bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of symptomatology in planning palliative care
Authors: Sebastian Paul , Varghese Cherian , Sankaranarayanan R. , Zaina CP , Nirmala G. , Jeevy Gladys
Published: November 2007

Cross-sectional surveys are a useful tool in planning health care, both in the community and in hospitals. We found that a review of routine case records did not yield sufficient information for planning palliative care services in the hospital environment, and therefore decided to conduct a cross-sectional survey involving random patients attending the outpatient division of the Regional Cancer Centre, Trivandrum, India. Three hundred and twelve patients were interviewed, and pain and weight loss were found to be the most prominent symptoms (>90%). This study indicates that symptomatology has to be addressed in detail while planning palliative care services in a hospital setting. Even with its selection bias, the study provides valuable clues for the adequate organization and continuation of palliative care services.
Subcutaneous ketorolac- a new development in pain control
Authors: Blackwell N. , Bangham L. , Hughes M. , Melzack D. , Trotman I.
Published: November 2007

Pain due to advanced malignant disease does not always respond to opioids, or the possible use of opioids may be limited by the occurrence of adverse effects. This paper describes the successful use of ketorolac, a new nonsteroidal anti-inflammatory drug, given by continuous subcutaneous infusion. Seven patients with pain due to advanced malignant disease taking opioid analgesia were considered to have inadequate symptom control because of opioid unresponsiveness (n = 1 ), opioid-related adverse effects (n = 2) or both (n = 4). All patients became symptom-free with the introduction of ketorolac by subcutaneous infusion and the total daily opioid requirement was substantially reduced in three and reduced to zero in four patients.
Staff support groups: do they support and are they even groups?
Authors: Alexander David A
Published: November 2007

This article emphasizes the need to adopt a rigorous approach to the establishment of staff support groups. They are too important to be allowed to materialize without careful consideration of their aims, methods and composition. As a method of combating work-related stress they have a role to play, but it cannot be assumed that they will fulfil this role without serious attention being paid to these matters. There are good reasons for suspecting that improperly run support groups might have a harmful as well as a positive effect. As with all forms of help, the 'therapeutic' ingredients of support groups have to be identified and developed to ensure they fulfil their potential.
Biography as therapy
Authors: Lichter Ivan , Mooney Janice , Boyd Mavis
Published: November 2007

The feeling that life has had no meaning is an impediment to a peaceful death. Life review enables a person to identify events that have been of worth and so enhances self-esteem. This approach has been extended and formalized by establishing a biographer service to compile oral and written biographies of patients who may be expected to benefit from such a re-examination of their lives. The service is now also being offered to patients whose disability precludes most other forms of activity. The value of biography as therapy is considered and it is concluded that it has much to offer in the circumstances described.
Should hospices offer respite admissions to patients with motor neurone disease?
Authors: Hicks Fiona , Corcoran Gerard
Published: November 2007

The provision of inpatient respite care for patients with motor neurone disease (MND) in hospices is variable. Some institutions are concerned about accepting patients who may need long-term care. Some see 'respite' care as simply a short residential stay with little nursing or medical input being necessary. Others, however, feel that respite offers the potential for palliative care and should be provided within the spectrum of a hospice service. This retrospective study examines that group of MND patients requesting respite care in terms of demographic details, problems identified and medical and nursing interventions made during respite admissions. The results indicate a great need for symptom management in these patients as well as co-ordination of future community care. Most patients were discharged home after respite admissions and the median stay in the hospice (15 days) was identical to that of cancer patients. We conclude that respite admissions to the hospice were valuable both for MND patients and their carers. Units not currently involved in this work may wish to reconsider their position.
The concept of hope and the will to live
Authors: Hockley Jo
Published: November 2007

Hope is defined as a concept that suggests a greater emotional component than mere expectation, and is seen as an active process of conscious and unconscious reasoning. Hope is intrinsically linked with caring, and the professional role of the nurse can often influence the generation of hope or hopelessness in the care of patients. The appropriateness of removing all hope even within palliative care is questioned. A case study is presented in which a patient, requesting euthanasia, hovered on the brink of death yet would not die. For this patient all 'hope' of wanting to live had waned, yet she could not die. A new concept of 'rational no-hope' is postulated.
The stream flows on
Authors: Swann Donald
Published: November 2007

All through the sixties, the two-man shows of Michael Flanders and Donald Swann were a byword even in the golden age of satire, and their revue 'At the drop of a hat' toured the world.

