bluuebunny/crossref_metadata_2025 huggingface dataset:
Raising awareness of the Macmillan Durham cachexia pack (MDCP) within a local cancer network
Authors: Hawkins Colette , Andrew Inga
Published: March 2012

Background

The Macmillan Durham Cachexia Pack (MDCP) was launched in 2007. In 2010, in response to sporadic awareness and use of MDCP within The North of England Cancer Network (NECN), a series of workshops were commissioned to raise awareness.

Aim

To raise awareness of MDCP, ascertain barriers to its use and establish its role in practice.

Method

Three workshops took place at different venues within NECN. The structure of each workshop was; sharing views on participants' experience of caring for patients with ACS, case presentation to highlight common issues, review of the MDCP and discussion around opportunities and barriers to use of the MDCP.

Results

Of the 46 participants, most were nursing staff with a wide range of healthcare professionals and allied staff represented. Views from participants' experience of patients with ACS largely corresponded with the literature; a feeling of helplessness/hopelessness when approaching patients, finding ACS difficult/hard/challenging, patients reporting powerlessness/desperation but appreciating support to cope with symptoms and to change expectations. Opportunities from use of MDCP included; ensures a consistent approach for generalist staff, resource to use in education sessions including for carers, can be adapted to local policy and need, useful tool for immediately after diagnosis. Barriers to use of MDCP included; changing patients attitudes that something can be done about ACS, lack of flexibility with hospital catering, time constraints, responsibility for assessing patients, number of other assessment tools requiring completion.

Conclusion

The workshops were reported to be useful and achieved the aim of raising awareness of MDCP. It appears that the future of MDCP lies as an educational tool to enable specialists to improve awareness and management of ACS and as a practical tool for generalists from all related professions, to dip in and out of.
How is the hospice today?: using Graffiti boards to capture the views of patients, visitors and staff
Authors: Spence Katharine , Haywood Sarah , Finucane Anne
Published: March 2012

Capturing the views of service users is now seen as an essential component of the quality assurance process. The challenge is to capture these views in a meaningful way. Marie Curie Hospice Edinburgh used an art-based approach known as ‘Graffiti Boards’ to elicit feedback. A Graffiti Board1 is a billboard to which participants are invited to add a contribution about any aspect of the hospice. Graffiti can be pictorial or verbal and is a creative way for patients, visitors, volunteers and staff to share their thoughts. For 1 week, in April 2009, all who stepped into The Edinburgh Hospice were invited to add graffiti to boards placed in patient areas and the staff room. The art therapist worked with those patients unable to contribute independently. Four themes emerged: (1) descriptions of the hospice or contributor, (2) comments about purpose (what happens here?), (3) images, and (4) constructive criticism. Patient contributions were overwhelmingly positive while staff comments revealed stress and tension. A visual presentation of the results enabled management to understand this contrast and introduce measures to support staff. Graffiti Boards are an engaging way to capture the views of all service users, including those who might not respond to traditional surveys. They offer an anonymous but public means for giving feedback. Some patients and visitors were reluctant to add negative comments. However, this innovative approach allows staff views to be heard, which improves management understanding. The project will be repeated to monitor progress.
Experience of a trainee in palliative medicine in a resource limited hospital PC setting
Authors: Dunn Joanna , Leng Mhoira
Published: March 2012

Introduction

Palliative Care was introduced to Uganda in 1993, with the development of Hospice Africa Uganda providing a clinical service together with education and research. Palliative medicine Specialist Registrars have been undergoing placements at Hospice Africa Uganda for many years, gaining experience in palliative medicine in a resource-limited setting as well as contributing to clinical care, education and research. With the development of the hospital palliative care team at Makerere University and Mulago hospital in 2008, there was an opportunity for healthcare professionals, specialist registrars in particular, to gain experience in hospital based palliative care in a resource-limited setting.

Description

An opportunity arose for a year's out of programme (Specialist Palliative Medicine Registrar) experience in the palliative care unit, part of the department of medicine, in the main government teaching hospital in Kampala. This provided opportunities for clinical experience in a resource-limited setting as well as experience in palliative care education, including teaching undergraduate and postgraduate medical and nursing students as well as some curriculum development. There was also an opportunity for contributing to the unit's research portfolio.

Lessons Learnt

There is a need to be very organised and plan things well in advance, especially if the experience is to be recognised for training.

Conclusion

This placement provides a great opportunity for trainees in palliative medicine to gain experience in many different areas of the curriculum, particularly in research, training and management. It also provides significant learning opportunities in developing a hospital-based palliative care service. Some of the experience can be used towards fulfilling the requirements of the specialist registrar training, but it is more of an opportunity to contribute to the development of palliative care services locally, nationally and internationally in a resource-limited setting.
Practical palliative care course for doctors in specialist training
Authors: Nicholson Alex , French Ann
Published: March 2012

Background

National directives (Supportive and Palliative Care: NICE 2004, End of life strategy: DoH 2008), National Service Frameworks for long-term conditions and Medical Specialty Training curricula have created demand for education of the medical workforce in palliative and end of life care. Traditional methods include seconded attachments spent with palliative care services including hospices, but expanding demands/expectations require alternative methods to deliver education and experience.

