bluuebunny/crossref_metadata_2025 huggingface dataset:
ADVANCE CARE PLANNING IN JAPANESE NURSING HOMES-USEFULNESS OF END-OF-LIFE CARE TEAM
Authors: Nishikawa M , Yokoe Y , Kubokawa N , Fukuda K , Hattori H , Yong-Jae H , Miura H , Endo H , Nakashima K
Published: April 2013

Background

Although advance care planning (ACP) in nursing homes is important, the best means of promoting it in Japan remains to be clarified.

Aim

The primary aim of this study, which was supported by trained ACP clinicians who are members of end-of-life care teams, was to clarify the usefulness of clinical strategies, such as a lecture about ACP and a multi-occupational interview regarding ACP in nursing homes. The secondary aim was to evaluate the quality of life (QOL) for families of residents who had died in nursing homes as per their wishes.

Methods

Out of 108 families of nursing home residents, 59 participated in the lecture. Among the families of residents left the nursing home, we have conducted a multi-occupational interview with 14 families, and investigated the QOL for 13 bereaved families of residents who had died in nursing homes as per their wishes.

Results

Out of 14 families of nursing home residents who received a multi-occupational interview, 13 residents died in the nursing home in accordance with the patient' wishes. Intervention by clinical strategies significantly increased the number of residents dying in nursing homes as per their wishes (p<0.01). The QOL of the bereaved was maintained.

Discussion

The most important finding was that the residents' wishes were respected.

Conclusion

Clinical strategies are more useful in promoting nursing home ACP.
ISSUES ASSOCIATED WITH DELIRIUM SEVERITY AMONG OLDER PATIENTS
Authors: Rajaram S , Chua H C , Lim S T
Published: April 2013

This article has been retracted.
PATIENTS WITH DYSPHASIA: ENCOUNTERS IN TAKING MEDICATION
Authors: Rajaram S , Chua H C , Fu X
Published: April 2013

This article has been retracted.
IMPROVING THE ROUTINE UPTAKE OF ADVANCE CARE PLANNING (ACP) DISCUSSIONS IN MANY SETTINGS AS PART OF GSF TRAINING PROGRAMMES IN END OF LIFE CARE
Authors: Thomas K , Stobbart Rowlands Maggie , Giles L , Thorn M , Bloomer C
Published: April 2013

Background

Advance Care Planning is introduced as an integral part of The Gold Standards Framework (GSF) Training Programme in end-of-life care in the UK, in a variety of settings. GSF enables a systematic way to deliver the ‘right care, for the right person, in the right place at the right time’ and is extensively used across the UK (eg, over 2000 GSF-trained care homes).

There is increased uptake of ACP, but is this the case in different settings?

Aim

To demonstrate change in end-of-life care in several settings including routine use of ACP discussions, as part of the GSF Training and Accreditation programmes, These include:-

Care homes (ACF)

Primary care

Acute hospitals

Domiciliary care

Community hospitals

To describe increase ACP in GSF care homes.

Methods

Evaluation findings following GSF training in End of life care and Accreditation in five settings are described, with illustrations and quantitative and qualitative examples.

Results

Increased uptake of ACP discussions was enabled in all settings, with comparative results described. Particularly high results (over 95%) were from care homes, where the GSF Accreditation standard is that “every resident is offered an ACP discussion.”

Discussion

Use of training to increase staff confidence, competence and organisation of care can be used extensively across many settings to support better relationships with patients near the end of life, enabling more ACP discussions, leading to better quality end of life care

Conclusion

Routine staff training in EOLC and assessment/accreditation of organisations leads to widespread improvements in care.
TALKING ABOUT END OF LIFE: MARKETING ADVANCE CARE PLANNING TO RESIDENTIAL AGED CARE FACILITIES
Authors: Piercy J , Walker H , Prior T , Buchanan G , Greeve Kim
Published: April 2013

Background

Of the 143 932 Australians who die each year, 10% die in residential aged care facilities (RACFs). 25% of these deaths occur within 6 months of admission. Frequently residents are transferred to hospital at the end of life.

Aim

To assist RACF staff to

identify residents with irreversible deteriorating conditions.

facilitate case conferences to record resident's and family's wishes

record advanced care plans (ACPs)

respond to and enact ACPs.

Methods

The Talking about end of life programme was branded and marketed to RACFs resulting in an inundation of registrants. To translate theory to practice, training was delivered to link teams from each RACF. Tailored mentoring encouraged ACP, team building, ongoing education and death reviews. Pre and post intervention surveys revealed ACP practices.

Results

Project results include increased numbers of ACPs and less residents transferred to hospital to die. Enablers and barriers to success were identified. Where ACPs were developed, staff experienced increased satisfaction in caring for residents in the terminal phase.

Discussion

The need and desire for training in ACP and care of the dying within RACFs was evident by the overwhelming response. Willingness of general practitioners to discuss end of life issues was pivotal to success. Risks included sustaining the trained workforce and supportive systems. Direct benefits of ACP to residents and families needs further exploration.

