bluuebunny/crossref_metadata_2025 huggingface dataset:
The Question of Dqr and Sterile Blades in P. Ebers 875
Authors: Bouchet-Bert Luc
Published: January 2018

Although a recent study interpreted the meaning of dqr as describing the process by which a guinea worm is removed from the body by winding on a stick, a contextual analysis of P. Ebers 875 suggests instead that dqr was used to describe the worm itself, and not the cure. Previous authors have also speculated that Egyptian physicians were aware of the importance of sterilized surgical equipment. Based on the known Egyptian medical mindset, this discussion proposes that no such advanced medical knowledge existed in ancient Egypt.
Mummies of Olive Baboons and Barbary Macaques in the Baboon Catacomb of the Sacred Animal Necropolis at North Saqqara
Authors: Goudsmit Jaap , Brandon-Jones Douglas
Published: January 2018

The major objective of the investigation of the Baboon Catacomb in Saqqara in 1996 was to establish the species, sex and age at death of all its surviving monkey cranial material. 146 of the estimated 169 individuals were identified as olive baboons (Papio hamadryas anubis). Twenty-one Barbary macaques (Macaca sylvanus) were identified. Two guenons were determined as Cercopithecus aethiops. Males outnumbered females by more than 2:1; infants and young juveniles were scarce. The 12% proportion of macaques is remarkable, since the habitat of this species is restricted to the mountainous areas of north-west Africa, in contrast to the extensive African savannah distribution of the green monkeys (Cercopithecus aethiops) and baboons.
The Epigraphic Survey of Samanud
Authors: Spencer Neal A.
Published: January 2018

Reliefs from the temple of Onuris-Shu at Samanud, recently rehoused by the SCA, are published. The temple was built between the Thirtieth Dynasty and the early Ptolemaic Period. Anepigraphic remnants, including palmiform capitals, further our knowledge of the destroyed sanctuary.
Black-Topped Ware in Early Dynastic Contexts
Authors: Sowada Karin N.
Published: January 2018

Black-topped ware is commonly associated with the Predynastic era, but a handful of examples made in the Early Dynastic Period are known to exist. Generally these vessels are variations of the hes-jar shape; their findspots, in tombs or temples, associate this shape with ritual or funerary use. It is argued here that during the Early Dynastic Period, black-topped ware acquired a symbolic significance linked to the shape and colours of the vessel. This symbolism continued in the depictions of such vases on the walls of tombs although the ware itself was probably no longer produced after the Early Dynastic Period.
A Saite Figure of Isis in the Petrie Museum
Authors: Thomas Susanna
Published: January 2018

The first publication of a small private statuette in the Petrie Museum (UC 42553), originally from the Wellcome Collection, dedicated to Isis and Horus during the Twenty-sixth Dynasty. It bears an unusual set of royal cartouches.
In Search of Legitimacy: The Private Entrepreneur in China
Authors: Tsang Eric W. K.
Published: January 2018

Private business is booming in China and the entrepreneurial spirit sweeps through the country. However, the apparent contradiction between Marxist ideology and private ownership has not been satisfactorily resolved. The ideological problems of labor exploitation and income polarization associated with private business have serious repercussions on policy implementation and have constrained the entrepreneurial development. Operating in a hostile institutional environment, many private entrepreneurs in China demonstrate some peculiar behavior seldom found In other countries. By using the concept of legitimacy, it is argued here that the entrepreneurs behavior is the result of their strategic responses to their less-than-legitimate status.
Prediction of Employment Status Choice Intentions
Authors: Kolvereid Lars
Published: January 2018

The present research applied the theory of planned behavior to predict employment status choice, defined as the intention to enter an occupation as a wage or salaried individual or as a self-employed one. The role of family background, sex, and prior self-employment experience was also investigated. Using a sample of 128 Norwegian undergraduate business students, the findings strongly support the theory of planned behavior as applied to employment status choice intentions. Moreover, demographic characteristics were found to influence employment status choice intentions only indirectly through their effect on attitude, subjective norm, and perceived behavioral control.
Entrepreneurial Entry into Foreign Markets: A Transaction Cost Perspective
Authors: Zacharakis Andrew L.
Published: January 2018

The best opportunity for growth is often overseas, even for smaller entrepreneurial firms. However, resource-constrained smaller firms do not have as many available entry strategies as do larger multinational enterprises (MNEs). Smaller firms frequently must ally themselves with partners in order to make international expansion feasible (e.g. employing an export agent, licensing, joint venture, or strategic alliance strategy). The alliance of two distinct parties central to these entry strategies lends itself to a transaction costs economics (TCE) perspective. TCE illuminates the underpinnings of these relationships, in particular, highlighting problems and risks that the respective parties face when entering into the partnership. These problems arise from the threat of opportunism, specifically, adverse selection and moral hazard. The paper develops these problems within the entrepreneur/export agent realm and suggests methods for overcoming these problems.
Venture Capitalists’ Appraisal of Investment Projects: An Empirical European Study
Authors: Manigart Sophie , Wright Mike , Robbie Ken , Desbrières Philippe , De Waele Koen
Published: January 2018

