bluuebunny/crossref_metadata_2025 huggingface dataset:
210: UTILIZATION OF MEDICAL IMAGES OF PACS FOR EVIDENCE BASED TRAINING
Authors: Yarmohammadi Zahra , Hosseiny Raham
Published: May 2024

Background and aims:

The more evidence the better decision making. Diagnosis is one of the medical determinants that seriously depend upon the evidence. Treatment and care as the other significant arms of medical practice relies on the right diagnosis. Medical education system tries to track whole capacity of health system to bring more evidence for education, comparison and critical thinking. Picture archiving and communication system (PACS) is used as a tool for providing, processing transferring and displaying the digital images in hospitals information system. Once the medical images stored in the PACS can be retrieved and used several times for different purposes by adding value with no more cost for system.

Methods:

The PACS system consists of a main PACS server which is used for storing the pictures and multiple clients in different places that can communicate with PACS central database through DICOM protocol. Clients can query the system, retrieve the images stored in the database, and show the images by using medical imaging software like DICOM viewer. Open sources software enable the user add/change the source for internal utilization purposes. If medical images is stored by additional metadata i.e. ICD codes and the Mesh /USML keywords along with the patients personal information, the system will be used as a source of evidence for educational propose. DICOM software will query the main database using the keywords and ICD codes that already have been attributed to the images to retrieve all the related images in the system for specific case. For ethical issues the personal information can be concealed when it is retrieved for education purpose.

Results and Conclusion:

By adding metadata through mesh/USML and ICD the images will become a source of evidence instead of being just a temporary diagnoses tool archived in patient's personal records. This method is a simple and cost less way of use of medical images in health system and medical education. It also makes the investments return to the system by multiple use of images
44: DETERMINATION OF FREQUENCY PERCENTAGE OF PROPHYLAXIS UTILIZATION AGAINST DEEP VEIN THROMBOSIS AMONG PATIENTS HOSPITALIZED IN DIFFERENT WARDS OF IMAM KHOMEINI TEACHING HOSPITAL
Authors: Azami Milad , Pashaklaee Esmaiil Ghasemi
Published: May 2024

Background and aims:

The current survey aims at determining the frequency percentage of Prophylaxis usage against deep vein thrombosis (DVT) according to ACCP instruction among the patients hospitalized in Imam Khomeini teaching hospital in Ilam.

Methods:

This study is descriptive and retrospective and the sampling was carried out amongst the cases of patients who were hospitalized and operated in the period occurred in March of 2012 to September of 2013 in Imam Khomeini hospital in Ilam. The type of receiving Prophylaxis was determined by ACCP (The American College of Chest Physicians) Guidelines. After investigating the input and output criteria, patients' data were extracted according to the dependent variables. Eventually the information gathered from the cases were analyzed by SPSS software version 17.

Results:

Studying 169 qualified cases from which 46.2% (78 participants) were female. Showed that from 132 patients needed to receive Prophylaxis only 39 persons (29.5%) were given Prophylaxis and according to ACCP Guidelines with respect to the appropriate type, dose, and duration of thromboprophylaxis was operated in only 30 individuals (22.5%) completely. The maximum rate of thrombo-prophylaxis happened to be in ICU (46.6%) and neurosurgery section (47.5%) and the least utilization of that was in the kidney and urinary tract section (0%).

Conclusion:

This study shows that there are a considerable difference in clinical performance recommended by ACCP in prophylaxis against DVT and in 75% of patients endangered by DVT, thrombo-prophylaxis according to ACCP Guidelines was not operated. Thus, new strategies must be implemented to operate thrombo-prophylaxis against DVT in Ilam hospitals.
51: EFFECT OF PERFORMANCE TELE NURSING ON QUALITY OF LIFE IN PATIENT WITH ATRIAL FIBRILLATION REFERRED IN EDUCATIONAL HOSPITAL OF QAZVIN
Authors: Yekefallah Leili , Najafi Mehdi , Shahrokhi Akram , Javadi Hamid Reza , asl Asghar Mohamadpoor
Published: May 2024

Background and aims:

Atrial fibrillation is the most common sustained cardiac arrhythmia and 1% of the population is affected by this disorder. Long duration of therapy Education requires constant pursuit with modern techniques, such as tele nursing can be achieved it. This study was performed to access the Effect tele nursing on quality of life in patients with Atrial fibrillation

Methods:

This quasi-experimental study was conducted in 2014. in this study 100 Patients with atrial fibrillation with Simple sampling method were randomly divided into two groups; experimental (50) and control (50).in experimental group telephone call was 12 weeks subsequently using SF-36 form, the level of quality of life was measured in the two groups at the beginning and the end of the study .the data was analyzed by using t-test and t couple

Results:

In intervention group, score mean of quality of life before intervention was 64.88that after intervention reached to (76.14) that was increased (p<0/0001) and in control group score mean before intervention was/9±6/62 that after intervention reached to 95/6±05/60

Conclusion:

our study results showed that using tele nursing can increase level of quality of life and better make way for nursing.
72: HIV PREVALENCE AMONG FEMALE SEX WORKERS IN IRAN: A SYSTEMATIC REVIEW
Authors: Faramani Roya Safari , Shahesmaeili Armita , Hooshyar Samira Hosseini , Khajehkazemi Razieh , Nasirian Maryam , Sharifi Hamid , Kamali Kianoosh
Published: May 2024

Background and aims:

Although injecting drug use is considered the main route of HIV transmission in Iran, the growing trend of sexual transmission of HIV infection has been much of a concern in recent years. Female sex workers (FSWs) are one of the most important key group populations that have made significant contributions to the spread of HIV in the community. This study was designed to review the current prevalence of HIV infection among this key population in Iran.

