bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of organisational context and practitioner attitudes on implementation of the carer support needs assessment tool (CSNAT) intervention
Authors: Diffin Janet , Ewing Gail , Grande Gunn 
Published: August 2016

BackgroundThe Carer Support Needs Assessment Tool (CSNAT) intervention identifies and addresses family carer support needs towards end of life.1–3A paucity of studies has investigated how to successfully implement evidence based interventions within palliative care.AimInvestigate how staff attitudes and organisational context affect implementation of the CSNAT intervention in palliative care.Methods36 UK palliative care services participated. Staff surveys measured attitudes and context prior to, and six months after the implementation began including (i) a questionnaire assessing staff attitudes to the CSNAT; (ii) The Alberta Context Tool (ACT) assessing organisational context. Data on use of the CSNAT intervention were collected over six months; services were classified as ‘high’ or ‘low’ adopters on this basis. Relationships between service characteristics, aggregate data on staff attitudes and organisational context, and level of adoption were analysed.Results157/462 surveys were returned at baseline and 69/462 at six months. Level of adoption depended on service type. ‘High’ adopters had a higher ratio of intervention ‘champions’ to total staff numbers and higher scores for ACT ‘informal interactions’ (e.g. more discussions with colleagues about patient care), compared to ‘low’ adopters. Both groups had similarly positive attitudes to the CSNAT intervention pre-implementation. By six months attitudes for ‘low’ adopters were significantly more negative, but remained similar or improved for ‘high’ adopters.ConclusionsEnsuring successful implementation of complex interventions within palliative care requires consideration of the organisational context, service type, strategies for maintaining positive staff attitudes over time, and the use of intervention ‘champions’.ReferencesEwing G, Brundle C, Payne S, Grande G. The Carer Support Needs Assessment Tool (CSNAT) for use in palliative and end-of-life care at home: A validation study.J Pain Symptom Manage2013;46(3):395–405Ewing G, Grande G. Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: a qualitative study.Palliat Med2013;27(3):244–256Ewing G, Austin L, Diffin J, Grande G. The Carer Support Needs Assessment Tool: A person centred approach to carer assessment and support.Br J Community Nurs2015;20(12):580–584
Systematic review of prescribing patterns of analgesic medications for older people living in care homes over time
Authors: Frenais Francesca La , Bedder Rachel , Stone Patrick , Sampson Elizabeth L 
Published: August 2016

IntroductionHistorically care home residents, including people with dementia, have been under-treated for pain (Nygaard and Jarland, 2005). Recent research suggests increased prescriptions within this population but trends are unclear (Sandviket al., 2016, Jensen-Dahmet al., 2015).AimTo explore changes in the prescription of analgesic drugs over time; (2) to compare the prescriptions of analgesic medication between the general care home population and cognitively impaired (CI): residents; (3) to carry out subgroup analyses on drug type (opioid; non-opioid; paracetamol) and prescription type (regular vs. regular + ‘as required’).Method(s)English-language articles indexed under care homes and analgesic medication; bibliographies of retrieved papers; correspondence. We searched for published and unpublished studies (no restriction on publication year) representative of the care home population that included number of participants, country and year(s) of data collection, and prescription rates of analgesics and/or subtypes. Correlations were generated between the percentage of residents prescribed an analgesic and year of data collection. Studies were rated for quality.ResultsSixty-two studies met our inclusion criteria. Regular prescription rates for analgesics, including subtypes of opioids and paracetamol, have increased over time for both the general care home population and residents with CI. There were no studies reporting regular prescriptions of analgesics post-2006 for CI residents. There is no trend when also considering PRN medication.Conclusion(s)Consistent with recent research, regular prescriptions appear to be increasing. We are unable to comment on whether, currently, residents with CI: receive less analgesic medication.ReferencesJensen-Dahm C, Gasse C, Astrup A, Mortensen PB, Waldemar, G. Frequent use of opioids in patients with dementia and nursing home residents: A study of the entire elderly population of Denmark.Alzheimers Dement2015;11:691–699Nygaard HA, Jarland M. Are nursing home patients with dementia diagnosis at increased risk for inadequate pain treatment?Int J Geriatr Psychiatry2005;20:730–737Sandvik R, Selbaek G, Kirkevold O, Husebo, BS, Aarsland D. Analgesic prescribing patterns in Norwegian nursing homes from 2000 to 2011: trend analyses of four data samples.Age Ageing2016;45:54–60
One year mortality: recognising the need for urgent or advance care planning in adults aged over 70 years old following emergency admission
Authors: Bielinska A-M , Obanobi A , Riley J , Urch CE 
Published: August 2016