Conclusion

The programme's marketing strategy was successful. Training alone is not enough, a systems approach to modifying and improving practice is essential to ACPs becoming routine practice in RACFs.
KNOWLEDGE AND ATTITUDES ABOUT ADVANCE CARE PLANNING AMONGST AN OLDER ADULT POPULATION LIVING IN SOUTH EAST QUEENSLAND
Authors: Crowe L , Boddy J , Chenoweth L
Published: April 2013

Background

The introduction of Advance Care Planning (ACP) in the hospital context when people are ‘vulnerable and unwell’ is challenging. The ‘Creating pathways to advance care planning: empowering the health consumer’ research and education project explored the knowledge base of people aged 60 years and over living in the community. Current knowledge on ACP and associated terms and legislation prior and post to a community education programme were investigated.

Aim

To understand and improve the knowledge and attitudes of people over the age of 60 years to ACP in South East Queensland.

Methods

Employing intervention and control groups n=150 people participated in community education. Both groups completed a pre-questionnaire to ascertain their knowledge base on ACP. Participants then engaged in an interactive training programme on ACP. Post questionnaires were completed following the education and 4–6 months after the training.

Results

While the majority of participants were familiar with terms related to ACP most were not able to articulate what the terms meant. Participants were confused by the paperwork with many hoping their relatives or doctors would ‘work it out for them’. Participants found the education empowering with many engaging in formal and informal ACP following the workshops.

Discussion

Despite growing awareness of ACP, medical terminology and legislative requirements continue to be misunderstood. Although wanting to remain independent, participants perceived that there were too many barriers to engaging in ACP prior to engagement in the training.

Conclusion

ACP continues to be confusing and overwhelming to people over the age of 60 years living in the community and there is a significant role for community education.
ADVANCE CARE PLANNING AND THE LAW: UNINTENDED BARRIERS
Authors: Cartwright C , Brownie S
Published: April 2013

Background

Under the Australian Constitution, each state/territory of Australia has responsibility for developing its own health law. Over the last 25 years, Advance Care Planning legislation in Australia has developed at a different rate, and with different emphasis, in each state/territory, resulting in different legislation, documentation and terminology in each state/territory. While there is some support for more national consistency, it is important to understand the current legislative provisions and the often unintended barriers to some aspects of ACP created by the law in various jurisdictions.

Aim

The aim of this project was to compare legislation across each state/territory, to support two national information seminar series across Australia in 2011 and 2012.

Methods

ACP legislation was examined and compared for each state/territory. As part of the seminar series, stakeholders in each state/territory were asked to alert the presenter if their understanding of their legislation was different to what was presented. When this happened, the presenter subsequently clarified the issue.

Results

Issues were identified in most states/territories that could be disincentives to effective ACP.

Discussion

Problems identified included incorrect assumptions in NSW and Tasmania that Advance Directives were not legally binding; confusion in NSW about the authority of the Person Responsible to refuse life-sustaining treatment; and inherent problems in South Australia resulting from there being no order of authority for substitute decision-makers.

Conclusion

Ensuring individual wishes/directions for future health care/medical treatment are respected requires that problems with state/territory legislation be addressed as a matter of urgency.
PROMOTING ADVANCE CARE PLANNING TO REDUCE THE IMPACT OF DEMENTIA: A NEW WEB RESOURCE FROM ALZHEIMER'S AUSTRALIA
Authors: Shanley C
Published: April 2013

Background

Advance care planning (ACP) is a particularly important issue within dementia care because many people lose the capacity to make their own decisions during their dementia journey.

Aim

This project, funded by the Dementia Consumer Research Network within Alzheimer's Australia, aims to improve the promotion and uptake of advance care planning for people with dementia in primary and community care.

Methods

The project involves a nationally-focused website, promoted through a broadly based social marketing campaign. Needs assessment involved extensive consultations with both consumers affected by dementia and professionals across Australia as well as an online survey with 249 respondents.

Results

Key aspects of the website are: it moves beyond providing information to include a number of consumer-focused templates that help users take action related to planning ahead; it provides information for people living with dementia and their family carers, healthcare professionals and the general community; and it has information and resources relevant for all States and Territories.

Discussion

While the website caters to people with early dementia and family carers, it also targets people in the general community who do not have dementia, as ACP is most helpful if done before a person starts to lose capacity through dementia. The project will enlist a number of State and National organisations as campaign supporters to promote a set of core messages about ACP and the website.

Conclusion

Dementia can have a devastating impact on individuals and families, and this new programme to promote ACP will help to reduce that impact.
INVOLVING PEOPLE LIVING WITH DEMENTIA IN RESEARCH: WHAT ARE THE ETHICAL ISSUES AND HOW IS IT COVERED IN ADVANCE CARE PLANNING?
Authors: Doyle C , Dowson L , Roberts G
Published: April 2013

Background

While we strive to involve people living with dementia (PWD) in their own health care decision making to the extent that their capacity permits, guidelines for their involvement in research which may not have an immediate personal benefit are less evident. Dementia is a national health priority in Australia, but significant gaps remain in our understanding of how best to involve PWD in research and how to address the issue in advance care planning.

Aim

This paper summarises research into the questions of what are the ethical issues about involving PWD in research?