This paper is adapted from the Coda added to Swann's Way, by Donald Swann and Lyn Smith, published as a paperback by Arthur James Limited, One Cranbourne Road, London N10 2BT, UK. In this, Donald Swann explains how he has recovered his creative spirit with the onset of late-stage cancer.
A novel morphine sulphate preparation: clinical trial of a controlled-release morphine suspension in cancer pain
Authors: Forman Walter B , Portenoy Russell K , Yanagihara Ronald H , Hunt Curtis , Kush Rebecca , Shepard Kirk
Published: November 2007

In order to determine the efficacy of a novel controlled-release morphine suspension, we performed two prospective sequential open-label studies in patients with pain due to cancer. The studies were identical except for the duration of treatment (three days and 30 days respectively). Sixty-nine patients with a variety of advanced cancers and associated pain participated. Fifty-three patients completed the trials, 38 on the three-day trial and 15 on the 30-day trial. In both groups the amount of morphine required to obtain pain relief was initially established using controlled-release morphine tablets and immediate-release morphine for 'rescue' dosing. Patients were begun on equivalent doses of the study drug in place of the controlled-release tablets. No differences in pain score or the amount of 'rescue' morphine were noted following the switch to the controlled-release morphine suspension. Toxicity was as anticipated for the use of morphine in this situation and no adverse effects were observed during administration of the suspension. These data suggest that this new formulation of morphine is equipotent to conventional controlled-release morphine tablets and provides pain relief for a 12-hour dosing interval. This novel morphine formulation could be especially useful for paediatric patients and for those who have difficulty in swallowing.
Some basic guidelines in the use of chemotherapy for patients with incurable malignancy
Authors: Kearsley John H
Published: November 2007

The increasing use of cytotoxic chemotherapy for patients with incurable malignancy has raised a number of practical and ethical dilemmas for health care workers in the fields of oncology and palliative medicine. This paper addresses some of these issues and attempts to suggest basic principles which may contribute to the successful use of palliative chemotherapy.
The closure of an abdominal fistula using self- polymerizing silicone rubbers - case study
Authors: Walls Awg , Regnard Cfb , Mannix KA
Published: November 2007

A case is described where an abdominal fistula was temporarily closed using a plug made from dental addition curing silicone rubber impression material. An effective seal was maintained using a stoma flange and a gentle pressure dressing; this still allowed normal gastric function.
Experience with dipipanone elixir in the management of cancer related pain - case study
Authors: Faull Christina , McKechnie Elizabeth , Riley Jean
Published: November 2007

The synthetic opioid dipipanone is infrequently used in the UK in the management of malignant pain, principally because of the inflexibility of the Diconal combination preparation (dipipanone 10 mg with cyclizine 30 mg). We present three patients in which dipipanone elixir proved to be their own drug of choice in the management of opioid responsive cancer pain, and our experience with 15 other patients. Dipipanone elixir was formulated 10 mg/5 ml, in single strength chloroform water.
The influence of general practitioner community hospitals on the place of death of cancer patients
Authors: Thorne Christopher P , Seamark David A , Lawrence Clive , Pereira Gray Denis J
Published: November 2007

All deaths from cancer were identified from death certificates in the Exeter Health District for a period of one year. Place of death, age, cancer type and access to general practitioner community hospital beds and the domiciliary hospice service were recorded. There were 1022 deaths attributable to cancer (parts 1 a, 1 b or 1 c of the death certificate) who were patients of general practitioners in the health district. The place of death for patients with access to community hospital beds were: home 173/590(29%), community hospital 232/590 (39%), specialist services unit 102/590 (17%), nursing or residential home 32/590 (5%), Marie Curie hospice 51/590 (9%). For patients without access to community hospital beds the place of death was: home 177/427 (41 %), specialist services unit 165/427 (39%), nursing or residential home 42/427 (10%), Marie Curie hospice 43/427 (10%).

The presence of community hospital beds was associated with a significant reduction of deaths in the specialist service unit ( p<0.001) and with a smaller reduction in home deaths ( p<0.01). Access to the domiciliary hospice services in areas with community beds was not associated with any significant change in the place of death. General practitioners cared for 74% of cases at the time of death in areas with access to community hospital beds and for 51 % of cases without such access, which was a significant difference ( p <0.001).

It therefore appears that community hospitals play a major role in the terminal care of cancer patients and access to such beds is associated with a decrease in cancer deaths occurring in specialist services beds.
Monitoring drug use in palliative care
Authors: Twycross Robert G , Bergl Stephen , John Sally
Published: November 2007

A computerized system for monitoring drug use which makes use of the British National Formulary (BNF) drug categories and a departmental formulary (DF) has been developed. Data entry takes less than one week of secretarial time per annum. Details of drug use in 385 patients three weeks after referral to a National Health Service palliative care unit over five years form the basis of this report.