IntroductionApproximately 1 in 3 hospital inpatients may be in their last year of life in Scotland (Clark, 2014); however no data exists for England. This study aimed to review outcomes of admissions for patients aged 70 years old and above admitted to a large London hospital Trust during 2014.AimTo establish the 1 year mortality of a cohort of admissions in patients aged 70+ years admitted to Imperial College Healthcare NHS Trust.MethodsAdmission data were obtained via the electronic patient record (Cerner) from 1st May-31 October 2014, stratified according to emergency overnight admission and age. Follow-up data on mortality, admission patterns and diagnoses were analysedResultsDuring the study period there were 6,701 admissions for patients aged 70+ years, of whom 49.4% were 70–79 years, 38.3% were 80–89 years and 12.3% were 90+years. The 1 year mortality for all age groups combined was 22.4%; 12.7% died within 3 months, 4.8% died between 3–6 months, 3% died between 6–9 months and 1.9% died between 9–12 months. One year mortality rose with age, from 20% in 70–79 year olds, to over 25% in 90+ year olds.ConclusionsThe data from London and Scotland both indicate that a single admission over the age of 70 years old is a significant predictor of death within 1 year. An emergency admission over the age of 70 years could be used to aid recognition of the last years of life and an indicator to initiate care planning. Care planning has been demonstrated to reduce further unscheduled admissions and improve out-of-hours care (Brinkman-Stoppelenburg, 2014).ReferencesClark, D.Imminence of death among hospital inpatients: Prevalent cohort study.Palliat Med2014;28(6):474–479Brinkman-Stoppelenburg A. The effects of advance care planning on end-of-life care: a systematic review.Palliat Med2014;28(8):1000–1025
Co-development strategy for successful recruitment of patients to a qualitative research study on compassion in a UK inpatient hospice
Authors: Armour Kathy , Grubb Rachel , Palfrey Hannah , Ives Jonathan 
Published: August 2016

BackgroundAn empirical bioethics analysis exploring what palliative inpatients understand as compassion was planned within an Intercalated BMedSc degree. Limited time was available, so to achieve deadlines, a co-developmental approach was employed maximising clinical/research expertise from hospice and university.AimTo study compassion by forming an effective university-hospice research partnership.MethodsA multi-disciplinary research team (MDRT) was created comprising a student, academic researcher, hospice nurse and hospice facilitator. Introductory meetings in January 2016 developed a research strategy appropriate to a hospice inpatient unit (IPU). Three members of the MDRT attended the IRAS committee and on-going support ensured governance permissions were obtained. Recruitment over 8 weeks (March–May 2016) was designed to be symbiotic with clinical care, promoting a good experience of exploratory qualitative interviewing.Results and discussionIntense support of the researcher facilitated timely transition through governance. All IPU patients were screened. Nineteen eligible patients were approached and introduced to the study by the nurse who also communicated with the clinical care teams. Six patients were consented by the student and 15–25 minute semi-structured interviews were conducted. Reasons for non-participation varied from feeling tired or poorly to exclusive interest in interventional research trials.ConclusionA MDRT approach can facilitate a qualitative research study in an inpatient hospice. Knowledge of the clinical setting maximised an effective recruitment strategy. Recruitment barriers included time constraints, patient willingness, patient availability, and perceptions of patient capacity and willingness. Ethics and procedural questions around promoting compassion research participation in this potentially vulnerable population can be addressed.ReferenceByrne A, Upton L, Townsend S. Mind the gap: a step forward in supporting hospice-based research.BMJ Support Palliat Care2014;5(1):4–6. doi:10.1136/bmjspcare-2014-000808
Development of a psychoeducational workshop for patients with cancer cachexia and their carers
Authors: Wheelwright Sally , Hopkinson Jane B , Darlington Anne-Sophie , Fitzsimmons Deborah , Johnson Colin D 
Published: August 2016

