bluuebunny/crossref_metadata_2025 huggingface dataset:
Using cannabinoids in pain and palliative care
Authors: Peat Sue
Published: May 2014

Interest in the use of cannabinoids in a clinical setting is gradually increasing, particularly in patients where more conventional treatments have failed. They have been reported as offering perceived benefits in a wide range of conditions, but the major interest at present is centred on their place in pain management and in the palliation of symptoms secondary to terminal cancer and neurological disease. The potential benefits include symptomatic relief for patients suffering from intractable neuropathic pain, anorexia, anxiety and muscle spasm. There is clear consensus that cannibinoids should not be used as a first-line monotherapy, but should be considered as valuable adjuvants to more commonly indicated therapeutic options in the management of palliative care patients. Scientific evidence documenting the benefits of the canibinoids nabilone and sativex is accumulating, but needs to be evaluated carefully in the light of the paucity of available data. Both drugs are usually used under the guidance of specialist units. Nabilone and Sativex are now controlled drugs, and are frequently used outside of their licensed indication (control of chemotherapy-induced nausea and vomiting) and hence particular care needs to be taken in evaluating the rational for their use. Sativex has been recently licenced for use in the management of patients with multiple sclerosis.
Disappointment and palliative care
Authors: Kelly Daniel
Published: May 2014

When serious illness strikes it is usually accompanied by a sense of hope that all may still turn out well. This may be followed by the gradual realization that cure is unlikely and a new normality must be accepted. Much of this process may remain unspoken, except with those closest to us. People find their own way to make sense of what is happening to them towards the end of life-and to reconcile this with their own expectations and the impact on those left behind. As Cicely Saunders said: ‘A search for meaning, of course, can take place quietly.’ (Saunders, 1986).
Continuous deep sedation, physician-assisted suicide, and euthanasia in Huntington’s disorder
Authors: Lindblad Anna , Juth Niklas , Fürst Carl Johan , Lynöe Niels
Published: May 2014

Aim: To investigate the attitudes among Swedish physicians and the general public towards continuous deep sedation (CDS) as an alternative treatment for a competent, not imminently dying patient with Huntington’s disorder requesting physician-assisted suicide (PAS) and euthanasia. Design: A questionnaire was distributed to 1200 physicians in Sweden and 1201 individuals in Stockholm. It consisted of three parts: 1) A vignette about a competent patient with Huntington’s disease requesting PAS. When no longer competent, relatives request euthanasia on behalf of the patient. Responders were asked about their attitudes towards these requests and whether CDS would be an acceptable alternative. 2) General questions about PAS and euthanasia. 3) Background variables. Results: The response rate was 56% (physicians) and 52% (general public). The majority of the general public and a fairly large proportion of physicians reported more liberal views on CDS than are expressed in current Swedish and international recommendations. Conclusion: In light of the results, we suggest that there is a need for a broader discussion about the recommendations for CDS, with a special focus on the needs of patients with progressive neurodegenerative disorders.
Educational podcasts: issues around assisted suicide
Authors: Smyth Dion
Published: May 2014

The New Year is well-established now and with it news that new technologies such as novel types of e-readers that allow you, among other things, to study newspapers and journals in an electronic format, have been launched. The provision of information in innovative formats that are impressively compressed into pocket sized, portable digital audio and video configurations-such as podcasts-will continue to be the theme for the first few editions of Web Words for 2010; the relevance of other systems will be considered as and when they are launched and linked to palliative care matters.
Using the media to promote palliative care
Authors: Downing Julia
Published: May 2014

Last weekend, while attending a concert in Jinja, Uganda, I was asked what job I did, when I explained that I worked in palliative care, there was a pause followed by the question, ‘what do you mean by palliative care?’. I proceeded to explain what palliative care is and what I, as a palliative care nurse, do. To many of us this is a familiar story when asked what we do—we are either greeted with comments such as ‘how depressing’, ‘that must be really hard’, people do not know what palliative care is, or worse still they change the subject immediately, thus posing the question: how do we portray the image of palliative care? What is the image that is portrayed about palliative care in the media, thus influencing the public’s views and understanding of palliative care?
Book Reviews
Authors: Stevens Anna-Marie
Published: May 2014

I was keen to review this book as I am in the process of undertaking a clinical doctorate, and research is very much at the forefront of my mind. This book offers information exactly as the title suggests in that it addresses the research process in nursing. Being the 6th edition, the book begins by acknowledging what is different from previous editions. The editors comment that the 6th edition incorporates ten new chapters including narrative research, mixed methods and how to apply research into clinical practice.
Reviewing the evidence for prescribing steroids for non-specific symptoms in patients with advanced cancer
Authors: Mumford Susan
Published: May 2014

