bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Perspectives on Teachers as Materials Developers: Why, What, and How?
Authors: Bouckaert Marina
Published: December 2018

Classroom materials play a major role in teachers’ professional lives and are a central component of the English as a Foreign Language (EFL) classroom. Teachers themselves have been found to create and adapt materials for a plethora of reasons, one of which is their own continuing professional development. This article aims to take stock of a growing body of literature on teachers as materials developers. It will offer various perspectives on the why, what and how of materials development by teachers. In addition to theoretical discussions, the article presents empirical findings of a recent doctoral study (Bouckaert, 2017) which explored the potential value of this creative process for teachers’ development of reflective practice. The article frames answers to the three who, what, where questions as it offers practical recommendations for teachers and those involved in language teacher education and training.
Balancing apparel assembly lines through adaptive ant colony optimization
Authors: Xu Huijuan , Xu Bugao , Yan Jiang
Published: December 2018

The goal of this study was to introduce an effective optimization method to balancing one-piece flow assembly lines by rearranging manufacturing tasks necessary for an apparel production to minimize the number of workstations and the idle time of the assembly line under certain conditions. In this paper, we firstly define an assembly-line-balancing (ALB) problem in apparel production and established an objective function for minimizing the smoothness index, a term that measures the difference between the worktime and the targeted cycle time of each workstation on an assembly line. We then illustrate an adaptive ant colony (AAC) algorithm with modifications made on the traditional ant colony algorithm for solving the ALB problem. Finally, we present the experiments using real-world data provided by an apparel manufacturer to compare the results generated from the AAC and the prior practice of the company. It was demonstrated that the AAC could help the company reduce the number of workstations on its assembly lines and cut the idle time at most of the workstations.
A test of the interpersonal-psychological theory of suicidal behaviour in a sample of mental health outpatients
Authors: Naidoo Sarojini , Collings Steven
Published: December 2018

Suicidality is a growing mental health problem, with statistics for South Africa being in line with global estimates. There has, however, been relatively little empirical advancement in the conceptualization of suicidal behaviour in recent years. Joiner’s interpersonal-psychological theory of suicidal behaviour is a relatively new theory that appears to hold promise for advancing our understanding of the mechanisms that underlie suicidal behaviour. The theory proposes that people die by suicide because they want to and because they can. This study sought to test two key hypotheses of the interpersonal-psychological theory of suicidal behaviour using a cross-sectional design and a sample of 239 mental health outpatients. Consistent with theoretical predictions, levels of suicidal ideation were significantly predicted by the interactive effects of high levels of thwarted belongingness and perceived burdensomeness in the presence of high levels of hopelessness in relation to both of these distressing states; with estimates of risk for suicide being most strongly predicted by the interactive effects of suicide ideation and an acquired capability for suicide. These findings are discussed in terms of their implications for theory, practice, and future research.
Immunohistochemical analysis of Otic Capsule Osteogenesis in the Palmerston North Autoimmune Mouse
Authors: Traynor Sean J. , Cohen James I. , Morton Jane I. , Trune Dennis R.
Published: December 2018

Autoimmunity and the immune complex disease associated with it have been hypothesized to be the cause of several idiopathic diseases of the inner ear—including the new bone formation associated with otic capsule osteogenesis and otosclerosis. The Palmerston North (PN) autoimmune mouse strain, which exhibits both spontaneous systemic autoimmune disease and otic capsule bone formation, has been proposed as a model relating these two disease processes. To investigate the potential role of immunopathologic processes in PN otic capsule lesion formation, inner ears from PN mice were immunostained for the presence of IgG and complement (C3), two immunologic markers involved in the development of the vascular and perivascular changes associated with immune complex deposition. Both systemic autoimmune disease and otic capsule bony lesions were confirmed in all animals. However, immunohistochemical analyses did not establish a direct relationship between the two conditions as complement was absent in all lesions and IgG stained positive in only one instance. These results suggest that immune complex deposition is not directly involved in the otic capsule lesions of the PN mouse, and alternate mechanisms relating autoimmune disease and otic capsule osteogenesis must be explored.
Delayed open conversion after endovascular aortic repair
Authors: Law Y , Chan YC , Cheng SW
Published: December 2018

Aim

We present the clinical outcomes of patients who underwent delayed (>30 days) open surgical repair after endovascular aortic aneurysm repair.

Methods

All patients receiving delayed open repair of infrarenal and juxtarenal aortic aneurysms after endovascular repair from July 2001 to December 2017 were retrospectively reviewed. Patients’ baseline characteristics, indications for delayed open conversion, and time between endovascular repair and open conversion are described. Early outcomes included operative approach, morbidity, and mortality. Midterm outcomes included survival.

Results

Twenty-two (3.3%) of 667 patients with prior infrarenal endovascular aortic aneurysm repair had delayed open conversion (20 elective and 2 emergency). The time from endovascular repair to open conversion was 60 ± 36 months. The indications were 6 (27%) type Ia endoleaks, 6 (27%) type II endoleaks with enlarging sac size, 2 (9%) endotensions, 7 (32%) unknown types of endoleak, and 1 (5%) graft infection. The 7 minutes unknown endoleaks were confirmed as lumbar leaks in 4 cases and fabric leaks in 3. Operative time was 222 ± 48 min with blood loss of 2211 ± 2057 mL. Hospital stay after conversion was 12 ± 8 days. There was no 30-day mortality. Estimated survival rates were 96%, 91%, 86%, 79% and 57% at 1, 2, 3, 4, and 5 years postoperatively.