The Investment appraisal and valuation process of venture capitalists includes Information gathering, the assessment of risk and required return, and the choice of a valuation method. This process is empirically studied in the United Kingdom, the Netherlands, Belgium, and France. The Importance of different information sources is equal in the four countries, except that the French venture capitalists Place more emphasis on personal references and the track record of the entrepreneur. The required return is lowest in the Netherlands and Belgium for every development stage of a company, and highest in the UK. The most widely used valuation method in the UK is the multiplication of past or future earnings with some price-earnings ratio. In the Netherlands and Belgium it is the discounting of future cash flows, and in France it is the book value of the net worth.
Founder Characteristics, Start-Up Process, and Strategy/Structure Variables as Predictors of Shortline Railroad Performance
Authors: Sapienza Harry J. , Grimm Curtis M.
Published: January 2018

This study combined secondary public data and a survey of founders of 70 shortline railroads to examine correlates of shortline railroad performance. Among founder characteristics, general education level of the founder was positively related to goal attainment, while the number of business courses exhibited a curvilinear relationship. Goal attainment was positively related to three strategy/industry structure variables: the percentage of traffic originated locally, the size of the railroad, and the degree to which the firm focused on customer satisfaction. Supplementary analyses on the determinants of firm growth revealed some overlap with and some differences from these results. In general, the study indicates that models of new venture performance should include a comprehensive set of variables and consider the impact of alternative measures of performance.
The Moderating Effect of Environmental Variables on the Entrepreneurial and Marketing Orientation of Entrepreneur-led Firms
Authors: Becherer Richard C. , Maurer John G.
Published: January 2018

A firm's marketing orientation and entrepreneurial orientation intuitively should relate to organizational performance. Considerable theory can be found concerning the causes and consequences of each orientation as well as their relationship, but little empirical evidence exists, especially for small-firm samples. This paper examines the relationship between the two concepts and how this relationship is moderated by the firm's external environment. In addition, the relationship of marketing orientation and entrepreneurial orientation to firm performance and the moderating effects of the environment on these two relationships are examined. The sample consists of entrepreneurs, defined as those individuals who have started or purchased a small business, and who are still leading the business they started or purchased.
The Relationship between Boards of Directors and Initial Public Offerings in the Biotechnology Industry
Authors: Finkle Todd A.
Published: January 2018

Utilizing the entire population of public biotechnology firms from 1980-1994, three models were tested to determine If a relationship exists between the size and composition of the board of directors and performance. Results indicate significant positive relationships between director expertise and the size of a firm's initial public offering. Going public during hot markets and larger firms were also related to larger Initial public offerings. These findings will benefit practitioners in the formation of boards within the biotechnology Industry. Managers of firms within the biotechnology industry who are contemplating a public offering will be able to proactively address the composition of their boards.
Factor XI contributes to myocardial ischemia-reperfusion injury in mice
Authors: Lorentz Christina U. , Verbout Norah G. , Cao Zhiping , Liu Lijuan , Hinds Monica T. , McCarty Owen J. T. , Ivanov Ivan , Tucker Erik I. , Gailani David , Gruber András
Published: January 2018

Key Points

Inhibiting contact activation of factor XI during reperfusion of acute myocardial ischemia reduces infarct size in mice. Factor XII/XI contact axis inhibition may improve the outcome of coronary artery recanalization in acute myocardial infarction.
Fast time-to-depth conversion and interval velocity estimation in the case of weak lateral variations
Authors: Sripanich Yanadet , Fomel Sergey
Published: January 2018

Time-domain processing has a long history in seismic imaging and has always been a powerful workhorse that is routinely used. It generally leads to an expeditious construction of the subsurface velocity model in time, which can later be expressed in the Cartesian depth coordinates via a subsequent time-to-depth conversion. The conventional practice of such a conversion is done using Dix inversion, which is exact in the case of laterally homogeneous media. For other media with lateral heterogeneity, the time-to-depth conversion involves solving a more complex system of partial differential equations (PDEs). We have developed an efficient alternative for time-to-depth conversion and interval velocity estimation based on the assumption of weak lateral velocity variations. By considering only first-order perturbative effects from lateral variations, the exact system of PDEs required to accomplish the exact conversion reduces to a simpler system that can be solved efficiently in a layer-stripping (downward-stepping) fashion. Numerical synthetic and field data examples show that our method can achieve reasonable accuracy and is significantly more efficient than previously proposed methods with a speedup by an order of magnitude.
Vitamin D in patients with intellectual and developmental disability in secure in-patient services in the North of England, UK
Authors: McKinnon Iain , Lewis Thomas , Mehta Naomi , Imrit Shahed , Thorp Julie , Ince Chris
Published: January 2018

Aims and method

To assess the benefits of the introduction of routine vitamin D serum sampling for all patients admitted to a secure in-patient hospital in the North of England providing medium security, low security and rehabilitation services for offenders with intellectual and developmental disability. The vitamin D levels of 100 patients were analysed at baseline. Those with insufficient or deficient levels were offered treatment and retested after 1 year. Vitamin D levels were analysed in the context of level of security, seasonality of test and co-prescription of psychotropic medications.

