bluuebunny/crossref_metadata_2025 huggingface dataset:
Traumatic elbow luxation in 14 dogs and 11 cats
Authors: Mitchell KE
Published: May 2011

Objective To report the presentation and treatment of traumatic elbow luxation and to evaluate success following closed or open reduction.

Design Retrospective case series conducted between April 1999 and April 2009.

Methods Records of 14 dogs and 11 cats were reviewed for signalment, history, radiographic findings and treatment; 14 owners were contacted via phone questionnaire to assess for limb function following treatment. Fisher's two‐tailed P test was used to evaluate potential risk factors for lameness.

Results The majority of luxations were caused by car accident and 96% of the cases luxated in a lateral direction. Closed reduction was successful in all cats and 11 dogs; 3 dogs required open reduction. Owners rated the animals' limb function as excellent (71%), good (7%), fair (22%) or poor (0%). All cats were rated excellent. An excellent result following closed reduction was achieved in 67% of canine cases. All cases of open reduction achieved fair results. All owners were satisfied with the outcome. No risk factors were significantly associated with post‐reduction lameness.

Conclusions Elbow joints with good stability following closed reduction have a favourable outcome. Poor stability following closed reduction is an indication for surgery. Results suggest that cats tolerate elbow luxation better than dogs.
Acute presentation of autoimmune hepatitis: Does it exist? A published work review
Authors: Takahashi Hiroki , Zeniya Mikio
Published: May 2011

Autoimmune hepatitis (AIH), initially called chronic aggressive hepatitis, is conceptually classified as a primary chronic disease; periportal fibrous expansion and periportal infiltration of mononuclear cells, including plasma cells, have also been considered to be histologically important diagnostic signs of AIH. However, several manuscripts which reported the acute presentation of AIH have been published recently and the reported cases of acute presentation in these manuscripts contained two different clinical entities. One is acute exacerbation of chronic AIH (acute exacerbation form) and the other is genuine acute AIH without chronic histological changes (acute form). It is clinically important to distinguish the acute form from the acute exacerbation form. The reports of the acute form revealed that the existence of centrilobular necrosis without chronic changes was the most important histological finding related to the acute form. Because the elevation of serum levels of immunoglobulin G and antinuclear antibody are not observed in some acute presentation AIH patients, the physician may not consider AIH when they encounter such patients. Therefore, it is very important to bear in mind a possibility of acute presentation AIH when the physician encounters patients with hepatic dysfunction of unknown cause because it became clear that delay of the diagnosis and start of therapy lead to the poor prognosis of AIH. In this review, we outline the current state of acute presentation of AIH including the genuine acute form based on the published clinical studies and case reports.
Risk for Suicidal Thoughts and Behavior after Childhood Sexual Abuse in Women and Men
Authors: Bedi Saaniya , Nelson Elliot C. , Lynskey Michael T. , Mc Cutcheon Vivia V. , Heath Andrew C. , Madden Pamela A.F. , Martin Nicholas G.
Published: May 2011

Earlier studies have found an elevated risk for psychopathology and suicidal behavior associated with childhood sexual abuse (CSA); however, the degree to which risk is mediated by depression and posttraumatic stress disorder (PTSD) in women and men remains unclear. We examined these issues in data from a family study of childhood maltreatment (N = 2,559). We found significant CSA‐associated risk for depression, PTSD, and suicidal behavior for women and men. In survival analyses controlling for these disorders, we observed persistent but somewhat reduced CSA‐associated risk for suicidal ideation and suicide attempt. Our findings suggest that these disorders partially mediate CSA‐associated risk.
Posttraumatic Stress Disorder, Traumatic Brain Injury, and Suicide Attempt History among Veterans Receiving Mental Health Services
Authors: Brenner Lisa A. , Betthauser Lisa M. , Homaifar Beeta Y. , Villarreal Edgar , Harwood Jeri E.F. , Staves Pamela J. , Huggins Joseph A
Published: May 2011

History of posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) has been found to increase risk of suicidal behavior. The association between suicide attempt history among veterans with PTSD and/or TBI was explored. Cases (N = 81) and 2:1 matched controls (N = 160) were randomly selected from a Veterans Affairs Medical Center clinical database. PTSD history was associated with an increased risk for a suicide attempt (OR = 2.8; 95% CI: 1.5, 5.1). This increased risk was present for those with and without a history of TBI. Results support incorporating PTSD history when assessing suicide risk among veterans with and without TBI.
Effects of Combustion Chamber Geometry Deviations Upon Exit Temperature Profiles for Populations With Varied Service Limitations
Authors: Kotzer Clayton , LaViolette Marc , Allan William , Asghar Asad
Published: May 2011

