bluuebunny/crossref_metadata_2025 huggingface dataset:
Filamentous fungal infections of the cornea: a global overview of epidemiology and drug sensitivity
Authors: Kredics László , Narendran Venkatapathy , Shobana Coimbatore Subramanian , Vágvölgyi Csaba , Manikandan Palanisamy ,   Indo‐Hungarian Fungal Keratitis Working Group
Published: February 2015

Fungal keratitis is a serious suppurative, usually ulcerative corneal infection which may result in blindness or reduced vision. Epidemiological studies indicate that the occurrence of fungal keratitis is higher in warm, humid regions with agricultural economy. The most frequent filamentous fungal genera among the causal agents areFusarium,AspergillusandCurvularia. A more successful therapy of fungal keratitis relies on precise identification of the pathogen to the species level using molecular tools. As the sequence analysis of the internal transcribed spacer (ITS) region of the ribosomalRNAgene cluster (rDNA) is not discriminative enough to reveal a species‐level diagnosis for several filamentous fungal species highly relevant in keratitis infections, analysis of other loci is also required for an exact diagnosis. Molecular identifications may also reveal the involvement of fungal species which were not previously reported from corneal infections. The routinely applied chemotherapy of fungal keratitis is based on the topical and systemic administration of polyenes and azole compounds. Antifungal susceptibility testing of the causal agents is of special importance due to the emergence and spread of resistance. Testing the applicability of further available antifungals and screening for new, potential compounds for the therapy of fungal keratitis are of highlighted interest.
Phenotypic and molecular identification of Fonsecaea pedrosoi strains isolated from chromoblastomycosis patients in Mexico and Venezuela
Authors: Carolina Rojas O. , León‐Cachón Rafael B. R. , Pérez‐Maya Antonio Alí , Aguirre‐Garza Marcelino , Moreno‐Treviño María G. , González Gloria M.
Published: February 2015

Chromoblastomycosis is a chronic granulomatous disease caused frequently by fungi of the Fonsecaea genus. The objective of this study was the phenotypic and molecular identification of F. pedrosoi strains isolated from chromoblastomycosis patients in Mexico and Venezuela. Ten strains were included in this study. For phenotypic identification, we used macroscopic and microscopic morphologies, carbohydrate assimilation test, urea hydrolysis, cixcloheximide tolerance, proteolitic activity and the thermotolerance test. The antifungal activity of five drugs was evaluated against the isolates. Molecular identification was performed by sequencing the internal transcribed spacer (ITS) ribosomal DNA regions of the isolated strains. The physiological analysis and morphological features were variable and the precise identification was not possible. All isolates were susceptible to itraconazole, terbinafine, voriconazole and posaconazole. Amphotericin B was the least effective drug. The alignment of the 559‐nucleotide ITS sequences from our strains compared with sequences of GenBank revealed high homology with F. pedrosoi (EU285266.1). In this study, all patients were from rural areas, six from Mexico and four from Venezuela. Ten isolates were identified by phenotypic and molecular analysis, using ITS sequence and demonstrated that nine isolates from Mexico and Venezuela were 100% homologous and one isolate showed a small genetic distance.
Modular organization of the white spruce (Picea glauca) transcriptome reveals functional organization and evolutionary signatures
Authors: Raherison Elie S. M. , Giguère Isabelle , Caron Sébastien , Lamara Mebarek , MacKay John J.
Published: February 2015

Transcript profiling has shown the molecular bases of several biological processes in plants but few studies have developed an understanding of overall transcriptome variation. We investigated transcriptome structure in white spruce (Picea glauca), aiming to delineate its modular organization and associated functional and evolutionary attributes.

Microarray analyses were used to: identify and functionally characterize groups of co‐expressed genes; investigate expressional and functional diversity of vascular tissue preferential genes which were conserved among Picea species, and identify expression networks underlying wood formation.

We classified 22 857 genes as variable (79%; 22 coexpression groups) or invariant (21%) by profiling across several vegetative tissues. Modular organization and complex transcriptome restructuring among vascular tissue preferential genes was revealed by their assignment to coexpression groups with partially overlapping profiles and partially distinct functions. Integrated analyses of tissue‐based and temporally variable profiles identified secondary xylem gene networks, showed their remodelling over a growing season and identified PgNAC‐7 (no apical meristerm (NAM), Arabidopsis transcription activation factor (ATAF) and cup‐shaped cotyledon (CUC) transcription factor 007 in Picea glauca) as a major hub gene specific to earlywood formation.

Reference profiling identified comprehensive, statistically robust coexpressed groups, revealing that modular organization underpins the evolutionary conservation of the transcriptome structure.
Mal de debarquement syndrome: new insights
Authors: Cha Yoon‐Hee
Published: February 2015