Conclusion

Delayed conversion to open surgery after endovascular aortic aneurysm repair by endograft explantation appears to be safe with good short- and mid-term outcomes. With careful preoperative assessment, open conversion remained a realistic and viable option in patients with failed endovascular treatment.
Older Parents’ and Middle-Aged Children’s Communication as Predictors of Children’s Successful Aging
Authors: Bernhold Quinten S.
Published: December 2018

The communicative ecology model of successful aging (CEMSA) examines how people’s language and communication surrounding the aging process (e.g., making age-related excuses) predicts successful aging. Using the CEMSA, this study examined how middle-aged U.S. American children’s and their parents’ age-related communication predicts children’s subjective perceptions of their own successful aging, via children’s aging efficacy. Three communication profiles emerged for children and their parents, namely engaged, bantering, and disengaged agers. Path analysis revealed that parents’ age-related communication predicted children’s successful aging, via children’s aging efficacy. Relative to children with disengaged parents, children with bantering parents were more likely to be efficacious with respect to their aging, which in turn positively predicted successful aging. The language and communication people observe from older family members may be consequential in shaping their aging trajectories for the better or worse.
Long-term quality of life in patients treated with extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock
Authors: Norkiene Ieva , Jovaisa Tomas , Scupakova Nadiezda , Janusauskas Vilius , Rucinskas Kestutis , Serpytis Pranas , Laurusonis Kestutis , Samalavicius Robertas
Published: December 2018

Objective:

The aim of our study was to explore long-term health-related quality of life (HRQOL) and incidence of post-traumatic stress disorder (PTSD) in extracorporeal membrane oxygenation (ECMO) survivors.

Methods:

Single-center prospective follow-up study. All patients in whom ECMO was initiated due to refractory cardiogenic shock between 2009 and 2014 were included in the study. We used Medical Outcomes Study 36-Item Short-Form Health Survey to evaluate HRQOL and IES-R questionnaire to assess incidence of PTSD.

Results:

Sixty-nine patients were treated with venoarterial (VA) ECMO during the study period. Nineteen patients survived until hospital discharge and 15 patients were alive at the study cut-off point in June 2017; mean follow-up time was 70.6 ± 10 months. The average Physical Component Summary and Mental Component Summary scores amongst long-term survivors were 46.1 ± 7 and 47.1 ± 8, respectively. PTSD was evident in 4 out of 15 participants.

Conclusions:

Despite the complex clinical course and prolonged recovery, ECMO survivors achieved satisfactory levels of both mental and physical recovery, which were comparable to the age- and pathology-adjusted population means.
Validation of the Spanish version of the Oxford Cognitive Screen (S-OCS): psychometric properties of a short cognitive stroke-specific screening tool
Authors: Valera-Gran Desirée , López-Roig Sofía , Hurtado-Pomares Miriam , Peral-Gómez Paula , García-Manzanares María , Sunyer Catlla Marta , Más Sesé Gemma , Navarrete-Muñoz Eva María , Sánchez-Pérez Alicia
Published: December 2018

Objective:

The aim of this study is to examine the psychometric properties of the Spanish version of the Oxford Cognitive Screen in a subacute stroke population.

Participants and setting:

Fifty-seven subacute stroke outpatients and 54 healthy individuals were recruited in Alicante province, Spain.

Main measure:

The Oxford Cognitive Screen.

Other measures:

The Montreal Cognitive Assessment, the Barcelona test, and the Barthel Index.

Design:

A validation study was conducted to analyze the inter-rater, intra-rater, test–retest, and internal consistency of the Spanish version of the Oxford Cognitive Screen. Concurrent validity was assessed using the Montreal Cognitive Assessment and the Barcelona test, and divergent validity using the Barthel index. Discriminant indices such as the sensitivity, specificity, predictive values, and optimal cut-offs were also estimated.

Results:

The subtests of the Spanish version of the Oxford Cognitive Screen showed excellent estimates for the inter-reliability (intraclass correlation coefficient (ICC) = 0.790 to 1.000; rs = 0.693 to 1.000), and acceptable-good for intra-reliability (ICC = 0.181 to 0.990) and test–retest reliability ( rs = 0.173 to 0.971). Internal consistency was also excellent (standardized Cronbach’s α = 0.907). Spearman correlations for the concurrent validity were low-strong ( rs = −0.193 to 0.95) and low-moderate ( rs = −0.091 to 0.443) for divergent validity. The optimal cut-offs estimated for the subtests of the Spanish version of the Oxford Cognitive Screen showed good-high specificity (66.7%–100%) and positive predictive value (67.9%–100%), and low-good sensitivity (14.8%–83.3%) and moderate-good negative predictive value (53.5%–76.6%). Discriminant power as measured by the area under the curve indicated acceptable-good values (0.397 to 0.894).