Methods

A narrative literature review was conducted and analysed with reference to the Australian National Statement on Ethical Conduct in Human Research.

Results

The review can be summarised under the following themes: substitute judgement; how capacity can vary due to risks; barriers to recruiting people with dementia; how to determine capacity to give consent; and gaining assent rather than consent from participants. The results of the review were further analysed in relation to the current guidelines for research and existing guides for developing advance care plans.

Discussion

Gaps in the National Statement included: how capacity should be determined; what defines best interests; how assent and dissent by someone with dementia should be determined and respected; and whether or not people with dementia should be included in high-risk research.

Conclusion

Researchers, ethics committees, health care professionals, PWD and their carers need better guidance about how to address this issue in advance care plans.
REVIEW OF THE INTRODUCTION AND AUDIT OF THE USE OF THEACUTE RESUSCITATION PLANAND RELATED DOCUMENTS TO ENHANCE END-OF-LIFE CARE ACROSS THE TOWNSVILLE HOSPITAL, A LARGE TERTIARY HOSPITAL IN PROVINCIAL QUEENSLAND
Authors: Cairns W , Maluga Y , Lane P , Aitken P , Howe D
Published: April 2013

Background

Historically many of the medical orders concerning end-of-life (E-o-L) care and ‘not for resuscitation’ (NFR) were inadequate as they did not include evidence of the decision making process or the wishes and capacity of the patient. The introduction in Queensland of the Advance Health Directive and Enduring Power of Attorney (AHD and EPOA)(1998) and the Acute Resuscitation Plan (ARP) (2009)—and the Paediatric ARP (PARP)(2012) – has changed the care delivered to dying patients.

Aim

To review the impact of the introduction of the use of the ARP and the PARP across The Townsville Hospital, a tertiary hospital in provincial Queensland.

Methods

The use of the ARP or satisfactory equivalent documentation was audited in the medical records of all people who died in The Townsville Hospital over 3 months from 1 January 2013 to 31 March 2013. Staff from across the hospital, including the MET service, were interviewed to ascertain their opinions on the impact of the introduction of these documents.

Results

Preliminary results from a limited QA audit in 2012 indicate that about 80% of dying patients had a resuscitation plan in place when they died. Clinicians are very positive about the benefits.

Conclusion

The response of clinicians indicates that care has been improved by the ARP with patients' wishes being respected. The quantitative data are likely to confirm this. The introduction of these forms across the hospital has contributed to a changed culture of health care to the benefit of patients, their families and clinicians.
WHY DON'T GPS DO ADVANCE CARE PLANNING OR END OF LIFE CARE?
Authors: Rhee Joel
Published: April 2013

Seminal research by Barbara Starfield and colleagues has shown that a strong Primary Care Health system is associated with improved patient outcomes, reduced costs and greater equity in the provision of health care. There is also evidence that primary health care professionals, such as general practitioners (GP), are capable of delivering good end of life care and the care they provide is appreciated by patients. Despite this, many General Practitioners (GP) are not involved in the provision of end of life care or in Advance Care Planning. This talk will present the findings of the literature and recent research conducted by the authors that illuminate the reasons for the lack of engagement of GPs. While barriers such as lack of time, remuneration, and knowledge have often been implicated, there may be other less obvious reasons on why GPs are not involved in Advance Care Planning or end of life care. The potential solutions and implications for policymakers, health care professionals and researchers will be discussed.
NEGOTIATING CONFLICT IN END OF LIFE DISCUSSIONS
Authors: Arnold RM
Published: April 2013

Background

Conflicts, particularly between health care providers and families regarding end of life care are common.

Aim

To provide a structured way to think about what causes these conflicts and the communication skills one might use to negotiate conflicts over treatment for seriously ill patients.

Results/Discussion

To help structure, health providers’ thinking about these cases, a question, “Why is this loving and caring family making a decision that you think is unreasonable?” will be discussed. The talk with focus on the psychology and business literature on conflicts to posit three reasons for why conflicts occur: misunderstandings over what is happening; inattention to the feelings associated with these conflicts and rigid beliefs about one’s identity. A variety of communication skills – ranging from ASK-TELL-ASK, to “rolling with resistance” to responding empathically to emotions will be discussed to help negotiate these conflicts.

Conclusion

A specific framework can help health care providers negotiate conflict with families over care at the end of life.
HOW RECOGNITION OF RELATIONAL KNOWING EXPANDS THE GENERAL PRACTITIONER'S ROLE IN ADVANCE CARE PLANNING
Authors: Robins-Browne K , Hegarty K , Palmer V , Guillemin Marilys , Komesaroff Paul
Published: April 2013

Background

The general practitioner's (GP) role in advance care planning is commonly tied to their knowledge of the patient and the family, but with limited attention to the nature of this knowing or the expectations it may give rise to (2012). GPs are often involved in advance care planning with the aim of having the patient complete formal documentation (2012). This paper proposes a broader role for the GP based on findings from a PhD study exploring older people's understandings of decision making in incompetence.

Aim

To explore patient's understanding of the GP's role in decision making in incompetence.

Methods

In-depth interviews with 19 people, aged ≥65 years, recruited from five general practices analysed using Giligan's (Gilliganet al., 2006) listening guide.