The purpose of this continuing research was to investigate the effects of combustion chamber geometry on exit temperature fields using a validated ambient pressure test rig. Rig test conditions were set to simulate an engine operating condition of 463 km/h (250 kn) at 7620 m (25,000 ft) by matching Mach number, equivalence ratio, and Sauter mean diameter of the fuel spray. Using a thermocouple rake, high resolution temperature measurements were obtained in the combustion chamber exit plane. Following the previously published procedures, a three-dimensional laser scanning system was used to quantify geometric deviations from two populations of combustion chambers. These populations differed in that one had a significantly higher allowable engine operating temperature for continuous cruise condition. Geometric deviations of both populations were compared with the reference model. The relationship between combustion chamber exit temperature profile and geometric deviation of each population was then compared. The main conclusion of this research was that the temperature profile degradation of both populations due to geometric deviations followed similar trends. These results highlighted that the difference in operating limitations of these populations did not significantly affect component performance.
Impact of Orifice Angle Configurations on the Droplet Atomization Enhancement of Diesel Fuel in a Group-Hole Nozzle
Authors: Suh Hyun Kyu , Lee Chang Sik
Published: May 2011

This paper presents the effect of orifice configuration on the droplet atomization characteristics of diesel fuel injected through different types of group-hole nozzle angles, which are converged (θ=−3 deg), parallel (θ=0 deg), and diverged (θ=+3 deg) orifices in atmospheric pressure and room temperature condition (0.1 MPa, 293 K). It was revealed that the parallel hole nozzle has the largest Sauter mean diameter (SMD) value and both sprays from diverged and converged hole nozzles show better atomization. A comparison of spray tip penetration illustrates that as the orifice angle is converged, spray tip penetration becomes longer, and it must be the reason for the fast spray velocity. These results can confirm the relationship among time, distance, and velocity. Therefore, it can be concluded that the droplet atomization enhancement can be expected in the converged nozzle spray rather than in the parallel and diverged nozzle sprays based on the results of smaller SMD, faster velocity, better air utilization, and higher percentage of small size of droplets in the measuring area.
Thermal Properties of PVP Cryoprotectants With Nanoparticles
Authors: Hao Baotong , Liu Baolin
Published: May 2011

Vitrification is an effective way for the cryopreservation of cells and tissues. The critical cooling rates for vitrification solution are relatively high. It is reported that nanoparticles can improve the heat transfer properties of solutions. To increase the heat transfer coefficient of aqueous cryoprotectant solutions, Hydroxyapatite (HA) nanoparticles were added into Polyvinylpyrrolidone (PVP) solutions (50%, 55%, and 60%, w/w). The glass-transition temperature, devitrification temperature, and specific heat of PVP aqueous solutions with/without HA nanoparticles (0.1%, 0.5%, and 1%, w/w) were measured by a differential scanning calorimeter at a cooling rate of 20°C/min and a warming rate of 10°C/min. The change in density of the above solutions with temperature was determined by using a straw that can reveal the volume change of solutions. The thermal conductivity was calculated based on the experimental data. A device that can be used to measure the thermal conductivity of vitrification solutions with/without nanoparticles was developed in this study. The results showed that the glass-transition temperature, devitrification temperature, and specific heat of PVP aqueous solutions with HA nanoparticles are larger than those without HA nanoparticles. The thermal conductivity of solutions with HA nanoparticles is larger than those without HA nanoparticles at a specific temperature. The lower the temperature, the smaller the difference in thermal conductivity between the solutions with and without HA nanoparticles. The calculated thermal conductivity meets the measured data well.
Vibration Reduction of a Floating Roof by Dynamic Vibration Absorbers
Authors: Utsumi M.
Published: May 2011

This paper investigates the use of dynamic vibration absorbers as a means to reduce the vibration of a floating roof due to sloshing caused by long-period earthquakes. It is shown that the damping ratio of the primary system caused by the dynamic vibration absorbers increases with rising filling level, hence increasing the probability of liquid overspilling, although the ratio of the vibration absorbers’ mass to the liquid mass decreases as the filling level rises. We also study dynamic vibration absorbers that can be more easily tuned to the filling-level dependent sloshing frequency. A feature of these vibration absorbers is that they use time-integral feedback of the primary structure’s displacement near the tuning frequency unlike ordinary vibration absorbers. Computer simulation is carried out using a sinusoidal wave function and an actual earthquake ground motion record as the excitation applied to the tank.
Diagnosis and Spectral Encoding in Integral Medicine Through Electronic Devices Designed and Developed by Path Integrals
Authors: Bulnes Francisco , Bulnes Francisco H. , Alvarez Eduardo Hernandez , Maya Juan Carlos
Published: May 2011

In integral medicine the spectral and vibration knowledge of the vital field in all points and parts of the human body, which is feasible in the application of their pharmacists in a space of states of energy (Chopra, 1989, Quantum Healing: Exploring the Frontiers of Mind/Body Medicine, Bantam Books, New York; Bulnes et al., 2010, “Integral Medicine: New Methods of Organ-Regeneration by Cellular Encoding Through Path Integrals Applied to the Quantum Medicine,” J. Nanotechnol. Eng. Med., 1, p. 031009) encoding points or regions of the human body, requires to recover the alignment, connectivity, and continuity of the field, and of that form to obtain the cure of different affections and sufferings. Using the spectral-vibration characteristic of the singularities of the vital field (Bulnes, F., 1998, Treatise of Advanced Mathematics (Monograph of Analysis of Systems and Sign Vol. I), 1st ed., Faculty of Sciences, UNAM, Mexico), and their medical similitude (Stumpf, 1990, Homoopathie, Everest, Grafe und Unzer GmbH, Munich, Germany), the design and development of an electronic device with the capacity of detection and diagnosis of a suffering in all parts of body are proposed. Afterward, wanting to unify the concepts of recovering the vital field of the human body (recovering of their alignment, connectivity, and continuity), under a same principle of the stability of their atoms, an electronic theory using an electronic bundle that can realize the synergic action of all and each of the formulas and pharmacists in integral medicine, to the cure of all sufferings, is proposed.
Clamped-Free Single-Walled Carbon Nanotube-Based Mass Sensor Treated as Bernoulli–Euler Beam
Authors: Elishakoff I. , Versaci C. , Maugeri N. , Muscolino G.
Published: May 2011

