bluuebunny/crossref_metadata_2025_split huggingface dataset:
What is the role of community at the end of life for people dying in advanced age? A qualitative study with bereaved family carers
Authors: Gott Merryn , Wiles Janine , Moeke-Maxwell Tess , Black Stella , Williams Lisa , Kerse Ngaire , Trussardi Gabriella 
Published: November 2017

Background: New public health approaches to palliative care prioritise the role of community at end of life. However, little is known about community support for the increasing numbers of people dying in advanced age. Aim: To explore the role of community at end of life for people dying in advanced age from the perspective of their bereaved family caregivers. Design: A constructionist framework underpinned a qualitative research design. Data were analysed using critical thematic analysis. Setting/participants: A total of 58 participants (19 Māori and 39 non-Māori) who cared for 52 family members who died at >80 years of age participated in semi-structured interviews. Results: A reduction in the social networks and community engagement of the older person was identified in the end-of-life period. Numerous barriers to community engagement in advanced age were identified, including poor health (notably dementia), moving into an aged care facility and lack of access due to transport difficulties. An active withdrawal from community at end of life was also noted. Carers felt limited support from community currently, but identified that communities could play a particular role in reducing social isolation and loneliness among people of advanced age prior to death. Conclusion: Our study provides strong support for public health approaches to palliative care that advocate building social networks around people who are dying and their family carers. However, it also indicates that strategies to do so must be flexible enough to be responsive to the unique end-of-life circumstances of people in advanced age.
The experiences of patients with advanced cancer and caregivers presenting to Emergency Departments: A qualitative study
Authors: Philip Jennifer , Remedios Cheryl , Breen Sibilah , Weiland Tracey , Willenberg Lisa , Boughey Mark , Jelinek George , Lane Heather , Marck Claudia , Weil Jennifer 
Published: November 2017

Background: Despite being a common event in the course of an advanced cancer illness, there is little understanding of patients’ perceptions of hospital Emergency Department presentations. Aim: To explore the experiences and perceptions of Emergency Departments held by patients with advanced cancer and their informal caregivers. Design: Cross-sectional study involving semi-structured interviews with advanced cancer patients and their informal caregivers. Qualitative data analysis was underpinned by a phenomenological approach utilising a data-driven inductive thematic frame. Setting/participants: In total, 19 patients with advanced cancer who presented to Emergency Departments in the previous 6 months and 10 informal caregivers from an Australian public hospital and community palliative care service were interviewed. Results: Patients reported that Emergency Department presentations were largely prompted by worsening symptoms or were a means to expedite hospital admission, with many instructed to attend by their health care provider. The experience in the Emergency Department was described as a time of anxiety and uncertainty with concerns over communication, the general environment and delays in the symptom management highlighted. Long waits were common. Despite this, patients described relief at receiving care. While the Emergency Department was viewed as a safety net for the health system, many believed advanced cancer patients should have alternative options. Conclusion: Relatively simple changes of regular communication updates and early symptom relief would improve patient experience of Emergency Department care. However, since an Emergency Department presentation is frequently serving as a default to access medical care, a significant re-orientation of the health care system is required to meet patient needs.
Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review
Authors: Artico Marco , Dante Angelo , D’Angelo Daniela , Lamarca Luciano , Mastroianni Chiara , Petitti Tommasangelo , Piredda Michela , De Marinis Maria Grazia 
Published: November 2017