Conclusion:

Our findings support that the Spanish version of the Oxford Cognitive Screen is a reliable and valid tool for screening cognitive impairments in subacute stroke patients.
A silicon nanomembrane platform for the visualization of immune cell trafficking across the human blood–brain barrier under flow
Authors: Mossu Adrien , Rosito Maria , Khire Tejas , Li Chung Hung , Nishihara Hideaki , Gruber Isabelle , Luke Emma , Dehouck Lucie , Sallusto Federica , Gosselet Fabien , McGrath James L , Engelhardt Britta
Published: December 2018

Here we report on the development of a breakthrough microfluidic human in vitro cerebrovascular barrier (CVB) model featuring stem cell-derived brain-like endothelial cells (BLECs) and nanoporous silicon nitride (NPN) membranes (µSiM-CVB). The nanoscale thinness of NPN membranes combined with their high permeability and optical transparency makes them an ideal scaffold for the assembly of an in vitro microfluidic model of the blood–brain barrier (BBB) featuring cellular elements of the neurovascular unit (NVU). Dual-chamber devices divided by NPN membranes yield tight barrier properties in BLECs and allow an abluminal pericyte-co-culture to be replaced with pericyte-conditioned media. With the benefit of physiological flow and superior imaging quality, the µSiM-CVB platform captures each phase of the multi-step T-cell migration across the BBB in live cell imaging. The small volume of <100 µL of the µSiM-CVB will enable in vitro investigations of rare patient-derived immune cells with the human BBB. The µSiM-CVB is a breakthrough in vitro human BBB model to enable live and high-quality imaging of human immune cell interactions with the BBB under physiological flow. We expect it to become a valuable new tool for the study of cerebrovascular pathologies ranging from neuroinflammation to metastatic cancer.
Parenting style as a predictor of music preference
Authors: Warrener Emily , Krause Amanda E , North Adrian C
Published: December 2018

Although previous research has established relationships between perceived parenting styles and children’s deviant behaviours and links between these behaviours and a liking for intense and rebellious music, no research has explored the associations between perceived parenting styles and children’s liking for different music styles. Whereas previous research has considered musical taste by looking at a small number of individual difference variables in isolation from one another, the present research used a cross-sectional correlational design to investigate whether parenting styles, the Big Five personality traits, sensation seeking, age, and gender were associated with a liking for different music styles. In total, 336 Australians completed an online, self-report questionnaire. Analyses demonstrated there were relationships between five of the six parenting style variables and five of the music styles considered. This indicates that various parenting styles were associated with musical taste, and the nature of these associations extends well beyond those concerning rebellious music and neglectful parenting that have been identified by previous research.
Manufacturing and properties of Carbon Nanotube Composites with Nbr, Sbr and Nr
Authors: Kummerlöwe C. , Vennemann N. , Yankova E. , Wege L. , Wanitschek M. , Erdmann R. , Siebert A.
Published: December 2018

Carbon nanotubes (CNTs) were incorporated as a filler in various elastomers in order to obtain rubbers with improved electrical and thermal conductivity. Composites with very low electrical percolation thresholds were successfully produced by direct mixing of elastomers and CNTs in an internal mixer. The effect of CNTs on vulcanisation behaviour and crosslink density of the rubbers was examined and it was shown that very small amounts of CNTs accelerate the curing reaction with sulfur curing systems and contribute to an increase in crosslink density. It was also confirmed that composites of elastomers and CNTs are suitable in principle for manufacturing heating elements with controllable surface temperatures.
Sex Roles and Social Skills Considerations for Interpersonal Adjustment
Authors: Kelly Jeffrey A. , O'Brien G. Gerald , Hosford Robert
Published: December 2018

In light of claims that sex roles are differentially related to behavioral flexibility, the current study investigated the relationship between sex role orientations and performance in interpersonal situations. Males and females in each of four sex role categories (masculine-typed, feminine-typed, androgynous and undifferentiated) role-played situations requiring the appropriate expression of either commendatory or refusal assertiveness. Androgynous subjects were most effective in rated skills components for both types of situations, while undifferentiated subjects were highly ineffective. Complex interpersonal situations apparently require the use of well-integrated masculine and feminine social skills.
Another Look at Sex Bias in Students’ evaluations of Professors: Do Winners Get the Recognition that They Have Been Given?
Authors: Kaschak Ellyn
Published: December 2018

Forty male and forty female students evaluated the identical teaching methods of three female and three male award-winning professors in two traditionally masculine, two traditionally feminine and two relatively non-sex-linked areas. Different ratings were assigned as a function of the sex of the professor and the teaching field. Students attributed the success of male professors to instrumental qualities and that of females to affective qualities.
Changes in Pronominal Usage in A Classroom Situation
Authors: Adamsky Cathryn
Published: December 2018