The median number of drugs per patient was five, with a maximum of 11; 97% of the drugs were from the DF. Analgesics were the commonest category of drugs used. The 10 most commonly used drugs included three analgesics (morphine, co-proxamol, flurbiprofen), two laxatives (co-danthrusate, lactulose), dexamethasone, metoclopramide, ranitidine, temazepam and amitriptyline/dothiepin. Seventeen per cent of patients received two preparations from the same second level BNF category (analgesics excluded). The concurrence was questionable in about half of these, and mostly related to the use of laxatives or to hypnotics and anxiolytics. Several unexpected inclusions in the top 10 drugs illustrate the need for quantification rather than pontification about drug use in palliative care. Examination of duplicate prescribing provides a forum for examining ways of simplifying drug regimens.
Breaking bad news - a flow diagram
Authors: Faulkner Ann , Maguire Peter , Regnard Claud
Published: November 2007

Breaking bad news is neither an easy nor a popular task. Properly handled, however. it can be given in a positive way that the individual can both accept and understand. There may be a range of emotions and concerns following the telling of bad news. These need to be explored and worked through with each individual. This flow diagram describes the steps in this important process.
Palliation in chronic respiratory disease
Authors: Shee Charles D
Published: November 2007

Prognosis in severe chronic obstructive pulmonary disease is poor, and it is increasingly accepted that such patients need good palliative care. This paper reviews the medical management of chronic obstructive pulmonary disease, and also discusses the place of long-term oxygen therapy. A multidisciplinary programme termed 'pulmonary rehabilitation' is being used increasingly, and, although this probably does not improve survival, there is evidence that it increases quality of life. The drug treatment of dyspnoea has been disappointing, but close attention to psychosocial aspects can improve mobility and control. The place of palliation in a number of other chronic lung conditions is also mentioned.
Terminal illness: views of patients and their lay carers
Authors: Field David , Douglas Carolyn , Jagger Carol , Dand Pauline
Published: November 2007

This paper examines the responses of 28 terminally ill patients and their lay carers to identical questions about the patients' experiences in the month prior to their admission to an inpatient hospice. No statistically significant differences were found between the reports of patients or carers regarding the patients' activities of daily living, their physical symptoms, or the evaluations of the care they received. Discrepancies between accounts were most likely to concern the presence or absence of psychological symptoms, the degree of distress caused to patients by their symptoms, and the main symptoms experienced by the patient on their admission to the hospice. It is suggested that the accounts of patients' experiences given by their carers can be used as a valid source of information.
Assessing the effectiveness of a hospital palliative care team
Authors: Ellershaw John E , Peat Sue J , Boys Lesley C
Published: November 2007

A prospective study was carried out of 125 hospital inpatients with malignant disease, referred to the King's College Hospital advisory palliative care team. A palliative care assessment (PACA) tool was developed in order to assess the outcome of interventions made within two weeks of referral with regard to: symptom control, change in the patients' and their relatives' insight regarding diagnosis and prognosis, and facilitation of patient placement. Reliability was assessed by cross-observer analysis, and validity by comparison with data obtained using the McCorckle symptom distress scale in a separate group of hospice inpatients.

At initial assessment, the commonest symptom was pain, as reported by 74% of patients. One-third of the patients were unsure of their diagnosis and placement had not been decided in 61 %. In total, the team undertook 245 pharmacological interventions for symptom control, 165 interventions regarding insight and 114 interventions concerning placement. Analysis of the data showed statistically significant improvements in pain (p < 0.001), nausea (p < 0.009), insomnia (p < 0.004), anorexia (p < 0.001) and constipation (p < 0.02). Discussion regarding diagnosis significantly changed the insight of patients (p < 0.001) and relatives (p < 0.02). Appropriate placement was assisted by interventions undertaken by the team.

This study shows that a hospital palliative care team is effective at improving symptom control, facilitates understanding of the diagnosis and prognosis, and contributes to the appropriate placement of patients.
Nurses in private nursing homes: a study of their knowledge and attitudes to pain management in palliative care
Authors: Gibbs G.
Published: November 2007

Nurses working in private nursing homes may not have the same degree of access to support and education in palliative care as nurses in NHS 'care of the elderly' wards. A study was conducted comparing two groups of nurses working in these two environments in one health district. Twenty-four nurses underwent semistructured interviews focusing on pain management.

Both groups showed equal enthusiasm for their work with elderly patients. However, those from the care of the elderly wards were able to offer many more treatment strategies to relieve pain than their colleagues from the private nursing homes.

The study uncovered a sense of isolation and a lack of postbasic education opportunities for nurses outside the NHS. If this small local study reflects a national trend, then there are major implications for the educational activities of palliative care teams.
Dying from cancer: results of a national population-based investigation
Authors: Addington-Hall Julia , McCarthy Mark
Published: November 2007

Objective: To describe the quality of care received in the last year of life by people who die from cancer, focusing particularly on symptom control, communication with health professionals, and care in the community.

Design: Interview survey of family members or others who knew about the last year of life of a random sample of people who died in the UK in 1990, based upon methods used in nationally representative surveys by Cartwright in 1969, and Cartwright and Seale in 1987.

Setting: Twenty district health authorities from a range of inner city, outer urban and rural settings. Although self-selected, districts were nationally representative in terms of social characteristics and on many indicators of health service provision and usage.

Participants: Interviews were obtained for 2074 cancer deaths out of a random sample of 2915, a 71 % response rate.