Mal de Debarquement Syndrome (MdDS) is an enigmatic neurotological disorder with high morbidity, psychosocial burden, and few treatment options. Fortunately, there has been recent growth in scientific interest in understanding the biological basis of and in treating MdDS. Recent studies using functional neuroimaging have shown increased glucose metabolism in the left entorhinal cortex (EC) and amygdala in the setting of decreased prefrontal and temporal cortex metabolism in subjects with persistent MdDS. The EC is a key player in processing and gating spatial information to be stored in the hippocampus and is a major driver of brain oscillations. A limbic focus may also be key to spontaneous MdDS‐like symptoms occurring in individuals with a history of anxiety or chronic stress. Treatment with repetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex can decrease the rocking dizziness of MdDS, with successful responses associated with decreases in the coherence between brain networks with nodes in the parietal and occipital lobes. A new theory of MdDS is proposed as pathology secondary to entrainment of intrinsic brain networks driven by oscillatory motion exposure coupled with an inability to subsequently desynchronize the activity of these nodes. Future treatment strategies may be directed toward unyoking these networks.
Splicing regulation in spinal muscular atrophy by an RNA structure formed by long‐distance interactions
Authors: Singh Natalia N. , Lee Brian M. , Singh Ravindra N.
Published: February 2015

Humans carry two copies of the survival motor neuron gene: SMN1 and SMN2. Loss of SMN1 coupled with skipping of SMN2 exon 7 causes spinal muscular atrophy (SMA), a leading genetic disease associated with infant mortality. Our discovery of intronic splicing silencer N1 (ISS‐N1) is a promising target, currently in a phase III clinical trial, for an antisense oligonucleotide–mediated splicing correction in SMA. We have recently shown that the first residue of ISS‐N1 is locked in a unique RNA structure that we term ISTL1 (internal stem through long‐distance interaction–1). Complementary strands of ISTL1 are separated from each other by 279 nucleotides. Using site‐specific mutations and chemical structure probing, we confirmed the formation and functional significance of ISTL1. Located in the middle of intron 7, the 3′ strand of ISTL1 falls within an inhibitory region that we term ISS‐N2. We demonstrate that an antisense oligonucleotide–mediated sequestration of ISS‐N2 fully corrects SMN2 exon 7 splicing and restores high levels of SMN in SMA patient cells. These results underscore the therapeutic potential of the regulatory information present in a secondary and high‐order RNA structure of a human intron.
Evolution of double‐stranded DNA viruses of eukaryotes: from bacteriophages to transposons to giant viruses
Authors: Koonin Eugene V. , Krupovic Mart , Yutin Natalya
Published: February 2015

Diverse eukaryotes including animals and protists are hosts to a broad variety of viruses with double‐stranded (ds) DNA genomes, from the largest known viruses, such as pandoraviruses and mimiviruses, to tiny polyomaviruses. Recent comparative genomic analyses have revealed many evolutionary connections between dsDNA viruses of eukaryotes, bacteriophages, transposable elements, and linear DNA plasmids. These findings provide an evolutionary scenario that derives several major groups of eukaryotic dsDNA viruses, including the proposed order “Megavirales,” adenoviruses, and virophages from a group of large virus‐like transposons known as Polintons (Mavericks). The Polintons have been recently shown to encode two capsid proteins, suggesting that these elements lead a dual lifestyle with both a transposon and a viral phase and should perhaps more appropriately be named polintoviruses. Here, we describe the recently identified evolutionary relationships between bacteriophages of the family Tectiviridae, polintoviruses, adenoviruses, virophages, large and giant DNA viruses of eukaryotes of the proposed order “Megavirales,” and linear mitochondrial and cytoplasmic plasmids. We outline an evolutionary scenario under which the polintoviruses were the first group of eukaryotic dsDNA viruses that evolved from bacteriophages and became the ancestors of most large DNA viruses of eukaryotes and a variety of other selfish elements. Distinct lines of origin are detectable only for herpesviruses (from a different bacteriophage root) and polyoma/papillomaviruses (from single‐stranded DNA viruses and ultimately from plasmids). Phylogenomic analysis of giant viruses provides compelling evidence of their independent origins from smaller members of the putative order “Megavirales,” refuting the speculations on the evolution of these viruses from an extinct fourth domain of cellular life.
Inflammatory and redox reactions in colorectal carcinogenesis
Authors: Guina Tina , Biasi Fiorella , Calfapietra Simone , Nano Mario , Poli Giuseppe
Published: February 2015

It has been established that there is a relationship between chronic inflammation and cancer development. The constant colonic inflammation typical of inflammatory bowel diseases is now considered a risk factor for colorectal carcinoma (CRC) development. The inflammatory network of signaling molecules is also required during the late phases of carcinogenesis, to enable cancer cells to survive and to metastasize. Oxidative reactions are an integral part of the inflammatory response, and are generally associated with CRC development. However, when the malignant phenotype is acquired, increased oxidative status induces antioxidant defenses in cancer cells, favoring their aggressiveness. This contradictory behavior of cancer cells toward redox status is of great significance for potential anticancer therapies. This paper summarizes the essential background information relating to the molecules involved in regulating oxidative stress and inflammation during carcinogenesis. Understanding more of their function in CRC stages might provide the foundation for future developments in CRC treatment.
The Extensively Corrected Score for Measurement Error Models
Authors: Huang Yih‐Huei , Wen Chi‐Chung , Hsu Yu‐Hua
Published: February 2015

