bluuebunny/crossref_metadata_2025 huggingface dataset:
Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: should we treat low effort capacity or reduced effort tolerance?
Authors: Van Houdenhove B. , Verheyen L. , Pardaens K. , Luyten P. , Van Wambeke P.
Published: November 2007

Aim: The aetiology, pathophysiology, diagnostic delineation and treatment of chronic fatigue syndrome (CFS) remain a matter of debate. Here some aspects of the debate are elucidated, with a particular focus on the patients' decreased motor performance.

Hypothesis: The pathophysiological basis of decreased motor performance in CFS may, theoretically, involve three components: (1) a peripheral energetic deficit (impaired oxidative metabolism and/or physical deconditioning); (2) a central perceptual disturbance (higher effort sense or increased `interoception'); and (3) a fundamental failure of the neurobiological stress system, leading to an abnormal `sickness response'. It is proposed that the first two components may lead to low effort capacity, while the third component may lead to reduced effort tolerance. Although there is evidence for low effort capacity influencing symptoms and functional limitations in CFS, it is assumed that reduced effort tolerance might be the primary disturbance in CFS.

Diagnostic implications: Distinguishing low effort capacity and reduced effort tolerance may contribute to a refinement of current diagnostic criteria of CFS and the identification of subgroups.

Therapeutic implications: The above-mentioned distinction may make it possible to formulate a rationale for an effective implementation and adequate outcome evaluation of rehabilitation strategies in CFS.

Research implications: This new heuristic framework may inform future research aimed at disentangling the complex determination of impaired motor performance in CFS, as well as studies aimed at customizing treatment to different subtypes of patients.
Accountability, advocacy and the nurse
Authors: Webber Jeanette
Published: November 2007

Recently I asked a group of nurses how they would describe the current state of nursing. Not surprisingly there were a variety of responses. Exciting, confusing, challenging, depressing, stressful and exhilarating were just some of the words used. As we applied these terms to nursing in general, and palliative care nursing in particular, we began to identify some of the central issues which must be addressed if conflicts are to be resolved. In this article I would like to explore some of these issues and suggest ways in which we, as nurses, might respond.
Review articles : Acupuncture for chronic pain: a review
Authors: Filshie J. , Morrison PJ
Published: November 2007

The history of acupuncture is described up to the present day. The different methods are explained and both empirical and controlled studies on acupuncture are reviewed. The neurophysiology and neuropharmacology of acupuncture are discussed, including the contribution of endorphins.
Hospice home care services: a Scottish perspective
Authors: Kindlen Margaret
Published: November 2007

This paper reports on a postal survey, undertaken in Scotland to describe the role of the 'specialist' nurse involved in the home care of dying patients. The issues raised and discussed as a result of this investigation include specialization in nursing, professional teamwork and the amount of information sharing which exists between patients, families and health care professionals.
Despair felt by the patient and the profiessional carer: a case study of the use of cognitive behavioural methods
Authors: Jones Kate , Johnston Marie , Speck Peter
Published: November 2007

The use of a mood and activity diary kept by a patient more clearly defined the relationship between patient and carer and identified those problems that could be tackled. It helped to reduce feelings of helplessness and to restore some control to the patient.
The family and loss: a systems framework
Authors: Jenkins Hugh
Published: November 2007

This paper introduces three important aspects of considering the difference between an individual and family focus for clinicians. These are: the family as a system; a cybernetic framework; the family life cycle. From this perspective, the impact of loss, whether or not through death, is discussed with some implications for practice.
Hospice - an update on the cost of patient care
Authors: Hill Frank
Published: November 2007

This follow-up survey to a study into the cost of providing hospice inpatient care in 1984, examines in detail the cost profiles of up to 40 well established hospices in the UK. The results are analysed in order to provide up to date financial and statistical information on the major areas of current hospice activity.
Preferred versus actual place of death: a hospital palliative care support team experience
Authors: Dunlop Robert J , Davies Robert J , Hockley Josephine M
Published: November 2007

A prospective study of the place of death of 160 patients referred to a hospital support team was carried out. Of these patients 62% died in hospital, 26% at home and 12% in a hospice. Overall, 56% of patients (90) were able to express a preference for place of death; 48 patients wished to die at home and 26 wanted to be cared for in a hospice. 71 % of these patients achieved their choice but the remainder became too unwell to transfer and died in hospital. Thirteen patients chose to die in hospital; other reasons for death in hospital included unexpected deterioration while undergoing active treatment or investigations (33), relatives unable to cope with home care (27) and late presentation precluding transfer (12). The lack of choice for some patients dying of nonmalignant disorders is highlighted and attention is drawn to the distress of patients sent to a hospice against their choice.
Evaluation of palliative care: steps to quality assurance?
Authors: Higginson Irene , McCarthy Mark
Published: November 2007