This article sets out to review the evidence for prescribing steroids for non-specific symptoms experienced by patients with advanced carcinoma. Factors influencing the prescription of steroids, for example, drug interactions and their side effects are explored. Furthermore the importance of including patients in prescribing decisions and promoting adherence is discussed. The evidence shows that the benefit of steroids is felt within a week of commencement but is usually not sustained much beyond two weeks. In practice there appears to be inconsistent prescribing and monitoring of steroids, creating a need for a change of practice to promote high quality care for patients.
Oral discomfort in palliative care: results of an exploratory study of the experiences of terminally ill patients
Authors: Rohr Yvonne , Adams Jon , Young Lindy
Published: May 2014

An exploratory qualitative study was undertaken with the aim of examining oral discomfort from the perspective of terminally ill patients. Interviews focusing on the experiences and perceptions of oral discomfort and effects on day-to-day functioning among 14 palliative care patients from a mid-size hospital in a regional city in Australia were conducted. The findings reveal that a range of oral problems significantly impact on the physical, social and psychological wellbeing of terminally ill patients to varying degrees, sometimes over extended periods of time. In particular, dry mouth (xerostomia) was experienced as a significantly troubling and ongoing symptom, and bouts of ulceration and infection were also commonly discussed. Furthermore, participants reported a lack of oral assessment and virtually no input from dental experts to assist with palliating oral problems. A better understanding of the impact of oral discomfort among terminally ill patients is a significant care issue for hospice and palliative care teams, especially nursing staff, and further research of this significant issue is required. The results of the current study provide preliminary evidence to support raising the clinical focus and priority of oral care for terminally ill patients in all settings.
Using the M technique as therapy for patients at the end of life: two case studies
Authors: Roberts Keris , Campbell Heather
Published: May 2014

Complementary therapies are increasingly used in palliative and end-of-life care, particularly in hospice settings. Most of these interventions use touch as a medium of therapy, which has been shown to reduce anxiety and pain perception, induce relaxation, and promote comfort and wellbeing. Traditionally, these touch therapies have been administered mainly by complementary therapists and only after many months of training. This article refects on the potential for palliative care nurses in a hospice setting to support patients with agitation and distress at the end of life by using the M technique. This simple method of structured touch can be learnt in two days and applied in any setting. It is particularly useful for end-of-life patients with pain and fragile skin tissue, because the pressure applied can be adjusted to meet the individual patient's needs while still being beneficial.
Leading end-of-life care: an action learning set approach in nursing homes
Authors: Hewison Alistair , Badger Frances , Swani Tina
Published: May 2014

If the end-of-life care needs of people living in nursing homes are to be met, effective leadership is necessary. This in turn requires that appropriate training and support are provided for nursing home managers. To meet this need, an action learning set (ALS) involving nursing home managers was developed, and as a result of the continuous process of learning and refection that characterizes ALS work the managers brought about a number of improvements in end-of-life care. These included more consistent use of care plans, increased involvement of clients and their families in planning end-of-life care, more training for staff, and the use of events and techniques to create opportunities for discussing the end of life. The managers set specific individual objectives focused on improving end-of-life care and were supported in meeting them through their membership of the set.
The constraints of the ordinary: ‘being with’ in the context of end-of-life nursing care
Authors: Haraldsdottir Erna
Published: May 2014

The concept of ‘being with’ was an essential part of the hospice philosophy developed by Cicely Saunders, and one that she believed was a key element in the care of the dying. In Saunders’ philosophy, ‘being with’ is a specific moment of engagement between a health professional and a patient whereby the patient has the opportunity to examine and express their thoughts and feelings relating to their imminent death. This study examined how ‘being with’ was implemented as a part of ordinary day-to-day practice in a hospice in Scotland. The study was based on the principles of ethnomethodology, which aims to reveal embedded and taken-for-granted rules and behaviours that determine practice. The data collection and analysis revealed that the nursing practice was constructed in such a way that ‘being with’, as Saunders understood it, could not be initiated either by a member of the nursing staff or by the patients. By adopting the philosophical framework of Heidegger, the study offers an understanding of how the nursing staff had developed ‘being with’ as provision of comfort in order to protect both themselves and the patients from engaging with painful emotions associated with facing death.
The practice of withholding and withdrawing life-support measures among patients with cancer in Jordan
Authors: Khater Wejdan A , Akhu-Zaheya Laila M , Abu Alhijaa Eyad H , Abdulelah Hazem A , EL-Otti Sanaa N
Published: May 2014