IntroductionCancer cachexia has a negative impact on the quality of life (QOL) of patients and their informal caregivers but there are few psychoeducational interventions to address this.AimTo develop a brief supportive group-based intervention for patients with cancer cachexia and their carersMethodsWorkshop development followed the Coventry Intervention Development Process.1Reasons why unintentional weight loss is difficult for patients and carers were mapped from interviews with 5 patients, 5 carers and 5 health care professionals (HCPs). A summary map was supplemented with data from systematic reviews of the patient and carer literature and by previously conducted interviews with patients and HCPs about the effect cancer cachexia has on QOL. Project advisory panel members rated the importance and changeability of each reason in the context of a workshop. The highest scoring reasons were grouped to form intervention targets. Reviews of the literature informed the information provided to address the targets and the methods used to do this.ResultsUnderpinning the intervention is the Integrated Theory of Health Behaviour.2The workshop has three intervention targets: providing information about eating well with cancer, addressing conflict and addressing negative emotions. Activities were devised to inform how cancer can cause unintentional weight loss, what to eat, strategies to maximise intake and conflict self-management. The underlying assumption is that negative emotions will be alleviated by providing clear information and advice.ConclusionWe have developed a workshop to educate, aid coping and provide relationship support for patients with cancer cachexia and unintentional weight loss.ReferencesMartin F, Turner A, Bourne C, Batehup L. Development and qualitative evaluation of a self-management workshop for testicular cancer survivor-initiated follow-Up.Oncol Nurs Forum2013;40:E14–E23Ryan P. Integrated theory of health behavior change: background and intervention development.Clinl Nurse Spec2009;23:161–170
How accurate are palliative care doctors at recognising dying?
Authors: White Nicola , Harris Adam , Reid Fiona , Harries Priscilla , Minton Ollie , McGowan Catherine , Lodge Philip , Tookman Adrian , Stone Patrick 
Published: August 2016

BackgroundBefore being able to plan for end of life care, a doctor must first recognise that a patient is dying. A recent review has highlighted that doctors are not very good at this (Neuberger, 2013).AimWe set out to develop a “test” to assess how accurate doctors are at recognising dying. The test will consist of case studies, or “vignettes”, based on real palliative care patients.MethodsIn order to create the vignettes for the test, we undertook a prospective observational study of patients at two sites (a hospice and a hospital palliative care team). Any inpatient, over 18 years old, English speaking, and who was identified by the palliative care team as likely to die within the next two weeks was eligible. The clinical course of each patient was observed and was used to create a vignette, which formed the basis of the prognostic test.Results50 participants were recruited and 20 were used to devise a prognostic test. For each vignette, clinicians were asked to assess the likelihood of death in the next 72 hours (scale 0% to 100%) based on the information presented. Illustrative examples of the test questions will be presented at the conference.ConclusionsWe have developed a standardised test to assess clinicians’ abilities to accurately diagnose imminent death. This test may be used to identify doctors who are most accurate at recognising dying. This may lead to an improved understanding of how this clinical skill is acquired and how it can be taught to less expert clinicians.ReferenceNeuberger J. More care, less pathway: a review of the Liverpool Care Pathway; 2013. Available at:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf
Multi-disciplinary research team approach to recruiting patients, close persons and healthcare professionals in hospices
Authors: Armour Kathy , Campbell Cathy L , Bailey Cara , Kinghorn Philip , Orlando Rosanna , Perry Rachel , Jones Louise , Coast Joanna 
Published: August 2016

