bluuebunny/crossref_metadata_2025 huggingface dataset:
Augmented skeletal muscle hyperaemia during hypoxic exercise in humans is blunted by combined inhibition of nitric oxide and vasodilating prostaglandins
Authors: Crecelius Anne R. , Kirby Brett S. , Voyles Wyatt F. , Dinenno Frank A.
Published: May 2011

Non‐technical summary  Blood flow to muscle increases during exercise in order to deliver more oxygen. When there is less oxygen in the blood, as in systemic hypoxia, blood flow also increases. If exercise occurs during hypoxia, the blood flow response is greater than during normal oxygen conditions, but the mechanisms by which this happens are not clear. We show that two substances that the body produces, nitric oxide and prostaglandins, contribute to this increased blood flow during hypoxic exercise. These results help us better understand how oxygen delivery is regulated and may be especially important for populations which are unable to produce these substances that help increase blood flow.
Contributions of descending and ascending pathways to corticomuscular coherence in humans
Authors: Witham Claire L. , Riddle C. Nicholas , Baker Mark R. , Baker Stuart N.
Published: May 2011

Non‐technical summary Neural activity in parts of the cerebral cortex related to movement oscillates at frequencies around 20 Hz. These oscillations are correlated with similar rhythms in contracting muscles on the opposite side of the body. In this work, we used an analysis method called directed coherence to investigate the direction of oscillatory coupling. We find that oscillations travel not only from cortex to muscle (as expected for a motor command), but also back from muscle to cortex (reflecting sensory input). This oscillatory loop may allow the cortex to measure features of the limb state, integrating sensory inflow with the motor command.
Toward a High Order Throughflow––Investigation of the Nonlinear Harmonic Method Coupled With an Immersed Boundary Method for the Modeling of the Circumferential Stresses
Authors: Thomas J. P. , Léonard O.
Published: May 2011

Capturing a level of modeling of the flow inside a multistage turbomachine, such as unsteadiness for example, can be done at different levels of detail, either by capturing all deterministic features of the flow with a pure unsteady method or by settling for an approximated solution at a lower computational cost. The harmonic methods stand in this second category. Among them, the “nonlinear harmonic method” (NLHM) from He and Ning [1998, “Efficient Approach for Analysis of Unsteady Viscous Flows in Turbomachines,” AIAA J., 36, pp. 2005–2012] revealed the most efficient. This method consists of solving the fully nonlinear 3D steady problem and a linearized perturbation system in the frequency domain. As it has been shown by the authors that the circumferential variations exhibit a harmonic behavior, it is proposed here to adapt the NLHM to the throughflow model, where the main nonlinear system would be the common throughflow equations and the auxiliary system would give access to the circumferential stresses. As the numerical local explicit impermeability conditions are unsupported by Fourier series, the adaptation of this technique to the throughflow model relies on a reformulation of the blade effect by a smooth force field as in the “immersed boundary method” from Peskin [2002, “The Immersed Boundary Method,” Acta Numerica, 11, pp. 1–39]. A simple example of an inviscid flow around a cylinder will illustrate the preceding developments, bringing back the mean effect of the circumferential nonuniformities into the meridional flow.
Airfoil Deflection Characteristics During Rub Events
Authors: Turner Kevin E. , Dunn Michael , Padova Corso
Published: May 2011

The turbomachinery industry continually struggles with the adverse effects of contact rubs between airfoils and casings. The key parameter controlling the severity of a given rub event is the contact load produced when the airfoil tips incur into the casing. These highly nonlinear and transient forces are difficult to calculate and their effects on the static and rotating components are not well understood. To help provide this insight, experimental and analytical capabilities have been established and exercised through an alliance between GE Aviation and The Ohio State University Gas Turbine Laboratory. One of the early findings of the program is the influence of blade flexibility on the physics of rub events. The focus of this paper is to quantify the influence of airfoil flexibility through a novel modeling approach that is based on the relationship between the applied force duration and maximum tip deflection. Results from the model are compared with experimental results, providing sound verification.
A Low Power Wireless Data Acquisition Device to Monitor Gait Patterns for Children With Toe Walking During Daily Activities
Authors: Lou Edmond H. M. , Brunton Emma K. , Kamal Fraaz , Renggli Andreas , Kemp Kyle , Lewicke Justin , Sukhdeep Dulai , Watt Joe M. , Andersen John
Published: May 2011

