bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of a Germination Bioassay as a Toxicological Screening System to Study the Potential Drug–Drug Interactions of (S)-Naproxen and (S)-Ibuprofen and their corresponding Oxidation State Analogues, (S)-Naproxol and (S)-Ibuprofen Alcohol
Authors: la Parra Mario González-de , Tejeda Veronica , Jimenez-Estrada Manuel
Published: April 2019

A germination bioassay employing radish ( Raphanus sativus L.) seeds was used for the identification and quantification of the synergistic or antagonistic effects of equimolar binary mixtures formed by the combination of (S)-naproxen, (S)-ibuprofen, (S)-naproxol and (S)-ibuprofen alcohol, by using an approach based on experiments with mixtures. Synergistic effects were found to be statistically significant for the radicle growth of the binary mixtures formed by the combination of (S)-naproxol with (S)-naproxen, and (S)-naproxol with (S)-ibuprofen alcohol. These findings might indicate the existence of the corresponding potential drug–drug interactions. However, due to the complexity of the biological processes in humans and the fact that the correlation between this bioassay and human biological activity has not yet been established, further studies with other organisms or test systems are necessary to confirm the existence of these drug–drug interactions.
Toxicity of Mercury to Hybridoma TA7 Cells
Authors: Remez Inessa , Andersons Pauls , Veksler Hackel
Published: April 2019

Environmental mercury and mercury compound contamination has increased dramatically since the industrial revolution. This paper describes the toxic effects of mercury on a culture of hybridoma TA7 cells, which produce antibodies against the A-subunit of viskumin. Cells were cultivated on 96-well flat-bottomed plates with RPMI-1640 medium supplemented with 10% fetal calf serum at 37°C in 5% CO2/95% air. The cells were exposed to 0.1nM/l–10μM/l Hg2(NO3)2.2H2O (mercury nitrate) during the exponential growth phase. Toxicity was assessed by using the colorimetric MTT (tetrazolium) assay after exposure for 48 hours. Cell growth and cell survival were evaluated by using percentage indices of cellular content in exposed cells when compared to non-exposed control cells. The concentrations of the no-effect level, the lowest observed effect level and the the highest toxic effect level were registered. The toxic effects of the mercury compound on the hybridoma cells occurred between 0.1μM/l and 10μM/l.
In Vitro Testing of the Responses of Human Gingival Fibroblasts and L-929 Cells to Nicotine
Authors: Ciapetti Gabriela , Remiddi Giulia , Savioli Franca , Monaco Giuseppe , Ori Giacomo , Checchi Luigi
Published: April 2019

Tobacco smoke is considered to be a major risk factor in the development of cardiac diseases and lung cancer. It has also been shown that periodontitis is more prevalent and more severe in smokers than in non-smokers. Nicotine, the major pyridine alkaloid in tobacco, has been shown to participate in periodontal disease, exerting both local and systemic effects. In the present study, the effects of nicotine (6μg/ml, 60μg/ml and 600μg/ml) on human gingival fibroblasts (HGF) were assessed by using various exposure protocols. The responses of HGF cultures obtained from smokers and non-smokers were compared to those found when using a continuous cell line (L-929). Neutral red uptake (NRU) and the measurement of DNA content with bis-benzimide dye were used to assess cell viability and cell number, respectively. NRU was the most sensitive technique for the detection of cytotoxic effects. L-929 cells were found to be affected by nicotine in the NRU assay, with a strong cytotoxic effect with 600μg/ml nicotine, and a “response” with 60μg/ml nicotine when prolonged or double challenge was applied. Non-smoker HGF and smoker HGF reacted to nicotine in different ways, depending on the concentrations and the exposure times used, but had identical reactions following double exposure. With the Hoechst DNA assay, 600μg/ml nicotine was found to affect the growth of non-smoker HGF after long or repeated exposure, while smoker HGF were affected only by repeated exposure; growth of L-929 cells was not affected. It was concluded that HGF from smokers are able to sustain higher concentrations of nicotine without adverse effects than are non-smoker HGF and L-929 cells. If this occurs in vivo, nicotine would not be considered to be a major toxicant to HGF in smokers.
Comparison of Hepatocyte Cultures and Liver Slices in In Vitro Toxicity Testing
Authors: George Elisabeth , Murdock Janice , Aylott Mike , Westmoreland Carl
Published: April 2019