In measurement error problems, two major and consistent estimation methods are the conditional score and the corrected score. They are functional methods that require no parametric assumptions on mismeasured covariates. The conditional score requires that a suitable sufficient statistic for the mismeasured covariate can be found, while the corrected score requires that the object score function can be estimated without bias. These assumptions limit their ranges of applications. The extensively corrected score proposed here is an extension of the corrected score. It yields consistent estimations in many cases when neither the conditional score nor the corrected score is feasible. We demonstrate its constructions in generalized linear models and the Cox proportional hazards model, assess its performances by simulation studies and illustrate its implementations by two real examples.
Identification and characterization of an ABA‐activated MAP kinase cascade in Arabidopsis thaliana
Authors: Danquah Agyemang , de Zélicourt Axel , Boudsocq Marie , Neubauer Jorinde , Frei dit Frey Nicolas , Leonhardt Nathalie , Pateyron Stephanie , Gwinner Frederik , Tamby Jean‐Philippe , Ortiz‐Masia Dolores , Marcote Maria J. , Hirt Heribert , Colcombet Jean
Published: February 2015

Abscisic acid (ABA) is a major phytohormone involved in important stress‐related and developmental plant processes. Recent phosphoproteomic analyses revealed a large set of ABA‐triggered phosphoproteins as putative mitogen‐activated protein kinase (MAPK) targets, although the evidence for MAPKs involved in ABA signalling is still scarce. Here, we identified and reconstituted in vivo a complete ABA‐activated MAPK cascade, composed of the MAP3Ks MAP3K17/18, the MAP2K MKK3 and the four C group MAPKs MPK1/2/7/14. In planta, we show that ABA activation of MPK7 is blocked in mkk3‐1 and map3k17mapk3k18 plants. Coherently, both mutants exhibit hypersensitivity to ABA and altered expression of a set of ABA‐dependent genes. A genetic analysis further reveals that this MAPK cascade is activated by the PYR/PYL/RCAR‐SnRK2‐PP2C ABA core signalling module through protein synthesis of the MAP3Ks, unveiling an atypical mechanism for MAPK activation in eukaryotes. Our work provides evidence for a role of an ABA‐induced MAPK pathway in plant stress signalling.
Relative efficacy of nucleic acid amplification testing and serologic screening in preventing hepatitis C virus transmission risk in seven international regions
Authors: Bruhn Roberta , Lelie Nico , Busch Michael , Kleinman Steven ,   the International NAT Study Group
Published: February 2015

BACKGROUND

The relative contribution of serologic screening and nucleic acid testing (NAT) to prevent hepatitis C virus (HCV) transmission has not been rigorously addressed.

STUDY DESIGN AND METHODS

Twenty‐one blood organizations in seven geographical regions performing individual‐donation (ID)‐NAT in parallel with anti‐HCV screening provided data from 10,897,105 donations to establish HCV infection rates in first‐time, lapsed, and repeat donations. Screening efficacy was modeled for: anti‐HCV alone, HCV antigen/antibody (combo), minipool (MP)‐NAT in pools of 8 and 16 with anti‐HCV, ID‐NAT and anti‐HCV, and ID‐NAT alone. Probabilities of infectivity for red blood cell transfusions were estimated as 100% from window period (WP) and concordant HCV RNA/antibody‐positive (concordantly positive [CP]) donations and 0.028% from anti‐HCV‐positive and RNA‐negative probable resolved (PR) donations.

RESULTS

There were 5146 confirmed infections (30 WP, 3827 CP, and 1289 PR). Infection rates and transmission risks varied substantially across regions and by donation status. Residual risk with ID‐NAT and serology screening was estimated at one in 250,000 in Egypt and at one in 10,000,000 in other regions combined; risk would increase to one in 7300 and one in 312,000, respectively, if NAT had not been performed. ID‐NAT with or without anti‐HCV testing showed higher efficacy than either MP‐NAT or combo assays, particularly in lapsed or repeat donors in whom 99.2, 98.5, and 93.2% of infectious donations were estimated to be interdicted by these respective testing strategies.

CONCLUSIONS

The incremental efficacy of anti‐HCV testing when ID‐ NAT screening is performed was minimal, particularly for screening lapsed and repeat donations.
Namibia's transition from whole blood–derived pooled platelets to single‐donor apheresis platelet collections
Authors: Pitman John P. , Basavaraju Sridhar V. , Shiraishi Ray W. , Wilkinson Robert , von Finckenstein Bjorn , Lowrance David W. , Marfin Anthony A. , Postma Maarten , Mataranyika Mary , Smit Sibinga Cees Th.
Published: February 2015

BACKGROUND

Few African countries separate blood donations into components; however, demand for platelets (PLTs) is increasing as regional capacity to treat causes of thrombocytopenia, including chemotherapy, increases. Namibia introduced single‐donor apheresis PLT collections in 2007 to increase PLT availability while reducing exposure to multiple donors via pooling. This study describes the impact this transition had on PLT availability and safety in Namibia.

STUDY DESIGN AND METHODS

Annual national blood collections and PLT units issued data were extracted from a database maintained by the Blood Transfusion Service of Namibia (NAMBTS). Production costs and unit prices were analyzed.

RESULTS

In 2006, NAMBTS issued 771 single and pooled PLT doses from 3054 whole blood (WB) donations (drawn from 18,422 WB donations). In 2007, NAMBTS issued 486 single and pooled PLT doses from 1477 WB donations (drawn from 18,309 WB donations) and 131 single‐donor PLT doses. By 2011, NAMBTS issued 837 single‐donor PLT doses per year, 99.1% of all PLT units. Of 5761 WB donations from which PLTs were made in 2006 to 2011, a total of 20 (0.35%) were from donors with confirmed test results for human immunodeficiency virus or other transfusion‐transmissible infections (TTIs). Of 2315 single‐donor apheresis donations between 2007 and 2011, none of the 663 donors had a confirmed positive result for any pathogen. As apheresis replaced WB‐derived PLTs, apheresis production costs dropped by a mean of 8.2% per year, while pooled PLT costs increased by an annual mean of 21.5%. Unit prices paid for apheresis‐ and WB‐derived PLTs increased by 9 and 7.4% per year on average, respectively.

