bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis Influence of Students' Source on College Students' Information Quality
Authors: Sun Hong-Yan , Jia Zhen-Hua , Sun Hong-Tao , Lu Ping
Published: March 2012

Information quality is one of the important indices in measuring quality of an individual in the era of information economy. This paper starts with an questionnaire survey conducted against campus college students, discusses the influence on students' information quality exerted by students' source conditions such as residence category, gender and parents' level of education, then puts forward some countermeasures based on these statistical analyses, intending to offer beneficial references for deeper research and practice.
Approach of Crime Scene Protection concerning Computer Forensics
Authors: Hang Qiangwei , Zhang Ying
Published: March 2012

Nowadays the computer crime has increased year by year around world due to the rapid development of computer technology. Consequently computer forensics has aroused wide attentions from scientists and government officials. In order to collect digital evidences which are supposed to be present in courts and maintain the integrality of evidence chain, crime scene protection is treated to be the critical factor during the computer forensics. This paper provides the foundation approach for initial computer scene investigation, outlines collection, documentation and electronic evidence storage.
Benchmarking Apache on Multi-Core Network Processor Platform
Authors: Song Yi , Zhang Wu , Ni Hong , Zha Qiwen
Published: March 2012

Apache is the most widely used HTTP server in the world. Requests per second, transfer rate, time per request is the widely used indices in benchmarking HTTP server. This paper used benchmark test program ab which is widely used compared the performances of Apache between the multi-core network processor OCTEON5860 and XEON E5506. The results show that the performance of OCTEON 5860 is better than XEON E5506. Finally, through analyzing the advantage of network processor OCTEON5860 explained the benchmarking result.
How Efficient is Support Vector Machine: A Comparative Analysis
Authors: Farquad M. A.H. , Basha S. M. , Ali Md. Anwar , Sultana Jabeen , Harikrishna S.
Published: March 2012

In this paper, efficiency of Support Vector Machine (SVM) and Artificial Neural Network (ANN) is analyzed using unbalanced dataset. The dataset analyzed in this study is obtained from COIL Challenge'2000 and it is highly unbalanced with 94% good customers' data and 6% bad or fraud customers' data. We employed balancing techniques and SMOTE to bring the balance in the data and analysis is carried out. We employed (1) Under-sampling, (2) Over-sampling and (3) Synthetic Minority Oversampling Technique (SMOTE) for balancing the dataset. Since identifying fraudulent cases is paramount from the business perspective, management accords higher priority on sensitivity only. Therefore considering sensitivity alone, we observed that SVM outperformed with original unbalanced data. It is also observed that NN performed better with balanced data compared to it performance using unbalanced data.
Research on the Common Platform of the Internet of Things
Authors: Wang Fu , Hang Qiangwei
Published: March 2012

Internet of Things (IOT) is known as the most influential technological revolution in this century, which is treated to change the world. Thus it is of great strategic, social and economic significance to conduct research about it, while the core of that is Common Platform of the Internet of Things (CPIT). This paper explains CPIT from the aspect of framework and hierarchy, while it concentrates on the researches regarding the sensor common management, data unification and common data interface, environment supporting, services providing and so on. Besides that, this paper provides the XML implementation to the key part of CPIT as well.
Wireless Data Acquisition System Design Based on Matlab and MCU
Authors: Xin Xiong , Wang Qianqian , Gengchen Shi
Published: March 2012

To avoid the constraint of wires during data acquisition, a wireless data acquisition system based on MATLAB and MCU is designed. Firstly, MCU, wireless serial communication module and other hardware are selected for the system, and the connection and interface for the hardware is designed. Secondly, the software of wireless communication is programmed based on MATLAB. Finally, an acoustic signal data acquisition experiment is performed to test the system, and experiment result verifies the feasibility of the system.
A Practical Architecture of Distributed Real-Time Main-Memory Databases for Modern SCADA Systems
Authors: Dai Hong-Bin , Shu Jin
Published: March 2012

As the automated control systems have been applied to various aspects of everyday life including industrial control, oil mining, building automation and traffic scheduling, the strong flexibility and the high real-time performance of modern SCADA (Supervisory Control and Data acquisition) systems, especially their core — real-time databases, are in urgent need. In this paper, a practical architecture of the distributed real-time main-memory database is proposed, with the help of which, a modern SCADA system would be flexible enough to configure differently for different application, while still easily meet the requirements of the rigid time constraints.
Real Time Web Publishing for Scada System with Comet
Authors: Jin-Guo Zhou , Shu Jin
Published: March 2012