The aim of this study was to compare the in vitro toxicities of two hepatotoxins in hepatocyte cultures and in liver slices from both rats and dogs. Hepatocytes and liver slices were pre-incubated for 2 hours and then exposed to galactosamine or paracetamol, both of which mainly induce liver necrosis in vivo. Following exposure to the compounds for 20 hours, neutral red uptake (NRU [hepatocyte cultures only]), MTT reduction, and reduced glutathione (GSH), adenosine triphosphate (ATP) and protein content, were used to measure the toxicity induced. In general, galactosamine and paracetamol exposure caused comparable levels of toxicity in hepatocyte cultures and in liver slices. For galactosamine, no consistent differences were seen between hepatocyte cultures and liver slices. With paracetamol, the toxic effects were generally slightly more pronounced in hepatocyte cultures than in liver slices, and the preparations from dog liver were more sensitive than those from rat liver to paracetamol exposure. These results are in agreement with previously described species differences in vitro. NRU and GSH content were more sensitive and more consistent endpoints than MTT reduction, ATP content or protein content. Liver slices appeared to lose viability over the 20 hours in culture. Therefore, it can be concluded that liver slices should only be used in relatively short-term investigations.
Validation of the Highway Capacity Manual Urban Street Travel Time Reliability Methodology using Empirical Data
Authors: Tufuor Ernest O. A. , Rilett Laurence R.
Published: April 2019

The 6th edition of the Highway Capacity Manual (HCM-6) includes the concept of travel time reliability (TTR), which attempts to determine the distribution of average trip travel times over an extended period. TTR is an inherent part of travelers’ route choice decisions and is used by traffic managers to better quantify operations rather than simply using average travel times. The focus of this paper is on the HCM-6 urban street TTR methodology contained in Chapter 17. The approach uses historical data (e.g., weather and volume fluctuations) and simple empirical data (e.g., 1-day volume count) to provide the user with average travel time and reliability predictions for a traffic facility over an extended period (e.g., a year). To the best of the authors’ knowledge, there is no existing literature on validating the HCM-6 methodology with empirical data. The goals of this paper were to validate the HCM-6 urban street reliability methodology by comparing the empirical Bluetooth (BT) travel time distributions with the estimated HCM-6 distribution, and to propose potential HCM-6 augmentation strategies. Archived BT data from a 0.5-mi urban arterial in Lincoln, Nebraska was used for comparison. It was found that there were statistically significant differences, but minimal practical differences, between the mean of the predicted HCM-6 travel time distribution and the mean of the empirical distribution. However, the HCM-6 distribution had a lower variance than the empirical distribution. Not surprisingly, the HCM-6 model underestimated the TTR metrics (buffer index and the planning time index) by approximately 62% and 9%, respectively.
Home versus Hospice Inpatient Care: Discharge Characteristics of Palliative Care Patients in an Acute Care Hospital
Authors: Fainsinger Robin L , Demoissac Donna , Cole Janet , Mead-Wood Kathy , Lee Ellen
Published: April 2019

This prospective survey was initiated to identify factors that helped and hindered home discharge for 100 consecutive patients who did not require further specialist palliative or acute care. Information was collected on demographics, functional ability (using the Palliative Performance Scale [PPS] and Kamofsky Performance Scale [KPS]), cognitive function at discharge as measured by the Mini-Mental State Examination (MMSE), home support circumstances, and patient and family preference for discharge. 59 patients were discharged home and 41 were transferred to a hospice. Younger patients with younger caregivers were discharged home more often. Patients with better MMSE and better functional ability (PPS and KPS) were also more likely to go home. Patients going home were more likely to be married. Preference for site of discharge was met for 76% of patients and 90% of families. Of the patients going to a hospice, 24% of patients and 7% of families preferred a home discharge. More physical support at home could have facilitated a home discharge for 13 patients. Functionally dependent and cognitively impaired patients were generally unable to return home. To support patients and their families in an environment of their choice, access to increased physical support in the home must be addressed.
Decision Making and End-of-Life Care in Critically Ill Children
Authors: Masri Christian , Farrell Catherine Ann , Lacroix Jacques , Rocker Graeme , Shemie Sam D.
Published: April 2019

Objectives

1) To comment on the medical literature on decision making regarding end-of-life therapy, 2) to analyze the data on disagreement about such therapy, including palliative care, and withholding and withdrawal practices for critically ill children in the pediatric intensive care unit (PICU), and 3) to make some general recommendations.

Data Sources and Study Selection

All papers published in peer-reviewed journals, and all chapters on end-of-life therapy, or on conflict between parents and caregivers about end-of-life decisions in the PICU were retrieved.

Results

We found three case series, three systematic descriptive studies, two qualitative studies, four surveys, and many legal opinions, editorials, reviews, guidelines, and book chapters. The main determinants of end-of-life decisions are the child's age, premorbid cognitive condition and functional status, pain or discomfort, probability of survival, and quality of life. Risk factors in persistent conflict between parents and caregivers about end-of-life care include a grave underlying condition or an unexpected and severe event.