We have reviewed the UK and North American evaluations of hospice and palliative care and consider the future needs for evaluation and quality assurance. Nonrandomized studies on single sites in the UK suggested that inpatient hospice care is more effective than hospital care, however, comparisons of hospital care with outpatient or home hospice care were equivocal. In North America the converse was found: one randomized controlled trial showed few advantages of inpatient hospice care compared with conventional care, while in another study, patients randomly allocated to a home care team reported greater satisfaction and spent more time at home than the controls. Multicentre studies in the UK have described only the process of care, whereas North American studies (especially the National Hospice Study) have included outcome measures. Their general conclusion, that hospice care was not worse than conventional care and in some special centres was better, is not likely to satisfy most health service managers and planners nor many hospice staff. Hospice care is now well established and it will be difficult to set up further randomized trials in the future. Yet many aspects of the services remain to be evaluated. Studies in progress in the UK are developing methods for clinical audit of care; these may prove useful guides to quality assurance in palliative medicine.
Hospice patients: a pilot study in 12 services
Authors: McCarthy Mark
Published: November 2007

We have developed an instrument to record details of patients referred to hospice services. Twelve services across the UK, including inpatient units, support teams and home care teams, participated in a pilot study and were asked to record data on 20 consecutive patients. The 195 patients included in the study ranged in age from 7 to 94 years; 95% had cancer and 4% had AIDS. Two-thirds (68%) of the patients were at home on referral to the service. Symptom control (77%) and emotional support (60%) were the dominant problems recorded. In the month prior to referral, the patients had received treatments including analgesic and psychotropic drugs, steroids, radiotherapy and surgery. Current symptoms correlated with these previous treatments, although not closely. Emotional problems, especially anxiety, were noted in a majority of patients and their carers, and social issues, especially housing problems and isolation, in a minority. This pilot study suggests that a full survey of patients in hospice services in the UK is feasible. The results would be of use both locally and nationally.
Cancer and sympathetic dependent pain
Authors: Churcher M.D.
Published: November 2007

For over a century there have been clinical clues to a relationship between pain and the sympathetic nervous system. Diagnosis of a sympathetic dependent pain (SDP) depends on pain characteristics, altered sensation and relief by sympathetic block. SDP is often accompanied by signs of sympathetic overactivity, and is most commonly seen in the lower limbs. Chemical sympathectomy is the treatment of choice.
Continuous brachial plexus block in the management of intractable cancer pain in the arm
Authors: Clark A.J. , Simpson K.H. , Ellis F.R.
Published: November 2007

Reversible nerve blocking procedures should be considered in the management of pain due to cancer which fails to respond to more conventional methods. Two cases are presented illustrating the use of continuous interscalene brachial plexus block for the relief of intractable metastatic bone pain in the upper limb. This technique, using local anaesthetic, afforded patients the first effective pain relief for months.
A personal initiative to improve palliative care in India
Authors: Burn Gillian
Published: November 2007

Gillian Burn served as a WHO temporary adviser in 1989. This article is a personal account of her educational tour of India.
The role of a palliative care service family conference in the management of the patient with advanced cancer
Authors: Miller RD , Krech R. , Walsh TD
Published: November 2007

Communication between patient/family and the professional medical team is a priority for a service working with advanced cancer. Family conferences including all those persons involved in the patient's care have been established in a busy palliative care service to facilitate open communication. We report on the questions asked by families during 50 consecutive family conferences, during which the questions were recorded verbatim and categorized. Families want detailed knowledge of the extent of the patient's illness and life expectancy. We make recommendations about how best to conduct these conferences, based on these data and our own experience.
The distress of inappropriate hospice transfer
Authors: Dunlop Robert J , Hockley Josephine M
Published: November 2007

Some terminally ill patients are having to transfer from hospital to hospice against their choice. The effect on patients and their carers is illustrated by a case history. We highlight the need for hospice workers to be alert to this problem.
Palliative care: training needs, developments, difficulties and perspectives
Authors: Rapin Ch-H , Weber A.
Published: November 2007

Approximately 3600 copies of a questionnaire on palliative care were sent out towards the end of 1989. Of the 594 returned, 61 % came from nurses, 23% from medical doctors and 16% from others. Fifty-six per cent had already had training in palliative care but 91 % wanted training or additional training, suggesting that instruction is incomplete or inadequate. The selective character of the persons approached and the low response rate prevent the generalization of the findings to all carers and persons concerned with palliative care.