In Jordan, an Arabic Islamic country, decisions around withholding and/or withdrawing life support measures still present both moral and professional dilemmas. The purpose of this study was to explore the use of such measures among patients with cancer in Jordan. The medical records of 436 patients with cancer who were at least 18 years old and who died at a specialized cancer centre in Jordan in 2008 were reviewed retrospectively. Of those, 212 (48.6%) had a written decision to withhold or withdraw life support measures. Among the 436 charts reviewed, only 7 patients (1.6%) had treatment withdrawn, while 212 (48.6%) had treatment withheld. Resuscitation was the most common treatment withheld, followed by medication, and poor prognosis was the most common reason for the decision. The time period between a decision being made and the death of the patient was short, indicating that treatment plans are not being made well in advance. A cultural and religious consensus regarding such decisions is needed to help ensure that a greater proportion of terminally ill people plan their care in advance, and to aid health-care providers in advising their patients and acting in the patients’ best interests.
Improving pain assessment for patients with cognitive impairment: development of a pain assessment toolkit
Authors: Chatterjee Jane
Published: May 2014

A significant number of people experience pain and cognitive impairment toward the end of life. Assessment of their pain becomes more complex as their cognitive abilities diminish and they lose their ability to express themselves and understand their experience of pain. The rate and pattern of cognitive decline differs between individuals, which makes it difficult to take a standardised approach to pain assessment. Based on a review of the literature, this article describes the development of a pain assessment toolkit consisting of guidelines and a selection of self-report and behavioural assessment tools to support health professionals in tailoring their assessment to meet the needs of an individual with cognitive impairment.
Total pain: a reflective case study addressing the experience of a terminally ill adolescent
Authors: Klepping Laura
Published: May 2014

This article is a reflective case study of the symptom control strategies implemented by a hospice team caring for Jack, a teenage male with metastatic nasopharyngeal cancer who was experiencing severe pain. The concept of a ‘total’ approach to pain assessment and management is introduced and Jack's pain is analysed in the context of total pain, including the psychological, social, spiritual, and physical dimensions that contributed to his overall pain experience during his final months. This paper examines the elements of Jack's life that caused him anxiety and triggered pain episodes, including familial and cultural issues, and discusses the pharmacological and non-pharmacological interventions used by the hospice to address these. The article demonstrates how the care delivered by local services was informed by UK strategies for palliative and oncological care of young people.
Staff perceptions of the impact of the Liverpool Care Pathway in aged residential care in New Zealand
Authors: Clark Jean , Marshall Bridget , Sheward Karen , Allan Simon
Published: May 2014

Aim:

To determine staff perceptions of the impact of the Liverpool Care Pathway for the dying patient (LCP) in three aged residential care facilities in New Zealand.

Methods:

A mixed methodology approach was adopted, including the use of a survey, focus groups, and individual interviews.

Findings:

Fifteen of 194 staff participated in the focus groups (five nurses and nine health-care assistants). The interviewees included three GPs, one registered nurse, and one manager. The post-implementation survey response rate of 13% was poorer than the 32% response rate to a pre-implementation survey reported elsewhere. Nevertheless, there was congruence across the data sources. The participating staff perceived multiple benefits to residents, family, whãnau, and staff following implementation of the LCP.

Conclusion:

As a tool the LCP was effective in supporting, guiding, and prompting care delivery. However, challenges remained, particularly regarding environmental factors.
Factors influencing nurses' attitudes toward death
Authors: Gama Georgeana , Vieira Margarida , Barbosa Filipe
Published: May 2014

Background:

Studies on nurses' attitudes to caring for terminally ill patients indicate that death and dying create fears and anxieties for health-care providers. Aim: To identify nurses' most common attitudes toward death and the sociodemographic, professional, and training factors that significantly affect those attitudes.

Method:

This was a descriptive correlational study with a sample of 360 nurses from the internal medicine, oncology, hematology, and palliative care departments of five health institutions in Lisbon (response rate 70.6% of all nurses). Data were collected using a sociodemographic and professional questionnaire (QSDE) and the Portuguese versions of the Death Attitude Profile-Revised (DAP-R) scale and the Adult Attachment Scale (AAS).

Results:

Older nurses (P<0.0001) and nurses with more work experience (P<0.0001) had higher escape acceptance. Female nurses had higher religious acceptance (P<0.0001). Medicine, oncology, and hematology nurses had significantly higher fear attitudes (P<0.01), avoidance of death attitudes (P<0.0001), and escape acceptance attitudes (P<0.0002) than palliative care nurses.

