bluuebunny/crossref_metadata_2025 huggingface dataset:
Melatonin, given at the time of reperfusion, prevents ventricular arrhythmias in isolated hearts from fructose‐fed rats and spontaneously hypertensive rats
Authors: Diez Emiliano Raúl , Renna Nicolás Federico , Prado Natalia Jorgelina , Lembo Carina , Ponce Zumino Amira Zulma , Vazquez‐Prieto Marcela , Miatello Roberto Miguel
Published: April 2013

Melatonin reduces reperfusion arrhythmias when administered before coronary occlusion, but in the clinical context of acute coronary syndromes, most of the therapies are administered at the time of reperfusion. Patients frequently have physiological modifications that can reduce the response to therapeutic interventions. This work determined whether acute melatonin administration starting at the moment of reperfusion protects against ventricular arrhythmias in Langendorff‐perfused hearts isolated from fructose‐fed rats (FFR), a dietary model of metabolic syndrome, and from spontaneous hypertensive rats (SHR). In both experimental models, we confirmed metabolic alterations, a reduction in myocardial total antioxidant capacity and an increase in arterial pressure and NADPH oxidase activity, and in FFR, we also found a decrease in eNOS activity. Melatonin (50 μm) initiated at reperfusion after 15‐min regional ischemia reduced the incidence of ventricular fibrillation from 83% to 33% for the WKY strain, from 92% to 25% in FFR, and from 100% to 33% in SHR (P = 0.0361, P = 0.0028, P = 0.0013, respectively, by Fisher's exact test, n = 12 each). Although, ventricular tachycardia incidence was high at the beginning of reperfusion, the severity of the arrhythmias progressively declined in melatonin‐treated hearts. Melatonin induced a shortening of the action potential duration at the beginning of reperfusion and in the SHR group also a faster recovery of action potential amplitude. We conclude that melatonin protects against ventricular fibrillation when administered at reperfusion, and these effects are maintained in hearts from rats exposed to major cardiovascular risk factors. These results further support the ongoing translation to clinical trials of this agent.
Habitual ‘sleep credit’ is associated with greater grey matter volume of the medial prefrontal cortex, higher emotional intelligence and better mental health
Authors: Weber Mareen , Webb Christian A. , Deldonno Sophie R. , Kipman Maia , Schwab Zachary J. , Weiner Melissa R. , Killgore William D. S.
Published: April 2013

In modern society, people often fail to obtain the amount of sleep that experts recommend for good health and performance. Insufficient sleep can lead to degraded cognitive performance and alterations in emotional functioning. However, most people also acknowledge that on a regular basis they obtain more sleep than they subjectively perceive they need at a minimum to stave off performance decrements, a construct we describe as subjective ‘sleep credit’. Few people would contest the notion that getting more sleep is better, but data on both behavioural and neuroanatomical correlates of ‘sleep credit’ are surprisingly limited. We conducted a voxel‐based morphometric study to assess cerebral grey matter correlates of habitually sleeping more than one's subjective requirements. We further tested whether these structural correlates are associated with perceived emotional intelligence and indices of psychopathology while controlling for age, gender, and total intracranial volume. In a sample of 55 healthy adults aged 18–45 years (28 males, 27 females), whole‐brain multiple regression showed that habitual subjective ‘sleep credit’ was correlated positively with grey matter volume within regions of the left medial prefrontal cortex and right orbitofrontal gyrus. Volumes were extracted and regressed against self‐report emotion and psychopathology indices. Only grey matter volume of the medial prefrontal cortex cluster correlated with greater emotional intelligence and lower scores on several indices of psychopathology. Findings converge with previous evidence of the role of the medial prefrontal cortex in the relationship between sleep and emotional functioning, and suggest that behaviour and brain structure vary with habitual ‘sleep credit’.
Reduced ADP‐ribosylation by PARP1 natural polymorphism V762A and by PARP1 inhibitors enhance Hepatitis B virus replication
Authors: Ko H. L. , Ng H. J. , Goh E. H. , Ren E. C.
Published: April 2013

HepG2 and Huh7 cell lines are frequently used as models to study viral hepatitis and hepatocellular carcinoma. However, they exhibit significantly different capacities in their ability to support hepatitis B virus (HBV) replication. To investigate the basis for this, transcription factor–binding motifs at the HBV core promoter (HBVCP) were tested in luciferase reporter constructs to identify the possible role of host factors. Among the transcription factors screened: PARP1, SP1, HNF4α, HNF3, hB1F and HNF1, deletion of the PARP1 binding motif abrogated transcriptional activity at the HBVCP in HepG2 but not Huh7 cells. Sequencing of the PARP1 gene revealed that HepG2 cells carried an Ala762 allele which has low ADP‐ribosylation activity, which was shown to have increased PARP1 binding affinity to its cognate motif thus resulting in higher transcriptional activity. PARP1 inhibitors that are being developed as broad cancer therapeutics also target PARP1 ADP‐ribosylation enzymatic function. Four PARP1 inhibitors: PJ‐34, ABT888, AZD2281 and AG014699 were tested for their effect on HBV replication. All four small molecules effectively enhanced HBV replication in vitro, confirming the role of PARP1 in HBV replication and that alteration of ADP‐ribosylation by mutation or drugs can affect HBV replication. Our data demonstrate that natural polymorphisms in the host affecting proteins such as PARP1 can have a significant effect on HBV replication. Hence, patients who are infected with HBV and are on clinical trials involving PARP1 inhibitors may be at risk from unintended side‐effects such as exacerbation of HBV replication.
Is There a Relation between Reticular Formation and Storage Symptoms in Men
Authors: ZORBA Orhan Ü. , KIRBAŞ Serkan , UZUN Hakkı , ÖNEM Kadir , ÇETINKAYA Mehmet , RIFAIOĞLU Mehmet M.
Published: April 2013

Objective

To reveal brainstem originated pathology in men with different types of lower urinary tract symptoms blink reflex latency times were assessed.

