were observed on day 10. Plaque and gingival indices increased from baseline in both treatment groups, but no intergroup differences were observed. Measurements of immune markers in gingival crevicular fluid revealed increased production of nitric oxide in the placebo group (P < 0.05). Prostaglandin E2 production decreased over time in both groups.

Conclusion

Lactobacillus brevisCD2 may delay gingivitis development in this model by downregulating an inflammatory cascade.
Effectiveness of Propranolol in the Treatment of Infantile Hemangioma Beyond the Proliferation Phase
Authors: Vivas‐Colmenares Grecia V. , Bernabeu‐Wittel Jose , Alonso‐Arroyo Veronica , Matute de Cardenas Jose A. , Fernandez‐Pineda Israel
Published: February 2015

During the last 5 years, many studies have shown the efficacy of propranolol as first‐line treatment for infantile hemangiomas (IHs), but not much has been written about the role of propranolol beyond the proliferation phase of IH (>1 year). Our aim was to assess propranolol efficacy and safety in the treatment of patients older than 1 year. A retrospective study of patients older than 1 year diagnosed with IH and treated in our vascular anomalies clinic between 2009 and 2013 was performed. Eighteen patients older than 1 year with a diagnosis of IH (15 girls, 3 boys) were identified. The mean age at the time of initiation of treatment was 25.7 months (range 13–72 mos). Single lesions were observed in 13 patients and multiple lesions in 5. Fifteen patients had focal lesions and three had segmental. The median duration of treatment with oral propranolol was 11.8 months (range 2–33 mos). Complete response was observed in 72.2% of the patients and partial response in 27.8%. Recurrence was observed in three patients 4.7 months after completion of therapy (range 0.3–8 mos). These patients required further therapy with propranolol for 6 more months. Bradycardia was documented in two patients and night terrors in one patient, which led to discontinuation of treatment. In our experience, propranolol may be useful in the treatment of IHs beyond the proliferation phase (>1 year old), but more studies are needed to support this observation.
Effect of arbuscular mycorrhizal inoculation on water status and photosynthesis of Populus cathayana males and females under water stress
Authors: Li Zhen , Wu Na , Liu Ting , Chen Hui , Tang Ming
Published: February 2015

Drought is one of the most serious environmental limitations for poplar growth. Although the ways in which plants deal with water stress and the effects of arbuscular mycorrhizal (AM) formation have been well documented, little is known about how the male and female plants of Populus cathayana respond to drought and AM formation. We also aimed to investigate the potential role of AM fungi in maintaining gender balance. We tested the impact of drought and AM formation on water status and photosynthesis. The results suggested that both sexes showed similar responses to water stress: drought decreased the growth of stem length (GSL), growth of ground diameter (GGD), relative water content (RWC), increased the relative electrolyte leakage (REL), and limited the photosynthesis and chlorophyll fluorescence indexes. However, the responses of the two sexes to drought and AM formation differed to some extent. AM formation had positive effects on RWC, photosynthesis and the intrinsic water use efficiency (WUEi) but negative effects on the REL of males and females, especially under drought. AM formation enhanced the maximum quantum yield of photosystem II (PSII) (Fv/Fm), the actual quantum yield of PSII (ΦPSII), non‐photochemical quenching (qN) and photochemical quenching (qP) under drought conditions, and had no significant effects under well‐watered conditions except on the qP of males. Principal component analysis showed that males were significantly more drought tolerant than females, and AM formation enhanced drought tolerance, particularly among males, which suggested that AM fungi are beneficial for ecological stability and for P. cathayana survival under drought conditions.
Association between pneumococcal pneumonia and venous thromboembolism in hospitalized patients: A nationwide population‐based study
Authors: Chen Yu‐Guang , Lin Te‐Yu , Huang Wen‐Yen , Lin Cheng‐Li , Dai Ming‐Shen , Kao Chia‐Hung
Published: February 2015

Background and objectives

This was a nationwide population‐based retrospective cohort study to investigate the risk of developing deep‐vein thrombosis (DVT) and pulmonary embolism (PE) in patients with a pneumococcal pneumonia.

Methods

We analysed data from 1998 to 2010 from the Taiwan National Health Insurance Database. The follow‐up period was extended to the end of 2011. We identified patients with pneumococcal pneumonia and selected a comparison cohort matched for age, sex and diagnosis year at a ratio of one pneumococcal pneumonia patient to four control patients. We analysed the risks of DVT and PE by using Cox proportional hazards regression models, including gender, age and comorbidities.

Results

In total, 18 928 pneumococcal pneumonia patients and 75 712 controls were included in the study. The risks of developing DVT and PE were 1.78‐fold (95% CI: 1.39–2.28) and 1.97‐fold (95% CI: 1.43–2.72), respectively, in patients with pneumococcal pneumonia compared to the control cohort after adjusting for age, gender and comorbidities. The increased risks of DVT and PE were significant in patients who exhibited any comorbidity. The incidences of DVT and PE were highest in the first 4 weeks after pneumonia and remained slightly elevated from 13 weeks to 2 years after acute infection.

