bluuebunny/crossref_metadata_2025 huggingface dataset:
Speak Up - A National Advance Care Planning Campaign in Canada
Authors: Baxter S , Chow K , Hanvey L
Published: May 2011

The Canadian Hospice Palliative Care Association has established a Canadian National Advance Care Planning (ACP) Day/Campaign – Speak Up: Start the Conversation about End-of-Life Care. This campaign, which includes a national day to recognize ACP, provides an annual opportunity for individuals to discuss their wishes with family, friends and health care professionals while raising overall awareness of the importance of ACP throughout the year. The ACP day/campaign engages professionals and the public alike through partnerships, organizational events and media events. The premier day was launched on 12 April, 2011.

The campaign has been launched in partnership with 16 partners, including professional associations (medicine, nursing and law); research organizations and academics; regional health authorities; health-focused non-governmental organizations; and communications experts. It was based on 2 years of work including the development of ACP in Canada: A National Framework through broad consultation with over 100 stakeholders across the country.

This workshop will highlight the accomplishments of Speak Up. It will demonstrate the ways that organizations and individuals across a country are able to promote ACP in their communities. The workshop will demonstrate and describe the various resources and tools used in the campaign, and discuss the communications strategies for promoting ACP awareness. Workshop presenters will showcase toolkits for professionals and the public, a dynamic website; and poster and other promotional templates, as well as communication strategies and background resources. Participants will explore how they, their organizations and their communities could develop and become engaged in similar campaigns.
Combining top-down and bottom-up change management strategies in implementation of ACP: the My Wishes program in South West Sydney, Australia
Authors: Shanley C , Johnston L , Walker A
Published: May 2011

Attempts to introduce advance care planning (ACP) and make it a part of normal clinical practice present significant challenges and one way of approaching these is to utilise the change management literature. One aspect of this literature is the relative importance of top-down and bottom-up strategies to promote and support organisational change.

The Sydney South West Area Health Service (SSWAHS) launched the My Wishes Advance Care Planning program in early 2010 and the implementation plan employed both top-down and bottom-up strategies.

Key strategies of a top-down nature included: a comprehensive, organisational-wide policy; several new forms as part of the medical records of all hospitals; incorporation of these into the developing electronic medical records system; hospital General Managers having to report on local implementation of the program; involvement of local General Practice Divisions as program partners; and launch of a comprehensive website (http://www.mywishes.org.au).

Bottom-up strategies included: community information forums; workshops for health service and residential care staff; liaising with hospital departments and other services to include ACP information on their normal education agenda; putting ACP on the agendas of other initiatives in the health service such as chronic care and end-of life care; and supporting staff who would be advocates for the program.
Let's talk about it: conversations in advance care planning
Authors: Beavan J , Fowler C , Russell S
Published: May 2011

This workshop is based on Chapter 23 in Thomas and Lobo (2010)1where communication skills are seen as integral to delivering advance care planning (ACP). It reflects the need to teach the principles of ACP alongside communication skills. It recognises that to teach these in isolation may lead to a lack of confidence in the professional engaging patients in discussions around end of life care issues. This workshop draws on models of communication that can lend structure, such as SPIKES, PREPARED, SAGE & THYME and the Calgary-Cambridge model of the consultation. To demonstrate how theory moves into practice, relevant scenarios have been identified to illustrate how they may be used. The theory outlined in Chapter 23 has been taken into the workplace to inform the model of education used in delivering ACP.

This work is innovative in understanding the relationship between communication skills and effective ACP and has been put into practice in education development.

The workshop will consider the key points of an ACP process. Role played scenarios will be used to engage participants in an interactive process that allows specific communication skills to be demonstrated and reflected upon in the context of ACP.
The three I's of advance care planning education: innovation, interdisciplinary and interactive
Authors: Hoffmann C
Published: May 2011

Fraser Healthy Authority (FHA) in British Columbia, Canada has been a champion and leader of Advance Care Planning (ACP) provincially and nationally.

Standardized education has been an integral part of the success of this program. Two 30 min on-line modules are augmented by 6 h classroom sessions. The on-line modules are interactive and focus on the importance of communication throughout the continuum of care. Classroom sessions provide an opportunity to discuss both personal and professional experiences, enhance ACP communication skills through practice exercises and further understanding of the legal underpinning as well as the role and responsibilities of professionals and substitute decision makers. Classroom sessions are purposely interdisciplinary and typically include professionals such as respiratory therapist, spiritual care practitioners, social workers, nurses, managers, care coordinators, etc who work in various program areas such as outpatient clinics, acute, residential and primary care. This assists to illustrate the number of professionals and perspectives patients and families encounter throughout their journey of care and the need for consistent and standardized ACP approach.