In this study, we investigate the vibrations of the cantilever single-walled carbon nanotube (SWCNT) with attached bacterium on the tip in view of developing the sensor. This sensor will be able to help to identify the bacterium or virus that may be attached to the SWCNT. Two cases are considered: These are light or heavy bacteria attached to the nanotube. The problem is solved by the exact solution, the finite difference method, and the Bubnov–Galerkin method.
Double Diffusive Natural Convection Heat Transfer Enhancement in a Square Enclosure Using Nanofluids
Authors: Esfahani Javad Abolfazli , Bordbar Vahid
Published: May 2011

Double-diffusive natural convection flow in square enclosure filled with nanofluid is studied in this paper. Water based nanofluid containing various nanoparticles including Cu, Ag, Al2O3, and TiO2 is used in the numerical analysis. The upper and lower walls of the enclosure are well insulated and impermeable and the left and right walls are imposed to constant temperatures and concentration. Laminar regime under steady state condition is considered. The Maxwell–Garnett model is used to predict the ratio of thermal conductivity. The system of conservation equations consisting of continuity, momentum, energy, and solute concentration in dimensionless form are solved by using finite volume SIMPLE algorithm. Results are presented for different values of the governing parameters Rayleigh and Lewis number, in terms of streamlines, isotherms, isoconcentration, local Nusselt number, and local Sherwood number. The effect of nanoparticle volume fractions are also discussed on heat transfer characteristics in the cavity.
Synthesis and Characterization of Novel Modified SBA-15/PSF Nanocomposite Membrane Coated by PDMS for Gas Separation
Authors: Jomekian A. , Pakizeh M. , Poorafshari M. , Mansoori S. A. A.
Published: May 2011

SBA-15 nanoparticles were prepared by in situ assembly of inorganic precursors and CTAB. The structure of nanoparticles was characterized by X-ray diffraction, transmission electron microscopy, particle size analysis, and N2 adsorption techniques. The surface modification of particles in order to perfect dispersion in PSF matrix was performed by DMDCS and APTMS as new modification agents. Thermogravimetric analysis and scanning electron microscopy analysis were applied to investigate thermal stability and quality of distribution of particle in the nanocomposite membrane, respectively. The PDMS was used to coat the possible defects of synthesized membranes. For all gases (N2, CO2, CH4, and O2), the permeance of uncoated DMDCS modified SBA-15/PSF (20 wt %) raised from 16 to 31.6, 0.47–0.99, 0.45–1.1 and 2.75–5.33 for CO2, N2, CH4, and O2, respectively in comparison with PSF. The corresponding values of CO2, N2, CH4, and O2 permeances through uncoated APTMS modified SBA-15/PSF (20 wt %) enhanced to 29.12, 0.8, 0.85, and 4.75 respectively, compared with neat PSF membrane. The ideal selectivities of CO2/CH4 and O2/N2 for DMDCS modified SBA-15 (20 wt %) nanocomposite membranes coated by 30 wt % PDMS solution enhanced from 26 to 35 and from 5.4 to 7.1, respectively. Using APTMS as modification agent resulted in higher selectivity of CO2/CH4 (38.2) and O2/N2 (7.2) than those of DMDCS modified. The measured actual selectivities of CO2/CH4 and O2/N2 and permeances of all gases tested are a few amounts lower than ideal selectivities and permeances of gases in single gas permeation tests but are still much higher than those for pure PSF.
Equilibrium, Stability, and Dynamics of Rectangular Liquid-Filled Vessels
Authors: Trahan Russell , Kalmár-Nagy Tamás
Published: May 2011

Here we focus on the stability and dynamic characteristics of a rectangular, liquid-filled vessel. The position vector of the center of gravity of the liquid volume is derived and used to express the equilibrium angles of the vessel. Analysis of the potential function determines the stability of these equilibria, and bifurcation diagrams are constructed to demonstrate the co-existence of several equilibrium configurations of the vessel. To validate the results, a vessel of rectangular cross section was built. The results of the experiments agree well with the theoretical predictions of stability. The dynamics of the unforced and forced systems with a threshold constraint is discussed in the context of the nonlinear Mathieu equation.
e-bra With Nanosensors for Real Time Cardiac Health Monitoring and Smartphone Communication
Authors: Varadan Vijay K. , Kumar Prashanth S. , Oh Sechang , Kegley Lauren , Rai Pratyush
Published: May 2011