Conclusion

Pneumococcal pneumonia should be considered a risk factor for DVT and PE, even after the patient has recovered from the acute infection.
Suicide attempts and stressful life events among female victims of intimate partner violence living in poverty in Nicaragua
Authors: Guillén Ana Isabel , Panadero Sonia , Rivas Esther , Vázquez José Juan
Published: February 2015

This article describes a study of 136 female intimate partner violence victims living in poverty in Nicaragua. The paper aimed to analyze the relationship between experiencing stressful life events (SLE) and perceived social support with suicide attempts, and to evaluate the differences in the SLE experienced by female suicide attempters versus non‐attempters. The results showed the existence of a high level of SLE among the interviewees, and that women who have attempted suicide have experienced substantially more of these events. Experiences of violence and less social support were especially related to suicide attempts among the interviewees.
Coalescence of fault‐bend and fault‐propagation folding in curved thrust systems: an insight from the Central Apennines, Italy
Authors: Pace Paolo , Calamita Fernando
Published: February 2015

The coalescence and spatial variability of different thrust‐related folding mechanisms involving the same mechanical multilayer along a curved thrust system are documented in this study. The field‐based analysis of thrust‐related folds spectacularly exposed in the Gran Sasso thrust system, Central Apennines of Italy, allowed us to reconstruct the interference fold pattern between fault‐bend and fault‐propagation folding. These two thrust‐related folding mechanisms exhibit spatial variability along the differently oriented ramps of the curved Gran Sasso thrust system, passing from one style to the other. Their selective development is controlled by contrasting styles of compressional normal‐fault reactivation related to positive tectonic inversion. Fault‐bend and fault‐propagation folding interact with a characteristic interference fold pattern in the salient apex zone of the curved thrust system due to their synchronous/in‐sequence growth. This interference fold pattern might be helpful and predictive when reconstructing lateral variations in different thrust‐related folds in similar subaerial or submarine thrust belts.
Effect of context on respiratory rate measurement in identifying non‐severe pneumonia in African children
Authors: Muro Florida , Mtove George , Mosha Neema , Wangai Hannah , Harrison Nicole , Hildenwall Helena , Schellenberg David , Todd Jim , Olomi Raimos , Reyburn Hugh
Published: February 2015

Objective

Cough or difficult breathing and an increased respiratory rate for their age are the commonest indications for outpatient antibiotic treatment in African children. We aimed to determine whether respiratory rate was likely to be transiently raised by a number of contextual factors in a busy clinic leading to inaccurate diagnosis.

Methods

Respiratory rates were recorded in children aged 2–59 months presenting with cough or difficulty breathing to one of the two busy outpatient clinics and then repeated at 10‐min intervals over 1 h in a quiet setting.

Results

One hundred and sixty‐seven children were enrolled with a mean age of 7.1 (SD ± 2.9) months in infants and 27.6 (SD ± 12.8) months in children aged 12–59 months. The mean respiratory rate declined from 42.3 and 33.6 breaths per minute (bpm) in the clinic to 39.1 and 32.6 bpm after 10 min in a quiet room and to 39.2 and 30.7 bpm (P < 0.001) after 60 min in younger and older children, respectively. This resulted in 11/13 (85%) infants and 2/15 (13%) older children being misclassified with non‐severe pneumonia. In a random effects linear regression model, the variability in respiratory rate within children (42%) was almost as much as the variability between children (58%). Changing the respiratory rates cut‐offs to higher thresholds resulted in a small reduction in the proportion of non‐severe pneumonia mis‐classifications in infants.

Conclusion

Noise and other contextual factors may cause a transient increase in respiratory rate and consequently misclassification of non‐severe pneumonia. However, this effect is less pronounced in older children than infants. Respiratory rate is a difficult sign to measure as the variation is large between and within children. More studies of the accuracy and utility of respiratory rate as a proxy for non‐severe pneumonia diagnosis in a busy clinic are needed.
Strawberry homologue of TERMINAL FLOWER1 integrates photoperiod and temperature signals to inhibit flowering
Authors: Rantanen Marja , Kurokura Takeshi , Jiang Panpan , Mouhu Katriina , Hytönen Timo
Published: February 2015