Methods:

The pertinent literature up to July 2014 was retrieved by a systematic search in the 5 electronic databases including PubMed, Scopus, Google Scholar, SID and Iranmedex. The following keywords were searched by using “and” and “or” operators: Sex worker, HIV, Incidence, Prevalence, and Iran. Two independent reviewers evaluated the quality of each paper by a checklist. In case of disagreement between reviewers, a third expert-opinion was sought. EndNote (Version 15) and Microsoft Office Excel 2007 were used respectively to record references and manage the extracted data.

Results:

Overall, we found 16 studies of which 4 were repetitive and only 2 studies were eligible to be included in the final review. Meta-analysis was not possible due to lack of sufficient studies. One of the two studies was conducted in 14 cities of Iran and the other in Shiraz city. Their sample size were respectively 872 and 278. Based on information retrieved from these two studies, HIV prevalence ranged between 5.4% and 7.4% among FSWs in Iran.

Conclusion:

FSWs are an important high-risk group in both transmission and acquisition of HIV in the community. Findings of this study also reveal the important role of this group in HIV epidemics in Iran. This requires policy-makers to provide, develop and implement prevention programs for this population. Despite recognition of the importance of this group, only a few studies have been carried out on the incidence and prevalence of HIV infection among FSWs. Hence further studies are needed to be carried out among this group in Iran.
75: HPV INFECTION IN WOMEN: KNOWLEDGE, ATTITUDES AND BEHAVIORS AND THE IMPLICATIONS FOR LIBYAN HEALTHCARE
Authors: Elghblawi Ebtisam
Published: May 2024

Background and aims:

The increasing incidence of human papillomavirus (HPV) infection and HPV-linked conditions like genital warts (GWs) among women is a worldwide concern. Sexual contact is the chief route of transmission of genital HPV infections and it has been estimated that about 70–80% of sexually active individuals will be exposed to genital HPV in their lifetime. Sexually active women under 25 years old have the highest rates of genital HPV infection. GWs are estimated to affect about 1% of sexually active women aged between 15 and 49 years old worldwide, with peak prevalence occurring in the twenties (20–29). GWs are seen in the dermatological or gynaecological outpatient clinics as there is no a STD clinic per se in Libya.

Goal:

To explore the evidence for possible interventions that might reduce the prevalence of genital warts.

Objective:

To examine the literature relating to the knowledge and attitudes of patients and others, and the behaviours (KAB) connected with GWs.

Methods:

The search strategy for this review was based on the context of “KAB”, and the key search words used were “genital wart”, “condyloma acuminate”, and “venereal warts”. The search was then focused on literature involving knowledge and GWs, attitudes and GWs and behaviours and GWs, in developing and developed countries. A database was used which integrated EBSCO, Scopus, Cochrane, life science database, journals, and peer review, and the English-language literature which were explored for the last ten years.

Results:

Many women are still uncertain about the basic facts regarding HPV and cervical cancer and GWs.

Conclusion:

From the literature review it has been found that there is a wide range of reported levels of knowledge about HPV internationally.

This project demonstrated significant gaps in knowledge among many women worldwide about genital and HPV infection which varies according to ethnicity, socio-economic and other demographic characteristics

Australian women in the literature seemed to be well informed about genital infection and HPV and this can possibly be attributed to the broad educational campaign about HPV connected to their vaccination campaign.

Moreover, Dermatologists need robust to acquire new skills in constructing answerable questions, efficiently searching electronic bibliographic databases, and critically appraising different types of studies.
80: IMPLEMENTING HEALTH TECHNOLOGY ASSESSMENT IN IRAN: A STAKEHOLDER ANALYSIS
Authors: Arab-Zozani Morteza , Jalilian Habib , Oskouei Mina Mahami , Dehghanian Mohammad , Aghbalaghi Zoleikha Asadi
Published: May 2024

Background and aims:

Because of growing costs in health system, resource allocation has vital role in assignment of existing resources to health technologies in recent years. Therefore, health technology assessment (HTA) is a good tool for allocating the resources based on evidence in health sector. In line with evidence-based decision making, HTA program conducted in Iran since 2007 and in this article explores the main stakeholders in implementing the HTA program.