Additional training was requested most on pain control, communication, relationships between carers and those cared for, relationships with families and support for family and friends. The majority of the respondents wanted both lectures as theoretical instruction and opportunities for practical training. Meetings with practitioners and seminars and workshops were the preferred teaching methods for theoretical instruction.

Fifty-one per cent of the respondents considered that the practice of palliative care had progressed in their region since 1987, and 41 % that there had been practically no progress or that it had regressed. Seventy-two per cent estimated that palliative care is better accepted by the carers and 70% by patients and those around them.

Ninety-two per cent felt that the practice of palliative care still encounters difficulties in their region, the commonest causes of the difficulties being lack of knowledge of palliative care by the carers, reticence on the part of the doctors and inadequate training.

The developments most desired are palliative care at home, in homes for the aged, and in geriatric and medical services. Priority in such developments should be given to patients with cancer or with AIDS.
Training for palliative medicine. I : A survey of professional opinion
Authors: Daley Andrew G , Lennard Rosemary F
Published: November 2007

Formalized training schemes in palliative medicine are currently being set up in the U K. However, some controversy exists as to the best training pathways for this specialty. The results are presented of a questionnaire survey of all senior palliative physicians in the UK. Information was sought on their qualifications; previous experience; how useful this experience was; and their opinions on the most appropriate qualifications and training prior to entering senior registrar posts. On the basis of the results, the authors make the following recommendations: (1) a broad-based training should be encouraged prior to specialization; (2) experience priorto taking up senior registrar posts should be encouraged in palliative medicine, oncology/radiotherapy, general practice, medicine and pain clinics. Lack of experience in any of these fields should be remedied during higher specialist training; (3) the MRCP and the MRCGP should both remain as suitable postgraduate qualifications for entry to senior registrar posts in palliative medicine; (4) appointment committees and committees planning training programmes should include palliative physicians with different backgrounds since individuals tend to be biased to their own training pathway.
Death and dying: perceptions and attitudes in Italy
Authors: Toscani Franco , Cantoni Laura , Di Mola Giorgio , Mori Maurizio , Santosuosso Amedeo , Tamburini Marcello
Published: November 2007

This research was started in Italy at the end of 1988. Its aim was to identify and describe how people perceive death, and to define its prevalence in the minds of people. Three key issues were studied: (1) the idea of death and the feelings it stirs in people; (2) the cult of the dead; (3) the death—disease relationship. The research was conducted by telephone interviews using a questionnaire comprising 17 multiple-choice questions and one question with an open reply. A thousand people were interviewed from a sample group best representing the Italian population in terms of geographic distribution, area of residence, sex, age, education, and profession. Our research highlighted that Italian culture, whether secular or catholic, is hardly used to thinking about death. The tendency is for Italians to relate death to disease, especially in the case of cancer, and death is therefore something to be shunned and feared. Nevertheless, a new and culturally innovative need is emerging in Italy, where it is felt that patients should be given the responsibility for and the option of choosing not only their own treatment, but also the way in which to live and die. This finding is extremely important because it clearly proves that patients have a growing awareness of their right to self-determination. Nevertheless, society also has the obligation to make sure that patients in the terminal phase of life are not abandoned or merely left to chance.
Sculptors in residence in hospice: report of a Lancaster project
Authors: McIllmurray MB , Gorst DW , Shand WS , Crimmin M. , Thomas J.A.
Published: November 2007

Two postgraduate sculptors from The Royal Academy carried out a 10-week residency at St John's Hospice in Lancaster. Their work is described and an evaluation report is discussed.
A study to develop and assess the value of a leaflet on pain control for cancer patients taking MST in the community
Authors: Walker Jacqueline R
Published: November 2007

The aim of the study was to investigate the extent to which an information leaflet on controlled-release morphine (MST) and complementary methods of pain control can increase knowledge and thus increase pain relief for cancer patients taking MST at home. An information leaflet on MSTwas adapted and extended to include complementary methods of pain control. Pre- and postleaflet tape-recorded interviews and a pain diary were then used to monitor the effect of the leaflet on a sample of 15 patients. The results indicated that knowledge regarding pain control was significantly increased by the administration of the leaflet (p = 0.01). Pain control also appeared to increase for some patients as a result of the leaflet, and this seemed to be due to the increased knowledge and subsequent use of complementary methods of pain control (p = 0.05). The patients who benefited most from the study were those with moderate pain, because they needed the information and were able to actively use it. It is concluded that this information leaflet is beneficial to patients and should be used as an adjunct to verbal instructions.
Brief social work intervention in the hospice setting: person-centred work and crisis intervention synthesized and distilled
Authors: Chung Kam
Published: November 2007