Changes in pronominal usage of students were investigated in a classroom situation where attention to usage was heightened by instructor use of 'she’ as the generic singular, and by instructor assessment of reactions to the practice. Two classes (N = 74) constituted the experimental group. Analyses of pronominal usage in the written work of students (compared to a control group, N = 20) and questionnaires to obtain student reaction to instructor usage and student views on language usage were the principal measures used. Results indicated a change in use of pronouns with more specific use of “he,” a reduction of use of “he” as the generic singular, and use of “she” as a generic. Results indicate that pronominal usage is susceptible to change.
Municipal solid waste higher heating value prediction from ultimate analysis using multiple regression and genetic programming techniques
Authors: Boumanchar Imane , Chhiti Younes , M’hamdi Alaoui Fatima Ezzahrae , Sahibed-dine Abdelaziz , Bentiss Fouad , Jama Charafeddine , Bensitel Mohammed
Published: December 2018

Municipal solid waste (MSW) management presents an important challenge for all countries. In order to exploit them as a source of energy, a knowledge of their calorific value is essential. In fact, it can be experimentally measured by an oxygen bomb calorimeter. This process is, however, expensive. In this light, the purpose of this paper was to develop empirical models for the prediction of MSW higher heating value (HHV) from ultimate analysis. Two methods were used: multiple regression analysis and genetic programming formalism. Both techniques gave good results. Genetic programming, however, provides more accuracy compared to published works in terms of a great correlation coefficient (CC) and a low root mean square error (RMSE).
Using an Individualized Observational Measure to Understand Children’s Interactions in Underserved Kindergarten Classrooms
Authors: Kim Helyn , Cameron Claire E. , Kelly Cara A. , West Hall , Mashburn Andrew J. , Grissmer David W.
Published: December 2018

This study extended existing work on the Individualized Classroom Assessment Scoring System (inCLASS), established as a measure of preschool-age children’s observed interactions in the four domains of Teacher Interactions, Peer Interactions, Task Orientation, and Negative Engagement. Our sample included kindergarten-age children ( N = 117; mean age = 5.53 years) in 11 classrooms in four schools from a low-income community. We had three aims: (a) examine the inCLASS’ applicability in this new sample, (b) examine associations with teacher reports of children’s social skills and learning behaviors, and (c) identify characteristics at the time point, child, and classroom levels that contribute to inCLASS scores. We found limited variability in scores for each of the four inCLASS domains, with scores related to teacher reports of children’s skills as expected. Children’s inCLASS scores were highly variable from one observation time point to the next, and time point, child, and classroom characteristics differentially contributed to their scores. Implications for observational assessment are discussed.
Experiences and needs of Bereaved Carers during Palliative and End-Of-Life Care for People with Chronic Obstructive Pulmonary Disease
Authors: Hasson Felicity , Spence Allison , Waldron Mary , Kernohan George , Mclaughlin Dorry , Watson Barbara , Cochrane Barbara
Published: December 2018

Aim: This study explored the experiences of palliative care that bereaved carers had while providing care to a dying loved one with chronic obstructive pulmonary disease (COPD). Method: Semi-structured interviews were undertaken with nine carers who had lost a loved one in the preceding 6 to 24 months. These interviews explored levels of satisfaction with disease management, symptom management, and end-of-life care. With permission, interviews were tape recorded, transcribed, and subjected to content analysis. Findings: Three themes emerged from the data: the impact of the caring experience, the lack of support services, and end-of-life and bereavement support. Carers experienced carer burden, lack of access to support services, a need for palliative care, and bereavement support. Conclusion: The findings provide a first insight into the experiences of carers of patients with advanced COPD. Bereaved carers of patients who had suffered advanced COPD reported that they had received inadequate support and had a range of unmet palliative care needs. Special attention should be paid to educating and supporting carers during their caring and bereavement periods to ensure that their quality of life is maintained or enhanced.
Delirium in Advanced Cancer Leading to Distress in Patients and Family Caregivers
Authors: Cohen Marlene Z. , Pace Ellen A. , Kaur Guddi , Bruera Eduardo
Published: December 2018

Background: Information is limited about the experiences of delirium among patients with advanced cancer and their caregivers, which makes designing interventions to relieve delirium-related distress difficult. To better understand the experience and thus permit the design of effective interventions, we collected and analyzed data from patients with advanced cancer who had recovered from delirium and their family caregivers. Method: Phenomenolog-ical interviews were conducted separately with 37 caregivers and 34 patients. One investigator reviewed verbatim transcripts of the audio-taped interviews to identify themes, which the research team confirmed. Results: Most patients and all caregivers had vivid memories of the experience; their descriptions were consistent. Most also attributed the confusion to pain medication. Caregivers had concerns about how best to help patients, patients’ imminent deaths, and their own well-being. Conclusions: The main finding that delirium leads to distress for both patients and care-givers indicates the importance of recognizing, treating, and, if possible, preventing delirium in this population. Concerns about pain medications also indicate the need to educate patients and caregivers about symptom management. Caregivers also need emotional support.
Bad News for the Patient and the Family? the Worst Part of Being a Health Care Professional
Authors: Rio-Valle Jacqueline Schmidt , Caro Mari Paz García , Juarez Rafael Montoya , Peña Diego Prados , Vinuesa Antonio Muñoz , Pappous Athanasios , Quintana Francisco Cruz
Published: December 2018