Background: Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers’ prevalence, incidence and associated factors are largely insufficient. Aim: To document the point prevalence at admission and the cumulative incidence of pressure ulcers in terminally ill patients admitted to an Italian home palliative care unit, and to analyse the patients’ and caregivers’ characteristics associated with their occurrence. Design: Retrospective chart review. Setting/participants: Patients ( n = 574) with a life expectancy ⩽6 months admitted to a palliative home care service were included in this study. Results: The prevalence and incidence rates were 13.1% and 13.0%, respectively. The logistic regression models showed body mass index ( p < 0.001), Braden score at risk ( p < 0.001), Karnofsky Performance Scale index <30 ( p < 0.001), patients’ female gender, patients’ age >70 and >1 caregiver at home as the dichotomous variables predictors of presenting with a pressure ulcer at time of admission and during home palliative care. Conclusion: The notable pressure ulcers’ incidence and prevalence rates suggest the need to include this issue among the main outcomes to pursue during home palliative care. The accuracy of body mass index, Braden Scale and Karnofsky Performance Scale in predicting the pressure ulcers risk is confirmed. Therefore, they appear as essential tools, in combination with nurses’ clinical judgment, for a structured approach to pressure ulcers prevention. Further research is needed to explore the home caregivers’ characteristics and attitudes associated with the occurrence of pressure ulcers and the relations between their strategies for pressure ulcer prevention and gender-related patient’s needs.
Impact of a Home Hospice Visit Program on Third-Year Medical Students: A qualitative analysis of student reflections
Authors: Strano-Paul Lisa , Lane Susan , Lu Wei-Hsin , Chandran Latha 
Published: November 2017

Aim This study evaluates the impact of an interprofessional home hospice visit (HHV) on third-year medical students’ attitudes toward, and understanding of, end-of-life care and the visit's effect on students’ views of their emerging professional roles and identities. Methods All third-year medical students at Stony Brook School of Medicine in Stony Brook, New York, USA, participated in an HHV. A didactic session preceded the HHV. Subsequently, students were required to submit a piece of reflective writing detailing the impact of the visit. We conducted a qualitative analysis of a random sample drawn from the 467 submitted reflections. Results Six themes emerged from the student reflections: three were related to the students’ direct observations during the HHV, and three were related to the reflective learning of the students based on their HHV experience. Conclusion The qualitative analysis of the reflective writings showed that the students gained a deep appreciation of the human identity of hospice patients and a humanistic understanding of their own role as future physicians.
Evaluation of the Utility of the Edmonton Symptom Assessment System (revised) Scale on a Tertiary Palliative Care Unit
Authors: Beddard-Huber Elizabeth , Jayaraman Jyothi , White Laura , Yeomans Wendy 
Published: November 2017

Aim The aim of this study was to evaluate the utility of the Edmonton Symptom Assessment System (ESAS-r) Scale on a tertiary palliative care unit. Method There were 92 admitted patients who participated in the study; the scale was administered to those able to participate on day 1 (n=35, 38 percent), on day 4 (n=20, 21 percent), and weekly. Patient comfort level with the ESAS-r tool was assessed using a 5-point Likert scale (strongly disagree to strongly agree) on day 4. Nurses’ and physicians’ perceptions of clinical assessment pre- and postimplementation of the scale were surveyed using a 5-point Likert scale. Results Of the participating physicians, 75 percent (n=3) found that the ESAS-r Scale did not enhance clinical assessment; the proportion of nurses with that response was 37.5 percent (n=6). Among these care providers, 50 percent of the physicians (n=2) and 62 percent of the nurses (n=10) thought that the scale was burdensome to patients; but 60 percent of the patients who were able to complete the comfort-level survey (n=12) indicated that they did not find the scale burdensome. Conclusion Patient acuity, team expertise, perceived burden to patients, and time commitment all influenced staff's recommendation not to implement the ESAS-r tool on the palliative care unit.
Barriers to, and Facilitators of Physical Activity in Patients Receiving Chemotherapy for Lung Cancer: An exploratory study
Authors: Mas Sébastien , Quantin Xavier , Ninot Grégory 
Published: November 2017

