bluuebunny/crossref_metadata_2025_split huggingface dataset:
22 GP perceptions of the adequacy of community-based care for patients with advanced heart failure in a uk region (NI): a qualitative study
Authors: Graham-Wisener Lisa , Chen Jingwen Jessica , Gamble Kathryn , McGlade Kieran , Doherty Jennifer , Donnelly Patrick , Stone Carol A 
Published: August 2018

IntroductionAlthough there is recognition of the multi-dimensional needs of patients with advanced heart failure (HF) conventional models of care have traditionally been medically focused. It is unknown whether community-based systems and services have improved and adapted to better meet the emotional social functional and medical needs of patients with HF and their families.AimsTo assess the adequacy of community-based services available in Northern Ireland (NI) to meet the multidimensional needs of patients living with New York Heart Association Stage III and IV HF as experienced and perceived by general practitioners (GP).MethodsSemi-structured interviews were conducted with GPs. Interviews were transcribed independently coded and analysed using a six-step thematic analysis approach.Results20 semi-structured interviews were conducted. GPs reported managing patients in a ‘reactive rather than proactive’ way responding only to acute medical needs with hospital admission the default due to lack of community-based services. Care provided by HF specialists was highly regarded but ‘access and coordination’ were lacking. Conversations regarding current and future care needs were considered important but challenging due to time constraints and prognostic uncertainty. GPs expressed that ‘specialist palliative care (SPC) is only a credible option in end stages’ related to limited understanding of the scope of SPC and concern that SPC services are cancer-focused.ConclusionsDespite recent evidence for the effectiveness of integrated SPC in improving quality of life for patients with HF health and social care services within NI have not yet adapted to assess and meet these needs.
27 Understanding public attitudes: a crucial component for developing palliative care services
Authors: Islam Ishrat , Byrne Anthony , Nelson Annmarie 
Published: August 2018

IntroductionA major challenge in developing new models of palliative care is to identify the current needs of the public patients and carer (Dixon 2015). There is a lack of evidence on people’s attitudes towards end of life care (EoLC) in Wales.AimTo increase understanding of people’s feelings views knowledge and preferences around EoLC.MethodAn online survey was conducted using an electronic survey tool. Descriptive statistics and thematic analysis were used to perform data analysis.Results2210 people (Age: Mean +SD; 55+14 years) participated in the survey 43% of those were members of the general public 29% were patients/carers and 23% were health professionals. 49% of respondents thought that available palliative care was inadequate and 92% believed that end of life care for dying people should have equal priority for the NHS. 95% of respondents thought that expressing preferences around EoLC in advance was important but only 13% had done this in practice and 60% did not know how to plan their EoLC. However the top three needs in EoLC were identified as having a trained carer (84%) access to other professionals (59%) and emergency care (44%). The top three preferences for EoLC were being surrounded by loved ones (62%) maintaining dignity (55%) and a feeling of peace (40%). Just 24% respondents would chose to be at home while receiving EoLC.ConclusionsUnderstanding public attitudes is essential to understanding changing contexts of care. Developing a need-based palliative care model enhances an effective service delivery.Reference. Dixon J, et al. Equity in the provision of palliative care in the UK: Review of evidence2015;pg. 1–145. London: Personal Social Services Research Unit. Available at: https://www.mariecurie.org.uk/globalassets/media/documents/policy/campaigns/equity-palliative-care-uk-report-full-lse.pdf
28 Quality of life of patients attending marie curie day hospice over time: preliminary findings from a prospective cohort study
Authors: Cudmore Sarah , Finucane Anne , Holloway Gail , Grundy Pippa , Haraldsdottir Erna , Brazil Kevin , George Kernohan W 
Published: August 2018