Methods:

At the first step the researchers searched the related articles, policy documents and secondary sources to identify the range of the stakeholders in this field. Then, semi-structured interview were conducted with all stakeholder from all categories and interpret according to the principles of the qualitative content analysis.

Results:

Stakeholder analysis has identified 10 main category of stakeholder (WHO, MOHME, The National Institute for Health Research, Graduates and researchers, Universities and research institutes, Department of Medical Equipment, Food and Drug Administration, Insurance agencies, Manufacturing and importer companies' of medicines and medical equipment, The Parliament Health Commission) in relation to HTA program. The MOHME and NIHR along with graduates and researchers who were educated abroad were the most powerful and supportive actors that had an important role in implementing this program. We found that Department of Medical Equipment and medicines and medical equipment companies were strongly opposition in implementing the HTA program. The presence of abroad graduates in the country at the time of implementation of the program was the most important factor in the successful implementation of this program.

Conclusion:

Conducting this program showed that the dialogue with opposition groups can enhance the possibility of the successful implementation of a program. Implementing these strategies at a country level will confidently decrease the knowledge gap between research and policy and increase health system outcomes in terms of resource allocation and EBM.
86: KNOWLEDGE, ATTITUDE AND BARRIERS AMONG DENTISTS IN APPLYING EVIDENCE-BASED PRACTICE IN CLINICAL DECISION MAKING
Authors: Shahrak Mehrnaz Zaker
Published: May 2024

Background and aims:

Evidence-based practice (EBP) guides to increase quality of tendance, and recourse to the administration of the newest powerful research into clinical practice .thus, it is substantial for dentists as well as all healthcare providers to notify clinical decision-making and apply EBP. Aims: The objective of this study was to investigate awareness, knowledge, attitude and barriers in relation to evidence-based practice (EBP) among dentists in bushehr.

Methods:

An overall of 250 copies of the questionnaire consisted of 16 multiple-choice questions were given out to dentists in bushehr early 2016 and response rate was 87%.

Results:

Knowledge and attitude of dentists were found to be low. 72% of the dentists represented a positive attitude toward EBP, although because of heavy workload they cannot be up to date with new research materials. Not having access, time availability and being unable to understand statistical terms were the top barriers of using EBP.

Conclusion:

Although dentists represented a positive attitude toward EBP, it is essential to increase their knowledge and skills. The findings of this research can be used to remodel the common educational strategies and to increase the quality of EBP implementation.
89: MAPPING THE CONCEPT OF VIP RELATED TO DELIVERY OF HEALTH CARE IN HOSPITALS: A SCOPING REVIEW
Authors: Khajavi Abdoljavad , Esmaeili Reza , Mircheraghi Seyed Farzin , Tavakolizadeh Mitra
Published: May 2024

Background and aims:

It is difficult to find a commonly agreed upon definition for Very Important Persons (VIPs) or VIP patients as the concept has minimal representation in the medical literature. Caring for VIP patients, however, can challenge standard professional routines and approaches to healthcare delivery, can affect staff's professionalism, and may be disorienting for a health care system. This scoping review aims to explore the terminology in use in relation to health care delivery to VIP patients in hospitals, as well as to elicit how particular terms are used, by whom and for what purpose.

Methods:

A scoping study was conducted using the ‘Arksey and O'Malley’ framework. We were considered any empirical and non-empirical studies for inclusion. Four electronic databases including Ovid MEDLINE, EBSCO CINAHL, SciVerse Scopus and Google Scholar were searched for English language articles, without any other limitations. Study selection and data extraction were performed by two independent reviewers using pretested forms. A thematic construction was used to provide an overview of the breadth of the literature, and a numerical analysis of the extent and nature of studies was presented.

Results:

A total of 71 publications of potential interest were identified, and 31 studies were selected and included in the review for analysis. All of the studies were non-empirical including overview (1), narrative review (1), and the others (29) were editorials, commentaries, brief report, CME, case study, or qualitative study design. The thematic analysis identified four themes: the first concerned the definition of VIP patients (individuals with wealth, fame, or power) in health care settings. The second theme highlighted the potential ethical and medicolegal issues in the care of the VIP patients. The third theme considered the concept of ‘VIP syndrome’, i.e., general effect of VIP patients on delivery of care. The final theme indicated the need for evaluation of VIP policy in health care delivery settings.

Conclusion:

This scoping review of the literature demonstrates little peer-reviewed evidence on the opportunities and threats of VIP policy implementation in hospitals. Besides, the emergent themes together indicate a number of important directions for future research.
14 Managing uncertainty in care for people with dementia at the end of life: the use of heuristics
Authors: Davies Nathan , Lamahewa Kethakie , Mathew Rammya , Wilcock Jane , Manthorpe Jill , Sampson Elizabeth L , Iliffe Steve
Published: May 2024

Introduction

The end of life for someone with dementia can present several challenges for practitioners. Challenges may be eased with the use of heuristics (rules-of-thumb). For example, FAST is used in stroke:Facial-weakness,Arm-weakness,Slurred-speech,Time to call 999. Our study developed a toolkit of heuristics to aid practitioners making difficult decisions when caring for someone with dementia at the end of life.