Aims

Building on success of an initiative for GPs, a course designed and run through Teesside University seeks to meet training needs of hospital doctors throughout the North East aspiring to become consultants in any discipline. Four palliative medicine consultants act as tutors albeit without formal funding. Several Deanery specialty training committees recognise the course as fulfilling necessary requirements. The course is rated Level 5 (Diploma) and provides 30 credits. Success awards a Certificate in Professional Development. Delivered partly through the virtual learning environment and partly through clinical placement the course comprises: 10 weekly on-line ‘lessons’ addressing key topics including objectives, reference material and a formatively reviewed assignment. 10 clinical sessions matching identified learning needs, arranged by the learner and linked to a reflective diary A group ethics tutorial The final summative assessment is a 4000 word reflective piece of writing demonstrating integration of learning from all course components into personal professional development.

Conclusion

Eighty-seven training grade doctors have enrolled since 2005. Formal evaluation (of 2005 and 2006 cohorts) and informal evaluation annually is positive. Graduates report high levels of satisfaction and impact. Modifications have been made in response to comments. A recurring concern is the difficulty in securing clinical placements due to competing pressure on palliative care services from other professional visitors. This is frustrating given that the underlying ambition is to enhance the skills in the ‘generalist’ workforce.
Art as tool and reflection of PC professionals' own espirituality
Authors: Merino Teresa García-Baquero , Cruz Belen Martinez
Published: March 2012

Background

Frida Kahlo was able to showcase her suffering through her work, oil paints, many of which self-portraits. Her pain allowed her to express her emotions too. Unhappiness, suffering, as well as joy and life's natural discourse strengthens artists' spirit giving way to their best works (Van Gogh, Beethoven, Frida Kahlo, Cervantes, etc). Does unhappiness generate art? Art therapy uses artistic expression as a vehicle to improve social, physical, emotional and personal dimensions.

Aim

To establish whether palliative care professionals feel the need to express emotions surfacing from professional activities, To establish the means used To know how they were helped by them.

Method

A questionnaire was designed and sent to different care levels PC teams. Descriptive study to analyse results PC professionals need a way to express their feelings and emotions and if so, how they go about it. Permission was sought from all respondents to use their responses.

Results

A total of 44 professionals responded (out of) 81.8% females and18.2 males, 79.5% chose their current job and 20.5% did not 93% had experienced the need to express their emotions brought about by professionals experiences. 75% expressed them verbally at work, 54% outside work and l 27% through art including painting, poetry, narrative and music. Of those who used art to express themselves: 19.5% were able to enter a creative process, 9.8% to reflect, 4.9% and 100% to Explore and pay better attention to own ideas and feelings.

Conclusions

(1) It is worth therefore to help PC professionals to express their inner me/self. (2) Organise workshops directed to gain insight into relationships with their own emotions. (3) Art can help PC professionals express their own spirituality and find solace.
The role of specialist palliative care services in stroke – views from an acute stroke unit
Authors: Jeffries Clare , Cathy Shipman , Wee Bee
Published: March 2012

Background

Stroke is the third commonest cause of death and causes significant symptoms and disability. In the UK, acute stroke care occurs in hospital. National Stroke Strategy guidelines recommend that patients should be cared for in stroke units to improve survival and disability. Previous research suggests that most patients dying from stroke are not referred to specialist palliative care services (SPCS) and some have unmet palliative care needs.1

Aims

To determine what healthcare professionals (HCP) on a stroke unit believe constitutes good end of life care (EOLC) and if barriers exist to its implementation.

Method

15 HCP from an acute stroke unit were purposively sampled. Semistructured interviews were undertaken to examine specific care domains. Participants were also asked their views on the role of SPCS in stroke and when they would refer to SPCS. Interviews were recorded, transcribed and analysed using framework analysis.

Results

Participants would consider referral if a patient has complex physical or psychological symptoms, discharge needs, family needing psychological support, cancer, been known to SPCS or for help with ethical decisions. Participants believed the EOLC they provided generally did not require SPCS input. Some believed that the expertise of SPCS lay elsewhere. It was proposed that symptoms due to stroke were either easier to control compared to other conditions or under-recognised.

Conclusion

HCP believe they provide good EOLC for stroke patients. The role of SPCS was not clear to all staff. HCP said they were more likely to refer for assistance with complex symptoms, psychological support, ethical dilemmas, if patients are known to the SPCS or have cancer. Expertise of SPCS is still perceived to be associated with malignancy. Education and improved links between stroke and SPCS teams could improve EOLC.
Pre-emptive prescribing for palliative care patients in primary care
Authors: Kemp Laurence , Holland Richard , Barclay Stephen , Swift Louise
Published: March 2012

Background

One of the challenges of palliative care at home is ensuring good symptom control, including access to medication out of hours. One potential solution is ‘pre-emptive prescribing’ (PEP) of medicines in advance of need.