Though surveys and on-going feedback, students have stated FHAs education has provided a unique opportunity to learn from colleagues, enhance communication and decisional conflict skills. Students further note that following this education they were able to incorporate ACP with individuals not deemed at the ‘end of life.’ For example, students experienced an 11% increase in conversations with those individuals with chronic illnesses and a 21% increase with healthy adults. To date, 1500 healthcare professionals have completed education.
Factors associated with community-based case managers' advance care planning practices
Authors: Black K
Published: May 2011

Community-based geriatric case managers work with an increasingly frail older population in need of advance care planning (ACP) throughout the end of life; however little is known regarding factors that influence their professional practices in this area. This study presents the findings from a mixed methods study which utilized focus groups and surveys to examine case managers' ACP practices in the state of Florida in the United States. Qualitative findings suggest that case managers hold ambiguous views regarding ACP, perceive divergent roles in this area, and engage in a range of primarily informational ACP practices. Themes from the study suggest that case managers view five key influences that either assist or impede practices including: (1) paradox of case management and programmatic realities; (2) extent of family presence and involvement; (3) level of proficiency in ACP; (4) degree of client receptivity to planning; and (5) limited communication with providers. Regression analyses of the state-wide surveys suggest the following correlates of practice: years of experience, the amount of ACP training experiences, perceived skill in geriatric practice competencies, perceived barriers to practice, and experience in ACP of a personal nature. The research reveals that community-based practitioners engage in a broader approach to ACP which extends beyond domains of health and end-of-life care by addressing social, legal, financial and residential planning as well. In addition, the study's findings empirically support a conceptual model of factors associated with professional practice.
Advanced care planning for people with motor neurone disease
Authors: Smith G
Published: May 2011

The proposed study is anticipated to commence in January 2011 with interviews of carers and people with MND, sourced initially through the member registry of the MND Association of Western Australia (MNDAWA). The purpose of these open-ended interviews is to assess their understanding of new Western Australian (WA) legislation relating to Advanced Health Directives (AHD) and Enduring Power of Guardianship (EPG) and individual needs of people with MND in relation to end-of-life care issues.

Thematic analysis of the interviews is anticipated to articulate key areas for support for people with MND, particularly how to target education packages specific to their needs.

To date, much of the research relating to MND relates to finding a cause or cure. Little research has been undertaken to establish the needs of people diagnosed with MND and no research has been undertaken in WA in relation to the new AHD/EPG legislation. The significance of this proposed research is to provide a baseline of understanding in the specific target community of their knowledge about this legislation and how it may be utilised to support their health care management when they are unable to articulate their desires as their disease progresses.

The findings from this research will be transferable to other neurological conditions, as well as other progressive degenerative diseases. It may be useful in community care situations as well as hospice and tertiary hospitals in the event of admission.
The evolution of Austin health's ‘Statement of Choices’
Authors: Jackson L , Detering K , Silvester W , Hancock A
Published: May 2011

Background

The Respecting Patient Choices team has been doing advance care planning since 2002. We encourage people to nominate a substitute decision maker (SDM) and document their health care wishes on a ‘Statement of Choices’ (SOC). This document has evolved and now includes four components to ensure that the written plans are understood and appropriately acted upon by doctors.

They are:

to record a person's wishes about future medical treatment based on their goals, values and beliefs.

to record this information in a language that doctors would recognise and could act upon.

be easy to fill in.

to provide prompts for people facilitating the ACP conversation.

Aim

To evaluate the evolution of the SOC.

Methods

A retrospective audit of SOC completed in 2010.

Results

Most people (70%) choose to nominate a SDM and complete a SOC. People generally nominate a family member as their SDM and the majority (>90%) indicate on their SOC that they ‘would not want CPR even if the doctors think it could be beneficial’ and ‘do not want life prolonging treatment (LPT) at all’. 25% provided guidance on what would be an ‘acceptable outcome’. The SOC is recognised by the doctors and is acted upon.

Conclusions

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Austin Health has devised a SOC form that enables people to record their medical treatment preferences especially in relation to CPR and LPT.