Results

Eighty-three per cent of patients had suboptimal vitamin D levels at initial test (41% deficient and 42% insufficient). This was seen among established patients and new admissions. Regression analysis of baseline vitamin D levels revealed no differences for levels of security, seasonality, whether patients were taking antipsychotic or anticonvulsant medication, or length of stay. Patients with deficiency or insufficiency were all offered supplementation. Those who opted in had significantly higher vitamin D levels at follow-up, compared with those who declined treatment.

Clinical implications

Established and newly admitted patients in our secure mental health services had substantial levels of vitamin D insufficiency. In the light of the morbidities that are associated with deficient vitamin D levels, routine screening and the offer of supplementation is advisable.

Declaration of interest

None.
Novel Health Information Technology Tool Use by Adult Patients Undergoing Allogeneic Hematopoietic Cell Transplantation: Longitudinal Quantitative and Qualitative Patient-Reported Outcomes
Authors: Runaas Lyndsey , Hoodin Flora , Munaco Anna , Fauer Alex , Sankaran Roshun , Churay Tracey , Mohammed Saara , Seyedsalehi Sajjad , Chappell Grant , Carlozzi Noelle , Fetters Michael D. , Kentor Rachel , McDiarmid Leah , Brookshire Kristina , Warfield Casiana , Byrd Michelle , Kaziunas Sharon , Maher Molly , Magenau John , An Larry , Cohn Amy , Hanauer David A. , Choi Sung Won
Published: January 2018

Purpose

Health information technology (IT) is an ideal medium to improve the delivery of patient-centered care and increase patient engagement. Health IT interventions should be designed with the end user in mind and be specific to the needs of a given population. Hematopoietic cell transplantation (HCT), commonly referred to as blood and marrow transplantation (BMT), is a prime example of a complex medical procedure where patient-caregiver-provider engagement is central to a safe and successful outcome. We have previously reported on the design and development of an HCT-specific health IT tool, BMT Roadmap.

Methods

This study highlights longitudinal quantitative and qualitative patient-reported outcomes (PROs) in 20 adult patients undergoing allogeneic HCT. Patients completed PROs at three time points (baseline, day 30 post-HTC, and day 100 post-HCT) and provided weekly qualitative data through semistructured interviews while using BMT Roadmap.

Results

The mean hospital stay was 23.3 days (range, 17 to 37 days), and patients had access to BMT Roadmap for a mean of 21.3 days (range, 15 to 37 days). The total time spent on BMT Roadmap ranged from 0 to 139 minutes per patient, with a mean of 55 minutes (standard deviation, 47.6 minutes). We found that patients readily engaged with the tool and completed qualitative interviews and quantitative PROs. The Patient Activation Measure, a validated measure of patient engagement, increased for patients from baseline to discharge and day 100. Activation was significantly and negatively correlated with depression and anxiety PROs at discharge, suggesting that this may be an important time point for intervention.

Conclusion

Given the feasibility and promising results reported in this study, next steps include expanding our current health IT platform and implementing a randomized trial to assess the impact of BMT Roadmap on critical PROs.
Using Process Improvement Tools to Improve the Care of Patients With Neutropenic Fever in the Emergency Room
Authors: Dang Avantika , Gjolaj Lauren N. , Whitman Myka , Fernandez Gustavo
Published: January 2018

Purpose:

The purpose of this study was to improve the care of patients with neutropenic fever in an academic acute care hospital’s emergency room (ER).

Methods:

Using the define, measure, analyze, improve, control method, a two-phase project with three critical to quality metrics (reduction in time to antibiotic administration, increase in percentage of patients with neutropenic fever identified as an oncology emergency, and increase in patients cohorted on oncology units) was completed. Phase I consisted of implementation of best practices (ie, use of neutropenic fever protocol and order set, altering ER workflow, and educating patients and staff). In phase II, the team drew from cardiac and stroke alerts and response teams and implemented an innovative hospital‐wide overhead neutropenic fever alert and an ER neutropenic fever response team.

Results:

After implementing phase I interventions, the time to antibiotic administration decreased from a mean of 100 minutes at baseline to a mean of 67 minutes. After implementing phase II interventions, the mean decreased by 73%, from 100 minutes at baseline to 27 minutes. Furthermore, after phase II interventions, 89% of neutropenic patients were assigned an Emergency Severity Index of 2 and 88% were placed appropriately in a bed on the oncology floor on admission, compared with 11% and 74%, respectively, at baseline.

