bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors associated with hospital death in patients with haematological malignancies: findings from a UK population-based study
Authors: Turner Andrew , Roman Eve , Smith Alex , Howell Debra
Published: August 2016

Introduction

Research suggests most people would prefer to die at home, yet patients with haematological malignancies (leukaemia, lymphoma and myeloma) die in hospital more often than people with other conditions, though reasons for this are unclear.2,3

Aims

To investigate factors associated with hospital deaths in patients with blood cancers.

Methods

This study is set within the Haematological Malignancy Research Network (www.HMRN.org),4an ongoing population-based cohort that follows patients from diagnosis onwards. All 886 adult patients diagnosed 2004–2012 and dying 2011–2012 were included, with data collected from their medical records.

Results

Over half (56.9%) the 886 patients died in hospital. After adjusting for sex and age, several additional factors remained associated with the likelihood of hospital death (P < 0.05). Patients receiving treatment with life-prolonging/curative intent in the 30 days before death were more likely to have died in hospital compared to those receiving palliative care (OR 3.83, 95% CI: 2.40–6.11). Those with documented discussions about preferred place of care/death were around half as likely to have died in hospital as those without discussions (OR 0.46, 95% CI: 0.35–0.61). Final discussions not involving the patient themselves were also associated with an increased likelihood of hospital death (family only vs patient involvement, OR 2.31 95% CI: 1.50–3.57).

Conclusions

Hospital deaths were most likely to occur in patients receiving life-prolonging/curative treatment, suggesting death was not anticipated; and when the patient themselves was not involved in discussions, implying advanced illness. This indicates that hospital deaths are often unexpected or unavoidable and that maximising the quality of end-of-life care in hospitals should be a priority.

References

House of Commons Health Committee.End of life care: fifth report of session, 2014–2015. London: The Stationery Office Limited; 2015

National Cancer Intelligence Network.Where do patients with blood cancers die?London: Public Health England, 2010

Howell DA, Roman E, Cox H,et al. Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy.BMC Palliat Care2010;9(9):1–8

Smith A, Roman E, Howell DA,et al. The Haematological Malignancy Research Network (HMRN): a new information strategy for population based epidemiology and health service research.Br J Haematol2010;148(5):739–753
How can we facilitate access to palliative care for homeless people? A systematic review of qualitative research
Authors: Hudson Briony F , Flemming Kate , Shulman Caroline , Candy Bridget
Published: August 2016

Introduction

The Department of Health (2008) strives to provide palliative care at the time of need for everyone, regardless of “wherever the person may be”, “irrespective of social economic deprivation”. Homeless people face multifaceted challenges in accessing general health care, palliative care access may be additionally challenging. Given the complexities of providing care and support to this population, qualitative research exploring perspectives of homeless people and care providers enhances understanding of the difficulties of palliative care provision to this vulnerable group.

Aims

To identify what may facilitate access to palliative care for the homeless population and relate these factors to existing interventions.

Methods

A systematic review of qualitative research using methods of thematic synthesis. Six databases were searched using terms to identify qualitative studies exploring perspectives regarding palliative care held by homeless people and/or care providers. Two reviewers completed key review processes.

Results

Twelve articles were included. Core themes relating to the provision of palliative care from the perspectives of homeless people and care providers were identified. Recommendations for the provision of palliative care for homeless people included the importance of the development of trusting relationships, flexible and joined-up services and increased training and support for professionals. International interventions that incorporate these principles in practice are being tested, particularly those that utilise the experiences of formerly homeless people.

Conclusions

Increasing awareness and flexibility may help facilitate access to high-quality palliative care for homeless people and so help to promote dignity and choice for this population as they reach the end of their lives.

Reference

Department of Health. End of life care strategy: promoting high quality care for all adults at the end of life; 2008.
Ethnicity affects the experience of family caregivers of people living with severe MS: findings from a cross sectional survey
Authors: Jackson Diana , Goddard Cassie , Gao Wei , Higginson Irene , Silber Eli
Published: August 2016

Background

The influence of ethnicity on family caregivers (FCG) of people severely affected by multiple sclerosis (PwMS) is unknown.

Aim

To compare experiences of White British (WB) and Black Caribbean (BC) FCGs of people with severe MS.

Design

Cross-sectional survey including ratings of caregiver burden and met/unmet needs. Open questions explored the cultural influence on the main effects of caring, its rewards and difficulties, and changes required to improve caregiving experiences.

Setting/participants

FCGs of BC and WB PwMS with Expanded Disability Status Scale ≥6 living in London.

Results

39 FCGs representing 43 BC and 43 WB PwMS were interviewed. 23 WB 14 BC or 2 mixed ethnicity caregivers were recruited. More BC caregivers were females caring for parents/offspring who resided elsewhere. Self-reported caregiver burden was similar across groups. Unmet needs common to both groups included timely access to health/social services, requiring more information about MS and its effects, and greater involvement in planning treatment and care. However, BC FCGs differed from their WB counterparts; they possessed little knowledge of MS, its complications and were more reticent about caring roles which prevented them accessing necessary support. They also reported more financial concerns.