Conclusion:

This study contributes to a better understanding of the factors that underlie nurses' attitudes toward death. This may be useful for creating relevant and effective pre- and post-graduate nursing training.
Validity and reliability of the Italian Constipation Assessment Scale
Authors: Molin Alberto Dal , McMillan Susan C , Zenerino Francesca , Rattone Valentina , Grubich Sergio , Guazzini Andrea , Rasero Laura
Published: May 2014

Constipation is a common problem among oncology patients and requires careful assessment. Use of validated instruments is important to improving its management. The aim of this study was to validate the Italian translation of the Constipation Assessment Scale (CAS). To test construct validity, patients and apparently healthy adults were asked to complete the CAS. The results indicated that there was a significant difference between the median CAS of the patient group and that of the apparently healthy group. Test–retest reliability was very high (r=0.96; P=0.0001), and the internal consistency as assessed by Cronbach’s alpha was 0.768. These findings suggest that the Italian CAS can be used in clinical practice to document the presence and severity of constipation in cancer patients. However, further studies should be conducted in a larger sample of patients to confirm the results.
A retrospective pilot study to explore the timing of cessation of laxatives before death in a palliative care unit
Authors: Clark K , Hipwell A , Byfieldt N , Clark K
Published: May 2014

Context:

Constipation is common and sometimes distressing in palliative care patients. Laxatives are often prescribed, but there is little guidance as to the most appropriate time to cease these medications as death approaches.

Objective:

To conduct a retrospective pilot review of usual prescribing of laxatives toward the end of life in a specialist palliative care unit.

Methods:

The notes of all 92 inpatients who died over a 2-month period were reviewed, with the main outcomes of interest being the number and types of laxatives prescribed and the documentation of bowel movements in relation to time of death.

Results:

On admission 70% of the patients were receiving laxatives, with a mean of two different types per person. The mean number of days before death that people had a bowel movement recorded by nursing staff was 3.8 (standard deviation (SD) 3.55). No differences were identified between those who had not received laxatives at any point, those who received laxatives until death, and those who ceased laxatives at distinct time points. However, differences were found between those who were commenced on an end-of-life care pathway (mean 4.30 days; SD 3.84) and those who were not (mean 2.50 days; SD 2.31) (P=0.01).

Conclusions:

The correct timing for cessation of laxatives as death approaches remains unclear. Further work is needed to understand how bowel function changes with disease progression and the subjective experiences of patients.
Working in a medicalised world: the experiences of palliative care nurse specialists and midwives
Authors: van Brummen Barbara , Griffiths Lauren
Published: May 2014

Aim: This paper reports a study that explored birth and death care experiences from the perspectives of midwives and palliative care clinical nurse specialists (CNSs). Methods: A grounded theory approach illuminated the social processes associated with caring during birth and death. Data was collected during 2011 through in-depth semi-structured interviews with eight participants: four midwives and four CNSs from UK NHS Trusts. Findings: Four categories were identified through thematic analysis: memories, one act, advocate, and medical event. These integrated to create a core category: working to counter the pathologisation of birth and death. Conclusion: The participants illustrate the impact of medicalisation on the experience of birth and death and struggle with the negative effects of this. Health professionals should work toward practice that emphasises the importance of holistic care.
The management of hypercalcaemia in advanced cancer
Authors: Pettifer Annie , Grant Sarah
Published: May 2014

Hypercalcaemia is common in patients with advanced cancer. If detected, it usually responds to palliative treatment and patients' distressing symptoms will improve markedly. However, if left untreated hypercalcaemia is potentially fatal. It can be difficult to detect as its symptoms can also be attributed to other common aspects of advanced malignancy. It is therefore essential that nurses are aware of the underlying physiology and can identify which patients are at risk of becoming hypercalcaemic. Hypercalcaemia often recurs and can become increasingly difficult to treat. Such refractory hypercalcaemia requires sensitive and considered management with advance care planning, particularly as difficult treatment dilemmas may arise if and when malignancy advances.
Breakthrough cancer pain: the current situation
Authors: Buchanan Alison , Davies Andrew
Published: May 2014

Breakthrough pain is common in patients with cancer. This paper describes the clinical features of breakthrough cancer pain (BTcP) and its impact on activities of daily living. It also describes the principles of BTcP management, highlighting some of the current issues and problems. A follow-up paper will describe current approaches to managing BTcP.
Politics and palliative care: Guyana
Authors: Smyth Dion
Published: May 2014

Dion Smyth's review of the internet for palliative nursing
Book review
Authors: Creek Jennifer
Published: May 2014

This is not an unbiased review. I have been an admirer of Estelle Breines’ work for many years and had the privilege of writing a foreword for this book.
Identifying and preventing ageism among health-care professionals
Authors: Weir Evelyn C
Published: May 2014

Acknowledging, confronting and changing the current practice of age-based decision making and ageism in the provision of health care is a political priority and a topic of public and media interest. Health-care providers function in a society that may be considered to have ‘ageist roots’ and when an individual begins training in health care, he or she presents with his/her own acquired stereotypical imagery and beliefs. If these students are ‘ageist’ before they begin their training, then the training period must address this.