Mortality due to cardiac related ailments has been consistently higher in women as compared with men since the early 1980s in the United States. Gender related differences in specificity of regular noninvasive diagnostic tools and the lack of a clear understanding of the effect of postmenopausal hormonal changes in women have been cited as the two main reasons for this disparity. Recent advances in secondary and tertiary diagnostic information extraction techniques from signals such as electrocardiogram (ECG) through heart rate variability (HRV) analysis and wavelet domain analysis techniques have revealed many differences in autonomic nervous-cardiovascular activity regulation, between men and women. Moreover, the diagnostic tests for cardiovascular diseases usually start upon the manifestation of chest pain or angina. At this stage, disease management is the only option as opposed to preventive treatments, which is also possible with early detection based on the diagnostic information extraction techniques as stated previously. In order to truly realize the potential of such techniques, continuous and long-term monitoring is an essential requirement. This, in turn, requires sensor systems to be seamlessly mounted on day to day clothing for women. This paper describes an e-bra platform for nanosensors toward cardiovascular monitoring. The sensors, nanomaterial, or textile based dry electrodes acquire electrocardiograph, which is sent to a textile mounted wireless module. A smartphone or a wireless Bluetooth enabled PC can receive these data and store or process the information as necessary. In this paper, we wirelessly acquire ECG from subjects with the e-bra and perform HRV analysis on a PC. The use of a Smartphone as a base station for receiving data offers the advantage of cellular network connectivity to internet and consequently cloud computing resources for more complex computations such as feature extraction and automatic diagnosis. To address this capability, we further propose a protocol for response to emergencies from both the cloud backend and the smartphone itself.
The Visual Impact of Gossip
Authors: Anderson Eric , Siegel Erika H. , Bliss-Moreau Eliza , Barrett Lisa Feldman
Published: May 2011

Negative gossip about a person renders that person’s face more visible to the onlooker.
Chromatin “Prepattern” and Histone Modifiers in a Fate Choice for Liver and Pancreas
Authors: Xu Cheng-Ran , Cole Philip A. , Meyers David J. , Kormish Jay , Dent Sharon , Zaret Kenneth S.
Published: May 2011

Screening histone modifications reveals distinctive patterns of chromatin marks for liver and pancreas development.
Predicting a Human Gut Microbiota’s Response to Diet in Gnotobiotic Mice
Authors: Faith Jeremiah J. , McNulty Nathan P. , Rey Federico E. , Gordon Jeffrey I.
Published: May 2011

Model microbial communities in mouse guts respond quickly and predictably to dietary shifts.
Shedding Light on Oxide Interfaces
Authors: Hammerl German , Spaldin Nicola
Published: May 2011

The properties of a metallic oxide can be altered when it is confined as an ultrathin layer by layers of an insulating oxide.
Widespread RNA and DNA Sequence Differences in the Human Transcriptome
Authors: Li Mingyao , Wang Isabel X. , Li Yun , Bruzel Alan , Richards Allison L. , Toung Jonathan M. , Cheung Vivian G.
Published: May 2011

All 12 categories of discordances can be observed where the RNA sequence does not match that of the DNA.
Truly Multidimensional

Cave of Forgotten Dreams
Werner Herzog, Director

Creative Differences Productions and History Films, France/Canada/USA/UK/Germany, 2010. 90 minutes. www.caveofforgottendreams.co.uk
Authors: Wills Stewart
Published: May 2011

Filmed during a few short trips into France's Chauvet Cave, Herzog's 3D documentary presents arresting imagery of the cave's paintings in their natural setting.
Spain's 'Lonely Fighter' Steps Down Amid a Highly Public Spat
Authors: Pain Elisabeth
Published: May 2011

Mariano Barbacid is leaving the helm of Spain's flagship cancer center, the National Cancer Research Centre, the way he has spent much of his time there: fighting fiercely.
Fukushima Revives The Low-Dose Debate
Authors: Normile Dennis
Published: May 2011

The general public avoided exposure to high levels of radioactivity, but questions linger about the long-term effects of contamination.
Crippled Reactors to Get Cooled and Wrapped
Authors: Normile Dennis
Published: May 2011

The crisis at the stricken Fukushima Daiichi nuclear power plant is far from over. Some 100,000 residents who were evacuated will not return home until the reactors are firmly under control.
Seismic Crystal Ball Proving Mostly Cloudy Around the World
Authors: Kerr Richard A.
Published: May 2011

Failing at quake prediction, seismologists tried making fuzzier forecasts, but Japan's megaquake is only the latest reminder of the method's shortcomings.
Defining asymptomatic status following sports concussion: fact or fallacy?
Authors: Alla Sridhar , Sullivan S John , McCrory Paul
Published: May 2011

The current management of sports concussion involves a return to the baseline 'asymptomatic' status prior to returning to play and training. Unfortunately, although the term 'asymptomatic' is widely used it has not been operationally defined. This review identifies the need to formally define the term 'asymptomatic' as used in sports concussion, discusses some of the challenges associated with its definition and offers some possible solutions for further debate. The operational definition of the term 'asymptomatic' may provide the stimulus for further informed discussion at a future meeting of the international Concussion in Sport group, and by other peak sports medicine bodies involved in management guideline development.
The extension of smoke-free areas and acute myocardial infarction mortality: before and after study
Authors: Villalbí Joan R , Sánchez Emília , Benet Josep , Cabezas Carmen , Castillo Antonia , Guarga Alex , Saltó Esteve , Tresserras Ricard ,   for the Barcelona Group for Smoking Regulation Policies Evaluation
Published: May 2011

Objectives

Recent studies suggest that comprehensive smoking regulations to decrease exposure to second-hand smoke reduce the rates of acute myocardial infarction (AMI). The objective of this paper is to analyse if deaths due to AMI in Spain declined after smoking prevention legislation came into force in January 2006.