Conclusion

FCG’s from both ethnic groups required greater responsiveness and support from formal services. We observed issues specific to FCGs of BC PwMS that caused distress. Health professionals must be mindful that those from ethnic groups may possess little knowledge or experience of living with MS and relevant services. They also need to sensitively advise on managing financial issues.

References

Koffman JS, Higginson IJ. Fit to care? A comparison of informal caregivers of first-generation Black Caribbeans and White dependants with advanced progressive disease in the UK.Health Soc Care Community2003;11:528–536

Koffman J, Gao W, Goddard C,et al. Progression, symptoms and psychosocial concerns among those severely affected by multiple sclerosis: a mixed-methods cross-sectional study of Black Caribbean and White British People.PLoS ONE2013;8:e75431
Evaluation of the effectiveness of music therapy in improving the quality of life of palliative care patients: a randomised controlled pilot and feasibility study
Authors: McConnell Tracey , Graham-Wisener Lisa , Regan Joan , McKeown Miriam , Kirkwood Jenny , Hughes Naomi , Clarke Mike , Leitch Janet , Mcgrillen Kerry , Porter Sam
Published: August 2016

Introduction

Music therapy is frequently used as a palliative therapy (Demmer, 2004), with the primary aim of improving people’s quality of life. To date, primarily because of a paucity of robust research, the evidence for music therapy’s effectiveness on patient reported outcomes is positive but weak (McConnellet al., 2016).

Aim(s)

This pilot and feasibility study will: test procedures; outcomes and validated tools; estimate recruitment and attrition rates; and calculate the sample size required for a phase III randomised trial to evaluate the effectiveness of music therapy in improving the quality of life of palliative care patients.

Method(s)

A pilot controlled trial supplemented with qualitative methods with n = 52 patients from an inpatient and day hospice setting. Baseline data collection includes the McGill Quality of Life Questionnaire (MQOL), medical and socio-demographic data. Participants in the intervention arm are offered two 30–45 minute sessions of music therapy per week for 3 consecutive weeks, in addition to care as usual. Participants in the control arm receive care as usual. Follow-up measures administered at 3 and 5-weeks. Qualitative data collection involves focus group/interviews with HCPs and carers.

Results

The results of the study will ensure a firm methodological grounding for the development of a robust phase III randomised trial of music therapy for improving quality of life in palliative care patients.

Conclusion(s)

By undertaking the pilot and feasibility trial under normal clinical conditions in a hospice setting, the trial will result in reliable procedures to overcome some of the difficulties in designing music therapy RCTs for palliative care settings.

References

Demmer C. A survey of complementary therapy services provided by hospices.J Palliat Med2004;7(4):510–516

McConnell T, Scott D, Porter S. Music therapy for end-of-life care: an updated systematic review.Palliat Med2016. doi:10.1177/0269216316635387. Accessed March 4, 2016
Priority setting for end-of-life care
Authors: Spence Michael , Spencer Rebecca , Diffin Janet , Mellor Peter , Grande Gunn
Published: August 2016

Introduction

End-of-life (EoL) care is an under-researched area. It is therefore vital to focus on priorities that are likely to bring the most benefit to patients, carers, and families.

Aim

This project aimed to identify EoL research priorities of Healthcare Professionals (HCPs) and carers in Greater Manchester.

Methods

Following a scoping exercise of EOL services in Greater Manchester, CLAHRC GM identified six EOL local research topics for further exploration within the 10 national priorities outlined by PeolcPSP.

Education and knowledge for staff and carers

Access to 24-hour care and support

Equitable Access

Advance care planning

Care at home

Continuity of care

CLAHRC GM held a priority setting event to consult with 32 HCPs and separate consultations with 26 carers facilitated by local carer groups from Manchester, Salford, and Bury. Carers and HCPs selected their priorities from the topics.

Results

Combining carer and HCP responses, the topics of shared priority were:

Advance care planning

Access to 24-hour care

Education and knowledge for staff and carers

Whilst carers emphasised training and education as the priority and HCPs focused more on advance care planning, it was clear that all topics had importance to both groups.

HCPs also identified important research questions within their chosen topics.

Conclusions

This study provides successful procedures for engaging with stakeholders to develop local priorities to guide EoL research of relevance to HCPs and user representatives.

Reference

Brereton L, Ingelton C, Gardiner C,et al. Lay and professional stakeholder involvement in scoping palliative care issues: methods used in seven European countries.Palliat Med2016
Breathe better: an evaluation of a hospice group to support people with end-stage chronic obstructive disease (COPD)
Authors: Middleton-Green Laura , Lawson George , Rayment Clare
Published: August 2016

Background

The Breathe Better group (BBG) has been running in the hospice in 2008. It aims to reduce dyspnoea, improve quality of life and mastery of illness for patients with end stage COPD using four methods: education, exercise, pharmacological management and individual consultations. We aimed to ascertain the short and long-term impact of the BBG.

Method

A retrospective longitudinal study was performed on patients referred between 2010 and 2013. Data were collected on shuttle walk distance, mastery, Hospital Anxiety and Depression Scores (HADS), advance care planning (ACP), and mortality. Outcomes were analysed using a paired t-test.

