bluuebunny/crossref_metadata_2025 huggingface dataset:
Introducing the accufuser: a new solution for ambulatory continuous epidural infusion
Authors: Thompson Anthony , Barton Greg , Coackley Alison , Finnegan Clare , Hyland Charlie , Levshenkov Kosta
Published: September 2011

Introduction

Epidural analgesia is useful for some patients with refractory cancer pain. However delivering a continuous epidural infusion can raise some challenges regarding safety and practicality. We present our experience of using the Accufuser Elastomeric Vacuum pump.

Aims

▶

To identify a delivery method for continuous epidural infusion for ambulatory patients in the Hospice and Community setting.

▶

To develop policies and procedures and facilitate staff training.

▶

To facilitate discharge of ambulatory patients with continuous epidural infusions.

Methods

The Integrated Pain service performs joint consultations and has monthly meetings to develop Policies and Procedures and discuss complex cases. In response to patient need we performed a literature review to select a device that was portable, light, easy to fill, has long duration of action and was safe. We met with the manufacturer to evaluate it fully prior to use.

Result

The Accufuser is an elastomeric device delivering a near linear infusion with a patented piston preventing under or over dosing. It has variable infusion rates and volumes. It is filled aseptically in the hospital pharmacy in the aseptic unit and we used a device which lasts 5.7 days. It was used for a patient with severe perineal pain despite maximal tolerated oral therapy who had benefitted from bolus epidural analgesia. Following titration of diamorphine, clonidine and levobupivacaine the patient was discharged and returned to the hospice for renewal.

Discussion

Introduction of the accufuser required an integrated approach from the Pain team, Pharmacy and the Specialist Palliative Care Team. Development of a policy and patient leaflets alongside intensive staff training was required. We feel this is innovative practice and opens up the choices for Units and Pain teams dealing with Epidural infusions. This device is unique in its mechanism and patented technology and offers a better patient experience.
Meeting the need of general practitioners for palliative care education
Authors: Coackley Alison , Powell Paula , Thompson Anthony , Clare Littlewood
Published: September 2011

Introduction

The care of patients with advanced illness is now shifting into the community setting. As a result general practitioners will provide the majority of care for these patients but often lack the confidence and experience to deal with increasingly complex problems. Local GPs identified the need for education in palliative care. However workload can make the provision of education in an acceptable format with good attendance can be a challenge.

The aim of this educational initiative was to offer an up to date, relevant and enjoyable course for doctors which improved knowledge, developed skills and influenced practice. The format was also designed to develop closer working relationships between specialists and generalists.

Method of delivery

A survey was conducted among local doctors asking for opinions on the need for palliative care education and optimum methods of delivery. The resulting education course was delivered by specialist palliative care professionals one evening a month for 6 months. Each session focused on a different aspect of symptom control and included pain, vomiting, emergencies, agitation, depression/anxiety/dyspnoea. A seminar was followed by small group workshops for case discussion.

Results

42 doctors registered for the course and 75% attended all 6 sessions. There was evaluation of individual sessions and the course as whole. Results for relevance and appropriateness were excellent. Each session influenced practice for the majority of delegates and fully met the expectations of the participants. The course allowed extensive networking and has resulted in closer working relationships.

Conclusion

There is a demand for education in symptom control among generalists working in the community. Traditional ways of delivering education can be extremely successful in terms of acceptability and impact. Consultation with local practitioners is key in providing a successful education initiative.
Those who can, do. Those who can do more, volunteer.
Authors: Turnbull Ian , Doran Dawn
Published: September 2011

Motivations, Challenges and Rewards

Introduction

Hospice volunteers have been credited with bringing a unique human dimension to an otherwise clinical setting and are considered to be core members of interdisciplinary palliative care teams.

This study looks at volunteers who have a mainly patient contact role within the Hospice.

Over 100 000 volunteers are currently within the hospice movement – contributing more than 18 million hours of work to their services each year yet they remain a largely under-researched group.

Aims

▶

This study hopes to give this under researched group the opportunity to share their experiences with the Hospice and prospective volunteers

▶

To understand the motivating factors for patient contact volunteers

▶

To explore the experiences of those volunteers

▶

To understand the profile of the volunteers, to aid future recruitment of new volunteers and target training and support.

Methods

▶

Qualitative study of the experiences of patient contact volunteers using semi structured interviews

▶

Ethics approval granted from Edge Hill University Ethics committee and the Integrated Hospice Governance Group

▶

Interpretative Phenomenological Analysis was used.

Results

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8 semi structured interviews conducted

▶

Volunteers are drawn to hospice work to make a difference

▶

Primary motivation is to discover more about themselves and others

▶

Relatively few negative challenges encountered

▶

Any negatives are cancelled out by the positive benefits gained

▶

Capacity for personal growth is strengthened

▶

Generic knowledge of symptoms would benefit the support they give.