Design

Information was collected on deaths registered by the Instituto Nacional de Estadística for 2004–2007. Age- and sex-specific annual AMI mortality rates with 95% CIs were estimated, as well as age-adjusted annual AMI mortality rates by sex. Annual relative risks of death from AMI were estimated with an age-standardised Poisson regression model.

Results

Adjusted AMI mortality rates in 2004 and 2005 are similar, but in 2006 they show a 9% decline for men and a 8.7% decline for women, especially among those over 64 years of age. In 2007 there is a slower rate of decline, which reaches statistical significance for men (−4.8%) but not for women (−4%). The annual relative risk of AMI death decreased in both sexes (p<0.001) from 1 to 0.90 in 2006, and to 0.86 in 2007.

Conclusion

The extension of smoke-free regulations in Spain was associated with a reduction in AMI mortality, especially among the elderly. Although other factors may have played a role, this pattern suggests a likely influence of the reduction in population exposure to second-hand smoke on AMI deaths.
Measuring symptoms at the end of life using the Edmonton Symptom Assessment System
Authors: Forbes K , Gibbins J , Burcombe M E , Bloor S J , Reid C M , McCoubrie R C
Published: May 2011

Introduction and aims

The Edmonton Symptom Assessment System (ESAS) has been validated for patient-completed, caregiver-assisted and caregiver-rated scoring of patients' symptoms, enabling symptom recording to continue as patients deteriorate. However, it has not been used to assess symptoms at the end of life specifically. We aimed to assess the utility of ESAS in scoring symptoms in the dying patient.

Methods

70 patients were recruited; 40 before and 30 following the introduction of a simple end-of-life (EOL) care tool. Nursing staff were asked to complete 12 hourly ESAS scores from the time the ‘diagnosis of dying’ was made until death.

Results

249 of a required 418 (59%) ESAS were completed in the pre- and 140 of 302 (46%) in the post-implementation group. 29/40 (72%) and 25/30 (83%) patients had an ESAS completed in the last 24 h in pre- and post- groups respectively. Comparison of scores for EOL symptoms before and after the introduction of the tool showed less symptom burden in the group where the tool was used. The differences in scores with 95% CIs (0–100 scales) were: pain 12.4 (−2.3 to 27.1); shortness of breath 11.7 (−6.2 to 29.6); anxiety 7.3 (−7.8 to 22.5); nausea 5.9 (−2.6 to 14.5) and secretions 12.3 (−6.7 to 31.3).

Conclusion

The amount of missing data suggests 12-hourly ESAS scoring was onerous for ward staff and would not therefore capture longitudinal symptom changes. However, ESAS was useful for assessing symptoms in the last 24 h of life, enabling comparison between the two groups.
Evidence driven practice and rapid learning in supportive and palliative care
Authors: Abernethy A P
Published: May 2011

Evidence-Based Medicine, more broadly termed ‘evidence-based practice’, is now recognised throughout medicine as routine approach to care, whereby research-derived evidence is incorporated into clinical decisions. Care is based on systematic and explicit appraisal, synthesis of information and integration of new information within the context of individual patient circumstances. Many of the barriers to evidence-based practice in palliative care are surmountable, provided they are critically considered and practical solutions developed. First and foremost, we must have evidence; generating evidence in palliative care is achievable.

Following on the heels of evidence generation is evidence implementation – the practical introduction of new information into clinical practice. Rapid learning is a model for systematic evidence development and implementation whereby the care of each individual patient is reinvested into linked continuously-accumulating databases so that the care of an individual person is informed by all people before her with similar circumstances, and lessons learned from her care are incorporated into aggregating knowledge of best practice for the future. Recent findings suggest that a rapid learning system for palliative and supportive care is feasible and acceptable to patients with advanced illness, helps monitor symptoms over time, facilitates study of the impact of novel interventions, and can identify unrecognised needs and concerns.
Treatment burden in end stage heart failure (ESHF): a qualitative study
Authors: Mair F S , Browne S , Morrison D , Gallacher K , Macleod U , May C R
Published: May 2011

Introduction and aims

Heart failure (HF) is as ‘malignant’ as many common cancers. It is known that end stage heart failure (ESHF) symptoms have a negative impact on the daily lives of patients who also feel unsupported. The aim of this study is to examine patient experiences of managing their condition, with a particular focus on their ‘treatment burden’, defined as the ‘work’ they do to manage their condition, including reference to the services they use and how they negotiate and mobilize these. It is essential to understand these issues if we are to be able to design more patient centred services.