IntroductionPalliative care day services (PCDS) is a popular if variable palliative intervention provided on a routine basis in many hospices.Aim and methodTo understand PCDS within Marie Curie hospices we set out to identify the structure process and outcome associated with the service. We present preliminary data on quality of life from the Edinburgh service. A prospective cohort design was used to describe outcomes over an eight-week period. Attendance was recorded. Participants were invited to complete a set of questionnaires to assess quality of life at baseline four weeks and eight weeks post-baseline. Patient assessment involved completion of questionnaires covering physical and emotional health quality of life and wellbeing. The primary outcome measure was QoL as assessed by the McGill Quality of Life scale.ResultsOver a nine-week period at one day hospice nine patients and five carers consented to participate. Of the nine patients eight were assessed at four-weeks post baseline (one patient was in hospital); seven patients were assessed at eight weeks post-baseline (one patient had died; one was unwell). Over the eight-week follow up period the total mean score remained stable. The single item quality of life score increased a little (as has quality of health care and environment) whilst symptoms worsened as might be expected in this population.ConclusionDay services may sustain quality of life in spite of deteriorating health. Further data collection from two other sites is underway to enhance sample size.
38 From theory to clinical practice: lessons learned from the delivery of a breathlessness support service
Authors: Reilly Charles C , Maddocks Matthew , Jolley Caroline J , Moxham J , Higginson Irene J 
Published: August 2018

IntroductionA single-blind randomised controlled trial demonstrated that an integrated palliative and respiratory care service for patients with advanced disease and chronic breathlessness known as the Breathlessness Support Service (BSS) resulted in improved patient’s mastery in the BSS group compared to standard care (mean difference 0·58 95% CI 0·01–1·15 p=0·048; effect size 0·44).1AimTo describe the clinical aspects of delivering the BSS with regards to; referral sources patient characteristics and interventions provided.MethodSecondary data analysis of all patients that were referred to and completed that BSS intervention as part of the delayed intervention model RCT.1Results105 patients enrolled in the study 86 patients attended the first BSS clinic 75 completed the BSS intervention (two clinic appointments and a physiotherapy-based home visit). 80% of patients had non – malignant disease; respiratory medicine constituted most referrals. The majority (88%) of patients received solely non – pharmacological interventions. 35 (41%) patients reported that the have never accessed Pulmonary Rehabilitation (PR). At the point of discharge the BSS provided on ward referral and/or access to additional services (PR=53% social work=41% palliative care=11%).ConclusionsMajority of referrals were from respiratory medicine and GP practices for patients with chronic breathlessness due to non – malignant disease which highlights the challenges of trying to palliate breathlessness in the generalist setting. The BSS provided patients with access to self-management non – pharmacological interventions delivered by integrated multi-disciplinary team with expertise in breathlessness management which resulted in improved breathlessness mastery.Reference. Higginson IJ, et al.An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: A randomised controlled trial.The Lancet Respiratory Medicine2014;2(12):979–987.
44 An evidenced-based heuristics model (or rule of thumb) to improve doctors’ intuition about when patients are imminently dying
Authors: White Nicola , Harries Priscilla , Harris Adam JL , Vickerstaff Victoria , Lodge Philip , McGowan Catherine , Minton Ollie , Tomlinson Christopher , Tookman Adrian , Reid Fiona , Stone Patrick 
Published: August 2018

IntroductionEvidence suggests that the majority of doctors are not very good at identifying when a patient is dying1however there is little training available to improve this skill. Even experts are unable to articulate how they recognise when a patient is dying other than by saying that ‘I just knew’.2AimTo understand how expert palliative care doctors recognise a dying person.MethodsRather than relying on ‘years of experience’ as a surrogate measure of expertise we developed a test to identify which doctors really are the prognostic ‘experts’. The prognostic test consisted of 20 real patient case summaries. Participants (palliative care doctors) were asked to predict whether or not they expected the patient to die within the next 3 days. Those who were the most accurate at this task were deemed to be the ‘prognostic experts’ and were invited to complete an additional online judgement task. In this task it was possible to identify which factors were most influential in their prognostic decision-making.Results19/99 doctors who completed the prognostic test were deemed to be ‘experts’. Of those 14 also completed the additional judgement task. The following factors influenced the experts’ decisions: Cheyne Stokes breathing palliative performance score (PPS) a decline in condition in the previous 24 hours respiratory secretions cyanosis and level of agitation or sedation.ConclusionThis novel study presents a simple evidenced-based heuristic (or rule of thumb) to help novices recognise when a patient is imminently dying.References. Neuberger J, Guthrie C, Aaronovitch D. More care less pathway: A review of the Liverpool Care Pathway.Department of Health2013.. Taylor P, Dowding D, Johnson M. Clinical decision making in the recognition of dying: A qualitative interview study. BMC Palliative Care2017;16(1):11.
46 Patient safety in palliative care: a mixed methods study of reports to a national database of serious incidents
Authors: Yardley Iain , Yardley Sarah , Williams Huw , Carson-Stevens Andrew , Donaldson Liam J 
Published: August 2018