Results

Participants distinguished between their GP and other doctors. Participants described their relationship with their GP as grounds for providing the GP with a distinct role in the event of their future incompetence. Participants expected this relationship to inform the way their GP approached advance care planning.

Discussion

Participants expected the GP to have a richer role reflective than they are commonly provided. Relational ethics and the concept of ‘generalism’ provide a theoretical basis for expanding the GP's role.

Conclusion

Current characterisations of the GP's role overlook much of what they can bring to the process of advance care planning.
DEVELOPING ADVANCE CARE PLANNING AND COMMUNICATION SKILLS IN THE NEW ZEALAND HEALTHCARE WORKFORCE
Authors: Muir S , Manson L
Published: April 2013

Background

Responding to a gap in the healthcare workforce training in advance care planning (ACP) and advanced communications skills, an ACP training programme was initiated. As part of this, an intense 2.5 day Level 2 training course was developed.

Aim

The course aims to develop participant's knowledge, experience of, and confidence in ACP. Through improving the communication skills of the healthcare workforce, patients and whanau/family are supported to make informed decisions regarding their end of life preferences.

Methods

Pre-course material provides substantial background and theory in ACP and communication. Participants are also required to engage in their own ACP process before attending the course. Video clips and case studies of people's experiences are used to bring patients and whanau/family into the training environment. Facilitated role play (involving a professional actor and video play back) is a substantial component of the course. Each course can be attended by up to 10 participants.

Results

164 clinicians completed the course in the 2012 pilot period. Course evaluation notes 93% of participants would definitely recommend the course to other clinicians.

Qualitative data analysis of pre and post confidence scores demonstrates statistically significantly increased confidence in:

explaining what ACP is, structuring conversations, the benefits of ACP

explaining the NZ legal and ethical framework

working with patients agenda, handling strong emotions

discussing future care options.

Discussion

This evidence based training programme is the first of its kind in New Zealand. In 2013 we aim to train a further 200 healthcare staff.

Conclusion

The course significantly increases participant's confidence in communicating with patients and their whanau/families.
INSTITUTIONAL POLICIES AND GUIDELINES FOR INFORMED CHOICES AND DECISION MAKING: A REVIEW OF ACP POLICIES IN SELECTED DISTRICT HEALTH BOARDS IN NEW ZEALAND
Authors: Chan H Y
Published: April 2013

Background

Although New Zealand does not have specific statutes governing advance directives, the Consumer Code provides the right of a consumer to make an advance directive in accordance with the common law. The Advance Care Planning Cooperative in New Zealand has been working towards engaging the public in care planning and participating with the district health boards to promote the same.

Aim

An examination of whether there are policies in place for advance care planning in the various district health boards and whether they provide the opportunity for people to be involved in making advance care plans.

Methods

I reviewed the received responses from the major district health boards in New Zealand soliciting information on the availability of advance care plans or if there are any advance care plans policies in place.

Results

There are positive indications that advance care planning is in the process of being implemented in the various district health boards surveyed, and they are carried out in specific healthcare units for the time being. Responses are still being received on an ongoing basis at the time of writing but based on the current situations, the response has been encouraging.

Discussion

Although there are no formal policies in place, the healthcare providers have taken the initiatives to introduce and implement advance care plans to the public.

Conclusion

Advance care planning has the potential to facilitate the end-of-life care conversations and supportive programmes are being implemented giving the opportunity for the public to engage in advance care planning.
THE IMPACT OF ADVANCE CARE PLANNING FOR RENAL PATIENTS
Authors: Silvester W , Mawren D , Detering K , Wallis K
Published: April 2013

Background

Research indicates that renal patients are uninformed about care options and have limited knowledge about illness prognosis and trajectories. Accordingly, facilitated Advance Care Planning (ACP) was introduced to the renal unit at the Austin Hospital in 2010.

Aim

To evaluate the impact of the introduction of ACP to the Austin Hospital renal unit.

Methods

Audit of medical records for (1) 58 patients who received ACP (2010–2012) (2) 58 age and gender matched control patients (2007–2009).

Results

The rate of withdrawal from dialysis was significantly higher in the implementation group (IG) (p=0.022), as was the involvement of the patient or family in the decision to withdraw dialysis (p=0.001). Medical decisions to withdraw dialysis was equal between groups (p>0.05) More ACP documents were completed in the IG (MEPOA=67%, SOC=27%, RTC=17%) compared to the control group (MEPOA=5%, SOC=10%, RTC=2%). Significantly more wishes were correctly documented in the IG (p<0.001) and more changes to patient management plans were observed (71%). Patients in the IG were more likely to have their wishes respected (p=0.007) and receive treatment in their best interest (p<0.001).

Discussion

The implementation of ACP led to patient wishes being documented and respected, and to dialysis being withdrawn at the patient's or family's request. No difference observed in the involvement of the medical team. More wishes were respected in the IG and more patients received treatment that was in their best interest.