Aims

To evaluate pre-emptive prescribing with respect to: (1) Prevalence in GP end of life care (2) Factors influencing its use (3) Association with likelihood of home death (4) Impact on utilisation of healthcare in the last month of life.

Methods

Retrospective examination of the records of all deaths occurring during 2009 in twelve diverse Cambridgeshire GP practices.

Results

PEP was used in 16% of predictable deaths: levels of usage varied widely between practices. Receiving a PEP was associated with having a recorded preferred place of death (OR 2.14, 95% CI 1.46 to 3.12) and being on the practice palliative care register (OR 2.23, 95% CI 1.24 to 4.00). Those living at home were less likely than those in care homes to receive a PEP (OR 0.53, 95% CI 0.31 to 0.89). The use of PEP was associated with increased chance of death at home in all groups, an effect modulated by the patient's usual place of residence (own home or care home) and history of previous hospital admissions (OR 6.02, 95% CI 1.70 to 21.2 for subgroup living in own home with previous hospital admissions). PEP use was also associated with decreased risk of hospitalisation in last month of life, and increased GP contact in both care home and community residents: it did not appear to affect hospice admissions of GP out-of-hours service contacts.

Conclusions

This is the first study to evaluate the use of PEP in primary care. There was a strong association with home death and decreased hospital admissions: however, a causal association is not demonstrated, and the active component of the intervention remains unclear.
Experiences and support needs of older care givers caring for family members (or friends) with cancer
Authors: Bailey Chris , Seymour Kim Chivers , Duke Sue , Moore Mike
Published: March 2012

Background

77% of cancer deaths occur in people aged 65 years and over. However, research has largely focused on younger adults, leading to a lack of understanding of the complex needs of older adults with cancer and their family care givers.

Aims

To explore the experience and support needs of older family care givers in end of life care.

Methods

A longitudinal study using indepth interviews and structured measure of service use (OMFAQ). 25 pairs were recruited via specialist palliative care nurses, comprising one person with cancer and their lay care giver, all aged 65 years and over. Mean age was 78 years. Mean length of relationships was 44 years. 25 indepth interviews were conducted; 19 second interviews two to four weeks later and 11 final interviews 6 months after the first. Data analysis was based on the process of microanalysis, constant comparison and theory development described by Strauss and Corbin (1998, 2008).

Results

A theoretical model of family caregiving was developed which suggests that the experience of family caregiving is characterised by a sense of anticipated loss in the context of which ties of duty and loyalty exert a strong influence. Arising from this central experience are a range of caregiving strategies, notably care management, maintaining the household and negotiating relationships with health and social care professionals, that focus on achieving a sense of equilibrium or containment across physical, functional and emotional domains.

Conclusions

The pressure to keep up with the responsibilities of caregiving leads to a strict scheduling of day-to-day life. Maintaining a sense of good governance within this concentrated and condensed physical and metaphysical space can be difficult. Supportive interventions are needed for care givers and should focus on providing relief from the difficulty of accommodating caregiving demands, and the tendency towards an increasingly tightly boundaried day-to-day life.
Barriers to provision of high quality care for patients with end stage heart failure
Authors: Mair Frances , Brown Susan , Morrison Deborah , Macleod Una , May Carl
Published: March 2012

Background

It is known that those with end stage heart failure (ESHF) experience symptoms that have a negative impact on their daily lives and that they feel unsupported.

Aims

The present study aims to identify barriers to provision of high quality care for those with ESHF.

Methods

Semistructured interviews with patients and close persons with ESHF (26 patients; 18 close persons). Qualitative data analysed using thematic analysis but informed by Normalisation Process Theory. Inclusion criteria: grade 3 or 4 NYHA classification heart failure, with ongoing symptoms despite optimal therapy, and a history of admissions or multiple health professional contacts for heart failure.

Results

Polypharmacy makes adherence difficult and is perceived as a precipitant of admissions. This is exacerbated by the fact that patients are dispensed ever changing brands of different coloured tablets, which makes adherence challenging. Multiple appointments at different clinics (for both cardiac and non-cardiac problems) on different days pose major difficulties for patients, both from the logistical perspective (eg, organising transportation) but also physically, as attendance at these appointments can be exhausting. Lack of continuity of care and poor communication between professionals and professionals and patients also presents difficulties. Information is often not communicated to patients in ways that they find coherent. Importantly, participants are usually unable to identify suitable emergency care plans that could help them when they experience deteriorations in their condition.