Conclusions

▶

Volunteering is a two way process

▶

The ‘Psychological Contract’ between the Hospice and its volunteers is very healthy

▶

The organisation has good role deployment, shared values and good level's of communication.

Further developments

▶

Volunteer inductions adapted to meet the training needs of individuals (eg, boundaries of care, consideration of first aid training for drivers)

▶

Development of individual ‘Psychological Contracts’ between the hospice and volunteers.
Souls and shadows live
Authors: Heath Bob
Published: September 2011

Souls and Shadows is a charitable foundation inspired and founded by Caspar Olsen through his songwriting work with Bob Heath, a music therapist based at Sir Michael Sobell House Hospice in Oxford.

Caspar died in 2006 and the Foundation began work shortly afterwards. Since its inception the foundation has supported many music therapists who work in palliative care by funding training in creative songwriting, the acquisition of recording equipment and in some cases the direct funding to hospices to pay for therapists services. As a result it has had an extremely positive impact on the creative output of many patients at the end of their lives.

It is now proposed that some of this work created by patients is to be presented as a live musical work entitled Souls and Shadows Live. The first concert will be held at The North Wall Theatre in Oxford on April 19th 2011. All of the proceeds will be donated to the Sobell House Hospice Charity.

The production programme takes each writer's work and express its unique emotional message using both live and pre recorded audio-visual musical performance. Simple choreographed scenes from each song are staged to re-enforce the emotion and narrative of each piece with a recurring musical theme linking the song cycle to each individual patients journey and story.

It is hoped that Souls and Shadows Live will not only promote the use of creative music interventions in palliative and bereavement care but will also create opportunities for networking and skills development in the wider musical arena.

This will be an oral presentation which will include pre-recorded and live music from the planned programme.
Closed bereavement therapy group: a new way forward?
Authors: Sutcliffe Olwen , Procter Sally , Holden Anne , Seed Jessica
Published: September 2011

Introduction

The End of Life Care Strategy recognises that care does not stop at the point of death but continues through to bereavement. A Closed Bereavement Therapy Group (CBTG) was developed by a hospice and a charity supporting people with cancer.

Aims and methods

The aim of the project was to provide an alternative choice to traditional bereavement support by offering a therapy group that nobody else could join once the programme had started. It offered a safe sharing environment to enable people to understand and explore their grief. Bereaved carers known to the specialist palliative care team (SPCT) were invited to attend over 5 months, of the 142 people contacted, 62 responded and 27 of those expressed a wish to take part. 2 groups were set up and the carers attended for 7 sessions. Feedback was collected at the end of each session.

Results

It was found that a time and number limited CBTG appears to be an effective way of working with bereaved people. The fall out rate from the programme was low and the evaluations showed that it had met the groups' expectations. One of the most important aspects was their sharing of experiences, as this assisted in normalising the grief process and enabled them to develop coping strategies and increase their resilience which reduced dependency on other professionals. Using expressive arts was particularly effective in that it facilitated access to deeper emotions in an unthreatening way with requests for further sessions. This new innovative project provided an inclusive equitable service across the region for families known to the SPCT. The closed group provides a different type of environment enabling deeper therapeutic work to take place compared to traditional bereavement support groups. It is user led and cost effective and its template can be replicated and adapted to suit other services needs.
Does an inpatient hospice have a role in medical student CP1 training?
Authors: Glascott Rachel , Gray Mandy-Jayne , Swanwick Maelie
Published: September 2011

Background

The GMC document ‘Tomorrows Doctors’ recognises that End of Life care is an important skill for all doctors to learn. Evidence shows that newly qualified doctors feel unprepared to care for patients at the end of life. The Palliative Medicine Department at Derby Hospitals NHS Foundation Trust has long been involved in CP2 training with a focus on holistic care, interdisciplinary learning and symptom management. It became part of the CP1 course in 2004. The CP1 placements aim to give a good grounding in clinical skills and team working. Reservations have been expressed about the impact on patients and the appropriateness of exposing 3rd year medical students to end of life care so early in their training.

Aim

To ascertain whether a CP1 Placement in an in-patient palliative care unit: Has a role in medical student education preparing ‘Tomorrows Doctors’

as a scholar/scientist, practitioner and professional. Is an appropriate environment for junior medical students. Is acceptable to our patients.

Methods

A questionnaire is given to each medical student on CP1 placement in Palliative Medicine during 2011 to complete at the end of their week. In addition we are giving patients who have been seen by a medical student a short questionnaire to ascertain their views on medical student interactions.