Methods

A co-design approach with three phases:

1. Focus groups and semi-structured interviews with family carers and practitioners, to identify key decisions and how these should be made.

Results were presented to a co-design group consisting of health and care practitioners, and family carers tasked with developing a toolkit of heuristics, through workshops.

2. Testing the heuristics in practice for six-months in five clinical and care settings.

3. Evaluation of heuristics through interviews and questionnaires at three and six-months.

Results

Four sets of heuristics were developed, covering; eating/swallowing difficulties, agitation/restlessness, reviewing treatment, and routine care. The heuristics are arranged as flowcharts. Eating/swallowing difficulties have two rules; ensuring eating/swallowing difficulties do not come as a surprise and reflection about ‘comfort-feeding’ only. Agitation/restlessness encourages a holistic approach, considering the environment, physical causes, and caregivers’ health/wellbeing. Reviewing treatment/interventions prompts practitioners to consider the benefits to quality-of-life and comfort. Finally, routine care, such as bathing, prompts practitioners to ensure care interventions improve or do not harm quality-of-life.

Conclusions

Practitioners liked the simplicity of the heuristics, making their implicit knowledge explicit, enhancing their confidence in making decisions at the end of life.
18 Constructing the hospice volunteer role: emerging findings from an ethnographic exploration
Authors: France Rachel
Published: May 2024

Introduction

The modern hospice movement in western societies has involved volunteers since its inception. With the increasing demand for end-of-life and palliative care, there is likely to be a corresponding increased demand for volunteers, who have been estimated to reduce hospice costs by 23 per cent (Help the Hospices, 2006). However, palliative and end-of-life care has tended to follow a medical model in western societies, which has placed the role of the volunteer outside the boundary of professional care.

Aims

To explore the role of patient-facing volunteers in adult end-of-life care.

Methods

Participant observation in two UK adult hospices, extended conversations with participants, analysis of relevant hospice documents.

Findings

The role is constructed by boundaries, including clinical and professional, but always within the framework of the boundary between life and death. My data showed that while the role is seen as distinct and separate from that of paid staff, the volunteer role was sometimes difficult to negotiate. How this played out demonstrated how the hospice constructed the volunteer role, but also how the hospice constructed death and dying.

Conclusions

My findings highlight what is happening in a clinical setting through the lens of a ‘neglected’ group of workers, and I will offer recommendations to improve current practice. Ethnography offers in-depth data to present the reality of the volunteer role that will have relevance to policy and practice.

Reference

. Help the Hospices: Volunteer value: A pilot survey of UK hospices. London: Help the Hospices 2006.
19 Tackling the rhetoric: an evidence-based support needs tool to enable supportive care in advanced non-malignant disease
Authors: Gardener Carole , Ewing Gail , Farquhar Morag
Published: May 2024

Introduction

Delivery of supportive and palliative care to patients with advanced non-malignant diseases such as COPD is hampered by the challenge of prognostication and unpredictability of disease trajectories. An alternative approach is delivery of care and support in response to patient-identified need.

Aim

This study aimed to develop a support needs tool for patients with advanced COPD, to enable patients to identify and express their support needs.

Methods

Two-stage qualitative study. Stage 1: domains of support need in advanced COPD were identified through a rapid review of the literature, analysis of qualitative data from the Living with Breathlessness Study (n=20 purposively sampled patients with advanced COPD) and patient focus groups. Stage 2: the draft Support Needs Approach for Patients (SNAP) tool was developed from the identified domains of support need, then reviewed and refined in stakeholder workshops to ensure acceptability and suitability.

Results

A comprehensive set of evidence-based support domains were identified and reformulated as questions. The draft tool asks patients to consider whether they need more support in relation to 16 broad areas of support need e.g. “knowing what to expect in the future” and “getting out and about”. Stakeholders broadly endorsed the content and wording of the draft SNAP tool and the proposed person-centred approach which it underpins.

Discussion

The SNAP tool has the potential to help patients with advanced COPD, and other non-malignant diseases, identify and express their support needs to enable delivery of supportive care. Follow-on work is testing tool validity and feasibility of the approach.
2 Sub-optimal care for patients in the out of hours primary care setting at the end of life: a mixed methods study
Authors: Williams Huw , Noble Simon , Kenkre Joyce , Edwards Adrian , Hibbert Peter , Donaldson Liam , Carson-Stevens Andrew
Published: May 2024

Background

Patients receiving palliative care are often at increased risk of unsafe care, (Mazzocato and Stiefel 1997; Dietz et al. 2014) and the identification of improved ways of delivering palliative care outside working hours is a priority area. (Best et al. 2015)

Aim

To explore the nature and causes of unsafe care delivered to patients receiving palliative care from primary care services outside normal working hours.