Conclusion

Making decisions about end-of-life care is a frequent event in the PICU. Children may need both intensive care and palliative care concurrently at different stages of their illness. Disagreements are more likely to be resolved if the root cause of the conflict is better understood.
Activities of Counsellors in a Hospice/Palliative Care Environment
Authors: Thompson Marney , Rose Caelin , Wainwright Wendy , Mattar Lucie , Scanlan Mairi
Published: April 2019

This study examined activities related to the provision of psychosocial care by counsellors in the hospice/palliative care setting. A qualitative design using written reports was used in an urban Canadian hospice/palliative care program. A convenient sample of 13 counsellors indicated the activities they typically performed in their work with patients and families. Thematic analysis of the activities directly related to patient and family care was performed and then validated by presenting these activities back to the counsellors in a group setting. Seven themes resulted: 1) companioning; 2) psychosocial assessment, planning, and evaluation; 3) counselling interventions; 4) facilitation and advocacy; 5) patient and family education; 6) consultation and reporting; and 7) team support. These thematic findings confirmed those of previous studies and also highlighted two additional findings. Team support was seen as an activity that directly affected client care, and there was a strong emphasis on the activity of companioning the dying and their families. Also discussed are implications of these results, as well as suggestions for further research.
The Challenge of Developing a Regional Palliative Care Data System: A Tale of Two Cities
Authors: Critchley Patrick P. , Lohfeld Lynne , Maxwell David , Mcintyre Paul , Reyno Leonard
Published: April 2019

This article reviews the purposes of health care databases and the findings from a literature review of the use of patient databases in palliative care. We present the history and goals of databases developed in two Canadian settings, Hamilton and Halifax. We present data on the strengths, limitations, and difficulties encountered in each setting. We review the types of data collected and the potential of these databases, and we offer practical recommendations for others looking to set up such systems.
End-of-life Care for Hematological Malignancies: The ‘Technological Imperative’ and Palliative Care
Authors: Mcgrath Pam
Published: April 2019

Recent research indicates that hospice/ palliative care practices have not yet been integrated into the care of patients with hematological malignancies. As research in relation to palliative care and hematological malignancies is in its infancy, many of the end-of-life care practices with these diagnostic groups are based on unexamined ideas. The findings presented in this article, which are taken from recent post-doctoral research on hematological malignancies and palliative care, make a contribution to documenting information on what is happening to patients and their families in this area. In particular, the findings provide insights on issues associated with the patient and carer awareness that the patient is dying, understanding of prognosis, and the desire to die at home. Such insights are placed in the context of descriptions of the patients’ experience with treatment during the terminal stage.
Addressing Spirituality in Pediatric Hospice and Palliative Care
Authors: Davies Betty , Brenner Paul , Orloff Stacy , Sumner Liz , Worden William
Published: April 2019

Hospice and palliative care principles mandate clinicians to provide “total” care to patients and their families. Such care incorporates not only physical, emotional, and psychosocial care, but spiritual care as well. Even though considerable attention has been directed to spiritual issues for adult patients in hospice and palliative care, spirituality in pediatric palliative care has been virtually neglected. The need for guidelines to assess spirituality in this population was identified as a priority issue by members of a subcommittee of the Children's International Project on Children's Palliative/Hospice Services, created under the auspices of the National Hospice Organization. Committee members, based on their clinical, research, and personal experiences, identified several aspects relevant to spirituality in general, and to spirituality in pediatric palliative care in particular, and developed guidelines for clinicians in pediatric palliative care. The purpose of this paper is to share the results of this committee's work and, in particular, to present their guidelines for addressing spiritual issues in children and families in pediatric hospice and palliative care.
Problem Solving by Telephone in Palliative Care: Use of a Predetermined Assessment Tool within a Program of Home Care Technology
Authors: Elfrink E.J. , Van Der Rijt C.C.D. , Van Boxtel R.J.J. , Elswijk-De Vries P. , Van Zuijlen L. , Stoter G.
Published: April 2019

In the Rotterdam Cancer Institute, nurses from the palliative care unit take care of accessibility outside office hours for patients transferred home with technical equipment for symptom control. The nurses use a predetermined assessment tool (PAT) for handling telephone calls. A retrospective evaluation on the registration forms used over the years 1997–1999 was performed to evaluate the telephone service. A total of 124 patients in need of technical support was transferred from the hospital during the study period: 52 in 1997, 33 in 1998, and 39 in 1999. Over the years, 157 calls were registered from 64 (52%) patients. In 1997, the majority of the calls (73%) came from the patient or the family. The frequency of calls from the general practitioner did not change, but calls from the district nurse increased from 12% in 1997 to 35% in 1998, and 48% in 1999. Professionals working in nursing homes have used the telephone service since 1998. The reasons for calling were pain (40%), symptoms other than pain (19%), technical problems (33%), general information and advice (6%), and logistic problems (2%). In 152 of the 157 telephone calls (97%), problems could be solved without admission. The mean time to answer a call was 16 minutes. The telephone service and the use of the PAT made it possible to solve 97% of problems without admission.
Developing Palliative Care Surveillance in Canada: Results of a Pilot Study
Authors: Gaudette Leslie A. , Shi Fan , Lipskie Tammy , Allard Pierre , Fainsinger Robin L. , Maxwell David , Harlos Mike
Published: April 2019

Objective

A pilot study compiled data from six palliative care centres across Canada to assess the feasibility of developing a national surveillance system.

Methods

Data provided for the three-year period between 1993–1997 were combined into a comparative minimum data set. Analyses included 6,369 care episodes from five centres, plus 948 patients from one centre.