Results

Data from 56 patients was analysed. Mean shuttle walk distance increased by an average of 10.8 m which was statistically significant (p = 0.05). Total HADS score improved by 2 points. 65% of patients had an ACP after the group, compared with 24% prior to commencement. 76% patients died with 2 years. Place of death was as follows: (n = 45) Care home 11%, Home 7%, Hospital 38%, Hospice 31%, Not recorded 13%. There was a significantly increased rate of hospice death compared to regional and national COPD data and a proportionate reduction in hospital deaths.

Discussion

Results suggest that BBG improved shuttle walk distance and recording of future health decisions and may influence place of death.

Implications

BBG improved patients’ exercise tolerance and ACP. From a public health perspective, the success of BBG suggests other hospices may wish to consider pilot schemes. A larger study with a defined control group (patients choosing not to attend) will allow more accurate comparison. Improved record-keeping is required to enhance data accuracy and reduce missing data.

References

Chin C, Booth S.Managing breathlessness: a palliative care approach.Postgrad Med J2016

Purdy S.Avoiding hospital admissions: What does the evidence say. London: The King’s Fund; 2010

Spathis A, Booth S. End of life care in chronic obstructive pulmonary disease: in search of a good death.Int J Chron Obstruct Pulmon Dis2008;3(1):11–29
A qualitative exploration of patient and carer perspectives on pancreatic exocrine insufficiency due to pancreatic cancer
Authors: Muircroft Wendy , Gooden Helen , Collier Aileen , Carey Sharon , Gott Merryn , Currow David
Published: August 2016

Pancreatic exocrine insufficiency (PEI) is a condition that commonly occurs due to pancreatic cancer and is known to cause weight loss and have a negative impact upon quality of life. The purpose of this qualitative study is to explore patient and carer perspectives on the experience of PEI in pancreatic cancer and gain a better understanding of the implications of treatment.

Semi-structured interviews were conducted with 14 patients and 9 carers recruited from palliative care and medical oncology services in the Adelaide region. Sampling continued until saturation of key themes. A critical thematic analysis was conducted.

The study findings corroborated the findings from a previous study in quality of life and pancreatic cancer1and also extended clinical knowledge on the impact of the symptoms that patients and carers described. The presence and severity of PEI may be underestimated by using the presence of weight loss, steatorrhoea and abdominal pain to the clinical syndrome of PEI. Where patients and carers described treatment failure with pancreatic enzyme replacement therapy, new findings gave explanations for this.

The results from this study suggest that further research needs to be done to compare the traditional clinical model assessing the presence of PEI in pancreatic cancer with a systematic approach to evaluation to increase the accuracy of clinical diagnosis, accessibility of treatment and monitoring of therapy.

Reference

Gooden HM, White KJ.Pancreatic cancer and supportive care – pancreatic exocrine insufficiency negatively impacts on quality of life.Support Care Cancer2013;27(7):1835–1841
‘Go home with your family and a lot of kit, and we’ll leave you to it’: perceptions of out of hours care by the PeolcPSP respondents
Authors: Nelson Annmarie , Godwin Jordan Van , Sivell Stephanie , Byrne Anthony
Published: August 2016

Introduction

Out of hours care was the top concern of the 1403 respondents to the PeolcPSP. The respondents of the PeolcPSP were asked to answer big questions. In return, they gave big answers often with highly personal narrative accounts in illustration of their concerns.

Aim(s) and method(s)

We undertook a supplementary thematic analysis as a valuable opportunity to explore the uncertainties, questions and experiences of respondents to supplement the interventional questions taken forward by the PeolcPSP.

Results

Survey respondents talked about the need for 24 hour and out of hours care. Most of these responses consider access to good quality home care support and services to be a key priority. In particular, respondents struggled to understand why services were restricted outside normal working hours and expressed anger and frustration. Emergency admissions for crisis care, as the only option, were discussed frequently. The results are categorised by themes and sub themes:

(Lack of) support out of hours

Quality of support

Community services

Hospice at home

Telephone support network

Emergency care and rapid response

Emergency care at the end of life

Coordination of out of hours emergency services

Dealing with crisis admissions

Conclusion(s)

The results of the supplementary analysis expand the findings of the PeolcPSP and further reinforce the call for further investment in out of hours services, and palliative care research, including societal aspects of living with a terminal illness and end of life.

The dual approach of the PeolcPSP protocol and a thematic approach can appropriately explore the entire dataset in recognition of the time and personal effort given by the survey respondents.

Reference

Best S, Tate T, Noble B,et al. The Palliative and End of Life Care Priority Setting Partnership (PEOLCPSP): Determining evidence uncertainties from the perspective of the end user of research.BMJ Support Palliat Care2014;4:A42. doi:10.1136/bmjspcare-2014-000654.117
How should compassion be conceived and enacted in end of life care? A patient perspective
Authors: Palfrey Hannah , Armour Kathy , Grubb Rachel , Ives Jonathan
Published: August 2016

Background

As agency and capacity decline towards the end of life, compassion becomes an increasingly important and apposite feature of healthcare. Whilst more compassionate healthcare is being called for, especially in end of life contexts, there is relatively little understanding of what compassion actually is, or how it can be enacted.