Conclusion:

Interventions were effective at improving three critical to quality metrics. Multiple iterations of the define, measure, analyze, improve, control cycle, together with new innovative interventions, were crucial to meeting project goals.
Five Steps to Successfully Implement and Evaluate Propensity Score Matching in Clinical Research Studies
Authors: Staffa Steven J. , Zurakowski David
Published: January 2018

In clinical research, the gold standard level of evidence is the randomized controlled trial (RCT). The availability of nonrandomized retrospective data is growing; however, a primary concern of analyzing such data is comparability of the treatment groups with respect to confounding variables. Propensity score matching (PSM) aims to equate treatment groups with respect to measured baseline covariates to achieve a comparison with reduced selection bias. It is a valuable statistical methodology that mimics the RCT, and it may create an “apples to apples” comparison while reducing bias due to confounding. PSM can improve the quality of anesthesia research and broaden the range of research opportunities. PSM is not necessarily a magic bullet for poor-quality data, but rather may allow the researcher to achieve balanced treatment groups similar to a RCT when high-quality observational data are available. PSM may be more appealing than the common approach of including confounders in a regression model because it allows for a more intuitive analysis of a treatment effect between 2 comparable groups.

We present 5 steps that anesthesiologists can use to successfully implement PSM in their research with an example from the 2015 Pediatric National Surgical Quality Improvement Program: a validated, annually updated surgery and anesthesia pediatric database. The first step of PSM is to identify its feasibility with regard to the data at hand and ensure availability of data on any potential confounders. The second step is to obtain the set of propensity scores from a logistic regression model with treatment group as the outcome and the balancing factors as predictors. The third step is to match patients in the 2 treatment groups with similar propensity scores, balancing all factors. The fourth step is to assess the success of the matching with balance diagnostics, graphically or analytically. The fifth step is to apply appropriate statistical methodology using the propensity-matched data to compare outcomes among treatment groups.

PSM is becoming an increasingly more popular statistical methodology in medical research. It often allows for improved evaluation of a treatment effect that may otherwise be invalid due to a lack of balance between the 2 treatment groups with regard to confounding variables. PSM may increase the level of evidence of a study and in turn increases the strength and generalizability of its results. Our step-by-step approach provides a useful strategy for anesthesiologists to implement PSM in their future research.
Validation of a Second-Generation Near-Infrared Spectroscopy Monitor in Children With Congenital Heart Disease
Authors: Nasr Viviane G. , Bergersen Lisa T. , Lin Hung-Mo , Benni Paul B. , Bernier Rachel S. , Anderson Michelle E. , Kussman Barry D.
Published: January 2018

BACKGROUND:

Cerebral oximetry using near-infrared spectroscopy is a noninvasive optical technology to detect cerebral hypoxia-ischemia and develop interventions to prevent and ameliorate hypoxic brain injury. Cerebral oximeters are calibrated and validated by comparison of the near-infrared spectroscopy–measured cerebral O2saturation (SctO2) to a “field” or reference O2saturation (REF CX) calculated as a weighted average from arterial and jugular bulb oxygen saturations. In this study, we calibrated and validated the second-generation, 5 wavelength, FORE-SIGHT Elite with the medium sensor (source-detector separation 12 and 40 mm) for measurement of SctO2in children with congenital heart disease.

METHODS:

After institutional review board approval and written informed consent, 63 children older than 1 month and ≥2.5 kg scheduled for cardiac catheterization were enrolled. Self-adhesive FORE-SIGHT Elite medium sensors were placed on the right and left sides of the forehead. Blood samples for calculation of REF CX were drawn simultaneously from the aorta or femoral artery and the jugular bulb before (T1) and shortly after (T2) baseline hemodynamic measurements. FORE-SIGHT Elite SctO2measurements were compared to the REF CX (REF CX = [0.3 SaO2] + [0.7 SjbO2]) using Deming regression, least squares linear regression, and Bland-Altman analysis.

RESULTS:

Sixty-one subjects (4.5 [standard deviation 4.4] years of age; 17 [standard deviation 13] kg, male 56%) completed the study protocol. Arterial oxygen saturation ranged from 64.7% to 99.1% (median 96.0%), jugular bulb venous oxygen saturation from 34.1% to 88.1% (median 68.2%), the REF CX from 43.8% to 91.4% (median 76.9%), and the SctO2from 47.8% to 90.8% (median 76.3%). There was a high degree of correlation in SctO2between the right and left sensors at a given time point (within subject between sensor correlationr= 0.91 and 95% confidence interval [CI], 0.85–0.94) or between T1 and T2 for the right and left sensors (replicates, within subject between time point correlationr= 0.95 and 95% CI, 0.92–0.96). By Deming regression, the estimated slope was 0.966 (95% CI, 0.786–1.147;P= .706 for testing against null hypothesis of slope = 1) with ayintercept of 2.776 (95% CI, −11.102 to 16.654;P= .689). The concordance correlation coefficient was 0.873 (95% CI, 0.798–0.922). Bland-Altman analysis for agreement between SctO2and REF CX that accounted for repeated measures (both in times and sensors) found a bias of −0.30% (95% limits of agreement: −10.56% to 9.95%).