Methods

The National Reporting and Learning System (NRLS) collates patient safety incident reports written by healthcare professionals in England and Wales. We characterised reports, identified by keyword searches, using codes to describe what happened, underlying causes, harm outcome, and severity. Exploratory descriptive and thematic analyses identified factors underpinning unsafe care.

Findings

We identified 1072 incidents of suboptimal care, which included: medication-related issues (n=613); access to timely care (n=123); and or non-medication related treatment such as pressure ulcer relief or catheter care. (n=102). Almost two thirds of reports (n=695) described harm with outcomes including increased pain, emotional and psychological distress and dying in a place not of their choosing.

Commonly identified contributory factors to these incidents were a failure to follow protocol (n=282); lack of skills/confidence of staff (n=156) and patients requiring medication delivered via a syringe driver (n=80).

Conclusions

This study is the largest characterisation of unsafe care for patients requiring palliative care in the community, outside working hours. Possible targets for organisations looking to improve care include improved communication between providers; better knowledge of commonly used medications and routes and easier access to medications and equipment.

References

1. Mazzocato C, Stiefel F. How safe are opioids in palliative care?Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 1997;5(6):427–427.

2. Dietz I, et al. “Please describe from your point of view a typical case of an error in palliative care”: Qualitative data from an exploratory cross-sectional survey study among palliative care professionals. Journal of palliative medicine2014;17(3):331–337.

3. Best S, et al. Research priority setting in palliative and end of life care: the James Lind Alliance approach consulting patinets carers and clinicians. BMJ supportive & palliative care2015;5(1):102.1–102.
26 The prognosis in palliative care ii (PIPS2): recruitment data collected during the first year of a multi-centre, prospective, observational cohort study
Authors: Kalpakidou Anastasia K , Todd Chris , Omar Rumana Z , Keeley Vaughan , Griffiths Jane , Vickerstaff Victoria , Stone Patrick
Published: May 2024

Introduction

More accurate methods of prognostication are likely to lead to improvements in the quality of care of patients approaching the ends of their lives. The Prognosis in Palliative care Scales (PiPS) predict survival in terms of ‘days’, ‘weeks’ or ‘months’ and have been shown to perform as well as, or better than Clinician Estimates of Survival (CES).1

Aims

a) To validate PiPS in a new cohort of patients and b) to evaluate the accuracy of other prognostic tools.2,3

Methods

This is a national, multi-centre, prospective, observational cohort study, aiming to recruit 1780 patients via palliative care services (PCS). Eligible patients have advanced, incurable cancer who have recently been referred to PCS. Patients with or without capacity are included in the study.

The primary outcome is the accuracy of PiPS predictions and the difference in accuracy between these predictions and the CES. The secondary outcomes include the accuracy of predictions by the Palliative Prognostic Score, Palliative Prognostic Index, Palliative Performance Scale, and the Feliu Prognostic Nomogram compared with actual patient survival and CES.

Results

Within 10 months of recruitment, 5699 patients were screened across 27 recruiting sites. Of those, 1608 were approached to participate in the study and 940 were recruited (812 patients with and 128 patients without capacity). Updated recruitment figures and a breakdown of the reasons for ineligibility, inability to approach patients and refusal to consent will be presented.

Conclusion

This study demonstrates the feasibility of recruiting large numbers of participants to a prospective palliative care study.

References

. Gwilliam B, Keeley V, Todd C, Roberts C, Gittins M, Kelly L, Barclay S, Stone P. Prognosticating in patients with advanced cancer-observational study comparing the accuracy of clinicians’ and patients‘ estimates of survival. Ann Oncol2013;24(2):482–488available from: PM:23028038.

. Kim ES, Lee JK, Kim MH, Noh HM, Jin YH.Validation of the prognosis in palliative care study predictor models in terminal cancer patients. Korean J Fam Med2014;35(6):283–294available from: PM:25426276

. Stone PC, Lund S. Predicting prognosis in patients with advanced cancer. AnnOncol2007;18(6):971–976available from: PM:17043092
3 Conversation analytic study of communication with the relatives and friends of patients in a hospice: study protocol
Authors: Anderson Rebecca , Stone Paddy , Low Joe , Parry Ruth , Tookman Adrian , Lodge Philip , Finlay Dori-Anne , Wood Barbara , Bloch Steven
Published: May 2024

Introduction

Family members of patients near the end-of-life value accurate prognostic information that is communicated sensitively by experienced healthcare professionals. This provides opportunities to say goodbye and make decisions about care. Current research is limited and has mostly focused on discussions early in the illness trajectory and with patients and not relatives.

Aims and methods

This study aims to investigate communication about prognosis and end-of-life care between expert healthcare professionals and the relatives and friends of patients who lack capacity and are approaching the end-of-life.

We will record conversations between experienced healthcare professionals and relatives of inpatients at a hospice. Recordings will be analysed using conversation analysis to identify practices used by healthcare professionals and relatives to attempt and accomplish communicative tasks. These tasks are likely to include: raising prognosis and care, receipt of information by relatives, communicating uncertainty, and ending these conversations.