This article considers the evolution of ageism and the influences from childhood and adult life that contribute to ageist behaviour. Using a wide range of literature from a variety of sources, the evidence of exposure to ageist behaviour in health-care education is reviewed and a series of strategies to reverse the trend are examined.
What is the evidence for the effectiveness of craniosacral therapy?
Authors: Fowles Kate
Published: May 2014

Craniosacral therapy (CST) is a complementary therapy widely used by a variety of practitioners including physiotherapists, osteopaths and chiropractors. It is a gentle manual therapy, reported to give clinical improvements in conditions that include musculoskeletal and neurological disorders, stress and emotionally-derived problems and autism. It is described as being holistic in its activation of inherent self-healing mechanisms, resolving dysfunctions together with any associated physical or emotional issues (Hollenbury and Dennis, 1994).
Book review
Authors: Rose John
Published: May 2014

This is a very useful book that looks at what practitioners can do to make sense of behaviours in order to support the people they work with more effectively. The preface suggests that it is written for frontline staff working in ‘ordinary’ settings and in general, I think it tailors its contents well to these individuals. However, it may also be useful for other practitioners, particularly at the start of professional training. While written for people working with individuals with a developmental disability, I believe that it may have additional use for people working with other client groups.
A study of occupational therapy interventions in oncology and palliative care
Authors: Cooper Jill , Littlechild Barbara
Published: May 2014

The purpose of this study was to identify the variety of interventions carried out by occupational therapists in oncology and palliative care settings and the proportion of time spent in each of these. Data were recorded onto a daily sheet, itemizing 10-minute blocks of activity. Results showed the proportion of time spent by occupational therapists in direct and indirect patient activity as well as information on the range and ages of patients and diagnoses treated.

The authors' conclusion confirms that a large proportion of occupational therapy time is dedicated to indirect and non-patient-related activities, reflecting the complex nature of this patient group. It also reflects the senior status of occupational therapists working in oncology and palliative care and their professional commitments of teaching other professions, caseload management, continuing professional development and contributions to current national agendas in oncology and palliative care. Different patient groups require different occupational therapy interventions and time allocation to meet their diverse functional requirements.
A multimedia learning resource for people with epilepsy and learning disability
Authors: Kushinga Katrina
Published: May 2014

Epilepsy is the most common serious neurological condition in the UK, with 80 new cases being diagnosed every NHS working day. There are many different possible causes, including scarring to the brain as a result of illness or injury or an inherited predisposition to seizures.
Robots for upper and lower limb motor rehabilitation: An overview
Authors: Hesse Stefan
Published: May 2014

Regaining arm and hand function and gait ability is crucial in the motor rehabilitation of neurologically-impaired and orthopaedic patients. An intensive, task-oriented treatment approach is currently advocated. Tight budgets, however, restrict the amount of labour-intensive therapy that is needed to guide the paretic arm and to control for balance and paresis while walking.
Clinical education in a nursing home setting: A structured framework for student learning
Authors: McCallum Christine
Published: May 2014

Clinical education is a vital link in the development of entry-level competence for health professional students. A need exists, however, for quality clinical education experiences for students in nursing home settings. As the population ages and the number of patients recovering from acute illness increases, student exposure to the practice of physical therapy is required in this setting.

This article introduces a three-tiered clinical education model for use by physical therapy students in a nursing home setting. Clinical, administrative and research skill development are highlighted. Integration of a variety of learning experiences across this spectrum helps students preparing for work in this environment after graduation.
Rehabilitative care in a specialist palliative day care centre: A study of patients’ perspectives
Authors: Belchamber CA , Gousy MH
Published: May 2014

This qualitative study set out to explore cancer patients’ perceptions of a rehabilitative care approach, which they experienced in an independent specialist palliative day care centre. A phenomenological approach was chosen and through semistructured interviews, patients’ perceptions of their symptoms, beliefs and attitudes towards their rehabilitative care were explored. The relevance and benefits of the rehabilitative care approach were then identified using quality of life markers established during data analysis.

The main factors uncovered and shown to contribute to the rehabilitation process were: environmental factors; participant interaction; normalization; health-care professional interaction; nutrition; mobilization; and education. However, more research is needed to understand how some of the treatment modalities discussed can help reduce fatigue, pain, dyspnoea and nausea in this group of people.
Using ‘mindfulness’ to enhance health and wellbeing
Authors: Martin Marion
Published: May 2014

Advertising lures us into believing that happiness can be bought by going on frequent exotic holidays, accessing our favourite pieces of music wherever we go and being able to contact our friends whenever we start to feel alone. Yet all this availability of entertainment and pleasure in the Western world does not seem to make us feel happier or less bored. We have reached a stage where one in four people in the UK will experience some kind of mental health problem in the course of a year (Mental Health Foundation, 2005), and the incidence of boredom seems to be on the increase (Svendsen, 2005).
Development of the Undergraduate Sources of Stress Questionnaire
Authors: Blackmore AM , Tucker Beatrice , Jones Sue
Published: May 2014