Conclusions

Uncoordinated care, multiple appointments and polypharmacy are major problems and there is clear potential for rationalisation of therapeutic regimens and systems for follow up. Those with ESHF need clear pathways/plans regarding what to do in an emergency and need access to services to help them action such plans. More counselling services are needed to help support these individuals who have a range of support needs, particularly as they transition from chronic disease management to palliative care.
Meeting the religious and cultural needs of children and young people with life-limiting conditions
Authors: Brown Erica
Published: March 2012

Many children have multiple ethnic and cultural identities, possessing mixed heritage with parents, grandparents and great grandparents from different groups or communities (Brown, Gatrad and Sheikh, 2008). Most cultures and communities have ways of marking major life events. The culture or faith in which children and young people are brought up and the way they are taught at home and at school will influence how they perceive what happens at the time of death and beyond. In order that professionals are able to work effectively with children and young people with life-limiting illnesses they will need to develop skills and confidence so that client's individual needs are met. This will include an awareness of what children and young people have been taught by their families and communities about death and dying (Brown, 2007). A child's or young person's age, cognitive ability and anxiety level will all influence their understanding of what happens at the time of death and beyond and this also determines how they communicate their ideas (Brown, 2010). The paper describes the findings of a small-scale qualitative study involving 15 children and young people diagnosed with life-limiting illness. It is argued that children and young people are experts about their own lives and deserve to be given a voice so that they are able to inform the cultural or religious care they receive. The presentation is supported by case studies and examples of children's and young people's written and spoken narrative, art and poetry.
‘They are just beginning to think: who am I?’ Health professionals on ill children's spirituality
Authors: Llewellyn Henry , Jones Louise , Kelly Paula , Craig Finella , O’Gorman Bernadette , Bluebond-Langner Myra
Published: March 2012

Background

There is widespread acknowledgement that care should include spirituality alongside physical, psychological and social aspects. Yet, little is known about how spiritual issues arise in conversations between healthcare professionals (HCPs), children and young people (CYP) and families and how they are managed in practice. The authors report qualitative data from a workshop with HCPs and faith leaders (FLs) which explored issues of concern to HCPs and FLs in anticipation of developing a community-based faith network across North Central London to meet these needs.

Aim

To understand how HCPs conceptualise spirituality and their experiences in addressing spiritual issues as they emerge in practice.

Method

Ethnographic participant-observation of a 1-day workshop to explore HCPs' (n=22) experiences of and attitudes towards spiritual issues and care for CYP and families; FLs (n=9) were present. Presentations and anonymised case scenarios were used to stimulate discussion. Presentations and discussions were audio-taped and transcribed verbatim. Four researchers recorded detailed field notes throughout the workshop. Data were analysed thematically.

Results

Four themes emerged from statements by HCPs:

(1)

Concepts of spirituality

(2)

Loss

(3)

Roles

(4)

Conflicts and challenges.

(1)

While spirituality for adults and CYP was seen to encompass a search for meaning, hope, and a sense of connectedness to self, others and the world; it was assumed as underdeveloped in CYP.

(2)

HCPs described CYP and families' losses of future, meaning, relationships, hope and faith.

(3)

HCPs approached spiritual care by ‘being there’ for patients and families; supporting spiritual enquiry; signposting to specialists such as community FLs where appropriate.

(4)

Challenges included, trying to balance the ideal of openness with managing hope in the face of a poor prognosis.

Conclusion

The way in which HCPs conceptualise spirituality in the context of CYP's development and multiple losses for CYP and families has implications for training including education in managing tensions between openness with CYP and respect for parents' wishes.
Piloting of an e-learning programme on children's palliative care
Authors: Downing Julia , Marston Joan , Boucher Sue
Published: March 2012

Background

The International Children's Palliative Care Network (ICPCN) has recognised the need to make training on children's palliative care (CPC) accessible and affordable to all who need it. A recent survey on the availability of CPC training internationally, demonstrated a lack of training in many parts of the world. Thus ICPCN developed a pilot e-learning programme to look at the feasibility of ICPCN using elearning for CPC.

Method

An e-learning programme was developed on pain assessment and management that links to new WHO guidelines for persisting pain in children due to be launched later 2011/early 2012. Articulate software was purchased along with a subscription to a Learning Management System (LMS), Articulate online. The programme is aimed at doctors, clinical officers and nurses. Following a brief introduction to the programme, there are discrete modules addressing palliative care in children, pain in children, pain assessment, pain management and the new WHO guidelines. Some resources and a glossary of terms has been included and there is a multiple choice assessment for students to complete. Students are encouraged to undertake a clinical placement, and placement guidelines are provided. Participants have been invited to undertake the programme from four different countries, including Argentina, Romania, Uganda and America. Notice about the programme has also been put up on the ICPCN website. An evaluation form will be completed by all participants. Results: Recruitment for the programme is currently on-going, and the pilot is due to finish by the end of 2011.

Results

of the piloting will be shared along with implications for future training developments.