CONCLUSION

Namibia's PLT transition shows that collections from repeat apheresis donors can reduce TTI risk and production costs.
Inducing competition: intensive grassland seeding to control Ambrosia artemisiifolia
Authors: Gentili R , Gilardelli F , Ciappetta S , Ghiani A , Citterio S
Published: February 2015

The invasion of Ambrosia artemisiifolia across European countries has been favoured by its ecological amplitude and by its ability to colonise and dominate disturbed/ruderal areas that have lost competition from native species. We supposed that a strong competition for habitat resources may inhibit A. artemisiifolia growth, generating a negative feedback to its establishment. Based on this hypothesis, in this study, we undertook a 1‐year field experiment to assess the effect of mixtures of grassland species on A. artemisiifolia growth and fitness in bare soils. We applied three different treatments within an abandoned quarry area invaded by A. artemisiifolia: (i) spontaneous succession, (ii) hayseed and (iii) a commercial seed mixture. Within plots, we recorded vegetation parameters, A. artemisiifolia abundance and traits. Results obtained after one growing season showed that the commercial seed resulted in the strongest reduction of A. artemisiifolia growth rate in terms of plant height, lateral spread and leaf size. This was ascribed to higher density of plants that play a key role in reducing biomass and fitness of A. artemisiifolia. However, hayseed should be preferred, as it preserves local biodiversity. Seeding mixtures of grassland species can successfully suppress A. artemisiifolia in the first year of establishment on a vegetation‐free soil derived from quarry activities. This study indicated that inducing dominance of different native species in a newly developing plant community should enhance competition for resources, reducing the success of early coloniser non‐native species.
Ultrasonographic anatomy of head and neck - a pictorial for the ENT specialist
Authors: Costache Adrian , Dumitru Mihai , Anghel Ion , Cergan Romica , Anghel Alina Georgiana , Sarafoleanu Codrut
Published: February 2015

An increased pressure on ENT departments has evolved as head and neck pathology is showing a higher incidence and preva- lence. Therefore, the ENT specialist should develop good skills in ultrasonographic examination of patients with head and neck masses. The aim of this paper is to enable the ENT specialist to identify anatomical landmarks on ultrasonographic images in order to expedite the diagnosis with a higher degree of certainty. We describe the steps for a proper ultrasound examination of the patient. We illustrate the following anatomical areas: submandibular gland, thyroid gland, parathyroid glands, oropharinx, larynx, parotid glands, etc. Moreover we emphasize the differential diagnosis that should be taken into account when examining pathology in these regions. Ultrasonographic examination of head and neck pathology is cost efficient, non irradiating and permits fast follow up with serial examination of the lesions. Furthermore one can perform an initial TNM staging of the case prior to other expensive imaging studies such as CT and MRI. We hope to raise the awareness of fellow ENT specialists in performing ultrasonography as future developments such as elastography and CEUS will increase the specificity and sensitivity of this diagnostic method.
A comparison between gastroesophagheal ultrasonography vs. barium swallow in determining the pattern of gastroesophageal reflux in a pediatric population
Authors: Khatami Alireza , Allameh Mohammad Mahdi , Shahnazi Makhtoom , Kiumarsi Azadeh , Tajik Ali
Published: February 2015

Background: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal pathology in infants and young children. Ultrasonography (US) has been considered to be a reliable diagnostic tool for GERD but the severity of GERD and the clinical implications based on imaging findings has not been evaluated. Aims: To compare the diagnostic value of lower esophageal US with that of barium swallow in demonstrating the severity of GERD. Materials and methods: Fifty one pediatric patients, age between 1 month to 12 years, 34 male and 17 female with clinical suspicion of GERD were included. The patients were initially submitted to barium swallow (BS) and subsequently to transabdominal US. During BS, the number of gastroesophageal reflux episodes was documented in a 5-minute period. Transabdominal US documented the number and duration of reflux episodes during a 5-minute period, the angle of His, mucosal thickness, and intraabdominal esophageal length (IAEL). Results: Duration and number of reflux episodes in US were significantly higher in patients that had severe gastroesophageal refluxes at BS. At US the cutoff point of 9.5 seconds (sensitivity 80%, specificity 60%) for reflux duration and more than 2 episodes in 5 minute ultrasound study (sensitivity 75%, specificity 58%) were defined to correlate with severe gastroesophageal reflux at BS.The angle of His, the esophageal wall mucosal thickness, and the IAEL did not cor- relate with the severity of GERD detected in BS. Conclusion: US can predict the severity of GERD. Therefore, except in the case of specific patients in whom mechanical causes are suspected to be responsible for GERD, BS can be replaced by US.
Acoustic Radiation Force Impulse (ARFI) elastography quantification of muscle stiffness over a course of gradual isometric contractions: a preliminary study.
Authors: Yavuz Alpaslan , Bora Aydin , Bulut Mehmet Deniz , Batur Abdussamet , Milanlioglu Aysel , Göya Cemil , Andic Cagatay
Published: February 2015

