bluuebunny/crossref_metadata_2025 huggingface dataset:
EVALUATION OF THE CURRENT PRACTICE OF DELIVERING INTRAVENOUS OPIOIDS INFUSIONS IN A UK PAEDIATRIC HOSPITAL
Authors: Rashed Asia N , Tomlin Stephen
Published: August 2016

Introduction

Opiate intravenous infusions are the therapy of choice in severe pain. However, administering infusions to children requires complex dosage calculations, rate adjustments and often multiple manipulations of injectable medicines to obtain the final “ready to use” solution for both continuous infusion and additional boluses; potentially putting children at high risk.1 2

Aim

To investigate the practice and accuracy of healthcare professionals (HCPs) in hospital theatres and wards in preparing morphine infusions for nurse/patient controlled analgesia (N/PCA) use in a UK children's hospital.

Methods

A mixed methods study in which direct observation of HCPs preparing paediatric morphine infusions for N/PCA in theatres and on wards, focus groups with HCPs and quantitative analysis of morphine concentration in the syringe using UV-Vis Spectrophotometer. The British Pharmacopoeia (BP) reference limits of ±7.5% were used to compare label strength (LS) of morphine infusion with measured concentration.

Results

The preparation of 153 syringes was observed which related to 128 paediatric patients [mean age (±sd) 7.5 years±5.6; 65.3% male]. 64% (98/153) were prepared by anaesthetists in theatres, 36% (55/153) by nurses at ward level.

Major differences in preparation methods were identified. The final volume prepared was above the required volume (50 mL) in 35.9% (55/153) preparations. Wearing gloves during preparation was not followed in theatre for 83.7% (82/98) of syringes. No decontamination of morphine ampoules was undertaken during preparation of any syringe. Inconsistency in the appropriate syringe size used to withdraw drug from the ampoule was observed in both theatres and wards. Lack of appreciation of the overage in morphine ampoules by HCPs was identified. Of the syringes analysed 61.5% (48/78) had a concentration outside the BP reference limits (92.5–107.5% of LS), most were in excess (83.3%, 40/48). Of these 20.8% (10/48) deviated by more than +20%, with one deviated by 100%.

Conclusion

This study identified that variation in preparation techniques followed by HCPs may result in morphine N/PCA dosages that are significantly higher or lower than that prescribed. Also, lack of understanding of ampoule overage, accuracy of the syringe size used and the ability to measure small volumes led to inaccurate concentrations in prepared infusions.
CHILDREN'S WARFARIN CLINIC-AN AUDIT OF THE NEW PHARMACIST-LED TELEPHONE SERVICE BASED ON A UNIQUE COMPUTERISED SYSTEM COMPARED TO THE WARD BASED PAPER SYSTEM
Authors: Brooks Teresa , Brown Jennifer , Woolley Elaine
Published: August 2016

Aims

To audit the new pharmacist-led telephone service for warfarin dosing and monitoring of INR, and compare it to the previous system. The previous system was based on the paediatric cardiology ward, dosing by junior medical staff to dose and documented on a paper system. Also to audit the parent satisfaction of the new system.

Methods

Search the computerised system to reveal 73 patients on warfarin with a total of 1547 INRs, and looked for any complications or out of range results. This to be compared to a previous audit of the original system of 44 patients on warfarin with a total of 1289 INRs.

For parent/carer satisfaction, a questionnaire was sent to parents/carers of all patients who were under the care of the pharmacist-led children's warfarin clinic.

Results

The pharmacist-led children's warfarin service was fully compliant for NPSA safety standards for warfarin dosing. There was no significant difference in the safety indicators from the original service and the pharmacist-led service.

11 patients (25%) were lost to follow up from the original service, compared to none in the pharmacist-led service. No patients from either service had an inappropriate target INR and every patient had been given the correct information. 38 out of 53 (72%) parents/carers returned the satisfaction survey. 28 (78%) reported that their overall experience of the clinic was excellent and the rest found it satisfactory.

Discussion

Changing to the pharmacist-led service has meant that it is now compliant with NPSA standards and the safety indicators are comparable to the original service. The service has generally been very well received, with all parents/carers finding the service at least satisfactory and 78% found it excellent. The pharmacist-led service is unique, as it uses a computerised system for documentation, with the aim to produce a paediatric dosing algorithm.
PAEDIATRIC ADVERSE DRUG REACTIONS (ADRS): A COMPARISON OF A NEWLY DEVELOPED AVOIDABILITY TOOL TO EXISTING HALLAS ASSESSMENTS
Authors: Bracken Louise , Kirkham Jamie , Nunn Anthony , Pirmohamed Munir , Peak Matthew , Turner Mark
Published: August 2016

Aim

To compare a newly developed avoidability assessment tool (AAT) to existing Hallas assessments1 for a set of paediatric ADR cases.

Method

The new AAT was employed to assess 249 case reports of ADRs causing admission to hospital. The case reports contained a description of the ADR, details of suspected and concurrent medication and past medical history. Each case report was independently assessed and an avoidability category assigned. For ADRs categorised as either ‘possibly' or ‘definitely avoidable' a rationale was recorded. A second reviewer independently assessed a purposive sample (10%) for validation and quality assurance purposes.