Results

In a previous departmental audit and in other research, patients have reported favourably about their experience of being involved with medical student teaching. We hope that analysis of the 2011 responses will add to the evidence that the hospice setting is an important learning opportunity for students but also a positive experience for patients. A more detailed evaluation of results will be presented.
Development of national audit tools for hospice community services
Authors: Newton Claire , Fisher Simon , Flanagan Pauline
Published: September 2011

Introduction

The remit of the National Audit Tools Group (NATG) is to produce a set of core audit tools to enable hospices to evidence compliance with national standards of care, irrespective of their processes or documentation systems. Quality impact analysis, feedback from workshops, training days and consultation with hospices identified a need for audit tools specific to community services.

Aims

Development of a comprehensive family of audit tools to measure quality of hospice care in the community against validated standards.

Methods

A NATG subgroup was formed drawing on expertise from different community areas, in particular Community Nurse Specialist and Hospice at Home. To inform the development and structure of the tools, it critically reviewed: statutory and regulatory requirements, relevant national standards and guidelines, range and scope of community services provided by hospices. Because of the size and complexity of the project, topics were grouped to reflect different community areas, each requiring specialist input and ensuring multi professional collaboration.

Results

Five audit tools under development are: Referral Management, Initial Assessment, Follow-up Assessment, Assessment Domains, Cooperation with Other Providers. Further tools are planned to include: Advance Care Planning, Communication, Confidentiality, Education and Training, Rapid Response, Documentation and Recording.

Discussion

The diversity of community service provision and the different work patterns across hospices presented a number of challenges in ensuring that the tools under development are fit for purpose and meet local needs.

Conclusion

Following testing and critical review, the first tool will be available by the end of 2011 and will be published on Help the Hospices website as a free download. Other tools will follow during 2012.
South west region infection prevention and control network
Authors: Stevens Alison
Published: September 2011

The Hospice Nurse Managers in the South West have worked collaboratively to develop a SW regional hospice network for Infection Prevention and Control. Initially it was agreed to host a launch event at Dorothy House Hospice to look at the changes in infection prevention and control at national level and how this might impact on hospices. Additionally there was open discussion on how a regional network for infection prevention and control might function and draft terms of reference were prepared. At the second meeting the terms of reference were agreed in addition to a range of topics that might be included at regional meetings, a list of suitable dates and ownership by hospices for hosting meetings. Challenges have included how this network might link to local PCT or Health Protection Agency initiatives/events, the varying levels of infection prevention and control already operating within hospices and meeting national requirements as small organisations. Benefits so far have included the opportunity to work collaboratively with other hospices on infection prevention and control issues, learning from each other and sharing experience and good practice. South West Region Forum for Hospice Nurse Managers. March 2011.
The ACT children's palliative care handbook for GPs
Authors: McNamara Katrina
Published: September 2011

ACT recognises that as long term family practitioners, GPs are ideally placed to facilitate good communication in and between multi-disciplinary and multi-agency teams. The GP has a major role to play in children's palliative care, in understanding its complexities, and the network of service providers involved. The GP remains the constant practitioner for the family, irrespective of the outcome of the child's condition.

The project aimed to promote reflective practice and learning, encouraging GP's to build their knowledge and develop case studies.

The handbook provides a practical guide for GPs across the UK who face the challenge of working with a child requiring palliative or end of life care, and their family. It addresses the following issues:

▶

How do I communicate with children and their families?

▶

How do I break significant news to children and their families?

▶

How do I handle strong emotions and difficult questions?

▶

How do I deal with ethical dilemmas in children's palliative care?

▶

How do I assess and manage all the needs of children and their families?

▶

How do I assess pain in children?

▶

How do I manage physical pain in children?

▶

How can I offer spiritual care to children and families?

▶

How do I provide good end of life care to children and their families?

▶

How do I manage acute, distressing terminal symptoms at the end of life?

▶

How do I deal with the practicalities arising after the death of a child?

▶

How do I help the family with grief and bereavement?

▶

How do I survive and thrive in children's palliative care?
Managing fluctuations in legacy income
Authors: Jackson Jane
Published: September 2011

Introduction

Recognising the unpredictability of legacy income, and as a result of a risk assessment of the hospice's financial structure and framework, the Trustees and Chief Executive of the hospice introduced a Designated Reserve - the Legacy Equalisation Fund.

Aim

The aim of this Fund is to enable the hospice to dampen the effect of annual fluctuations in the flow of legacy income and forms part of the hospice reserves. The Fund is used at the discretion of the Trustees for revenue or capital expenditure in future years when a shortfall in income from other sources occurs.

Method

The annual budget for legacy income is calculated on the basis of the average received in the previous 5 years. Management accounts and reporting reflect this figure while the Financial Accounts, in line with SORP, reflect the actual amount receivable in the SOFA. A Balance Sheet transfer between Funds reflects the surplus/deficit legacy monies receivable compared to budget.