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The SOC is being further evolved for specific chronic conditions (eg, dialysis).
The role of the community volunteer in advance care planning
Authors: Threlkeld G , Bidstrup B , Downing J
Published: May 2011

This presentation reports findings about the volunteer's role in an intervention developed through research to establish an accessible and sustainable model of advance care planning (ACP) for older people in rural communities in south eastern Australia. Entrust-U is innovative for initiating ACP through engaging volunteers in a number of roles, including: focussed interviews which move from an evaluative life review to identify values, a trusted decision-maker, and future wishes for care; preparing a life story from these interviews; facilitating conversations with a trusted decision-maker; and preparing a letter to a participant's General Practitioner.

Existing palliative care volunteers are given additional training for Entrust-U. Using a facilitated action research design, volunteers engaged in piloting the evolving model participated in briefing, training and debriefing, and a focus group. Informed by the principles of interpretative description, thematic analysis of notes and transcripts of these meetings and evaluation interviews identified three emergent orientations taken by volunteers in their role. This emergent new knowledge indicates each orientation brings a different approach to the project, with these differences exemplified in interviewing styles during the evaluative life review and exploration of ACP. A volunteering orientation focussed on inter-personal relations concentrated on building rapport. An orientation focussed on process, approached the interview as a procedure to be followed. An orientation focussed on the task of ACP adopted an instrumental and linear interview approach. Recognition of these volunteer orientations has significant implications for training and coordination of volunteers.
Sharing stories: a place for aboriginal elders to tell their story, so their journey continues …
Authors: Hawke J , Morris L , Wighton M
Published: May 2011

Aboriginal organisations throughout Victoria are funded to deliver quality services to Aboriginal people through HACC, Aged Care, and Disability programs. Services are delivered in a culturally appropriate way taking into consideration the Aboriginal way of life and taking a holistic approach which may include the whole family. These services may be in the homes or in residential care facilities.

Service Co-ordination was targeted recently with linkages and relationships being made between Aboriginal services and mainstream services to find best practices on how to deliver services to Aboriginal people. A 5 stage consultation process occurred and many communities had great results in achieving their goals and outcomes.

A booklet was developed by the Elders, HACC & Disability Services at GEGAC as an information sharing tool for use within the Aboriginal Community for those with Dementia, their families, and the staff involved in their care. In consultation with the local Aboriginal community, the book provides a method of recording a person's life as well as giving them the opportunity to tell their story. It also provides conversation points for aspects that they remember well.

Elders who have shared their story have taken great delight in sharing their childhood experiences, life journey, trials and tribulations with staff. All staff have a better insight into the clients life and challenges that they have had to overcome. This booklet has had an extremely positive result from the local community and health related services.
Life before death: Living Well, Leaving well
Authors: Lee P W , Foundation Lien
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.
Preliminary results of a formal advance care planning program in voluntary welfare nursing homes in Singapore
Authors: Siew C W , Onn Y , Koh M , Gan C M , Zainal R , Ng T W , Ismail H
Published: May 2011

In Singapore, most voluntary nursing homes(VNHs) residents with next-of-kins(NOKs) do not receive advance care planning(ACP). A local hospital embarked on a pilot program, Project CARE (PC), to conduct formal ACP and enable enhanced palliative care delivery in selected VNHs.

This pilot cohort study of six VNHs residents included those with advanced medical conditions(UK Gold Standards Framework criteria) with Modified Shah Barthel Index score <30. Excluded are residents <65 years old (unless satisfied inclusion criteria), without NOKs and decision making capacity(DMC), or on police evaluation. ACP were initiated with documentation of preferences on cardiopulmonary resuscitation (CPR), medical intervention(comfort, limited intervention, full treatment) and place of death. Residents would be enrolled into PC when preferences were for comfort care/limited intervention in nursing home without or with further treatment at hospital. Hospital team would co-manage with VNHs during residents' deterioration. Outcomes are evaluated from program inception on September 2009 till January 2011.

Of a total of 1464 residents, female(55.1%), Chinese(88.8%) and age ≥75 years old(61.7%) predominated. 54.4% of residents fulfilled criteria for possible ACP. Of this latter group, 51.2% completed ACP with 46.3% enrolled into PC. 4 NHs with minimum 6 months of patient reviews in PC framework were further evaluated with 153 deaths recorded. Success in honouring preferences on medical intervention and death place while in PC were 89.4% and 66% respectively. Mortality rate among eligible residents but without ACP yet, had ACP and in PC/not in PC were 24.6%, 25.8% and 24.2% respectively.

Care preferences could be honoured under PC framework.
Managing the quality of sleep among elderly patients using the Pittsburgh Sleep Quality Index
Authors: Cheah E , Rajaram S , Cheah E , Sidek N , Tan M H , Fadillah F , Zheng D , Hamid H
Published: May 2011

Introduction

Sleep is a necessary part of life. Assessment of sleep patterns enables the nurse to intervene immediately by implementing interventions with the client, or by referring the client for further assessment.