The final outcome was then compared to the Hallas assessments (1) previously completed as part of another study, which was carried out in a consensus group setting. Both tools used categorical scores with the same four point ordinal scale ‘definitely avoidable', ‘possibly avoidable', ‘not avoidable' and ‘unassessable'.

Results

Assessment of the 249 ADR case reports using the new AAT found that 19.3% were either possibly or definitely avoidable. This figure increased to almost 32% for the non-oncology cases (129/249) and decreased to 5.8% for the oncology cases (120/249). This was similar to the Hallas results (1), where overall, 22% of ADRs were deemed either possibly or definitely avoidable.

Percentage exact agreement (%EA) was 90% overall; when subcategorised into oncology and non-oncology cases the %EA was found to be 94.2% and 86% respectively. Percentage extreme disagreement (%ED) was 0.8%. The kappa score was 0.71 (95% CI 0.60–0.82) for all cases, 0.54 (95% CI 0.40–0.68) for the oncology cases and 0.73 (95% CI 0.58–0.88) for the non-oncology cases. In total there were 25/249 cases with disagreement. %EA agreement from the validation check was 72%.

Conclusion

Assessment with the new AAT showed that approximately 19% of all cases were either possibly or definitely avoidable. This was comparable to the Hallas assessments (1). The sub-categorisation of the analysis into oncology and non-oncology cases showed a change in the number of avoidable cases. The avoidability rate increased to almost 32% for the non-oncology cases and decreased to 5.8% for the oncology cases. The reason for this marked difference may be explained by the nature of the oncology ADRs. The most common oncology reactions were neutropenia, thrombocytopenia and anaemia; these are often expected and largely 'not avoidable' given the benefit risk ratio.

The AAT was designed specifically for use in paediatrics following difficulty using other tools including Hallas (1). The AAT refers to guidelines and patient history rather than to abstract concepts such as “present-day knowledge of good medical practice” and “effort exceeding the obligatory demands” as per Hallas (1). Further work to identify potentially avoidable ADRs and strategies to prevent them is needed.
Native bivalvular endocarditis byGemella haemolysansrequiring venovenous extracorporeal membrane oxygenation
Authors: Ando Akika , Kagihara Jaclyn , Chung Heath , Bolger Dennis Thomas
Published: August 2016

A 24-year-old otherwise healthy man presented with a 3-week history of malaise, headache, fever and rigors after he was treated with oral clindamycin for left parotitis andGemella haemolysansbacteraemia. He developedG. haemolysansinfective endocarditis, septic emboli and heart failure due to progressive bivalvular disease. He underwent urgent mechanical aortic valve replacement and mitral valve repair, which required venovenous extracorporeal membrane oxygenation, to support severe respiratory failure. This is the first documented case ofG. haemolysansinfective endocarditis affecting native aortic and mitral valves in a healthy adult.
Vedolizumab: a novel treatment for ipilimumab-induced colitis
Authors: Hsieh Amy Hsin-Chieh , Ferman Mutaz , Brown Michael P , Andrews Jane M
Published: August 2016

Use of the immune checkpoint inhibitors, ipilimumab and nivolumab, has revolutionised treatment in patients with metastatic melanoma. However, these drugs can cause an autoimmune enterocolitis, with diarrhoea as the presenting symptom. This is conventionally managed by prompt institution of corticosteroid therapy if moderate diarrhoea (3–6 times/day; grade 2) is present for >5 days or if diarrhoea is severe (>6 times/day; grade 3). We report a case of steroid-dependent ipilimumab-induced colitis successfully treated with vedolizumab (an inhibitor of memory T-cell trafficking to the gut), after which complete withdrawal of corticosteroid was achieved. Hence, vedolizumab warrants further evaluation as a potential novel treatment of ipilimumab-induced colitis.
Supported self-management of analgesia and related treatments at the end of life
Authors: Campling Natasha , Latter Sue , Richardson Alison , Mulvey Matthew , Bennett Michael
Published: August 2016

Introduction

Although supported self-management has been defined theoretically at end of life (Johnstonet al.,2014), and has empirically been demonstrated to be beneficial within long-term condition management, it is not known how it plays out in the realities of end of life care.

Aim

To use empirical data to describe supportive self-management within end of life in relation to the specific context of analgesia and related treatments

Methods

A qualitative approach was taken using semi-structured focus groups and interviews with healthcare professionals and patients/carers. The data were coded in NVivo 11 utilising Framework Analysis.

Results

The sample comprised 38 participants recruited via two geographical regions in Northern and Southern England. The patient/carer and healthcare professional samples had 19 participants each.

Supportive self-management was enacted on a far-reaching continuum from:

Expertise and mastery, with full responsibility chosen by the individual, and acceptance of the possibility of risk and the requirements of complex decision-making, through to

Reduced capabilities and engagement in self-management behaviours, negatively affected by uncontrolled pain, the side-effects of opioids, clinical depression and memory loss, with responsibilities transferred to another (the carer and/or palliative care clinical nurse specialist)

Conclusion

Supported self-management of analgesia and related treatments at end of life was an ever-changing process affected by the complexity of end of life itself and opioid related fears. The complexity of end of life with continual disease progression, frequent changes in symptoms and side-effects, resulted in fluctuating self-management capabilities of the patient, and in turn fluctuating supportive behaviours of the carer.