CONCLUSIONS:

This study calibrated and validated the FORE-SIGHT Elite tissue oximeter to accurately measure SctO2in pediatric patients with the medium sensor.
PAWS1 controls cytoskeletal dynamics and cell migration through association with the SH3 adaptor CD2AP
Authors: Cummins Timothy D. , Wu Kevin Z. L. , Bozatzi Polyxeni , Dingwell Kevin S. , Macartney Thomas J. , Wood Nicola T. , Varghese Joby , Gourlay Robert , Campbell David G. , Prescott Alan , Griffis Eric , Smith James C. , Sapkota Gopal P.
Published: January 2018

Our previous studies of PAWS1 (protein associated with SMAD1; also known as FAM83G) have suggested that this molecule has roles beyond BMP signalling. To investigate these roles, we have used CRISPR/Cas9 to generate PAWS1-knockout U2OS osteosarcoma cells. Here, we show that PAWS1 plays a role in the regulation of the cytoskeletal machinery, including actin and focal adhesion dynamics, and cell migration. Confocal microscopy and live cell imaging of actin in U2OS cells indicate that PAWS1 is also involved in cytoskeletal dynamics and organization. Loss of PAWS1 causes severe defects in F-actin organization and distribution as well as in lamellipodial organization, resulting in impaired cell migration. PAWS1 interacts in a dynamic fashion with the actin/cytoskeletal regulator CD2AP at lamellae, suggesting that its association with CD2AP controls actin organization and cellular migration. Genetic ablation of CD2AP from U2OS cells instigates actin and cell migration defects reminiscent of those seen in PAWS1-knockout cells.

This article has an associated First Person interview with the first authors of the paper.
Midwives as smoking cessation counsellors
Authors: Hajek Peter , Owen Lesley
Published: January 2018

Smoking during pregnancy has been identified as one of the priority targets for antismoking education (Floyd et al, 1993) and a number of studies have examined various antismoking interventions with pregnant women. A thorough and detailed summary of this work has recently been published by the Health Education Authority (HEA, 1994). The good news is that interventions in pregnancy can be effective in promoting tobacco abstinence. Midwives would appear to be the prime agents of change in such intervention, although in the 18 studies reviewed (West, 1994) it was primarily other counsellors rather than midwives who provided the interventions. Further research in interventions tailored for routine use specifically by midwives is needed. Midwives are in a unique position to influence their clients' health behaviours. They have an opportunity to establish a personal relationship with their clients, are seen as experts on vitally important issues regarding child health, and their guidance and advice on a range of topics is usually readily and gratefully accepted. A recent largescale survey conducted by the Royal College of Midwives, in collaboration with the HEA, has also shown that midwives attempt routinely to address smoking in their clients. However, the same survey indicated that they do not feel sufficiently prepared and trained for the role of smoking cessation counsellors (Hajek, 1993).
Breastfeeding in neonatal care
Authors: Ingram Jennifer , Redshaw Margaret , Harris Anne
Published: January 2018

A range of maternal and infant factors were examined in relation to the initiation and continuation of breastfeeding in the neonatal unit. Suggestions are made for changes in policy and practice in neonatal units with the aim of encouraging higher breastfeeding rates.
The extent, severity and effect of health problems after childbirth
Authors: Bick Debra , MacArthur Christine
Published: January 2018

This article shows, for the first time, the extent, severity and effect of health problems experienced after childbirth. It also confirms the findings of earlier studies with regard to the high levels of morbidity persisting after birth.
Detecting fetal abnormality: serum screening and fetal anomaly scans
Authors: Smith Deana K , Marteau Theresa M
Published: January 2018

Observations of 215 antenatal consultations revealed that women receive little information about routine screening tests for fetal abnormality, particularly fetal anomaly scans. In this article, the reasons for the lack of information provided about ultrasound scans and the consequences of this for women are discussed.
Burnout and midwifery: an occupational hazard?
Authors: Sandall Jane
Published: January 2018

Midwifery is changing to provide greater continuity of care for women, and in the process, midwives are becoming more flexible in their working patterns so as to be available during childbirth for women they have got to know during pregnancy. But how sustainable is such a way of working?
The need to define competence in midwifery
Authors: Worth-Butler Michelle , Murphy Roger , Fraser Diane
Published: January 2018

It has become widely accepted that the profession of midwifery needs a comprehensive definition of competence to ensure that its practitioners are safe and able to meet the changing needs of childbearing women and society. This article explores some of the difficulties in agreeing a definition and seeks to clarify whether a single formulation of a definition of competence is feasible and desirable.
History or herstory - the decline and fall of the midwife?
Authors: Jackson Charlotte , Mander Rosemary
Published: January 2018