Healthcare professionals will participate in a focus group on what makes a ‘good’ conversation. Relatives will be invited to take part in one-to-one interviews 3–6 months later to gather their perspectives about experiences of communication about end-of-life care and prognosis.

Results

We anticipate starting data collection in October 2017.

Conclusion

No study to date has directly examined how healthcare professionals communicate prognostic information and discuss care with friends/relatives at the very end-of-life. Findings will therefore provide valuable new information and contribute to developing communication skills interventions for less experienced clinicians working in palliative care settings.
37 With my family i have to think about them… with the girls [friends] i don’t: the role of friendships in advance care planning
Authors: Russell Sarah
Published: May 2024

Introduction

The role of friendships is under-reported in the research literature despite evidence that advance care planning is both a social experience and a health care decision making one.

Aim/Method

As part of a doctoral study, the influences on advance care planning was explored using a qualitative narrative approach to 15 indepth interviews; analysed by a data driven thematic analysis method.

Results

One finding was the influence of friendships on advance care planning; forums for discussion, entertainment, diversion, practical support, reality checks and ‘safe’ spaces for discussions/decisions about preparing and planning for dying unencumbered by concerns for the emotional well being of informal carers, family or children. Participants retained their identity as a ‘person’ rather than a dying patient supporting them to live with the knowledge of their future death.

Conclusion

The importance of friendships at the end of life (Cartwright and Seale 1990) and influence of social networks is described in the literature (Leonard et al 2015), especially in terms of formal and informal support (Lewis et al 2014). However, the role of friendships is often under reported because dying is seen primarily as a family event or difficult to define (de Vries and Johnson 2002). If death is both a health and social experience (Sudnow 1967) then the social elements of dying (e.g friendships) should not be subsumed by the biomedical focus of palliative care (Lewis et al 2013). The findings from this study provides practical insights into the role and definitions of friendships in advance care planning and end of life.

References

. Cartwright A and Seale C (1990) The natural history of a survey:an account of methodological issues encountered in a study of life before death. King Edwrds Hospital Fund for London.

. de Vries B and Johnson C (2002) The death of friends in later life. Advances in life course research7:299–324

. Leonard R, Horsfall D, Noonan K (2015) Identifying changes in the support networks of end of life carers using socia network analysis. BMJ Supportive and Palliative Care 5(2):153–159.

. Lewis JM, DiGiacomo M Currow DC, Davidson PM (2013) A Social Capital Framework for Palliative Care: Supporting Health and Well Being for People with Life Limiting Illness and their Carers through Social Relations and Networks. Journal of Pain and Symptom Management45(1):92–103

. Sudnow D (1967) Passing On. Prentice Hall.
50 A multi-professional educational intervention to improve and sustain respondents’ confidence to deliver palliative care: a mixed methods study
Authors: Reed Elizabeth , Todd Jennifer , Sadler Clair , Berg Jane , Lucas Caroline , Lawton Sally , Grant Robert , Watson Max
Published: May 2024

Background

Education has been highlighted as fundamental in equipping healthcare professionals with essential knowledge and skills to provide good end of life care. Multiprofessional educational programmes have a positive influence on knowledge, attitude and confidence but few explore the longer term impact on care delivery. The educational intervention we evaluated is an eight week home-study based programme for healthcare professionals and is currently run in nine European centres.

Aims

To evaluate the impact the educational intervention has on participants’ confidence in palliative care, to determine if this is sustained over time.

Design

A mixed method longitudinal approach

Setting/participants

A survey using a self-efficacy scale was emailed to 342 candidates who undertook the educational intervention and semi-structured interviews to a sub-sample of 15 candidates at baseline, 3 and 6 months.

Results

At three months, candidates had twenty times higher odds of being above any given level of confidence than baseline which was sustained at six months. Confidence was expressed in terms of communication clinical practice and multiprofessional working.

Conclusion

Findings suggest the ECEPC improves confidence in palliative care that is sustained over time with evidence of confidence in symptom control, communication and a holistic approach in clinical practice.
51 Improving care out of hours by reducing remote prescriptions: a pharmacy-led intervention
Authors: Patel Ronika , Shafqat Abbas , Gishan Faye , Weil Anna
Published: May 2024

Introduction

The Marie Curie Medicines Management Policy1states that remote prescriptions may be used under certain circumstances. General Medical Council prescribing guidance for doctors (2) and national guidance for nurses and nurse prescribers3,4allow for remote prescribing. This normally requires written confirmation using secure email, following a verbal order from a doctor to a nurse. In an inpatient hospice setting without resident medical cover this process may delay administration of medication.

AIms

To understand which medications are remotely prescribed and investigate whether the administration by nurses of ‘homely remedies’(an approved lists of non-prescription or over the counter (OTC) medicines) can reduce the burden on on-call medical staff, enabling more timely delivery of medication .

Method

The hospice pharmacy team undertook an audit of inpatient remote prescriptions issued over twelve months and categorised them into prescription and non-prescription medications. Following an educational intervention for nurses and junior doctors and displaying information posters on the wards, we re-audited remote prescriptions after three months.