Main results: At some stage in the last year of life, 88% were reported to have been in pain, 66% were said to have found it to be'very distressing', and 61 % to have experienced it in their last week. Treatment that only partially controlled the pain, if at all, was said to have been received by 47% of those treated for pain by their GPs and by 35% of hospital patients. Other common symptoms experienced by more than half the sample in their last year were loss of appetite, constipation, dry mouth or thirst, vomiting or nausea, breathlessness, low mood, and sleeplessness. Half of the respondents (51%) were unable to get all the information they wanted about the patient's medical condition when they wanted it.

Relatives bore the brunt of caring for 81 % of the sample. Of respondents who had helped to care for the deceased, 65% said that their activities had been at least fairly restricted, but 53% had found it rewarding. District nurses had helped 60% of the deceased, 20% had had a home help, and 9% had received'meals on wheels'. More help with activities of daily living was reported to have been needed by 31 %; 24% were reported to have needed more help with domestic chores; 25% were reported to have needed more financial help, and 29% were reported to have needed either more care from district nurses (if had some) or some care (if had none).

Conclusion: There is still some way to go before all dying cancer patients receive high quality care. Education in the principles of palliative care is needed at all levels of the NHS if high standards are to be reached. In addition, adequate resources are required to meet the social and health care needs of cancer patients at home. There is, as yet, no room for complacency about the care of dying cancer patients.
Epidural diamorphine and bupivacaine stability study
Authors: Kreeger Louisa , Cowin Peter , Noble-Gresty Jocelyn , Naysmith Anne
Published: November 2007

Diamorphine and bupivacaine are commonly used together for spinal analgesia, although stability data relating to the mixture of the two drugs have not actually been established. We therefore performed a stability study using high performance liquid chromatography for both drugs and the British Pharmacopoeia 2,6-dimethylaniline limit test for bupivacaine, over a period of eight days and at room temperature. Diamorphine and bupivacaine were combined in various concentrations in 100 ml bags for use with the Bard patient controlled analgesia pump.

We found no significant change in concentration of either drug, and the 2,6- dimethylaniline limit test was well within set limits. We therefore conclude that it is safe to combine these two drugs in this way.
The role of embolization in palliative care
Authors: Broadley KE , Kurowska A. , Dick R. , Platts A. , Tookman A.
Published: November 2007

Transcatheter arterial embolization (TCAE) is a well recognized radiological technique that has been used for over 25 years. It is a method of diminishing blood flow through selected vessels by inserting haemostatic material under angiographic control. The procedure is performed under local anaesthetic through a femoral or, occasionally, an axillary approach.

We present our experience of the use of TCAE in the management of pain and haemorrhage in three hospice inpatients in whom other options had been exhausted. The use of TCAE as a technique for the palliation of these symptoms in the hospice setting is discussed.
Communicating the diagnosis of motor neurone disease
Authors: Johnston Marie , Earll Louise , Mitchell Elspeth , Morrison Valerie , Wright Stephen
Published: November 2007

Communication of the diagnosis of motor neurone disease (MND) is a particularly difficult task for doctors in view of the poor prognosis and the lack of significant treatment. This study examined patients' views of being given the diagnosis and of how it was communicated. Fifty people who had been diagnosed with MND more than six months previously were interviewed about their experience of the diagnosis. The majority reported positive aspects of being told, especially having a label for their condition. The most frequently mentioned critical aspect of how they were told was the directness and clarity with which they were given the information. Patients were more critical if the diagnosis was worse than expected (as it was for most patients) and more satisfied if they felt they had been able to ask questions. There was no evidence that unsatisfactory communications were associated with later mood disturbance. A longitudinal study is recommended to overcome limitations in this cross-sectional design.
Evaluation of the psychological status of ventilatory-supported patients with ALS/MND
Authors: McDonald Evelvn R. , Hillel Al , Wiedenfeld Sue A.
Published: November 2007

Many medical professionals feel that a choice of long-term ventilatory support leads to a life of hopeless desperation. We compared the sociodemographic, physical and psychological status of 18 amyotrophic lateral sclerosis/motor neurone disease (ALS/MND) patients on ventilatory support for 1 to 120 months with that of 126 nonventilatory-supported ALS/MND patients. Patients filled out a comprehensive data form and completed ten psychological tests. A composite psychological status score was computed, representing a continuum from psychological distress to psychological well-being. Mann-Whitney and χ2 tests were used to compare the two groups. There were no significant differences in sociodemographic makeup, depression, hopelessness, overall quality of life or psychological well-being. However, ventilatory-supported patients had a more internal health locus of control. Many patients on ventilatory support were able to live high quality lives. When ventilatory support is an option, we suggest that medical professionals be supportive of the patient's choices and recognise that a decision for ventilatory support is probably the best predictor of an acceptable quality of life on a ventilator.
Questions of training- choice or force?
Authors: Bennett Michael I. , Alison Dawn L. , O'Neill William M. , Mclllmurray Malcolm
Published: November 2007