Photoperiod and temperature are major environmental signals affecting flowering in plants. Although molecular pathways mediating these signals have been well characterized in the annual model plant Arabidopsis, much less information is known in perennials. Many perennials including the woodland strawberry (Fragaria vesca L.) are induced to flower in response to decreasing photoperiod and temperature in autumn and they flower following spring. We showed earlier that, in contrast with Arabidopsis, the photoperiodic induction of flowering in strawberry occurs in short days (SD) when the decrease in FvFT1 (FLOWERING LOCUS T) and FvSOC1 (SUPPRESSOR OF THE OVEREXPRESSION OF CONSTANS1) expression leads to lower mRNA levels of the floral repressor, FvTFL1 (TERMINAL FLOWER1). By using transgenic lines and gene expression analyses, we show evidence that the temperature‐mediated changes in the FvTFL1 mRNA expression set critical temperature limits for the photoperiodic flowering in strawberry. At temperatures below 13°C, low expression level of FvTFL1 in both SD and long days (LD) allows flower induction to occur independently of the photoperiod. Rising temperature gradually increases FvTFL1 mRNA levels under LD, and at temperatures above 13°C, SD is required for the flower induction that depends on the deactivation of FvSOC1 and FvTFL1. However, an unknown transcriptional activator, which functions independently of FvSOC1, enhances the expression of FvTFL1 at 23°C preventing photoperiodic flowering. We suggest that the observed effect of the photoperiod × temperature interaction on FvTFL1 mRNA expression may allow strawberry to induce flowers in correct time in different climates.
The utility of 40 MHz periodontal ultrasonography in the assessment of gingival inflammation evolution following professional teeth cleaning.
Authors: Chifor Radu , Badea Mindra Eugenia , Vesa Ştefan Cristian , Chifor Ioana
Published: February 2015

Aim: To describe the radiological findings of idiopathic granulomatous mastitis (IGM). Material and methods: Radiologic findings of 30 women with histopathological diagnosis of IGM were retrospectively evaluated. All had breast feeding history. All the patients had ultrasonography (US), with 12 of them having additional Doppler US. Of 30 patients, 11 had mammography (MG) and 5 MRI. Results: US showed multiple irregular hypoechoic masses and collection areas with tubular connections in 25 of 30. The collection area with low-level internal echoes but without tubular connections, suggesting an abscess were seen in 2 of 30 (6.6%); a hypoechoic mass with an indistinct border in 2 of 30 (6.6%); multiple milimetric hypoechoic nodular masses in 1 of 30 (3.3%). On MG, normal findings were noted in 5 (45.4%); focal asymmetric density in 4 (36.4%), parenchymal distortion in 1 (9%) and diffuse asymmetric opacity with trabecular thickening in 1 (9%) of 30 patients. On MRI, segmental T2 hyperintensity with contrast-enhancement on T1 were seen in 4 of 5 (80%). An enhancing T2 hypointense mass with irregular margin was present in 1 of 5 (20%). Time-signal intensity curve of lesions showed slow enhancement in 1 and moderate in 4 of 5 patients. Conclusions: In IGM, MG findings were nonspecific. In US, multiple irregular hypoechoic masses and collections with tubular connections with fingerlike aspects, and fistulae formation to the skin in patients with breastfeeding history suggested IGM rather than carcinoma. Due to the limited number of patients, no conclusion was reached regarding MRI of IGM.
The evaluation of the retrobulbar orbital fat tissue and optic nerve with strain ratio elastography
Authors: Vural Murat , Acar Dilek , Toprak Ugur , Alp Mehmet Numan , Köz Özlem Gürbüz , Sayin Bige , Abat Gizem Kuşçuoğlu
Published: February 2015

Aim: The aim of this study was to evaluate the diagnostic performance of strain ratio elastography in the assessment of retrobulbar orbital fat tissue. Materials and methods: The retrobulbar fat tissue of 14 eyes in 14 participants was scanned by sonoelastography. All the participants had permanent vision loss secondary to glaucoma in at least one eye. The elasticity scores were determined and the strain ratio was based on the comparison of the average strain measured in the retrobulbar fat tissue around the optic nerve at the same depth. Results: The mean strain values for the optic nerve (B) and the retrobulbar fat tissue (A) were 0.78±0.61 and 1.43±0.99, respectively (p=0.005). The mean strain ratio (B/A) was 0.56±0.24. Conclusion: This preliminary study showed that by providing strain values and ratios of different orbital tissues sonoelastography may have a potential use in the diagnosis and follow-up of orbital inflammatory and infiltrative diseases.
Ultrasound elastography in thyroid disease
Authors: Dudea Sorin M. , Botar Jid Carolina
Published: February 2015

Thyroid elastography has become, lately, one of the main focuses in thyroid imaging. With more than one hundred papers published on this subject, the core of accumulated knowledge justifies the need for a comprehensive review on the topic. The paper presents the various elastographic techniques used for thyroid assessment. Both strain and shear wave elastography, with all their variants, are discussed. Thereafter the paper proceeds to a detailed description of the technical peculiarities, diagnostic value, limitations and pitfalls for each technique. Although the main accent is placed on thyroid nodules, the applications of elastography in other thyroid disease, diffuse or focal, are also presented. The results of the available metaanalyses are re- viewed and the proven value of the technique is highlighted. Still unanswered questions and directions for future research are emphasized, whenever appropriate.
Sedimentary DNA from a submerged site reveals wheat in the British Isles 8000 years ago
Authors: Smith Oliver , Momber Garry , Bates Richard , Garwood Paul , Fitch Simon , Pallen Mark , Gaffney Vincent , Allaby Robin G.
Published: February 2015

Early wheat movement into Britain

The transition into the New Stone Age, or Neolithic period, in Great Britain and Europe was characterized by a change from hunter-gatherers to farmers. However, the early stages of this transition are not well understood. Smith
et al.
studied archaeological remains at an 8000-year-old site that has been underwater ever since the Neolithic (see the Perspective by Larson). The finds include evidence of wheat (or a relative of wheat) 2000 years before the first documented farmers in Britain. It seems that trade may have preceded the adoption of farming.