Conclusion

Facilitated ACP successfully increased the likelihood of wishes being respected and patients receiving treatment in their best interest.
SPIRITUAL CARE NEEDS AND SPIRITUAL CARE RECEIVED
Authors: Phibal Anong , Hatthakit Urai
Published: April 2013

The purpose of this descriptive study was to compare the level of the spiritual care needs and spiritual care received among Muslim patients at the end of life during hospitalisation. The subjects were recruited using purposive sampling from the end of life Muslim patients during hospitalisation in five main government hospitals, namely Yala Hospital, Pattani Hospital, Narativas Hospital, Betong Hospital, and Su-Ngaikolok Hospital, and/or family caregivers who used to provide care to their dying family members while hospitalised in these hospitals. The data were collected from 174 subjects from November 2008 to January 2009. The research instruments were questionnaires developed by the researcher. Cronbach's α of reliability coefficients of the spiritual care needs among Muslim patients at the end of life during hospitalisation and received spiritual care among Muslim patients at the end of life during hospitalised in the hospitals questionnaires were 0.86 and 0.94, respectively. Data were analysed using percentage, mean, SD and paired t test.

The results were as follows:

The mean total score of the spiritual care needs of Muslim patients at the end of life during hospitalisation was at a high level. The highest mean score was that of the needs for hope, followed the score of needs for meaningful and purposive life aspects and the needs for relationships with another and/or a supreme being.

There was a statistically significant difference between the spiritual care needs and spiritual care received among Muslim patients at the end of life during hospitalisation (p<0.001). This indicated that the level of spiritual care received was high but still did not meet the spiritual care needs of the patients. The findings should be beneficial in providing information for nurses to improve their spiritual care to meet the clients' care needs and be congruent with their belief and culture.
COMMUNICATION SKILLS FOR ADVANCE CARE PLANNING AND END-OF-LIFE CONVERSATIONS
Authors: Arnold RM
Published: April 2013

Background

Clinician’s communication skills are central to advance care planning and discussions of goals of care.

Aim

To discuss and practice three core communication skills needed to discuss goals of care with seriously ill patients.

Methods

Discussion and role playing in small groups

Results/Discussion

The session will focus on how to assess a patient’s values and then make a recommendation based on those values. The key skills involved include: 1) attending to patient’s emotions; 2) using the patient’s emotions to explore a patient’s hopes and concerns; 3) asking for permission to make a recommendation; and 4) making a recommnedation by “showing one’s work”.

Conclusion

Skills needed to have discussions with seriously ill patients about their goals can be taught.
ADVANCE CARE PLANNING FROM THE CONSUMERS PERSPECTIVE: THE MAKING OF A DVD
Authors: Billings S , Nicholes M , Gill L , Van Es H
Published: April 2013

Background

RealTime Health is a Melbourne-based online health content producer, specialising in the niche area of ‘patient and carer narrative'. Alfred Health Advance Care Planning (ACP) Service partnered with Realtime Health to make a DVD on the patient and carer experience of going through the process of Advance Care Planning.

Aim

To produce a consumer driven DVD on ACP that can be utilised as a marketing and education tool for consumers, health care professionals and community groups.

Methods

Five consumers and carers were recruited and went through a consent process to participate in the DVD. Each person was chosen because of their unique background to illustrate a variety of experiences such as caring for someone with dementia and making difficult decisions for someone who is dying. The interviews were unscripted which allowed for a natural flow of information.

Results

The DVD will be showcased on the Realtime Health website in their ‘Speaking form Experience’ series, which comprises an extensive database for a range of illnesses/health issues which is easily accessed by Health Care Professionals and the general public. Alfred Health will have video clips inserted onto the ACP internet and intranet pages and this will be utilised as client, staff and community based education.

Conclusion

Hearing first hand accounts from real people that have lived through an experience is powerful and thought provoking. We hope to motivate individuals to consider doing ACP for themselves.
CASE REPORT: DISABILITY AND ADVANCE CARE PLANNING (ACP): LESSONS LEARNT
Authors: Brean S , Bee Andrea , Brabender Lauren
Published: April 2013

Background

A young man with multiple complex and overlapping disability disorders presenting with cognitive decline was referred for advance care planning. ACP within group homes is increasingly being discussed and investigated yet the process of developing strategies to increase awareness and uptake of advance care planning for disability clients is less defined.

Aim

To describe the processes undertaken to engage key stakeholders with ACP.

Methods

A total of 16 h was spent over a 3 week period to facilitate completion of the advance care plan. Of this 7 h were spent with the family, the remaining 9 h were spent in meetings with key stakeholders and at the group home to support his carers. Communication, time and sensitivity were required for both the family and key stakeholders.

Results

An ACP was completed. During this process significant learnings were identified in terms of the intense emotional connection some health care providers working in the disability sector hold along with the differing views of the multiple health professionals involved within this case.

Discussion

This case identified that the disability health care providers are also effectively ‘family’ which was unexpected. The diagnostic uncertainty added to the duration of discussions. Areas identified as needing further clarification and discussion included defining slowly dying, ACP and how to enact and follow a plan.