BackgroundPatients receiving palliative care are vulnerable to patient safety incidents but little is known about the extent of harm caused or the origins of unsafe care in this population.AimTo quantify and qualitatively analyse serious incident reports in order to understand the causes and impact of unsafe care in a population receiving palliative care.Setting and participantsReports to a national database of ‘serious incidents requiring investigation’ involving patients receiving palliative care in the National Health Service (NHS) in England during the twelve year period April 2002 to March 2014.DesignA mixed methods approach was used. Following quantification of type of incidents and their location a qualitative analysis using a modified framework method was used to interpret themes in reports to examine underlying causes and the nature of resultant harms.ResultsA total of 475 reports were identified: 266 related to pressure ulcers 91 to medication errors 46 to falls 21 to healthcare associated infections (HCAIs) 18 were other instances of disturbed dying 14 were allegations against health professions eight transfer incidents six suicides and five other concerns. The frequency of report types differed according to the care setting. Underlying causes included lack of palliative care experience under-resourcing and poor service coordination. Resultant harms included worsened symptoms disrupted dying serious injury and hastened death.ConclusionsUnsafe care presents a risk of significant harm to patients receiving palliative care. Improvements in the coordination of care delivery alongside wider availability of specialist palliative care support may reduce this risk.
48 Junior doctors and end of life care: a systematic review and narrative synthesis
Authors: Bharmal Aamena , Morgan Tessa , Barclay Stephen 
Published: August 2018

BackgroundNearly 50% of all deaths in the UK occur in hospitals.1The majority of these patients die in a generalist setting2where their medical care is predominately provided by junior doctors. There is a growing recognition of a need to embed palliative care into doctors’ training.3Little evidence exists, however, concerning junior doctors’ current experiences of palliative care.AimsTo review the empirical literature between 2000 and 2018 concerning junior doctors experience of and preparation for palliative and end of life care.MethodsSystematic review and narrative synthesis of qualitative and quantitative studies within six databases to find empirical studies on junior doctors experience of adult palliative care in inpatient hospital or hospice settings.ResultsFrom the initial 6308 titles identified, 32 studies met the inclusion criteria with a further five identified from reference searching.Three key themes were identified:‘Significance of death and dying’‘Thrown into the deep end’‘Addressing the gaps’. All the studies provided evidence that junior doctors care for many dying patients very early in their career. Junior doctors do not feel adequately prepared to care for dying patients and feel unsupported when doing so. Junior doctors report emotional distress when caring for their first few dying patients, memories of which continue to affect them throughout their careers. Their attitudes towards end–of–life care varied: some reported it as a privilege while others associated it with a culture of disengagement that stigmatised dying patients.ConclusionsJunior doctors need further support, education and preparation for their exposure to palliative care. Experiential learning, reflective practice and role modelling are described as the most effective ways to learn palliative care and this also teaches them other transferrable skills such as communication, teamwork and professionalism that are vital for their future careers.References. Office for National Statistics Deaths Registered in England and Wales2016.. Gomes B, Higginson I. Where people die (1974–2030): Past trends, future projections and implications for care.Palliative Med2008;22:33–41.. General Medical Council.Tomorrow’s doctors: Recommendations on undergraduate medical education2002 (2nd ed.). London: GMC.
5 What needs to change to better support carers at end of life? a multi-perspective mixed methods study to identify recommendations for change in organisational structures and processes
Authors: Ewing Gail , Grande Gunn 
Published: August 2018