This work was part of a larger study (SMART) funded by the NIHR’s HTA programme.

Reference

Johnston B, Rogerson L, Macijauskiene J, Blazeviciene A, Cholewka P.An exploration of self-management support in the context of palliative nursing: a modified concept analysis.BMC Nurs2014;13:21
Supporting people bereaved through advanced illness: a systematic review of the evidence
Authors: Harrop Emily J , Cowey Luke , Morgan Fiona , Byrne Anthony , Sivell Stephanie , Fitzgibbon Jim , Pickett Sara , Nelson Annmarie
Published: August 2016

Background

Palliative care has an important role to play in addressing the bereavement needs of families, although a lack of evidence-based guidance has been noted (Hudsonet al., 2012; PeolcPSP 2015). A small number of systematic reviews of bereavement interventions are available, but these have typically been restricted to evidence from randomised controlled trials and provide little information on interventions and support specifically provided for adult populations bereaved through advanced, progressive illnesses (e.g. Forteet al., 2004; Currieret al., 2008).

Aim

To systematically review the evidence on bereavement support for adults bereaved through advanced, progressive illness.

Methods

Key databases have been searched using indexed terms and key words for papers published in English between 1990 and 2016. Supplementary searches will also be conducted. The review will include studies conducted in the UK or comparable countries reporting evaluations of interventions or services, delivered to adults bereaved through advanced, progressive illness. Study quality will be assessed using appropriate checklists. This mixed methods review will identify interventions and services and look at both the quantitative and qualitative evidence for their effectiveness and utility.

Results/conclusions

This review, funded by Marie Curie, will help to identify what type of bereavement support works best for different groups of people, and how such support might be improved. It is also being used to inform the development of a Core Outcome Set for bereavement research in palliative care. This presentation will provide an overview of results, highlight gaps in the evidence base and make recommendations for further research.

References

Currier J, Nemeiyer R, Berman J. The effectiveness of psychotherapeutic interventions for bereaved persons: A comprehensive quantitative review.Psychol Bull2008;134:648–661

Forte A, Hill M, Pazda R, Feudtner C,et al. Bereavement care interventions: a systematic review.BMC Palliat Care2004;3:3

Hudson P, Remedios C, Zordan R,et al. Guidelines for the psychosocial and bereavement support of family caregivers of palliative care.J Palliat Med2012;15(6):696–702

Palliative and end of life care Priority Setting Partnership. Putting patients, carers and clinicians at the heart of palliative and end of life care research, 2015.http://www.palliativecarepsp.org.uk/finalreport
Using electronic primary care record searching to help identify people with palliative and anticipatory care needs for 24/7 care
Authors: Mason Bruce , Boyd Kirsty , Steyn John , Kendall Marilyn , Murray Scott A
Published: August 2016

Introduction

Effective care planning and coordination is strongly associated with fewer hospital admissions in and out-of-hours.1,2Many people who die are not being identified consistently for such pro-active care.3,4Clinical indicators type tools (SPICT™ and GSF-PIG) help professionals identify people but more systematic screening is needed.5

Aim

To develop an electronic tool using GP surgery software to output a list of patients who might benefit from anticipatory palliative care.

Methods

Our prototype search was installed in GP software. It permitted “combination searches” generating a detailed set of outputs. The search was run 35 times in 10 practices over 9 months with iterated refinements to remove over-generation. The researcher attended 31 team meetings and conducted qualitative observations. The palliative care lead in each practice was interviewed.

Results

Over 2,500 patients were identified. After refinement, the search reliably identified around 0.7% patients per practice. Practice teams used the list to prompt patient/carer reviews and often started or updated a Key Information Summary: the Scottish electronic, anticipatory care planning record. Running the searches in practices enabled participating teams to integrate them into their normal working routines.

Conclusions

This ‘proof of concept’ study shows that systematic electronic searches of GP practice lists complements case-based identification by helping primary care teams identify more patients and carers who stand to benefit from a palliative care needs assessment, anticipatory care planning and having current information accessible out-of-hours. It informs future development of electronic primary and secondary care records across the UK.

References

Mason BL,et al. Coordination of care for people at risk of dying in the next 12 months: a multi-site prospective study and consensus seeking exercise. NIHR Service Delivery and Organisation programme: London; 2013

Addington-Hall J,et al. Variations in out of hours end of life care provision across primary care organisations in England and Scotland. Final Report, in NIHR Service and Delivery Organisation Programme, Southampton, UK; 2013

Scottish Government, The primary medical services directed enhanced services (Scotland) 2012 palliative care H.a.S.C.I. Directorate, Editor. NHS Scotland: Edinburgh; 2012

Murtagh FE, Bausewein C, Verne J,et al. How many people need palliative care? A study developing and comparing methods for population-based estimates.Palliat Med2014;28(1):49–58

Mason BL, Boyd K, Murray SA,et al. Developing a computerised search to help UK General Practices identify more patients for palliative care planning: a feasibility study.BMC Fam Pract2015;16(1):99
Which measures assessing quality of death and dying and satisfaction with care at the very end of life have been psychometrically validated? A systematic review
Authors: Kupeli Nuriye , Candy Bridget , Vivat Bella , Harrington Jane , Davis Sarah , Sampson Elizabeth L , Gola Anna , Lodwick Rebecca , Stone Paddy
Published: August 2016

Introduction

The very end of life can be associated with pain, anxiety and caregiver burden. Numerous measures seek to assess the quality of death and dying and satisfaction with care, but there is a lack of evidence and consensus on the best tools.