Results

The level of legacies received over the last 5 years has enabled the Hospice to budget and plan with confidence in the knowledge that there are adequate reserve resources available to cover any shortfall in other sources of income.

Discussion

During an unprecedented period of economic turbulence, the hospice has continued to manage its finances with a view to long term viability, while retaining the flexibility to take advantage of opportunities for new service development which meets its core objectives.

Conclusion

The value of having the Legacy Equalisation Fund is particularly apparent in current financial circumstances as it will allow the hospice to continue to support capital and revenue service development projects in a period when traditional sources of finance may not be available due to likely cuts in government expenditure and the general economic climate.
Productive ward at Earl Mountbatten Hospice
Authors: Plummer Brigid , Parkes Lena
Published: September 2011

Background

The Productive Ward is a National Initiative developed by the NHS Institute of Innovation & Improvement (NHS). Promoting proactive change that concentrates on innovation in practice and on staff having the control to make changes, as stated by the Boshoff (2005). It is different to reactive change, which comes about as a result of needing to modify practice.

The Hospice was invited to be part of the Productive Ward project in order for us to review our systems and processes and enable us to save time that could be used to deliver direct patient care.

Aim

To complete the three foundation modules, followed by eight process modules.

Photographs were taken prior to the de-cluttering/re-organisation on the ward. This resulted in time saving as all the equipment for a procedure is kept in the same place, that is, catheterisation – the dressing pack, catheter, catheter bag, stand etc are now located in the same place.

Knowing how you are doing – this provides monthly outcome measures for key performance indicators.

Meal Wastage Action was taken to reduce meal wastage which resulted in significant cost savings.

Stock/Finance Stock is now kept to a minimum, that is, dressings, drug, etc, making it easier to ascertain exactly how much stock the ward is holding, this has also resulted in a tidier store room.

Hand overs

Morning handovers were held in the staff room taking up to an hour. The change introduced (with a huge amount of resistance) was to hold the handover in the nurses' office to ensure visibility and swiftness. The intention from my perspective was to speed up and reduce the time/cost of this handover. The handover now takes approx. 15 min.

Overall, the Productive Ward initiative has proved successful with positive outcomes.
Prioritising care in a community palliative care setting using a dependency scoring tool
Authors: Dark Dawn , Cardy Claire , Green Sarah
Published: September 2011

With increasing referral rates to the Specialist Palliative Care community team, it became necessary to analyse the dependency of the caseload. A review showed a lack of available tools that had been used successfully, so an in-house solution was sought to develop one.

The starting point was to utilise the experience and instincts of the Nurse Specialists to place the patients on their caseload into four different categories:- Red, Amber, Green and Blue, depending on perceived urgency and complexity of needs (with Red being the highest and Blue the lowest).

10 patients from each of the four categories were randomly picked and scored using the modified Support Team Assessment Tool. This identified a lower symptom score for patients assigned to the Blue and Green categories compared to those in Red and Amber.

Of the10 Red category patients, 7 died and 3 required admission to the Hospice for symptom control within a 2 week period. This contrasted with the patients in the other categories, who remained well controlled at home.

Analysing the scores, pain could be considered the most important indicator. The exercise showed that Nurse Specialists were able to accurately determine patients' dependency.

This has influenced the way the team manages their caseload. All patients are now categorised and home visits are carried out by the most appropriate team member, using the different skill mix of roles. Red and Amber patients are assessed by the Nurse Specialist, whereas patients in the Green and Blue category may be assessed by a Staff Nurse, reporting back to the Nurse Specialist who maintains overall responsibility.

This ensures that each patient on the caseload has regular contact, and is seen by the most appropriate professional at the appropriate time. Patient evaluation is currently underway, but informal feedback from patients and families has been positive.
Outcome of referrals to a community specialist palliative care service, where do patients die?
Authors: Capel Margred , Vout Lauren , Gazi Terri
Published: September 2011

The majority of people would prefer to die at home, yet more than 50% of the UK population die in hospital. NHS policy and specialist palliative care services encourage the individual to choose and expect to experience end-of-life care in their preferred place. Commissioners for specialist services use place of death as a quality marker against funding provided.

Method

A proforma was completed upon the death of every patient referred to the service in 2009–10. Information captured included preferred and actual place of death, aspects surrounding end-of-life care including any triggers for admission.

Results

788 patients known to the hospice died, the median number of days patients were known was 83 and mean 160.

7% of deaths were from non-malignant disease.

55% of patients specified their preferred place of death was their current place of living (home, residential or nursing home and prison). 67% of patients who expressed this preference achieved this. 14% of patients identified they would prefer to be admitted as an inpatient to the hospice for end-of-life care, 81% achieved this. New conditions and lack of social support were significant triggers for admission.