Conclusion

Defining strategies for ACP within this population requires further work. However we recommend allowing for an extended period of time to raise awareness, educate and most importantly develop trust and rapport with group homes and disability advocates.
CLINICAL DECISION-MAKING MOMENTS: A REALITY FOR ADVANCE CARE PLANNING AT END-OF-LIFE
Authors: Lee S F , Beattie J , O'Connor M , Komessarof P , Gold M , Hunter P
Published: April 2013

Background

Decision-making at the end-of-life is complex and requires significant resources despite the presence of advance care plans. Questions often arise as to the meaning of an advance care plan, what constitutes such a plan and its legal status.

Aims

This study aimed to examine issues influencing the decisions of people with advanced medical conditions.

Methods

Case study methodology was used to inform the design of the study in two phases. Firstly, chart audits informed development of cases discussed in interviews. A purposive sample (n=20) with experience in advance care planning at end-of-life including health professionals, community leaders, patients and carers were interviewed. The study was conducted in a metropolitan health service.

Results

Results indicate that advance care planning takes place in decision-making moments. The readiness of those involved in decision-making to either commence planning for end-of-life care or to implement a plan at end-of-life to provide for care needs were factors. End-of-life care planning and action occur in a context of difference (people, place and tensions).

Discussion and Conclusions

This study suggests that, whether advance directives are available or not, towards the end of a patient's life, clinical decision-making is often in response to issues that may not have been predicted or discussed in the planning phase. Health professionals and family members may be ill-equipped to engage in discussions, despite the presence of an advance care plan. Policy, education and resources need to support the necessity for in the moment decision-making.

Acknowledgement

This project was funded by the National Health and Medical Research Council of Australia Palliative Care Program Grant.
IMPROVING ADVANCE CARE PLANNING AND END OF LIFE CARE IN ACUTE HOSPITALS, USING THE GOLD STANDARDS FRAMEWORK ACUTE HOSPITAL PROGRAMME
Authors: Thomas K , Ahmad N , Battye F
Published: April 2013

Background

Communication across boundaries of care is often poor and use of advance care planning discussions to determine preferences and needs of patients in hospitals is increasing but still very limited. What is realistic for use of ACP busy hospital wards, and how much could be achieved?

Aim

Phase 2 GSFAH included 8 acute hospitals, ranging from 1 to 3 wards per hospital. A comparative evaluation was carried out before and after the 9 month intervention of the GSFAH training programme.

Methods

An analysis of qualitative and quantitative data was undertaken by ICG GHK to analyse evaluation data from Phase 2 of the acute hospital programme. Eight hospitals participated and completed the following surveys before and 1 year after implementing GSF in their hospitals;

Staff Survey

Organisational Survey

After Death/Discharge Analysis (ADA)

Qualitative data from a focus group

Results

The key results included improvements in staff knowledge and confidence in most areas of end of life care, increased identification of patients nearing the end of life, increased advance care planning discussions, improved communication with primary care teams etc details available.

Discussion

A hospital compromise for ACP was agreed ie use of introduction, DNAR, LPOA/proxy and noting preferred place of care

Conclusion

The programme offers hospitals the opportunity to raise awareness around end of life care, develop and educate all staff within the organisation, improve cross boundary care and to move onto to deepen and work towards accreditation.
Republished: Innate and adaptive immune responses in chronic hepatitis B virus infections: towards restoration of immune control of viral infection
Authors: Bertoletti Antonio , Ferrari Carlo
Published: April 2013

Knowledge of the immunological events necessary to control hepatitis B virus (HBV) infection has accelerated in recent years, but their translation towards therapeutic strategies able to achieve a durable HBV suppression has been challenging. The scenario of how HBV deals with the host immunity is presented and used to discuss how the immune response can be harnessed to potentially achieve infection control.
POLARIZED SPIN STATE AND INTERMITTENT SUPERCONDUCTIVITY IN MESOSCOPIC SUPERCONDUCTING RINGS
Authors: SHI LIANG-MA
Published: April 2013

Ground states are studied by solving a modified Ginzburg–Landau model for mesoscopic metallic superconducting rings. It is found that surface effect related spin-orbit (SO) interaction can generate an effective orbital magnetic field of opposite orientations for spin-up and spin-down electrons which leads to spin-polarized states with opposite chirality. The quantum phase transition between the spin-polarized states and spin singlet superconducting states can occur by applying an external magnetic field normal to the ring-plane.
BANACH DIRAC BUNDLES
Authors: ANASTASIEI MIHAI , SANDOVICI ADRIAN
Published: April 2013

Banach Dirac bundles are introduced within the framework of infinite-dimensional Banach manifolds and their basic properties are derived. Banach Lie algebroids are geometrical objects recently introduced by the first author. It is the main goal of the present paper to reveal the most important links between Banach Dirac bundles and Banach Lie algebroids, respectively.
Rhcg1 and Rhbg mediate ammonia excretion by ionocytes and keratinocytes in the skin of zebrafish larvae: H+-ATPase-linked active ammonia excretion by ionocytes
Authors: Shih Tin-Han , Horng Jiun-Lin , Lai Yi-Ting , Lin Li-Yih
Published: April 2013