Clinical gait analysis is the accepted “gold standard” for evaluating an individual’s walking pattern. However, in certain conditions such as idiopathic toe walking (ITW), the degree of voluntary control that a subject may elicit upon their walking pattern in a gait laboratory may not truly reflect their gait during daily activities. Therefore, a battery-powered, wireless data acquisition system was developed to record daily walking patterns to assist in the assessment of treatment outcomes in this patient population. The device was developed to be small (30×50×12 mm3), light-weight (15 g), easy to install, reliable, and consumed little power. It could be mounted across the laces of the shoe, while forces and walking activities were recorded to investigate the percentage of toe walking during the assessment. Laboratory tests were performed and preliminary clinical trials at a gait laboratory were done on six normal gait walkers. These volunteers also try to walk on their toes to simulate the toe walking at the gait laboratory. The system was able to track the gait pattern and determine the percentage of toe walking relative to normal gait. Three boys and one girl were diagnosed with ITW then participated into this study. A total of 4 sets thirty-three 10 min data sessions (5.5 h) were collected outside the laboratory. The results showed that the test subjects walked on their toes 70±4% of the total walking time, which was higher than that they performed 64±5% at the gait laboratory. This preliminary study shows promising results that the system should be able to use for clinical assessment and evaluation of children with ITW.
Internal Flow Losses: A Fresh Look at Old Concepts
Authors: Schmandt Bastian , Herwig Heinz
Published: May 2011

Losses in a flow field due to single conduit components often are characterized by experimentally determined head loss coefficients K. These coefficients are defined and determined with the pressure as the critical quantity. A thermodynamic definition, given here as an alternative, is closer to the physics of flow losses, however. This definition is based upon the dissipation of mechanical energy as main quantity. With the second law of thermodynamics this dissipation can be linked to the local entropy generation in the flow field. For various conduit components K values are determined and physically interpreted by determining the entropy generation in the component as well as upstream and downstream of it. It turns out that most of the losses occur downstream of the components what carefully has to be taken into account when several components are combined in a flow network.
Study on Performance and Flow Condition of a Cross-Flow Wind Turbine With a Symmetrical Casing
Authors: Fukutomi Junichiro , Shigemitsu Toru , Daito Hiroki
Published: May 2011

A cross-flow wind turbine has a high torque coefficient at a low tip speed ratio. Therefore, it is a good candidate for use as a self-starting turbine. Furthermore, it has low noise and excellent stability; therefore, it has attracted attention from the viewpoint of applications as a small wind turbine for an urban district. However, its maximum power coefficient is extremely low (10%) as compared to that of other small wind turbines. Prevailing winds in two directions often blow in urban and coastal regions. Therefore, in order to improve the performance and the flow condition of the cross-flow rotor, a casing suitable for this sort of prevailing wind conditions is designed in this research and the effect of the casing is investigated by experimental and numerical analysis. In the experiment, a wind tunnel with a square discharge is used and main flow velocity is set as 20 m/s. A torque meter, a rotational speed pickup, and a motor are assembled with the same axis as the test wind turbine and the tip speed ratio is changeable by a rotational speed controller. The casing is set around the cross-flow rotor and flow distribution at the rotor inlet and the outlet is measured by a one-hole pitot tube. The maximum power coefficient is obtained as Cpmax = 0.19 with the casing, however Cpmax = 0.098 without the casing. It is clear that the inlet and the outlet flow condition is improved by the casing. In the present paper, in order to improve the performance of a cross-flow wind turbine, a symmetrical casing suitable for prevailing winds in two directions is proposed. Then, the performance and the internal flow condition of the cross-flow wind turbine with the casing are clarified. Furthermore, the influence of the symmetrical casing on performance is discussed and the relation between the flow condition and performance is considered.
On the Modeling and Simulation of Ion Drag Electrohydrodynamic Micropumps
Authors: Mohammed Hasnain S. , Bakshi Akhilesh , Ravi Selvaganapathy P. , Ching Chan Y.
Published: May 2011

A numerical model for ion-drag electrohydrodynamic (EHD) micropumps has been developed. The Poisson and charge conservation equations are solved to determine the electric body force within the flow domain. The charge distribution at the electrodes is assumed to depend on the magnitude and the gradient of the electric field at the surface of the electrode. The flow field is then determined by solving the momentum equation with the inclusion of the electric body force. Simulations were performed for micropump configurations that consisted of a series of planar electrode pairs embedded along the bottom wall of a microchannel. A two-dimensional segment of the channel with a single electrode pair is simulated using periodic boundary conditions at the inlet and outlet for the charge and electric fields. An empirical model was developed to estimate the charge boundary condition for the simulations. The simulation results were in good agreement with existing experimental data. The model was then used to perform a parametric study of the effect of channel height on the pump performance.
Ultrahigh luminescence extraction via the monolithic integration of a light emitting active region with a semiconductor hemisphere
Authors: Wu S.-N. , Yu S.-Q. , Ding D. , Johnson S. R. , Zhang Y.-H.
Published: May 2011

A light emitting active region with three InGaAs quantum wells is monolithically integrated with a GaAs hemisphere as a means to increase the extraction efficiency of light emitting diodes. For a device with a small active region and large hemisphere and optimal antireflection, theoretical calculations show that the extracted fraction of spontaneous emission incident on the hemisphere is greater than 99.9% and the overall extraction efficiency of the integrated device is as high as 90%. The hemisphere is fabricated with a consistent aspect ratio (height versus width) using photoresist reflow and inductive coupled plasma etching. Detailed numerical simulations are performed to predict the reflow and dry etch processes as an aid to device fabrication. The fabrication results show that near perfect GaAs hemispheres can be successfully integrated with light emitting active regions and that the resulting light emitting diodes have the potential for mass production.
Time Is Not of the Essence
Authors: VanHook Annalisa M.
Published: May 2011