Aim Physical activity (PA) has a positive effect on the cardiorespiratory fitness, lung cancer symptoms, and quality of life of lung cancer patients. The aim of our study was to identify barriers to, and facilitators of PA in lung cancer patients. Methods We collected data from five patients diagnosed with primary, advanced non-small-cell lung cancer (NSCLC) who were receiving chemotherapy. Choosing a qualitative approach, we conducted an exploratory analysis using the thematic analysis technique to process the data. Results Seven barriers to, and facilitators of PA were identified and grouped into four categories. We found that psychological and social factors affect patients’ willingness and ability to engage in PA, while physiological and environmental factors have an impact on the duration, intensity, and regularity of their PA. Conclusion Our study highlighted some of the effects that the barriers to PA have on the practice of it in our patient group. Our findings may be used by professionals to design adapted PA programs.
Attention-Deficit Hyperactivity Disorder (ADHD) in Epilepsy and Primary ADHD: Differences in Symptom Dimensions and Quality of Life
Authors: Ekinci Ozalp , Okuyaz Çetin , Erdoğan Semra , Gunes Serkan , Ekinci Nuran , Kalınlı Merve , Teke Halenur , Direk Meltem Çobanoğulları 
Published: November 2017

Purpose: We aimed to (1) compare quality of life (QOL) among children with epilepsy, epilepsy and attention-deficit hyperactivity disorder (ADHD), and primary ADHD and (2) compare ADHD symptom dimensions and subtypes between children with epilepsy-ADHD and primary ADHD. Methods: A total of 140 children; 53 with epilepsy, 35 with epilepsy-ADHD, and 52 with primary ADHD were included. KINDL-R (quality of life measure), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and Conners’ Parent Rating Scale (CPRS) were completed. Neurology clinic charts were reviewed for epilepsy-related variables. Results: Children with epilepsy-ADHD had the lowest (poorest) KINDL-R total scores. Epilepsy-ADHD group had more inattentiveness symptoms, whereas primary ADHD group had more hyperactivity/impulsivity symptoms. The frequencies of ADHD combined and inattentiveness subtypes were 60% and 40% in children with epilepsy-ADHD and 80.7% and 19.3% in children with primary ADHD, respectively ( P = .034). Conclusion: ADHD in epilepsy is associated with a significantly poor quality of life and predominantly inattentiveness symptoms.
Wound-healing effects of human dermal components with gelatin dressing
Authors: Jang Hyun-Jun , Kim Yu-mi , Yoo Bo-Young , Seo Young-Kwon 
Published: November 2017

There have been numerous investigations regarding various types of dressings and artificial dermis of solid form, yet limited research and development on paste types, such as hydrogels with dermal powder, have ensued. In this study, we compared the in vivo wound healing effects of gelatin paste containing dermal powder to a collagen type I/chondroitin 6-sulfate (coll/chondroitin) sponge and gelatin alone, after 48 days post grafting, in a skin wound rat model. In the dermis powder/gelatin paste-treated group, wound area contraction was minimized 50%, while in the gelatin and coll/chondroitin sponge groups, the initial area contracted 83–85% and 79–85%, respectively. Histological analysis revealed the wounds treated with dermal powder/gelatin were associated with many fibroblasts, which infiltrated the wound bed, as well as thick collagen bundles that were arranged in dendritic arrays, resembling normal skin. Furthermore, in contrast to the gelatin- and coll/chondroitin sponge-treated groups, the powder/gelatin paste-treated wounds exhibited an abundance of elastic fibers (Victoria blue staining) and extensive formation of blood vessels around the dermis (CD31 staining). Therefore, the dermis powder/gelatin paste not only renders convenience to users but also has prominent wound-healing effects on full-thickness wounds.
Impact of Healthy Vending Machine Options in a Large Community Health Organization
Authors: Grivois-Shah Ravi , Gonzalez Juan R. , Khandekar Shashank P. , Howerter Amy L. , O’Connor Patrick A. , Edwards Barbara A. 
Published: November 2017