Conclusion

The need for training on CPC is great, and there is demand from many different parts of the world for training. In order for CPC training to be accessible and affordable, elearning courses need to promoted and developed where appropriate.
Prescribing in paediatric palliative care: an association for paediatric palliative medicine survey
Authors: Brook Lynda , Aindow Anita , Jassal Sat
Published: March 2012

Background

Most indications and doses of medicines used in paediatric palliative medicine are derived from anecdotal evidence and involve scaled down adult doses.

Aims

To review current prescribing practices and identify priority areas for research and prescribing guidance.

Methods

Questionnaire survey of Association of Paediatric Palliative Medicine (APPM) members and non-medical prescribers working in paediatric palliative care.

Results

Twenty-seven medical and nine non-medical prescribers working in hospice (49%), hospital (57%) and community (66%) completed the survey. Priorities for further systematic review evidence and consensus guidance to support prescribing were identified as (% reporting as important or priority): 1 Equivalent starting doses of strong opioids administered PO, SC or IV in babies and young children (89%) 2 ketamine (81%) 3 buccal or intranasal fentanyl (77%) 4 methadone (74%) 5 dexamethasone doses for different indications (71%) Experience of prescribing these options ranged from 63% prescribing strong opioids in babies and young children several times a year to 47% never having prescribed methadone. Respondents reported prescribing ketamine regularly several times a year (31%) or not at all (28%). Respondents reported never prescribing buccal or intranasal fentanyl (39%) or prescribing regularly several times a year (33%). 53% prescribed dexamethasone regularly several times a year. 61% prescribers would start wherever a dose range (eg, 200–300 mg/kg/dose) seemed most appropriate, the remainder at the lowest dose. When calculating doses 71% respondents would round up or down to the nearest doses that is practical to administer as long as the actual dose administered falls within the dose range given but 14% would always round down.

Conclusions

Respondents identified clear priorities for further systematic review evidence and consensus guidance to support prescribing. Prescribing practices appear to vary considerably from individual to individual: this requires further exploration. Doses given as a range can be ambiguous.
Palliative care in the acute hospital setting: a qualitative interview study
Authors: Richards Naomi , Ingleton Christine , Gott Merryn
Published: March 2012

Background

Access to high quality palliative care at the end of life is becoming of increasing public health concern, and UK policy has highlighted a need to improve palliative care in the hospital setting. The majority of deaths in the UK occur in acute hospitals, and the numbers of patients dying in this setting are predicted to increase over coming years.

Aim

The aim of this qualitative study was to explore the perspectives of patients with palliative care needs regarding recent care received in the acute hospital setting.

Methods

Sixteen patients with palliative care needs participated in semistructured interviews to explore views and experiences of a recent hospital admission. Patients were identified during a survey of palliative care needs at two UK acute hospitals, interviews were conducted postdischarge. Data were analysed using the principles of thematic analysis.

Results

Findings indicated that most hospital admissions were emergency/crisis led, and a palliative approach to care was rarely evident. Patients reported particular issues relating to (1) continuity of care, both within the hospital setting and after discharge; (2) communication between care providers in secondary care and communication with the patient; (3) communication between primary and secondary care, and issues surrounding discharge from hospital.

Implications

The palliative care needs of patients within the acute hospital setting may not be adequately addressed. Improved communication and continuity of care are necessary to enhance the provision of quality palliative care. The study highlights a need to further explore palliative care provision in the acute hospital setting from the perspectives of both patients and providers, and to further define and expand the role of generalist palliative care providers in acute hospitals.
Analysis in qualitative longitudinal research: possibilities, benefits and challenges
Authors: Carduff Emma , Scott Murray , Marilyn Kendall
Published: March 2012

Background

Qualitative longitudinal research (QLR) generates rich data which would seem ideal for exploring the dynamic experiences of patients towards the end of life, yet most studies in palliative care are cross-sectional.

Aim

Taking a case study from a QL project I will highlight the rich analytical possibilities which result from QLR compared to a snapshot approach, while reflecting on the challenges and how they can be overcome.

Methods

The project adopted a qualitative longitudinal design, employing indepth interviews with 16 participants with metastatic colorectal cancer who had advanced disease but were expected to survive a year. Narrative and thematic analyses were employed to capture the major issues and themes at each time point and longitudinal analysis was conducted to explore how the participants' experiences evolved over time.

Key findings

Thematic analysis at each time point allows the researcher to synthesise the experiences of the group as they approach the end of their lives. Although useful for informing practice, thematic techniques may neglect the nuances of the individual experience. Narrative techniques allow the researcher to maintain the participant's story rather than fragmenting it, thus better capturing the individual experience. Longitudinal analysis further enhances this interrogation as it follows changes over time. Managing the immense volume of data that is generated in QLR can be challenging so the use of a carefully designed strategy for the analysis, and a qualitative research computer package (such as NVivo) can confront some of the complexities.