Three contrasting views are presented in three short papers: that a short period of oncology training should be mandatory for trainees in palliative medicine; that many disciplines are important in palliative medicine and training programmes should be tailored to the needs of individuals while recognizing that there will always need to be close cooperation between oncology and palliative medicine; and that a short period of training in palliative medicine should be mandatory for those wishing to pursue a career in oncology.
National survey of drug use in palliative care
Authors: Drummond Sarah H , Peterson Gregory M , Galloway James G , Keefe Patrick A
Published: November 2007

The objective was to compile data on therapeutic approaches employed in palliative care in Australia, including practices relating to combining drugs in syringe drivers for administration by subcutaneous infusion. A questionnaire, with a reply-paid envelope, was sent to 130 teaching hospitals and palliative care services throughout Australia. Ninety-six responses were received (74% response rate). Drugs commonly administered in palliative care included oral morphine (97% of respondents), subcutaneous morphine (76%), oral metoclopramide (82%), subcutaneous metoclopramide (41%), oral dexamethasone (70%), oral haloperidol (50%), subcutaneous haloperidol (43%), oral prochlorperazine (47%), oral codeine (38%) and subcutaneous midazolam (36%). Drugs frequently combined in syringe drivers for subcutaneous infusion included morphine plus metoclopramide (67%), morphine plus midazolam (66%), and all three of these drugs (35%). Only 48% of the palliative care services had a policy on combining drugs in syringe drivers for administration by subcutaneous infusion and 34% had an upper limit on the number of drugs combined in syringe drivers. Twenty-nine per cent of respondents had encountered problems (e.g. incompatibilities) when combining drugs in syringe drivers for administration by subcutaneous infusion. This study has revealed considerable variation in the practice of therapeutics and the combining of drugs in syringe drivers for administration by subcutaneous infusion in palliative care.
Validity of the McGill Quality of Life Questionnaire in the palliative care setting: a multi-centre Canadian study demonstrating the importance of the existential domain
Authors: Robin Cohen S. , Mount Balfour M , Bruera Eduardo , Provost Marcel , Rowe Jocelyn , Tong Kevin
Published: November 2007

This study was carried out in eight palliative care services in four Canadian cities. A revised version of The McGill Quality of Life Questionnaire (MQOL) is compared to a single-item scale measuring overall quality of life (SIS), and the self-administered version of the Spitzer Quality of Life Index (SA-QLI), to obtain evidence of validity. MQOL total score predicts SIS better than does SA-QLI, although much of the variance remains to be explained. The results of principal components analysis of data using this revised version of MQOL are similar to those from previous MQOL studies with different patient populations. The MQOL subscales, constructed on the basis of principal components analysis, demonstrate acceptable internal consistency reliability. The MQOL measures reflecting physical well-being and existential well-being are important for predicting SIS.
Dysgraphia and terminal delirium
Authors: Macleod AD , Whitehead LE
Published: November 2007

Delirium is a frequently encountered clinical condition in palliative medicine, but it is often unrecognized and misdiagnosed. The cardinal sign of delirium is that of impaired consciousness. Writing skills are reported to be a delicate indicator of consciousness impairment, and a too infrequently utilized clinical sign of delirium. Ten delirious hospice patients completed the Frenchay Aphasia Screening Test which showed that writing was the most impaired of the language dysfunctions assessed. The simple clinical task of a request to write 'name and address' revealed overt dysgraphic errors among delirious patients. This examination is clinically acceptable to hospice practice and may be an adequate and accurate bedside test of delirium.
The challenge of evaluating a child bereavement programme
Authors: Stokes Julie , Wyer Sarah , Crossley Diana
Published: November 2007

This paper will discuss the challenge of evaluating the efficacy of child bereavement services. Such services are being developed and it is essential that expansion is based on research and evaluation. A literature review details the limited research which has so far been conducted on such interventions. The paper then addresses four key components regarding child bereavement programme evaluation: preliminary evaluation of the Winston's Wish programme; the feasibility and validity of using an experimental method in the evaluation of child bereavement services; the identification of appropriate measures - what are we really attempting to measure with regard to child bereavement interventions; and the importance of measuring the family dynamics of grief - how can we incorporate the Dual Process Model?
Nebulized morphine in the palliation of dyspnoea
Authors: Zeppetella Giovambattista
Published: November 2007

Seventeen terminally ill cancer patients with primary or secondary intra- thoracic malignancy complaining of breathlessness were treated with nebulized morphine in doses of 20 mg 4-hourly for 48 h. The effect on dyspnoea was evaluated using the Dyspnoea Assessment Questionnaire. Most patients felt less dyspnoeic after 24 h; the effect was maintained, but not improved upon, after 48 h.
Disclosure of concerns by hospice patients and their identification by nurses
Authors: Heaven Cathy M , Maguire Peter
Published: November 2007

As part of an evaluation of the training of hospice nurses in communication skills, the selectivity of patients in disclosing their concerns and the ability of nurses to register all the concerns disclosed were studied.