Methods

A total of 32 men, 16 with storage and 16 with voiding symptoms, were enrolled in the study. Blink reflex latency times were analyzed through electrical stimulation of the supraorbital nerve. Two responses in the orbicularis oculi muscle were recorded: the latency times for the early ipsilateral response, R1, and the late bilateral responses, R2.

Results

The mean ages of the patients with storage and voiding symptoms were 57.31 ± 6.87 and 58.06 ± 6.29 years, respectively. The R2 latency times were significantly longer in men with storage symptoms. However, the R1 latency times were similar for the two groups.

Conclusion

Late blink latency times were long only in patients who had storage symptoms. An oligosynaptic path through the trigeminal nuclei, which includes one or two interneurons, is responsible for early response; however, late response is relayed through a polysynaptic path, including neurons in the reticular formation. It has also been shown that stimulation of the pontine reticular formation inhibits the micturition contraction. In some patients, storage symptoms may result from pathology that originates with the reticular formation and this pathology may lead to increases in late blink latency times. Additional studies are needed on other reflexes that are mediated through reticular formation, in order to show the possible dysfunction of the reticular formation in men with storage symptoms.
Apoplastic immunity and its suppression by filamentous plant pathogens
Authors: Doehlemann Gunther , Hemetsberger Christoph
Published: April 2013

Microbial plant pathogens have evolved a variety of strategies to enter plant hosts and cause disease. In particular, biotrophic pathogens, which parasitize living plant tissue, establish sophisticated interactions in which they modulate the plant's metabolism to their own good. The prime decision, whether or not a pathogen can accommodate itself in its host tissue, is made during the initial phase of infection. At this stage, the plant immune system recognizes conserved molecular patterns of the invading microbe, which initiate a set of basal immune responses. Induced plant defense proteins, toxic compounds and antimicrobial proteins encounter a broad arsenal of pathogen‐derived virulence factors that aim to disarm host immunity. Crucial regulatory processes and protein–protein interactions take place in the apoplast, that is, intercellular spaces, plant cell walls and defined host–pathogen interfaces which are formed between the plant cytoplasm and the specialized infection structures of many biotrophic pathogens. This article aims to provide an insight into the most important principles and components of apoplastic plant immunity and its modulation by filamentous microbial pathogens.

Contents

Summary
1001

I.
Live and let die – the basics of interaction
1001

II.
A kettle of color – components of apoplastic plant defense
1003

III.
A kettle of color – components of apoplastic plant defense
1004

IV.
How they learned to live with the bomb – disarming proteases
1005

V.
Hide and seek – how to survive the apoplast
1006

VI.
Hide and seek – how to survive the apoplast
1007

VII.
Back to the future – challenges and opportunities
1011

Acknowledgements
1011

References
1011
The validity, reliability, and time requirement of study model analysis using cone‐beam computed tomography–generated virtual study models
Authors: Luu N. S. , Mandich M‐A. , Flores‐Mir C. , El‐Bialy T. , Heo G. , Carey J. P. , Major P. W.
Published: April 2013

Structured Abstract

Objectives

To investigate the validity, reliability, and time spent to perform a full orthodontic study model analysis (SMA) on cone‐beam computed tomography (CBCT)‐generated dental models (Anatomodels) compared with conventional plaster models and a subset of extracted premolars.

Setting and Sample Population

A retrospective sample of 30 consecutive patient records with fully erupted permanent dentition, good‐quality plaster study models, and CBCT scans. Twenty‐two extracted premolars were available from eleven of these patients.

Materials and Methods

Five evaluators participated in the inter‐rater reliability study and one evaluator for the intrarater reliability and validity studies. Agreement was assessed by ICC and cross‐tabulations, while mean differences were investigated using paired‐sample t‐tests and repeated‐measures anova.

Results

For all three modalities studied, intrarater reliability was excellent, inter‐rater reliability was moderate to excellent, validity was poor to moderate, and performing SMA on Anatomodels took twice as long as on plaster.

Conclusions

Study model analysis using CBCT‐generated study models was reliable but not always valid and required more time to perform when compared with plaster models.
Cardiac Resynchronization Therapy: Do Patient Selection and Implant Practice Vary Depending on the Volume a Center Handles?
Authors: HERNÁNDEZ MADRID ANTONIO , MATÍA FRANCÉS ROBERTO , MORO CONCEPCIÓN , ZAMORANO JOSÉ
Published: April 2013

Background

The annual volume of implants may condition and determine many aspects of cardiac resynchronization therapy (CRT).