Methods

This study involves semi-structured interviews with ESHF patients focusing on the work they do to manage and ‘live’ with their condition. Qualitative data analysed using framework methods informed by Normalization Process Theory. Inclusion criteria: at least Grade 3 or 4 NYHA classification HF; who have ongoing symptoms despite optimal therapy; and have a history of admissions for this condition.

Results

33 patients identified, 21 consenting to participation. 16 male; 5 female. Patients described a vast range of treatment burdens many which were secondary to the health care systems and the lack of a patient centred approach. Issues raised included: the work imposed by disorganised systems of care necessitating multiple attendances for check-ups and investigations; lack of continuity; inadequate communication between health professionals; polypharmacy; and difficulties accessing services.

Conclusions

This study has highlighted a range of challenges for patients posed by current health care systems, highlighting clear points for intervention.
Moving Forward – Developing an information resource for breast cancer patients at the end of hospital based treatment
Authors: Scanlon K , Reed E , Wray J , Fenlon D
Published: May 2011

Background

Following completion of hospital based treatment breast cancer patients often feel isolated and abandoned and report a lack of information and support to address their recovery needs. Feedback from service users at Breast Cancer Care identified a need for a resource at the end of breast cancer treatment. In collaboration with our Service User Research Partnership (SURP) group we set about designing and delivering this study.

Aims

To develop a resource for breast cancer survivors based on their identified unmet information and support needs and user feedback.

Methods

A qualitative mixed method approach:

Phase 1:

▶

Two Focus groups with 12 women at the end of hospital based treatment.

▶

Telephone interviews of 12 healthcare professionals.

Phase 2:

▶

Reconvened focus groups and email review of healthcare professionals to critique a prototype resource.

Results

Resource content was informed by the conceptual framework developed from interview analysis which identified a process of reconciliation – ‘reflection’, ‘isolation’, ‘loss of self’ and ‘moving forward in life’. Participants wanted a comprehensive resource that could be individually tailored and includes self management strategies Real-life experiences of patients, signposting to other resources and usefulness over time were also considered important.

Conclusion

This is the first information resource for breast cancer survivors in the UK. It has considerable potential to improve the experiences of many living with breast cancer. Further, it will assist healthcare professionals in the care of their patients at the transition from active treatment to survivorship. SURP involvement has strengthened the quality of the research.
How good is palliative care at following the MRC new guidance on complex interventions?
Authors: Evans C J , Higginson I J
Published: May 2011

Introduction

Improved and cost-effective palliative care services are required to advance care for patients, their families and society. Service developments are however, often ad hoc with limited evaluation and little research investment. MORECare (MRC/NIHR) is developing research methods to evaluate the effectiveness of such serviceshttp://www.csi.kcl.ac.uk/morecare.html.

Aims

To systematically review the application of effectiveness research methods in evaluations on models of service delivery in palliative care To synthesis ‘best practice’ and identify contentions or uncertain areas that require methodological debate.

Methods

We drew on narrative synthesis to systematically search 6 electronic databases and the bibliographies of the included papers. We included systematic reviews on the effectiveness of palliative care services for patients and/or their families with advanced progressive malignant/non-malignant disease. The MRC New Guidance structured the data synthesis with quality assessment to examine robustness.

Results

35 systematic reviews met the inclusion criteria. The findings indicate a disparate application of the MRC guidance. Prominent areas include debate on evaluating effectiveness (eg, outcome measurement), while less attention is given to intervention development and modelling, leading to a prominence of weak trial design. The implementation of evidence into clinical practice is the weakest area.

Conclusion

The MRC guidance is rarely used in its entirety. Application and development of some components is evident, but methodological discussions concern challenges to undertaking effectiveness research and the weaknesses of the research methods. Opportunities for innovation in trial design are apparent, particularly intervention development and modelling. Innovation in research methods is imperative to strengthen the evidence base.
Impact of information intervention on social distress; a randomised pilot study
Authors: Ingleson E J , Hector C , Campbell L , Bartlett Y , Brown J , Wright P , Velikova G
Published: May 2011

Introduction and aims

Unresolved social difficulties are prevalent in oncology patients, can impact on well-being and undermine ability to cope with the larger stressors of disease and treatment. Information may deal with psychosocial issues without over-burdening staff. A randomised pilot study investigated the impact of a specifically designed Support Services Information Pack (SSIP) on levels of social distress in routine practice.

Methods

The SSIP was designed and evaluated. Adult patients receiving active treatment were randomised to intervention or control group. The Social Difficulties Inventory (SDI-21) assessed the severity of social difficulties at baseline and after the last of four review consultations. The intervention group received the SSIP prior to the second consultation. The sum of 16 of the SDI-21 items was used to provide an overall index of social distress (SD-16, range 0 to 44). All participants were interviewed on completion. Counts were taken of the number that used the SSIP. Analysis of covariance tests compared mean SD-16 scores.

Results

Participants: 165 patients were approached, 88 consented and 75 completed the study. Complete SD-16 data was available for 70 patients. The SSIP was not extensively used; the majority of patients read it but took no action, but may use it in future (67%). The mean SD-16 scores were 8.53 for the intervention group (95% CI 7.1 to 9.9) and 8.25 for the control group (CI 6.7 to 9.8).