Forty-two nurses were recruited from two hospices in the north of England. They were asked to determine and write down patients' current concerns before and after training, and nine months later. Their interviews were tape recorded to permit rating of the concerns disclosed. After each interview a research nurse used a semistructured interview and the

Concerns Checklist to elicit patients' concerns. The Spielberger State Anxiety Scale and Hospital Anxiety and Depression Scale were then administered to assess patients' mood. In total, 87 patients were thus assessed.

Patients were highly selective in what they disclosed and showed a strong bias towards disclosing physical symptoms. Overall, 60% of concerns remained hidden and concerns about the future, appearance and loss of independence were withheld more than 80% of the time. Patients who were more anxious or depressed were less likely to disclose concerns. The nurses registered only 40% of the concerns disclosed to them at interview, and less than 20% of patients' concerns were identified approprately.

The nurses were selective in the categories of concerns that they registered. Pain, family worries, appetite and weight loss, nausea and vomiting were noted most frequently, while concerns about cancer, bowel function, treatment and emotional worries were not registered. The patients' main concern was identified and recorded in only 45% of cases.

Overall, it was found that hospice patients selectively disclosed physical symptoms while nurses did not elicit or register patients' concerns accurately. Nurses therefore need to improve their ability to elicit and register all of their patients' concerns and to pay particular attention to those who are anxious and depressed.
Pain scales in children: a review
Authors: Hain Richard DW
Published: November 2007

This is a review of tools that have been developed to assess pain in children, with a brief evaluation of their practicality and validity. There are some suggestions for the direction of future research in the development and use of the scales.
Improving the effectiveness of palliative care education
Authors: MacLeod RD , James CR
Published: November 2007

Over the last three decades palliative care has emerged as a discrete specialty that has brought with it a developing field of education. Problematic areas have been identified within palliative care education that may limit its effectiveness. Areas of particular concern are identified that may prove obstructive in the pursuit of effectiveness in palliative care education. The possibility of developing performance indicators is explored with reference to the development of such indicators in other areas of education. Proposals are made as a starting point for the evolution of such indicators.
Percutaneous endoscopic gastroenterostomy and jejunal extension for gastric stasis in pancreatic carcinoma
Authors: Watson JP , Mannix KA , Matthewson K.
Published: November 2007

Gastric stasis in pancreatic cancer without mechanical obstruction is distressing and difficult to manage. We describe two patients who were treated by percutaneous endoscopic gastroenterostomy (PEG) combined with a jejunal extension. Both patients had pancreatic cancer and gastric stasis, with recurrent vomiting and no evidence of distal duodenal obstruction. They were unresponsive to high-dose prokinetic agents. In both cases a Bower-PEG feeding tube with jejunal extension was inserted endoscopically, with clinical improvement. The technique has the advantages of permitting enteral feeding and allowing aspiration of upper gastrointestinal secretions between feeds, which produces symptomatic relief from nausea and vomiting. This manoeuvre can produce effective palliation, perhaps allowing the patient to be managed at home during the terminal phase of their illness.
Tuberculosis in the hospice — a cause for concern?
Authors: McKeogh Maeve M
Published: November 2007

Open pulmonary tuberculosis has been increasingly seen in HIV-infected patients in this hospice. Multidrug-resistant tuberculosis is a new and serious threat and two cases have occurred in our hospice in the past two years. This infection poses a health risk to staff, patients, relatives and volunteers. Palliative care teams in the hospice and community must have an index of suspicion for this infection, take active measures to ensure patient compliance with tuberculosis treatment and be prepared to implement infection control guidelines when needed.
A randomized crossover study comparing the efficacy and tolerability of a novel once-daily morphine preparation (MXL® capsules) with MST Continus® tablets in cancer patients with severe pain
Authors: O'Brien T. , Mortimer PG , McDonald CJ , Miller AJ
Published: November 2007

The efficacy, tolerability and 24-h duration of action of MXL® capsules, a novel once-daily morphine preparation, were compared with twice-daily morphine tablets (MST Continus® tablets) in patients with severe cancer pain. Eighty-five patients were recruited to this randomized, double-blind, double-dummy, crossover study. There was no significant difference between the two treatment groups in the number of occasions that escape medication was required, the pain scores at each of three time points throughout the day, and the number of nights woken due to pain. Both preparations were well tolerated with no significant difference in the number or severity of reported symptoms and side-effects. Sixteen patients withdrew from the study, of whom 13 withdrew for nontreatment-related reasons. There was no difference between the preparations in terms of expressed treatment preference. MXL capsules were shown to provide effective analgesia over the 24-h dosing interval which was comparable to that of MST Continus tablets administered twice daily.
Beach sediment budgets and coastal modification
Authors: Clayton Keith M.
Published: November 2007

In recent years a start has been made in developing the concept of the coastal sediment compartment because of a growing interest in the question of sediment budgets. In many ways the coastal compartment is the equivalent of the drainage basin in terrestrial geomorphology-a unit within which it is theoretically possible to compute sediment gains and losses and so arrive at a quantitative budget statement. On coasts of relatively free transport where natural 'sediment-tight' compartments do not exist it is necessary to define notional compartments or longshore drift cells, the boundaries of which may be placed where transport rates are reduced, change significantly or are more easily measured.