Opposing signals specify cell fate along the proximal-distal axis of the chick limb.
Sleepy Signal for Neurogenesis
Authors: Gough Nancy R.
Published: May 2011

The precursor of melatonin is a signaling mediator that stimulates the production of new neurons during sleep.
Bacteria Promote Repair
Authors: Gough Nancy R.
Published: May 2011

Commensal bacteria in the gut stimulate repair of the epithelial barrier by stimulating reactive oxygen species production and cell migration.
Susceptibility of
Streptococcus pneumoniae
to Fluoroquinolones in Canada
Authors: Patel Samir N. , McGeer Allison , Melano Roberto , Tyrrell Gregory J. , Green Karen , Pillai Dylan R. , Low Donald E. ,   for the Canadian Bacterial Surveillance Network
Published: May 2011

Ciprofloxacin, the first fluoroquinolone to be used to treat lower respiratory tract infections (LRTI), demonstrates poor potency against
Streptococcus pneumoniae
, and its use has been associated with the emergence of resistance. During the last decade, fluoroquinolones with enhanced
in vitro
activity against
S. pneumoniae
have replaced ciprofloxacin for the treatment of LRTI. Here, we analyzed the impact of more active fluoroquinolone usage on pneumococci by examining the fluoroquinolone usage, prevalence of fluoroquinolone resistance, and mutations in the genes that encode the major target sites for the fluoroquinolones (
gyrA
and
parC
) in pneumococcal isolates collected in Canada-wide surveillance. A total of 26,081 isolates were collected between 1998 and 2009. During this time period, total per capita outpatient use of fluoroquinolones increased from 64 to 96 prescriptions per 1,000 persons per year. The proportion of prescriptions for respiratory tract infection that were for fluoroquinolones increased from 5.9% to 10.7%, but the distribution changed: the proportion of prescriptions for ciprofloxacin decreased from 5.3% to 0.5%, and those for levofloxacin or moxifloxacin increased from 1.5% in 1999 to 5.9% in 2009. The prevalence of ciprofloxacin resistance (MIC ≥ 4 μg/ml), levofloxacin resistance, and moxifloxacin resistance remained unchanged at <2%. Multivariable analyses showed that prevalence of mutations known to be associated with reduced susceptibility to fluoroquinolones did not change during the surveillance period. If fluoroquinolone therapy is required, the preferential use of fluoroquinolones with enhanced pneumococcal activity to treat pneumococcal infections may slow the emergence of resistance in
S. pneumoniae
.
Epidemiological study of severe febrile reactions in young children in Western Australia caused by a 2010 trivalent inactivated influenza vaccine
Authors: Armstrong P K , Dowse G K , Effler P V , Carcione D , Blyth C C , Richmond P C , Geelhoed G C , Mascaro F , Scully M , Weeramanthri T S
Published: May 2011

Background

The 2010 influenza vaccination program for children aged 6 months to 4 years in Western Australia (WA) was suspended following reports of severe febrile reactions, including febrile convulsions, following vaccination with trivalent inactivated influenza vaccine (TIV).

Methods

To investigate the association between severe febrile reactions and TIV, three studies were conducted: (i) rates of febrile convulsions within 72 h of receiving TIV in 2010 were estimated by vaccine formulation and batch; (ii) numbers of children presenting to hospital emergency departments with febrile convulsions from 2008 to 2010 were compared; and (iii) a retrospective cohort study of 360 children was conducted to compare the reactogenicity of available TIV formulations.

Findings

In 2010, an estimated maximum of 18 816 doses of TIV were administered and 63 febrile convulsions were recorded, giving an estimated rate of 3.3 (95% CI 2.6 to 4.2) per 1000 doses of TIV administered. The odds of a TIV-associated febrile convulsion was highly elevated in 2010 (p<0.001) and was associated with the vaccine formulations of one manufacturer—Fluvax and Fluvax Junior (CSL Biotherapies). The risk of both febrile convulsions (p<0.0001) and other febrile reactions (p<0.0001) was significantly greater for Fluvax formulations compared to the major alternate brand. The risk of febrile events was not associated with prior receipt of TIV or monovalent 2009 H1N1 pandemic vaccine. The biological cause of the febrile reactions is currently unknown.