This essay explores the difficulties faced in a hospice when offering brief intervention work with the friends or relatives of patients. The relevance of various theories of intervention is explored and it is concluded that elements from a number of theories need to be applied flexibly when working for one or two meetings with people.
Palliative/hospice care in Poland
Authors: Luczak Jacek
Published: November 2007

The first hospice in eastern Europe was the Hospicium in Krakow, which was created 10 years ago. Three years later the leading independent Polish hospice, Hospitium Pallotinum, was founded in Gdansk. This hospice helped to organize more than 20 similar groups, usually Catholic agencies which offer home care programmes. The University Palliative Care Service in the Academy of Medical Sciences in Poznan, which was created in 1988, consists of a home care team caring for 600 patients a year and has a seven-bed inpatient unit. It offers an education programme for physicians, nurses, medical and pharmacy students as well as a research programme. There is currently an academic link between the Poznan Palliative Care service and Sir Michael Sobell House in Oxford, sharing medical and nursing education in palliative care. The educational courses and conferences have been attended by international speakers offering education which will help to change the attitudes of professional health care workers and the public. We hope that the Polish Ministry of Health and Welfare and the government will be interested in establishing policies that will cover the cost of palliative care in the newly developing health care system.
Prediction of life-expectancy in hospice patients: identification of novel prognostic factors
Authors: Rosenthal Mark A. , Gebski Val J. , Kefford Richard F. , Stuart-Harris Robin C.
Published: November 2007

The prediction of life-expectancy in terminally ill patients is important both for medical and social reasons but is widely recognized as being inaccurate. In this study we prospectively collected data items which we proposed might influence survival on 148 consecutive patients at first admission to one of two hospices. Of the 19 parameters collected, four were associated with a significantly shortened survival. These were low performance status (PS), requirement for admission at first referral to the palliative care service, elevated serum bilirubin, and hypotension. Factors previously identified as predictive of shortened survival such as hyponatraemia, weight loss, confusion and tumour type were not confirmed as statistically significant independent variables. We plan to collect these data items on future patients in order to test the validity of these results.
Dealing with anger in a patient or relative: a flow diagram
Authors: Faulkner Ann , Maguire Peter , Regnard Claud
Published: November 2007

Anger from any cause can block effective interaction between the patient and the carer. It has many possible causes, which may be rational, irrational (i.e. inappropriate or misdirected) or pathological. This flow diagram suggests strategies for handling anger in patients with advanced disease.
Communication with parents of children with cancer
Authors: Eden OB , Black I. , MacKinlay GA , Emery Aeh
Published: November 2007

The purpose of this study was to assess the receptiveness of parents to information given about their child's life threatening illness.

Three months after the child's diagnosis, an independent interviewer, using a structured questionnaire, interviewed the parents about what and how they had been told, and assessed the stage of parental coping reached at that time. All patients were treated at a regional paediatric oncology centre (RHSCE) and the interviews were conducted preferably in the family home (61 %), or in a 'quiet' hospital room (39%). Twenty-five, unselected, consecutive patients with cancer and leukaemia diagnosed and treated at the RHSCE and their families were recruited into the study (1988-1989). One child died during the first three months and one single parent family refused co-operation. Eighteen of the 23 interviews conducted were with both parents, and five were with single parents (all maternal).

All 23 sets of parents admitted deep shock and devastation on hearing the initial diagnosis, with 12 sets feeling that they had taken in little or none of the information given. A long interview was conducted a few days after the initial talk with the consultant. The parents of four children (17%) denied that the long interview had occurred whilst 10/19 who remembered it expressed specific lack of understanding of some or all details. All families remembered a large number (10-20) of subsequent talks with a wide range of staff, but 14/23 felt that some of the information was still confusing or conflicting, and 9/14 did not want to ask for further clarification, principally because they did not want to hear more bad news. The majority felt the child understood little of what was going on. At the study interview, most parents were assessed as still being very anxious about their child's illness, whilst two couples, one single mother and one father, were content with what and how they had been told about their child's illness and were in a state of emotional homeostasis.

It is concluded that communication of bad news is a two-way process requiring skilled medical staff, but also a receptive audience. The emotional state of the parent determines his or her ability to hear and comprehend the information given. The results imply that repetition and clarification at consultation interviews is required until parents are emotionally able to hear, accept and comprehend complex news. Written material, taped interviews and simple videos can assist in this process.
Comparison of metal Versus Vialon® subcutaneous catheters in a palliative care setting
Authors: Currow David , Cooney Neil
Published: November 2007