In Spain, there is a general tendency to conceal the prognosis from a terminally ill patient. We conducted grounded-theory-based, phenomenologi-cal, qualitative research on this using a final sample of 42 in-depth interviews with doctors and nurses from different fields. We found that most health professionals believe that although patients don't ask questions, they know what is happening to them. Many professionals feel bad when communicating bad news. In hospitals, doctors take responsibility for doing so. The attitudes of professionals are influenced by their sense of responsibility and commitment to the principle of patient autonomy, as well as to the level of their agreement with the cultural context. The tacit agreement of silence makes communication impossible: the patient does not ask questions, the health professional does not want to be interrogated, and family members don't talk about the disease and want health professionals to follow their example. This situation is detrimental to patients and their families and leads to suffering, low levels of satisfaction, and feelings of guilt and helplessness. Health care professionals must acquire the means and the skills for communicating bad news.
Quality of Life in Terminally Ill Cancer Patients: Contributors and Content validity of Instruments
Authors: Shahidi Javad , Bernier Nadine , Cohen S. Robin
Published: December 2018

Over the last few decades, improvement in the quality of life (QOL) of cancer patients has received a lot of attention in oncology. This study aims to further explore what factors terminally ill cancer patients report as influencing their QOL. Content analysis of 110 terminally ill cancer patients’ answers to the McGill Quality of Life Questionnaire open-ended question was performed. Negative and positive factors reported by patients as having an impact on their QOL were identified then categorized into eight domains: “physical condition and symptoms,” “psychological status,” “existential,” “relationships and support,” “quality of care,” “physical environment and living facilities,” “hobbies and daily activities,” and “finances.” The “physical condition and symptoms” and “relationships and support” domains were the two most often described by participants as important to their QOL. The results support previous work identifying domains important to the QOL of terminally ill patients with cancer, but they also identify “finances” as a new domain. Based on these findings, we suggest including “finances” in QOL instruments for the terminally ill as an experimental domain.
Letters from Relatives: A Source of Information Providing Rich Insight into the experience of the Family in Palliative Care
Authors: Centeno Carlos , Arantzamendi María , Rodríguez Belén , Tavares Miguel
Published: December 2018

Studies on the effectiveness and efficiency of palliative care (PC) services that use a methodology similar to that used by studies in other medical specialties face serious limitations, since the goals of PC are substantially different. Qualitative research methods can make an important contribution to our understanding of the features of palliative care (PC) that are most relevant to patients and their relatives. The goal of this study was to understand the reasons behind the gratitude shown in letters from bereaved relatives sent to two PC units, one in Spain and one in Portugal. A thematic analysis of the content of the letters was independently carried out by three researchers, who later collaborated to write up the results. Relatives appeared grateful primarily for the humane attitude, professional treatment, and emotional support that their loved ones received from the PC team; they thanked the team for creating a special atmosphere and offering holistic care, and they talked about the contrast between PC and other forms of care. The unsolicited gratitude expressed in their letters constitutes a valid and particularly rich source of information about the contribution that a PC team can make.
Patients’ Perspectives on End-Of-Life Issues and Implantable Cardioverter Defibrillators
Authors: Strachan Patricia H. , Carroll Sandra L. , de Laat Sonya , Schwartz Lisa , Arthur Heather M.
Published: December 2018

Increasing numbers of cardiovascular patients are receiving implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac death (SCD). This report examines patients’ perspectives on related end-of-life issues. Using a grounded theory approach, audiotaped, semi-structured interviews were undertaken with 30 participants from two ICD referral centres in southwestern Ontario (24 who accepted an ICD and 6 who declined). Interview transcripts, verification with interviewees, researcher memos, published literature, and participant demographics were analyzed using NVivo7. Most participants were male, had comorbidities and an ejection fraction of less than 30 percent, and ranged in age from 26 to 87. Consensus was reached by three research team members on three main themes: quality versus quantity of life, preferred mode of death, and the technical realities of the ICD. The ICD was considered in relation to both quantity and quality of life. Most participants focused on the prevention of SCD, not the implications of the ICD for death by any other cause. Participants advocated for incorporating the ICD into advance care planning. Our findings have implications for the development of advance care plans and education of health professionals.
Identifying Population Groups with Low Palliative Care Program Enrolment Using Classification and Regression Tree Analysis
Authors: Gao Jun , Johnston Grace M. , Lavergne M. Ruth , McIntyre Paul
Published: December 2018

Classification and regression tree (CART) analysis was used to identify subpopulations with lower palliative care program (PCP) enrolment rates. CART analysis uses recursive partitioning to group predictors. The PCP enrolment rate was 72 percent for the 6,892 adults who died of cancer from 2000 and 2005 in two counties in Nova Scotia, Canada. The lowest PCP enrolment rates were for nursing home residents over 82 years (27 percent), a group residing more than 43 kilometres from the PCP (31 percent), and another group living less than two weeks after their cancer diagnosis (37 percent). The highest rate (86 percent) was for the 2,118 persons who received palliative radiation. Findings from multiple logistic regression (MLR) were provided for comparison. CART findings identified low PCP enrolment subpopulations that were defined by interactions among demographic, social, medical, and health system predictors.
Neuroleptic Prescription Pattern for Delirium in Patients with Advanced Cancer
Authors: Hui David , Reddy Akhila , Palla Shana , Bruera Eduardo
Published: December 2018