Hierarchies of compartments may be identified where large exclusive compartments may contain smaller non-exclusive subcompartments. Again the analogy is with different orders of drainage basins in the terrestrial situation (Davies, 1979).
Tropical palaeoenvironments
Authors: Street F. Alayne
Published: November 2007

Two geographical types of pluvials are therefore to be distinguished: those of middle latitudes, which coincide with glaciations (North Africa, western United States, Iran, etc.) and those of low latitudes which, on the contrary, fall within the interglacial periods (Tricart, 1956, 167, translation).
The impact of weather and climate on transport in the UK
Authors: Thornes John E.
Published: November 2007

An attempt is made to classify the impact of weather and climate upon air, rail, road and water transport by considering for each: climatic design and required levels of maintenance; weather sensitivity and thresholds; weather forecasting and new technology. This analysis is conducted for both the vehicles of transport and the travel surfaces and nodes. It is clear that much more research and training is required before transport managers and users fully understand the atmospheric impact on transport both from a hazard and from a resource point of view. Similarly meteorologists and climatologists need to understand more fully the problems faced by transport managers and users. The recent establishment of the National Road Ice Prediction Network by the Department of Transport is suggested as a useful model for other transport sectors such as rail and airport authorities to emulate.
Temporal variations in bedload transport rates and sediment storage in gravel-bed rivers
Authors: Hoey Trevor
Published: November 2007

Temporal variability in bedload transport rates and spatial variability in sediment storage have been reported with increasing frequency in recent years. A spatial and temporal classification for these features is suggested based on the gravel bedform classification of Church and Jones (1982). The identified scales, meso-, macro-, and mega- are each broad, and within each there is a wide range of processes acting to produce bedload fluctuations. Sampling the same data set with different sampling intervals yields a near linear relationship between sampling interval and pulse period. A range of modelling strategies has been applied to bed waves. The most successful have been those which allow for the three-dimensional nature of sediment storage processes, and which allow changes in the width and depth of stored sediment. The existence of bed waves makes equilibrium in gravel-bed rivers necessarily dynamic. Bedload pulses and bed waves can be regarded as equilibrium forms at sufficiently long timescales.
Hilislope geomorphology and geotechnique
Authors: Bovis Michael J.
Published: November 2007

This review focuses on recent Canadian contributions to hillslope geomorphology, and emphasizes geotechnical studies of mass movement phenomena in the Canadian Cordillera, including debris flows, rock avalanches, talus slopes, rock creep, and slow earthflows. A brief discussion is included of quick-clay flow slides in eastern Canada, and gelifluction phenomena in arctic and alpine areas. Comparisons are made with similar geotechnical work conducted in the Pacific-rim steeplands.
Fluvial facies models: a review of Canadian research
Authors: Hickin Edward J.
Published: November 2007

Canadian river scientists made significant contributions to the early development (1960-80) of fluvial facies models, particularly to those for braided rivers. More recent Canadian studies (1980-92) have centred on understanding the facies sedimentology of anastomosed and wandering gravel-bed rivers.

River planform facies models are distinctly limited as indicators of fluvial style because of: (1) spurious environmental correlations; (2) the difficulty of river planform definition; (3) differential preservation potential of facies; (4) inadequate and unsystematic field sampling; (5) flawed statistical testing; and (6) the inappropriate space scale adopted for analysis.

The scale problems of facies analysis may be overcome by employing architectural element analysis in conjunction with modem geophysical methods such as shallow reflection seismology and ground-penetrating radar. Future research should focus on devising specific tests of element-scale sedimentological relationships based on the contemporary fluvial enrivonment.
Landscapes of cold-centred Late Wisconsinan ice caps, Arctic Canada
Authors: Dyke Arthur S.
Published: November 2007

Uplands of the Canadian Arctic Islands supported Late Wisconsinan ice caps that developed two landscape zones reflecting basal thermal conditions regulated by long-sustained ice flow patterns. Central cold-based zones protected older glacial and preglacial landscapes while peripheral warm-based zones scoured and otherwise altered their beds.

Some geomorphic effects are independent of ice cap scale, others vary with scale. For ice caps of 30 km radius or more, scour-zone width remains proportionally constant to flowline length under similar flow conditions. But intensity of scouring, ice moulding of drift and rock eminences, size and abundance of subglacial meltwater features, and development of end moraines increase with ice cap size.