Conclusion

The proportion of patients achieving their preferences for home and inpatient hospice with this community service compares favourably with results reported. Achieving preferences is a reflection of healthy community services as a whole. Despite the more unpredictable time course of non-malignant illnesses, the majority of these patients were able to achieve their preferences for end-of-life care.

This audit provided basic information for discussion with our commissioners. Breakdown by primary care team and cause of admission enabled the service to consider targets for future education and activity by looking at triggers for acute admissions as starting points to change health behaviour and target social care.
An audit around preferred place of death: one UK hospice experience
Authors: Walker Susan , Read Susan , Priest Helena
Published: September 2011

Introduction

According to the End of Life Care Strategy, good end of life care includes choosing a place of care for one's death. It is easy to assume that all hospice patients discuss their wishes and that plans for death are recorded. The audit data in this paper, however, suggests that such planning is not universal and asks questions about why this might be so.

Aims

To present an audit of 150 hospice case notes to show the documentation of patients' preferred place of death over a 2 year period.

Methods

As phase one of a PhD research study, case notes of deceased patients were accessed from January 2008 (n=50); January 2009 (n=50) and January 2010 (n=50) during September – November 2010. Data collected included actual place of death, whether preferred place of death was documented, whether preferences were achieved, whether patients had conversations about end of life care options; whether wishes were reviewed and which professionals recorded information. The 2 year time frame represented a range of experiences within the hospice context. Descriptive statistics were used for analysis.

Results

Results illustrated that place of death was varied; that preferred place of death was recorded in only 18.7% of cases and of this very small number whose wishes were documented, the majority (89.3%) died in their chosen location. Only 10.6% of the sample recorded conversations about preferences, and reviews were infrequent (21%) with few changes of preference.

Conclusions

This research demonstrates that identification, documentation and review of preferred place of death was achieved for only a small percentage of patients of this hospice during 2008–2010. This prompts further research questions around why this is so.
Lean on us – a clinical kitchen
Authors: Kelby Simon
Published: September 2011

Recognising the importance of food for patients is central to successfully delivering nutritional care. Our hospice sought to improve the patient experience by bringing kitchen staff into the clinical team. A project using Lean principles run by a volunteer industry expert and a Macmillan palliative dietician is underway to achieve this.

Aim

▶

Improve the patient food experience.

▶

Integrate kitchen staff into the clinical team

▶

Develop team working without altering reporting structures

▶

Use the new team to improve nutritional care.

Method

▶

Utilise Lean (a widely used tool in industry and the care sector) to affect the changes.

▶

Ward and kitchen staff discuss problems, seek solutions, implement them and take responsibility for their success.

▶

Launch a full review of nutritional care to find and resolve issues using Lean principles.

Results

The project is still underway but already we have successfully brought together the kitchen and nursing staff increasing their mutual understanding. The team is developing better systems and have Lean tools to help them continuously improve. This has resulted in more consistent delivery of nutritional care to patients.

Conclusion

We have not yet seen the full patient benefit but by bringing together the kitchen and nursing staff makes delivering nutritional care much simpler and more effective. Frustrations caused by lack of processes for communication between kitchen and ward staff led to inefficiencies and lower patient care. These are being overcome and the whole team is now more efficient and reactive to changing patient needs and is more efficient.

Recommendations

▶

Bringing nutrition into clinical care ensures this critical area is more fully delivered.

▶

Allowing the whole team to develop and implement ideas ensures full staff buy in.
Lean on us – industrial efficiency in hospice care
Authors: Kelby Simon
Published: September 2011

With a tightening economy and increasingly complex patient needs our hospice sought novel ways to increase efficiency. Turning to industry for inspiration we appointed a volunteer expert in process management to help develop and run hospice efficiency projects.

Aims

▶

Expert develops a clear methodology for hospices and leads the process

▶

The expert trains staff in these principles

▶

Improve patient safety and care

▶

Increase staff and volunteer satisfaction

▶

To be Staff led – Staff to identify problems, seek solutions, implement and take responsibility for them

▶

Develop processes to continuously improve.

Methods

A volunteer industry expert in process management first developed Lean for use in hospices and then ran the Lean projects. Lean is a widely used tool in industry and the care sector but not previously used in hospices. Staff identified problems; solutions were trialled, adjusted and implemented using Lean tools. The expert ensured projects were focused, delivering a tangible benefit in reasonable time.

Results

▶

£2500 reduction in purchasing of goods

▶

Reduced handovers by over 5 h per week

▶

Increased gift aid by £10 000 per year

▶

Higher staff and volunteer satisfaction as fully involved.

▶

Reduced wasted time increasing time spent with patients.

Conclusions

Using an industry expert allowed the development of Lean for hospices and greatly speeded the implementations of solutions, helping us see processes in a fresh light. Staff trained in Lean now use their own initiative to solve problems using Lean principles.