Science
, this issue p.
998
; see also p.
945
Prediction, precaution, and policy under global change
Authors: Schindler Daniel E. , Hilborn Ray
Published: February 2015

Emphasize robustness, monitoring, and flexibility
CTCF establishes discrete functional chromatin domains at the
Hox
clusters during differentiation
Authors: Narendra Varun , Rocha Pedro P. , An Disi , Raviram Ramya , Skok Jane A. , Mazzoni Esteban O. , Reinberg Danny
Published: February 2015

Keeping repressed genes repressed

Hox
genes confer positional identity to cells and tissues. Maintaining precise spatial patterns of
Hox
gene expression is vital during metazoan development. The transcriptional repressor CTCF is involved in the regulation of chromatin architecture. Narendra
et al.
show that a CTCF protein binding site insulates regions of active and repressed
Hox
gene expression from each other. This protects heterochromatin containing repressed
Hox
genes from the encroaching spread of active chromatin. The CTCF protein appears to organize the active and repressed chromatin regions into distinct architectural domains.

Science
, this issue p.
1017
Drought triggers alarms in Brazil's biggest metropolis
Authors: Escobar Herton
Published: February 2015

Water shortages blamed on climate anomaly, tardy response.
Controlled-release mitochondrial protonophore reverses diabetes and steatohepatitis in rats
Authors: Perry Rachel J. , Zhang Dongyan , Zhang Xian-Man , Boyer James L. , Shulman Gerald I.
Published: February 2015

Special delivery for fatty liver disease

Nonalcoholic fatty liver disease is one of many unwelcome consequences of the global rise in obesity rates. Fat accumulation within the liver can lead to inflammation and cirrhosis, a predisposing factor for liver cancer. Treatment options are limited. Perry
et al.
revisit a mitochondrial uncoupling agent (2,4-dinitrophenol) that was used as a drug for weight loss in the 1930s but was discontinued because of serious toxicities. Encouragingly, an altered formulation of the drug that ensures its controlled release at low levels ameliorated fatty liver and diabetes in rodent models, without side effects.

Science
, this issue p.
1253
Human-specific gene
ARHGAP11B
promotes basal progenitor amplification and neocortex expansion
Authors: Florio Marta , Albert Mareike , Taverna Elena , Namba Takashi , Brandl Holger , Lewitus Eric , Haffner Christiane , Sykes Alex , Wong Fong Kuan , Peters Jula , Guhr Elaine , Klemroth Sylvia , Prüfer Kay , Kelso Janet , Naumann Ronald , Nüsslein Ina , Dahl Andreas , Lachmann Robert , Pääbo Svante , Huttner Wieland B.
Published: February 2015

Build the builders before the brain

Humans are much smarter than mice—key to this is the relative thickness of the human brain's neocortex. Florio
et al.
combed through genes expressed in the progenitor cells that build the neocortex and zeroed in on one gene found in humans but not in mice. The gene, which seems to differentiate humans from chimpanzees, drives proliferation of the key progenitor cells. Mice expressing this human gene during development built more elaborate brains.

Science
, this issue p.
1465
Insulin secretory granules control autophagy in pancreatic β cells
Authors: Goginashvili Alexander , Zhang Zhirong , Erbs Eric , Spiegelhalter Coralie , Kessler Pascal , Mihlan Michael , Pasquier Adrien , Krupina Ksenia , Schieber Nicole , Cinque Laura , Morvan Joëlle , Sumara Izabela , Schwab Yannick , Settembre Carmine , Ricci Romeo
Published: February 2015

Too hungry to eat, too hungry not to eat

Pancreatic beta cells, the source of insulin in response to food, employ an unusual mechanism to adapt to nutrient depletion. Goginashvili
et al.
found that starvation of beta cells induced selective degradation of newly formed insulin granules through their fusion with lysosomes, the cell's garbage disposal units (see the Perspective by Rutter). The nutrient sensor mTOR is recruited to these lysosomes, leading to its local activation and the suppression of autophagy—a process by which cells “eat” their own constituents. Protein kinase D, a major regulator of insulin granule biogenesis, controls this granule degradation in response to nutrient availability. Thus, unlike most other cells, autophagy is not the strategy of choice in beta cells to adapt to starvation.