Web publishing for SCADA system is not new. Traditional way for web publishing uses polling mode to refresh data. This method works well in most situations, but it can not meet the SCADA system for real-time data update requirements. The solutions is plugins, but the plugins have its own problems, such as security, platform, and requires too more system resources consume to use in resource-limited devices. To improve above issues, this paper attempts to present a new way for data publishing with Comet. Our solution includes a frame of SCADA system web publishing and event triggering mode used in web communication.
Architecture of Home Network and Residential Gateway for IOT
Authors: Yuan Kaiyin
Published: March 2012

with development of IOT (Internet of Things), a new architecture of home network is required. In the architecture, semantic description of services and devices is introduced. And hardware architecture of residential gateway is for the home network architecture based on the multi-core processor. At last software architecture of residential gateway is put forward.
Solving Economic Dispatch Problem with Piecewise Quadratic Cost Functions Using Lagrange Multiplier Theory
Authors: Thang Nguyen Trung
Published: March 2012

This paper presents the solution of economic dispatch (ED) problem of generating units with multiple fuel options based on the Lagrange multiplier theory (LMT). LMT is a conventional and efficient theory used to solve the optimal generation dispatch problem with only one fuel option for each generating unit. Finally, a simple and efficient method has developed based on formulating conventional Lagrange function to solve ED problem with multiple fuel options in this paper. The proposed approach has been examined and tested with the numerical results of ED problems with ten generating units with two or three fuel options. The test results compared to other methods and show the effectiveness of proposed approach for solving ED problems.
A Hybrid Genetic Algorithm to Solve Supplier Selection Problem under Stochastic Demand Condition and Quantity Discount Policy
Authors: Jafari Azizollah , Tehrani Seyedeh Marzieh Banihashemi , Chiniforooshan Payam
Published: March 2012

In this paper, we investigate a supplier selection problem composed of single manufacturer and multiple suppliers under stochastic demand condition and quantity discount policy. The objective of this problem is to select the most economical set of suppliers and to allocate the ordering quantity among the selected suppliers to minimize total costs including selection, purchase, holding and shortage costs. Since the considered problem is NP-hard, this paper presents a novel hybrid algorithm (hybrid GA_VNS) that combines genetic algorithm (GA) with variable neighborhood search (VNS) to find near optimal solutions. This algorithm merges the explorative nature of GA with the exploitative nature of VNS to enhance the effectiveness of the algorithm. The performance of the hybrid GA_VNS is verified with comparing its results with the existing GA in the literature with 60 instances.
Stability for a Class of Infinite Dimension Stochastic Systems with Delay
Authors: Xu Lei , Shi Jizhong
Published: March 2012

The global exponential stability of a class of infinite-dimension stochastic interconnected large-scale systems with time delay was analyzed based on stochastic box theory, by constructing a vector Lyapunov function. A criterion was concluded for global exponential stability of the systems. t is independent of the delays and convenient of the computation, so it is easy for application.
AVD — A New Classification Algorithm
Authors: Pramala S. , Rajalakshmi B. , Balamurugan Appavu
Published: March 2012

This paper proposes a new classification algorithm named the Attribute Value Dependant classifier (AVD). This AVD classifier mainly focuses on identifying the relationship between the attribute values in the training dataset and the class label values. The ‘Attribute Value Dependant’ is the value which determines the extent to which each attribute value has its impact in deciding the class label is identified; and the training model is built based on these values. The attribute values in the test dataset are compared against the ‘Attribute Value Dependant’ values and based on this comparison the test dataset is classified. Since individual attribute value dependency on the class label is found, the irrelevant and inconsistent data in the training dataset are ignored during the classification and consequently the classification accuracy is improved. The performance of the AVD classifier has been compared with seven traditional classifiers and has been proved to produce better results.
Effectiveness of it Courses on the University Staffs Performance with Fuzzy Logic
Authors: Elyasi Ardalan , Yaghoubi Zohreh , Eliasi Morteza
Published: March 2012

Today, IT is an important part of human life and does things more efficiently with Lower costs, less time and More Quality. The purpose of this study the effectiveness of IT courses on employee performance Islamic Azad University-IAU (Qaemshahr Branch, IRAN). Statistical population of this descriptive study is 498people and the sample size based on Krejcie and Morgan table was 217. Because of different objectives and indexes related to performance effectiveness, we used Multiple Attribute Decision Making with TOPSIS method for data analysis in which distance of indexes from positive and negative ideal points were evaluated. The results show that in managers group relatively improving abilities, occupational knowledge and objective realization had the highest impact and planning and decision making had the lowest impact. In Staff's group relatively improving occupational knowledge, improving quality, skills level and abilities had the highest impact and reducing costs, typing letters, occupational motivation, planning, and access to scientific resources and organizing had the lowest impact. In comparison of these indexes and their impact on managers and staff, we can say IT course's implementation was effective on IAU workers and gender and organizational posts had no impact on IT training effectiveness.
Simulation of Fast Trimaran Seakeeping Amelioration Using T-foil
Authors: Zhuang Lin , Guo Zhiqun , Yang Qiang , Li Xiaowen
Published: March 2012