Interpretation

One brand of influenza vaccine was responsible for the increase in febrile reactions, including febrile convulsions. Until the biological reason for this is determined and remediation undertaken, childhood influenza vaccination programs should not include Fluvax-type formulations and enhanced surveillance for febrile reactions in children receiving TIV should be undertaken.
Exploring the transition from curative care to palliative care: a systematic review of the literature
Authors: Gardiner Clare , Ingleton Christine , Gott Merryn , Ryan Tony
Published: May 2011

Background

UK policy guidance on treatment and care towards the end of life identifies a need to better recognise patients who are likely to be in the last 12 months of life. Health and social care professionals have a key role in initiating and managing a patient's transition from ‘curative care’ to palliative care. The aim of this paper is to provide a systematic review of evidence relating to the transition from curative care to palliative care within UK settings.

Method

Four electronic databases were searched for studies published between 1975 and March 2010. Inclusion criteria were all UK studies relating to the transition from curative care to palliative care in adults over the age of 18. Selected studies were independently reviewed, data were extracted, quality was assessed and data were synthesised using a descriptive thematic approach.

Results

Of the 1464 articles initially identified, 12 papers met the criteria for inclusion. Four themes emerged from the literature: (1) patient and carer experiences of transitions; (2) recognition and identification of the transition phase; (3) optimising and improving transitions; and (4) defining and conceptualising transitions.

Conclusions

The literature suggests that little is known about the potentially complex transition to palliative care. Evidence suggests that continuity of care and multidisciplinary collaboration are crucial in order to improve the experience of patients making the transition. An important role is outlined for generalist providers of palliative care. Incorporating palliative care earlier in the disease trajectory and implementing a phased transition appear key components of optimum care.
What challenges good palliative care provision out-of-hours? A qualitative interview study of out-of-hours general practitioners
Authors: Taubert Mark , Noble Simon I R , Nelson Annmarie
Published: May 2011

Background

Not much is known about how general practitioners (GPs) who work regular out-of-hours shifts in the community feel about prescribing medication for symptom control in end-of-life care patients, how they gain palliative care experience and what they perceive as benefits and hindrances within service delivery to this vulnerable patient and carer group.

Objectives

To determine, by interviewing GPs who provide out-of-hours care, aspects of care provision that augmented or challenged palliative care delivery.

Methods

Semistructured interviews were conducted with GPs who worked out-of-hours shifts regularly. All interviews were analysed using interpretative phenomenological analysis.

Results

Out-of-hours doctors were not confident about their palliative care knowledge and expressed a wish for more education. Lack of familiarity with patients requiring acute palliative care, compared with the closer bonds formed within the in-hours general practice setting, was perceived as troublesome and problematic, and lack of follow-up was felt to be a major factor. There was a clearly expressed fear of killing or harming patients with the strong drugs used in palliative care. Opiophobia, especially when faced with patients who were seen only once, affected prescribing decisions.

Conclusions

This study provides further evidence of the needs of a specific subgroup of GPs. In-depth interview analysis of their experiences with palliative care provides a framework for which aspects are perceived as a hindrance in providing good palliative care, and can inform out-of-hours policy and teaching.
A Cochrane systematic review of acupuncture for cancer pain in adults
Authors: Paley Carole A , Tashani Osama A , Bagnall Anne-Marie , Johnson Mark I
Published: May 2011

Background

Cancer-related pain is a significant and debilitating problem. Non-pharmacological treatments such as acupuncture may have an adjunctive role in controlling pain without the undesirable side effects of drug regimens and yet the evidence base remains limited.

Objectives

The main objective of this systematic review was to evaluate the effectiveness of acupuncture in the management of cancer-related pain in adults. Subgroup analyses were planned for acupuncture dose and for the outcome of studies investigating acupuncture for cancer-induced bone pain.

Methods

Six electronic databases were searched, including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, AMED and SPORTDiscus. Studies included in the review were randomised controlled trials investigating the use of acupuncture for cancer pain using pain as a primary outcome measure. In total, 253 published references were identified but only three studies met the inclusion criteria and were included in the final review.

Results

Of the three included studies, only one was judged to be of high methodological quality and showed auricular acupuncture to be superior to placebo acupuncture and ear seeds at placebo points. However, the study was relatively small and blinding was compromised. The two low-quality studies gave positive results in favour of acupuncture for cancer pain, but these results should be viewed with caution due to methodological limitations, small sample sizes, poor reporting and inadequate analysis.

Conclusion

There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.
What questionnaires exist to measure the perceived competence of generalists in palliative care provision? A critical literature review
Authors: Frey Rosemary , Gott Merryn , Banfield Rachel , Campbell Taima
Published: May 2011

Background

The increase in the numbers of patients requiring palliative care input prior to death, and a global economic situation where few countries are able to invest further in specialist palliative care services, has meant an increased focus upon ‘generalist palliative care provision’. The goal of the present review is to ascertain what questionnaire tools exist to measure the perceived competence of generalists in palliative care provision.

Method

A systematic review of both qualitative and quantitative literature was undertaken. Medline, Medline in Progress, PubMed and CINAHL databases as well as hand searches ofPalliative Medicine,International Journal of Palliative Nursingand theJournal of Palliative Carewere conducted for the period 1990–2010. A checklist adapted from Hawkeret al(Appraising the evidence: reviewing disparate data systematically.Qual Health Res2002;12:1284–99) was used to select and assess data.