The aim of this research was to develop and trial a questionnaire to assess sources of stress in undergraduate students. The questionnaire was developed on the basis of research literature on sources of stress in students and was administered to 65 recent graduates and 320 undergraduates in physiotherapy and podiatry. The questionnaire was revised after each administration. On the basis of a factor analysis, three subscales emerged. The internal consistency of these subscales was moderate to good. The final Undergraduate Sources of Stress Questionnaire, which is reproduced in this article, consists of 18 items in three subscales – academic demands, financial issues and personal issues – and is suitable for undergraduates in various disciplines.
Exploring students' views of interprofessional education: 1year on
Authors: Johnson Ros
Published: May 2014

The promotion of interprofessional education at a pre-qualifying level presents higher education institutes with complex cultural, organizational and education challenges. Research into students' experiences of these new learning environments is needed to ensure successful implementation.

This study explores health- and social-care students' views of their second interprofessional module. Qualitative comments were collected from 67 Level 2 students and subjected to content analysis, and compared with the views of the same cohort after their first interprofessional module. The findings reveal both positive and negative experiences, relating to the quality of facilitation and group dynamics. Students were more comfortable with the enquiry-based learning approach than at level 1, but many were unable to relate the module to clinical practice and expressions of professional rivalry emerged.
Using standard office software in computer-assisted cognitive rehabilitation
Authors: Gunning Stephen , Clegg Frances
Published: May 2014

Although specialized computer software for cognitive rehabilitation was initially welcomed, it has turned out to have limited value in functionally-based neurorehabilitation. The last 20 years have seen an exponential rise in the use of domestic computers, an increase in computer literacy and a wide availability of sophisticated yet user-friendly software. Most of the authors' patients at the Harrowbased Regional Rehabilitation Unit are now computer literate and have been found to prefer to reacquire their previous keyboard skills before developing new skills. All these skills can be relevant to everyday life or the workplace.

Standard office software (as opposed to specialized software) offers these opportunities and additionally, provides great scope for assessing and compensating for many cognitive deficits. The flexibility of current software also means that therapeutic applications can be created around the user's needs, rather than expecting the user to adapt existing programmes. The authors have also found office software to be useful when working with patients who have impaired executive skills. This article details how the authors have developed the use of computers to play an important role in cognitive rehabilitation.
Identifying cognitive impairment and emotional distress in people admitted to stroke rehabilitation
Authors: Macniven Jamie AB , McKeown Alison C , Chambers Hannah M , Lincoln Nadina B
Published: May 2014

The authors describe a local audit of cognitive and emotional difficulties for people admitted to a stroke rehabilitation service. In total, 19 people who had sustained a stroke participated. All participants were found to be impaired in one or more areas of cognitive functioning.

Over 60% of participants scored within the significant range on measures of anxiety and/or depression. A high proportion of the audit data directly contradicted existing shared medical and multidisciplinary opinion of the emotional and cognitive status of the participants. The results are discussed in the context of recent national stroke guidelines from the British Psychological Society, the NHS and the Royal College of Physicians.
Advantages of low-cost mobility aids in health-care settings
Authors: Swain Jane , Jeffery Karen
Published: May 2014

Rope bed ladders, hand blocks and transfer boards have been available for years in a number of health-care settings. They are recommended for clients with some mobility, who would otherwise need manual assistance, yet research indicates that they are an underused resource.

This article sets out to promote awareness of these and similar ‘low-tech’ aids by identifying the advantages of promoting independence by equipping and educating clients to move themselves.

The use of hand blocks, bed ladders, lifting poles (‘monkey poles’) and transfer boards are examined. The type of patients for whom they may be helpful, the assessment of the clients and contraindications are considered and recommendations are made for the provision of these aids.
Tailoring treatment for aphasia to the right time after stroke
Authors: Hillis Argye E
Published: May 2014

It is challenging to evaluate language of patients in the first few days of stroke because of the variability of their deficits, making the diagnosis of aphasia a moving target. I have become interested in the fluctuation of aphasia in the acute period. Is it random, or does it reflect changes in the brain that might be important clues for how to best aid recovery? Which therapies, then, work at particular time points after stroke?
Use of microstimulators to aid upper limb function in hemiplegia
Authors: Turk Ruth , Burridge Jane
Published: May 2014