Results

Care was provided in various settings including acute care wards, dedicated palliative care units, tertiary care, chronic care, and at home. Palliative care patients comprised equal numbers of men and women, with a median age of 69 years; 92% had cancer diagnoses. Median length of stay (LOS) for each care episode was 13 days, increasing to 40–43 days for a patient's entire time in care. LOS varied greatly, by care setting, from seven days (dedicated unit), to 19 days (tertiary unit), 37 days (home), and 54 days (chronic care). Our findings are similar to those reported from national surveys in Australia and the United Kingdom.

This study generated useful baseline data and identified key issues requiring resolution before establishing a national surveillance system, including the need to track patients across care settings.
Factors that Promote Success in Home Palliative Care: A Study of a Large Suburban Palliative Care Practice
Authors: Maida Vincent
Published: April 2019

It has been repeatedly shown that most people would prefer to die in their own homes. However, many factors affect the feasibility of this choice. This study retrospectively examined the medical and nursing charts of 402 cancer patients who wished to die at home and had been referred to a palliative care service. Of those reviewed, 223 (55%) died at home, while 179 died in hospitals. The presence of more than one caregiver, an increased length of time between diagnosis and referral to a palliative care physician, an increased length of time under that physician's care, older age at referral, home ownership, and race were all significantly associated with home death, as were certain cancer diagnoses. The most compelling of these predictive factors have formed the basis for an evaluation tool, soon to be validated, to help palliative health professionals assess the viability of home-based palliative care culminating in a home death.
Examining the Perspectives of Family Members Involved in the Delivery of Palliative Care at Home
Authors: Stajduhar Kelli I.
Published: April 2019

This ethnographic study examined the social context of home-based palliative caregiving. Data were composed of observation field notes, interviews, and textual documents, and were analyzed using constant comparative methods. Findings show that home-based palliative caregiving resulted in life-enriching experiences for many caregivers. However, assumptions about dying at home and health care reforms resulted in some caregivers feeling “pressured” to provide home care, and consequently, left them feeling their obligations to care were exploited by the health care system. Shifts toward providing care closer to home not only changed caregivers, but also changed the home setting where palliative care was provided. Findings indicate a need for interventions designed to improve support for caregivers at home, and to explore how assumptions influence and sometimes drive the provision of home health care.
Mapping the Journey: Family Carers’ Perceptions of Issues Related to End-Stage Care of Individuals with Muscular Dystrophy or Motor Neurone Disease
Authors: Dawson Sky , Kristjanson Linda J.
Published: April 2019

Progress in medical technology and treatment has resulted in more people with neurodegenerative conditions surviving for longer periods of time. This increased lifespan means that these individuals have a longer period of dependency on others, with a heightened need to maintain quality of life for both the individual and the family. Our paper reports on the findings of a study involving in-depth interviews with 16 carers to determine their perceived needs during the final stage of caring for someone with muscular dystrophy (MD) or motor neurone disease. Results suggest that the palliative care model has much to offer individuals with degenerative neuromuscular conditions and their families, but it is not yet recognized as an important part of care for young people with MD. Three major themes emerged in the analysis: reactions and responses, health system crossing points, reaching forward.
A Good Death in Rural Kenya? Listening to Meru Patients and Their Families Talk about Care Needs at the End of Life
Authors: Grant Elizabeth , Murray Scott A , Grant Angus , Brown Judith
Published: April 2019

What constitutes a good death in sub-Saharan Africa? In Meru District in Eastern Kenya, we listened to 32 patients with ongoing cancer or AIDS, and to their carers as they talked about end-of-life experiences and care needs. Patients described how the support of close family relationships, and the care shown by their community and religious fellowships helped meet many of their emotional, social, and spiritual needs. But physical needs often went unmet. Patients died in pain. Some suffered in poverty, others were troubled by the guilt of using all available family resources to pay for treatment and care. Accessible pain relief, affordable clinic or inpatient care when required, and help to cope with the burden of care were among the key needs of patients. Until these are available, many will not die well.
A Comparison of Attitudes of Medical Students in England and in South Africa towards Patients with Life-Limiting Illness
Authors: Lloyd-Williams Mari , Dogra Nisha , Morake Rachel
Published: April 2019

All medical schools in the U.K. now include teaching in palliative care in the undergraduate curriculum, and this is mirrored in Europe and the U.S.A. In South Africa, however, palliative care education and provision are not widely available. An increasing number of medical and nursing staff are invited to teach palliative care in other countries. Such teaching should, however, take into account the cultural attitudes the students have towards the care of patients with a chronic or terminal illness. Nineteen statements on attitudes were constructed, and medical students in Leicester, U.K., and in Medunsa, South Africa, were invited to respond to them using a 10-point Likert scale. The questionnaire was distributed before either cohort of students had received any teaching in this area. Students in South Africa were significantly more likely to want to work in a speciality where most patients were likely to be cured (p<0.001) and significantly less likely to believe that caring for dying patients could be rewarding (p<0.001). South African medical students had significantly fewer positive attitudes than had their U.K. counterparts toward patients being informed of a terminal prognosis (p<0.001). This study indicates that cultural differences between medical students may have an effect on the teaching of care for patients with life-limiting illness. This has relevance for curriculum delivery, especially when professionals are invited to teach or develop material on palliative care for other countries.
How Do Physicians Learn to Provide Palliative Care?
Authors: Schulman-Green Dena
Published: April 2019