Recommendations

▶

Lean is successfully adaptable for hospices

▶

Project solutions must be management encouraged but staff led

▶

Use an expert to set up the process but staff must be trained to run the process long term

▶

Significant efficiencies can be made while improving staff enthusiasm.
Rainbow of ribbons (ROR)
Authors: Ramsden Ramsden
Published: September 2011

Introduction

ROR is a campaign which gives individuals a chance to dedicate a ribbon to someone who has added colour to their lives. The ribbon is then tied in the grounds of the Hospice with an open day for the public to view the ribbons.

Aims

▶

To find a new income stream from an in-memory campaign.

▶

Replace our Ray of Sunshine (ROS) balloon release event with something environmentally friendly

▶

Encourage visitors to the Hospice

▶

Organise an event with low staff time costs.

Methods

All individuals that have made an in-memory donation in the last 3 years on our system are mailed, these people are invited to dedicate a ribbon to someone special. Once returned a ribbon is tied in the Hospice grounds, and name entered into the Ribbons book.

To gain extra publicity we ask a celebrity to tie the first ribbon to encourage supporters not known to the Hospice a chance to donate. ROR is aimed at in-memory donations but we stress that people can donate a ribbon to anyone who has added colour the their lives.

Results

▶

A significant income increase from the ROS event

▶

Increased gift-aid on donations

▶

More visitors to the Hospice

▶

Less staff time on the day therefore less cost compared to ROS

▶

Environmentally friendly

▶

The dip in 2009 was from the introduction of our Midnight Walk which takes place in September by 2010 income increased again.

Conclusions

ROR is a fantastic alternative to our original event and is on a par with Light Up A Life for an in-memory event. The event captures and inspires people's imaginations, there is a wealth of opportunities for community groups to get involved and therefore makes this event a fantastic income stream for any Hospice.
Enhanced summary care record “significant conversations” template
Authors: Plenderleith Stephen , Clack Sam , Nightingale Tracy , Speakman John
Published: September 2011

This project, supported by a grant from West Midlands Workforce Deanery, is working with PCT commissioners and IT department, Primary Care, Hospice services and the regional Cancer centre to pilot an End of Life “significant conversations” template. This is available via the Summary Care Record to any acute service providing care to an EoL patient across South Birmingham; West Midlands ambulance, Primecare OOH services, PCT drop in centres and the Accident and Emergency department.

Patients do not want to have to give the same information over and over again and yet the Gold Standards Framework, Holistic Needs Assessment, Preferred Priorities of Care and Liverpool Care Pathway documents all cover similar ground again and again. No pilot of any nationally recommended “pathway” document, has so far seriously addressed the need for information to travel with the patient. Patient held records though trialled in some areas have the ever present problem of being forgotten or lost and so often lead to clinical staff having to duplicate their clinical entries.

Bury and Bolton both piloted the use of an End of Life template with one GP system using the functionality of the Summary Care Record. This pilot project takes the template a leap further by working across four GP systems (potentially covering over 95% of patients nationally). “Significant conversations” data can be collected in primary care, hospital and hospice settings. Daily automatic transfer of data back to the patients' primary care record ensures the GP is kept up to date and that the SCR record remains current for use by any service providing ongoing or acute care to patients.

Due to complete in November 2011. The proposed poster will outline details of the project scope, data being collected and technical solutions utilised.
Working alone, in the safety zone!
Authors: Birch Helen , Edmondson Kate , Stafford Jane
Published: September 2011

Background

A hospice at home service was set up 2 years ago to work alongside existing primary care services to fill identified gaps in care for patients nearing the end of life whose preferred place of care is home. Part of the service is a 24 h 7 day a week sitting service predominately delivered by trained healthcare assistants (HCA's) plus Bank RN and HCA's.

Aims

Staff follow the care plans of the district nurse who undertake all patient assessments. However the personal safety of the staff (lone workers) is the responsibility of the Hospice. A simple daily risk assessment to ensure continuous attention to safety was required.

Method

A comprehensive risk assessment checklist which covers all aspects of safety and security is quickly completed by staff at each shift in the patient's home. Completed checklists are checked by the Co-ordinator after every shift with identified risks immediately addressed prior to the next staff member visiting that patient. This complements other staff safety measures: Lone Worker Policy, provision of personal tracker badges and mobile phones.

Results

For each of the 4000 patient sits provided since the service began, a checklist has been completed. Recurring themes identified excessive smoking, threatening dogs and ‘difficult to find’ home addresses as key areas of risk. Expected risk, that is, insecure environment and difficult family dynamics, are hardly featured. A recent survey demonstrated that hospice at home staff felt robust systems were in place to minimise risks to their safety as lone workers in the community.