Methods

After the Spanish centers performing CRT were identified, data were recorded voluntarily by each implantation team from September 2010 to September 2011.

Result

A total of 88 implanter centers were identified, and of these 85 (96.5%) answered the questionnaire. In total, 2,147 device implantations were reported, comprising 85% of the Eucomed's overall estimate for the same period, which was 2,518 implantations. Centers handling a higher volume of implants have a higher percentage of patients referred from other centers and more indications in patients over 80 years of age, with atrial fibrillation (AF), right bundle branch block, and unspecific disorders of intraventricular conduction. These high‐volume centers stimulate more frequently in patients with very wide QRS > 200 ms. Lower‐volume centers select more classic patients for resynchronization, whereas higher‐volume centers increase the rate of patients with AF and prior cardiac stimulation (upgrade). Implant duration is shorter for higher‐volume centers, which also perform implants in patients with congenital heart disease. By contrast, there are no significant differences in terms of heart disease, device type (pacemaker or defibrillator), implant techniques, achieved optimal site location, or complications.

Conclusions

High‐volume centers perform CRT more frequently in elderly patients, mostly with AF and other alternative implants. No significant differences were found between the complications reported by high‐volume centers and those reported by low‐volume centers.
The Jewish nose in early modern art and music
Authors: Harrán Don
Published: April 2013

The Jewish nose has often been an object of parody in art and literature, most notably in examples of anti‐Semitic content from Fascist Germany. Early anthropologists devoted no little energy to the topic in the later nineteenth and early twentieth century. They distinguished the ‘Jewish’ or ‘Semitic’ nose from straight, aquiline, flat, and snub noses by its being ‘hooked’. A major study on the Jewish nose, referring to these early essays of largely German origin and to their usually racist arguments, is Sander L. Gilman's ‘The Jewish Nose’. But, to date, there is no literature on the Jewish nose in art works of the fifteenth to seventeenth centuries. Nor is there any on the Jewish nose in relation to music for the same or any other era. The present article opens, by way of introduction, with a few words on Jews as delineated in early painting. In continuation, it discusses a typical, yet hitherto neglected graphic example of the Jewish nose as satirized in a work from the early modern era. It concludes with a review of various attempts of composers, at the time, to simulate the sonic qualities of Jewish nasalized speech in works of music.
On Endogeneity Bias: Some General Remarks and Correction of the ROIW Paper by Bourguignon, Ferreira, and Menéndez (2007)
Authors: Krishnakumar Jaya
Published: April 2013

This paper is a short note on the question of correcting for endogeneity bias in a regression. It also points out errors and omissions in the derivation of this bias in Bourguignon, Ferreira, and Menéndez (2007). We show that some assumptions needed for the derivation are not explicit and even under these assumptions, certain simplifications adopted are not valid. We support our points using simulation experiments.
Distinct intracellular calcium responses of individual cultured human keratinocytes to air pressure changes
Authors: Ikeyama Kazuyuki , Nakatani Masashi , Kumamoto Junichi , Denda Mitsuhiro
Published: April 2013

Background

We previously showed that application of hydraulic pressure to cultured human keratinocytes induced elevation of intracellular calcium concentration ([Ca2+]i), but the absolute value of the pressure could not be determined.

Purpose

To evaluate the effect of the absolute value of pressure on keratinocytes and other skin cells.

Methods

In the present work, we examined the effect of changes in absolute pressure level by observing the [Ca2+]i responses of cultured human keratinocytes and other cells cultured at the bottom of a hermetically sealed plastic flask as the air pressure in the flask was increased gradually, held stable, and then decreased abruptly, using the Ca2+‐indicator fura‐2.

Results

We found that the [Ca2+]i of differentiated keratinocytes was changed significantly in each phase, whereas undifferentiated keratinocytes and other cells derived from skin or dorsal root ganglion showed no response. Removal of calcium from the medium blocked the increase in [Ca2+]i in differentiated keratinocytes. The [Ca2+]i responses of individual differentiated keratinocytes in the increasing, stable and decreasing phases of pressure change varied from cell to cell. The threshold of air‐pressure increase from the original level for inducing [Ca2+]i response was 5 – 20 hPa.

Conclusion

These results suggest that epidermal keratinocytes might contain a sensory system that detects changes of external pressure on the skin.
Symptoms of antenatal common mental disorders, preterm birth and low birthweight: a prospective cohort study in a semi‐rural district of Vietnam
Authors: Niemi Maria , Falkenberg Torkel , Petzold Max , Chuc Nguyen Thi Kim , Patel Vikram
Published: April 2013

Objectives

To examine the association of low birthweight (LBW) and prematurity with clinically significant symptoms of antenatal common mental disorders (ACMDs) during the third trimester of pregnancy in a semi‐rural area in Vietnam.

Methods

Prospective community‐based cohort study. Severity of ACMD symptoms was assessed with the Edinburgh Depression Scale, low birthweight was defined as below 2500 g, and gestational age was estimated according to last menstrual period. Reproductive and socio‐demographic risk factors were measured as potential confounders of the association between ACMD and the outcomes. We conducted bivariate analyses of association between ACMD and the perinatal outcomes, employing chi‐square tests, crude odds ratios and 95% confidence intervals. Multiple logistic regression analysis was used to adjust for confounding.