IntroductionThere are several well-known barriers to conducting research in hospices. Hospices may lack experience of research and have less developed governance procedures. The vulnerability of patients and the sensitivity of the topic may also form real, or perceived, barriers. Recruitment of participants to end-of-life projects therefore tends to be slow and resource intensive. It requires clear communication between academic researchers and hospice staff.AimTo establish a multi-disciplinary team (MDT) approach to enhance research in a voluntary-sector hospice incorporating day services, outpatient clinical services and inpatient unit.MethodAn integrated multi-disciplinary research team (MDRT) was created comprising four sub-teams: the hospice team including a dedicated research lead, the university team, a wider project group and an external advisory group. Seventy-two participants: 33 patients, 21 close persons and 17 healthcare professionals were recruited to a semi-qualitative research study between October 2012 and February 2014. Challenges to recruitment were identified and solutions applied during the course of the study by the MDRT.ResultsKey members of the MDRT, identified early in the research process, enabled recruitment difficulties to be overcome. Approaches included increasing the visibility of researcher, increasing and regularising communication between core MDRT team members and maintaining ongoing dialogue with potential participants to reduce staff gatekeeping.ConclusionSimulating a clinical MDT-style working approach can facilitate palliative care research activity. Creating a research-supportive environment identifies problems and creates solutions. The MDRT model is offered to researchers and hospice staff to develop and enact effective participant recruitment to build end-of-life research.ReferenceBailey C, Kinghorn P, Orlando R,et al. The ICECAP-SCM tells you more about what I am going through: A think-aloud study measuring quality of life among: patients receiving supportive and palliative care.Palliat Med2016;30(7):642–652
JOINT RESPONSE UNIT: IMPROVING PATIENT CARE AND SAFETY THROUGH COLLABORATIVE WORKING BETWEEN AMBULANCE AND POLICE SERVICES
Authors: Zipfel Rebecca , McIlwaine Scott 
Published: August 2016

BackgroundThe London Ambulance Service NHS Trust receives more than one million calls every year, with roughly 10% of these coming from the Metropolitan Police Service. The majority of calls from the police are for patients with non-life-threatening symptoms, to which a clinical response is aimed to be dispatched within 30 minutes. When demand is high, however, ambulances get re-directed to more severely ill patients and police officers end up waiting on-scene for prolonged periods. This has a detrimental impact on the police services' response to calls.MethodsThe Joint Response Unit is an initiative designed to address the above problem. It consists of a solo clinician providing a dedicated response to police requests within an assigned borough. Initiated in 2011, it now covers 12 London boroughs, with the hope of further expansion within and outside of London. This evaluation is assessing the necessity and clinical safety of this initiative.FindingsAn on-scene clinical response was required for 95% of patients, highlighting the need for the Joint Response Unit. Arrival time to life-threatening calls is improved and conveyance to hospital decreased due to the clinician's ability to appropriately assess, treat and discharge on-scene. Since its implementation in 2012, the Joint Response Unit has reduced police on-scene waiting times from an average of 36 minutes to 7 minutes. Over the course of just one weekend, the faster clinical response equates to a total of 13 hours of officer-time saved.ConclusionsThe Joint Response Unit is a unique and successful model of collaborative working between emergency services, with benefits to both the ambulance and police services. Other services should look at replicating this model to enable effective collaboration nationally.
A STUDY TO DETERMINE THE EZ-IO® INTRAOSSEOUS INFUSION SYSTEM SUCCESS RATE, INCLUDING IMPACT ON RETURN OF SPONTANEOUS CIRCULATION
Authors: Woodhart Ben , Shaw Joanna 
Published: August 2016

BackgroundIn the UK the EZ-IO® Intraosseous Infusion System is a paramedic delivered technique involving the placement of the Intraosseous (IO) needle into the patient's bone marrow via an EZ-IO driver. The primary use for EZ-IO is when intravenous (IV) access is not possible, mainly for patients in cardiac arrest but may include severely unwell/injured patients. This study aimed to determine EZ-IO success rate, including impact on return of spontaneous circulation (ROSC).MethodsOne hundred and ninety-five cardiac arrest patient records where EZ-IO placement was attempted were retrospectively examined to determine whether ROSC was achieved at any point. Findings were compared to records where resuscitation was attempted and patients were administered drugs IV and tested for association using Pearson's Chi-Square Test.In addition, patients' records were assessed for their compliance to best practice guidance issued by the Joint Royal Colleges Ambulance Liaison Committee for use in UK Ambulance Services and manufacturer's guidelines.ResultsROSC was achieved for 29% of the patients who had an EZ-IO inserted (n=57), therefore for 71% (n=138) ROSC was not achieved. This compares to 46% (n=338) and 54% (n=399) retrospectively for patients administered drugs IV.We observed a strong association between method of access and patient's outcome (χ2(1)=17.465, p=.000).Where an EZ-IO was attempted 100% (n=195) were identified as having a successful IO placement, although certain areas of documentation were highlighted as requiring improvement, specifically: insertion site (recorded for 26%, n=51); needle size (74%, n=145), and saline flush (93%, n=182).ConclusionsAlthough, this shows that the practice of pre-hospital EZ-IO insertion is successful, it compares less favourably to administering resuscitation drugs IV. However, there may be other factors associated with achieving ROSC that have not been taken into account, including the reasons IV access was not possible and whether this was an influencing factor.
PRE-HOSPITAL ANALGESIA FOR PATIENTS WITH FEMORAL FRACTURE: A SYSTEMATIC REVIEW OF THE LITERATURE
Authors: Bulger Jenna , Ford Simon , Pallister Ian , Rees Nigel , Russell Daphne , Russell Ian , Snooks Helen 
Published: August 2016