The history of midwifery in the USA illustrates the multiplicity of factors which may affect women's care in childbearing. The importance of cultural factors and the midwife's relative weakness in negotiating her role are apparent. This knowledge may be relevant to the current UK situation.
How information management and technology benefits midwives
Authors: Betts Helen , Washbrook Marie
Published: January 2018

This article outlines some of the national Information Management and Technology (IM&T) projects and groups in which midwives are involved and highlights implications for quality midwifery care. Educational issues for preregistration student midwives and practising midwives are considered.
Survey of computerised midwifery information systems
Authors: Dobson Pam
Published: January 2018

Exploring computerized midwifery information systems across the country and focusing on a research project and local initiatives.
Role of midwives in a teaching hospital in the Republic of Ireland
Authors: McCrea Hally , Thompson Kate
Published: January 2018

This article describes the role and responsibilities of midwives in one maternity hospital in the Republic of Ireland. Descriptive statistics and content analysis were used to analyse quantitative and qualitative data collected by means of semi-structured interviews with midwives.
Promoting improvements in mental health for children and young people
Authors: Glasper Alan
Published: January 2018

Emeritus Professor Alan Glasper, University of Southampton, discusses a report from the Care Quality Commission into the current state of services for children and young people with mental health problems
Conducting research with the dying: ethical considerations and experience
Authors: Aranda Sanchia
Published: January 2018

This article explores the ethical considerations that arose during a qualitative evaluation study of an Australian domiciliary palliative care agency. The research sought to answer the question: ‘What is the relationship between palliative care philosophy and that received by dying clients and their primary carer?’. Interviews were conducted with clients, carers and agency staff, which exposed particular issues relating to the protection of vulnerable groups such as the dying. The fact that key aspects of research ethics can only be understood when the context of people's lives and experiences are taken into account is explained. Questions raised during the implementation of the study illustrate the complexity of research ethics and form the basis of the discussion.
Research priorities in palliative care
Authors: Cawley Nik , Webber Jeanette
Published: January 2018

Using the Delphi technique, social workers, occupational therapists, physiotherapists, chaplains, doctors and two groups of nurses were surveyed to determine priorities for clinical research in palliative care. The total number of panellists was 1304 and, of these, 821 completed all three rounds of the survey. Problem statements were generated from data supplied by panellists in each of the six groups. Subsequent rounds were conducted to enable panellists to (a) rank questions to determine their top 10 priority items and (b) indicate those items for which their own professional group should take research leadership. None of the items identified as research priorities appeared in the top 10 lists of all six groups. However, a number of items were selected by several of the groups. These included multi-professional teamwork and symptom management. A number of items, including the needs of informal carers and aspects of spiritual care, were selected by only one of the groups.
After diagnosis of cancer: the patient's view of life
Authors: Bliss Joan , Johnson Barbara
Published: January 2018

This research was undertaken to increase our understanding of cancer patients' perceptions of their needs, and how these changed over time. Sixty five patients with breast, prostate/testes or colorectal cancer were each interviewed at 5 and 13 months. Concrete accounts were elicited of good and bad experiences that were significant to patients. Three dimensions of need were identified: care availability and quality in disease management; good information and sympathetic communication; and, most importantly, regaining control of life.
District nurses' views on the role of rehabilitation in palliative care
Authors: Leedham Kay
Published: January 2018

Recently, there has been a surge of interest in the notion that rehabilitation should become an integral part of palliative care. The World Health Organization (WHO; 1987) asserts that integrating a rehabilitative approach will assist in achieving the aims of palliative care by enhancing the patient's quality of life. However, WHO suggests that health-care workers have not yet appreciated the opportunities presented by this approach in order to be able to succeed in achieving the aims of palliative care. District nurses (DNs) are in a key position to integrate the philosophy of rehabilitation and their approach to palliative care. A small study was undertaken to investigate the beliefs of DNs in relation to rehabilitation in palliative care, specifically with regards to patients with cancer. The findings demonstrated that DNs generally support the view that rehabilitation has a role to play in palliative care. However, barriers which, according to the literature, prevent a rehabilitative approach being used were identified as problematic for this sample group. The findings have helped to identify areas that should be addressed; these have implications for clinical practice, management of resouces and education.
Palliative care in motor neurone disease
Authors: Barby Teresa FM , Leigh P Nigel
Published: January 2018

Motor neurone disease (MND) is a fatal, progressive, neurodegenerative disease with no known cure. Deterioration of upper and lower motor neurones leads to progressive weakness, and disability and death usually occur within 5 years. The symptoms of MND are many and varied, and lead to progressive loss of function and potential loss of dignity. Professionals may wrongly give the impression that little can be done for patients with this devastating disease. However, symptom relief is of paramount importance in maintaining quality of life in MND. Patients may suffer from pain and immobility, speech and swallowing problems, emotional difficulties, bowel and bladder problems, dyspnoea and ventilatory failure. Nurses and therapists involved in palliative care will have met many of these symptoms in other diseases and are well placed to extend their expertise to patients with MND and their families.
Psychological reactions to cancer recurrence
Authors: Dixon Rosaleen , Lee-Jones Claire , Humphris Gerry
Published: January 2018