This poster describes the setting up of the risk assessment system, the checklist, results of the staff survey, and themes emerging from completed checklists.
How common are palliative care needs among older people who die in the emergency department?
Authors: Beynon Teresa , Gomes Barbara , Murtagh Fliss E M , Glucksman Ed , Parfitt Andy , Burman Rachel , Edmonds Polly , Carey Irene , Keep Jeff , Higginson Irene J
Published: September 2011

Objective

To determine the prevalence and nature of palliative care needs in people aged 65 years or more (65+) who die in emergency departments (EDs).

Methods

This was a retrospective analysis of routine hospital data from two EDs in South London. Patients aged 65+ living in the hospitals' catchment area who died in the ED during a 1 year period (2006–2007) were included. Palliative care needs identified by diagnosis and symptoms, and problems likely to benefit from palliative care documented in clinical records 3 months prior to the final ED attendance were extracted.

Results

Over 1 year, 102 people aged 65+ died in the ED, frequently following an acute event (n=90). 63.7% presented out of hours. 98/102 were admitted by ambulance, over half (n=59) from home. Half (n=50) had attended the same ED or been admitted to the same hospital in the previous 12 months. Over half (58/102) presented with diagnoses that signalled palliative care need. Of these, 29 had recorded symptoms a week before death and 28 had complex social issues 3 months prior to death. Only eight were known to palliative care services.

Conclusions

There is considerable palliative care need among older people who ultimately died in the ED, of whom only a minority were known to palliative care services in this study. Previous ED and hospital admission suggest opportunities for referral and forward planning. More older people in need of palliative care must be identified and managed earlier to avoid future undesired admissions and deaths in hospital.
Thermal and hydrocarbon-charge history and the relationship between diagenesis and reservoir connectivity: Venture field, offshore Nova Scotia, eastern Canada1Geological Survey of Canada Contribution 20100418.
Authors: Karim Atika , Pe-Piper Georgia , Piper David J.W. , Hanley Jacob J.
Published: September 2011

Fluid inclusions in diagenetic cements in Upper Jurassic – Lower Cretaceous sandstones offshore Nova Scotia provide constraints on the fluid migration history in gas reservoirs of the Scotian basin. Diagenetic minerals from six wells in the Venture field were analysed by optical petrography, scanning electron microscopy (SEM), and electron microprobe. A total of 122 primary and secondary fluid inclusions were analysed from different cements. Primary aqueous inclusions in quartz overgrowths have homogenization temperatures (Th) of 111.8 ± 7.1 °C (1σ) and in later carbonate cements 126.5 ± 2.1 °C; inclusions in both cements are highly saline (16–26.1 wt.% NaCl equivalent). Secondary aqueous and hydrocarbon-bearing inclusion trails crosscutting silica cement and detrital quartz have Th of 121.6 ± 13.6 °C and low salinities (8.7 ± 6.0 wt.%). Secondary carbonic inclusions have CO2 melting temperatures (–56.6 ± 0.1 °C) and Th (–9.3 ± 0.8 °C) indicating a high-density carbonic phase. Late carbonate cements in the same sandstone units vary in chemical composition in different wells, and connected reservoirs show similar late carbonate assemblages, suggesting that the late carbonate cementation may be partly controlled by the reservoir fill and spill sequence. Silica and late carbonate cementation involved highly saline fluid flow, likely at about ∼135 Ma. Hydrocarbon migration postdated silica cementation and was associated with secondary fracturing, suggesting that it corresponded to the onset of overpressure.
Basal ornithopod (Dinosauria: Ornithischia) teeth from the Prince Creek Formation (early Maastrichtian) of Alaska
Authors: Brown Caleb Marshall , Druckenmiller Patrick
Published: September 2011

A diverse and prolific record of polar dinosaurs comes from the Upper Cretaceous (Campanian–Maastrichtian) sediments of the Prince Creek Formation exposed on Alaska’s North Slope. Previous assignment of basal ornithopod material from this formation has been based solely on teeth, which have either been referred to “hypsilophodontid” indet. or Thescelosaurus sp. Here, we re-examine this material and describe several new specimens, including five isolated premaxillary teeth and three cheek teeth. The premaxillary teeth are most similar to those of Thescelosaurus , whereas the cheek teeth are more similar to its sister taxon Parksosaurus , for which premaxillary teeth are unknown. Referral of this new material to Thescelosaurus would represent the oldest occurrence of this taxon and considerably extend its stratigraphic range. A more likely possibility is that the premaxillary teeth are referable to Parksosaurus, an interpretation that is more parsimonious from a stratigraphic perspective. Intriguingly, one cheek tooth previously referred to as “hypsilophodontid” cannot be referred to either Thescelosaurus or Parksosaurus. Previously, faunal comparisons of the Prince Creek Formation have largely been made with non-contemporaneous formations, including the Campanian-aged Judith River and Aguja formations, or to the latest Maastrichtian Hell Creek Formation. On the basis of age and faunal similarities, a more appropriate comparison should be made with coeval rocks of the Horseshoe Canyon. This study expands our knowledge of Cretaceous ornithischian diversity at polar paleolatitudes and underscores the importance of small, rare, or easily misidentified fossils in paleoecological studies.
HOW NATURAL IS THE RECENT CENTENNIAL WARMING? AN ANALYSIS OF 2249 SURFACE TEMPERATURE RECORDS
Authors: LÜDECKE HORST-JOACHIM , LINK RAINER , EWERT FRIEDRICH-KARL
Published: September 2011