Fast trimaran holds excellent performance because of its high transverse stability, large deck, economy of fuel consumption and high speed. However, the highspeed craft can easily make 1Âœdolphin movement1Â in heading seas. The T-foil is the most effective stabilizer for alleviating the pitch and heave motions of fast craft. This work designs an autonomous trimaran motion control system utilizing a T-foil which can control the longitudinal motion of fast trimaran. Numerical simulation results show that the motion control system can satisfactorily improve seakeeping performance of fast trimaran.
Machinery Recycling Experiment and Study on the Degradation Characteristics for Waste Thermosetting Plastics
Authors: Wu Zhong-Wei , Liu Zhi-Feng , Ping He , Shao-Bo Pan
Published: March 2012

Waste thermosetting plastics are considered to be a difficulty of recycling of polymeric materials due to its three-dimensional reticular cross-linkage structure and the complexity of the types of materials. Take the hard thermosetting polyurethane plastic which is widely used in the market as the research object and deferent from the traditional methods, this paper puts forward waste thermosetting plastics recycling process based on mechanical and physical methods. Through strong shear, extrusion, grinding and other mechanical forces combined with the frictional heat generated, not only the physical properties and morphology of the material change, but also the molecular structure and chemical properties of the material change and produce degradation. The paper has analyzed the degradation mechanism of polyurethane and influencing factors based on mechanical and physical methods. At last the reasonable parameters of effective degradation are obtained, which are combined with the actual experimental results.
The Construction and Practice of Inorganic and Analytical Chemistry Curricula by 1ÂœSix Improvements for One Central Goal1Â Curriculum Teaching Mode
Authors: Xi Limin , Yunhua Chen
Published: March 2012

The paper recounts the integration and construction of inorganic and analytical chemistry curricula by 1Âœsix improvements for one central goal1Â curriculum teaching mode (SIOG mode). 1ÂœOne central goal1Â is the high-skilled talent training goal orientation of biochemical pharmacy technology; 1Âœsix improvements1Â are the pragmatization of the teaching materials, the dual qualified teaching faculty, the integration of the training and the learning, the project-oriented teaching method, the standardization of the basic operations, and the diversification of the evaluation mode. The cooperation of the 1Âœsix improvements1Â completed the high-skilled talent training goal orientation of biochemical pharmacy technology. The teaching result of the SIOG mode was continuously surveyed for 4 years, and the result showed that the satisfaction degree increases steadily as SIOG mode teaching reform develops further.
Medium Voltage High Power Drives: A Review
Authors: Manohar V. Joshi , Anjaneyulu K. S. R.
Published: March 2012

High power medium voltage drives covers power ratings from 1 MW to 100MW and at the medium voltage level of 2.3KV to 13.8 KV. They have been receiving greater attention in the past few decades for high power applications due to their high efficiency, high reliability, effective fault protection, high dynamic performance, regenerative braking capacity and four quadrant operation. This paper provides an over view on commonly used CSI topology in MV drives. In High power MV drives maximum switching frequency is limited due to thermal losses this leads to production of lower order of the unwanted harmonics in PWM CSI output current. The most effective modulation technique to eliminate lower order of harmonics is Selective Harmonic Elimination (SHE). Finally in this paper recent research progress in the area of SHE modulation technique is reviewed.
Multi-Class SVM with General Tree
Authors: Nguyen Vu Thanh , Nguyen Hoang Vu , Cuong Le Quy Quoc
Published: March 2012

In this paper, we propose a new approach which is General Tree (GT) model to be used to combine binary Support Vector Machine (SVM) classifiers for multi-class classification. In addition, the error probability of a tree is also introduced with purpose for evaluating the fitness of different General Trees.
Validation of GPU based TomoTherapy dose calculation engine
Authors: Chen Quan , Lu Weiguo , Chen Yu , Chen Mingli , Henderson Douglas , Sterpin Edmond
Published: March 2012

Purpose

: The graphic processing unit (GPU) based TomoTherapy convolution/superposition(C/S) dose engine (GPU dose engine) achieves a dramatic performance improvement over the traditional CPU‐cluster based TomoTherapy dose engine (CPU dose engine). Besides the architecture difference between the GPU and CPU, there are several algorithm changes from the CPU dose engine to the GPU dose engine. These changes made the GPU dose slightly different from the CPU‐cluster dose. In order for the commercial release of the GPU dose engine, its accuracy has to be validated.

Methods

: Thirty eight TomoTherapy phantom plans and 19 patient plans were calculated with both dose engines to evaluate the equivalency between the two dose engines. Gamma indices (Γ) were used for the equivalency evaluation. The GPU dose was further verified with the absolute point dose measurement with ion chamber and film measurements for phantom plans. Monte Carlo calculation was used as a reference for both dose engines in the accuracy evaluation in heterogeneous phantom and actual patients.