Conclusions

The range of analytical possibilities available in QLR means that with careful planning and reflexive practice the benefits outweigh the challenges. The findings can inform us about how the participant's experience changes in real time which is not possible with cross-sectional analysis. Such research can help model patient-centred healthcare which is responsive to dynamic needs.
Poster to paper – the academic value of the palliative care congress
Authors: McKeown Alistair , Al-khayer Ahmed , Clyde Aileen , Basler Mike , Keeley Paul W , Clark David
Published: March 2012

The Palliative Care Congress (PCC) is a biennial conference co-hosted by The Association for Palliative Medicine (APM) and The Palliative Care Research Society (PCRS). Each year there are a number of poster presentations, but currently there is no objective measure of the scientific content of this. Establishing the proportion of posters that progress to publication in peer-reviewed journals is one possible measure. The publication rate reported by other European medical societies ranges from 10% to 70% (median 42%). This is the first study to measure the publication rate of poster presentations at a palliative care meeting.

Aim

To establish what proportion of the posters presented in the PCC progress to publication in peer reviewed journals, and to compare the results with the publication rate of other European medical societies.

Method

All posters presented from 2002 to 2008 were included. Posters from 2010 were not considered as sufficient time for publication was not considered to have elapsed. MEDLINE, Pub Med, Google Scholar, Embase and HighWire were searched to look for peer-reviewed papers generated from each abstract. Search terms used included each author's name and key words of the abstract title.

Results

Over the four congresses studied, a total of 204 posters were presented, with 72 of these progressing to peer reviewed publication (35%). Publication rate ranged from 26% in 2002 to 40% in 2006 and 2008. Publication was across a range of journals, with the majority appearing in palliative care and pain medicine literature.

Conclusions

The PCC is generating poster abstracts of comparable academic value to other specialist societies throughout Europe. Using this method of analysing objectively, the publication rate may be a useful way of providing feedback to the specialist interest groups of the PCC as a way of incentivising research areas.
Can e-learning help surface or change medical students' attitudes towards palliative care, death and dying?
Authors: Gibbins Jane , Williams Jane , Cooke Jules , Alder Dominic , Forbes Karen
Published: March 2012

Aims

e-Learning tutorials are usually used to teach knowledge and skills in medicine. Professional attitudes are important in many areas of medicine, but particularly so in palliative care, where seeing death as failure, therapeutic nihilism, avoiding dying patients and fears about opioids can all influence patient care adversely. The literature suggests that medical students have misconceptions about palliative care, and articulate anxieties and expectations similar to those of the lay public. No studies have explored the use of e-learning tutorials and attitudes. Methods: e-learning tutorials were produced by final year medical students about palliative care topics of their choice and developed further by the departments of Palliative Medicine and Medical Education. The authors performed a mixed methods study to evaluate whether these tutorials enable students to consider their attitudes and/or teach attitudes. As part of each e-learning tutorial, students were asked to write reflective notes on what they had learnt.

Results

133 students wrote 1012 reflective comments on five tutorials. The authors analysed 499 of these comments using a qualitative coding system. 322 (65%) of the 499 responses written by senior medical students revealed reflection on an attitude relevant to the scenarios presented within the e-learning tutorials. Of these 43% made a general reflection on a relevant attitude, 37% reflected on their own attitude/s and 19% indicated a change in their attitude following the e-learning tutorial.

Conclusion

Our findings suggest that e-learning can surface attitudes and may encourage attitudinal change about palliative care for final year medical students. The results of this reflective analysis will be presented and discussed.
High fidelity simulation – a novel approach to end of life teaching
Authors: Reed Nikki , Boulstridge Lisa , Nelson Annmarie
Published: March 2012

Background

The hospice model of care is the model of excellence for delivering high quality care to dying patients. However, only a small number of patients in the UK actually die in a hospice with the majority of patients dying in hospital. The major challenge faced by specialist palliative care services has been the transfer of best practice from the hospice setting to other care settings. At the Hollier Simulation Centre an end of life course has been developed for band five and six nurses within the acute trust, using the novel teaching modality of high fidelity simulation. High risk industries such as aviation and the armed forces have been using this type of simulation as an integral education tool for years and using this form of teaching to train healthcare professionals is becoming increasingly common.

Aims

The study aimed to look at what impact high fidelity simulation teaching had on the participants' confidences and their perception of their knowledge and skills in end of life care.

Method

The study used a mixed method approach with a combination of pre and post course focus groups and pre and post course questionnaires. Two separate cohorts were used for this study.

Results

Using thematic analysis, the focus groups' transcripts were analysed. Free text from the questionnaires was used to support the focus group analysis.