In 63 evaluable palliative care patients requiring intermittent bolus subcutaneous administration of medication, who were randomly assigned either a standard metal subcutaneous needle or a PTFE (Vialon®) catheter, there was a significantly greater incidence of local reactions at the insertion site with the metal needles (9/30) compared with the PTFE catheters (2/33). Despite this, there was no significant difference between the two in functional survival. Volume of medication injected per day was the best predictor of total time that the subcutaneous lines remained in situ.
The need for inpatient palliative care facilities for noncancer patients in the Thames Valley
Authors: Wilson Ian M , Bunting John S , Curnow Robert N , Knock Joan
Published: November 2007

Inpatient facilities in palliative care units are generally considered to be mainly for cancer patients. We present and discuss the results of a survey that attempted to estimate the number of noncancer patients requiring inpatient palliative care. Questionnaires sent to all general practices in the Thames Valley area asked about the diagnosis and the number of bed-days that would have been required for each noncancer patient in the practice dying in the last year or still in their care. The replies suggest that about 11 noncancer patients per practice per year were in need of respite or continuing care. For the Thames Valley area this would amount to at least 66 000 bed-days per year for noncancer patients, compared with the current provision, mainly for cancer patients, of about 40 000 bed-days per year. The diagnoses involved and the reasons why our figures may overestimate need, are discussed. There can be no doubt that, if the need is to be met, current facilities will be inadequate and additional beds and services will be required.
Nurses working 12-hour shifts in the hospice setting
Authors: Hodgson Linda A
Published: November 2007

A system of 12-hour nursing shifts was adopted at a newly-opened independent hospice. This paper presents the results from an exploratory, descriptive study in which nursing staff reported perceived advantages, disadvantages and satisfaction with the 12-hour shift system.

A small sample (n = 11) of both qualified and unqualified nurses working the 12-hour shift completed the questionnaire. A content analysis of the qualitative data produced a number of categories relating to the perceived advantages and disadvantages of the 12-hour shift system in relation to the respondents, to the hospice and to patient and family care. The need for continuing to monitor and evaluate the shift system was demonstrated, particularly in relation to patient and family satisfaction, and the quality of care.

It was concluded that examining the advantages and disadvantages of the 12- hour shift system increased awareness of the needs of staff, presented a useful way of identifying and managing potential difficulties within the workplace, and highlighted areas for future research.
Models of care for children dying of malignant disease
Authors: Chambers E Joanna , Oakhill Anthony
Published: November 2007

Two-thirds of children with cancer are now cured of their disease. For the majority of the remainder there is a period of terminal care. The emphasis of care at this stage is on the quality of life for both child and family. Most families prefer that their child should be cared for at home, with professional support from those known to them. This paper looks at various approaches to terminal care in children and describes the model of care for such children in the south west of the United Kingdom. From this information, key elements of an effective service are identified.
Non-pharmacological intervention for breathlessness in lung cancer
Authors: Corner J. , Plant H. , A'Hern R. , Bailey C.
Published: November 2007

Objective - To evaluate the effect of non-pharmacological intervention for breathlessness in lung cancer on breathlessness ratings and patient functioning.

Design - Randomised controlled pilot study.

Setting - A nurse led clinic in a specialist cancer centre.

Subjects - 20 patients with advanced small cell and non-small cell lung cancer.

Intervention - Weekly sessions with a nurse research practitioner over 3-6 weeks using counselling, breathing re-training, relaxation and teaching coping and adaptation strategies.

Main outcome measures - Visual analogue scale ratings of breathlessness, distress caused by breathlessness, functional capacity, ability to perform activities of daily living and the Hospital Anxiety and Depression Scale.

Results - Improvements in median scores on all measures were observed in the intervention group with the exception of depression, compared with the control group where median scores were static or worsened. Distress from breathlessness was improved by a median of 53%, breathlessness at worst by 35% and functional capacity by 21 %. In contrast, distress in the control group worsened by a median of 10%. Significant improvements compared with the control group were observed in breathlessness at best (p < 0.02), breathlessness at worst (p < 0.05), distress caused by breathlessness (p < 0.01), functional capacity (p < 0.02) and ability to perform activities of daily living (p < 0.03) but were not observed for anxiety or depression.

Conclusion - Lung cancer patients suffering from breathlessness benefited from this rehabilitative approach to breathlessness management and strategies employed in this pilot study warrant further multicentre research. Macmillan nurses and palliative care teams are recommended to explore the potential of adopting similar approaches.
Place of death correlated to sociodemographic factors
Authors: Axelsson B. , Borup Christensen S.
Published: November 2007