We evaluate to what extent the temperature rise in the past 100 years was a trend or a natural fluctuation and analyze 2249 worldwide monthly temperature records from GISS (NASA) with the 100-year period covering 1906–2005 and the two 50-year periods from 1906 to 1955 and 1956 to 2005. No global records are applied. The data document a strong urban heat island effect (UHI) and a warming with increasing station elevation. For the period 1906–2005, we evaluate a global warming of 0.58°C as the mean for all records. This decreases to 0.41°C if restricted to stations with a population of less than 1000 and below 800 meter above sea level. About a quarter of all the records for the 100-year period show a fall in temperatures. Our hypothesis for the analysis is, as generally in the papers concerned with long-term persistence of temperature records, that the observed temperature records are a combination of long-term correlated records with an additional trend, which is caused for instance by anthropogenic CO2, the UHI or other forcings. We apply the detrended fluctuation analysis (DFA) and evaluate Hurst exponents between 0.6 and 0.65 for the majority of stations, which is in excellent agreement with the literature and use a method only recently published, which is based on DFA, synthetic records and Monte Carlo simulation. As a result, the probabilities that the observed temperature series are natural have values roughly between 40% and 90%, depending on the stations characteristics and the periods considered. "Natural" means that we do not have within a defined confidence interval a definitely positive anthropogenic contribution and, therefore, only a marginal anthropogenic contribution cannot be excluded.
HIGH PRECISION INTEGER MULTIPLICATION WITH A GPU USING STRASSEN'S ALGORITHM WITH MULTIPLE FFT SIZES
Authors: EMMART NIALL , WEEMS CHARLES C.
Published: September 2011

We have improved our prior implementation of Strassens algorithm for high performance multiplication of very large integers on a general purpose graphics processor (GPU). A combination of algorithmic and implementation optimizations result in a factor of up to 13.9 speed improvement over our previous work, running on an NVIDIA 295. We have also reoptimized the implementation for an NVIDIA 480, from which we obtain a factor of up to 19 speedup in comparison with a Core i7 processor core of the same technology generation. To provide a fairer chip to chip comparison, we also determined total GPU throughput on a set of multiplications relative to all of the cores on a multicore chip running in parallel. We find that the GTX 480 provides a factor of six higher throughput than all four cores/eight threads of the Core i7. This paper discusses how we adapted the algorithm to operate within the limitations of the GPU and how we dealt with other issues encountered in the implementation process, including details of the memory layout of our FFTs. Compared with our earlier work, which used Karatsuba's algorithm to guide multiplication of different operand sizes built on top of Strassen's algorithm being applied to fixed-size segments of the operands, we are now able to apply Strassen's algorithm directly to operands ranging in size from 255K bits to 16,320K bits.
NONLINEAR TUNNELING INDUCED DYNAMIC-EFFECT OF BOSE–EINSTEIN CONDENSATES IN AN EXTENDED JOSEPHSON-JUNCTION MODEL
Authors: LIU J.-L. , LIANG J.-Q.
Published: September 2011

In this paper, we investigated theoretically the dynamic effect induced by nonlinear tunneling of two weakly linked Bose–Einstein condensates in an extended boson Josephson-junction model, in which the two-body interaction is extended to neighboring lattice sites in strong interaction regime. As a consequence the dynamic properties compared with the usual Josephson-junction model are crucially modified by the atom-pair tunneling, which leads to the macroscopic quantum-states of coherent relative-phase between two condensates seen to be effective Schrödinger cat states. The relative-phase is controllable by system parameters and thus can be used to realize the qubit in quantum computation.
THEORETICAL FORMULATION FOR THE EFFECT OF TEMPERATURE ON NANOMATERIALS
Authors: KUMAR R. , BHATT ARCHANA , KUMAR MUNISH
Published: September 2011

A simple theoretical formulation is developed to study the effect of temperature on nanomaterials. An alternative method is also discussed using thermodynamic analysis. The formulation discussed in the earlier literature may also be obtained from the present theory. To show the real connection with the nanomaterials, we have studied the effect of temperature. We have considered different nanomaterials viz. Zirconia, Ag , ZnO , NiO and Al composites. The results obtained are compared with the experimental data. A good agreement between theory and experiment demonstrates the validity of the present work.