Method

The Pittsburgh Sleep Quality Index (PSQI) is an effective instrument created by Buysse et al in 1989. It differentiates ‘poor’ from ‘good’ sleep by measuring seven areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency and sleep disturbances, use of sleep medication and daytime dysfunction over the last month. The client self relates each of these seven areas of sleep. Scoring of the answers is based on a 0 to 3 scale, three reflects the negative extreme on the Likert scale. A sum of ‘5’or greater indicates a ‘poor’ sleeper.

Result

Seven patients who had sleeping problems were assessed. Data using the PSQI was collected from the 18th of June till the 18th of July 2010. Out of these seven patients, four of them were found to a sum of 5 to 6 as their global PSQI score. Two of them were given sleep medication to improve their sleeping patterns and the other two of them were referred to a psychologist. Three of the patients were found to have subjective sleep problems; two of them were overweight and were asked to start an exercise program. The other patient was found to lead a sedentary lifestyle and was encouraged to be more active.

Conclusion

The PSQI can be used for both initial assessment and ongoing comparative measurements with older adults across all health settings.
Developing a culture of medication safety in the rural palliative care home setting New South Wales (NSW) Australia
Authors: Short C
Published: May 2011

Improving Medication Safety for Clients and their Carers in the Rural Palliative Care Home Setting Project commenced January 2008 in response to an error involving a carer administered medication. Clinicians identified that no formalised process existed within NSW for carer medication administration despite a widespread practice of carers administering subcutaneous medications at home, especially in the last few days of life. It was recognised that formalised protocols and standardised training for carers were required to ensure patient safety.

The need to respect patient and carer choices is emphasised throughout care while providing effective symptom control in the palliative care home setting. The project consisted of evaluating a carer's preparedness to administer subcutaneous medications and provided education and structured support to the carer to administer these medications. A culture of medication safety emerged that was welcomed and embraced by patients, carers and families and the clinicians. The project developed a legal and ethical framework on which to base these standardised practices.

This project was an initiative of a health promoting palliative care service as per Allan Kellehear's 1999 model with service delivery strategies based on the five major ‘action’ principles of the Ottawa Charter. The outcomes demonstrated that carers were trained to safely administer subcutaneous medication and there were no medication errors.

Additional outcomes included improvements in After-Hours Occupational Health and Safety for staff, and improved the end of life decision-making abilities and processes for patients, carers and families enabling choice in place of care.
Launching ADVANCE care planning as a collabrative approach
Authors: Fowler C , Bettany A , White J , Finch J
Published: May 2011

A multi-organisational/professional project group formed to implement advance care planning, to include the Preferred Priorities of Care document. An early outcome indicated the need to develop a communication pathway and engage with the out of hours providers.

Consequently the group developed the use of The Lions ‘Message in a Bottle’ (MIB), a plastic bottle placed in a patients fridge to hold key information about an individual's ACP and contact numbers of health professionals involved with the patient.

The purpose of the MIB was to ensure patients wishes and preferences were known, and to assist the Out of Hours GPs and Ambulance service in difficult decision making.

The project identified other areas to address to ensure the implementation of advance care planning was robust;

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EoLC Education to Emergency Care Practitioners, (ambulance professionals with a remit to prevent admission).

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Advance care planning workshops for all health and social care professionals.

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A succinct transfer of information form

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Collaborative End of Life Care registers between in hours and out of hours.

The project is being launched to an audience of 80 encompassing commissioners, GPs, user representation, Acute and Community staff, care home staff, Learning Disability and Mental Health nurses, Hospital Consultants, Adult Care Services, Hospice staff and many others.

The impact of the launch will be measured using a confidence questionnaire.

The longer term outcomes for commissioners will include;

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Increased home deaths

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Fewer hospital admissions.

These will be monitored using vital signs data.
The end-of-life care for patients with advanced chronic obstructive pulmonary disease
Authors: Chen T R , Hu W Y
Published: May 2011

Palliative care historically focuses on cancer patients. It is important to gain more insight into the end-of-life (EoL) care for chronic obstructive pulmonary disease (COPD) patients. The aim of this systematic review was to identify the EoL care needs of patients with advanced COPD. A computerized literature search was performed to identify relevant studies. Papers were obtained from searches of MEDLINE, CINAHL and PubMed databases (timespan: 2001 to November 2010). Studies were included that reported original data on EoL care in patients with advanced COPD. A total of 58 articles were identified in the different databases. 18 studies met the inclusion criteria.