Results

: The GPU dose engine showed excellent agreement with the current CPU dose engine. The majority of cases had over 99.99% of voxels with Γ(1%, 1 mm) < 1. The worst case observed in the phantom had 0.22% voxels violating the criterion. In patient cases, the worst percentage of voxels violating the criterion was 0.57%. For absolute point dose verification, all cases agreed with measurement to within ±3% with average error magnitude within 1%. All cases passed the acceptance criterion that more than 95% of the pixels have Γ(3%, 3 mm) < 1 in film measurement, and the average passing pixel percentage is 98.5%–99%. The GPU dose engine also showed similar degree of accuracy in heterogeneous media as the current TomoTherapy dose engine.

Conclusions

: It is verified and validated that the ultrafast TomoTherapy GPU dose engine can safely replace the existing TomoTherapy cluster based dose engine without degradation in dose accuracy.
Governance of preventive Health Intervention and On time Verification of its Efficiency: the GIOVE Study
Authors: Mennini Francesco Saverio , Baio Gianluca , Montagano Giuseppe , Cauzillo Gabriella , Locuratolo Francesco , Becce Gerardo , Gitto Lara , Marcellusi Andrea , Zweifel Peter , Capone Alessandro , Favato Giampiero
Published: March 2012

Objectives

The GIOVE Study was aimed to the achievement of allocative efficiency of the budget allocated to the prevention of human papillomavirus (HPV)-induced diseases. An ex-ante determination of the most efficient allocation of resources between screening and multicohort quadrivalent immunisation programmes was followed by the ex-post assessment of the allocative efficiency actually achieved after a 12-month period.

Design

A bound optimisation model was developed to determine the ex-ante allocative efficiency of resources. The alternatives compared were the screening programme alone and the quadrivalent immunisation with access to screening. A sensitivity analysis was carried out to assess the uncertainty associated with the main inputs of the model. Subsequently, a cohort of girls with a complete recorded vaccination history were enrolled in an observational retrospective study for 18 months to ensure full compliance with the recommended schedule of vaccination (0, 2, 6 months) within a 12-month time horizon.

Setting

Basilicata region, in the south of Italy.

Participants

12 848 girls aged 12, 15, 18 or 25 years.

Intervention

Immunisation with quadrivalent anti-HPV vaccine.

Outcome measures

The vaccination coverage rate was considered to be the indicator of the best achievable benefit, given the budgetary constraints.

Results

Assuming a vaccine price of €100 per dose, a vaccination coverage rate of 59.6% was required for the most effective allocation of resources. The optimal rate of coverage was initially in favour of the multicohort strategy of vaccination against HPV (72.8%±2%). When the price paid for the quadrivalent vaccine dropped to €85 per dose, the most efficient coverage rate (69.5%) shifted closer to the immunisation rate actually achieved during the 12-month observation period.

Conclusions

The bound optimisation model demonstrated to be a useful approach to the ex-ante allocation and the ex-post assessment of the resources allocated to the implementation of a multicohort quadrivalent anti-HPV vaccination programme.
Development and evaluation of a 3-day patient safety curriculum to advance knowledge, self-efficacy and system thinking among medical students
Authors: Aboumatar Hanan J , Thompson David , Wu Albert , Dawson Patty , Colbert Jorie , Marsteller Jill , Kent Paula , Lubomski Lisa H , Paine Lori , Pronovost Peter
Published: March 2012

Purpose

To develop a patient safety curriculum and evaluate its impact on medical students' safety knowledge, self-efficacy and system thinking.

Methods

This study reports on curriculum development and evaluation of a 3-day, clinically oriented patient safety intersession that was implemented at the Johns Hopkins School of Medicine in January 2011. Using simulation, skills demonstrations, small group exercises and case studies, this intersession focuses on improving students' teamwork and communication skills and system-based thinking while teaching on the causes of preventable harm and evidence-based strategies for harm prevention. One hundred and twenty students participated in this intersession as part of their required second year curriculum. A pre–post assessment of students' safety knowledge, self-efficacy in safety skills and system-based thinking was conducted. Student satisfaction data were also collected.

Results

Students' safety knowledge scores significantly improved (mean +19% points; 95% CI 17.0 to 21.6; p<0.01). Composite system thinking scores increased from a mean pre-intersession score of 60.1 to a post-intersession score of 67.6 (p<0.01). Students had statistically significant increases in self-efficacy for all taught communication and safety skills. Participant satisfaction with the intersession was high.

Conclusions

The patient safety intersession resulted in increased knowledge, system-based thinking, and self-efficacy scores among students. Similar intersessions can be implemented at medical, nursing, pharmacy and other allied health schools separately or jointly as part of required school curricula. Further study of the long-term impact of such education on knowledge, skills, attitudes and behaviours of students is warranted.
A new model for breaking bad news to people with learning disabilities
Authors: Tuffrey-Wijne Irene
Published: March 2012

Background

Current models for breaking bad news are inadequate in meeting the needs of people with learning disabilities (LD). People with LD are often not told of a life-limiting diagnosis. The task of breaking bad news is often left to carers who are poorly prepared and supported to cope with this. Healthcare professionals don't know how to communicate adequately with people with LD.