Functional electrical stimulation (FES) is used to facilitate movement in people who have suffered a central nervous system lesion such as a stroke. FES can be used as an orthosis, where muscles are activated in a precise sequence to assist in functional activities such as walking, or as a therapeutic strategy, aimed at improving impairments such as limited range of movement, weakness and spasticity, and hence enhance recovery (Chae and Yu, 1999).
To interview or not to interview? That is the question
Authors: Bailey Chris , Hong Chia Swee , Wright Jon
Published: May 2014

Interviewing is one of the methods used by occupational therapy schools to select prospective students. There has, however, been little research on how interviewing is used in the UK.
The analysis of interaction in online focus groups
Authors: Watson Mohinder , Peacock Susi , Jones Derek
Published: May 2014

Computer mediated communication has enabled researchers to transfer the focus group method to the online environment. This has important practical, ethical and theoretical implications including the challenge of maximizing and analysing focus group interaction in a faceless medium, devoid of visual and vocal cues. In the online setting where written communication is the only means of understanding data, interaction offers the researcher a critical window to interpret meaning and to understand better what is happening in the social context of the group.

A schema of questions has been used in this study to draw attention to this interaction and to examine the transcripts of online focus groups, which sought to investigate the lived experiences of sufferers of repetitive strain injury. Five asynchronous online focus groups were conducted on a closed website specifically created for the study.

Online focus group interaction was found to generate rich qualitative data. More studies are required to explore what is potentially an innovative tool for qualitative researchers.
Maintaining autonomy: The role of prospective memory in rehabilitation
Authors: Kennard Jerry , Lewis Kevin
Published: May 2014

Memory is the cornerstone of our ability to think, reason and problem solve. Its reciprocal relationship with learning and planning enables us to exercise free will, to be autonomous and to be seen to make things happen around us.
Helping people to live independently in the home
Authors: Finucane Caroline
Published: May 2014

This article offers information on how standard furniture around the house can be adapted and devices used to make activities of daily living easier for those who need assistance, removing the need for specialist furniture and major alterations to the home environment. Contact details for the manufacturers and suppliers of such equipment are provided. The article aims to provide a useful guide for occupational therapists who are assessing and giving advice and information on equipment to people who need daily living assistance, to promote their independence.
Development and evaluation of a communication clinic for patients' relatives
Authors: Gupta Romesh , McCann Peter , Rawcliffe Colette , Brigden David
Published: May 2014

This article describes a new, successful concept of providing a service within rehabilitation, which to the authors' knowledge has not been described before in the literature. The ‘relatives communication clinic’ is a dedicated clinic solely for the purpose of communicating to patients' relatives in a formal environment. The weekly relatives communication clinic is attended by the consultant physician, members of nursing staff, members of the multidisciplinary team, the patient and the patient's relatives and/or carers. The clinic was formally audited to evaluate its effectiveness.

In the period studied (May–December 2003), 47 separate families were seen. A retrospective audit analysed the notes of the patients involved. Complaints were reduced by 25% and concordance with the management plan was 100%. Feedback showed that the multidisciplinary team and trainee health-care professionals benefited greatly from the clinics: for example, it reduced fragmented care plans, helped timely discharge planning and empowered junior staff.

The relatives' communication clinic should be an integral part of modern hospital rehabilitation, especially when dealing with elderly, complex patients.
Are we theoretically motivated?
Authors: Kennard Jerry , Lewis Kevin
Published: May 2014

Motivation is a key concept in psychological theories of learning and goal setting. Its pervasive use in everyday language and association with positive adjectives, such as success and achievement, make it a sought after commodity for teachers, coaches, managers and health professionals.
The Molift Partner 230: An innovative hybrid patient lifter
Authors: Richardson Norma
Published: May 2014

Whether in the acute sector or in social care, diverse clients present many differing moving and handling needs.

This article looks at the Molift Partner 230, in light of whether one piece of equipment can meet the needs of such clients.
Assistive bathing and showering equipment
Authors: Fernandes Tanya
Published: May 2014

Individuals with mobility difficulties or impairments of function may view activities of daily living such as bathing and showering as a task instead of an enjoyable and relaxing experience.

This article will focus on the types of equipment available that can be used within the bathroom to increase independence and reduce difficulties when bathing or showering.
Advanced Care Technology: A programme for future provision
Authors: Cudd Peter
Published: May 2014

Recent moves by UK government towards the increased use of community or home-based care is largely based on adding technology to the care intervention, i.e. through telecare, telehealth and telemedicine (Department of Health, 2005). The tele-technologies all remotely augment delivery of care. Currently, telecare primarily identifies social or health events that require a rapid response, whereas telehealth delivers some health monitoring and/or intervention in the home. Telemedicine involves inter-professional-or professional-to-patient services. The role of assistive technology (AT) for anyone with reduced functional capabilities is also recognized (Audit Commission, 2003). Assistive technologies are any products that assist a user to achieve tasks that current functional incapacity would otherwise make impossible, difficult or dangerous.
Improving rehabilitation outcomes in unilateral neglect
Authors: Plummer-D’Amato Prudence
Published: May 2014