Aims: To evaluate the feasibility of quantitative analysis of muscle stiffness by Acoustic Radiation Forced Impulse (ARFI) elastography over a course of graduate isometric voluntary contractions. Material and methods: The stiffness of the bilateral biceps muscle of 13 healthy volunteers was measured in real time by ARFI elastography, while the forearm was in neutral- extended position, 90 degree self-flexed positions and 90 degree self-flexed position, with altered weights ranging from 1 to 8 kg placed on flattened palmar surfaces consecutively. The determined increases in biceps muscle stiffness were measured for both arms and correlated with the loadings weights adopted at progressive trial stages. Results: The mean shear wave velocity (SWV) values of biceps muscles in a neutral position, in 90 degree flex position and 90 degree flex position with 1 to 8 kg weights on palmar surfaces were 2.162±0.302 m/sec, 3.382±0.581 m/sec, and 3.897±0.585 to 5.562±0.587 m/sec, re- spectively. Significant correlations between the muscle SWV values and related palmar weights and between the SWV values of right and left sides at different trial stages were identified (r=0.951 and r=0.954, respectively). A mutual propagation path of deep regions to entire areas was described to account for the distribution of increase in stiffness with increases in palmar weights. The confidence of method regarding inter-observer difference was confirmed by the correlation analyses of the re- sults (r=0.998). Conclusions: ARFI elastography is a feasible imaging modality for quantifying the stiffness of isometrically voluntarily contracting muscles.
Dawn probe to look for a habitable ocean on Ceres
Authors: Hand Eric
Published: February 2015

Asteroid belt's largest body to yield its icy secrets to NASA orbiter, due to arrive next month.
How wheat came to Britain
Authors: Larson Greger
Published: February 2015

Wheat reached Britain from the Near East at least 2000 years before the arrival of wheat farming

[Also see Report by

Smith
et al.

]
TRAINING AND SUPPORT FOR A PERSON-CENTRED APPROACH TO SUPPORTING FAMILY CARERS: A FUTURE DIRECTION TO ACHIEVE IMPROVED OUTCOMES IN PALLIATIVE AND END OF LIFE CARE
Authors: Ewing G , Diffin J , Austin L , Grande G
Published: February 2015

Introduction

In palliative care a key policy driver is carer assessment and support. For provider services to achieve meaningful change in carer outcomes in the future requires a change to a person-centred approach for supporting family carers.

The Carer Support Needs Assessment Tool (CSNAT) intervention facilitates a person-centred assessment and support process that is carer-led. Targeted practitioner training and support is required as this represents a change from current practitioner-led approaches.

Aim(s) and method(s)

To test and revise a training and support package for implementation of carer-led assessment and support in palliative care practice, informed by the Promoting Action on Research Implementation in Health Services (PARiHS) Framework.

36 palliative care services participated including specialist community teams, hospice at home and social work/family support teams. The researchers delivered one day training on carer-led assessment and support: reflection on existing approaches; background to the CSNAT; interactive sessions on integrating CSNAT in practice. 2–3 practitioner ‘champions' per site attended (N=82) then cascaded training and facilitated implementation within sites. Peer support was through Skype/Webex discussion sessions. The PARiHS Framework informed champion interview analysis.

Results

The finalised training and support package addresses: (1) nature of the evidence – underpinning policy/research, CSNAT approach and its benefits; (2) organisational context—recommended internal managerial, administrative, and IT support (3) internal facilitation including resources for champions to cascade training (4) external facilitation by the research team – Webex support networks/information exchange.

Conclusions

The package provides a changed approach to carer support provision for future palliative care practice with potential to improve carer outcomes.
THE FUTURE OF PALLIATIVE CARE: USING A NOVEL APPROACH TO PREPARE THE WORKFORCE
Authors: Roberts A , Gambles M , Hellaby M
Published: February 2015

Introduction

The delivery of world class palliative care dying requires the workforce to have substantial technical knowledge, clinical skill & excellent communication skills.

Aim(s) and method(s)

To develop, pilot and evaluate an MDT simulation course focused on care in the last days of life. The bespoke course consisted of e-learning & a study day focusing on 4 scenarios simulating the last days of life in a hospital setting. It was piloted on 2 occasions. Evaluation included pre & post course questionnaires & thematic analysis of post course focus group interviews.

Results

Twelve participants completed the training and 11 participated in focus groups immediately following the training. Participants were overwhelmingly positive about the course, valuing the realism, small group size, & MDT nature of the training. Feedback and the opportunity for reflection including video recording were also highly valued. Participants were fairly knowledgeable & held generally positive perceptions of caring for dying patients prior to the training. The greatest shift pre to post training was the reduction of participants' level of perceived helplessness when caring for dying patients. Confidence in all three domains (Communication, Management of the Patient, MDT Working) was relatively high (around 60%) pre-training, particularly for MDT working. It rose immediately post training (T2) in all domains but especially with regard to communication with the family & the provision of and referral for spiritual care.