Aims

To identify all existing tools for assessing quality of death and dying and the quality of care and satisfaction with care at the very end of life, and systematically evaluate those which have been psychometrically validated.

Method

Four databases (Medline, Embase, Cinahl and Psycinfo) were searched in February 2016 using a combination of MeSH and free-text terms on end of life and satisfaction with care. Article titles, abstracts and full-text papers were reviewed to identify all papers reporting multi-item measures for assessing quality of death and dying and/or quality of care and satisfaction with care at the very end of life. Articles reporting on at least one psychometric investigation of the measures identified were then assessed for quality, using the COSMIN checklist (Mokkink, 2010).

Results

The initial search terms identified 4136 articles after excluding any duplicates. Seventy-seven papers, reporting 48 different measures, met the initial inclusion criteria. The most commonly used measures were the Quality Of Death and Dying (QODD; Patrick, 2001) and FAMCARE (Kristjanson, 1986). Both have been validated in a variety of cultural settings and participant groups.

Conclusion

Many measures assess quality of death and dying and satisfaction with care, but few have been thoroughly validated. QODD and FAMCARE are the best of those assessed.

References

Kristjanson LJ.Indicators of quality of palliative care from a family perspective.J Palliat Care1986;1(2): 8–17

Mokkink LB, Terwee CB, Patrick DL,et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study.Quality of Life Research2010;19(4):539–549

Patrick DL, Engelberg RA, Curtis JR.Evaluating the quality of dying and death.J Pain Symptom Manage2001;22(3):717–726
Advance care planning in dementia: ‘living well’ with an uncertain future
Authors: Ryan Tony , McKeown Jane
Published: August 2016

Introduction

There is compelling evidence that Advance Care Planning (ACP) remains a key factor in the delivery of appropriate end of life care and facilitates the timely transition to palliative care for people with dementia (van der Steenet al.,2014).

Aims

To explore the experiences in the use of ACP amongst spousal couples affected by dementia.

Method

The study utilised a constructivist grounded theory (CGT) methodology (Charmaz 2014). Sixteen participants (eight couples) living at home in the community were interviewed to gain insight into the process of planning for future and use of ACP.

Results

All participants were aged 65 or above and the minimum length of time since diagnosis was 18 months. There was limited evidence that ACP was being undertaken by participants. A number of factors were identified to help explain why this was the case with a focus on the core social process of ‘postponement’. Important categories are noted: discordance between ACP and ‘living well’ with dementia; caregiver precedence in seeking to maintain an equilibrium in day to day life; maintaining couplehood.

Conclusions

ACP remained a difficult proposition for spousal couples. Reluctance to engage in ACP for them is grounded in the realities of living as a couple with dementia, perceptions of the planning process and caregiver priorities. The findings will have implications for practice which may best facilitate actions enabling ACP to take place. The work also contributes to burgeoning discussion around the planning of future care in relation to the discourse of individual responsibility in end of life care.

References

Charmaz, K. Constructing Grounded Theory (2nd Edition). London: SAGE; 2014

van der Steen, Radbruch L, Hertogh CM,et al. White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care.Palliat Med2014;28(3):197–209
Challenges in resource planning as a barrier to patients achieving death at home
Authors: Sayma Meelad , Kerwat Doa’a , Jamshaid Shiraz , Saleh Dina , Ahmed Aaniya , Oyewole Folashade , Wahid Abdul Samad
Published: August 2016

Introduction

Evidence suggests that the majority of patients wish to die at home. However, this is only attainable for few.

Aim

To identify the barriers and facilitators to being able to die at home in the UK. Methods: A two-step study approach was adopted.1A systematic literature review (SLR) and2primary qualitative data collection. In the SLR 3241 papers were retrieved. 72 articles remained after screening and filtering processes. Qualitative articles were analysed using meta-ethnography and quantitative articles were analysed using a descriptive approach. In the primary study, 33 in-depth interviews were conducted with experts in end-of-life care. Thematic Analysis of interview transcripts was conducted. Approval from Imperial College Research Ethics Committee was obtained for the study. The results from the SLR and primary data collection were amalgamated to produce a set of overarching barriers and facilitators.

Results

Six barriers and four facilitators were identified. The specific barrier of ‘challenges in resource planning’ will be discussed in this paper. This overarching theme included logistical issues in getting both the patient and equipment home, lack of continuity of care and geographic variation in resource provision, including 24/7 care.