The issue of fear of cancer recurrence in patients is poorly understood despite being acknowledged as important by nurses. Patients report feeling more emotional distress when a recurrence of their cancer recurs than at initial diagnosis. Many patients think that they have overcome the cancer and are bitterly disappointed when a recurrence is diagnosed. Courage is a theme that is present in many conversations with relatives and friends of cancer patients. This may inhibit the patient's need to express his/her distress and disappointment about the recurrence. If the patient's feelings cannot be expressed with the family, the nursing and medical staff need to work with the patient to allow him/her to explore these areas. This review paper draws together some significant findings that will assist oncology nurses when caring for patients with cancer.
Orem's self-care model and clinical supervision
Authors: Jones Alun
Published: January 2018

This article explores Orem's self-care model in relation to the care of a dying person and his/her family and gives an overview of the model together with illustrations of key concepts. The main recommendation of the article is that Orem's model should be viewed within the context of existential humanism. It concludes with the view that the model should be linked to the concept of clinical supervision.
Spiritual care: the heart of palliative nursing
Authors: Amenta Madalon O'Rawe
Published: January 2018

The spiritual realm can be broadly defined as the life force springing from the unknown that pervades each person's entire being. It encompasses the volitional, emotional, ethical, social, intellectual and physical dimensions. It is the centre or core that integrates the whole person, surpassing the biological and the psychosocial. It is the self, or I, the essence of person-hood, the God within, that which communicates with the transcendent. It is that part of each individual that aspires to ultimate awareness, meaning, value, purpose, beauty, dignity, relatedness and integrity. The spiritual is the source of faith, hope and courage. It inspires theology, artistic inspiration and expression, love and healing.
Organisational structures and personal spiritual belief
Authors: Keighley Tom
Published: January 2018

This paper is based on the author's experience of working with NHS chaplains who may or may not have worked in palliative care areas. ‘A Framework for Spiritual, Faith and Related Pastoral Care’ (1995), developed in response to ‘The Patient's Charter’ (Department of Health (DoH) 1991) provides much of the material that underpins this paper. While certain material within this paper relates directly to palliative care, the main thrust concerns the principles that sustain good organisational practice when trying to meet the increasingly diverse spiritual needs of patients.

The Framework paper on which this is based recognises the major changes that have occurred in the nature of care delivery and, therefore, the way in which traditional approaches to chaplaincy have been modified. This paper outlines a number of strategies that can be pursued to facilitate this change and concludes with some specific observations about the significance of change for the palliative care arena.
Directions in spirituality: an introduction to the theme
Authors: Hawkett Sue
Published: January 2018

When, in 1995, the Editorial Board discussed the subject of spirituality it became clear that those of us assembled had very different perceptions of this intriguing concept. Spiritual pain, angst, search for meaning, faith, hope, humanism and the power of love, all sprang to people's lips. It was abundantly clear that, despite the myriad opinions which arose, we were committed to a common aim.
Teaching spiritual care to nurses: an alternative approach
Authors: Bradshaw Ann
Published: January 2018

This paper presents an approach to teaching spiritual care that is underpinned by a traditional philosophy of care as agape. In this approach spiritual care is considered a fundamental character of care, not a self-conscious addition. The caring function of the nurse is qualitatively differentiated from that of the religious minister, whose role is considered to be currently underestimated.

From this perspective, teaching spiritual care to nurses is not so much achieved through theoretical or experiential analysis and reflection, but by following an established moral pattern; it is not taught so much as caught. It is argued that this traditional approach to spiritual care provides an alternative to current educational ideologies in nursing, and reflects patients' and nurses' own attitudes to – and expectations of – the spiritual dimension of care.
For whenever I am weak, I am strong…
Authors: Cornette Katrien
Published: January 2018

A large scale empirical study concerning spiritual pain at the end of life was set up by a multi-disciplinary group of palliative care specialists in Flanders, Belgium. All Flemish speaking palliative care health workers were sent a questionnaire concerning spiritual/religious needs, care and growth.

This paper focuses on issues relating to spiritual needs and growth of the caregivers. Although respondents considered the ability to identify personal spiritual needs as an important criterion for offering good spiritual care, in-depth analysis suggests a considerable gap between theoretical insight and daily practice.