Conclusions

The sample was small but the course was universally valued by participants. Findings have been used to refine the course and evaluation of further courses is planned.
USING SCHWARTZ CENTRE ROUNDS TO CHANGE HOSPICE CULTURE: DOES IT WORK?
Authors: Gishen F , Wood M
Published: February 2015

Introduction

Following a review of organisational culture in 2013, Schwartz Centre Rounds (SCR) were introduced to Marie Curie Hospice Hampstead (MCHH). Aiming to promote a ‘one hospice’ ethos, the SCR were chosen as an evidence-based tool to address psychological issues felt by staff managing the increasingly complex physical and emotional burden of palliative care delivery. Unlike in NHS hospitals in which SCR are usually conducted, which have large numbers of staff, MCHH is a hospice with a relatively small pool of staff. Consequently, there were reservations about the Rounds being effective in this setting, and initially trepidation from staff concerned about sharing and exposing their emotions.

Aim(s) and method(s)

Facilitators underwent the training licensed and delivered by the Point of Care Foundation. A multi-professional steering group met regularly to choose topics for discussion at the SCR. Panel members for each session were chosen from a range of multi-professional backgrounds. Quantitative and qualitative data were collected using Point of Care standardised evaluation forms. Process reflections on running the Rounds were systematically captured by the trained facilitators.

Results

So far over 140 people have attended four Rounds (April–November 2014), with 85% response rate evaluation forms. Descriptive statistics, thematic analysis of SCR participants' written feedback and anecdotal observations will be reported in the poster. Factors required to sustain and improve the smooth running of Rounds will be identified.

Conclusions

The introduction of the Schwartz Centre Rounds in a small hospice requires commitment and hard work from its facilitators, and support from senior management. With these in place, the Rounds at MCHH have so far, made a considerable positive impact on its staff culture and consequently patient care.
DO FLAGGING LETTERS FROM HOSPITAL PALLIATIVE CARE TEAMS IMPROVE COMMUNITY CARE OF PATIENTS APPROACHING END OF LIFE?
Authors: Georgiade K , Kelt S , McKenna E , Hookey C
Published: February 2015

Introduction

The Gold Standards Framework (GSF) was developed to improve primary palliative care and has now extended to all health care settings. The palliative care team at Royal Stoke University Hospital developed a system to alert patients' GPs, by means of a “flagging letter”, that the patient has an anticipated prognosis less than 12 months and would benefit from entry onto the practice GSF register. The letter suggests consideration of discussions about resuscitation status and end of life care preferences.

Aim(s) and method(s)

To assess the effect of these letters on patient care including enrolment onto GSF, advance care planning, and DNAR discussions. Retrospective data analysis over 2 month period with focus on distinguishing any differences between those enrolled or not enrolled onto GSF.

Results

A large proportion of patients were enrolled on practice GSF registers (68%). 86.44% had DNAR orders irrespective of their enrolment to GSF.Patients on GSF registers were more likely to have district nurses involvement and anticipatory medication in place (38% compared to 6%). In 77% of all patients preferred place of death was documented (of whom 71% were registered to GSF) and this was achieved in 73% of cases.

Conclusion(s)

Highlighted need for open discussions regarding advance directives and better documentation of preferred place of death. Overall though, identification of patients with limited prognosis and the communication of this information to primary care can lead to improvements in care for end of life patients.
TRANSFORMING PALLIATIVE AND END OF LIFE CARE SERVICES THROUGH A WHOLE SYSTEMS APPROACH
Authors: O'Hara B , Davidson N , McClements C , Wilson D
Published: February 2015

Introduction

Current strategies to address palliative and end of life care in Northern Ireland emphasise the importance of providing care as close to home as possible. In order to achieve this the transforming your palliative and end of life care programme in Northern Ireland has adopted a whole systems approach to service redesign which promotes meaningful patient, family and carer involvement.

Aim(s) and method(s)

Through a whole systems approach enable stakeholders to make suggestions as to how services could be improved, changed or developed; and generate new ideas for providing care for people towards the end of life at home or as close to home as possible.

Key stakeholders were identified across statutory, voluntary/community and independent sectors including patients, families and carers. Seven workshops were held across Northern Ireland. Participant booklets were used to capture all suggested ideas. Meetings also took place with service users and carers individually and in small groups. Recorded ideas were systematically themed by the programme team before undergoing a two-stage shortlisting process using set criteria.

Results

412 stakeholders attended the workshops. 648 ideas were recorded resulting in and informing eight priority initiatives being taken forward: identification and planning; enhanced access to services at home; day hospice; support for patients and carers; pharmacy; training for healthcare providers; ambulance; discharge and equipment.

Conclusion(s)

Through a whole systems approach stakeholders across various sectors were able to engage in meaningful discussion to transform how palliative care will be delivered in Northern Ireland.
ENGAGING MINORITY ETHNIC COMMUNITIES TO IMPROVE ACCESS TO PALLIATIVE CARE: BARRIERS AND STRATEGIES
Authors: Nawaz S
Published: February 2015

Introduction

In September 2012, Marie Curie employed a keyworker at a Welsh hospice to work with local minority ethnic communities to increase access and to improve awareness of palliative care. The Big Lottery funded this project, which is being evaluated by a palliative care research centre in Cardiff University.

This presentation outlines the:

keyworker outreach project being undertaken;

Barriers identified by minority ethnic communities;

Steps taken by the hospice to reduce barriers

Feedback from minority ethnic patients and families accessing the service

Aim(s) and method(s)

The aim of the keyworker role is to build relationships with local minority ethnic communities, and address barriers that may prevent individuals accessing palliative care services.