Medical interns, residents, and fellows are heavily involved in caring for dying patients and interacting with their families. Due to a lack of formal medical education in the area, these house staff often have a limited knowledge of palliative care. The purpose of this study was to determine how, given inadequate formal education, house staff learn to provide palliative care. Specifically, this study sought to explore the extent to which physicians learn to provide palliative care through formal medical education, from physicians and other hospital staff, and by on-the-job learning. Twenty physicians were interviewed about their medical education and other learning experiences in palliative care. ATLAS/ti software was used for data coding and analysis. Analysis of transcripts indicated that house staff learn little to nothing through formal education, to varying degrees from attending physicians and hospital staff, and mostly on the job and by making mistakes.
Palliative Care Volunteers: Why Do They Do It?
Authors: Claxton-Oldfield Stephen , Jefferies Joanna , Fawcett Catherine , Wasylkiw Louise , Claxton-Oldfield Jane
Published: April 2019

Two studies were conducted to examine people's motives for joining a palliative care volunteer program. To generate a pool of reasons for becoming a palliative care volunteer, previous studies of motivations relevant to palliative care were reviewed and interviews were conducted with 15 palliative care volunteers (Study 1). Combining the literature review and interviews, a total of 22 distinct reasons for volunteering were identified and used to create an Inventory of Motivations for Palliative Care Voluntarism (IMPCV). In Study 2, 113 palliative care volunteers responded to the IMPCV. “To help ease the pain of those living with a life-threatening illness” was rated as the most influential reason for becoming a palliative care volunteer. A principal components factor analysis was conducted on the IMPCV. It was decided that four factors adequately represented the items: Leisure, Personal Gain, Altruism, and Civic Responsibility.
Harms to Dignity, Bioethics, and the Scope of Biolaw
Authors: Simpson Evan
Published: April 2019

Dignity is an expansive ideal, figuring in international covenants, codes of research involving human participants, and debates about decision making at the end of life. One result of this expansiveness is that human dignity can be appropriated by proponents on both sides of many issues, thereby appearing more as a rhetorical flourish than as a serious element in argumentation. However, an appreciation of narrative inquiry shows that opposing representations of dignity constitute alternative assessments of responsible action, both of which can be morally reasonable. One implication is that normative disagreements, as between deathbed decisions about palliative care or euthanasia, can be expected to occur, so that the ideal of dignity should be legally expressed in a practice of supportive laissez-faire in preference to any undue regulation of dying.
Building Capacity to Provide Palliative Care in Rural and Remote Communities Does Education Make a Difference?
Authors: Kelley Mary Lou , Habjan Sonja , Aegard Joanna
Published: April 2019

One strategy for improving access to palliative care services in rural and remote communities is to educate community-based health professionals in the knowledge and skills required to provide end-of-life care. It is, therefore, important to evaluate palliative care educational initiatives. This article provides an evaluation of the interdisciplinary education program at Lakehead University which aims to: improve the knowledge and skills of individual providers; contribute to the development of palliative care programs in rural communities; and develop palliative care trainers to educate their co-workers in the workplace. A survey of 353 providers who participated in the education program was completed after eight years of providing education. Results confirm that the goals of the education program were met, and that rural and remote communities reported a greater capacity to deliver palliative care. Nevertheless, respondents identified a lack of resources, especially home care visits, as an obstacle to improving care.
End-of-Life Care in a Children's Hospice Program
Authors: Steele Rose , Davies Betty , Collins John B. , Cook Karen
Published: April 2019

A project was completed in 1999 to evaluate the Canuck Place children's hospice program. This article reports only on the end-of-life care component. Results are provided from mail-out surveys with families who required end-of-life care and are supplemented by qualitative data which were collected from interviews with individuals prior to the survey. Eighteen families completed face-to-face interviews and another 70 families completed the mail-out questionnaire developed from the initial interviews. A total of 39 parents responded to the survey section about end-of-life care services. Results indicated that parents were reasonably comfortable discussing death with staff; they generally felt well prepared for their child's death because of the staff; the death of another child had a significant effect on families; parents’ wishes at the time of their child's death were very supported by staff; and families were well supported by staff at the time of a child's death. Implications for practice and suggestions for future research are discussed.
Indicators of Poor Quality End-of-Life Cancer Care in Ontario
Authors: Barbera Lisa , Paszat Lawrence , Charter Carole
Published: April 2019