Conclusions

Addressing this barrier could allow more patients to achieve death at home. However, it is important to acknowledge the qualitative nature of results. As a result, further research is required to identify the relative impact this barrier has on patients’ ability to achieve home death when compared to other barriers and facilitators identified.
Contact with out of hours services by palliative care patients in a rural care setting
Authors: Bowers Sarah , Hillis Eileen , Shennan Bill , Isherwood Ruth
Published: August 2016

Introduction

Palliative care provision for patients in rural areas has unique challenges for out of hours usage. GPs on this Scottish island cover both in and out of hour services for 6000 patients with no additional palliative out of hours coverage from district nurses or the Macmillan specialist nurse.

Aim

The project aimed to assess the out of hours need of palliative care patients on the island by looking at the demographics of patients, the service contacted and the reason for contact from the start of 2015 until 1st August.

Method

Docman was utilised to identify encounters with out of hours services on the island. 16 palliative care patients were identified in the given time period on the island and became the focus of this project.

Results

For the 16 patients on the island, there were 33 presentations to out of hours in total, with the number of presentations per patient ranging from 0 to 6. The majority of contacts were directly to A+E with only 6/33 contacts via NHS24. Most presentations were disease related (e.g. hiccups, chest infection) though 5/33 contacts were for non-emergency reasons (e.g. prescription request, dressings change). None of the presentations were deemed to be as a result of uncontrolled symptoms.

Conclusion

Out of hours contact was not related to symptom burden, as patients appeared to have well-controlled symptoms. The extent to which this is the result of anticipatory care planning requires further investigation.
Lothian care assistant development programme – an education initiative
Authors: Cassidy L
Published: August 2016

Introduction and aims

With Scottish Government’s integration of health and social care, social care teams are increasingly leading the care for elderly clients and their families who are living with a terminal illness and also have multiple complex care needs. Addressing the palliative care learning needs of social care workers is essential to ensure the provision of high quality palliative care in families’ in their preferred place of care, and to reduce emergency admissions to hospital where avoidable.

The education programme aimed to increase the knowledge and confidence of social care workers working in a care home or home care setting in Lothian.

Methods

Through consultation, a tiered approach to learning was developed. Care workers attended a single training day, with a portion going on to complete an online module. The module was contextualised to reflect the Lothian focus. Care workers were supported by a workplace mentor.

Results

500 social care workers will have completed the single day training and 75 will have gone on to have completed the online professional development module by the conference date. Single day evaluation, pre and post knowledge and confidence questionnaire and focus groups are being used to evaluate the programme and its transferability.

Conclusions

To achieve the aims set out in the Strategic Framework for Action on Palliative and End of Life Care, it is essential that social care teams are adequately supported and trained to provide high quality palliative care for people and their families living with a terminal illness.

References

Bliss J, While A.Decision-making in palliative and continuing care in the community: an analysis of the published literature with reference to the context of UK care provision.Inter J Nurs Studies2003;40:881–888

Kelly D, Gould D, White I, Jane BE. Modernising cancer and palliative care education in the UK: insights from one cancer network.European J Oncol Nurs2006;10:187–197

Scottish Government. Strategic Framework for Action on Palliative and End of Life Care. Edinburgh: The Scottish Government; 2015
Electronic key information summaries can highlight patients’ wishes out of hours
Authors: Finucane Anne , Tapsfield Julia , Hall Charlie , Lunan Carey , McCutheon Hazel , McLoughlin Peter , Rhee Joel
Published: August 2016

Introduction

Electronic Key Information Summaries (KIS) are shared electronic patient records widely used throughout Scotland.1These allow selected parts of the GP patient record to be routinely shared with healthcare professionals across settings. The KIS may contain vital information to support out of hours palliative care decision-making, such as patient preferences for place of care, DNAPCR status and anticipatory medicines.

Aim

To identify when different information pertinent to out of hours palliative care decision-making was serially recorded within the KIS for patients who died with cancer, organ failure or frailty and/or dementia.

Method

A retrospective review of the primary care notes of deceased patients across nine general practices in Lothian was conducted in 2014. Sudden and unexpected deaths were excluded. Data were collected on the type and timing (number of weeks before death) of information recorded in the KIS.

Results

We analysed 605 patient notes. A KIS was shared for patients with organ failure 22 weeks before death (Mdn = 22, IQR = 10–31), and for those with frailty and/or dementia, 20 weeks before death (Mdn = 20, IQR = 8–34). For patients with cancer, KIS’s were commenced later (Mdn = 14, IQR = 6–27). Most patients with a KIS had information on anticipatory care, preferred place of care and DNACPR shared during the last month of life. Information on anticipatory medicines was shared two weeks before death (Mdn = 2, IQR = 1–6).

Conclusion

Electronic key information summaries facilitate the timely documentation and sharing of patient information that is vital to support out of hours decision-making and prevent inappropriate hospital admissions.