A new model for breaking bad news

The model was developed following a focus group/interview study involving 109 participants, including people with LD, family carers, LD professionals and healthcare professionals (see related abstract for oral presentation). The findings were combined with the literature. A preliminary model was developed; 60 stakeholders gave feedback on this, including a wide range of family carers, professionals and academics. The preliminary model was modified following this feedback. The poster will present the model in a visual format. The model has four components.

Building a Foundation of Knowledge is central to the model. Gradually and over time, the person with learning disabilities builds his/her understanding of the way his/her situation is changing because of the bad news. The people around him/her help with this, by giving small, singular chunks of information that make sense to the person. This does not have to done by talking much of the information will be understood through experience. The other three components must be considered throughout.

Capacity and understanding, taking account of the Mental Capacity Act

The people involved, including family, partners, friends, paid carers and professionals

The support needed by everyone involved, including information, emotional, social, practical and spiritual support The model now needs to be tested in practice.
Hospital mortuaries: the blind spot of end of life care
Authors: Wilson Eleanor , Arthur Antony , Seymour Jane
Published: March 2012

Background

There is a marked absence of research about the role of hospital mortuaries in palliative care, despite ‘care after death’ being step six in the End of Life Care Strategy (2008). Mortuaries are seen as ‘backstage’ areas and consequently receive little recognition or resource. This paper reports qualitative data from an independent evaluation of the King's Fund programme to enhance Environments for Care at End of Life. As part of the programme teams of hospital staff renovated physical environments in which end of life care was delivered.

Aim

To understand the role of hospital mortuaries within end of life care.

Methods

This paper presents qualitative data from a subset of three case studies where renovation and refurbishment of mortuary viewing facilities at three UK hospitals took place. At phase one, prior to building work, participants from each hospital took part in a focus group (n=3). At phase two after the renovations had been completed, the same participants took park in individual interviews (n=15).

Findings

Three themes were extracted from the data. Mortuaries were ‘hidden from view’, both in terms of their physical location and in the function that they provided. Mortuaries were ‘resource poor’ with a history of underinvestment resulting in staff having to compensate and apologise for the environment in which they worked. There was evidence of ‘untapped potential’ with relatively simple changes to the environment resulting in improved hospital flow and an area in which the deceased could be cared for rather than processed.

Conclusions

Mortuaries play a key role in end of life care which is often unrecognised. The authors have constructed an understanding of mortuaries as the ‘blind spot’ within the provision of end of life care.
Caring for the carers? An observational study of the role of the district nurse in palliative care
Authors: Walshe Catherine , Payne Sheila , Luker Karen
Published: March 2012

Background

Current policies emphasise the importance of informal/family carers in supporting people at the end of their lives. Guidance suggests that carers' needs should be assessed, acknowledged and addressed. If carers' needs are not met this can precipitate changes in their health status and unplanned care setting transitions. There are few studies that investigate how carer assessment and support is enacted in practice.

Aim

To investigate the role of the district nurse in palliative care provision, with a particular focus on observational exploration of their role and practice in providing care to patients and their carers.

Methods

A longitudinal qualitative ethnographic design, comprising observation of district nurse/palliative care patient/carer encounters over time, and post observation interviews with patients, carers and district nurses (DNs). Patients were sampled from 12 DN team caseloads across three primary care organisations. Observations and interviews were audio-recorded and transcribed. Iterative data analysis comprised familiarisation, coding and categorisation using techniques of constant comparison to generate typologies of concepts. The study received all necessary ethics and governance approvals.

Results

17 DN/patient/carer encounters were observed (n=11 patients, 8 nurses) with 23 postobservation interviews (11 DN, 12 patient/carer). DNs talked about developing a relationship with carers to facilitate future care. Carers discussed the DN role as being with patients rather than themselves. This is borne out in practice, as the focus of all observed encounters where the carer was present (n=11) was the patient. Overt carer assessment or support by DNs was negligible. Carers were participants in the DN/patient encounter, primarily facilitating the provision of information about patient care and problems.

Conclusions

Carer needs appeared tangential to DNs practice, although DNs appreciated their role and acknowledged their needs outside the observed encounters. DNs need to understand how to better incorporate carer assessment and support into their everyday practice.
Perspective of healthcare professionals on ‘do not resuscitate’ decision-making in Singapore
Authors: Kwee Ann , Yang Grace , Krishna Lalit
Published: March 2012

Background

It has been established that families play a significant role in decision making in Asian societies, particularly those imbued with family centric ideals and Confucian ethics. Yet the implication of familial determination and its anticipated effect upon end of life decision-making, particularly ‘do not resuscitate’ (DNR) orders remain unstudied in this region.

Aims

To determine the views of oncology and palliative care doctors and nurses on who should be involved in DNR discussions and the implications and perceptions of such orders.

Methods

146 doctors and nurses in oncology and palliative care working within a tertiary specialist cancer centre in Singapore participated in a questionnaire survey.