Findings

We found a prevalence of clinically significant symptoms of ACMDs of 37.4%, which were significantly associated with preterm birth (adjusted OR 1.98, CI95% = 1.14–3.43) and low birthweight (adjusted OR 2.24, CI95% = 1.02–4.95). Among the examined risk factors for the outcome measures, only maternal age was found to be statistically significant for low birthweight and preterm birth.

Conclusions

This study confirms that clinically significant symptom levels of ACMD in Vietnam are associated with preterm birth and low birthweight. These findings highlight the importance of cost‐effective public health interventions for ACMD in Vietnam and further exploration of its physiological link with preterm birth and low birthweight.
Simulation of the Transitional Flow in a Low Pressure Gas Turbine Cascade With a High-Order Discontinuous Galerkin Method
Authors: Ghidoni A. , Colombo A. , Rebay S. , Bassi F.
Published: April 2013

In the last decade, discontinuous Galerkin (DG) methods have been the subject of extensive research efforts because of their excellent performance in the high-order accurate discretization of advection-diffusion problems on general unstructured grids, and are nowadays finding use in several different applications. In this paper, the potential offered by a high-order accurate DG space discretization method with implicit time integration for the solution of the Reynolds-averaged Navier–Stokes equations coupled with the k-ω turbulence model is investigated in the numerical simulation of the turbulent flow through the well-known T106A turbine cascade. The numerical results demonstrate that, by exploiting high order accurate DG schemes, it is possible to compute accurate simulations of this flow on very coarse grids, with both the high-Reynolds and low-Reynolds number versions of the k-ω turbulence model.
Hypoglycaemia due to interaction of glimepiride with isoniazid in a patient with type 2 diabetes mellitus
Authors: Boglou Panagiotis , Steiropoulos Paschalis , Papanas Nikolaos , Bouros Demosthenes
Published: April 2013

Hypoglycaemia is a well-recognised untoward effect of sulfonylureas. We report a case of severe hypoglycaemia after isoniazid initiation in a type 2 diabetic patient. An oral glucose tolerance test revealed high serum insulin and C peptide, suggesting hyperinsulinaemia, and it was used to ascertain the relationship between insulin, glucose and C peptide levels. Insulin and C peptide elevation was attributed to the interaction between the two drugs. As a cytochrome inhibitor, isoniazid increased serum glimepiride concentration, resulting in hyperinsulinaemia. The diagnosis of occult insulinoma or nesidioblastosis was ruled out by CT and MRI, as we could not perform more sensitive, still invasive, diagnostic procedures. After isoniazid withdrawal, hypoglycaemia regressed and glimepiride was reinitiated. In conclusion, this case illustrates the need of caution when prescribing isoniazid in patients with type 2 diabetes mellitus receiving glimepiride to avoid hypoglycaemia.
Preoperative diagnosis by three-dimensional angiography of a leiomyosarcoma arising from the left ovarian vein
Authors: Saigusa Susumu , Ohi Masaki , Inoue Yasuhiro , Kusunoki Masato
Published: April 2013

Leiomyosarcoma arising from the ovarian vein is extremely rare; we present a case with this unusual finding. A 78-year-old woman, diagnosed 2 years prior with a left retroperitoneal mass located in the lower part of the left kidney, was admitted to our hospital with a decrease in oral intake and a palpable, hard, abdominal mass. Contrast-enhanced CT showed a solid mass in the left lower abdominal cavity. On three-dimensional (3D) angiography the mass appeared to originate from the left ovarian vein. A simple total excision, including the involved vein, was performed and the tumour was found to be leiomyosarcoma. The patient's postoperative course was uneventful. There was no evidence of recurrence 5 months after surgery. In this patient, the previous information about the location of the retroperitoneal mass as well as the 3D angiography results were helpful in giving preoperative evidence of leiomyosarcoma originating from the left ovarian vein.
Acute crystal deposition arthritis of the pubic symphysis
Authors: Kenzaka Tsuneaki , Wakabayashi Tetsuji , Morita Yoshinori
Published: April 2013

A 68-year-old woman presented with an acute onset of lower abdominal pain. A CT scan of the pelvis showed acute crystal deposition arthritis, and her symptoms markedly reduced with non-steroidal anti-inflammatory drugs. Further, a radiographic evaluation of the right knee joint and CT of the cervical spine revealed calcification; calcium pyrophosphate (CPP) crystals were identified in the synovial fluid of the right knee. This established the diagnosis of CPP crystal deposition disease, while the inflammation of the pubic symphysis was considered as acute crystal deposition arthritis related to calcium pyrophosphate dihydrate crystal deposition. Acute crystal deposition arthritis of the pubic symphysis should be considered in the differential diagnosis of lower abdominal pain.
PLACE OF DEATH AND END-OF-LIFE CARE IN NURSING HOME RESIDENTS AFTER IMPLEMENTING GERMANY'S FIRST REGIONAL ADVANCE CARE PLANNING PROGRAMME: A CONTROLLED TRIAL (STUDY PROTOCOL)
Authors: in der Schmitten J , Wegscheider K , Marckmann G
Published: April 2013

Background

Two years after implementation, a regional advance care planning (ACP) programme has led to a rate of meaningful and valid advance directives of 36% in nursing homes that adopted the programme (control: 0.4%). Effects on clinical endpoints, however, were not compared yet.