Purpose: To determine whether increasing the proportion of healthier options in vending machines decreases the amount of calories, fat, sugar, and sodium vended, while maintaining total sales revenue. Design: This study evaluated the impact of altering nutritious options to vending machines throughout the Banner Health organization by comparing vended items’ sales and nutrition information over 6 months compared to the same 6 months of the previous year. Setting: Twenty-three locations including corporate and patient-care centers. Intervention: Changing vending machine composition toward more nutritious options. Measures: Comparisons of monthly aggregates of sales, units vended, calories, fat, sodium, and sugar vended by site. Analysis: A pre–post analysis using paired t tests comparing 6 months before implementation to the equivalent 6 months postimplementation. Results: Significant average monthly decreases were seen for calories (16.7%, P = .002), fat (27.4%, P ≤ .0001), sodium (25.9%, P ≤ .0001), and sugar (11.8%, P = .045) vended from 2014 to 2015. Changes in revenue and units vended did not change from 2014 to 2015 ( P = .58 and P = .45, respectively). Conclusion: Increasing the proportion of healthier options in vending machines from 20% to 80% significantly lowered the amount of calories, sodium, fat, and sugar vended, while not reducing units vended or having a negative financial impact.
Evaluation of the Pharmacodynamic Effects of the Potassium Binder RDX7675 in Mice
Authors: Davidson James P. , King Andrew J. , Kumaraswamy Padmapriya , Caldwell Jeremy S. , Korner Paul , Blanks Robert C. , Jacobs Jeffrey W. 
Published: November 2017

Introduction: Hyperkalemia is a common complication in patients with heart failure or chronic kidney disease, particularly those who are taking inhibitors of the renin–angiotensin–aldosterone system. RDX7675, the calcium salt of a reengineered polystyrene sulfonate-based resin, is a potassium binder that is being investigated as a novel treatment for hyperkalemia. This study evaluated the pharmacodynamic effects of RDX7675 in mice, compared to 2 current treatments, sodium polystyrene sulfonate (SPS) and patiromer. Methods: Seven groups of 8 male CD-1 mice were given either standard chow (controls) or standard chow containing 4.0% or 6.6% active moiety of RDX7675, patiromer, or SPS for 72 hours. Stool and urine were collected over the final 24 hours of treatment for ion excretion analyses. Results: RDX7675 increased stool potassium (mean 24-hour excretion: 4.0%, 9.19 mg; 6.6%, 18.11 mg; both P < .0001) compared with controls (4.47 mg) and decreased urinary potassium (mean 24-hour excretion: 4.0%, 12.05 mg, P < .001; 6.6%, 6.68 mg, P < .0001; vs controls, 20.38 mg). The potassium-binding capacity of RDX7675 (stool potassium/gram of resin: 4.0%, 1.14 mEq/g; 6.6%, 1.32 mEq/g) was greater (all P < .0001) than for patiromer (4.0%, 0.63 mEq/g; 6.6%, 0.48 mEq/g) or SPS (4.0%, 0.73 mEq/g; 6.6% 0.55 mEq/g). RDX7675 and patiromer decreased urinary sodium (mean 24-hour excretion: 0.07-1.38 mg; all P < .001) compared to controls (5.01 mg). In contrast, SPS increased urinary sodium excretion (4.0%, 13.31 mg; 6.6%, 17.60 mg; both P < .0001) compared to controls. Conclusions: RDX7675 reduced intestinal potassium absorption and had a greater potassium-binding capacity than patiromer or SPS in mice. The calcium-based resins RDX7675 and patiromer reduced intestinal sodium absorption, unlike sodium-based SPS. These results support further studies in humans to confirm the potential of RDX7675 for the treatment of patients with hyperkalemia.
A Comparison of Health Outcomes in the Use of Stem Cells, Surgical, and Nonsurgical Approaches to Treat Degenerative Disk Disease: A Systematic Review
Authors: Indorato Daniel C , Sadacharan Marx C 
Published: November 2017