Results

19 of the 1361 articles met the inclusion criteria. Overall, a lack of validation and a focus upon the physical aspects of symptom management was apparent. No single validated questionnaire to measure perceived competence in palliative care management among health professionals involved in generalist palliative care management could be identified.

Conclusion

The rising prominence paid to generalist care provision points to an urgent need for further development of comprehensive and validated perceived competence measurement tools.
Honouring the informed choices of persons coming to the end of life
Authors: Colorado J Lynn
Published: May 2011

This presentation gives participants the opportunity to review major conceptual insights into planning care for serious illness, starting from the demand for honesty about the options, working through the challenges of having so few cultural landmarks for long-term illness with ambiguous timelines, and addressing the changing challenges of caregiving. Categorizing trajectories of illness allows mass customization of service arrays and appears to be especially useful in making appropriate services readily available. But still, patient and family preferences must determine the actual course, so some practical pointers on how to frame and elicit those conversations will be in order. I close with some very challenging issues: assuring quality in the timeliness of death; defining quality of care plans across settings; and conceptualizing quality in unique situations. These issues are still unsettled, but the requirement to plan ahead in order to honour the informed choices of persons living with fatal illness is a settled mandate of good care.
Advance care planning in Japanese nursing homes
Authors: Nishikawa M , Nakashima K , Miura H , Endo H , Toba K
Published: May 2011

Background

Japan has the highest rate of aging worldwide. In Japan, the Ministry of Health, Labour and Welfare is concerned that there are insufficient doctors to care for the elderly in nursing homes and also insufficient advance care planning (ACP). In Japan, the study of the ACP at the nursing home just still started.

Purpose

The study aim was to evaluate the utility of ACP at the nursing home, supported by an ACP clinician trained in the National Centre for Geriatrics and Gerontology in Japan.

Methods

Out of 80 families of nursing home residents, 51 participated in this study with all attending a lecture about ACP.

We investigated the following:

Do the families of the residents prefer the nursing home as the place for the residents' last moments?

Would the families like the residents to use mechanical ventilators, gastric feeding tubes, blood transfusion, intravenous infusion or sedative drugs in their terminal states?

Do the families prefer to care for the residents on their deathbeds at the nursing home, even if death certificates are not promptly issued because the nursing home does not have any full-time doctors?

Results

Intervention by a trained ACP clinician significantly increased the number of families who chose terminal care at the nursing home, and the nursing home as the place for the residents' last moments, even if death certificates are not promptly issued (p<0.01).

Conclusion

A trained ACP clinician is useful for ACP in the nursing home.
Delaying cognitive decline in nursing home residents with mentally stimulating and physical activities: a randomized controlled trial
Authors: Cheng S T , Chow P
Published: May 2011

Objectives

Nursing homes, especially those in developing countries, are understaffed and favor physical over psychosocial care. However, leisure activities, especially those that can be run with little professional staff cost, may be highly beneficial. This study examined the effects of mentally stimulating (mahjong) and physical (Tai Chi) leisure activities on the cognitive functioning of nursing home residents.

Methods

110 residents from six nursing homes in Hong Kong were randomized into three conditions: (a) mahjong, (b) Tai Chi and (c) handicrafts (placebo). Inclusion criteria were Mini-Mental State Examination (MMSE) ≥10 and ≤24, and suffering from at least very mild dementia (Clinical Dementia Rating (CDR) ≥0.5). Exclusion criteria were audio/visual impairment, and contraindication to do mahjong or Tai Chi. Each activity was carried out three times a week over a 3-month period. Outcome measures including MMSE, verbal memory (both immediate and delayed recall), digit memory (forward and backward), categorical fluency and CDR were collected at baseline, post-treatment (3 months), 6 months and 9 months.

Results

There were moderate effects of mahjong on all outcome measures except CDR up to 6 months, but no benefits for the Tai Chi group over the placebo.

Conclusion

Leisure activities can be highly beneficial even for older adults with significant cognitive impairment and frailty. This study provides strong evidence for the effectiveness of mahjong in maintaining cognitive abilities in this population. It can be implemented in nursing homes with minimal staff cost. While this was a time-limited intervention, regular mahjong activities should provide long-term benefits.
A survey of opinion regarding wishes toward the end-of-life among thai elderly
Authors: Srinonprasert V , Kajornkijaroen A , Kornbongkotmart S , Praditsuwan R
Published: May 2011

Advance-care-planning has not been a popular concept among eastern countries despite of the growing awareness in western world. In order to provide optimal end-of-life care, the patients' wish is an essential component but unfortunately is often impossible to seek for when the time is approached. We surveyed older people attending Geriatric clinic at Siriraj Hospital to enquire their wishes concerning end-of-life in hoping of carry out proper care in this regard.