Aim

To evaluate whether a regional ACP programme leads to improved end-of-life outcomes, judged from the patients' perspective, and saves resources at the same time.

Methods

Endpoints:Reduction of hospital days during the last 3 months of life (primary), increase of nursing home as place of death, improvement of quality of life during end-of-life period (as judged by bereaved relatives), and congruence of factual medical treatment in the last year of life with documented advance care plans.

Sample:

All long-term care residents dying within 2 years study period PLUS all long-term residents deceased within 3 years before the study period in in the two post-intervention nursing homes, compared with a corresponding sample in two structurally similar control homes. 250 deceased residents per group are sufficient to demonstrate a reduction of the average number of hospital days from 5 to 3 days with a power of 80%.

Analysis:

Two-sided permutation tests for each endpoint, extended by statistical modelling.

Discussion

Demonstrating relevant effects of regional ACP programmes on clinical outcomes is methodologically challenging, but possible and necessary. This study protocol has been proposed to the German ministry of education and research in 11/2012, the funding decision is pending.
THINK AHEAD: AN IRISH CARE PLANNING TOOL
Authors: Murphy S , O'Shea B
Published: April 2013

Background Think Ahead

is a public awareness initiative of the Forum on End of Life in Ireland. The Forum is guided by the National Council of the Forum on End of Life. An extensive year-long public consultation in 2009 identified a wide range of issues which impacted on end of life.

Aim

To present the development of the Think Ahead project, an Irish public awareness initiative and system to guide people in discussing and recording their preferences.

Methods

Resources, including a Think Ahead form and website (www.thinkahead.ie), have been developed. A wide range of consultation processes have been engaged in with members of the public as well as professional organisations and State agencies.

Results

Two GP pilots were carried out, involving 120 patients up to 70 years of age, which looked at the people's experiences in filling in the Think Ahead form. Two regional community pilots were also conducted in 2012.

Discussion

Think Ahead has been very positively received by the public and health professionals. The majority of people in all age groups considered Think Ahead to be a welcome initiative, in particular in its capacity to initiate conversations with family members who may be ill or dying. GPs reported that the tool had enhanced their relationship with their patients and reduced the potential for family conflict in relation to a person's wishes.

Conclusion

The presentation will address the learnings of the public consultation and the pilots in relation to attitudes among the public to discussing preferences around end of life.
YOU DECIDES WHO DECIDES: AN ONLINE TOOL FOR CHOOSING ENDURING POWERS OF ATTORNEY
Authors: Lawrence J , Rushford H , Chesterman J , McNamara C , Turnbull L
Published: April 2013

Background

The Office of the Public Advocate's (OPA) experience of enduring powers of attorney indicates that the crucial step of thinking about who to appoint as substitute decision-maker and considering the sorts of decisions those people are likely to make, is too often overlooked in the haste to get the documents in place. OPA saw the need for resources that encourage people to consider these issues as an important part of the process.

Aim

To develop an online, interactive facility, accessed through the OPA website, that guides participants to consider their important criteria when choosing substitute decision-makers.

Methods

We established a collaborative partnership with Associate Professor Jeanette Lawrence, Psychological Sciences, University of Melbourne.A/Professor Lawrence contributed psychological expertise on drawing out values and beliefs without bias and using stories as a vehicle to do this. She works with a team of graphics and programming experts who translate these ideas into computer programmes. A steering committee met regularly to develop the programme, which was subsequently trialled with 40 participants.

Results

The programme was launched on the OPA website in October 2012. In addition, the programme has been produced in CD format to broaden accessibility.

Discussion

This tool assists in effective planning for the future through the appointment of appropriate representatives.

Conclusion

Feedback indicates that the programme succeeds in getting people to think about criteria for whom to appoint as their representative and fills a resource gap.
ADVANCE CARE PLANNING FOR MENTAL HEALTH TREATMENT: THE PERSPECTIVES OF AUSTRALIAN MENTAL HEALTH CLINICIANS
Authors: Mawren D , Silvester W , Newton R , Fullam R , Mountjoy R
Published: April 2013

Background

International research highlights that the successful implementation of Advance Care Planning (ACP) for mental health treatment can depend on clinicians' attitudes and knowledge of Psychiatric Advance Directives (PADs). With proposed revisions to the Victorian Mental Health Act considering the introduction of ACP, it is vital to explore the attitudes and knowledge of mental health clinicians in an Australian setting.

Aim

To establish Australian mental health clinicians' knowledge and attitudes regarding PADs.

Methods

A national online survey of Australian psychologists and case managers.

Results

Of 260 respondents, 67% reported low to very low knowledge of PADs and only 20% reported any experience with PADs. 73% of clinicians welcomed service change that would give consumers more control over their management and 63% would be more inclined to use PADs if the law acknowledged their role as important. PADs were expected to have a positive impact on mental health care (80%) and not pose major limitations to consumer care (65%), however 45% expressed concern that the benefit of PADs may be outweighed by the refusal of indicated treatments such as counselling.