Reference

Tapsfield J, Hall C, Lunan C, McCutheon H, McLoughlin P, Rhee J, Rus A, Spiller J, Finucane A, Murray SA. Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners.BMJ Supportive and Palliative Care2016. doi:10.1136/bmjspcare-2015-001014
The unique role of the nurse preceptor in community palliative care
Authors: Legg MJ , Graham L , McAleer A , McCann L , Dempster M
Published: August 2016

Introduction

Practitioners new to palliative care experience multifaceted stressors from exposure to complex and challenging situations.3Preceptorship is considered an accessible and generalizable intervention to address issues with wellbeing, recruitment and retention of nursing staff.2There is however a lack of research to enhance our understanding of this role in supporting newly hired staff1and within palliative care.

Aim(s)

This study aims to develop an understanding of the nurse preceptor role in community palliative care, in order to determine the theoretical underpinnings and scope of the role

Method(s)

Nurse preceptors involved in a programme for newly hire RNs and HCAs to a community palliative nursing service were identified by the hospice practice educator and invited to take part in focus groups. A semi-structured interview schedule was developed from previous literature.

Results

A total of n = 7 nurse preceptors were included in focus groups, all of whom had undertaken the preceptor role for approximately 8 months. A number of themes emerged which will aid the further development of this vital role in palliative care settings.

Conclusion(s)

As far as the research team is aware, this this is the first study to explore the role of the nurse preceptor in palliative care, with both nurses and health care assistants. Preceptorship has emerged as a major theme in facilitating role development, with the potential to lessen the impact of a practitioner making the transition into palliative care.

References

Hyrkäs K, Shoemaker M. Changes in the preceptor role: re-visiting preceptors’ perceptions of benefits, rewards, support and commitment to the role.J Advanced Nurs2007;60(5):513–524

McCloughen A, O’Brien L. Development of a mentorship programme for new graduate nurses in mental health.Inter J Mental Health Nurs2005;14(4):276–284

Newton J, Waters V. Community palliative care clinical nurse specialists descriptions of stress in their work’.Inter J Palliative Care Nurs2001;7(11):531–540
EMERGENCY MEDICAL DISPATCHERS' ABILITY TO DETERMINE OBVIOUS OR EXPECTED DEATH OUTCOMES USING A MEDICAL PRIORITY DISPATCH PROTOCOL.
Authors: Whitaker Ivan , Olola Christopher , Toxopeus Corike , Scott Greg , Clawson Jeff , Schultz Bryon , Robinson Don , Calabro Christopher , Gardett Isabel , Patterson Brett
Published: August 2016

Abstract previously published in Annals of Emergency Dispatch and Response
THE USE OF THE PAEDIATRIC ASSESSMENT TRIANGLE IN THE MANAGEMENT OF THE SICK CHILD
Authors: Ogden Kimberley
Published: August 2016

Background

The Paediatric Assessment Triangle (PAT) has been proven to be effective in the general impression of the health status of the child and can interlink the potential underlying pathophysiology so to alert the clinician into how critically ill/ injured the child might be. It is a rapid ‘hands off’ approach when you first encounter the child. The aim is to highlight the use of this assessment tool to allow the clinician a step wise approach to paediatric care so to enhance our treatment in the prehospital environment.

Method

A mixed method approach was used to gather quantifiable data from auditing patient report forms over a 3 month period during the implementation of the PAT which was followed by a questionnaire to gather qualitative information from the staff regarding their feelings towards using it.

Results

Data gathered from patient report forms over the 3 month period after the introduction of the PAT showed an initial baseline of 12% of it being used. Once the tool had been implemented an increase to 63.3% showing a significant uptake from the staff who were trained in its use.

The questionnaire indicated that staff were welcoming of the use of the assessment tool and felt more confident when assessing a child.

Conclusion

The PAT showed a marked increase in being used throughout this project and the majority of staff appeared to be able to utilise it appropriately.

An attempt to perform this on a larger scale would be beneficial to gauge whether it would be welcomed on a broader spectrum amongst staff and managers.

Recommendations would include receiving more training for paediatrics and for consideration to be made to create a clinical performance indicator for child patients to ensure that patient report forms are being completed appropriately and quality care is being delivered to this category of patients.
DEVELOPING A MODEL TO ENHANCE PATIENT INVOLVEMENT IN DESIGNING AND CONDUCTING RESEARCH: VIEWS OF PATIENTS, ACADEMICS AND HEALTH SERVICE STAFF
Authors: Evans Bridie Angela , Porter Alison M , Snooks Helen A , Burholt Vanessa
Published: August 2016

Background

Patients with chronic conditions are at high risk of using unscheduled and emergency services because health status fluctuates and deteriorates. We work with them to design and conduct collaborative research, but need an effective interaction process with academic and organisational experts.

Objectives

To describe development and implementation of a model to enhance patient involvement in health and social care research.

Methods

Twenty patients with chronic conditions were supported by a researcher to develop ways to enable their involvement in health services research. We explored experience of being involved in research through the model through interviews with participating patients, academics and senior managers responsible for health policy and services. Data were audio-recorded with consent and analysed using Interpretative Phenomenological Analysis.

Results

Patients established a pool structure, sharing support, information and skills development. Members were recruited to more than 30 collaborative research opportunities over three years. Interview respondents agreed the model increased the number and proficiency of patients involved in research. Academics and health service managers perceived this was a credible and legitimate patient group. However recruitment and communication processes were seen as confusing and interaction in research meetings was not consistently effective. Patients found the language and culture of research environments was off-putting and said they did not always know what they should and could contribute.