Science
, this issue p.
878
; see also p.
826
Complete Genome Sequence of an Aldoxime Degrader, Bacillus sp. OxB-1
Authors: Yamaguchi Takuya , Asano Yasuhisa
Published: February 2015

Bacillus sp. OxB-1 has been characterized as a strain that produces a new enzyme, aldoxime dehydratase, which catalyzes the dehydration of aldoxime to form nitrile. Here, its complete genome sequence (3,594,618 bp, with a GC content of 47.85%), comprising a circular chromosome, is announced.
Complete Sequences of Six IncA/C Plasmids of Multidrug-Resistant Salmonella enterica subsp. enterica Serotype Newport
Authors: Cao Guojie , Allard Marc W. , Hoffmann Maria , Monday Steven R. , Muruvanda Tim , Luo Yan , Payne Justin , Rump Lydia , Meng Kevin , Zhao Shaohua , McDermott Patrick F. , Brown Eric W. , Meng Jianghong
Published: February 2015

Multidrug-resistant (MDR)
Salmonella enterica
subsp. enterica serotype Newport has been a long-standing public health concern in the United States. We present the complete sequences of six IncA/C plasmids from animal-derived MDR
S
. Newport ranging from 80.1 to 158.5 kb. They shared a genetic backbone with
S
. Newport IncA/C plasmids pSN254 and pAM04528.
TACT: WHAT IMPACT DOES RESEARCH PARTNER INVOLVEMENT HAVE ON THE WORKING PRACTICES OF A CANCER CLINICAL TRIAL UNIT AND ACADEMIC RESEARCH CENTRE?
Authors: Hopewell-Kelly N , Fitzgibbon J , Baillie J , Nelson A
Published: February 2015

Introduction

From 2005, lay representatives (‘Research Partners-RPs) have been involved as memebers of the research team in a clinical trials unit, and more recently a Marie Curie facility. However, the impact of their work has not been routinely examined. The TACT study was designed as a means of evaluation.

Aim(s) and method(s)

Semi-structured interviews were conducted with ten RPs and eight researchers to explore RPs’ input; documents from Trial Management Groups (TMGs), emails and relevant outputs were analysed using a Framework approach.

Results

Both the RPs and researchers saw the RP as an advocate for patients. RPs generally felt welcomed into the trials unit with most happy with their level of involvement. However, some RPs spoke about a perceived bias in the unit's tendency to use more experienced RPs, the RP role being a tokenistic funding requirement, and the need for greater monitoring and support. Researchers were unclear about the degree to which RPs should be involved in their work and the processes involved in working alongside RPs. They recognised greater commitment was required of them in the RP initiative, although time pressures and stresses were barriers to achieving this.

Analysis of RP Impact led to generally unfavourable results. Evidence of input in TMGs did not equate with subsequent actions and contributions in outputs were either minimal or absent.

Conclusions

Despite, a structured model of RP involvement, the results show a need for further improvement. Work is currently underway to design and implement a toolkit with which to tackle some of these challenges.
MARIE CURIE COMPANIONS AT MUSGROVE PARK HOSPITAL
Authors: Bearne Julia
Published: February 2015

Introduction

The Marie Curie Companions are a group of volunteers who have been specially trained by Marie Curie and Musgrove Park hospital to provide emotional support to dying patients and their families.

Aim(s) and method(s)

An information session was advertised to attract companion volunteers from a cross section of the community. Advertisements were placed on the Marie Curie website, volunteer bureau and in the local press. 21 people attended the event with 17 people attending an interview 1 candidate was not accepted. 16 people (4 males and 12 females) went on to complete the training programme over 5 weeks.

The training programme was based on that used for the Marie Curie Helper core training for volunteers and consisted of topics about death and dying, communication skills, spirituality, the hospital environment and bereavement and loss.

3 pilot wards were chosen a medical, surgical and the medical assessment unit, to commence delivery and the hours of work were from 18.00–21.00 on weekday evenings and 15.00–21.00 (2 shifts) at weekends.

Ward based training was delivered to provide hospital staff teams with the information about the project and how to refer.

Results

15 Companion volunteers work across the hospital and since delivery commenced in mid July 2014, 47 referrals have been received to the service resulting in more than 70 support visits to dying patients and their families.

Conclusion(s)

The support provided was mostly companionship and emotional support including being a listening ear to patients and their families, alongside short term respite care in the form of sitting with the patient, while families took a break. The support provided was felt to be needed by ward staff at the hospital and the early evidence suggests that dying patients and their families are already benefiting from this service. We will report on the impact that the service has had on the ward staff and perceived impact on patients and their families'.
A STUDY TO ASSESS THE USE AND COMPLETION OF THE ELECTRONIC KEY INFORMATION SUMMARY (KIS) AT THE POINT OF HOSPITAL ADMISSION FOR PATIENTS AT RISK OF DETERIORATION OR DYING
Authors: Hall CC , Spiller JA
Published: February 2015

Introduction

The electronic Key Information Summary (KIS) is an evolution of the Emergency Care Summary. The KIS contains vital patient information, is accessible to unscheduled/ emergency care services and more recently in secondary care. A KIS is completed by GPs foranypatient with complex care needs. Information ranges from a “special note” to a comprehensive electronic Palliative Care Summary. Little is known however about the usefulness and perspectives of hospital clinicians regarding the KIS.