Results

The keyworker has identified barriers experienced by minority ethnic communities in accessing palliative care, the need for community engagement to increase awareness and has highlighted steps that are needed to improve access to services by minority ethnic communities.

The hospice has seen a significant increase in numbers of minority ethnic patients accessing the service since September 2012.

Conclusion(s)

This project highlights the importance of working with communities to improve awareness of palliative care and ensure equal access to services.
WHAT ARE THE PATTERNS OF DYING IN ACUTE STROKE?
Authors: Burton C , Turner M , Payne S
Published: February 2015

Introduction

Implementation of stroke professionals' palliative care role outlined in the UK National Clinical Guidelines for stroke is challenged by uncertainty about prognosis. Understanding the patterns of dying in acute stroke may help stroke clinicians improve implementation.

Aim(s) and method(s)

To identify the patterns of dying in acute stroke services, and explore patient and family carer experiences. Over a six month period, biographical and clinical data, including the type of dying trajectory for deceased patients, were collected from admissions to four acute stroke services. Death trajectories were classified as sudden; rapid; episodic; slow decline; or other. Interviews were conducted with a sample of patients, family carers and bereaved relatives, exploring narratives of experience and initiation of end of life care.

Results

686 admissions were screened; with 627 (91.4%) eligible for inclusion. Six patients, nine family members and two bereaved family members took part in interviews. There were 91 deaths during the study period (14.5% of stroke patients) with dying trajectories classified for 72 deceased patients. Five (7.3%) were classed as sudden deaths; 64 (88.6) as rapid; 2 (3.3%) as episodic and 1 (0.8%) as slow decline. Interviews highlighted the significance that patients and families attach to clinical geography, including the type of care setting, in making sense of prognosis, and helpful messages that staff could use around planning for end of life care.

Conclusion(s)

The pattern of dying that acute stroke service staff encounter most is a rapid decline in a patient's condition, with a distinct terminal phase, although not set within a context of deterioration.
CANOPY: CARE NEEDS OF PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS AND THEIR CARERS
Authors: Sampson C , Hope-Gill B , Harrison N , Nelson A , Byrne A
Published: February 2015

Introduction

Idiopathic pulmonary fibrosis (IPF) is a chronic, fibrotic interstitial lung disease of unknown origin and median survival of three years. National Institute for Clinical Excellence guidelines promote patient and carer centred approaches, emphasising multidisciplinary, supportive and palliative care interventions. However there is limited evidence of patient and carer experiences to guide care pathways.

Aim(s) and method(s)

Multi-centre mixed methods study identifying palliative and supportive care needs of patients and carers to inform future clinical management pathways. Interpretative Phenomenological Analysis used with 8 sets of semi-structured interviews with patients (27) and paired carers (21) in 4 groups (n=48). Patients also completed validated questionnaires for symptoms and QoL.

Results

Patients and carers experienced uncertainty in five domains across all IPF stages.

Communication and Information

Understanding symptoms and interventions

IPF course

IPF and everyday life

Adapting roles and coping strategies

Patients and carers perceived disparity between clinic assessments and their lived experience of IPF. Potential intervention triggers were complex diagnosis, health deterioration, oxygen use, carer information needs, and interpreting symptoms, particularly cough and breathlessness.

Conclusion(s)

Key turning points for patients and carers are structured around:

Assessment, including diagnosis.

Active role of carers, specifically information and symptom management.

Access triggers, around changes in health status and management, such as oxygen use.

The development of a keyworker service delivery model, responding to need as appropriate along an ongoing trajectory of decline, offers palliative care intervention in conditions where there is a terminal prognosis but an uncertain disease course.
FACTORS ASSOCIATED WITH END OF LIFE TRANSITION FOR OLDER ADULTS LIVING AT HOME: ANALYSIS OF CARERS' POST-BEREAVEMENT SURVEY
Authors: Evans CJ , Bone AE , Yi D , Wei G , Gomes B , Maddocks M , Sleeman KE , Wright J , Mc Crone P , Higginson IJ ,   on behalf of OPTCare Elderly
Published: February 2015

Introduction

Transfer to hospital in the last weeks of life is common for older adults. It is imperative to better understand factors associated with transition to enable older people to remain in their usual place of care.

Aim(s) and method(s)

To explore possible determinants of transition from home to institutional care settings in last weeks of life. Post-bereavement survey of carers to people aged over 75 who died in 2012 in the South of England (n=883). Main outcome is death at home versus hospital/care home (hospice deaths excluded) for decedents whose usual place of care was home. Exploration of socio-demographic factors and illness factors using multivariate modified Poisson regression.

Results

235 decedents spent most of the last 3 months of life at home. The majority died from non-malignant conditions (71.9%) with mean age 86 years. 51.1% died at home and 48.9% transitioned in the last 3 months to a hospital (44.7%) or care home (4.3%). Death outside usual place of care was independently associated with increasing age (85–90 years [PR=3.4; 95% CI 1.9–6.1] compared with 75–80 years), and severity of breathlessness (PR=1.9; 95% CI 1.2–3.4) and difficulty communicating (PR=2.0; 95% CI 1.5–2.8).