Discussion

Australian mental health clinicians have limited exposure to PADs, but display encouraging attitudes towards their potential benefits and related systems changes.

Conclusion

Australian mental health clinicians were supportive of the use of PADs and further research will help to develop a sustainable model of ACP for mental health care in Australia.
IS THERE AN IDEAL LEGAL FRAMEWORK FOR END OF LIFE DECISION-MAKING?
Authors: Menon S
Published: April 2013

Background

The law should help and not hinder patients, their loved ones and healthcare professionals in making advance care plans and end of life decisions.

Aim

This paper will review the relevant laws of England and Singapore, and compare their frameworks for end of life decision-making.

Methods

The advantages and disadvantages of each regime will be analysed in the context of three groups of patients and their loved ones facing an end of life scenario. The first group is patients who have capacity to make their own treatment decisions and have expressed their wishes. The second is patients who have lost capacity and did not make their wishes known, and the final group is patients who made their preferences known before they lost capacity.

Results

There are some similarities between the English and Singapore frameworks but also some striking differences, especially relating to the powers of donees on healthcare decision-making and advance refusals of treatment.

Discussion

Given initiatives in advance care planning in England and Singapore, this paper will make recommendations on the elements of an ideal legal framework. England and Singapore do not have legislation pertaining to Physician Orders for Life Sustaining Treatment (POLST) or default surrogates. Are these aspects essential in an ideal legal framework for end of life decision-making?

Conclusion

The ideal legal framework is one that empowers patients and their loved ones to plan for their future health care and enables health care professionals to honour those wishes at the appropriate time.
ADMISSION TO INTENSIVE CARE FOR PROVISION OF END OF LIFE CARE IN AUSTRALIA AND NEW ZEALAND: DO THE PATIENTS ALL DIE?
Authors: Melville A , Mitropoulos J , Philpott S J , Pilcher D V
Published: April 2013

Background

Caring for those at the end of their lives is an increasing component of work for Intensive Care Units (ICUs). Limited research is available about patients specifically admitted to ICU with the aim of providing end of life care.

Aim

To define epidemiology of patients admitted to ICU for consideration of organ donation or palliative care and identify factors associated with outcome.

Methods

Retrospective analysis of data from the Australian and New Zealand Intensive Care Society Adult Patient Database between 2007 and 2011.

Results

Between 2007 and 2011, there were 1428 admissions to ICU for palliative care and 343 for consideration of organ donation (0.4% of the total 445 381 ICU admissions). Mortality was 87% and 93% respectively, compared with 9% in patients admitted for active management. 122 patients were discharged home alive. Median length of ICU stay was 17 h (IQR 6–39) in the palliative care group, 24 h (IQR 14–42) in the potential organ donation group, compared with 42 h (IQR 22–86) in patients admitted for active management. The most common diagnosis was intra-cerebral haemorrhage. A diagnosis of gastrointestinal cancer (OR 12.3, 95% CI 2.3 to 62.9, p=0.002) and planned admission following elective surgery (OR 4.3, 95% CI 2.6 to 7.2), p<0.001) were independently associated with being discharged home alive.

Discussion

Admission to ICU for palliative care or consideration of organ donation is uncommon and most patients die. Functional status of survivors remains unknown.

Conclusion

More work is required to better identify patients who might survive, and assess needs and functional outcomes.
COMFORT CARE FOR A HEPATOCELLULAR CARCINOMA PATIENT IN HOSPICE WARD
Authors: Chen Y , Cheng S-F
Published: April 2013

Background

Cancer is the major cause of illness and mortality in Taiwan. It is noteworthy that the psychosocial and spiritual needs of patients with terminal cancer patients often are neglected by families and healthcare providers in Taiwan.

Aim

The purpose of this study was to apply the Comfort Theory to explore the experience on comfort care of a patient with terminal HCC near the end of life in hospice ward.

Methods

Data were collected and evaluated based on Kolcaba's theory of comfort. It directs nurses to assess physical, psycho-spiritual, sociocultural and environmental comfort needs of the patient; design holistic interventions to meet those needs; and measure the effectiveness of interventions to enhance the patient's comfort.

Results

Four contexts of a terminal hepatocellular carcinoma patient experience are as follows: (a) Physical: abdominal distention resulted from ascites deterioration. (b) Psycho-spiritual: Fear of death anxiety resulted from the uncertainty of life-threatening. (c) Sociocultural: Altered family process resulted from family worry and conceals the patient's condition. (d) Environmental: Un-homelike setting related to the limitation of hospital hardware.

Discuss

The caring experience of this study provide important information to health professionals while caring terminal cancer patients based on their comfort needs. Health professionals could design an individualised care plan, establish a trusting relationship, control symptoms, provide complementary medicine, reconnect family relationship and create a homelike atmosphere to meet patients' needs.

Conclusion

The study will help health professionals to perceive psychosocial and spiritual needs and properly provide support for terminal cancer patients.
ASSESSING PATIENT VALUES FIRST: CREATING A PLATFORM FOR ADVANCE CARE PLANNING (ACP) IN THE ADULT ONCOLOGY POPULATION
Authors: Mikan Sabrina , Taniguchi Cynthia , Harrison Deb , Hoverman Russell
Published: April 2013

Background

Patients, families and health care providers can be apprehensive about having end-of-life (EOL) conversations in Oncology. However, asking patients about personal values regarding their healthcare goals creates a platform for more in depth conversations.