Conclusions

We developed a model which enhanced patients' contributory expertise and strengthened some interaction processes when they were involved in research through collaboration. Further research training for patients, improved communication and better ways to match patients' skills to research opportunities are needed to strengthen the model. Research teams should also clarify aims and roles of all collaborators when involving patients in research, to enable all expertise to be effectively integrated within research processes.
VARIATION IN INTERPRETATION OF GUIDANCE AS AN EXPLANATION OF BETWEEN-SERVICE VARIATION IN AMBULANCE QUALITY INDICATORS ON NON-CONVEYANCE
Authors: Stone Tony , O'Cathain Alicia , Knowles Emma
Published: August 2016

Background

Ambulance Quality Indicators (AQI) are used by NHS England to monitor ambulance services and by Clinical Commissioning Groups to commission services. The aim of this research is to quantify how much between-service variation in the AQI can be explained by the difference in interpretation of the AQI guidance between ambulance services.

Methods

Computer Aided Dispatch (CAD) data was requested from the 10 large English ambulance services for a one month period. The AQI relating toCalls closed without transportwas selected for this analysis. A ‘standardised’ interpretation of the AQI guidance was applied to the CAD data for each service to recalculate the AQI. Additionally, the supplied CAD data was investigated to identify the cause of any discrepancies between the published AQI and the ‘standardised’ AQI.

Results & Conclusion

Analysis of the data is ongoing. We will present a comparison of the between-service variation found using the published figures with the between-service variation found using the ‘standardised’ interpretation of the AQI guidance for the twoCalls closed without transportindicators. Thus we will identify if differing interpretations of the AQI guidance between ambulance services explains some of the between-service variation inCalls closed without transportrates. We will go on to explore the differences in interpretation of the AQI guidance, explaining the discrepancies between the published AQI figures and those found using the ‘standardised’ interpretation of the AQI guidance.
Radiology as an aid to diagnosis in lung disease
Authors: Ellis Stephen , Aziz Zelena
Published: August 2016

A great deal has changed in the imaging of chest diseases over the last 90 years. The plain chest radiograph has gone through numerous improvements and continues to be the front-line investigative technique with the mainstream adoption of digital imaging opening the doors to more advances in imaging efficacy and computer-aided diagnostics. The main change is in the advent and dramatic advances in CT, in some instances superseding the chest X-ray (CXR) as the first-line imaging investigation, not entirely to the authors' liking, and providing in vivo morphological data to aid a more specific diagnosis. However, in our view, there is a danger that the improvement in diagnostic imaging is starting to undermine clinical diagnostic acumen and that there is an increasing reliance on imaging that in the long run may not be advantageous to patient management.
Fractal study of pion void probability distribution in ultrarelativistic nuclear collision and its target dependence
Authors: Bhaduri Susmita , Ghosh Dipak
Published: August 2016

There are numerous existing works on investigating the dynamics of particle production process in ultrarelativistic nuclear collision. In the past, fluctuation of spatial pattern has been analyzed in terms of the scaling behavior of voids. But analysis of the scaling behavior of the void in fractal scenario has not been explored yet. In this work, we have analyzed the fractality of void probability distribution with a completely different and rigorous method called visibility graph analysis, analyzing the void-data produced out of fluctuation of pions in [Formula: see text]S–AgBr interaction at 200 GeV in pseudo-rapidity [Formula: see text] and azimuthal angle [Formula: see text] space. The power of scale-freeness of visibility graph denoted by PSVG is a measure of fractality, which can be used as a quantitative parameter for the assessment of the state of chaotic system. As the behavior of particle production process depends on the target excitation, we can dwell down the void probability distribution in the event-wise fluctuation resulted out of the high energy interaction for different degree of target excitation, with respect to the fractal scenario and analyze the scaling behavior of the voids. From the analysis of the PSVG parameter, we have observed that scaling behavior of void probability distribution in multipion production changes with increasing target excitation. Since visibility graph method is a classic method of complex network analysis, has been applied over fractional Brownian motion (fBm) and fractional Gaussian noises (fGn) to measure the fractality and long-range dependence of a time series successfully, we can quantitatively confirm that fractal behavior of the void probability distribution in particle production process depends on the target excitation.
An Evolutionary and Local Refinement Approach for Community Detection in Signed Networks
Authors: Amelio Alessia , Pizzuti Clara
Published: August 2016

An approach to detect communities in signed networks that combines Genetic Algorithms and local search is proposed. The method optimizes the concepts of modularity and frustration in order to find network divisions far from random partitions, and having positive and dense intra-connections, while sparse and negative inter-connections. A local search strategy to improve the network division is performed by moving nodes having positive connections with nodes of other communities, to neighboring communities, provided that there is an increase in signed modularity. An extensive experimental evaluation on randomly generated networks for which the ground-truth division is known proves that the method is competitive with a state-of-art approach, and it is capable to find accurate solutions. Moreover, a comparison on a real life signed network shows that our approach obtains communities that minimize the positive inter-connections and maximize the negative intra-connections better than the contestant methods.
RCL: An A. I. Tool for Computing Maximal Consensuses
Authors: Grégoire Éric , Lagniez Jean-Marie
Published: August 2016