The purpose of this study was to ascertain where patients with malignant disease died and to establish whether such factors as age, sex, marital status, place of residence, diagnosis and interval between diagnosis and death bore any relation to the place of death. All medical records of 203 patients who died in one particular Swedish county in 1990 of cancers of the GI tract, the urogenital organs, the breast, the skin and the thyroid were analysed. Of all 203 patients, 25 (12%) died at home, 49 (24%) in nursing homes and 129 (64%) in hospital. The proportion of home deaths was significantly smaller when the interval from diagnosis to death was less than one month. Death in a nursing home, compared with death in a hospital, was more usual among patients older than 80 years, among those living more than 40 km from the hospital and among those from areas where the local health care centre had a nursing home attached.
Hospice and palliative care in the UK 1994-5, including a summary of trends 1990-5
Authors: Eve Ann , Smith Anthony M , Tebbit Peter
Published: November 2007

A survey of hospice and specialist palliative care services in the UK in the year 1994-5 was undertaken, enquiring about inpatient, home care and day care services. Over 500 questionnaires were sent out in June 1995 and replies were analysed by the Hospice Information Service. Details of admissions, deaths, discharges and length of patient care are given, as well as an analysis of ethnic grouping, diagnosis, age and sex of patients. The response rates to various parts of the questionnaire are tabulated and national estimates are made of the numbers of patients receiving palliative care from specialist providers. The survey is one in a series of annual surveys and the development of specialist palliative care services over the last five years is discussed.
Schooling as a part of palliative care in paediatric oncology
Authors: Bouffet E. , Zucchinelli V. , Costanzo P. , Blanchard P.
Published: November 2007

For children with incurable life-threatening diseases, social reintegration is an illusion. Schooling for these children is both possible and desirable, but its specific objectives must be adapted.

The educational career of 30 French school children with incurable cancer was followed. Data concerning the children's degree of motivation to attend school and its evolution during the course of the disease as well as the measures adopted to maintain school attendance were analysed.

Sixty per cent of the children demonstrated a genuine desire to attend school until the advanced stages of their disease. Reading, mathematics and computer work were their favourite subjects. Increasing physical disability and fatigue diminished their motivation over time. Refusal to attend school occurred in 40% of the children, who had either extracurricular interests or poorly controlled pain.

School attendance for the terminally ill child is part of palliative care and has specific medical and educational goals. As such, its objectives are quite distinct from those of other educational reintegration projects proposed for children with cancer.
Family coping and bereavement outcome
Authors: Kissane David W , Bloch Sidnev , McKenzie Dean P
Published: November 2007

Using a three-phase longitudinal design, the bereavement of 115 adult Australian families following the death of a parent from cancer was studied. The cohort comprised 115 spouses and 153 offspring ; 670 individual responses were obtained. A range of psychosocial variables was studied through a semistructured interview covering the experience of the deceased's illness, death and funeral, spousal health, family coping, sources of support, use of ritual and completion of estate duties. Bereavement outcome was measured by standardized questionnaires of the intensity of grief (Bereavement Phenomenology Questionnaire), depression (Beck Depression Inventory), psychological distress (Brief Symptom Inventory) and social adjustment (Social Adjustment Scale). Those psychosocial variables found to be significantly correlated with bereavement outcome were entered into best sub-set regression analyses. Family coping was the most consis tent correlate of bereavement outcome in these regression analyses, which accounted for up to 38% of the variance in grief, 64% in distress, 53% in depression and 46% in social adjustment. The nature of family functioning is a key aspect of social support in influencing the outcome of bereavement.
Support needs in the last year of life: patient and carer dilemmas
Authors: Grande GE , Todd CJ , Barclay Sig
Published: November 2007

The aim of this study was to identify needs for support and problems in the introduction of support to terminally ill patients and their carers. The design involved semistructured interviews with patients and carers as well as a survey of general practitioners' (GPs) views, and took place in GP practices and homes of patients in Cambridgeshire.

The subjects comprised 43 terminally ill patients, 30 carers, 80 GPs and 13 of their GP partners. The main outcome measures were quantitative data about additional help required and qualitative data on reasons for reluctance to seek help.

Needs for help with transport, personal care and housework were identified. Carers may also need reassurance from health professionals. The need for outside help may at times conflict with the need to preserve independence, dignity and familiar aspects of life. Sometimes carers may feel that there is need for more help, but that this conflicts with patients' wishes. There may also be reluctance to seek help because of a perceived lack of resources and professionals' time.