The findings reveal that advanced COPD patients have significantly poorer physical, psycho-spiritual and social functioning. They suffered from multiple complicated symptoms that are usually poorly controlled. They also experienced a high degree of emotional-spiritual distress and social isolation, but these usually managed to inadequately and may even be ignored. They had high levels of information need of the disease process regarding the illness itself, likely future symptoms and their management and information about EoL treatment options. In addition, health care professionals tend to avoid discussion of communication with these patients in order to explore clinical issues and end-of-life care issues. As a result, theses patients' needs in terms of EoL care are unmet. The findings of these studies all call for palliative care will benefit to advanced COPD patients.

Future research should further assess how best to apply the palliative care to COPD patients.
Hoping for the best and preparing for the worst: end-of-life attitudes of the elderly
Authors: Kahana B , Kahana E , Lovegreen L , Brown J
Published: May 2011

This paper describes findings from research based on 514 elderly persons (mean age=76.7, SD 8.0) living in a US metropolitan community about their attitudes toward and plans for end of life care. Individual interviews reveal that most respondents were not afraid to die but feared suffering near the end of life. End of life plans were typically undertaken to protect family members from feeling burdened. The most frequently reported plans included living wills, durable power of attorney and funeral arrangements. Elders were far more likely to discuss plans with adult children and other family than with physicians or other health care professionals.

Attitudes of respondents regarding death and dying may be characterized by the adage ‘hope for the best and prepare for the worst.’ Accordingly, only a small minority reported often worrying about their health (13.2%). When facing a hypothetical incurable illness, 80.3% endorsed remaining hopeful and planning activities unrelated to their illness. Similarly, 80.6% felt that people who have in incurable illness should focus on preparing for end of life issues. These elders also valued preservation of comfort through pain medications (85.6%), being surrounded by friends and family near the end of life (90.3%), and having others pray for them (91.8%). The vast majority of respondents preferred to die at home, if possible (92.3%). These data point to determination and planfulness, coupled with optimism, as elders consider the end of life.
Making health choices: advance care planning in aged care. Perception versus reality
Authors: Sjanta R , Jackson L , Fullam R , Silvester W
Published: May 2011

Introduction

The Making Health Choices pilot project being undertaken within Residential Aged Care Facilities in Victoria (Australia) by the Respecting Patient Choices team is currently undergoing evaluation. This presentation will provide insight into pre-existing knowledge and perceptions of advance care planning (ACP) in a group of residential aged care staff, prior to a major ACP education program.

Project evaluation methods

We conducted a pre-implementation survey of staff knowledge attitudes and behaviours around ACP. Feedback from ACP debrief sessions held during the course of the education program was examined for significant themes.

Results

The staff survey revealed disparities between staff perceptions of their skill and confidence in conducting ACP conversations and findings relating to the accuracy of their ACP knowledge and attitudes towards ACP. Nearly half of staff surveyed indicated they were comfortable (46%) and skilled (45%) with ACP/End-of-life discussion. However, the majority of participants reported a lack of confidence in their knowledge of key areas such as surrogate decision makers (75%) and of state laws regarding ACPs (88%). Responders performed at just above chance on a true/false test of ACP knowledge.

ACP Debrief sessions reflected participants concerns about the challenging nature of ACP discussions and general ACP provision within the Australian aged care context.

Discussion

The findings of the evaluation to date will be discussed in terms of ACP sustainability, future education models and in the context of systemic challenges facing the Australian Residential Aged 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 ageing 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.
Management of depression among the elderly patients in ward 3 Geriatric ward using the Geriatric Depression Scale (GDS)
Authors: Cheah E , Rajaram S , Chua H C , Ng H L , Tim H M , Fadillah F , Zheng D
Published: May 2011

Aim

The geriatric trained nurses in Khoo Teck Puat Hospital wanted to assess the degree of depression in the elderly patients. Thus they used the geriatric Depression scale (GDS) created by Yesavage et al. to assess the patients.

Method

The GDS created by Yesavage et.al (1986) has been tested and used extensively in the older population. The GDS created in 1983 had 30 questions but this was simplified in 1986 to 15 questions with scores above 5 representing depression of ascending severity. Score of 0–4 are considered normal, complaints of 5–8 indicate mild depression, 9–11 moderate depression and 12–15 indicate severe depression. This short form was used on 12 elderly patients aged between 75–83 in Geriatric ward. The data collection was for 1 month.