IntroductionCarers play a vital role in supporting patients at end-of-life (EOL). EOL care policy promotes comprehensive person-centred assessment/support for carers but without a clear implementation strategy this will only remain an aspiration.AimTo develop recommendations for organisational structures/processes required for implementation of comprehensive person-centred comprehensive assessment/support for carers in EOL practice.MethodsSecondary analysis of qualitative data on implementation in 36 services to identify factors facilitating/hindering implementationExpert consultation (focus groups with 19 lead practitioners/hospice managers) to review Stage–1 findings and develop draft recommendationsWider stakeholder consultation–two professional workshops (23 participants: hospice hospital community policy and academics) online survey (62 participants) and two carer workshops (nine participants) to finalise recommendations.ResultsComprehensive person-centred carer assessment/support requires whole-systems change; a cultural shift at practitioner and organisational level. 10 recommendations identify key structures and processes not normally met by current provision:Consistent identification of carers within the care settingDemographic and contextual data on who the carer is and their situationA method/protocol for assessing carers and responding to assessmentA recording system for carer information (separate from patient data)A process for training staff about carer assessment/supportAvailable time/workload capacity for carer assessment/supportSupport from senior managersRole models/championsPathways for communication about carer assessment/supportProcedures for monitoring/auditing processes and outcomes of carer assessment/support.ConclusionsComprehensive person-centred carer support requires radical change at different organisational levels. Carers’ fit within service provision also urgently needs clarification. Our 10 recommendations outline necessary building blocks to achieve this change.FunderHospice UK and CLAHRC Greater Manchester
52 Drug therapy for delirium in terminally ill adults: a cochrane systematic review
Authors: Finucane A , Jones L , Leurent B , Sampson E , Stone P , Tookman A , Candy B 
Published: August 2018

IntroductionDelirium is a complex neuropsychiatric syndrome common in palliative care occurring in up to 88% of patients in the weeks or hours preceding death. Our Cochrane review on drug therapy for delirium in 2012 identified one trial (Candyet al.2012). New trials have been conducted and an updated review is now recognised as a Cochrane priority.AimTo evaluate the evidence from randomised controlled trials (RCTs) examining the effectiveness and safety of drug therapies to treat delirium in adults with a terminal illness.MethodsWe searched for RCTs comparing any drug treatment with any other treatment for delirium in terminally ill adults. Primary outcomes included delirium symptoms at 24 hours and between 24–48 hours; and adverse events. Risk of bias assessment was conducted; we assessed overall quality of evidence using GRADE.ResultsWe retrieved 9431 citations. Four studies were included in the final review. All trials were vulnerable to bias most commonly due to small sample size or incomplete outcome data. Figures 1 and 2 illustrate the mean difference between trial arms at 24 hours and between 24–48 hours respectively. Three studies reported adverse events revealing mixed results.Abstract 52 Figure 1Abstract 52 Figure 2ConclusionThis review identified four trials. It found low quality evidence examining the impact of drug therapy on delirium symptoms and adverse events in terminally ill adults. Results for each comparison were based on single studies. Undertaking trials on delirium in this patient group is methodologically complex. Only one study compared drug therapy with placebo. This limited our ability to answer our review questions.Reference. Candy B, Jackson KC, Jones L, Leurent B, Tookman A, King M. Drug therapy for delirium in terminally ill adult patients. Cochrane Database of Systematic Reviews2012;(11). Art. No. CD004770. doi:10.1002/14651858.CD004770.pub2
Response of sunflowers (Helianthus annuus L.) to varying seeding rates and nitrogen fertilizer rates in a no-till cropping system in Saskatchewan
Authors: May W.E. , Dawson M.P. , Lyons C.L. 
Published: August 2018