Conclusion

During this pilot study the SSIP was not used. Timing of delivery of the intervention will be investigated in future trials.
Management of emotional distress in cancer patients: is there a role for antidepressants?
Authors: Holch P , Absolom K L , Pini S , Hill K , Liu A , Sharpe M , Richardson A
Published: May 2011

Introduction

Depression is common in cancer patients and often associated with increased morbidity, hospitalisation and reduced quality of life. Current opinion supports the use of antidepressants (AD) for moderate and severe depression in physical illness. However, AD may be inadequately prescribed to oncology patients and factors other than need may influence prescribing practice.

Aims

To explore oncology professionals views on the use of AD in the management of emotional distress in cancer patients.

Methods

18 randomly selected professionals from the Yorkshire Cancer Network (oncologists, surgeons, clinical nurse specialists and ward nurses) participated in a qualitative interview study. To explore their views on AD use in oncology they were asked: What leads you to prescribe AD? or Do you have any views on the use of AD? key themes were extracted via framework analysis.

Results

Despite recognising the value of AD in cancer care, professionals were reluctant to prescribe AD stressing a lack of knowledgeI would be very worried about my ability to do thatand overwhelmingly saw the general practitioner (GP) as most appropriate for this role. Overreliance on AD was voiced as were views that taking AD was defeatistmedicating them is a slippery slope.

Conclusion

These findings highlighted a need for training on the use of AD in cancer care and to counteract negative views contributing to exclusion from treatment plans. A key prescribing role for the GP is described however it is unclear whether referrals are made. Future work should determine the role of the GP and map prescribing patterns elsewhere.
Comparison of clinicians' and advanced cancer patients' estimates of survival
Authors: Gwilliam B , Keeley V , Todd C , Gittens M , Roberts C , Kelly L , Barclay S , Stone P
Published: May 2011

Aims

To determine whether doctors, nurses or the multi-professional team (MPT) are better at prognosticating in advanced cancer. To determine which clinician factors influence prognostic accuracy. To investigate patients' views about receiving prognostic information and to evaluate the accuracy of their own estimates.

Methods

As part of a large prospective multi-centre study to develop a novel prognostic scoring system for patients with advanced cancer, clinicians were asked to estimate whether patients were expected to live for ‘days’, ‘weeks’ or ‘months+’. Patients were asked whether and how they would wish to receive prognostic information and whether they would be willing/able to estimate their own prognosis. Survival was calculated from date of study entry. Prognostic accuracy of different groups was compared using linear weighted κ (LWK).

Results

1018 patients with advanced cancer were studied; 127 doctors, 281 nurses and 290 patients provided 829, 954 and 290 prognostic estimates respectively. MPT estimates were available for 987 patients. LWK varied between 0.14 (patients) and 0.46 (MPT). Patients' estimates were significantly worse than doctors', nurses' or MPT estimates (all p<0.001). Nurses' estimates were significantly worse than the MPT estimate (p=0.007). No clinician factors (age, gender, experience or grade) were consistently associated with better prognostic accuracy. Most patients (61.4%) wanted to know their prognosis of whom 48% wanted to know it ‘approximately’ and 52% wanted to know ‘exactly’.

Conclusion

Most patients wish to know their prognosis. Clinicians' predictions are inaccurate and patients' predictions are significantly worse. MPT estimates are the most accurate.
Palliative care delivery in Kenya and Malawi: a review of models
Authors: Grant L , Downing J , Leng M , Namukaya L , Murray S A
Published: May 2011

Introduction and aims

There is an urgent need to develop serviceable models of palliative care. A case study evaluation of eight palliative care programmes in Kenya and Malawi was undertaken to define the current models, understand their context, identify challenges and explore transferable lessons.

Methods

A desk based review was conducted on the health environment and systems. Eight sites were visited and interviews held with staff, community and local health leaders.

Results

Models of palliative care fell into three categories – specialist, district hospital, and rural health clinic/community level. Staffing levels and the type of work undertaken were influenced by the model, but lack of support systems meant that all models ended up delivering a mix of services. All consistently emphasised pain relief, symptom management and comprehensive care, but differed in their integration into mainstream services, and ability to understand and actively respond to dynamic patient need. This was influenced by staff knowledge, and level of clarity on staff roles. Questions arising in terms of the models of care include ‘who shapes the work?’, ‘who delivers the work?’, ‘who plans the working day?’, ‘who defines what palliative care is?’, ‘who manages changing patient needs? and ‘is the model patient or professional centred? ‘Challenges include the diversity of diseases and need, limited referral options, the tendency to ‘be everything for everyone’, and the speed of scaling up of services.

Conclusion

Stand alone models of palliative care have evolved, but many are trying to deliver beyond capacity. When developing a programme, questions on defining the role of palliative care, who and how work is delivered, and support networks need to be asked.
Determining cost-effectiveness of advanced cancer care: a systematic review of economic models
Authors: Hulme C , Browne C , Mansfield J , Pavitt S , Hall P S , Bennett M I
Published: May 2011

Aim

To determine the strengths and limitations of current approaches used in economic analyses of advanced cancer care.