Result

Five of the patients had earlier referral to a psychologist. This led the psychologist to assess and find these patients moderately depressed. They received outpatient psychologist appointments. Four were found to be severely depressed and had earlier referral to psychiatrists and Medical Social workers. All 4 had to be institutionalized in the Institute of Mental Health in Singapore. All of these patients were also started on anti-depressants. 2 were found to be mildly depressed receiving a score of 5–8. Both these patients were not started on anti-depressants but were given outpatient referrals to psychologists.

Conclusion

The GDS is a brief, non-somatically focused and can be either an observer or self-administered. The nurses could assess this tool easily and found it a good tool to administer.
Managing functional decline among the elderly patients in ward 3 Geriatric ward using the Katz Index of Independence in Activities of Daily Living (ADL)
Authors: Cheah E , Rajaram S , Chua H C , Ng H L , Tim H M , Fadillah F , Zheng D
Published: May 2011

Introduction

The Katz Index of Independence in Activities of Daily Living commonly referred to as Katz ADL by Katz et al (1970) is the most appropriate instrument to assess functional status as a measurement of the person's ability to perform acts of daily living independently.

Method

This Katz ADL was used in 15 geriatric patients aged between 78–84. The instrument employs a dichotomous (yes or no) scale, with 1 point given for each ADL in which the patient is independent. Six signifies independence in all ADLs: the lowest is 0 t full assistance is needed. The index ranks adequacy in performance in the six functions of bathing, dressing, toileting, transferring, continence and feeding. Six indicates full function, four indicate moderate impairment and two or less indicates severe impairment. 15 assessed, 9 had moderate impairment and 6 severe impairment, none of them had full function.

Result

Nine had moderate impairment were given extensive rehabilitation. Physiotherapists and occupational therapists assessed them twice a day. Five continued to improve and were discharged with therapy appointments. Four worsened had to be downgraded to severe impairment. They also were not able to look after themselves and were discharged to long term care (nursing homes) 6 had severe impairment, 2 after a month of rehab were upgraded to moderate impairment and discharged with occupational therapy and physiotherapy appointments. Four were not able to manage on their own and had to be transferred to nursing homes.

Conclusion

The Katz Index has emerged as an especially useful tool in assessing older adults, in determining nursing load and predicting length of hospitalisation, morbidity and mortality over time. The Katz Index has determined accuracy in predicting functional outcome over time among older adults.
Managing the cognitive impairment of elderly patients using the Mini Mental State Examination (MMSE)
Authors: Cheah E , Rajaram S , Chua H C , Ng H L , Tim H M , Cinnappan S , Lim S T
Published: May 2011

Introduction

Cognitive impairment is no longer considered a normal and inevitable change of ageing. Although older adults are at a higher risk than the rest of the population, changes in cognitive function often call for prompt and aggressive function. In older patients cognitive functioning is especially likely to decline during illness or injury. The nurses' assessment of an older adult's cognitive status is instrumental in identifying early changes in physiological status, ability to learn and learning responses to treatment.

Method

The Mini Mental State Examination created by Folstein et al in 1975 (MMSE) is a tool that can be used to systematically and thoroughly assess mental status. It is a 11 –question measure that tests five areas of cognitive function: orientation, registration, attention and calculation, recall and language. The maximum score is 30. A score of 23 or lower is indicative of cognitive impairment. The MMSE only takes 5–10 min to administer and is therefore practical to use repeatedly and routinely.

Result

10 patients were assessed. 3 of the patients were found to have problems with orientation, 2 of them with registration, 2 of them with attention and calculation, 2 of them with recall and 1 of them with language. 9 patients out of the 10 were assessed and had to be placed in nursing homes and this was reflected in their application for nursing homes. Assessment of the older adult's cognitive function is best achieved when it is done routinely, systematically and thoroughly.

Conclusion

The MMSE is effective as a screening instrument to separate patients with cognitive impairment from those without it. In addition when used repeatedly the instrument is able to measure changes in cognitive status that may benefit from intervention.
Compensatory growth of Euphorbia peplus regenerating from a bud bank
Authors: Latzel Vít , Malíková Lenka , Klimešová Jitka
Published: May 2011