In the past, most sunflower research was conducted in tilled cropping systems and was based on wide row configurations established using precision planters. Little agronomic information is available for the no-till systems predominant in Saskatchewan, where crops are typically seeded in narrow rows using an air drill. Two studies were conducted in Saskatchewan to determine the optimum seeding and nitrogen (N) rates for short-season sunflowers in a no-till cropping system. The N rate study used 5 N rates (10, 30, 50, 70, and 90 kg N ha−1) with the hybrid 63A21. The seeding rate study used 7 seeding rates (37 000, 49 000, 61 000, 74 000, 86 000, 98 000, and 111 000 seeds ha−1) with two cultivars, AC Sierra (open pollinated) and 63A21 (hybrid). There was a linear yield increase as the N rate increased from 10 to 90 kg N ha−1. Based on the N rates tested in this study and current N fertilizer costs below $1 kg−1, sunflower yields and gross returns were most favorable at 90 kg N ha−1. Future N response research with a wider range of N rates is warranted to best determine the optimum N rate. The optimum seeding rate was between 98 000 and 111 000 seeds ha−1 for AC Sierra and between 74 000 and 86 000 seeds ha−1 for 63A21. The optimum plant density, approximately 70 000 to 75 000 plants ha−1, was similar for both cultivars. These results are higher than the current recommended seeding rates for wide-row precision planting systems in areas with a longer growing season.
Charged hadron fragmentation functions from collider data
Authors: Bertone V. , Hartland N. P. , Nocera E. R. , Rojo J. , Rottoli L. 
Published: August 2018

AbstractWe present NNFF1.1h, a new determination of unidentified charged-hadron fragmentation functions (FFs) and their uncertainties. Experimental measurements of transverse-momentum distributions for charged-hadron production in proton-(anti)proton collisions at the Tevatron and at the LHC are used to constrain a set of FFs originally determined from electron–positron annihilation data. Our analysis is performed at next-to-leading order in perturbative quantum chromodynamics. We find that the hadron-collider data is consistent with the electron–positron data and that it significantly constrains the gluon FF. We verify the reliability of our results upon our choice of the kinematic cut in the hadron transverse momentum applied to the hadron-collider data and their consistency with NNFF1.0, our previous determination of the FFs of charged pions, kaons, and protons/antiprotons.
Muscle type-specific RNA polymerase II recruitment during PGC-1α gene transcription after acute exercise in adult rats
Authors: Masuzawa Ryo , Konno Ryotaro , Ohsawa Ikumi , Watanabe Atsuya , Kawano Fuminori 
Published: August 2018

Epigenetic regulation of gene expression differs between fast- and slow-twitch skeletal muscles in adult rats, although the precise mechanisms are still unknown. The present study investigates the differences in responses of RNA polymerase II (Pol II) and histone acetylation during transcriptional activation in the plantaris and soleus muscles of adult rats after acute treadmill running. We targeted the peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) gene to analyze epigenomic changes by chromatin immunoprecipitation. The mRNA expression of the PGC-1α-b isoform was significantly upregulated in both plantaris and soleus muscles 2 h after acute running, although the magnitude of the upregulation was more pronounced in the plantaris muscle. The sequences of proximal exons of the PGC-1α locus were expressed more in the plantaris muscle after acute running. Accumulation of Pol II was noted near the alternative exon 1 in both plantaris and soleus muscles in association with the enhanced distribution of acetylated histone 3. Accumulation of Pol II was also observed at the transcription start site, exon 2, and exon 3 in the plantaris muscle, but not the soleus muscle. It was noted that in the soleus muscle, acetylation of histone 3 at lysine 27 was enhanced throughout the PGC-1α locus in response to transcriptional activation, suggesting that elongating Pol II was capable of traveling through to the end of the locus. These results indicate that the mobility of Pol II during PGC-1α transcription differed between fast- and slow-twitch skeletal muscles, affecting the strength of the transcriptional activity. NEW & NOTEWORTHY Fast- and slow-twitch skeletal muscles have distinct characteristics in both force production and metabolism. Epigenetic regulations also largely differ in these muscles. Here we show that RNA polymerase II is distributed extensively at the proximal regions downstream of transcription start site during the transcriptional activation of PGC-1α in fast-twitch muscles, but it accumulates at the first exon in slow-twitch muscles. These findings will provide a basis to understand type-specific mechanisms in skeletal muscle.