Background: Neuroleptics are frequently used by palliative care specialists to treat delirium. In this study, we determined the median daily neuroleptic dose and prescription pattern in a cohort of unselected advanced cancer in-patients with delirium. Methods: We retrospectively reviewed the charts of 100 consecutive patients admitted to our acute palliative care unit with delirium for demographics, delirium characteristics, and neuroleptic use during the first five days of delirium. The dose of neuroleptics was expressed using the concept of haloperidol equivalent daily dose (HEDD). Results: The median delirium duration was six days, and the median Memorial Delirium Assessment Scale on day 1 was 13/30. Subtypes of delirium in cluded hypoactive (31 percent), mixed (59 percent), and hyperactive (10 percent). Haloperidol, olanzapine, and chlorpromazine were given to 94 (94 percent), 8 (8 percent), and 5 (5 percent) of patients, respectively. The median five-day average HEDD was 3.2 mg (interquartile range 1.5–6.0 mg). HEDD was not associated with any clinical characteristics except delirium subtype. Among the 31 occasions in which ≥3 breakthrough doses were given in a day, only 9 (29 percent) resulted in an increase in the scheduled neuroleptic dose, and 1 (3 percent) resulted in the addition of a new neuroleptic the next day. Among the 73 patients with ≥4 days of delirium, only 49 (67 percent) had an increase in the neuroleptic dose, and 2 (3 percent) had a new neuroleptic added. Conclusion: HEDD was lower than doses reported in previous studies involving cancer patients and was adjusted sparingly. Prospective clinical trials are necessary to identify the optimal neuroleptic dose for delirium.
Factors Associated with Medical Cost among Patients with Terminal Cancer in Hospice Units
Authors: Kim Jung-Hoe , Kim Sun-Min , Joo Ji-Soo , Lee Kun-Sei
Published: December 2018

This study identified factors associated with higher medical costs for patients with terminal cancer in hospice units in order to develop a daily payment system for hospice services within Korea's National Health Insurance (NHI) program. Through chart reviews conducted by staff nurses, medical information and costs were obtained for 274 patients with terminal cancer in 20 hospice units in October 2007. The daily medical cost per patient was calculated based on the fee-for-service scheme. The characteristics of the hospice units were examined by means of a semi-structured questionnaire administered to hospice unit coordinators. Higher daily costs were associated with general hospital-based hospice units (as compared with free-standing units: p<0.01), low Palliative Performance Scale scores (PPS<50, p<0.05), and the presence of fever (p<0.01). In multivariate analysis, hospice unit type was found to be the factor most strongly associated with medical cost. A hospice payment system based on patient characteristics should be thoroughly considered.
Paramedics’ perceptions of Their Role in Palliative Care: Analysis of Focus Group Transcripts
Authors: Lord Bill , Récoché Katrina , O'Connor Margaret , Yates Patsy , Service Melinda
Published: December 2018

Paramedics play an important role in out-of-hospital health care. They provide unscheduled care, assisting both patients with minor injuries and those experiencing life-threatening emergencies. Increasingly, paramedics are called on to manage chronic and complex health needs, including symptom relief for patients at the end of life. However, paramedics may not be well prepared to offer palliative care, as practice guidelines and education tend to focus on the management of acute medical emergencies and major trauma. Emergency medical services that employ paramedics rarely have practice guidelines or protocols that deal specifically with palliative care.
Family care of the Dying in the republic of Moldova: A Qualitative Study
Authors: Kellehear Allan , Mindruta-Stratan Rodica , Pogonet Vadim , Gorelco Victor
Published: December 2018

This paper reports the principle findings of a national, cross-sectional, interview-based study of the experiences of people who cared for a dying family member in the Republic of Moldova. Study data, collected from 102 interviews, covered four broad areas: the experiences of the dying person; family members’ own experiences of caring; the practice (or non- practice) of any traditional customs for dying or death; and family carers’ views of their own needs in these circumstances. Most carers reported high levels of psychological distress. Dying persons were reported to experience significant and unrelieved suffering. The practice of traditional customs was uneven, and there were significant levels of non-practice. Most respondents expressed a need for greater professional support, respite, specialized equipment and medicines, and home help from health care professionals. The implications of these findings are discussed in terms of potential local developments and international aid.
A Population-Based Study on Advance Directive Completion and Completion Intention among citizens of the Western Canadian province of Alberta
Authors: Wilson Donna M. , Houttekier Dirk , Kunju Sabu Aliyar , Birch Stephen , Cohen Joachim , MacLeod Rod , Hewitt Jessica A.
Published: December 2018