Tolerance to very severe disturbance by the annual herb Euphorbia peplus L. was examined. We explored the role of disturbance timing, competition, and site productivity on the performance of disturbed plants. Ninety-three percent of disturbed plants survived following disturbance 14 d after plant emergence, whereas only 48% of disturbed plants survived disturbance 42 d after emergence. Early disturbed plants compensated for biomass loss and had higher fecundity than undisturbed plants, but this was not the case for plants that were disturbed at later times following emergence. Field assessment revealed that disturbed plants were, in general, of the same height as undisturbed plants, even under competition. Undisturbed plants had very conservative architecture across various conditions (competition and nutrients), whereas disturbed plants had more branched architecture under moderate competition and nutrient availability. Accordingly, we suggest that E. peplus utilizes a bet-hedging strategy where adventitious meristems are reserved for regrowth after a severe disturbance event that removes all dormant axillary meristems. Moreover, we propose that the tolerance to disturbance in short-lived species could play an important role in the ecology of disturbed communities. Finally, the tolerance to disturbance could be one of the prerequisites of invasibility of E. peplus in non-native ranges. We also speculate about the potential costs and benefits related with the tolerance to disturbance in short-lived species and about a mechanical control of E. peplus in invaded ranges.
A new endoconidial black meristematic genus,Atramixtia, associated with declining white spruce and phylogenetically allied to a lineage of dothidealean conifer pathogens
Authors: Tsuneda A. , Davey M.L. , Currah R.S.
Published: May 2011

An endoconidial, black meristematic taxon Atramixtia arboricola gen. et. sp. nov. (Dothideales) from the black subicula found on twigs of declining white spruce, Picea glauca (Moench) Voss, in Alberta is described. It is morphologically distinguishable from other endoconidial taxa by the conidioma composed of clumps of endoconidial conidiogenous cells, scattered meristematically dividing cells, dematiaceous hyphae, abundant brown, granular matrix materials, and sometimes plant tissue. Endoconidia also occur in conidiogenous cellular clumps that are not organized into a conidioma but develop directly from stromatic cells on the bark. In culture, it forms similar endoconidial conidiomata and also a mycelial, blastic synanamorph that superficially resembles Hormonema . Atramixtia arboricola is a member of the Dothideales and shows phylogenetic affinities to a clade of conifer-stem and -needle pathogens, including Sydowia and Delphinella , although no teleomorph was found either on the natural substrate or in culture. It has not been determined whether A. arboricola is pathogenic to its host, but the occurrence of abundant intracellular hyphae in the host periderm suggests that the fungus is at least parasitic.
Germinability of arctic plants is high in perceived optimal conditions but low in the field
Authors: Müller Eike , Cooper Elisabeth J. , Alsos Inger Greve
Published: May 2011

Sexual reproduction is crucial for plant populations to track and adapt to climate change, but it is uncertain to what degree arctic vascular plants reproduce by seed. Several studies on arctic species show low germination. To re-examine seed germination and evaluate factors limiting sexual reproduction, seeds of 6–22 arctic species were germinated in five different, increasingly more realistic, conditions. Thirteen out of 15 species that were tested in an earlier study in Svalbard, Norway, germinated better in our study. Compared with perceived optimal conditions in a growth chamber, average germination per species was 6%–52% lower in five out of six species germinating at a colder temperature in soil, 36%–64% lower when germinating outdoors in soil, 49%–91% lower when germinating in a moss covered moraine, and 55%–91% lower when germinating in open soil on a moraine. Germination outdoors was below 5% in 10 out of 13 species and not correlated to germination in perceived optimal conditions. The high germination compared with earlier studies suggests that climate warming has already increased seed viability. However, caution should be taken when evaluating species-recruitment potential based on laboratory studies, as germination in the field was limited by species-specific responses to low temperatures, moisture, predation, and safe-site availability.
Role of selected dark septate endophyte species and other hyphomycetes as saprobes on moss gametophytes
Authors: Day Melissa J. , Currah Randolph S.
Published: May 2011

Dark septate endophytes (DSEs) live asymptomatically in the roots of vascular plants, are common in arctic and alpine areas, and are thought to play a quasimycorrhizal role. It is not known, however, whether they precede or arrive with their hosts. Previously reported enzymatic abilities of Phialocephala fortinii suggest that DSEs can live on organic debris in the soil, but there is little direct or experimental evidence for this. Phialocephala fortinii , Leptodontidium orchidicola , Cadophora melinii , Cadophora luteo-olivacea , and Lecythophora sp. were inoculated onto autoclaved Hylocomium splendens gametophytes and incubated for 3 months to determine if they degrade this organic material based on observations made using light and scanning electron microscopy. All fungi were able to colonize the bryophyte tissue to some extent. Lecythophora sp. and L. orchidicola penetrated cells by forming bore holes. Cadophora luteo-olivacea and P. fortinii were also observed inside cells, but bore holes through bryophyte cell walls were not observed. Cadophora melinii sporulated and grew abundantly on the surface of gametophytes but did not appear to penetrate cell walls. Phialocephala fortinii and L. orchidicola formed sclerotia in the gametophytes similar to those formed in roots. These results suggest that DSE fungi can persist and produce propagules, i.e., sclerotia and conidia, in the absence of host roots. These observations support the hypothesis that DSE fungi are able to precede their hosts during primary succession events.
EXISTENCE OF GROUND STATES OF HYDROGEN-LIKE ATOMS IN RELATIVISTIC QED I: THE SEMI-RELATIVISTIC PAULI–FIERZ OPERATOR
Authors: KÖNENBERG MARTIN , MATTE OLIVER , STOCKMEYER EDGARDO
Published: May 2011