Aim(s) and method(s)

Aims: To identify acute medical admissions with a KIS and analyse KIS quality. To identify those at risk of deterioration/ dying (using SPICT™ tool). To ascertain levels of clinician KIS awareness/ access, views on usefulness and suggested improvements. Methods: Retrospective case note analysis/ semi-structured interviews.

Results

24% of all patients had a KIS. Of patients at risk of deterioration or dying, 53% had a KIS. KIS quality was variable. Access to ECS medications (which now includes an ‘abbreviated’ KIS) was high (96%) but only 19% of clinicians had viewed their patient's KIS. Access to a ‘full’ KIS (including Palliative Care fields) was only 4%. 75% of clinicians found the KIS a useful tool.

Conclusion(s)

KIS are present for almost 1/4 of medical admissions to secondary care and are deemed useful by the majority of admitting clinicians. Patients at risk of deterioration or dying are more likely to have a KIS, but KIS are not routinely viewed by admitting clinicians. Education regarding the KIS/SPICT™ in hospitals and prompting on admission may improve complex (including palliative) patient management.
DANCING TO A DIFFERENT TUNE: LIVING AND DYING WITH CANCER, ORGAN FAILURE AND PHYSICAL FRAILTY
Authors: Kendall M , Carduff E , Lloyd A , Kimbell B , Pinnock H , Murray S A
Published: February 2015

Introduction

The “danse macabre” has been depicted in Europe since medieval times. Providing good end-of-life care for all patients, whatever form their last dance takes, is a global challenge.

Aim(s) and method(s)

To explore typical narratives of living with and dying from advanced illnesses, to provide insights into providing effective care.

Secondary analysis of data from 8 qualitative longitudinal studies: 3 cancer; 3 organ failure; 1 frailty; 1 with South Asian participants from all 3 trajectories. Patients were interviewed up to 4 times over 18 months. Researchers from each study reviewed the data using a narrative analytic framework. The narratives were initially synthesised by illness trajectory, then compared and discussed at analysis workshops.

Results

The dataset was 828 in-depth interviews with 156 patients. Cancer narratives had a well-rehearsed beginning, middle and anticipated end, with dual themes of hope for recovery alongside fear of dying. People with organ failure struggled to tell their story, being unclear when the illness began, or how one event linked to another. Fewer spoke about death, hoping instead to avoid further deterioration. Frail older people's narratives often began with a specific event in combination with ageing, yet lost salience amidst increasing losses and future fears. Death was only fully anticipated very near the end, and feared less than nursing homes or dementia.

Conclusion(s)

Patients from different illness groups gave very different accounts. Consequently the cancer-based model of end-of-life care seems poorly suited to the needs of those dying in other ways. Understanding how different patient groups perceive their deteriorating health and approaching death will inform appropriate future palliative care for all.
“THE ICECAP-SCM TELLS YOU MORE ABOUT WHAT I'M GOING THROUGH”—MEASURING THE QUALITY OF LIFE AMONGST PATIENTS RECEIVING SUPPORTIVE AND PALLIATIVE CARE
Authors: Coast Joanna , Bailey Cara , Orlando Rosanna , Armour Kathy , Perry Rachel , Jones Louise , Kinghorn Philip
Published: February 2015

Introduction

The ICECAP Supportive Care Measure (ICECAP-SCM) is a self-complete questionnaire developed to rate quality towards the end of life, particularly for economic evaluation. It measures a person's capability to experience a good life and death.

Aim(s) and method(s)

The study aimed to determine the feasibility of completing ICECAP-SCM alongside EQ-5D-5L and ICECAP-A (measures commonly used for economic evaluation). Each measure was completed by hospice patients (n=33), close persons (n=22) and healthcare professionals (HCPs n=17) in a ‘think aloud’ semi-qualitative interview. Five raters identified the frequency of error (e.g. misunderstanding, poor memory) from interview transcripts. Qualitative data were analysed using constant comparison, focusing on issues affecting response.

Results

Amongst patients, fewest errors were identified for ICECAP-SCM (3.9%) and the most for EQ5D-5L (9.7%). Amongst close persons there were also fewest errors in the ICECAP-SCM (4.5%) compared to ICECAP-A (5.5%) and EQ-5D-5L (5.5%). HCPs had most errors for ICECAP-SCM (6.7%) and fewest for EQ-5D-5L (3.5%). Qualitative data suggested that HCPs found EQ-5D-5L easiest to answer because it focuses on health states which could be directly observed. The ICECAP-SCM, appeared more meaningful to patients near the end of life and close persons; it was also easier to complete.