RCL is an original Artificial Intelligence tool for computing maximal consensuses among conflicting agents in the Boolean logic framework. It extracts one maximal set of information that does not conflict with any of the agents, taking all possible deductions into account. This form of consensus can go far beyond what is actually shared by all agents. It might be endorsed by every agent since it does not conflict with any of them. Several types of preference criteria can be selected and iterated in order to orient the computation towards some preferred consensuses. From a computational point of view RCL relies on an internal transformation of the maximal consensus-finding problem into one single instance of the Weighted Partial Max-SAT problem.
Quark deconfinement in neutron stars and astrophysical implications
Authors: Bombaci Ignazio , Logoteta Domenico
Published: August 2016

We investigate the quark deconfinement phase transition in cold ([Formula: see text]) and hot [Formula: see text]-stable hadronic matter. Assuming a first-order phase transition, we calculate and compare the nucleation rate and the nucleation time due to quantum and thermal nucleation mechanisms. We show that above a threshold value of the central pressure a pure hadronic star (HS) (i.e. a compact star with no fraction of deconfined quark matter (QM)) is metastable to the conversion to a quark star (QS) (i.e. a hybrid star or a strange star). This process liberates a huge amount of energy, of the order of 10[Formula: see text] erg, which produces a powerful neutrino burst, likely accompanied by intense gravitational waves emission, and possibly by a second delayed (with respect to the supernova explosion forming the HS) explosion which could be the energy source of a powerful gamma-ray burst (GRB). This stellar conversion process populates the QS branch of compact stars, thus one has in the universe two coexisting families of compact stars: HSs and QSs. We introduce the concept of critical mass [Formula: see text] for cold HSs and proto-hadronic stars (PHSs), and the concept of limiting conversion temperature for PHSs. We show that PHSs with a mass [Formula: see text] could survive the early stages of their evolution without decaying to QSs. Finally, we discuss the possible evolutionary paths of PHSs.
Multi-field inflation and cosmological perturbations
Authors: Gong Jinn-Ouk
Published: August 2016

We provide a concise review on multi-field inflation and cosmological perturbations. We discuss convenient and physically meaningful bases in terms of which perturbations can be systematically studied. We give formal accounts on the gauge fixing conditions and present the perturbation action in two gauges. We also briefly review nonlinear perturbations.
Local wellposedness in Sobolev space for the inhomogeneous non-resistive MHD equations on general domain
Authors: Zhao Weiren
Published: August 2016

In this paper, we prove the local existence and uniqueness of the solution with discontinuous density for the inhomogeneous non-resistive magnetohydrodynamics (MHD) equations on a [Formula: see text] bounded domain [Formula: see text] or [Formula: see text], if the initial data [Formula: see text] with [Formula: see text] satisfies [Formula: see text].
The fundamental theorems of affine and projective geometry revisited
Authors: Artstein-Avidan Shiri , Slomka Boaz A.
Published: August 2016

The fundamental theorem of affine geometry is a classical and useful result. For finite-dimensional real vector spaces, the theorem roughly states that a bijective self-mapping which maps lines to lines is affine-linear. In this paper, we prove several generalizations of this result and of its classical projective counterpart. We show that under a significant geometric relaxation of the hypotheses, namely that only lines parallel to one of a fixed set of finitely many directions are mapped to lines, an injective mapping of the space must be of a very restricted polynomial form. We also prove that under mild additional conditions the mapping is forced to be affine-additive or affine-linear. For example, we show that five directions in three-dimensional real space suffice to conclude affine-additivity. In the projective setting, we show that [Formula: see text] fixed projective points in real [Formula: see text]-dimensional projective space, through which all projective lines that pass are mapped to projective lines, suffice to conclude projective-linearity.
On the construction of suitable weak solutions to the 3D Navier–Stokes equations in a bounded domain by an artificial compressibility method
Authors: Berselli Luigi C. , Spirito Stefano
Published: August 2016

We prove that suitable weak solutions of 3D Navier–Stokes equations in bounded domains can be constructed by a particular type of artificial compressibility approximation.
On cohomology of a class of nonclassical restricted simple Lie algebras
Authors: Shu Bin , Yao Yu-Feng
Published: August 2016

In this note, we study the cohomology of the nonclassical restricted Lie algebras [Formula: see text], [Formula: see text] over a field [Formula: see text] of characteristic [Formula: see text], which are by definition the Lie algebras of derivations on the truncated polynomial algebras [Formula: see text] (called the Jacobson–Witt algebras), and simple unless [Formula: see text] and [Formula: see text]. We show a vanishing theorem for the cohomology of [Formula: see text] with coefficients in the trivial module [Formula: see text], which says that [Formula: see text] for all [Formula: see text]. Moreover, we compute the cohomology of [Formula: see text] with coefficients in its defining truncated polynomial algebra under a certain assumption on the characteristic of the ground field.