In conclusion, an increase in services is necessary but not sufficient to meet patients' needs fully. Services should be introduced in ways that help patients to preserve independence, dignity and familiar aspects of life. The perception of accessibility to health professionals may need to be improved. Carers' needs should be assessed separately from patients' needs.
Existential consequences of unrelieved cancer pain
Authors: Strang Peter
Published: November 2007

Seventy-eight cancer patients who were being treated for pain-related problems underwent a semistructured interview concerning the influence of cancer and cancer pain on existential issues. Pain intensity was assessed with visual analogue scales in order to quantify the overall mean pain intensity as well as pain intensity during the best and worst periods. Patients with a higher overall mean pain score (i.e. insufficient pain control) or higher mean worst pain score expressed significantly more fear about the future (P < 0.01), worries about pain progression (P < 0.05) and general anxiety that hampered their daily living (P < 0.05). Younger patients expressed more fear of pain progression and of the future in general and they were much more concerned about the future of their families (P < 0.05). The fear of future pain problems was related to the duration of the pain (P < 0.01). In conclusion, partly unrelieved pain contributes to the 'total pain' experience, not only by causing immediate physical suffering, but also by increasing the anxiety level and the fear about the future and future problems. The study underlines that effective symptom control is a prerequisite for a good quality of life: pain control is a matter of the highest priority.
Problems of anticoagulation within a palliative care setting: an audit of hospice patients taking warfarin
Authors: Johnson MJ
Published: November 2007

Patients with cancer have an increased risk of venous thromboembolism (VTE) compared with a healthy population. The risk increases as cancer progresses and this is reflected in the number of hospice inpatients with VTE. These patients also have an increased risk of bleeding due to tumour site, complications of treatment, progressive liver involvement and concurrent medication such as nonsteroidal anti-inflammatory agents. Therefore anticoagulation of cancer patients with VTE is fraught with difficulty. This audit of hospice inpatients taking warfarin showed a high incidence of bleeding which was possibly improved with very stringent international normalized ratio (INR) monitoring: 15 episodes in 17 patients improved to 11 episodes in 18 patients. Patient numbers were small and the two groups heterogeneous, thus formal statistical analysis could not be applied. One patient in each group continued to thrombose despite overanticoagulation with warfarin. Monitoring of INR increased from an average of once every six days to once every 2.4 days. Such frequent monitoring is likely to be highly impractical in many hospice and general practice settings. Control of warfarin as measured by average percentage of INRs in, above or below the therapeutic range if anything appeared to be worse in the second group. Any bleeding in these patients was distressing. As a result of this audit, practice in Huntershill Marie Curie Centre has changed. Low molecular weight heparins are proven to be efficacious in the treatment of VTE, are renally excreted and therefore do not interact with many commonly used concurrent medications. They can be administered once daily and do not need monitoring of anticoagulant effect. Thus they will be used in patients for whom anticoagulation is indicated during a six-month period, after which practice will be again reviewed.
Social class variation in place of cancer death
Authors: Sims Anita , Radford John , Doran Keith , Page Hilary
Published: November 2007

The aim of this research was to describe the distribution of place of death for cancer. An analysis of place of death for all 831 cancer deaths in 1995 among Doncaster Health Authority's residents was carried out. The data were extracted using the Public Health Mortality File. It was found that there is statistically significant evidence that place of death is associated with social class. Social class I and II with 15% of all cancer deaths contributed 24% of hospice deaths, 14% of hospital deaths and 12% of home deaths. Social class III with 24% of all cancer deaths contributed 58% of hospice deaths, only 9% of hospital deaths and 35% of home deaths. Social classes IV and V with 61 % of cancer deaths contributed only 18% of hospice deaths, 77% of hospital deaths and 53% of home deaths. The reasons for these differences may be to do with access to services, perceptions of different services by patients and general practitioners and the availability of social support within different sections of the community.
Performance standards: ensuring that the specialist nurse in palliative care is special
Authors: Colquhoun Margaret , Dougan Helen
Published: November 2007

Recently there has been a rapid, if somewhat haphazard, proliferation of specialist roles in palliative care. The need to define levels of nursing practice in palliative care and the appropriate educational input for each level has been acknowledged. This paper discusses how one education team has described levels of practice in the form of performance standards as a basis for developing the curriculum of a postregistration degree course for the specialist nurse in palliative care.
Launching a palliative care homepage: the Edmonton experience
Authors: Pereira J. , Macmillan A. , Bruera E.
Published: November 2007

The Internet, with its graphical subdivision, the World Wide Web (WWW), has become a powerful tool for the dissemination of information and for communication. This paper discusses the authors' experiences with creating, launching and maintaining an official publication on the Internet by the Edmonton Regional Palliative Care Program and the Division of Palliative Medicine, University of Alberta, Canada. It describes the content and format of the homepage and the process of publication. Over a six-month period there were 892 visits to the site and 84 separate items of correspondence to the site's editors. Of these correspondence items, 36 were requesting further information regarding clinical and other programme information. Sixty-nine of the 84 communications came from North America and Europe. The pattern of readership is briefly discussed as are some of the potential advantages and challenges when utilizing this electronic medium. To promote the dissemination of reliable information on the Internet, the authors encourage other palliative care groups and organizations to publish on the WWW. The URL is http://www.palliative.org (previously http://www.caritas.ab.ca/~palliate).
The Relationship of Stress, Impulsivity, and Beliefs to Drug Use Severity in a Sample of Women Prison Inmates
Authors: Mooney Jennifer Lynn , Minor Kevin I. , Wells James B. , Leukefeld Carl , Oser Carrie B. , Staton Tindall Michele
Published: November 2007