Conclusion(s)

This paper provides insight into the meaning of quality of life for those approaching death, those close to them and those involved in their care. Complexities in disease trajectories and adaptation to poor health make quality of end of life difficult to measure. The ICECAP-SCM captures the subtleties required and may be useful in evaluating future palliative care interventions.
A QUALITATIVE ANALYSIS OF BARRIERS TO FUTURE CARE DISCUSSIONS WITH FAMILY MEMBERS OF CARE HOME RESIDENTS WITH ADVANCED DEMENTIA
Authors: Moore Kirsten J , Elliott Margaret , Kupeli Nuriye , Davis Sarah , Harrington Jane , Vickerstaff Victoria , Gola Anna , Candy Bridget , King Michael B , Leavey Gerard , Omar Rumana Z , Morris Steve , Nazareth Irwin , Sampson Elizabeth L , Jones Louise
Published: February 2015

Introduction

Discussion about care preferences and end of life wishes between family and staff on entry to a care home is an important predictor of family satisfaction with end of life care for residents with advanced dementia.

Aim(s) and method(s)

This paper aims to examine issues relating to end of life discussions with family members of residents with advanced dementia. Data were collected during piloting of the Compassion intervention that engaged an Interdisciplinary Care Leader (ICL) in two care homes and aimed to improve end of life care for residents with advanced dementia. Data included the ICL's reflective diary, time record and interviews with family carers, care home staff, GPs and other health professionals. The ICL assessed 30 residents with advanced dementia and had 37 conversations of at least 15 minutes with family members. Qualitative data were thematically analysed by two researchers.

Results

Family members described not having discussed end of life care with healthcare professionals, despite interest in learning more. Nurses described lack of time and confidence as barriers to these discussions. While healthcare professionals described conflicts with family about goals of care, these barriers were not experienced by the ICL.

Conclusion(s)

This study identified a gap in provision of information and support for family members in decision making around end of life care. Findings suggest benefits of having a co-ordinator with dementia and end of life knowledge and communication skills, and who has adequate time to communicate with family to plan end of life care for the growing number of people who have dementia.
WHY IS INTEGRATED CARE NOT WORKING IN END OF LIFE CARE FOR THOSE WITH ADVANCED DEMENTIA? FROM THE HEALTH CARE PROFESSIONAL PERSPECTIVE
Authors: Kupeli Nuriye , Sampson Elizabeth L , Harrington Jane , Moore Kirsten J , Elliott Margaret , Davis Sarah , Vickerstaff Victoria , Gola Anna , Candy Bridget , King Michael B , Omar Rumana Z , Morris Steve , Nazareth Irwin , Leavey Gerard , Jones Louise
Published: February 2015

Introduction

In line with the National Dementia Strategy (2009), a mixed methods programme was designed to develop and pilot a complex intervention to improve end of life care for people with advanced dementia. A facilitation-based model provided education, training and support to health care professionals (HCPs) creating an integrated, individualised and holistic service.

Aim(s) and method(s)

To inform the intervention development, we conducted a series of qualitative interviews to examine HCPs attitudes and knowledge regarding integrated care. A topic guide was used to interview 14 HCPs including commissioners, care home managers, nurses and health care assistants. We used a rigorous approach to data analysis (quality framework recommended by Spenceret al2003). Thematic analysis identified meaningful themes.

Results

Interviews revealed how shortfalls in different sectors providing care for this vulnerable population contribute to discontinuity of care. The main themes found to contribute to care fragmentation were care homes are business-driven establishments, conflictive relationships between HCPs, poor elements to good quality care and governmental factors. Additionally, the cardinal factors underlying care fragmentation are lack of staff and resources in care homes and hospitals and lack of funding from the local authority required for delivering good collaborative and integrated care.

Conclusion(s)

Health and social care services provided for those at the palliative stages of dementia receive fragmented care. Recommendations for utilising the volunteering sector and providing professional development opportunities for health care providers of this vulnerable population are discussed.
RESEARCH PRIORITY SETTING IN PALLIATIVE AND END OF LIFE CARE: THE JAMES LIND ALLIANCE APPROACH CONSULTING PATIENTS, CARERS AND CLINICIANS
Authors: Best S , Tate T , Noble B , Smith R , Tuft J , Tracey N , McCullugh A , Eley J , Black J , Stockton M , Cheesley A , Berry L , Burton C , Dechamps A , Stevens E , Penny A , McEnhill L , McNair A , Cupid B , Maeso B , Chapman D , McIlfatrick S , Nelson A , Sivell S , Baillie J , VanGodwin J , Candy B , Beaumont N , Cowan K
Published: February 2015

Introduction

There can be a mismatch between what the public see as important unanswered questions and those which are actually researched. The Palliative and end of life care Priority Setting Partnership, facilitated by the James Lind Alliance (JLA), identified and prioritised questions about palliative and end of life care that people in the last years of life, current/bereaved carers and professionals feel are important for research to address.