Ice caps became entirely cold based early in retreat as the boundary between warm and cold ice shifted outward, probably because ice thinned and flow slackened. The frozen margins deflected meltwater, thus maximizing formation of lateral meltwater channels throughout retreat. The landform record of cold-based glaciers in this region is easily interpreted. Hence, regional ice sheet models invoking or based on the premise that cold-based ice leaves no geomorphic record seem untenable.
Neotectonics and large-scale geomorphology of Canada
Authors: Adams John , Clague John J.
Published: November 2007

Canada includes active convergent and strike-slip plate boundaries, several major mountain systems, two passive continental margins, and a stable craton. Neotectonic activity, as indicated by earthquake occurrence, is highest along the west coast and lowest in the interior of the country. Correlations between tectonics and physiography are strongest in the west. Here, the landscape bears a strong imprint of convergent and strike-slip plate regimes. Late Mesozoic and early Cenozoic tectonic events established the setting in which the present physiography of western Canada developed, but the landscape acquired its present form much more recently, in Pliocene and Quaternary time. In contrast, the neotectonic imprint in eastern and northern Canada is enigmatic, and although major concentrations of earthquakes in many areas are associated with reactivated, early Phanerozoic structures, there has been only limited late Quaternary faulting. The vast Canadian craton, despite its very low seismicity, is deforming isostatically at a moderate rate due to melting of the Laurentide Ice Sheet thousands of years ago.
Modelling the dynamics of ice sheets
Authors: Hindmarsh Richard C.A.
Published: November 2007

Although the mechanics and qualitative dynamics of grounded ice sheets and ice shelves are fairly well understood, this is not true for the transition between the two. In consequence, the existence and nature of any grounding line instability have yet to be established. Further problems are understanding how uncertainties in input parameters affect results, and obtaining optimal techniques for parameter inference using ice-sheet models.
Isotope hydrograph separations and rapid delivery of pre-event water from drainage basins
Authors: Buttle J.M.
Published: November 2007

Environmental isotopes, such as oxygen-18 and deuterium, have been used increasingly to separate stormflow into its event and pre-event components in order to elucidate the sources, pathways and residence times of water in drainage basins. The majority of isotopic hydrograph separations indicate that pre-event water supplies at least 50% of streamflow at peak discharge in small- and medium-sized basins; however, there is no consensus as to the means by which pre-event water is rapidly exported from drainage basins. The hydrological processes that have been invoked to explain the observed isotopic response of streamflow to rainfall and snowmelt inputs in various environments are reviewed. These processes include groundwater ridging, translatory flow, macropore flow, saturation overland flow, kinematic waves and release of water from surface storage. Tests of the ability of the hypothesized mechanisms to explain the isotopic signature of stormflow from drainage basins will require a more complete integration of hydrometric methods with the use of environmental isotopes than has been achieved previously. Along with various methodological issues associated with the isotopic hydrograph separation technique, the overall relevance of these hydrograph separations to the understanding and prediction of stream hydrochemistry must be evaluated critically.
A qualitative view of sub-ice-sheet landscape evolution
Authors: Shaw John
Published: November 2007

Qualitative analysis of sub-ice-sheet landscapes is based on processes inferred from landform and sediment. Striation and plucking give information on the dynamic and thermody namic conditions at the ice bed. Lodgement and melt-out tills indicate that basal accretion and freezing conditions were followed by melting during till deposition, under sliding ice in the case of lodgement and stagnant ice in the case of melt-out. Surging is inferred from evidence of low ice- sheet profiles. Melt-out appears to have taken place over large areas in periods of stagnation following surges. Interbedded stratified sediment and melt-out till indicate decoupling of the ice from its bed during relatively minor subglacial drainage events. The bulk of glacial erosion, transport and deposition took place during ice-sheet advance. Over-ridden proglacial sediment, lodgement/deformation and melt-out tills, with subglacial sorted beds, were eroded by cataclysmic meltwater outburst floods that produced erosional and depositional drumlins, flutings, Rogen moraines and vast tracts of scoured bedrock. These floods marked a dramatic change in glacier regime over large areas of ice sheets. Low ice-sheet profiles caused widespread stagnation; glacial erosion and transport came to a halt. Extensive esker systems attest to a regional, integrated subglacial drainage network. Tunnel channels, glaciotectonic landforms and hummocky moraine are other elements of the subglacial landscape related directly or indirectly to meltwater storage and outburst floods. Models of landscape evolution are based on the conclusions derived from the analysis of sediment, form and process.
Global terrestrial vegetation 'prediction': the use and abuse of climate and application models
Authors: Henderson-Sellers A.
Published: November 2007

The Holdridge life-zone classification scheme is examined as an example of an impacts (or application) model which is already being applied to output from global climate models representing both present-day and greenhouse-warmed environments. Although intrinsically very simple, the Holdridge scheme has been modified (at least ten versions already exist in the climatic change/impacts literature) and tuned. Very different conclusions can be drawn about future distributions of continental vegetation, depending upon the version of this application model that is selected, the input used and the subsequent assessment procedure employed.