Aim

To conduct an empirical bioethics analysis to explore the concept of compassion and how this is understood by patients, in order to inform an ethical analysis of how compassion ought to be conceived and performed in end of life care (EOLC).

Methods

An exploratory qualitative approach underpinned by Frith’s Symbiotic Empirical Ethics methodology was used. Six semi-structured interviews were conducted in a UK hospice.

Results and discussion

Compassion was conceived in different ways by different participants, but 6 key themes emerged that patient’s identified as essential to a compassionate experience: ‘caring motivation’, ‘attentive acts’, ‘caring what I care about’, ‘being relational’, ‘response to suffering’ and ‘time.’

However, these themes are not all compatible. Consequently, each constituent of compassion was explored; examining whether each was necessary for an acceptable definition of compassion. From this analysis, a conceptualisation of compassion in EOLC was developed that focuses on compassion being relational, centred on performing attentive individualistic acts.

Conclusion

Compassionate care should be based on an individual patient’s needs, and this study acts as a reminder that compassionate acts need not be lengthy. Moreover, compassion is a holistic concept, should be treated as such. Finally, through attentive practice, compassion can be ‘learned’.

References

Bramley L, Matiti M. How does it really feel to be in my shoes? Patients’ experiences of compassion within nursing care and their perceptions of developing compassionate nurses.J Clin Nurs2014;23(19–20):2790–2799

Dewar B, Adamson E, Smith S,et al. Clarifying misconceptions about compassionate care.J Adv Nurs2013;70(8): 1738–1747

Frith L. Symbiotic empirical ethics: a practical methodology.Bioethics2012;26(4):198–206

Wenrich MD, Curtis JR, Ambrozy DA,et al.Dying patients’ need for emotional support and care from physicians: perspectives of patients with terminal illness, families, and health care providers.J Pain Symptom Manage2003;25(3):236–246
Unpublished studies in a palliative care systematic review: a case study
Authors: Vickerstaff Victoria , Jones Louise , Larkin Philip , Stone Paddy , Candy Bridget
Published: August 2016

Introduction

Published literature provides only limited and possibly selective knowledge (Chanet al., 2014; Ionnidis, 2014). We are updating a Cochrane systematic review on mu-opioids antagonistic for bowel dysfunction in palliative and cancer patients in which we hope to include all relevant literature, including unpublished results. We have identified several trials where it is not known whether the study has been completed and/or whether the results are available. Including the results from these unpublished studies is in the interest of patients, doctors and the pharmaceutical industry. Furthermore, it is an important ethical issue.

Aim

To obtain unpublished results.

Methods

We sought contact with the authors and trial sponsors for the 13 trials we identified with no published data. We also searched regulatory drug reports of these trials.

Results

Two of the six drug companies approached responded to our letter. After inspecting the review protocol, one company stated that they were unable to give us the requested information as they disagreed with our choice of participants. A second company agreed to meet to discuss their work. They directed us to a relevant poster available on the company website and stated that they planned to write-up the trial. Responses from authors of studies not sponsored by drug companies were easier to obtain.

Conclusion

From trial registers and published protocols we have been able to identify many unpublished trials. Contacting the authors and companies is challenging. However, it is important to try to obtain unpublished trial reports to complete the evidence and reduce publication bias.

References

Chan AW, Song F, Vickers A,et al. Increasing value and reducing waste: addressing inaccessible research.The Lancet2014;383(9913):257–266

Ioannidis JP. Clinical trials: what a waste.BMJ2014;349:7089
Evaluate the improved value that NHS 111 can provide to palliative care patients and their families by utilising specialist palliative care nurses within urgent and emergency care
Authors: Bradley Alison , Littlewood-Prince Michela , Kaushal Usha , Mitchell Kathryn , Leyland Claire , Wanstall Judith , Cooper Nicholas
Published: August 2016

Introduction

NHS111 Yorkshire and Humber, using the 4C’s framework to review Concerns, Complaints, Compliments and Comments became aware of issues regarding ‘delays’ to care for palliative care patients. We conducted a systematic review of palliative care services to identify areas for improvement.

Aims

To improve the value that NHS111 could provide to palliative care patients by understanding pathways for palliative care, testing the use of specialist palliative resources, developing ideas for technology developments, enhancing access to medicines through the use of pharmacists and to understand how NHS111 can work to enhance out-of-hours palliative care services in the region.

Methods

Intelligence was gathered to identify the current position to support palliative patients. Interventions were designed to provide new and improved ways of working. Palliative Nurses were employed for 5-weeks during out-of-hours and training provided to the wider healthcare team.

Results

Analysis of the results allowed further improvements to the provision of 24-hour care and out-of-hours provision. Higher levels of demand were experienced during weekend hours and at the start of a Bank Holiday periods. Palliative Care Nurses were also able to provide high levels of self-care’ advice without requiring onward referral.

Conclusions

We directly identified empirical evidence and delivered a range of benefits which support the ‘Dying without Dignity’ report and provided recommendations to directly address the issues of poor symptom control, inadequate out of hour’s service and poor care planning.

Furthermore Training and Development for NHS 111 staff in palliative care matters was further enhanced with the development of a palliative care e-learning package.