Aim(s) and method(s)

A UK public survey (December 2013–April 2014) identified questions about support, care and treatment of people in the last years of life. Some 83 questions were formulated and prioritised via a second public survey. The resulting top 28 were prioritised in a workshop comprising patients, carers and clinicians to determine the top 10 research questions.

Results

1403 surveys were returned. Most respondents identified as bereaved family/friends and health or social care professionals. Respondents submitted a range of questions on services, communication, symptoms and perceptions of palliative care. 1331 respondents completed the second survey. In November 2014, 24 people participated in a workshop to prioritise the ‘top 10’ questions (using the Nominal Group Technique) which will be reported in January 2015.

Responses that are ‘out of scope’ of the JLA protocol will be analysed and reported separately.

Conclusion(s)

The ‘top 10’ uncertainties will guide project partners' and other organisations' funding strategies, ensuring that future research is relevant to palliative care populations. We will discuss how the results of this project will guide the palliative and end of life care research agenda in future.
INCREASING COMPLEXITY AT THE END OF LIFE IN PEOPLE WHO DIED FROM CANCER AGED 85 YEARS OR OLDER, ENGLAND 2001–2012
Authors: Davies JM , Verne J , Higginson IJ , Gao W
Published: February 2015

Introduction

Cancer patients are dying at increasingly older age and with more coexisting conditions. A lack of knowledge about these conditions is hindering better end of life care planning, policy and care for this rapidly growing group.

Aim(s) and method(s)

Population-based observational study using death registry data in England, 2001–2012. All hospital deaths for people who died aged 85 or older from cancer were included for this study (N=121,921). The number and types of contributing causes of death (CCoD) are described by time periods (2001–2004, 2005–2008, 2009–2012).

Results

The median number of CCoD for elderly people dying from cancer was 1.0 (range: 0 to 14). The range gradually increased over the study period (2001–2004 0–10; 2005–2008 0–13; 2009–2012 0–14).

The majority (69.3%; 95%CI: 69.0%–69.6%) of elderly people dying from cancer in hospital had at least one CCoD recorded; 18.8% (95% CI: 18.6%–19.0%) had Pneumonia, 8.5% (95% CI: 8.3%–8.7%) Respiratory disease, 7.6% (95% CI: 7.5%–7.8%) Circulatory disease, 7.4% (95% CI: 7.3%–7.6%) Ischaemic heart disease, 27.6% (95% CI: 27.4%–27.9%) ‘Other’ conditions. The prevalence of each CCoD category increased from the earliest (2001–2004) to the latest (2009–2012) time period. This increase was greatest for Pneumonia (4.5%; 95% CI: 4.2%–4.8%) and smallest for Old age (0.9%; 95% CI: 0.7–1.2%) and Cerebrovascular disease (0.9%; 95% CI: 0.6%–1.2%).

Conclusion(s)

The increase in the number of contributing causes of death may represent an increased complexity in managing elderly people at the end of life. Further attention is needed on how palliative care and health care for the elderly can meet these challenges in the future.

Acknowledgements:

We thank Public Health England for funding this work, the Office for National Statistics for supplying the data.

This work is part of the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, National Institute for Health Research (NIHR).
THE USE OF SOCIAL MEDIA IN A PALLIATIVE CARE RESEARCH CENTRE
Authors: Hopewell-Kelly N , Baillie J , Sivell S , Bowyer A , Thomas K , Prout H , Taylor S , Sampson C , Newman A , Nelson A
Published: February 2015

Introduction

Online communities are full of discussions about illness, death and dying and these communications are increasingly repositioned within research environments as sources of publically available data. As a palliative care research centre, we have been keen to embrace social media within our research work, however, with no definitive set of ethical or practical guidelines we have been unsure of how best to proceed. The centre thus initiated two consensus days to construct a workable, ethical framework for future research in the field.

Aim(s) and method(s)

Researchers within the centre, and two external experts in online research, met to focus on constructing a set of ethical guidelines. Issues of confidentiality, anonymity and informed consent were all discussed.

Results

A framework for social media research was constructed, the guiding principles include:

Recruitment of participants should be transparent with adequate opportunity for participants to ask questions.

Information sheets should be provided and be clear about confidentiality issues that are specific to online research.

Consent should always be taken from participants for the use of their online communications as research data.

Potential anonymity issues in dissemination of research must be highlighted to participants.

The use of historical text is considered problematic and therefore not encouraged.

Closed forums created specifically for research purposes are considered to be the most appropriate way to conduct online research.

Conclusion(s)

Social media has the potential to be of benefit to palliative care research; however, it is important that ethical principles in relation to this medium are fully considered, and guidelines in place, prior to the commencement of research.