ObjectiveTo identify and estimate the effectiveness of interventions to provide analgesia for patients with femoral fracture in the emergency pre-hospital setting.MethodsWe searched the Cochrane Library, CINAHL, HMIC, Medline, PubMed, Scopus, Web of Science, grey literature and citations of included studies. We included randomised trials and observational studies that included pain score measurements. We carried out a meta-analysis using Review Manager.ResultsWe identified 858 studies and assessed 36 full articles for eligibility. Ten studies met the inclusion criteria, including 478 patients. Five studies were randomised controlled trials, comparing outcomes between: fascia iliaca compartment block (FICB) with standard care; femoral nerve block with standard care; Transcutaneous Electrical Nerve Stimulation (TENS) with placebo; auricular acupressure with sham acupressure; and simple splints with traction splints. Two cohort studies included comparisons of pain scores with and without FICB. Three uncontrolled observational studies reported effects of FICB. Meta-analysis of four randomised studies with 227 patients showed that, compared with control, proactive interventions reduced pain scores by 1.9 standard deviations (95% CI from 1.1 to 2.7; p<0.0001); but these trials were clinically and statistically heterogeneous.ConclusionsCurrent published research suggests that interventions to enhance the provision of analgesia for femoral fracture in emergency pre-hospital care reduce pain scores significantly more than standard care. However, as only five randomised studies are available with a range of diverse interventions, further research is warranted.
OVERCOMING CHALLENGES OF SETTING-UP A LARGE AND COMPLEX PRE-HOSPITAL TRIAL: AIRWAYS-2
Authors: Robinson Maria , Taylor Jodi , Voss Sarah , Rogers C , Brett S , Benger Jonathan 
Published: August 2016

BackgroundAIRWAYS-2 is an NIHR-funded study to determine the best initial approach to advanced airway management during out of hospital cardiac arrest (OHCA). The trial will enrol more than 9,000 patients and 1,500 paramedics. To achieve this, collaboration between four Ambulance Trusts and every hospital served by these was required. Patients receive the trial intervention pre-hospital, and the primary outcome and other data are collected in-hospital. We describe the set-up process for this large, complex, pre-hospital trial.MethodsPre-hospital research presents unique challenges. Obtaining approvals and set-up can be complex, time consuming and expensive. A strategy to engage with all stakeholders was developed, ensuring that they were well informed during the planning and set-up phases. Specifically, this included: establishing R&D and Clinical Research Network contacts; involving critical care leads; consultation with ambulance trusts; utilisation of network support; implementation of a wide-reaching communications plan. All hospitals were contacted to identify local collaborators prior to SSI submission, and were provided with FAQs and study information. The approval process was streamlined. The SSI was generic and did not require input from local teams. A one page statement of responsibilities replaced review of contracts for sites. Comprehensive review by REC & CAG meant that full consideration was given to the ethical challenges during planning and set-up phases.ResultsTrust permission was obtained from all acute hospitals (95 in total), served by participating ambulance trusts. All set-up milestones were achieved and the first patient was enrolled on time.ConclusionsAmbulance services are increasingly research active. Incidents attended can be life-threatening emergencies but good quality pre-hospital trials are possible. Early and comprehensive engagement assists with sites' participation and enables successful set-up of collaborative trials.