Determining what proportion of the public has completed an advance directive and which population subgroups complete or do not complete such a directive is crucially important for planning purposes. Our research objective was to examine and compare advance directive completion, intention to complete, and noncompletion rates among citizens of one Canadian province. A telephone survey was conducted with 1,203 Albertans who met gender, age, and other requirements for a representative sample. When asked, “Do you have a living will or personal directive?” 43.6 percent reported having completed a directive and 42.1 percent indicated that they planned or intended to complete one. Completion rates increased with age. Widowed, self-employed, and retired people, and those who had lost a family member or friend and had other select end-of-life experiences and viewpoints were significantly more likely to have completed one. Although older people more often had an advance directive, personal life-and-death experiences should be recognized as major influences on directive completion.
Evaluation of the Role and cost-effectiveness of End-Of-Life Orthopaedic Interventions in Cancer Patients with Skeletal Metastases to the Hip
Authors: Singh Gurpal , Lim Chin Tat , Jonathan Tan Jiong Hao , Nathan Saminathan Suresh
Published: December 2018

This study aimed to evaluate the effect of hip reconstruction on patients with skeletal metastases to the hip. We investigated the effect of hip reconstruction on quality of life and ambulatory status, as well as cost-effectiveness of hip reconstruction in this group of patients.
Development of Advance Care Planning Research Priorities: A Call to Action
Authors: Johnson Ana P. , Hanvey Louise , Baxter Sharon , Heyland Daren K. ,   for the Canadian Researchers at the End of Life Network (CARENET)
Published: December 2018

The objective of this study was to develop a national, prioritized research agenda for advance care planning (ACP). We first identified a list of comprehensive ACP research topics and determined priority criteria through focus groups. We next conducted a survey wherein importance weights were assigned to priority criteria and each ACP topic was rated. We combined weights and ratings into overall scores. A total of 17 ACP topics were developed and placed into four categories: patients and family members, the general public, professionals, and the healthcare system. Four main priority criteria were created: feasibility, consistency with ethical and societal values, economic considerations, and impact. Of the 100 individuals we invited to participate in the survey, 62 accepted. Prioritized topics centred largely on the impact of ACP on health resource utilization, communicating advance care planning across settings, and the preferred manner of engaging patients in ACP.
The voices of Young New Zealanders Involved in Pediatric Palliative Care
Authors: Gaab Erin M. , Owens R. Glynn , MacLeod Roderick D.
Published: December 2018

The perspectives of young New Zealanders receiving pediatric palliative care (PPC) are not well understood. A qualitative study of the perceptions of 16 PPC patients and their siblings, aged 9 to 18, was conducted through audio and written diary accounts. Inductive thematic analysis revealed several concerns of participants, including special treatment that patients had received, spending time with their families, their feelings of being judged or discriminated against, their sense of being understood themselves and of understanding others, and mortality. A nonjudgemental, open approach is recommended when consulting with patients and their siblings in order to determine their needs.
Attitudes of Terminally Ill Older Adults toward Complementary and Alternative Medicine Therapies
Authors: Grief Cindy J. , Grossman Daphna , Rootenberg Mark , Mah Linda
Published: December 2018

Aim: The aim of this study was to characterize the attitudes of older adults on an inpatient palliative care unit toward complementary and alternative medicine (CAM) therapies. Methods: A consecutive sample of 33 inpatients (61 to 98 years old) completed a questionnaire that examined their attitudes toward CAM to determine the acceptability of these therapies. Corresponding questionnaires were gathered from 10 substitute decision makers (SDMs). Preferences for specific CAM modalities were identified. Correlational analyses were performed between interest in CAM therapies and demographic variables and clinical status, including physical and psychological distress. Results: A total of 27 patients (82 percent) were interested in trying CAM therapies. The greatest interest was shown in music therapy (61 percent) and massage therapy (58 percent). All of the SDMs were interested in having CAM therapies available for their loved ones to try. Discussion: Attitudes toward CAM therapies of terminally ill older inpatients and their SDMs are highly favourable. CAM treatments merit closer evaluation as a means of enhancing end-of-life care.
Using Heart Failure Instruments to Determine when to Refer Heart Failure Patients to Palliative Care
Authors: Timmons Matthew J. , MacIver Jane , Alba Ana C. , Tibbles Alana , Greenwood Sarah , Ross Heather J.
Published: December 2018

Aim: The purpose of this study was to determine whether the Edmonton Symptom Assessment Scale (ESAS) or the Palliative Performance Scale (PPS) are associated with traditionally used scores for heart failure patients — specifically, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), an overall health visual analog scale (VAS), and the Seattle Heart Failure Model (SHFM). Furthermore, we sought to determine whether the PPS or the ESAS provided additional information on quality of life, symptom severity, or prognosis above that provided by the traditional scores for patients with heart failure. Methods: We administered the ESAS, MLHFQ, VAS, PPS, and SHFM in a shuffled manner to 78 New York Heart Association Functional Classification (NYHA-FC) III-IV ambulatory heart failure patients. Pearson's r correlation was used to determine whether the scores from the ESAS and PPS correlated with the scores from the MLHFQ, VAS, and SHFM. Results: The sample was predominately male (62.8 percent), mean age 60.1 ± 13 years, with a diagnosis of idiopathic cardiomyopathy (45 percent). Moderate correlations were found between the ESAS and MLHFQ (r=0.483, p<0.01), the ESAS and VAS (r=-0.345, p<0.01), the PPS and MLHFQ (r=-0.54, p<0.01), and the PPS and VAS (r=0.53, p<0.01). There was no significant correlation between the PPS and SHFM. Conclusion: The results of this study suggest that administration of the ESAS and PPS provides additional information on symptom severity and functional decline for patients with heart failure. Standardized administration of these scales may aid in the assessment and evaluation of heart failure patients.
Healthcare Professionals’ Views on the provision of Gastrostomy and Noninvasive Ventilation to Amyotrophic Lateral Sclerosis Patients in England, Wales, and Northern Ireland
Authors: Ruffell Tamatha O. , Martin Naomi H. , Janssen Anna , Wijesekera Lokesh , Knights Catherine , Burman Rachel , Oliver David J. , Al-Chalabi Ammar , Goldstein Laura H.
Published: December 2018