Conclusion

Using high fidelity simulation to teach end of life care did have an impact on the participants' confidence, knowledge and skills. Participating in the scenarios was felt to be more beneficial then didactic teaching. This course allowed the study groups to both participate and observe their peers in the scenarios. The facilitated debrief sessions were found to be beneficial and the participants felt they learnt a number of new skills within these sessions from their peers.
Probing the composition of unexposed basement, South Portuguese Zone, southern Iberia: implications for the connections between the Appalachian and Variscan orogens
Authors: Braid James A. , Murphy J. Brendan , Quesada Cecilio , Bickerton Luke , Mortensen James K.
Published: March 2012

Geochemistry and Sm–Nd and U–Pb (magmatic zircon) isotope data from a postcollisional batholith that crosscuts the allochthonous South Portuguese Zone (SPZ) of southern Iberia suggest that the basement is compositionally more juvenile than the exposed upper crust. The SPZ is an allochthonous terrane of the late Paleozoic Variscan orogen. The oldest exposed units in the SPZ are Late Devonian continental clastics, and as a result, the origins of the SPZ are unknown. Multifaceted inherited zircon cores from a granitoid batholith (Sierra Norte Batholith, SNB) reveal Neoproterozoic (ca. 561–647 Ma) and Mesoproterozoic ages (ca. 1075 – ca. 1116 Ma). Granitoid samples are characterized by εNd values ranging from +1.4 to –9.6 and model ages ca. 0.76–1.8 Ga. Conversely, the exposed Late Devonian clastics of the SPZ are characterized by more negative εNd values (–7.5 to –10.4). Taken together, U–Pb and Sm–Nd data indicate the lower crust that melted to yield the SNB was (i) Neoproterozoic (ca. 560–650 Ma) to Mesoproterozoic (ca. 1.0–1.2 Ga) in age, (ii) was not compositionally similar to the overlying Devono-Carboniferous continental detritus but was instead more juvenile, with model ages between ca. 0.9–1.2 Ga. This unusual relationship is similar to the relationship between the relatively juvenile basement and ancient upper crust documented in the exposed portion of the Meguma terrane in the northern Appalachians, which paleogeographic reconstructions show was immediately outboard of southern Iberia in the Late Devonian.
MIXED FINITE ELEMENT APPROXIMATION OF THE VECTOR LAPLACIAN WITH DIRICHLET BOUNDARY CONDITIONS
Authors: ARNOLD DOUGLAS N. , FALK RICHARD S. , GOPALAKRISHNAN JAY
Published: March 2012

We consider the finite element solution of the vector Laplace equation on a domain in two dimensions. For various choices of boundary conditions, it is known that a mixed finite element method, in which the rotation of the solution is introduced as a second unknown, is advantageous, and appropriate choices of mixed finite element spaces lead to a stable, optimally convergent discretization. However, the theory that leads to these conclusions does not apply to the case of Dirichlet boundary conditions, in which both components of the solution vanish on the boundary. We show, by computational example, that indeed such mixed finite elements do not perform optimally in this case, and we analyze the suboptimal convergence that does occur. As we indicate, these results have implications for the solution of the biharmonic equation and of the Stokes equations using a mixed formulation involving the vorticity.
ABSORBING BOUNDARY CONDITIONS FOR THE TWO-DIMENSIONAL SCHRÖDINGER EQUATION WITH AN EXTERIOR POTENTIAL PART I: CONSTRUCTION AND A PRIORI ESTIMATES
Authors: ANTOINE XAVIER , BESSE CHRISTOPHE , KLEIN PAULINE
Published: March 2012

The aim of this paper is to construct some classes of absorbing boundary conditions for the two-dimensional Schrödinger equation with a time and space varying exterior potential and for general convex smooth boundaries. The construction is based on asymptotics of the inhomogeneous pseudodifferential operators defining the related Dirichlet-to-Neumann operator. Furthermore, a priori estimates are developed for the truncated problems with various increasing order boundary conditions. The effective numerical approximation will be treated in a second paper.
AN A POSTERIORI ERROR ESTIMATOR FOR hp-ADAPTIVE DISCONTINUOUS GALERKIN METHODS FOR ELLIPTIC EIGENVALUE PROBLEMS
Authors: GIANI STEFANO , HALL EDWARD J. C.
Published: March 2012

In this paper we present a residual-based a posteriori error estimator for hp-adaptive discontinuous Galerkin methods for elliptic eigenvalue problems. In particular, we use as a model problem the Laplace eigenvalue problem on bounded domains in ℝd, d = 2, 3, with homogeneous Dirichlet boundary conditions. Analogous error estimators can be easily obtained for more complicated elliptic eigenvalue problems. We prove the reliability and efficiency of the residual-based error estimator also for non-convex domains and use numerical experiments to show that, under an hp-adaptation strategy driven by the error estimator, exponential convergence can be achieved, even for non-smooth eigenfunctions.
GRAPHICS PROCESSING UNIT CLUSTER ACCELERATED MONTE CARLO SIMULATION OF PHOTON TRANSPORT IN MULTI-LAYERED TISSUES
Authors: JIANG CHAO , HE HENG , LI PENGCHENG , LUO QINGMING
Published: March 2012