Results

Majority thought that patients (78.8%) and their next-of-kin (78.1%) should be involved in DNR discussions, but only 24.7% thought as many family members as possible should be involved. On a 5-point Likert scale, 15.1% thought doctors should always ultimately decide on the DNR order, while 22.6% felt that the patient/family should always take on the responsibility. Between patients and their families, 21.2% felt that patients should always be more involved as opposed to just 4.8% who opted for the family always being more involved. 35.6% felt that a DNR should be discussed as early as possible and 10.2% felt it should be discussed when prognosis was a week or less.

Conclusions

From the viewpoint of oncology and palliative care healthcare professionals; this paper suggests that local healthcare professionals do subscribe to the patient autonomy albeit with limitations. This for the most part does tally with other studies conducted in Asian contexts that suggest to a greater family involvement than patients in decision-making. This reflects the complexity of decision-making at the end of life and the importance of considering the innumerable psychosocial, cultural, financial and physical factors involved.
How do people with cancer and palliative care needs understand and contribute to the management of communication surrounding their care?
Authors: Jarrett Nikki , Porter Katerina , Addington-Hall Julia , Corner Jessica , Davis Carol , Duke Sue , Lathlean Judith
Published: March 2012

Background

The authors have very limited knowledge regarding how people with cancer and palliative care needs understand and contribute to the often complex networks and pathways of communication between the different people, teams and locations involved in their care.

Aim

Explore how people with cancer and palliative care needs understand and contribute to the communication surrounding their care.

Method

During indepth interviews (n=24; mean length 65 min), patients were asked to discuss the communication that surrounds their care. Framework analysis of the transcribed interviews considered patients' understanding of the communication surrounding them, and any contributions they make to facilitating or managing that communication.

Results

Patients (15 female, 9 male; age range: 48–85) had a wide range of primary tumours (mean time since diagnosis: 9.5 months; range: 0.5–61 months). All were described as receiving or needing specialist or generalist palliative care at the time of recruitment (through General Practice (n=5); Hospital Specialist Palliative Care Team (n=8); Specialist Palliative Care Unit (n=11)). Analysis reveals variation in the extent of patients' understanding of, and contribution to, the management of the communication surrounding their care, including ‘active involvement’, ‘understanding’, ‘storing information’, ‘opportunism’ and ‘delegation’. Some patients are less involved, with approaches including ‘cooperation’ and ‘reluctance to communicate’. Some patients who attempt ‘active involvement’ encounter ‘barriers’ to achieving this.

Conclusion

It is concluded that patients demonstrate a variety of ways of dealing with, understanding, and contributing to the communication surrounding their care. Example cases illustrate the range of approaches some individuals appear to use, compared with those that appear available to other patients. These are explored in terms of factors such as patient disposition, ‘insider knowledge’, uncertainty in less-common cancer, ‘behind the scenes’ communication, and the complexity of some care packages. These findings present implications for facilitating supported self-management while recognising/minimising patient burden.
Factors considered in end-of-life decision-making of healthcare professionals
Authors: Foo Wei Ting , Zheng Yiliang , Yang Grace Meijuan , Kwee Ann K , Krishna Lalit Kumar Radha
Published: March 2012

Background

The factors considered in decision making at the end of life is largely unknown.

Aim

To explore the importance of factors influencing end-of-life decision-making of healthcare professionals (HCP).

Methods

This short survey reviewed the significance of regularly reported factors and scenarios involving the patient, family and HCPs themselves in discerning end of life decision making and was carried out among physicians and nurses from the Oncology and Palliative Medicine department at the Singapore General Hospital and the National Cancer Centre between 1 and 31 March 2011. A response rate of 78.6% was acquired from the 187 questionnaires distributed. The ages of participants ranged from 19 to 68 years (mean 32.1, median 29) and their experience in oncology or palliative care ranged from 0 to 40 years (mean 5.87 years, median 4).

Results

First, respondents rated patient's wishes (96.6%), their clinical symptoms (93.9%) and the patient's beliefs (91.1%) as the pivotal factors determining their decision making process. Least important were the HCP's own beliefs (54.79%). Second, 94.6% of HCPs reported that they would respect the wishes of a competent patient over the family's wishes should there be a conflict of goals, but 59.9% would switch to the family's wishes when the patient loses capacity even if it ran against the patient's previously stated wishes. Third, of the 57.1% of respondents who had read the hospital's end of life care policy, most felt it useful in guiding their decisions and rarely required for them to be overruled.