All of the participants were Buddhism with mean age of 75.8 (7.8).

Approximately half of subjects had less than 4 years of education, 75% were female and 31% rated themselves as being in good health. Majority of elderly wanted to know the truth of their physical condition, to be involved in decision making or name a decision maker. Freedom from suffering symptoms and unfinished business, presence of love one and being mentally aware near the time of death were attributes rated as highly important in most participants. 75% did not want to receive treatments to prolong life when chance of surviving is slim.

Interestingly, 55% of elderly did not want to die at home and 32% did not wish to have any religious ritual conducted near the time of death.

Having less than 4 years of education was the only factor that found to be significantly associated with unwilling to die at home with OR of 2.89 (95%CI 1.10 to 10.71) after adjusted in multivariate analysis.
An experience of a care home in northeastern Brazil
Authors: Rebelo M
Published: May 2011

Home care in Brazil is still precarious. In most regions, it is restricted to treatment of patients with low complexity performed by primary care with the intention of prevention and promotion health. Until 2010, there was not a national policy for home care patients with greater complexity. In most cases they remained hospitalized or care poorly in their houses, suffering from recurrent hospitalizations.

On March 19 last year, the Institute of Medicine Professor Fernando Figueira with the secretary of health of the city of Recife, started one Home Care Services. Already received 139 patients, aged between 13 and 101 years, with various pathologies, children with cerebral palsy, young adult sequelae of gunshot trauma, bedridden woman infected with HTLV, oncology patients and elderly patients with dementia. As a result of this care, there was a reduction in the rate of emergency room visits, hospitalizations, in addition to improved quality of life. Also the quality of death, because it was possible to die at home without having to be referred to the autopsy service to receive the death certificate. But we believe that the best achievement was to show that the daily cost of this service is 10 times smaller than the ICU and three times smaller than a hospital bed. With this we motivate an argument for deployment of a national policy.
Enhanced nursing aides for enhanced care in nursing homes
Authors: Tan W K , Tan G
Published: May 2011

In Singapore, past efforts to develop the capacity and capability in palliative care among health care workers have largely excluded nursing aides, the non-regulated segment of the health care rank and file. More recently, nursing homes in Singapore are eager to use the palliative care approach in the care of the frail elderly. These are largely attended to by nursing aides, supervised by qualified nurses. In January 2010, a part-time 48-h Palliative Care course for Nursing Aides was conducted over 19 sessions. It was designed to prepare selected nursing aides of a nursing home in anticipation of an expanded new residential facility being planned.

A face-to-face individual interview was conducted with the participants 6 months post-course. Open-ended questions based on the learning objectives asked for actual examples that illustrated the application of the new knowledge. Participants gave very heartening narratives that showed understanding of palliative care concepts. For example, one said, the course has ‘opened my heart’; another said she felt she was gave hope to her residents who were depressed and afraid; yet another shared that she was able to show care and lead patient to peaceful death; importance of family involvement and comfort during the last days.

Their supervisor reported observations which indicated positive behavioural changes for example, more observant of patients' symptoms, more interested in learning to cope with complex problems, more gentle with the very frail.

The training was worthwhile when the nursing aides expressed deep appreciation for the learning opportunity which has enabled them to give better care to the residents using the palliative care approach.
Hoping for a cure and planning for end-of-life
Authors: Robinson C
Published: May 2011

Objective

Advance care planning (ACP) aims to enhance end-of-life care yet often fails to live up to that potential. This interpretive study was designed to explore the process and outcomes of ACP using the Patient-centered ACP interview (PC-ACP) developed by Respecting Choices.

Method

Patients diagnosed with advanced lung cancer and family members were recruited. Nine family dyads participated in the PC-ACP interview. Follow-up interviews took place 3 and 6 months after the PC-ACP interview. Thematic analysis was conducted on transcribed interviews using constant comparison.

Results

Hope was a significant theme in the ACP process and this paper reports on that theme. Hope for a cure was one of many hopes that supported quality of life. Three themes were identified: hope is multi-faceted, hope for a cure is well considered and hope is resilient and persistent. The seeming paradox of hoping for a cure of an incurable cancer did not interfere with the process of ACP. The dyads engaged in explicit discussions of end-of-life scenarios and preferences for care. ACP did not interfere with hope and hope for a cure did not interfere with ACP.

Significance

Concerns about false hope are called into question. The principle of honouring hope is not necessarily in conflict with the principle of truthful communication. This is clinically significant as the findings suggest we need not disrupt hope we think of as ‘unrealistic’ as long as it supports living well. Further, ACP can be successful even in the context of hoping for a cure.
Increase the qualities of hospice care in ICUs
Authors: Tsai Y M , Hnug L C , Lee P Y , Hsu S F
Published: May 2011

The concept of hospice care in critical care unit is to provide a ‘good death’ to patients with terminal illness. The purpose of this project was to promote the quality of hospice care in critical care units. According to the investigation, we found that nurses in ICUs do not follow the SOP of hospice care, lack of audit and quality control, lack of knowledge of hospice care of critical care, those reasons cause the low satisfaction rate of hospice care of nurses in critical care unit.