Findings advocate greater awareness and assertiveness among caregivers regarding their own spiritual experiences. A structural implementation of supervision to address the hidden spiritual agenda of the palliative team may need to pre-empt systems that teach how to respond more adequately to patients' spiritual needs.
Patient and professional centred care in the hospice
Authors: Ellis Susan
Published: January 2018

Palliative nursing has an underpinning philosophy of caring for patients holistically and being patient centered. The essence of palliative nursing, however, may be compromised when nurses and other health care professionals fail to acknowledge and address their own care in an environment intense with loss, grief, pain and suffering. This paper explores how neglected anxieties and stress, coupled with factors of unconscious motivation, may jeopordise the excellence and expertise in hospice nursing and precipitate professional centred care. Recommendations include implementing and supporting initiatives such as reflection, clinical supervision and nurse debriefing.
The concepts of truth telling and informed consent
Authors: Gent Carolyn
Published: January 2018

In the palliative care setting, nurses are regularly faced with the dilemma of what to tell their patients about the progress of their illness, treatment and their prognosis. This dilemma is not always handled in the best way and there are many difficulties for the nurse. This article examines the legal aspects of informed consent and highlights the dilemmas faced by nurses working in the palliative care field of nursing.

This is an area which will remain controversial until open and clear guidance is given to carers on their roles and responsibilities. The objective of this article is to highlight the areas of difficulty where lack of clarity exist in order to provoke discussion on how these problems can be resolved.
Sexuality: the neglected component in palliative care
Authors: Howlett Catherine , Swain Maxine , Fitzmaurice Nicki , Mountford Kathy , Love Pauline
Published: January 2018

Although sexuality is an integral part of holistic care, it appears to be an area that is seldom fully addressed or is even neglected entirely. The main reason appears to be nurses' discomfort with the issue of sexuality and a lack of nurse education in this area. This article advocates an eclectic model of care drawing on the work of several theorists. The ultimate aim is to look at the relevance and place of sexuality in the palliative care setting. A scenario identifies issues relating to sexuality in which this model was utilised.
A composite model of palliative care for the UK
Authors: Lindop Edward , Beach Rosie , Read Sue
Published: January 2018

This paper argues that there has been a paradigm shift in recent times in the service needs for palliative care as a result of the UK's National Health Service internal market structure, the shift to community care and the rising needs of the private sector. Nursing models associated with palliative care are reviewed and represented within the ‘Composite Model of Palliative Care’ which blends current and traditional models of care, focusing upon a multidisciplinary approach involving professionals, family and friends. The roles of advocate, manager, educator, carer/therapist, researcher and communicator/counsellor are presented as the vehicle to implement the model of care through a learning contract and associated clinical supervision. The paper also argues that there is a need for specialist palliative care courses at least at diploma level, with appropriate professional recognition, designed to make the paradigm shift and to project this into clinical practice through a tripartite learning contract involving specialist tutor, clinical supervisor and student. The rationale and outline of the course are presented along with the argument that this paradigm shift needs to take place if palliative care is to be truly holistic care.
Clinical supervision in moderating organisational conflict and preserving effective working relationships
Authors: Jones Alun
Published: January 2018

This paper examines the role of clinical supervision in relation to the work of a palliative care nurse, although the issues discussed relate to all nurses whatever specialities. The effects of market forces and organisational culture on the delivery of human service are explored in context. The writer draws on psychoanalytical ego defence construction and existential-phenomenological ideas to throw light on the deliberation. Through a case study illustration the writer makes a case for the development of a safe and effective working relationships helped by clinical supervision and through agreed working arrangements. The discussion concludes with the central recommendation that constructing a safe working environment for clinical supervision, through which to explore the dynamic forces influencing the organisation of health care, transcends methodological considerations. (The writer has changed all names and circumstances)
The development of holistic dependency criteria for a specialist palliative care service
Authors: Birch Dorothy , Fisher Maggie , Grey Alison , Veitch Jenny , Williams Audrey
Published: January 2018

This paper offers an overview of the development of holistic dependency criteria for a specialist palliative care unit. These were developed through action research in order to respond to peaks and troughs of work load in a way that both contained staffing costs and provided high quality care. Separate criteria were developed for in-patient, day, community and lymphoedema services. These are actively used in day-to-day practice and long term planning to provide appropriate cost-efficient staffing. A broad framework has been developed for measuring dependency across clinical palliative care services. Each palliative care service would, however, need to develop its own criteria to take into account the nature of its particular patients.
A Comparative Analysis of Classification Algorithms on Weather Dataset Using Data Mining Tool
Authors: Ramesh D. , Pasha Syed , Roopa G
Published: January 2018

Data mining has become one of the emerging fields in research because of its vast contents. Data mining is used for finding hidden patterns in the database or any other information repository. This information is necessary to generate knowledge from the patterns. The main task is to extract knowledge out of the information. In this paper we use a data mining technique called classification to determine the playing condition based on the current temperature values. Classification technique is a powerful way to classify the attributes of the dataset into different classes. In our approach we use classification algorithms like Decision Tree (J48), REP Tree and Random Tree. Then we compare the efficiencies of these classification algorithms. The tool we use for this approach is WEKA (Waikato Environment for Knowledge Analysis) a collection of open source machine learning algorithms.