Conclusion

End-of-life care decision making in Singapore appears to be largely patient-centred with patients' wishes and objective factors such as clinical symptoms taking precedence over HCP-related factors. However, familial determination remains influential especially when the patient is incapacitated. A better understanding of the factors can help inform future decision-making framework or guidelines.
‘We all talk about it as though the authors are thinking about the same thing’: healthcare professionals' goals in the management of pain due to advanced cancer – a qualitative study
Authors: Bhatia Rebecca , Reid Colette , Forbes Karen , Gibbins Jane
Published: March 2012

Background and aims

Cancer pain remains a significant problem worldwide. As well as challenges relating to the assessment and measurement of pain, barriers still exist which impede the successful treatment and there is no consensus as to what constitutes good pain control. Despite the plethora of research tools available to assess pain, little is known about what patients and healthcare professionals (HCPs) feel is important in pain management. This study aimed to explore what goals HCPs hold when managing pain.

Methods

HCPs involved in the management of cancer pain were purposively sampled and interviewed using a semistructured technique. Data were analysed using the constant comparison technique, based on the principles of grounded theory.

Results

Analysis of the interviews revealed four main themes: assessing pain, managing pain, managing expectations and building relationships. Managing pain included helping patients to maintain function and sleep, but also involved finding the meaning of the pain, being with, educating and empowering, and maintaining hope and a sense of self for the patients. HCPs used different terms when managing pain, such as ‘pain control’, but found it difficult to define these terms. Managing patients' expectations was seen as an important goal for HCPs in managing pain but it wasn't always clear how these expectations had been elicited. The HCPs discussed the importance of building therapeutic relationships but alluded to the tension between being patient-centred and controlling pain, particularly when patients were reluctant to increase opioids.

Conclusion

The interview findings suggest that the use of goal setting, a technique used commonly in the management of chronic pain, would allow explicit joint identification of goals and expectations and a negotiated patient-centred outcome measure. The setting of realistic targets may also protect HCPs from burnout by preventing a sense of failure.
Education and training in end of life care for health and social care professionals in north west England
Authors: Duxbury Joy , Obrien Teri , Pulsford Dave , Yates Sue
Published: March 2012

Background

Education and training in end-of-life care is recommended for health and social care staff at a range of levels. Such education should embrace an understanding of contemporary policy, best practice initiatives, care pathways and key interpersonal skills.

Aims of study

To scope the nature and content of education and training in end-of-life care for health and social care professionals in one region of England; To identify gaps in existing provision and priorities for future educational initiatives.

Methods

An online survey of University-based educational provision in North-West England (n=7 Universities) and health and social care provider-based training initiatives (n=48 provider organisations); An online survey of health and social care professionals (n=446) to ascertain their views regarding their preparedness for delivering end-of-life care and perceived gaps in their education and training; Focus groups of health and care staff (n=21); people receiving end-of-life care (n=16) and carers of such people (n=16) to provide further information regarding staff's preparedness for end-of-life care and education and training needs.

Results

Education and training was wide-spread but varied widely in extent and content. Key learning methods were discourse and discussion but skills' training was less formally evident. Contemporary best practice and policy initiatives were widely but not universally addressed. Staff's preparedness for end-of-life care varied with role but many staff identified additional learning needs, particularly those is non-specialist roles. Awareness of policy and best practice was not universal. Patients and carers reported mixed experiences of care which they perceived to be the result of poor skills preparation, attitudinal barriers and a lack of co-ordination.

Conclusion

While much education and training related to end-of-life care is on offer in North West England, best practice is not always being addressed. Staff overall require greater awareness of contemporary policy and practice initiatives and enhanced interpersonal skills.
Exploring attention restorative theory and its use in fatigue management
Authors: Kirshbaum Marilyn N Y , Purcell Brigid , Graham Joanne , Phillips Stephen , Malone Jackie , Kaye Vicky
Published: March 2012

Background

Fatigue is a common and distressing symptom of long term illness, palliative care conditions and cancer, and a concern for families, carers and healthcare practitioners. Attention Restorative Theory (ART) was developed by Kaplan (2001) following his interest in restoring mental attention within the ‘person-environment interaction’. Within this framework, restorative activities have aspects of ‘being away’ (ie, distinct from routine), ‘fascination’, ‘extent’ (ie, scope) and ‘compatibility’.

Aims

To explore the routines and activities of fatigue suffers to determine which activities are enjoyed and could be seen to reduce mental fatigue. To analyse identified activities within an ART framework to determine core attributes of potentially beneficial interventions.

Method

A qualitative ethnographic approach was used to obtain knowledge about a discrete population of people who suffer from fatigue as a result of a long term illness or palliative care condition. A purposive sample of 25 participants was selected according to diagnosis, age and disability from identified contacts within the local hospice, a podiatry clinic and service user representative groups. Those who had severe mental illness, a chronic fatigue syndrome or were under 18 years of age were excluded.Semistructured interviews lasting no more 45 min were conducted using an interview guide where the emphasis was on describing activities that are enjoyed, rather than dwelling on the limitations of fatigue.

Results

Early analysis has identified activities such as: involvement in creative arts, baking, reading (all sorts), watching motor bike racing, singing or having a facial, as would be expected based upon individual personalities and characteristics. Upon further examination, two clear attributes emerged; activities had to have an aspect of assured safety or social interaction. Mental restoration attributes were also prominent.