Aim

To test a structured process for identifying eligible patients for upstream advance care planning (ACP) conversations through development and validation of a quantitative instrument.

Methods

Recruitment was conducted at seven cancer centres in the USOncology Network over a 90-day pilot study. A cross-sectional descriptive design was used in 301 metastatic cancer patients. Sixty-three participants completed the questionnaire. The 13-item instrument was created after a literature review regarding EOL choices and interventions using a 5-point Likert scale. Descriptive statistics were examined, in addition to analysis of the relationships between items using Pearson'srcorrelations.

Results

59% of participants were female, predominantly Caucasian, with a mean age of 66 years. 68% reported the importance of being told by their oncologist when dying. Additionally, 76% reported the importance of selecting who would make medical decisions for them. Lastly, 62% reported the importance of choosing where their EOL medical care occurs. There was a significant association between discussing feelings about dying and being told by a physician when dying, (r=0.373, p<0.01).

Discussion and Conclusion

The instrument allows for healthcare providers to understand the patient's needs, creating a segue for patient collaboration during EOL care. ACP conversations can be further developed through review of the validated instrument in adults with life-limiting illness in Oncology.
HOME AS THE PREFERRED PLACE OF DEATH: ARE THERE LIMITATIONS?
Authors: Ganga-Krishnan S , Wong Lawrence , Song Angeline , Nah Tan Hui , Chung Irwin
Published: April 2013

Background

The HOME Programme provides home palliative services to patients with end-stage organ failure in Singapore.

Aim

To study the reasons for patients who were not able to fulfil their wish to die at home.

Method

A retrospective study was done based on historical data gathered from case notes of patients who had died during the period of April 2011 to September 2012.

Results

A total of 143 patients had died. 102 patients (71%) had completed their ACP. Out of the 102 patients, 62 (61%) chose their homes as their preferred place of death.

Out of the 62 patients who had chosen their homes as their preferred place of death, 41 patients (71%) died at home while 21 patients (29%) did not have their wish fulfilled.

Discussion

Figure 1

Cause and Effect Diagram

Conclusion

Singapore has a multi-ethnic population. It's diverse cultural beliefs and perspectives towards palliative care and care-giving have an impact on end of life care decision-making.

Currently, there is little research in this area. This paper has identified some causes to why patients were not able to fulfil their wish to die at home. It also navigates the way for future research to help patients die at home according to their wishes.
ADVANCE CARE PLANNING IN RESIDENTIAL CARE: 5 YEARS OF CONTINUOUS QUALITY IMPROVEMENT
Authors: Nicholes M , Billings S , Perta A , Melican G
Published: April 2013

Aim

Until recently Australia has lacked guidelines and practical examples from the field on best practice for implementing Advance Care Planning (ACP) in Residential Care Facilities (RCFs). In 2008 the Victorian Department of Health funded an ACP programme at Alfred Health. This presentation will detail our experience of 5 years of continuous quality improvement in ACP in RCFs.

Methods

Alfred Health has three RCFs on site at Caulfield Hospital, which provides care to 120 permanent residents. Over the 5 year time period, initiatives were implemented in an effort to improve ACP processes and outcomes. These included: dedicated ACP staffing time in partnering with staff in RCFs, education and training of staff, development of documents, implementation of systems and procedures, engagement of GP's and the development of an auditing tool to measure change.

Results

Prior to the implementation of ACP in 2008, there were no obvious systems in place to support ACP. Documentation of resident end of life care wishes and NFR status were unclear and confusing for staff to follow. The 2012 audit of RCFs at Caulfield Hospital reveal that 89% of residents participated in ACP and 48% of residents have clear medical treatment plans which have been completed by the GP.

Conclusion

Our experience provides a successful example of how to implement quality improvement in ACP in RCFs over a realistic time frame with limited resources.
QUALITY OF LIFE AMONG END-OF-LIFE FORMER COMMERCIAL PLASMA DONORS INFECTED WITH HIV IN RURAL HENAN, CHINA
Authors: Sheng Y , Qiu Z , He Y , Zhang Y
Published: April 2013

Background

China has began providing antiretroviral therapy to people living with HIV/AIDS (PLWHA) since 2003.

Aim

Purpose of present study was to investigate quality of life and happiness, as well as their needs in hospice care at their end-of-life among HIV-positive people in rural Henan.

Methods

One-hundred AIDS patients at their end-of –life were selected from Weishi, Zhenping and Tanghe counties, Henan province of middle China using convenience sampling. WHO Quality of Life for HIV (WHOQOL-HIV) BREF Chinese version was used to measure their quality of life, and Memorial University of Newfoundland Scale of Happiness (MUNSH) was used to measure their subjective welfare. Personal in-depth interview and focus group discussion were used to learn their needs for hospice care at end-of-life of the patients.

Results

Overall quality of life was moderate among the patients with an average score of 12.62 and SD of 1.97, higher in domains of spirituality, religion and personal belief (with an average score of 14.40±2.96) and psychological domain (13.58±2.06), and lower in independence (12.15±2.15) and environment (12.50±3.28) domains. Average MUNSH score was 21.00±6.20, with moderate range.