Conclusion(s)

Transition to hospital at the end of life is common for older adults living at home. Transition occurs most frequently for the oldest old and those with severe symptoms of breathlessness and difficulty communicating. To reduce reliance on hospital care at the end of life requires timely services responsive to increasing symptom distress and wider anticipation of end of life for adults of advanced age.
PATIENT AND FAMILY EXPERIENCES OF DNACPR DISCUSSIONS: AN INTEGRATIVE REVIEW OF THE LITERATURE
Authors: Hall CC , Carduff E , Lugton J , Spiller J
Published: February 2015

Introduction

DNACPR decisions and the communication of such advance decisions have relevance in all areas of clinical care. An advance decision not to attempt CPR is taken if such an attempt is deemed be futile or if the patient does not wish it to occur. Following the recent release of revised National Guidance from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing, there is an increased awareness of good practice guidance around DNACPR decision making and communication. However little is known about patients' and their family members' experience of DNACPR discussions. This information will be useful in informing the development of recommendations for current clinical practise.

Aim(s) and method(s)

The aim of this review is to identify patient and family views on DNACPR decisions and their experiences after having had DNACPR discussions. Methods: A literature search of multiple databases was performed including all (adult) patients in hospital, hospice and community settings, for all countries over the last 10 years.

Results

Initial search results generated 558 papers. Abstracts were coded by relevance, power of study and country of origin. Exclusion criteria were applied and full texts were analysed to elucidate and summarise important themes. Analysis is currently on going.

Conclusion(s)

Conclusions will be drawn taking in to account limitations such as cultural differences for the study population. Separate conclusions regarding UK specific data will be drawn. Areas for further study and recommendations for improving clinical practise will be suggested.
MALIGNANT BOWEL OBSTRUCTION—A SYSTEMATIC LITERATURE REVIEW AND EVALUATION OF CURRENT PRACTICE
Authors: Longford E , Scott A , Fradsham S , Jeffries C , Ahmad F , Holland G , Telfer R , Carlson J , Ferguson H
Published: February 2015

Introduction

Malignant bowel obstruction (MBO) is a recognized complication of advanced pelvic or abdominal malignancy frequently occurring in advanced stages of illness. Suggested incidences in ovarian carcinoma range from 5.5 to 42% and in colorectal cancer 4.4 to 24%. Where surgery for MBO is inappropriate medical management may help bring about resolution of the unpleasant symptoms.

Aim(s) and method(s)

The aim of this review was to evaluate current evidence and opinion on treatment of symptoms associated with MBO.

A comprehensive systematic review of the literature was undertaken to evaluate the evidence for themedicalmanagement of MBO. A questionnaire-based survey was used to establish professional attitudes, opinions and to review current practice.

Results

Following exclusions 44 relevant papers were systematically appraised.

There is good evidence for the use of octreotide to reduce secretions and corticosteroids may help bring about resolution of MBO. Ranitidine may also reduce secretions. Venting gastrostomies can alleviate nausea and vomiting with low complication rates and may be considered where prognosis is greater than 2 weeks. No evidence was found for any specific medication to treat vomiting or pain associated with MBO.

In local current practice hyoscine buytlbromide is used first line to treat colic; cyclizine and/or haloperidol to treat vomiting with levomepromazine second line. Corticosteroids and octreotide are routinely prescribed. In practice consideration for referral for venting gastrostomies is guided by local surgical practice.

Conclusion(s)

There is a paucity of evidence with regards to medical management of MBO, much more is required. Subsequent to this review, new local guidelines have been developed.
CHEMICAL COMPATIBILITY/STABILITY OF ALFENTANIL WITH COMMONLY USED SUPPORTIVE DRUG COMBINATIONS ADMINISTERED BY CONTINUOUS SUBCUTANEOUS INFUSIONS FOR END OF LIFE CARE
Authors: Dickman Andrew , Roberts Ellen , Bickerstaff Matthew , Jackson Richard , Weir Phil , Ellershaw John
Published: February 2015

Introduction

In 2007, the National Patient Safety Agency recommended that healthcare staff need to have full technical information about compatibility of commonly used mixtures used in specialist areas only. In 2008, the Commission on Human Medicine (CHM) recommended that research should be commissioned to develop authoritative national advice on mixing of medicines to encompass compatibility and stability data.

In the UK, a continuous subcutaneous infusion (CSCI) is considered to be the preferred method of drug administration to maintain symptom management at the end of life. Alfentanil is occasionally administered via CSCI and compatibility data are lacking. Analysis of national practice (1) identified 8 commonly used drug combinations administered by CSCI that included alfentanil.

Aim(s) and method(s)

To determine the chemical compatibility/stability of alfentanil with other supportive drugs in 8 commonly encountered drug combinations, at minimum and maximum concentrations.

A CME T34 syringe pump was used to simulate infusion of the syringe preparation over a 24 hr period. A total of 16 combinations were analysed by High Performance Liquid Chromatography-Diode Array Detection (HPLC-DAD).

Results

Thirteen combinations were identified as compatible by HPLC-DAD. These combinations also remained clear and free from visible particulate matter and the pH remained constant over the monitored period. Three combinations will require additional analysis as the HPLC peaks were small and difficult to distinguish.

Conclusion(s)

This research is the first step towards providing technical information required by healthcare staff for the mixing of injectable medicines in the same syringe.