References

Keogh B. Transforming urgent and emergency care services in England

NHS The Five Year Forward View; 2014

NHS EnglandNHS 111 Learning & Development Programme – Phase 2; 2014

Dying without dignity. Investigations by the Parliamentary and Health Service Ombudsman into complaints about end of life care. [online] Ombudsman service; 2015. Available at:http://www.ombudsman.org.uk/__data/assets/pdf_file/0019/32167/Dying_without_dignity_report.pdf[Accessed 7 Jun. 2016]

Willett K. Pharmacy and the urgent and emergency care review, 2014
Are patients who are rejected for a liver transplantation referred to palliative care?
Authors: Stewart Molly , Speakman John
Published: August 2016

Objectives

The primary objective was to assess whether a referral to palliative care was made in a sample of end-stage liver disease (ESLD) patients, turned down for a liver transplant, due to being too sick or having a malignancy that excludes them.

The secondary objective was to record the outcomes of: demographics, diagnosis, age when rejected for a liver transplant, length of survival post-rejection for a liver transplant, age at death and place of death.

Methods

A retrospective service evaluation of 48 ESLD patients who were rejected for a liver transplant at the Queen Elizabeth Hospital Birmingham (QEHB), due to either being too sick or the liver tumour being inoperable.

Results

Of the 48 patients included in the service evaluation, there were a total of 12 referrals (25%) made to palliative care. The most common diagnoses were alcohol-induced cirrhosis (25%), followed by non-alcoholic steatohepatitis (16.7%), Hepatitis C (10.4%) and cryptogenic cirrhosis (10.4%). The mean age at transplant assessment was 59 years old and the mean age at death was 60 years old. The mean length of survival following rejection for a transplant was 72 days. The place of death was difficult to determine for many of the patients due to technology constraints.

Conclusion

Better integration of palliative care and liver transplant services is needed to ensure that patients with ESLD are supported in order to ensure the best quality and quantity of life.

References

Kendrick E. Getting it right: improving end of life care for people with liver disease. North East: Department Of Health; 2014

Deaths Registered In England and Wales in2010, by cause. London: Office Of National Statistics; 2011

Effiong K, Osinowo A, Pring A, Verne J. Deaths from liver disease: Implications for end of life care in England. National end of life care intelligence network 2012

Kaner E, Newbury-Birch D, Avery L, Jackson K, Brown N, Mason H. A rapid review of liver disease epidemiology, treatment and service provision in England. Institute for Health and Society, Newcastle University; 2007

Wood A, Arthur C, Myatt R, Sargeant I. Role 4 Trauma Fellowship: The Military Registrar’s Training Experience.Arthroscopy2012;3:2

Adam SJ. Palliative care for patients with a failed liver transplant.Intensive and Critical Care Nursing2000;16(6):396–402

Larson AM, Curtis JR. Integrating palliative care for liver transplant candidates: ‘too well for transplant, too sick for life’.JAMA2006;295(18):2168–2176

Back AL, Arnold RM, Quill TE. Hope for the best, and prepare for the worst.Ann Intern Med2003;138(5):439–443

Saunders DC. First national VOICES survey of bereaved people: key findings report, 2012
How far can we trust proxy respondents for patients receiving supportive and palliative care who are unable to consent to research?
Authors: Bailey Cara , Kinghorn Philip , Orlando Rosanna , Armour Kathy , Perry Rachel , Jones Louise , Coast Joanna
Published: August 2016

Introduction

Patients near the end of life are not always able to consent to research participation but it is important they have the opportunity to be represented. Proxies may offer a valuable perspective on the quality of end of life care. Although there is evidence that proxy responses differ, exploring why and where differences occur may help in deciding on their use in empirical studies.

Aim

What is the agreement on quality of life outcome questions between patients receiving supportive care and proxy response by close persons (CPs) and healthcare professionals (HCPs)?

Methods

A mixed methods study was conducted with 72 participants recruited via the hospice (33 patients, 22 CPs and 17 HCPs). Participants completed three quality of life outcome scales (ICECAP-SCM, EQ-5D-5L and ICECAP-A) during think-aloud interviews. Analysis explored difficulties and enablers for proxy completion. Constant comparison and extreme case analysis explored how CPs and HCPs completed the scales on behalf of patients.

Results

Proxy responses depend on how well the proxy knows the patient but there is no clear difference between proxy roles. Choice and dignity are more accurately completed by proxies than physical or emotional suffering. This may be related to the relationship between the patient and proxy and willingness to discuss care planning preferences.

Conclusion

This study has important implications for research and practice. Accurate measurements of the quality of end of life care from the patient perspective is essential, especially as the provision of 24/7 palliative care becomes the priority.
A qualitative exploration of the lived experience of inpatients receiving support from the hospital specialist palliative care team (HSPCT), in one acute hospital setting
Authors: Black Anne , Mayland Catriona , McGlinchey Tamsin , Gambles Maureen , Ellershaw John
Published: August 2016

Background

The importance of person centred care has been dominant in End of Life Care (EoLC) national guidance since publication of the EoLC Strategy in 2008. However, variations in quality of care remain concerning. National frameworks have been developed to enable care providers to drive changes to improve patient care and experience (NPELCP 2015). It is therefore important to explore what patients and those close to them think about services they encounter; it is widely recommended that engaging with service users should inform ongoing service improvement strategies.