This study measures the proportion of cancer patients in Ontario, Canada, with intensive care unit (ICU) admissions, emergency room (ER) visits, or chemotherapy in the last two weeks of life. We used the Ontario Cancer Registry to identify a cohort of cancer patients who died in 2001. These cases were then linked to administrative sources of data to measure each indicator, and to describe the associated clinical and health service factors. In the cohort, 27% had at least one ER visit and 5% had an ICU visit in the last two weeks of life. Of those who received chemotherapy in the last six months, 16% received chemotherapy in the last two weeks of life. Receiving a home care visit in the last six months of life, or a physician house call or a palliative care assessment in the last two weeks of life was consistently associated with decreased odds of each of the indicators. Our results indicate that a significant proportion of Ontario cancer patients have indicators of poor quality end-of-life care. Certain health care factors may influence these indicators.
Palliative Care Training: A Survey of Physicians in Australia and Europe
Authors: LÖfmark Rurik , Mortier Freddy , Nilstun Tore , Bosshard Feorg , Cartwright Colleen , Van Der Heide Agnes , Norup Michael , Simonato Lorenzo , Onwuteaka-Philipsen Bregje
Published: April 2019

The purpose of this paper is to present data about the level and background characteristics of physicians’ training in palliative care in Australia (AU), Belgium (BE), Denmark (DK), Italy (IT), the Netherlands (NL), Sweden (SE) and Switzerland (CH) (n=16,486). The response rate to an anonymous questionnaire differed between countries (39%-68%). In most countries approximately half of all responding physicians had any formal training in palliative care (median: 3–10 days). Exceptions were NL (78%) and IT (35%). The most common type of training was a postgraduate course. Physicians in nursing home medicine (only in NL), geriatrics, oncology (not in NL), and general practice had the most training. In all seven countries, physicians with such training discussed options for palliative care and options to forgo life-sustaining treatment more often with their patients than did physicians without. Irrespective of earlier palliative care training, 87%-98% of the physicians wanted extended training.
Are Supportive Services Meeting the Needs of Australians with Neurodegenerative Conditions and Their Families?
Authors: Kristjanson Linda J. , Aoun Samar M. , Yates Patsy
Published: April 2019

Objective

To identify the needs for supportive care/palliative care services of people in Australia with four neurodegenerative disorders—motor neurone disease, multiple sclerosis, Parkinson's disease, Huntington's disease—and the needs of their families; and to determine the extent to which existing supportive and palliative care services models meet these needs.

Design

A mailed self-administered questionnaire to individuals with the four neurodegenerative diseases and their carers, in Western Australia, Victoria, and Queensland, using stratified proportional sampling from membership lists of the disease associations.

Participants

A total of 503 patients and 373 carers responded, representing a response rate of 25.6% and 19.0%, respectively. Exclusion criteria included those who had been recently diagnosed, and those too sick or disabled to participate.

Results

As patient dependency increased and more support was needed, both patients and carers exhibited higher distress symptoms and a poorer quality of life. Those who received more tailored services and more palliative care services were the most satisfied. The results highlighted the need for tailored and flexible models of care for these groups with unique care requirements.

Conclusions

This is the first empirical evidence of the needs and services used by these patient groups in Australia, and will form the basis for future developments of palliative and supportive care services for people with these four neurological conditions.
Symptom Prevalence and Severity in People Severely Affected by Multiple Sclerosis
Authors: Higginson Irene J. , Hart Sam , Silber Eli , Burman Rachel , Edmonds Polly
Published: April 2019

Aim

This study sought to assess symptom severity and prevalence in people severely affected by multiple sclerosis (MS).

Methods

We collected data on symptoms and problems of patients as self-reported to trained interviewers on standardized questionnaires (including the Palliative Outcome Scale MS symptom checklist, POS-MSS).

Results

52 patients were included, mean age 53 years; 26 had secondary progressive MS, 23 had primary progressive MS, three had other forms; 32/52 were unable to walk independently. Patients reported a mean of nine (median=8.5, mode=12) symptoms. Six symptoms affected more than 50% of patients: problems using legs, problems using arms, fatigue/lack of energy, spasms, pain, and feeling sleepy. Higher levels of disability were correlated with greater symptom severity for nine symptoms (Spearman rho ranged 0.28–0.56, p<0.05).

Conclusion

Many symptoms in people severely affected by MS are as highly prevalent and severe as those experienced by patients with advanced cancer. Increased disability is associated with increased severity for some symptoms.
Parents’ and Children's Perspectives of a Children's Hospice Bereavement Program
Authors: Davies Betty , Collins John , Steele Rose , Cook Karen , Distler Vivian , Brenner Amy
Published: April 2019

The provision of some form of bereavement services is an integral part of any pediatric hospice program. The Canuck Place hospice program has offered bereavement services since it began in 1995. A mixed-method evaluation of the impact of the Canuck Place program on the families it served during its first two-and-a-half years of operation was conducted. The bereavement services reviewed included follow-up care for families, and bereavement support groups for children and their parents. Eight children were interviewed in the initial phase, and nine completed a survey questionnaire; 28 parents rated their level of satisfaction with various aspects of their experience with the parent support group. Findings indicated that the follow-up component of the program was well-received by family members. When assessing their group experiences, children and parents most appreciated the support and understanding they received, the freedom to express themselves, a diminished sense of isolation, and the normalization of their emotions. Practical considerations when offering bereavement support groups are discussed in this paper.
The Role of Support Staff in Pediatric Palliative Care: Their Perceptions, Training, and Available Resources
Authors: Swinney Ryan , Yin Lu , Lee Andrew , Rubin David , Anderson Clarke
Published: April 2019