Methods

We conducted a systematic review of EMBASE, AMED, PsycINFO, CINAHL, and MEDLINE from inception to June 2010 using search terms advanced or terminal illness, cancer, and cost or economic studies. We included studies that reported economic evaluations using decision analytical models, within patients with advanced cancer, with any intervention and published in English. We extracted data on health system context, model type, model time horizon and model outcomes.

Results

28 papers were eligible for inclusion, the majority of these were undertaken in Europe or USA. 17 Markov models and 10 decision trees were identified. Most (z) models used lifetime horizons but (x) used curtailed horizons without any clear rationale between studies for time horizon selected. Model outcomes varied; most used quality of life (QOL), but some used survival, and one estimated the likelihood of effective pain management. Measurement of QOL was the most commonly cited limitation in all models. (Z) studies relied on healthcare professionals' valuations of QOL rather than patients' own valuations.

Conclusion

We found no consistent model type or time horizon used in studies assessing cost effectiveness of interventions in advanced cancer. In models with shorter durations, additional future costs such should be considered such as those related to further operative procedures, or palliative treatments. The validity of these models may be weakened by using utility values that are not derived directly from patients with advanced cancer.
A checklist for reporting factor analysis in palliative care research
Authors: Ramsenthaler C , Siegert R J , Higginson I J
Published: May 2011

Background

Factor analysis (FA) is a statistical technique that analyses underlying relationships in a data set. It is mainly used in the development and validation of questionnaires. Since valid outcome measures have become important in palliative care, criteria to judge the quality of FA are needed.

Aims

To systematically review the current use and reporting of either exploratory or confirmatory FA and recommendations for FA, in order to design a checklist for reporting FA in the field of palliative care.

Methods

In this systematic literature review, a hand search identified all studies using factor analytical techniques published in the four peer-reviewed journals Palliative Medicine, Journal of Pain & Symptom Management, Journal of Palliative Medicine, and the Journal of Palliative Care (inception – Mai 2010). Included were studies of any design, except reviews, reporting the results of one or several exploratory or confirmatory FA.

Results

In 575 issues screened, 189 factor analytical studies were identified. Since the year 2000, FA has increasingly been applied in palliative care. It is mainly used in the development of new measures, to create subscales and to assess the multidimensionality of a measure, or in the evaluation (eg, translation) of an existing measure. The frequencies of different criteria (eg, ratio of sample size to number of items, factor extraction models, criteria for retaining factors, rotation techniques) will be analysed. On this basis, recommendations will be designed.

Conclusion

The checklist developed provides guidance for journal editors, clinicians and researchers who need to judge or report a FA in palliative care.
The social difficulties of cancer patients of South Asian Indian and Pakistani origin
Authors: Dharni N , Hanif N , Bradley C , Velikova G , Stark D , Wright P
Published: May 2011

Introduction

Cancer patients experience psychosocial and informant needs. The National Cancer Survivorship Initiative recommends a shift towards assessment, information provision, personalised care planning and support for self-management including assessment within the social domain. This shift may be particularly difficult to implement with people for whom the language and culture do not fit with the majority.

Aims

In a sample of patients of South Asian (SA) origin to:

evaluate feasibility and acceptability of introducing assessment of social difficulties in everyday practice,

examine the range and severity of reported social difficulties,

inquire about their management.

Methods

A cross-sectional study in which participants completed the Social Difficulties Inventory (SDI-21) in English, Urdu, Punjabi or Hindi followed by a semi-structured interview (subjected to Framework Analysis).

Results

26 men and 29 women (age range 18 and 80) with a range of diagnoses participated. Commonest primary languages were Urdu (n=17), Punjabi (n=17). SA cancer patients would welcome routine assessment of social difficulties as part of cancer care. They reported higher levels of social distress than found in earlier studies of white British patients. The majority self-managed their social difficulties with little discussion with clinicians, although this would have been welcomed. SA patients lacked information and were unaware of available support, especially when language was a barrier.

Conclusion

Inclusive introduction of routine psychosocial assessment into cancer care requires not only appropriate screening tools but also staff trained to respond to the difficulties with knowledge of relevant information and supportive care services.
Managing employees with mental ill health
Authors: Walsh Luke , Ravetz Gudrun
Published: May 2011

In recent years, several reports have looked at the occupational health of doctors and dentists. Many of the health problems experienced by this group are also relevant to veterinary surgeons. In this article, Luke Walsh and Gudrun Ravetz discuss some of the recommendations set out in these reports and highlight their relevance for the veterinary profession. In particular, they consider the role of occupational health services in the management of mental ill health in veterinary surgeons.
Pet insurance problem
Authors: Cousquer Glen
Published: May 2011

Your manager reprimands you for including details of a newly identified condition in the clinical notes of a client's dog. The client has very recently taken out pet insurance and thus risks being refused cover for the investigations and treatment you are proposing. This is a long‐standing client with limited means. Your manager suggests that you omit such details in future until the owner has secured the necessary pet insurance and points out that any misrepresentation would therefore be committed by the owner. You feel uncomfortable with this instruction. How should you proceed?