We developed the checklist of the signs and symptoms of pre-dying, a brochure for families including useful information of S/S of dying and funeral, beauty package for nurses to use for patient beauty at the end of life, arrange lecture of hospice care of critical care unit. Through the above activities, the Implementation rate of hospice care in ICUs was 100%, the satisfaction rate of nurses increased to 4.2, the score of quality of hospice care increased 25%. We expected the result of this project can provide some ideas of hospice care in ICUs then promote the qualities of hospice care in ICUs.
The role of palliative and end-of-life clinical nurse specialist in accident and emergency and the acute medical unit
Authors: Brockis H
Published: May 2011

A Clinical Nurse Specialist (CNS) was employed in a pilot role based in A&E/AMU at Heatherwood and Wexham Park NHS Foundation Trust (9–5 Monday to Friday) caring for patients who had palliative and end of life care needs The post holder undertook a holistic assessment of patient and family needs and developed a plan of care including guidance of life expectancy, Symptom management, Do Not Attempt Cardio-pulmonary Resuscitation status (DNACPR) and preferred place of care communicating this to the patients, GP, Care home, Community and hospital teams and families.

Data re source of referral and interventions was collected on a daily basis onto an excel spreadsheet, according to Caldicott principles to aid evaluation of the outcomes of the role.

Evaluation of the pilot has shown that;

(A) 15% patients can be assessed and with early development of a care plan communicated to other agencies, discharged from A&E/AMU back to care home, home or directly to a hospice thereby ensuring that care occurs in the preferred place. This also reduces inappropriate hospital readmissions.

(B) The length of stay for those patients who clinically need admission is reduced to 8 days (against an SHA average of 18).

(C) The 14% of patients that died in A&E/AMU received expert.

symptom management and family support.

(D) A&E/AMU staff received support, training and modeling of good practice.

Through an evaluative questionnaire the pilot has demonstrated improved patient and staff experience and satisfaction.
Life before death: living well, leaving well
Authors: Lee P W
Published: May 2011

The ‘Life Before Death’ initiative is conceived and spearheaded by a Singapore philanthropic foundation to advocate and create greater awareness of the need to improve care for the dying.

First conceived as a local campaign in Singapore in 2006, ‘Life Before Death’ has evolved as an ongoing social experiment that harnesses unconventional online and offline initiatives to break the taboo of death and to foster ‘die-logues’ or conversations on end-of-life matters.

The Singapore initiative reached out to the terminally ill and their caregivers using print advertisements, radio talk shows, newspaper editorial features, TV documentaries and a caregiver's diary. A national street poll on death attitudes was conducted to spur ‘die-logues’ on end-of-life issues.

Today, the initiative works with diverse partners to reach a wider global audience through social media, films, photography, cartoons and art, enthusing the public to view life and death differently. A recent project, ‘Happy Coffins’, allowed people to personalize coffins for themselves or a loved one, and by so doing, overcome the stigma of death.

The Foundation commissioned the first-ever global Quality of Death index that ranked 40 countries on their provision of end-of-life care. In the pipeline is an international feature documentary that examines the global crisis of untreated pain and end-of-life care. Shot in 10 countries, the film has attracted diverse participation from 40 nationalities.

This initiative demonstrates how a ground-up non-profit effort can create conversations and greater awareness of end-of-life care, as well as spur advocacy for better care for the dying
The impact on the place of death through advance care planning documentation in heart failure and end stage respiratory disease patients
Authors: Chadwick S , Miller B , Russell S
Published: May 2011

A retrospective review was performed of 23 respiratory (n=21) and heart failure (n=2) hospice patient notes, who died between 1 January 2009 and 31 June 2010, (12 women, 11 men: 54–92 years). All the notes included letters documenting advance care planning (ACP) preferences and decisions (eg, preferred place of care (PPC) and/or death (PPD), treatment preferences, resuscitation status etc).

78% (18/23) of deaths were achieved in the preferred place of death or care as documented in ACP letters or the ongoing ACP process

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13/23 (57%) patients achieved their documented PPD (9/23 Home, 4/23 Hospice).

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4/23 (17%) patients did not achieve their initial documented PPD but died in the Hospice.

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1/23 (4%) patients died in their PPC (hospital) as they had requested admission for treatment of potentially reversible causes including ITU.

2/23 (9%) were sudden deaths at home for patients who had otherwise requested admission for treatment of potentially reversible causes.

2/23 (9%) were deaths in hospital for patients admitted for treatment who died while inpatients (one for blood transfusion; one reason unknown).

1/23 (4%) place of death was unknown.

16/18 (89%) patients did not die in hospital as requested.