Pediatric palliative care requires the orchestrated efforts of a multidisciplinary care team of medical staff, nursing, psychosocial staff, and other healthcare professionals. Augmenting this team are support staff including financial counsellors, volunteers, secretaries, and others not involved in the direct administration of medical services. Prior research in palliative care has studied the perceptions, training, and professional resources of medical staff and social workers, but neglected to investigate such factors in support staff. Our study examined the effect of involvement in end-of-life pediatric care on support staff. We found this community to consist of a heterogeneous population of hospital employees, who develop numerous, substantial, direct interactions with dying children and their families. They indicated that such experiences had caused some adverse outcomes in their lives, and that few felt they had sufficient knowledge or training in palliative care. Our respondents voiced noteworthy opinions on symptom control, cultural issues, and spirituality pertinent to pediatric palliative care. Support staff play a key role in the palliative care team; research and resources need to be directed to educating, training, and supporting them.
Improving End-of-Life Care through Community-Based Grassroots Collaboration: Development of the Chinese-American Coalition for Compassionate Care
Authors: Chou Wen-Ying Sylvia , Stokes Sandy Chen , Citko Judy , Davies Betty
Published: April 2019

As a volunteer-formed, community-based organization devoted to improving the quality of end-of-life care for Chinese Americans, the new Chinese-American Coalition for Compassionate Care (CACCC) is a unique and promising venture. This article has several aims: 1) to describe the history and development of the recently founded CACCC; 2) to introduce and critically evaluate one of CACCC's first public programs, a volunteer and caregiver training on end-of-life care, which prompted subsequent programs and activities; 3) to report on CACCC's current projects and short- and long-term goals; and 4) to discuss the implications for other similar community-based organizations devoted to the health and quality of life of a targeted population.
Needs and Experiences of Caregivers for Family Members Dying with Parkinson Disease
Authors: Goy Elizabeth R. , Carter Julie H. , Ganzini Linda
Published: April 2019

The caregiver burdens and unmet needs of patients with Parkinson disease (PD) in the final months of life are poorly documented. We surveyed 47 family caregivers of PD patients a median of 18 months after death. We measured caregiver preparedness for their role, assistance provided the patient, and types and settings of care received by the patient. Typical caregivers were older female spouses. Though 66% of patients resided in a care facility during the last month, over half received care from hospice, 36% from a home health agency, and 43% by privately paid aide in the months before death. Caregivers rated tasks involving physical effort as most difficult. While most caregivers felt prepared for their role, one-third or more were unprepared for the stress and physical strain encountered. These data suggest that increasing education and assistance with physical tasks may address unmet needs of PD caregivers.
Creating a Research Culture in a Palliative Care Service Environment: A Qualitative Study of the Evolution of Staff Attitudes to Research during a Large Longitudinal Controlled Trial (ISRCTN81117481)
Authors: Grbich Carol , Abernethy Amy P. , Shelby-James Tania , Fazekas Belinda , Currow David C.
Published: April 2019

This study investigated the impact of a three-year randomized control trial of different models of service provision on palliative care staff associated with the hospice where the trial was being conducted. Eleven open access de-identified qualitative focus groups were held over a period of three years: three months into the trial, one year after its inception, and at the end of the trial. Four staff groups were involved: inpatient hospice nurses, palliative care outreach nurses, medical palliative specialists, and administrative staff and social workers. Initially the impact of the trial produced high levels of staff stress which largely diminished over time, to be replaced by enthusiasm for the changes achieved and sadness that post trial the perceived benefits gained would be lost. When attempting to change a clinical culture to incorporate research, and in particular where increased staff workload is involved, highly interactive levels of communication and valuing of staff input are required to minimize the stress and burden of this imposition.
Hospice U.K. – 2000 AD
Authors: Hillier Richard
Published: April 2019

This paper examines the possible shape of the hospice movement in the year 2000 AD. The number of patients dying from cancer will be similar to today, and cancer will remain the most common disease referred to hospices. After reviewing the key developments during the past fifteen years, the effects of national policy and financial constraint on future developments are examined. Most advances will stem from better organization and more realistically staffed hospices and hospice care teams. This will encourage greater flexibility and imaginative development. Advances will be made in rehabilitation, halfway houses for the elderly frail, and greater involvement with mainstream medical services. The role of home care teams, hospital support teams and day care, coupled with the better use of volunteers will maintain more patients at home and reduce the bed norms to 25 per million. A statement on education and training is made.
Considerations on Cancer Pain Management
Authors: Ventafridda Vittorio
Published: April 2019