Gastrostomy and noninvasive ventilation (NIV) are recommended interventions for the management of symptoms associated with amyotrophic lateral sclerosis (ALS). This study aimed to quantify the views of a range of healthcare professionals (HCPs) on the provision of these interventions in the United Kingdom. A total of 177 HCPs participated in an online survey. Significant differences were found between medical and allied HCPs’ views on: whether HCPs adhere to policy and accept legal constraints when it comes to making gastrostomy available to people with ALS; the impressions that HCPs receive of the way patients and caregivers understand the effects of gastrostomy and NIV on symptoms and quality of life; and the challenges HCPs face when caring for patients who have refused gastrostomy. More widely available guidelines for the provision of gastrostomy and advice on the best way to impart information to patients and caregivers about gastrostomy and NIV appear to be needed.
The Survival time of Terminal Cancer Patients: Prediction Based on Clinical Parameters and Simple Prognostic Scores
Authors: Kim A Sol , Youn Chang Ho , Ko Hae Jin , Kim Hyo Min
Published: December 2018

Aim: By examining clinical parameters associated with survival time and analyzing patients’ survival times using prognostic scores, this study aimed to provide helpful information related to the treatment of terminal cancer patients. Methods: We retrospectively reviewed the medical records of 415 inpatients who died in the hospices of two hospitals from March 2009 to August 2011 then analyzed differences in survival times and relative risk for clinical parameters and prognostic scores. Results: There were 15 parameters associated with survival time. Performance decline was the most influential factor. The optimal scores for predicting four-week survival were over 4.5 on the Palliative Prognostic Index (PPI), over 10 on the Palliative Prognostic (PaP) Score, and 30 or under on the Palliative Performance Scale (PPS). Conclusion: Performance decline is a major factor affecting survival time. The PaP is the most useful tool for predicting four-week survival, with an optimal value of over 10.
Measuring quality of Life among Colorectal Cancer Patients in Jordan
Authors: Mhaidat Nizar M. , Al-Wedyan Tahani J. , Alzoubi Karem H. , Al-Efan Qais M. , Al-Azzam Sayer I. , Balas Qosay A. , Bataineh Ziad A.
Published: December 2018

Quality of life among colorectal cancer (CRC) patients was evaluated using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and EORTC QLQ-CR29. We interviewed 74 CRC patients, and our results indicated lower anxiety functional scores and higher abdominal pain and embarrassment symptom scores among patients aged 55 and under. Patients with disease metastasis showed significantly lower global health scores and higher fatigue, loss of appetite, hair loss, and change in taste symptom scores. Scores for emotional functioning were significantly lower among patients with stage IV disease. Fatigue, nausea and vomiting, loss of appetite, abdominal pain, and change in taste symptom scores were significantly higher in patients treated with a combination of surgery and chemotherapy compared to surgery alone. Age, disease metastasis, late disease stage, and combined treatment modalities were associated with lower scores on health-related quality-of-life scales; patients likely to have low scores on these measures should receive special attention from healthcare providers and be targeted by supportive care strategies.

Nous avons évalué la qualité de vie de patients atteints du cancer colorectal à l'aide du Questionnaire C30 et EORTC QLQ-CR29 de l'Organisation européenne pour la recherche et le traitement du cancer. Nous avons interviewé 74 patients et nos résultats indiquent que les patients agés de 55 ans et moins éprouvent un moindre niveau d'anxiété alors que le niveau de douleurs abdominales et du sentiment de gêne est élevé. Les patients atteints de métastases ont démontré lors des tests que leur état général de santé était plutôt mauvais et qu'ils souffraient de fatigue accrue, de perte de cheveux et de la perte du goût L'état émotionel était à son plus bas chez les patients au stade IV de la maladie. La fatigue, la nausée, le vomissement, la perte d'appétit, les douleurs abdominales, et la perte de goût étaient significativement plus élevés chez les patients ayant été traités par chirurgie et chimiothérapie comparativement à ceux qui n'avaient subi que la chirurgie. L'âge, les métastases et le stade avancé de la maladie combinés à divers traitements médicaux sont les facteurs ayant contribué aux scores plus bas observés sur l'échelle de qualité de vie. Les patients susceptibles de démontrer de faibles résultats devraient recevoir une attention spéciale de la part des soignants et être la cible de soins de soutien appropriés à leur état.