Discussion and Conclusion

Palliative care model used was beneficial to the patients. In-depth interviews indicated that Henan provincial government's policy of treatment and care for AIDS patients has had a beneficial impact on them at their end-of-life overall, although care component could be improved further by assisting their families as a whole.
MEETING THE PRIME MINISTER'S DEMENTIA CHALLENGE: IMPROVING CARE AND INCREASING ACP DISCUSSIONS FOR PEOPLE WITH DEMENTIA FOLLOWING THE GOLD STANDARDS FRAMEWORK (GSF) DEMENTIA CARE TRAINING PROGRAMME
Authors: Thomas K , Stobbart Rowlands M , Giles L
Published: April 2013

Background

The UK's Prime Minister's Dementia Challenge highlights the need to improve care for people with dementia. There is growing evidence that hospitalisation can often cause them harm, with increased mortality and morbidity. They can suffer increased disorientation and distress during hospital admissions, with over use of psychotropics and sedatives. However uptake of ACP discussions is often poor.

Aim

To improve end-of-life care and reduce hospitalisation for people with dementia through the GSF Dementia Care distance-learning training programme.

The GSF Dementia Care Training interactive programme aims to:

Increase awareness of dementia.

Improve communication and Advance Care Planning/Best Interest discussions.

Reduce inappropriate hospitalisation, with more dying in their usual place of residence.

Improve pain management

Methods

The pilot study involving 50 learners from different settings is currently underway, using the GSF Virtual Learning Zone. Certifications is supported by Stafford University.

The evaluation includes recording number of ACPs undertaken, rate of hospitalisation, use of pain assessment tools and illustrative case histories. Evaluations are being analysed, with results available by May 2013

Results

It is hoped that the training programme will show improvements in the areas noted, particularly increased ACP and reduced hospitalisation rates, enabling more to live and die at home.

Discussion

These findings are in line with the UK's PM Challenge in dementia.

Conclusion

We hope to demonstrate the quantitative and qualitative improvements in care in increased uptake and implementation of ACP discussions in people with dementia.
PATIENT PREFERENCES AND ACTUAL TREATMENT IN OLDER PEOPLE AT THE END OF LIFE. A MORTALITY FOLLOW-BACK STUDY
Authors: Roeline H , Pasman W , Kaspers Pam J , Deeg Dorly J H , Onwuteaka-Philipsen Bregje D
Published: April 2013

Background

Respecting patients' preferences is seen as good palliative care.

Aim

Studying actual treatments in relation to preferences for starting or forgoing treatment of older people at the end of life.

Methods

Mortality follow-back study among relatives of deceased older people (2006–2009) of two cohorts representative for the older Dutch population (n=168) and for people with an advance directive (n=184). Preferences and actual treatment were studied for each of four treatments: starting or forgoing resuscitation, artificial nutrition/hydration, antibiotics, and artificial respiration.

Results

In most patients who preferred receiving treatment this preference was followed (88% to 100% for different situations). In about half of the patients who preferred that a treatment would be forgone, the preference was followed (except artificial respiration: 12% concordance). The majority of people for whom no preference was known received treatment (59% to 79% for different situations). People with a known preference for receiving a specific treatment (as opposed to forgoing that treatment) had a higher chance of preference being followed (OR 7.4). People with a preference for forgoing a treatment had higher odds (OR 6.3), and people with a preference for starting a treatment had lower odds (OR 0.28) of treatment being forgone compared to people having no known preference.

Conclusions

Concordance between preferred and actual treatment is high in older people who prefer treatment, and lower in people who prefer no treatment. Yet, making preferences for forgoing treatment known is useful as it increases the chance of treatments being forgone in those who wish so.
ENGAGING CONSUMERS: THE UNTAPPED DRIVERS OF CHANGE
Authors: Holman T , Brici N , McDonald D , Langdon T , Chea J
Published: April 2013

Background

Advance care planning appears such a sensible and logical process to assist in the approach to death but it has a relatively low uptake. Healthcare professionals have increased their consideration of decisions at end of life and now avenues to better engage the general community need broader discussion.

Aim

A meta-analysis and primary research with Australian consumers were used to explore end of life considerations from the perspective of GPs, people in palliative care, consumers and carers. These studies investigated the role GPs play in initiating dialogue, the priorities of people experiencing palliative care and those yet to directly address death and how to assist in a better approach.

Methods

710 general consumers, 302 invited GPs, 692 people in palliative care and 936 bereaved carers were surveyed in 2012. Two focus groups further explored some of the issues raised.

Results

Most conversations about death are triggered by a significant decline in health. While GPs are comfortable with the discussion when prompted, less than 2% rate their training as being comprehensive. 52% of consumers do not have a written advance care plan but feel their wishes are known. Carers do not share the same level of understanding. The sharing of an open discussion is hampered by confusing and uncommon terminology and euphemisms.

Discussion

There is wide variation of attitudes and experience regarding death. Drivers of this situation are postulated and ideas to address better standards of care and the engagement of consumers earlier in their lives are explored.

Conclusion

Greater responsibility of planning for death by families and individuals can be encouraged by health professionals and community educators through appropriate engagement.