We consider a hydrogen-like atom in a quantized electromagnetic field which is modeled by means of the semi-relativistic Pauli–Fierz operator and prove that the infimum of the spectrum of the latter operator is an eigenvalue. In particular, we verify that the bottom of its spectrum is strictly less than its ionization threshold. These results hold true, for arbitrary values of the fine-structure constant and the ultraviolet cut-off as long as the Coulomb coupling constant is less than 2/π. For Coulomb coupling constants larger than 2/π, we show that the quadratic form of the Hamiltonian is unbounded below.
MODELING SELECTION AND EXTINCTION MECHANISMS OF BIOLOGICAL SYSTEMS
Authors: AMIRJANOV ADIL
Published: May 2011

In this paper, the behavior of a genetic algorithm is modeled to enhance its applicability as a modeling tool of biological systems. A new description model for selection mechanism is introduced which operates on a portion of individuals of population. The extinction and recolonization mechanism is modeled, and solving the dynamics analytically shows that the genetic drift in the population with extinction/recolonization is doubled. The mathematical analysis of the interaction between selection and extinction/recolonization processes is carried out to assess the dynamics of motion of the macroscopic statistical properties of population. Computer simulations confirm that the theoretical predictions of described models are in good approximations. A mathematical model of GA dynamics was also examined, which describes the anti-predator vigilance in an animal group with respect to a known analytical solution of the problem, and showed a good agreement between them to find the evolutionarily stable strategies.
NONSINGULAR ORIGIN OF THE UNIVERSE AND ITS PRESENT VACUUM ENERGY DENSITY
Authors: GUENDELMAN E. I.
Published: May 2011

We consider a nonsingular origin for the universe starting from an Einstein static universe, the so-called "emergent universe" scenario, in the framework of a theory which uses two volume elements [Formula: see text] and Φd4x, where Φ is a metric independent density, used as an additional measure of integration. Also curvature, curvature square terms and for scale invariance a dilaton field ϕ are considered in the action. The first-order formalism is applied. The integration of the equations of motion associated with the new measure gives rise to the spontaneous symmetry breaking of scale invariance. After spontaneous symmetry breaking of scale invariance it is found that a nontrivial potential for the dilaton is generated. In the Einstein frame we also add a cosmological term that parametrizes the zero point fluctuations. The resulting effective potential for the dilaton contains two flat regions, for ϕ → ∞ relevant for the nonsingular origin of the universe, followed by an inflationary phase and ϕ → - ∞, describing our present universe. The dynamics of the scalar field becomes nonlinear and these nonlinearities are instrumental in the stability of some of the emergent universe solutions, which exists for a parameter range of values of the vacuum energy in ϕ → - ∞, which must be positive but not very big, avoiding the extreme fine tuning required to keep the vacuum energy density of the present universe small. Zero vacuum energy density for the present universe defines the threshold for the creation of the universe.
THERMOFIELD DYNAMICS AND e+e- REACTIONS
Authors: CHEKERKER M. , LADREM M. , KHANNA F. C. , SANTANA A. E.
Published: May 2011

The thermofield dynamics, a real-time formalism for finite temperature quantum field theory, is used to calculate the rates for e+e- reactions at finite temperature. The results show the role of temperature in defining a hadronic state after the plasma has been cooled down.
M-BRANES ON k-CENTER INSTANTONS
Authors: GHEZELBASH A. M. , ORAJI R.
Published: May 2011

We present analytic solutions for membrane metric function based on transverse k-center instanton geometries. The membrane metric functions depend on more than two transverse coordinates and the solutions provide realizations of fully localized type IIA D2/D6 and NS5/D6 brane intersections. All solutions have partial preserved supersymmetries.