Conclusions

The ART approach has interesting prospects and scope within fatigue management. Further research is required to explore and test potential implications.
Advance care planning in dementia and severe and enduring mental illness
Authors: Bass Madeline , Jackson Helen
Published: March 2012

Background

Dementia diagnoses are set to increase rapidly in the UK and this means that services need to be aware of the ethical issues associated with end of life care. The National Council for Palliative Care in the UK has worked hard to increase the knowledge of specialist palliative care professionals around issues relating to end of life care for people with dementia and their families. However, the bulk of the work will fall to generalist staff. This project looked at educating staff in a local mental health unit in Suffolk, as well as the patients and family carers of those with dementia, about this. It also looked at patient documentation, how staff approach such conversations and related ethical issues.

Aim

This project looked at educating mental health staff about advance care planning in a local mental health unit and extending this into all mental health services across the county. The project would also produce specific documentation to ensure sustainability in the future.

Methods

Five subjects of education occurred on a weekly basis each for 30 min between July and December 2010: (1) what is advance care planning?, (2) use of SPIKES model in communication, (3) how to communicate ACP information to other healthcare professionals, (4) issues around DNAR in end of life care for people with dementia and (5) five important points to know when caring for someone with dementia. During the education sessions, staff were asked for their opinions about formats for documentation and guidelines.

Results

By early 2011 documentation, guidelines, staff information, patient information and competences had all been completed. The documentation will be piloted in mid 2012.

Conclusion

All staff were supportive and recognised the benefits of this care, not only for the patient and family carers but for them as well.
Hospital2home: face to face conferences and telephone conferences, is the outcome different?
Authors: Cave Lyn , Smith Clare , Stevens Anna-Marie , Riley Julia
Published: March 2012

The Hospital2home (H2H) Service was initiated to improve handover communication between the Royal Marsden NHS Foundation Trust and the primary care team. Patients who are no longer receiving active anti-cancer treatment are offered a face to face meeting in their home, with key members of the community team invited. Sometimes, due to a change in the patient's condition or patient preference, a telephone handover is conducted instead. The aim of this service is to create a care plan including current and anticipated problems and identify a community key worker. This includes discussions around preferred place of care (PPC) and preferred place of death (PPD). Aim: The aim of this audit was to compare outcomes in the 2 groups. Specifically, actual place of death and achievement of PPD

Method

Data were collated between February 2011–August 2011 by H2H staff as part of routine clinical practice Results: A total of 105 case conferences took place between February 2011-August 2011, 67 face to face (FtF) and 39 telephone case conferences (Tcc). In the FtF group 38 patients (57%) have died and in the Tcc group 24 patients (62%) have died. The median survival was 12 days (interquartile range 8-35) in the FtF group and 16 days (IQR 12–33 days) in the Tcc group. Average Palliative Performance Status in each group was 50. Place of death (%): FtF Telephone National Home 53 63 18 Hospice 29 29 4 Nursing Home 8 0 17 Hospital 11 4 58 Not known 0 4 PPD was achieved for 93% of the ftf group and 86% of the Tcc group.

Conclusion

High home death rates are achieved in both groups. More patients in the FtF group achieved their PPD. Both services may be viable options. By 2012, we will have collated more data to confirm the preliminary findings.
Audit of delayed discharges from a specialist palliative care unit
Authors: Thompson Sara , Frampton Emma
Published: March 2012

Background

Effective discharge planning is vital for palliative care patients so they can be cared for, and ultimately die, in their preferred location. Delayed discharges can result in ineffective use of resources and cause distress to patients. This audit looked into causes of delayed discharge from a specialist palliative care unit, and examined ways to improve the discharge process to ameliorate these factors.

Methods

Notes from the first 26 admissions to a specialist palliative care unit from 1 January 2011 were examined. Incomplete or missing notes were excluded, as were admissions for end of life care. Information recorded included patient demographics, reason for admission, discharge destination, proposed and actual date of discharge, and reasons for any delay.

Results

44% of patients' discharges were delayed 3–57 days, leading to 164 extra bed days, with an average of 10 days delay per admission. Three patients were delayed due to medical causes; each of these had multiple reasons for their delay. Four of the five patients delayed for non-medical reasons were held-up by delayed package of care (POC) provision; late referral to social services was implicated in 75%. Men are 2.1 more times likely to be delayed than women and patients over 75 years of age are 2.1 times more likely to be delayed.

Conclusion

Causes for delayed discharge are varied and complex. Improvements in POC provision would reduce this major cause of delay. Discharge planning should begin early, with adequate information for patients to be able to make an informed decision. Increased efficiency in the multi-disciplinary team would increase the effectiveness of the discharge process. Identification of certain higher risk demographics should help to focus improvements in the discharge process. This audit has identified important trends, which, if improved, may save resources and improve patient satisfaction.