Study design: Systematic literature review. Objective: This study provided a systematic review of randomized controlled trials which assessed the therapeutic effects of stem cell treatments, surgical interventions, and nonsurgical treatments on the outcomes of patients diagnoses with intervertebral disk degeneration (IDD). Methods: A MEDLINE (2000-2017), PubMed (2000-2017), and Google scholar (1995-2000) database search was performed to identify published articles reporting on patient-reported clinical outcomes. A total of 12 articles were identified and met the inclusion criteria. Results: Literature evaluating the comparative treatment outcomes between patients who underwent surgical versus nonsurgical interventions demonstrated mixed findings in treatment efficacy. Although studies involving the manipulation of endogenous stem cells in fibrocartilage suggested that this application could be a potentially noninvasive, stem cell–based strategy to treat fibrocartilage degeneration, especially in patients with IDD. Conclusions: The reviewed literature suggested that no clinical significance exists between surgical and nonsurgical treatment for IDD. The decision to undergo surgical or conservative treatment should depend on the patient’s state of health at the time of surgery, as well as any other potentially alarming factors (altered mental status, level of consciousness, comorbidities, etc) that could be exacerbated with the proposed treatment. Mesenchymal stem cells and fibrocartilage stem cells may also be an effective therapeutic option for the regeneration of a degenerated intervertebral disk. To move forward in finding an effective therapeutic treatment protocol for IDD, further research needs to be implemented that minimizes the limitation discussed in this review.
A Projection Quality-Driven Tube Current Modulation Method in Cone-Beam CT for IGRT: Proof of Concept
Authors: Men Kuo , Dai Jianrong 
Published: November 2017

Purpose: To develop a projection quality-driven tube current modulation method in cone-beam computed tomography for image-guided radiotherapy based on the prior attenuation information obtained by the planning computed tomography and then evaluate its effect on a reduction in the imaging dose. Materials and Methods: The QCKV-1 phantom with different thicknesses (0-400 mm) of solid water upon it was used to simulate different attenuation (μ). Projections were acquired with a series of tube current–exposure time product (mAs) settings, and a 2-dimensional contrast to noise ratio was analyzed for each projection to create a lookup table of mAs versus 2-dimensional contrast to noise ratio, μ. Before a patient underwent computed tomography, the maximum attenuation [Formula: see text] within the 95% range of each projection angle (θ) was estimated according to the planning computed tomography images. Then, a desired 2-dimensional contrast to noise ratio value was selected, and the mAs setting at θ was calculated with the lookup table of mAs versus 2-dimensional contrast to noise ratio,[Formula: see text]. Three-dimensional cone-beam computed tomography images were reconstructed using the projections acquired with the selected mAs. The imaging dose was evaluated with a polymethyl methacrylate dosimetry phantom in terms of volume computed tomography dose index. Image quality was analyzed using a Catphan 503 phantom with an oval body annulus and a pelvis phantom. Results: For the Catphan 503 phantom, the cone-beam computed tomography image obtained by the projection quality-driven tube current modulation method had a similar quality to that of conventional cone-beam computed tomography . However, the proposed method could reduce the imaging dose by 16% to 33% to achieve an equivalent contrast to noise ratio value. For the pelvis phantom, the structural similarity index was 0.992 with a dose reduction of 39.7% for the projection quality-driven tube current modulation method. Conclusions: The proposed method could reduce the additional dose to the patient while not degrading the image quality for cone-beam computed tomography. The projection quality-driven tube current modulation method could be especially beneficial to patients who undergo cone-beam computed tomography frequently during a treatment course.
Museums, health and wellbeing research: co-developing a new observational method for people with dementia in hospital contexts
Authors: Morse Nuala , Chatterjee Helen 
Published: November 2017

Aims: The aim of this article is to present a new observational tool for assessing the impacts of museum object handling for people with moderate-to-severe dementia in hospital settings, focusing on wellbeing, social interaction, level of engagement and agitation. This article presents a four-step approach to collaboration towards co-developing the tool, which involved a range of academics, museums professionals, and health and social care partners, and describes the process of integrating multiple perspectives towards common research methodologies. Methods: The research team organised a series of meetings and workshops with museum and healthcare partners to identify commonly used assessments and their perspectives on the objectives and possible outcomes of museum object handling activities. These were integrated with findings from a review of current conceptualisations of engagement in people with dementia (PWD) to produce a fit-for-purpose video evaluation method of the health and wellbeing impacts of the museum object handling programmes. Results: This article presents the Museum Engagement Observation Tool for use in hospital settings for people with moderate-to-severe dementia. Conclusion: This article suggests that collaborative approaches can inform the development of future methods for creative health research and evaluation initiatives and to support this, it outlines the process of development of a new observational tool for people with dementia.