This review provides evidence that ACP conversations and documentation influence patient's attainment of their preferred place of death, including not dying where they don't want to. When implementing ACP, consideration should be given to where people want to die, where they do not and their preferred places of care.
Current status and physician's attitude toward advance care planning in hospice palliative care units in Japan
Authors: Kizawa Y , Shima Y , Tsuneto S
Published: May 2011

Objective

To examine the current status and physicians' attitude toward ACP in PCU in Japan.

Method

We conducted a questionnaire survey and retrospective chart review of 203 certified PCU in December 2010.

We received permission to perform a retrospective chart review of ACP before and during admission, and who made the decision to admit a patient into the hospice palliative care program for the last 3 patients who died before 30 November 2010 in each PCU. Physicians working in the PCU were asked to complete a questionnaire regarding their attitude toward, and practice of ACP.

Main results

Among 203 PCUs contacted, 95 participated (response rate 47%). 285 patients were reviewed. The percentage of patients for whom their physicians expressed their intentions regarding implementation of CPR, mechanical ventilation, antibiotics, tube feeding, artificial hydration and Power of Attorney of health care prior to admission to PCU was 44%, 44%, 9%, 15%, 29% and 41% respectively. However during their admission this increased to 47%, 46%, 19%, 18%, 43% and 49% respectively. 70% of patients had a physician's order to implement DNAR and 44% of families consented to implementation of the DNAR order without discussing the issue with the patient. We also assessed physicians' attitudes toward and practice of ACP.

Conclusions

This study will clarify the current status of and physicians' attitude toward ACP in PCU in Japan, and provide evidence of the unique cultural diversity toward end-of-life care and ACP among Japanese.
Linking human rights with advance care planning
Authors: Tehan M
Published: May 2011

There are five Human Rights Standards related to Palliative Care 9Open Society Institute Human Rights Standards (2007)). Are these Human Rights Standards compatible with Advance Care Planning?

This presentation will outline the Human Rights Standards related to palliative care and link them to Advance Care Planning. In addition, the presentation will address identifiable, unmet Human Rights needs pertaining to an Advance Care Plan (as per Victoria, Australia).
End-of-life PSP module in BC
Authors: Clelland C , McGregor D
Published: May 2011

The GP Services Committee (GPSC) is a joint Ministry of Health – BC Medical Association committee with the mandate of improving Primary Care in British Columbia. The Practice Support Program (PSP) was developed to encourage and support Family Physicians to undertake QI initiatives.

While the initial modules targeted family practice, in December 2010, the PSP expanded to a broader program designed to integrate Family Practice, Palliative Care, Specialty Care and Home and Community Care around improving the provision of end-of-life services for patients and their families. Two major components of this module are:

(1)

Advance Care Planning using the ‘My Voice’ tool developed by BC Fraser Health Authority

(2)

Foundational concepts for identification, assessment and planning taken from the UK Gold Standards Framework.

Provincial legislation on ‘Advance Directives’ is to be implemented in BC later in 2011. Family physicians, specialists, their staff and front line health care providers are being trained and supported by Regional Support Teams to facilitate colleagues undertaking the End-of-Life PSP module across BC. The goal is to improve the use of ACP, communications, collaboration of care provided by the full healthcare.

Tools have been developed to assist family physicians in shifting to a palliative approach to care and increase their comfort in undertaking advanced care planning with patients identified on their registry. This poster board will highlight both the PSP process as it promotes Advance Care Planning in BC as well as demonstrate some of the electronic tools that have been developed to support End-of-Life Care.
Reasons cited by ESRD patients and caregivers for withdrawal from hemodialysis
Authors: Two S N , Hu W Y , Lee H T S
Published: May 2011

The aim of the study was to explore the reasons End Stage Renal Disease (ESRD) patients and caregivers withdraw from hemodialysis in South Taiwan. Semi-structured interviews were conducted with three patients and three caregivers individually, and analyzed by a content analysis method.

The study found patients and caregivers each had five different concerns influencing the decision to withdraw from hemodialysis. For the patients, these were as: (1) Patients would like to continue hemodialysis, but trust their doctor's judgment in recommending the treatment be discontinued. (2) Physical deterioration (3) Lack of access to hemodialysis (4) The burden on the family (5) Lack of value or dignity in their lives. Caregivers' concerns were: (1) Self-criticism and self-blame for giving up on patients (2) Respect for patients' own decisions (3) The economic burden on the family (4) The suffering caused to the patient by disease progression (5) Respect for the opinions of medical professionals. The findings suggest that ESRD patients and caregivers have quite different reasons for withdrawing from hemodialysis. Advance care planning should provide clear information about disease progress and medical treatment options, and help ESRD patients and caregivers openly express their anxieties and opinions, empathizing with one another while making decisions for end of life care.

In conclusion, the study has revealed a range of concerns from hemodialysis patients and caregivers. As medical professionals, we should initiate discussion on advance care planning to help patients and caregivers clarify their ideas and reach informed agreement on the decision to withdraw from hemodialysis.