In zebrafish, Rhcg1 was found in apical membranes of skin ionocytes [H+-ATPase-rich (HR) cells], which are similar to α-type intercalated cells in mammalian collecting ducts. However, the cellular distribution and role of Rhbg in zebrafish larvae have not been well investigated. In addition, HR cells were hypothesized to excrete ammonia against concentration gradients. In this study, we attempted to compare the roles of Rhbg and Rhcg1 in ammonia excretion by larval skin and compare the capability of skin cells to excrete ammonia against concentration gradients. Using in situ hybridization and immunohistochemistry, Rhbg was localized to both apical and basolateral membranes of skin keratinocytes. A scanning ion-selective electrode technique (SIET) was applied to measure the NH4+ flux at the apical surface of keratinocytes and HR cells. Knockdown of Rhbg with morpholino oligonucleotides suppressed ammonia excretion by keratinocytes and induced compensatory ammonia excretion by HR cells. To compare the capability of cells to excrete ammonia against gradients, NH4+ flux of cells was determined in larvae exposed to serial concentrations of external NH4+. Results showed that HR cells excreted NH4+ against higher NH4+ concentration than did keratinocytes. Knockdown of the expression of either Rhcg1 or H+-ATPase in HR cells suppressed the capability of HR cells.
Noise-induced cochlear neuropathy is selective for fibers with low spontaneous rates
Authors: Furman Adam C. , Kujawa Sharon G. , Liberman M. Charles
Published: April 2013

Acoustic overexposure can cause a permanent loss of auditory nerve fibers without destroying cochlear sensory cells, despite complete recovery of cochlear thresholds ( Kujawa and Liberman 2009 ), as measured by gross neural potentials such as the auditory brainstem response (ABR). To address this nominal paradox, we recorded responses from single auditory nerve fibers in guinea pigs exposed to this type of neuropathic noise (4- to 8-kHz octave band at 106 dB SPL for 2 h). Two weeks postexposure, ABR thresholds had recovered to normal, while suprathreshold ABR amplitudes were reduced. Both thresholds and amplitudes of distortion-product otoacoustic emissions fully recovered, suggesting recovery of hair cell function. Loss of up to 30% of auditory-nerve synapses on inner hair cells was confirmed by confocal analysis of the cochlear sensory epithelium immunostained for pre- and postsynaptic markers. In single fiber recordings, at 2 wk postexposure, frequency tuning, dynamic range, postonset adaptation, first-spike latency and its variance, and other basic properties of auditory nerve response were all completely normal in the remaining fibers. The only physiological abnormality was a change in population statistics suggesting a selective loss of fibers with low- and medium-spontaneous rates. Selective loss of these high-threshold fibers would explain how ABR thresholds can recover despite such significant noise-induced neuropathy. A selective loss of high-threshold fibers may contribute to the problems of hearing in noisy environments that characterize the aging auditory system.
Ecological Vulnerability Assessment Integrating the Spatial Analysis Technology with Algorithms: A Case of the Wood-Grass Ecotone of Northeast China
Authors: Qiao Zhi , Yang Xi , Liu Jun , Xu Xinliang
Published: April 2013

This study evaluates ecological vulnerability of the wood-grass ecotone of northeast China integrating the spatial analysis technology with algorithms. An assessment model of ecological vulnerability is developed applying the Analytical Hierarchy Process. The composite evaluation index system is established on the basis of the analysis of contemporary status and potential problems in the study area. By the application of the evaluation model, ecological vulnerability index is calculated between 1990 and 2005. The results show that ecological vulnerability was mostly at a medium level in the study area, however the ecological quality was deteriorating. Through the standard deviational ellipse, the variation of ecological vulnerability can be spatially explicated. It is extremely significative for the prediction of the regions that will easily deteriorate. The deterioration zone was concentrating in the area of Da Hinggan Ling Mountain, including Xingan League, Chifeng, Tongliao, and Chengde, whereas the improvement zone was distributing in the north-central of Hulunbeier.
PostexitSurface Engineering of Retroviral/Lentiviral Vectors
Authors: Metzner Christoph , Kochan Feliks , Dangerfield John A.
Published: April 2013

Gene delivery vectors based on retroviral or lentiviral particles are considered powerful tools for biomedicine and biotechnology applications. Such vectors require modification at the genomic level in the form of rearrangements to allow introduction of desired genes and regulatory elements (genotypic modification) as well as engineering of the physical virus particle (phenotypic modification) in order to mediate efficient and safe delivery of the genetic information to the target cell nucleus. Phenotypic modifications are typically introduced at the genomic level through genetic manipulation of the virus producing cells. However, this paper focuses on methods which allow modification of viral particle surfaces after they have exited the cell, that is, directly on the viral particles in suspension. These methods fall into three categories: (i) direct covalent chemical modification, (ii) membrane-topic reagents, and (iii) adaptor systems. Current applications of such techniques will be introduced and their advantages and disadvantages will be discussed.
Adverse Psychosexual Impact Related to the Treatment of Genital Warts and Cervical Intraepithelial Neoplasia
Authors: Campaner Adriana Bittencourt , Vespa Junior Nelson , Giraldo Paulo César , Leal Passos Mauro Romero
Published: April 2013