Aim

In one acute hospital trust:

Explore the lived experience of being a hospital inpatient, and receiving support from the HSPCT;

Make recommendations to the acute trust regarding improving patient experience.

Method

A phenomenological approach was adopted utilising the following methods:

Narrative Interviews – In-depth interviews with recently discharged palliative patients;

Case note review – key documentation from recent in-patient episode.

Results

20 interviews completed. Qualitative data analysis is currently being undertaken using Thematic Analysis. Initial emerging themes identify the following:

Modes of communication impact on perceptions of care;

Levels of understanding affect perceptions of control and loss of self;

Burden of symptoms impact on patients holistic wellbeing/quality of life;

Institutional culture and prior experiences may exacerbate feelings of concern.

Conclusion

Study findings will contribute to a greater understanding of the inpatient experience within the acute hospital setting, as well as provide information directly to the acute trust to promote local change and improvements to care delivery.

Reference

National Palliative and End of Life Care Partnership (NPELCP). Ambitions for Palliative and End of Life Care: a national framework for local action; 2015.http://endoflifecareambitions.org.uk/. Accessed June 17, 2016
A QUALITATIVE INVESTIGATION INTO PARAMEDICS' THOUGHTS ABOUT THE INTRODUCTION OF NATIONAL EARLY WARNING SCORES
Authors: McClelland Graham , Haworth Daniel
Published: August 2016

Background

The National Early Warning Score (NEWS) is a simple, rapid assessment tool developed by the Royal College of Physicians to standardise the assessment and monitoring of acutely ill patients and facilitate communication across settings. Ambulance Service introduced NEWS in 2013/14. Previous work in this area showed that paramedics were not using NEWS in practice so this study explored the reasons why and how paramedics use, or don't use, NEWS in practice.

Methods

Qualitative study using a pragmatic approach. Semi-structured interviews were conducted on a purposive volunteer sample of 8 paramedics with a range of roles, locations and lengths of service. Interviews were digitally recorded and transcribed for analysis. Five stage framework analysis commenced in parallel with data collection.

Results

Two main themes emerged from the data. The first theme was when and how paramedics used NEWS in their decision making. All participants thought that they, and their peers, collected all the observations necessary to calculate a NEWS but that it didn't enter their thoughts until after decisions had been made and were being documented. Participants saw NEWS as a tool to support their decisions but also thought NEWS may be beneficial for triggering decisions by non-paramedic ambulance staff.

The second theme was how interactions with other healthcare professionals impacted on paramedics' use of NEWS. The reception participants received when handing a NEWS over at hospital had a strong influence on their continuing use of NEWS. The perception that Emergency Department staff weren't interested in NEWS acted as a negative influence on pre-hospital practice apart from one area where the local hospital encouraged the use of NEWS which had a localised positive reinforcing effect.

Conclusions

Paramedics use NEWS to support rather than trigger decisions. The perceived importance placed on information handed over at hospital influences paramedics pre-hospital practice.
FREQUENT CALLER MANAGEMENT SWASFT
Authors: Morgan Claire , Thayre Shaun
Published: August 2016

Background

A Frequent Caller (FC) to the Ambulance Service, defined nationally by FreCaNN, is an adult (18y+) who makes 5 or more emergency calls a month, or 12 or more in 3 months.

The SWASFT FC Team analyse the monthly data following the SWASFT FC Management Policy including multiagency working across Primary Health, Social Care, Police and Housing.

This study aimed to establish whether low level FCs (5-9 times/month or ≥12 in 3 months) were a warning marker for future high level FCs (>10 times/month) and if the management of these callers by a Frequent Caller Lead (FCL) reduced call volume.

This study analysed 425 high level Frequent Callers.

Method

South Hub: The FCL collected data from Jan 14–Aug 15 on High Level FCs to identify if patients were recorded as low level FCs in the 6 months previous. The 6 months following the recording of a high level FC was also examined to measure the benefit of managing these patients.

North Hub: The FCL was not appointed until September 2015, thus providing a control group.

Results

▸ Low Level 999 FCs do not necessarily become a High Level FCs (table 1).

▸ Managing High Level FCs shows a reduction in call volume, with many ceasing to call (table 2).

▸ The average call volume for FCs to the South Hub (managed) was lower than that to the North Hub (unmanaged) (table 3).

Table 1Categorisation of call volume before becoming High Level FCN%Non frequent caller (<5)26862Low level frequent caller (5–9)16138Table 2Categorisation of call volume after becoming High Level FCN%Non frequent caller (<5)32777Low level frequent caller (5–9)246High level frequent caller (>10)7417Table 3Volume of FCs Jan 15–Aug 15SouthNorthTotal no of FCs identified26802057Sum of all Calls made by FCs1847317164Average Call Volume per FC6.98.3

Conclusions

▸ There is no indication that Low Level FCs become High Level FCs.Those calling 5× month, or 12 × in 3 months are therefore not currently being managed proactively.