Results

Ninety-three remote prescriptions were issued over twelve months, approximately two prescriptions each week. The majority of these prescriptions were for OTC medications, usually for symptom management. The re-audit showed a reduction in the number of remote prescriptions issued, to less than one per week.

Conclusion and discussion

Education and training by pharmacists resulted in a reduction in remote prescriptions. Formulating an approved list of ‘homely remedies’ could further reduce this, which may result in more timely administration of medications to patients thereby improving patient care.

References

. Marie Curie Medicines management in Hospices policy (2016) https://mariecurie365.sharepoint.com/PPG/Shared%20Documents/Medicines%20Management%20in%20Hospcies%20policy.pdf#search=medicines%20management

. http://www.gmc-uk.org/guidance/ethical_guidance/14326.asp

. NMC Standards of proficiency for nurse and midwife prescribers (2015) http://www.nmc-uk.org/Documents/NMC-Publications/NMC-Standards-for-medicines-management.pdf

. National Institute for Clinical Excellence. Managing Medicines in Care Homes, 2014https://www.nice.org.uk/guidance/sc1/chapter/1-recommendations#care-home-staff-giving-non-prescription-and-over-the-counter-products-to-residents-homely
53 Compassionate communities in north wales: a service evaluation
Authors: Watt Bethany , Hiscock Julia , Poolman Marlise , Livingstone Tracy
Published: May 2024

Aim

To evaluate hospice-supported, volunteer-led community befriending services in North Wales operating within the Compassionate Communities model.

Methods

Five semi-structured, qualitative interviews lasting 1–2 hours were conducted with facilitators of current hospice-supported community befriending services in North Wales. These comprised the four volunteer coordinators, two at each site, in addition to the hospice lead for the facilitation of these services.

Ten (out of a total of nineteen) volunteers involved with the befriending services completed an online (or paper if preferred) survey about their current activities within, and views on, the befriending services.

Data from the qualitative interviews was fully transcribed verbatim, and subsequently combined with qualitative data from the volunteer survey and analysed using the Framework approach. Descriptive statistics were used to provide frequency data (counts, percentages) from the volunteer survey where the answer format provided pre-determined responses.

Results

Initial analysis of the results has provided an understanding of the development and operation of these community-led services, and has given insight into perceived barriers to and facilitators of their optimal functioning. It has revealed duality of opinion about the role of the hospice and the role of the community within the befriending services, most notable in the coexistence of views expressed regarding the need to be protected and guided by the hospice, and the desire to be free from the confines of hospice-imposed regulations and the medical model of care.

We will present the results of the full analysis and consider implications for hospices nationwide in facilitating the development of Compassionate Communities.
58 Assessing and managing constipation for patients receiving palliative care in a hospice setting: a systematic review of the literature
Authors: McIlfatrick Sonja , Preshaw Deborah , Hasson Felicity , Carduff Emma , Clarke Mike , Coast Jo , Ferguson Claire , Finucane Anne , Graham Lisa , Larkin Philip , McCorry Noleen , Slater Paul , Watson Max , Wright Eileen
Published: May 2024

Introduction

Constipation causes considerable suffering, either as a direct result of physical symptoms or due to related social and psychological problems. Despite this, uncertainty persists about the best management within hospice settings.

Aim

To synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a hospice setting.

Methods

A systematic search of MEDLINE, Embase, Cinahl, Scopus, and Cochrane databases was undertaken in April 2017 for empirical studies, written in English, on the assessment and management of constipation in the hospice, between 2007 and 2017. Two researchers independently reviewed and critically appraised all studies, conducted data extraction and undertook a thematic analysis.

Results

Fourteen studies were included in the review including randomised trials (n=3), observational (n=5), and descriptive studies (n=6). The majority of the research was conducted in palliative care units and targeted either healthcare professionals or patients. The analysis highlighted a lack of standard definition of constipation. Clinicians experienced challenges in constipation assessment, with a need to combine patient reports with physical examination. Clinicians focused on pharmacological management, however, consideration around non-pharmacological aspects is also essential. Finally, the need to assess current practice for the management of constipation in light of changing priorities of care at end of life was emphasised.

Discussion

Supporting clinicians to more effectively assess and manage the complexities of constipation in this setting is essential in improving overall symptom management. Gaps in the evidence base included defining constipation, constipation prevention, non-pharmacological management, and management in the dying patient.
6 Caregivers’ difficulty rating scale: development and initial validation of a tool to identify unmet needs of indian caregivers
Authors: Bhardwaj Tushti
Published: May 2024

Background

Caring for a cancer patient is debilitating for caregivers especially among Indian population as culturally people prefer to care at home than nursing home. Unavailability of palliative care services and professional caregivers add to the family burden.

Objectives

Caregiving difficulties need assessment but cancer specific burden instruments are rare in Indian context. This paper presents development and initial validation of Caregiver’s Difficulty Rating scale and highlights the nature of caregiving burden on primary caregivers.