Objective. To compare the psychosexual impact related to the treatment of genital warts and cervical intraepithelial neoplasia (CIN) in women. Methods. 75 patients presenting with HPV-induced genital lesions, belonging to one of two patient groups, were included in the study: 29 individuals with genital warts (GWs) and 46 individuals with CIN grades 2 or 3 (CIN 2/3). Initially, medical charts of each woman were examined for extraction of data on the type of HPV-induced infection and treatment administered. Subjects were interviewed to collect sociodemographic data as well as personal, gynecologic, obstetric, and sexual history. After this initial anamnesis, the Sexual Quotient-Female Version (SQ-F) questionnaire was applied to assess sexual function. After application of the questionnaire, patients answered specific questions produced by the researchers, aimed at assessing the impact of the disease and its treatment on their sexual lives. Results. It is noteworthy that patients with CIN 2/3 had statistically similar classification of sexual quotient to patients with GWs (P=0.115). However, patients with GWs more frequently gave positive answers to the specific questions compared to patients with CIN 2/3. Conclusion. Based on these findings, it is clear that GWs have a greater impact on sexual behavior compared to CIN 2/3.
The Psychological Challenge of Late-Life Vision Impairment: Concepts, Findings, and Practical Implications
Authors: Wahl Hans-Werner
Published: April 2013

The intention is to summarize the body of evidence speaking to the psychological challenges faced by visually impaired older adults, as well as their coping efforts. This evidence is substantiated by a rich set of concepts, theories, and empirical findings that have accumulated under the umbrella of age-related psychoophthalmology (APO). I introduce the field of APO and continue with a discussion of important concepts and theories for a better understanding of adaptational processes in visually impaired older adults. I then summarize the most relevant and most recent data from four areas: (1) everyday competence, (2) cognitive functioning, (3) social functioning, and (4) subjective well-being-related outcomes, depression, and adaptational processes. Thereafter, major insights related to the current state-of-the art psychosocial interventions with visuallyimpaired older adults are reviewed. I close with the need that the public health community should become more aware of and address the psychosocial needs of visually impaired older adults.
Decrease of Plasma Glucose byHibiscus taiwanensisin Type-1-Like Diabetic Rats
Authors: Wang Lin-Yu , Chung Hsien-Hui , Cheng Juei-Tang
Published: April 2013

Hibiscus taiwanensis(Malvaceae) is widely used as an alternative herb to treat disorders in Taiwan. In the present study, it is used to screen the effect on diabetic hyperglycemia in streptozotocin-induced diabetic rats (STZ-diabetic rats). The extract ofHibiscus taiwanensisshowed a significant plasma glucose-lowering action in STZ-diabetic rats. Stems ofHibiscus taiwanensisare more effective than other parts to decrease the plasma glucose in a dose-dependent manner. Oral administration ofHibiscus taiwanensisthree times daily for 3 days into STZ-diabetic rats increased the sensitivity to exogenous insulin showing an increase in insulin sensitivity. Moreover, similar repeated administration ofHibiscus taiwanensisfor 3 days in STZ-diabetic rats produced a marked reduction of phosphoenolpyruvate carboxykinase (PEPCK) expression in liver and an increased expression of glucose transporter subtype 4 (GLUT 4) in skeletal muscle. Taken together, our results suggest thatHibiscus taiwanensishas the ability to lower plasma glucose through an increase in glucose utilization via elevation of skeletal GLUT 4 and decrease of hepatic PEPCK in STZ-diabetic rats.
Epigenetic Mechanisms Shape the Biological Response to Trauma and Risk for PTSD: A Critical Review
Authors: Heinzelmann Morgan , Gill Jessica
Published: April 2013

Posttraumatic stress disorder (PTSD) develops in approximately one-quarter of trauma-exposed individuals, leading us and others to question the mechanisms underlying this heterogeneous response to trauma. We suggest that the reasons for the heterogeneity relate to a complex interaction between genes and the environment, shaping each individual’s recovery trajectory based on both historical and trauma-specific variables. Epigenetic modifications provide a unique opportunity to elucidate how preexisting risk factors may contribute to PTSD risk through changes in the methylation of DNA. Preexisting risks for PTSD, including depression, stress, and trauma, result in differential DNA methylation of endocrine genes, which may then result in a different biological responses to trauma and subsequently a greater risk for PTSD onset. Although these relationships are complex and currently inadequately described, we provide a critical review of recent studies to examine how differences in genetic and proteomic biomarkers shape an individual’s vulnerability to PTSD development, thereby contributing to a heterogeneous response to trauma.
The Quaternary Interpolating Scheme for Geometric Design
Authors: Siddiqi Shahid S. , Younis Muhammad
Published: April 2013

A novel 4-point interpolating subdivision scheme is presented, which
generates the family of C2 limiting curves and its limiting function has support on [−7/3,7/3]. It behaves better than classical 4-point binary and ternary schemes with the same approximation order in many aspects that it has smaller support size, higher smoothness, and is computationally more efficient. The proposed nonstationary scheme can reproduce the functions of linear spaces spanned by {1,sin(αx),cos(αx)} for 0<α<π/3. Moreover, some examples are illustrated to show that the proposed scheme can also reproduce asteroids, cardioids, and conic sections as well.