▸ Managing High Level FCs reduces their 999 demand.

▸ Evidence has also shown that management of the Entrenched FCs was beneficial as it reduced their call volume.
PILOT EVALUATION OF UTILISING MENTAL HEALTH NURSES IN THE MANAGEMENT OF AMBULANCE SERVICE PATIENTS WITH MENTAL HEALTH PROBLEMS
Authors: Irving Andy , O'Hara Rachel , Johnson Maxine , Harris Angela , Baker Kieran
Published: August 2016

Background

The urgent and emergency care review advocates new models of care to provide safer, faster and better care. Available evidence highlights scope for improvement in the delivery of care for patients calling 999 with mental health problems. The purpose of this abstract is to describe an ongoing initiative in Yorkshire Ambulance Service utilising specialist triage by mental health nurses in the Emergency Operations Centre (EOC) since December 2014.

Methods

An exploratory mixed methods evaluation was conducted. Interviews (n=12) with key stakeholders in the ambulance service were conducted to explore their experiences of service provision for patients with mental health problems and the impact of introducing Mental Health Nurse triage in the EOC. Interview data was coded and thematically analysed to identify key issues around service delivery for patients with mental health problems. Routine data from ambulance service computer aided dispatch was used to examine impact on patient care and resource allocation.

Results

Initial findings indicate that access to mental health nurses in the EOC reduced the ambulance response rate by clinically triaging calls for patients with mental health problems and only sending a resource where appropriate. Staff interviews revealed the developmental process and challenges involved in implementing the mental health triage initiative, for example, recruitment, training and governance. Staff perceptions of the initial positive impact of the mental health nurses include the delivery of more appropriate patient care and reduced anxiety for staff managing calls that now have access to specialist support.

Conclusions

Despite the relatively short time period since the inception of this initiative, the preliminary findings from this pilot evaluation suggest a positive impact on service delivery from a patient and organisational perspective. Lessons learned from the implementation of this initiative and its progression are potentially informative for other Ambulance Service Trusts considering adopting a similar approach.
MEASURING IMPACT OF INVOLVEMENT IN RESEARCH – WHAT SERVICE USERS THINK
Authors: Evans Bridie Angela , Porter Alison M , Snooks Helen A , Burholt Vanessa
Published: August 2016

Background

There is increased interest from researchers in evaluating public involvement by service users in health and social care research, with debate about feasibility of doing this. Discussion is led by researchers.

Objective

To describe service users' views about whether evaluating impact of public involvement in research is feasible and helpful.

Method

19 patients or carers were interviewed. All were members of the SUCCESS service user group supporting emergency, unscheduled and trauma research. Some had regular involvement in research studies about prehospital emergency care and chronic conditions management to reduce people's risk of using unscheduled services.

Results

Service users found it difficult to identify their impact on research and questioned the value of thinking in those terms. Respondents said that involving people in research changed research because it changed structures, relationships and, consequently, affected the results. Involving patients and carers in research was seen as a radical approach because it challenged hierarchical relationships between academia and patients, gave value to experiential knowledge and placed this alongside clinical and academic knowledge. They also recognised the difficulty of attributing influence and measuring change over long research timescales when their contribution was describing experiences and opinions, neither of which were tangible or definitive. They also doubted they could recognise impact on studies without insider knowledge of research.

Conclusion

Service users believe involvement processes are key to ensuring that patient and carer views are included when designing and undertaking research, suggesting impact on research is a consequence of effective collaborations rather than an aim in its own right. This focus on process contrasts with academic emphasis on impact and needs to be considered when discussing whether and how to measure impact.
A COMPARISON OF MANUAL AND MECHANICAL CARDIOPULMONARY RESUSCITATION ON THE MOVE USING A MANIKIN: SINGLE-PERSON AND TWO-PERSON EMERGENCY MEDICAL SERVICE CREWS
Authors: Blair Laura , Kendal Simon Peter , Shaw Gary Richard , Byers Sonia , Wright John
Published: August 2016

Background

Delivery of good quality cardiopulmonary resuscitation (CPR) is essential for survival from cardiac arrest but manual CPR has its limitations, especially in the pre-hospital environment and situations which demand transportation.

Our aim was to examine the effect that transporting a patient during Advanced Life Support (ALS) has on the quality of CPR being provided. In the same simulated pre-hospital scenario we directly compared manual (standard) CPR (SCPR) and mechanical CPR (MCPR), as well as comparing both against the 2010 European Resuscitation Council guidelines. The quality of CPR provided by one and two person crews was also compared.

Methods

Ten experienced paramedics volunteered to take part in four pre-hospital observational manikin CPR scenarios each. The mechanical CPR device chosen was the LUCASTM2. Data were captured electronically using QCPRTMwith the core values being minute-by-minute mean compression rate and depth, as well as variations within, hands off ratios and the average time to CPR commencement.

Results

A marked reduction in the rate, depth and percentage of correct compressions was noted when the paramedics started to move the patient. When compared against the 2010 ERC guidelines, SCPR was more variable than MCPR and not delivered in a way that conforms to the guidelines. MCPR was consistent and conformed to the guidelines. There was significant time required for a single paramedic to start CPR with a mechanical device.