We present a graphics processing unit (GPU) cluster-based Monte Carlo simulation of photon transport in multi-layered tissues. The cluster is composed of multiple computing nodes in a local area network where each node is a personal computer equipped with one or several GPU(s) for parallel computing. In this study, the MPI (Message Passing Interface), the OpenMP (Open Multi-Processing) and the CUDA (Compute Unified Device Architecture) technologies are employed to develop the program. It is demonstrated that this designing runs roughly N times faster than that using single GPU when the GPUs within the cluster are of the same type, where N is the total number of the GPUs within the cluster.
Transient Current of Resistive Switching of a NiOx Resistive Memory
Authors: Liu Chih-Yi , Ho Jen-Yen , Huang Jyun-Jie , Wang Hung-Yu
Published: March 2012

A NiO
x
thin film was fabricated by thermal oxidization on a Pt-coated substrate. Then, a Pt top electrode was deposited by an electron-beam evaporator to form a Pt/NiO
x
/Pt structure. The NiO
x
-based device can be reversibly switched between a high resistance-state (HRS) and a low resistance-state (LRS) by DC voltage sweeping. The resistive switching behavior occurs due to conducting filaments with a thermochemical reaction. A transient current was observed during the forming and SET processes (from a HRS to a LRS). The transient current increased with an increase in magnitude of the forming and SET voltage. The transient current was usually larger than the compliance current, and this caused the resistive switching behavior to be unstable. The transient current was caused by the discharge process of the parasitic capacitance of the measurement system. A circuit model of the measurement system was also proposed to simulate the transient current during the SET process. A resistor was series-wound with the NiO
x
-based device to decrease the transient current during the forming and the SET processes. The series-wound resistor also increased the LRS resistance and reduced the RESET (from a LRS to a HRS) current.
Optimization of the Dielectric Layer Thickness for Surface-Plasmon-Induced Light Absorption for Silicon Solar Cells
Authors: Xu Rui , Wang Xiaodong , Liu Wen , Song Liang , Xu Xiaona , Ji An , Yang Fuhua , Li Jinmin
Published: March 2012

In this study, we investigate the effect of dielectric layer thickness on light reflection due to random self-assembled Ag nanoparticles with diameters of less than 160 nm deposited on the Si substrate, indicating that a dielectric layer with an appropriate thickness is useful for reducing the amount of reflected light. In the short wavelength range, reflectivity is determined by the metallic plasmon and the SiO2antireflection layer, and the effect of the surface plasmon dominates over the antireflection effect. In the long wavelength range, reflectivity decreases with increasing dielectric layer thickness and is determined by the oxide antireflection layer, while the effect of the surface plasmon is negligibly small. Moreover, the surface plasmon is affected by the SiO2layer and Si substrate when the dielectric layer is thin; however, it is only determined by the SiO2layer when the oxide layer is sufficiently thick. These observations have substantial applications for the optimization of surface-plasmon-enhanced silicon solar cells.
Effects of Substrate Temperature on Electrochromic Properties of Cobalt Oxide and Oxyhydroxide Thin Films Prepared by Reactive Sputtering Using O2 and H2O Gases
Authors: Lee KyoungMoo , Abe Yoshio , Kawamura Midori , Kim Kyung Ho
Published: March 2012

Cobalt oxide and oxyhydroxide thin films were prepared by reactive sputtering of a Co target in O2 and H2O gases at substrate temperatures from -20 to +200 °C. Co3O4 films were formed at all the substrate temperatures in O2 gas and at 200 °C in H2O gas, and amorphous CoOOH films were formed in the range from 10 to -20 °C in H2O gas. A large transmittance change of approximately 26% and high electrochromic (EC) coloration efficiency of 20 cm2/C at a wavelength of 600 nm were obtained for the CoOOH thin films deposited at -20 °C in 0.1 M KOH aqueous solution. The good EC performance of the CoOOH film is attributed to the low film density and amorphous structure.
Simultaneous In situ Measurement of Silicon Substrate Temperature and Silicon Dioxide Film Thickness during Plasma Etching of Silicon Dioxide Using Low-Coherence Interferometry
Authors: Koshimizu Chishio , Ohta Takayuki , Matsudo Tatsuo , Tsuchitani Shigeki , Ito Masafumi
Published: March 2012

We have successfully performed real-time noncontact monitoring of substrate temperature and thin film thickness during plasma etching using optical-fiber-based low-coherence interferometry. The simultaneous measurement of the silicon (Si) substrate temperature and the etching depth of the silicon dioxide (SiO2) thin film on this substrate was performed in a dual-frequency capacitively coupled Ar/C4F8/O2 plasma. The SiO2 film thickness was deduced from the ratio of the interference intensity at the SiO2/Si interface to that at the Si/air interface. The measurement error in the SiO2 film thickness was less than 11 nm. The temperature variation of the Si wafer was derived from the temperature change of its optical path length. The temperature measurement error, caused by the shift in optical path length due to the change in SiO2 film thickness, was reduced from 7.5 to 0.6 °C by compensating for the shift using the SiO2 thickness data. This method enables precise control of etching performance and improves process reproducibility.