There is a paucity of research examining substance abuse issues among women prisoners. This study explored relationships between perceived stress, impulsivity, and beliefs in the efficacy of drugs as these variables pertain to self-reported drug use severity. Women prisoners ( N = 100) participated in structured face-to-face interviews based on established research instruments. Although there was no significant correlation between demographic characteristics and substance use severity, positive relationships were found between substance use severity, perceived stress, impulsivity, and beliefs. A multiple linear model was estimated regressing drug use severity on beliefs, impulsivity, and perceived stress. Only the measures of beliefs and impulsivity were significant correlates of drug use severity. Implications are discussed for prison substance abuse programming and future research.
Moving and shaking: business élites, state localism and urban privatism
Authors: Peck Jamie
Published: November 2007

The first barons were landed gentry. In late Victorian times, they were iron and rail magnates. In the earlier half of this century, they were manufacturers, engineers and shipbuilders. Not any more. [Now] the regional barons are jacks of all trades, who made it big with a local company or in property, and now dabble in media, sit on the board of the development corporation, and chair the football club ... everybody know the local Mr Big. He is a man - always a man, unfortunately- who more often than not started with nothing and now dominates business life in the area. Often maverick and outspoken, they are the first names that spring to mind when talking about business. [They] are the movers and shakers (Independent on Sunday 3 January 1993).
Environmental issues
Authors: Smith Keith
Published: November 2007

The year covered by this report (October 1982 to September, 1983) has been characterized by concern for, and development of, existing themes rather than the emergence of totally new issues. This in no way is meant to suggest a static scene. With changing emphases and the achievement of definite progress in certain areas, there is a great deal of significance to report.
Use of satellite-based sensing in land surface climatology
Authors: Greenland David
Published: November 2007

Common types of satellite-derived measurements are reviewed with respect to how they are used to provide information on variables important to land surface climatology. The variables considered include solar radiation, surface albedo, surface temperature, outgoing longwave radiation, cloud cover, net radiation, soil moisture, latent and sensible heat flux, surface cover and leaf area index. A selection of land surface climate modelling schemes is identified and considered with a view to their practicality for use with satellite-derived data. Issues arising from the foregoing considerations include the absence from satellite data of some variables required by land surface climate models, the importance of extreme pixel values in model parameterization, the importance of matching spatial resolution in satellite data and climate model, and the need to have concurrent, independently observed, meteorological data in order to make full use of the satellite data.
Explanations for biogeographic tracks across the Pacific Ocean: a challenge for paleogeography and historical biogeography
Authors: Sluys Ronald
Published: November 2007

Amphi-Pacific organismal distributions form the ingredients of trans-Pacific biogeo graphic tracks, which may either be explained as the result of dispersal or vicariance. Under a vicariance paradigm the classical predrift reconstruction of Pangea cannot adequately explain trans- Pacific tracks. Alternative paleogeographic models that have been invoked as explanations for such tracks are discussed: the lost continent Pacifica, island integration, a new reconstruction of eastern Gondwanaland, and the expanding earth theory. None of these models is fully compatible with all geologic and biogeographic data available at present. Incompatibility of geological and biogeo graphical hypotheses could well result from different time scales involved. It is stressed that biogeographic data and theories should not be made subservient to geological theories but that both biological and geological information should shed their light on the causal explanation of trans- Pacific organismal tracks.
Long-term study of the natural environment - perceptive science or mindless monitoring?
Authors: Burt T.P.
Published: November 2007

The importance of long-term observation of the natural environment has long been recognized, and yet 'monitoring' is often dismissed as low-grade science which can contribute little to our understanding. The value of long-term study is assessed within the context of the Environmental Change Network (ECN) which was established in 1992 to provide a minimum of 30 years' data from a network of sites within the UK. Following a description of the ECN programme, there follows an assessment of the value and limitations of long-term study and consideration of alternative approaches. Three examples of long-term study (Coweeta Hydrologic Laboratory; Radcliffe Meteorological Station; and the Slapton Ley catchment study) are described by way of illustration. It is concluded that long-term study provides an invaluable basis for the development of environmental science. Well designed programmes, supported by sustained funding, provide the best conditions for studying processes whose effects can only be identified over long periods of time and for revealing new questions which could not have been anticipated at the time the monitoring began.