Conclusion

In the pre-hospital setting having to transport a patient during ALS can have a negative impact on the quality of CPR being provided. The quality of CPR is closer to that currently recommended when provided by a mechanical device rather than manually, but two persons would be required for rapid deployment of the device. This could suggest a potential role for pre-hospital MCPR even in the absence of recommendation for routine use.
PARAMEDIC PRACTITIONER: A SURVEY OF SCOPE OF PRACTICE AND DEVELOPMENT REQUIREMENTS
Authors: Colver Keith , Fitzpatrick David , Cooper Matthew , Ward Jim
Published: August 2016

Background

The Scottish Ambulance Service introduced paramedic practitioners in 2004 to reduce unnecessary hospital admissions. Development of the role has varied across the UK but little is known about this professional group within Scotland.

Aims

To describe paramedic practitioners views on their scope of practice and identify areas for improvement.

Methods

An online cross-sectional questionnaire was undertaken during July–August 2015. Participants: current staff identified as having completed paramedic practitioner training (N=64). Quantitative data are reported using descriptive statistics and qualitative data analysed using framework analysis.

Results

Forty two per cent (n=27) completed the survey, of which 52% (n=14) were active practitioners. Average length of service was 19.52 years (range: 3–24 years) including 4.66 years (range: 0.83–11) within a practitioner role. Variation was reported on funding sources and educational levels (stand-alone level 9 modules to MSc). Current practice settings were described as urban (57% [n=8]), semi-rural (29% [n=4]) and rural (14% [n=2]) involving 999 response, Minor Injuries Clinics, Out of Hours and GP practices.

Adult, paediatric and care of the elderly were the most common areas of practice (73%). The remaining areas consisted of: critical, palliative, mental health and other (27%). Most used skills were described as: advanced clinical assessment and medicines; least used: catheterisation, minor ailments/injuries. Skills reported as missing or requiring development were: paediatrics, palliative care and mental health. Mean ‘comfort in practice’ was rated as 4.23 on a 7 point-scale (‘comfortable’ [1] -‘very comfortable’ [7]).

Difficulties were reported in call-allocation and utilisation. Variation across practice settings caused difficulties with: record-keeping, inconsistent referral processes, guideline use, peer review and CPD. These created governance and role development challenges.

Conclusion

Practice is inconsistent, reflecting variations in development processes and practice areas. Practitioners are comfortable in their role and would value standardisation in clinical practice guidelines, education and governance.
DATA LINKAGE ACROSS AMBULANCE SERVICES AND ACUTE TRUSTS: ASSESSING THE POTENTIAL FOR IMPROVING PATIENT CARE
Authors: Clark Sophie , Porter Alison , Halter Mary , Damiani Mike , Dorning Holly , McTigue Martin
Published: August 2016

Background

Currently, most callers to 999 ambulance services are transported to the hospital emergency department (ED). However, ambulance services receive no further information on those patients, and commissioners do not have the full picture of patient care. The London Ambulance Service have worked with one acute trust to establish the feasibility of data linkage, but questions remain about transferability of the model, and how learning from linked data can bring about changes in patient care and outcomes.

Methods

PHED Data is our two-year mixed-methods observational study which began in May 2015. We aim to establish the potential for routinely linking data from acute trusts and ambulance services, to allow diagnosis, health care intervention, and mortality outcomes to be tracked, with a range of potential benefits for patient care within ambulance services and across the healthcare economy.

We will work with six acute trusts from across London, selected to give a range of performance. The study has six work packages: WP1 examines the technical aspects of the linkage process; WP2-5 each analyse the data to develop one themed indicator set, with qualitative work examining their perceived relevance and viability; WP6 examines how the indicator sets might influence commissioning decisions and service improvements.

Results

So far, we have engaged with six selected acute trusts; all have shown strong interest in collaborating. We are currently arranging the logistical aspects of data sharing. We aim to respond to trusts' particular interests in our analyses, in addition to developing our common indicator set.

Conclusions

The proposed work has the potential to bring about quality improvements to current systems and support the development of new pathways and protocols for pre-hospital interventions. Benefits will be felt across the healthcare system. Our findings will be relevant to health service providers across the UK, who all face similar challenges in pre-hospital care.
The anaesthetic management of a lemur (Prolemur simus) undergoing craniotomy for brain tumour resection
Authors: Portier Karine , Viguier Eric , Quintard Benoit
Published: August 2016

A nine‐year‐old greater bamboo lemur (Prolemur simus) was presented for the resection of a 3×2 cm occipital brain tumour. Intracranial surgery has not been previously reported in lemurs. Pain management, maintenance of an adequate perfusion pressure in the CNS, maintenance of autoregulation, provision of neuroprotection and prevention of the complications induced by the surgical technique (positioning, haemorrhage, seizures, etc) are the challenges associated to this surgery in domestic animals. The management of anaesthesia for such a condition in a wild animal is even more challenging. This report illustrates how difficult the management of anaesthesia is in a wild animal undergoing a procedure that requires intensive care and restraint, while published information on anaesthesia and critical care in this species is limited.