Methods

108 items were prepared in English after case-interviews and reviewing existing scales for face validity. Experts judged the items for content validity, 54 items with 100% agreement were retained. Forward-backward policy was used for Hindi translation. Reliability analysis was performed with 30 respondents. Final scale was administered to 100 caregivers of head and neck cancer patients for internal consistency and item-scale statistics. For construct validity know-group comparison was made using EORTCQOL instrument with caregiver-patients dyads.

Results

High correlation among 3 translated versions (r>0.76, p<0.01), chronbach’s alpha (0.948), and spilt-half coefficient (0.965) suggested translation reliability and scale consistency. Caregiver’s burden had significant negative correlation with global quality of life of patients (−0.514**) supporting theory base. Help for food arrangement, managing work- life and treatment cost were highly rated difficulty.

Conclusion

CDRS had 50 items under four dimensions viz- physical, emotional, social and financial hardships. Scale requires further work on convergent and divergent validity and testing sensitivity to change which are underway. Study has implications to educate caregivers and making provisions of respite care. Community engagements and caregivers’ support group may work as sources of emotional and social support.
9 The opinions of hospice staff and patients towards routine weighing upon admission to an inpatient hospice setting
Authors: Byrne Niall , Codling Jan , Phippen Alison , Pickard Jennie , Kay Samantha
Published: May 2024

Introduction

The role of inpatient hospice care is gradually changing from overwhelmingly providing care at the end of life, to focusing more on symptom management which facilitates discharge home. However, some hospice clinical practices have not adapted to reflect that change, as seen by infrequent bodyweight assessment at admission. This leads to an inability to conform to best practice in medication management and nutritional assessment.

Aims and methods

To facilitate altering our clinical guidelines to achieve best clinical standards of care we needed to understand the rationale for the reluctance among hospice staff to weigh patients and understand if those fears are justified by consulting with patients. Two paper-based surveys were designed and completed with staff and patients at our hospice. Outcome measures were descriptive information about staff and patient opinions that were grouped into themes for quantitative analysis.

Results

Results among patients mirrored previous research and showed that the majority of patients 37/38 (97.3%) surveyed did not find being weighed distressing, and in fact, 36/38 (94.7%) would prefer to know their bodyweight if measured. We found that staff members, however, were broadly opposed to routine weighing on admission (50.63%).

Conclusion

Rationale for opposition included fear of causing upset and a belief that it is inappropriate for the holistic environment of the hospice. Weight loss can be distressing and preventing unnecessary procedures is important. However, to ensure optimal clinical care we have recommended that weighing patients should be the default position unless reasons for exclusion exist.

References

. Watson M, Coulter S, McLoughlin C, Kelt S, Wilkinson P, McPherson A, Wilson, R, Eatock M. Attitudes towards weight and weight assessment in oncology patients: survey of hospice staff and patients with advanced cancer. Palliative Medicine2010;24(6):623–629.

. National institute for health and clinical excellence (NICE). Nutrition support in adults 2006, [CG32]. London: NICE.

. Charani E, Gharbi M, Hickson M, Othman S, Alfituri A, Frost G, Holmes A. Lack of weight recording in patients being administered narrow therapeutic index antibiotics: a prospective cross-sectional study. BMJ Open2015;5(4);e006092–e006092.

. Khan A, Flavin K, Tsang J. Weight a minute - iatrogenic paracetamol toxicity is preventable by utilisation of well-designed drug charts.BMJ Quality Improvement Reports2014;3(1):u203956.w1721.
Research and Development of an Embedded Multi-Channel Sensor Data Acquisition Device for Reservoir Dams
Authors: Wang Keming , Wang Chengli , Wenbing Jin
Published: May 2024

The embedded system of intelligent reservoir dam achieves the integration and efficient utilization of water conservancy dam system data through multi-channel data collection and analysis calculated by computer technology, CNC system, and neural network. Compared with traditional data collection and processing methods, both timeliness and accuracy have been greatly improved. This study aims to develop a multi-channel sensor data acquisition device for reservoir dams based on embedded system technology. This device can collect real-time and efficient data from sensors in various parts of the dam, ensuring the safe operation of the reservoir dam. By using advanced embedded system technology, this device has advantages such as low power consumption, high stability, and real-time data transmission. The Analytic Hierarchy Process (AHP) was used to study the embedded multi-channel sensor data acquisition device for reservoir dams in multiple directions and factors. The AHP method provides an effective means for problem decision-making in complex situations. Referring to the AHP method, the factors that affect reservoir dams can be divided into different levels. Compare the importance of two random factors in each level to obtain a specific quantitative expression of the relative important factors on a scale. Then repeat this step to obtain the weight ranking for different levels. At the same time, the device monitors key parameters such as temperature, humidity, displacement, and pressure in various parts of the dam through multiple sensors, providing strong support for early warning and decision-making of reservoir dams. The results of this study have important practical significance and application value for improving the safety and stability of reservoir dams.