Unilateral neglect is a complex and disabling condition that occurs in as many as 80% of people after right hemisphere stroke. The neglect syndrome is characterized by an absence of awareness or failure to respond to stimuli on the side opposite the brain lesion, which cannot be attributed to primary sensory or motor dysfunction. The behavioural consequences of neglect are devastating and can severely limit a person’s ability to regain functional independence. Moreover, the presence of neglect has been shown to be a predictor of poor response to rehabilitation.
Research-informed teaching in health professional education
Authors: Sparkes Victoria
Published: May 2014

Research - informed teaching (RIT) is the current buzz-word pertaining to Higher Education (HE) quality enhancement initiatives. Here, it is proposed that delving deeper into the model underpinning RIT could unearth the fabric which binds the true concepts of academia together.
An investigation of day hospital outcome measures
Authors: Palmer Síobhán , Kneebone Ian
Published: May 2014

It is important to evaluate services in order to establish best practice, allocate limited resources, and strive towards clinical excellence. This study explored outcome measures for medical rehabilitation day hospitals for older people, where a broad range of needs are addressed. The aim was to identify alternatives to the current measure in use across four day hospitals, as it was considered by staff that this measure was not consistently reflecting observed and clinically significant changes.

Consultation with day hospital staff clarified the outcomes they hoped to capture in a measure, nd their concerns about current measures. Literature review identified potential alternatives, one of which was piloted; the CANE-S (Camberwell Assessment of Need-Short Form). The CANE-S was selected for pilot owing to it being specifically designed for use within services for older people, with established reliability and validity.

Pilot results indicated that the CANE-S was not a suitable measure for all of the four day hospitals because it did not offer the brevity and distinctiveness required by all. Recommendations for further evaluation are discussed.
Disability rights in a global context
Authors: Karna GN
Published: May 2014

During recent decades, a number of momentous developments have taken place in the global disability rights movement; culminating in the adoption of the United Nations (UN) Convention on the Rights and Dignity of Persons with Disabilities on December 13 2006. This convention has been viewed as the fi rst international human rights treaty of the 21st century (CBC News, 2006). It touches on almost the whole gamut of issues related to empowering people with disabilities, such as:
Using confidence intervals to assess clinical relevance of research findings
Authors: Wright CC
Published: May 2014

Background: There is a need for reporting of statistics that convey information about the clinical importance of findings. Estimation is a method that is used to produce such statistics and confidence interval estimates, in particular, are frequently reported in research studies.

Contents: This article introduces the concept of estimation by focusing on key features of confidence intervals and how they are related to precision of findings from a research study. It illustrates how to interpret confidence intervals through a simple hypothetical study on recurrent low back pain, with the Visual Analogue Scale for pain and the Oswestry Disability Index as the two outcomes. Use of confidence intervals to assess clinical importance of research findings is demonstrated. Key properties of confidence intervals are discussed and illustrated graphically, and consideration is given to aspects at the design stage that influence the precision of results in a research study.

Conclusions: An understanding of the concept of confidence intervals will enable researchers to report results that might be used to judge clinical importance of findings from their research, and consumers of research to critique clinical importance of results presented in published studies.
Preventing avoidable admissions for disabled people of working age: An exploratory study
Authors: Hanley Laura Jane , Triskel Natty , Cozens Phillipa
Published: May 2014

Aims

There is a significant number of disabled people of working age who are at risk of experiencing an unplanned and potentially avoidable hospital admission. However, despite the huge cost of these admissions for both the NHS and the individual involved, there is very little research into health-care strategies that would enable disabled people of working age to avoid unplanned admissions. The authors aimed to investigate experiences of, and problems linked to, potentially avoidable admissions experienced by disabled people of working age in the UK, and propose ways of addressing problems identified.

Methods

Focus groups and interviews with health professionals (n=10) and service users (n=3) from similar services in South West England were conducted to explore issues around avoidable admissions. Thematic analysis of the date was then conducted.

Findings

Analysis revealed that the needs and expectations of disabled people of working age are different to those of older people, that there is a lack of information and specialist equipment available to service users and a shortage of age-appropriate services for disabled people of working age.

Conclusions

Disabled people of working age who experience unplanned admissions experience double discrimination: as disabled people their impairment-related needs can be poorly understood and met, and as younger people they can be excluded by services designed to meet the needs of older people. Short and long-term recommendations for further research and strategies which may help to reduce the number and impact of potentially avoidable admissions by disabled people of working age are suggested.