This feature in each issue of the journal, will serve to indicate a main direction of thought about palliative care, somewhat as the compass and map offer guidance in the sport after which this section is titled.
The Role of the Social Worker in Terminal Care with Institutionalized Elderly People
Authors: Sakadakis Venes , Bonar Rita , Maclean Michael J.
Published: April 2019

There is considerable evidence that many dying elderly persons in institutions experience feelings of hopelessness and isolation in their terminal phase. This is often when we, as social work practitioners, experience difficulty in developing active interventions, such as supportive therapy, advocacy, and treatment planning. Ethical dilemmas may also arise around issues of appropriateness of treatment or the quality of life for the elderly person, requiring social work intervention. Through case illustrations of some work with dying elderly individuals in an institutional setting, the role of the social work practitioner will be discussed in respect to these interventions.
Recognizing Personhood and the Right to Die with Dignity
Authors: Smith George P.
Published: April 2019

Death cannot be viewed properly as either an event or a configuration. Indeed, multiple parts of the body can continue to live long after the disintegration of its central organization is recorded. Instead of collapsing at a moment in time, technological mechanisms are capable of sustaining the major bodily processes indefinitely — all designed to allow for the harvesting of needed organs for transplantation. State legislative efforts have been undertaken in America to define those specific circumstances when death occurs legally. Although always allowed to exercise reasonable discretion in their decision making, attending physicians will nonetheless be aided by these laws that not only limit their legal liability but assure for the patient that his final choices will be honored consistent with basic principles of self-determination. The Law Reform Commission of Canada recommended in 1987 that criminal liability be rejected for the offenses of helping, advising, or inciting a person to commit suicide. This is an exceedingly wise and humane position to follow. Instead of being held captive to words such as “rational suicide” or “euthanasia”, what is needed is an acceptance of more contemporary watchwords such as autonomy and self-determination. When at all possible, final choices about death should be made by the patient's family and their medical advisers — and not be subjected to judicial scrutiny.
Symptom Control during the Last Week of Life on a Palliative Care Unit
Authors: Fainsinger Robin , Miller Melvin J. , Bruera Eduardo , Hanson John , Maceachern Tara
Published: April 2019

A recent report suggested that more than 50 % of terminal cancer patients have physical suffering that requires sedation in the last days of life. To evaluate this finding on our 14-bed palliative care unit, a retrospective analysis of 100 consecutive patients admitted for 6 days or more was carried out. Information was collected on major symptoms requiring treatment, symptom control at admission and during each of the last 7 days of life, medications used, and changes that may have contributed to sedation. Of the 100 patients, 99 had pain, 46 had dyspnea, 71 had nausea, and 39 experienced delirium. Visual Analogue Scores (VAS) were done twice a day in all patients; mean pain showed a change from 31±24 on Day 6 to 24±19 on day of death (DOD) (p<0.05); nausea from 19±18 on Day 6 to 13±9 on DOD (p<0.01); drowsiness from 51±28 on Day 6 to 85±45 on DOD (p<0.001); symptom distress score from 49±11 on Day 6 to 52±9 on DOD (p<0.01). On the day of admission (DOA), 69 % of VAS were done by the patient and 28 % by the nurse as compared to 8 % by the patient and 90 % by the nurse on DOD. Level of consciousness on DOA was alert (72 %), drowsy (28 %), unresponsive (0 %) and by DOD was alert (2 %), drowsy (41%), unresponsive (57%). Symptom control on DOA was evaluated as good (64%), fair (26 %), poor (10 %) and by DOD was good (84 %), fair (14 %), poor (2 %). Evaluation of patient records and medication changes revealed 6/99 patients with pain (6 %) and 10/39 patients with delirium (26 %) requiring increased treatment, probably resulting in sedation in the last days of life. Thus, only 16 of 100 patients (16 %) required treatment for pain and delirium that would have caused sedation in order to achieve symptom relief.
Common Symptoms in Patients with Advanced Cancer
Authors: Curtis Elizabeth B. , Krech Ruth , Walsh T. Declan
Published: April 2019

The goal of this study was to identify the symptoms of patients with advanced cancer. One hundred consecutive patients referred to the Palliative Care Service at the Cleveland Clinic Foundation were studied using a standard tool that included questions on 38 specific symptoms. The most common symptoms were pain, weight loss, and anorexia. Significant findings also included that women had more frequent and severe gastrointestinal complaints than men. These do not appear to be related to specific cancer primary sites.
Teaching Palliative Care in General Practice: A Survey of Educational Needs and Preferences
Authors: Macleod Roderick D.
Published: April 2019

We surveyed general practitioners in the Bath District Health Authority to determine their educational needs in palliative care and their preferred methods of learning, in order to develop an appropriate education program. The survey con-firmed our ideas as to the content of the program. There was support for our hypothesis that the majority would favor didactic approaches and would feel generally uncomfortable with experiential methods. The issue of professionals’ needs in stressful situations proved to be a surprisingly strong one.