bluuebunny/crossref_metadata_2025_split huggingface dataset:
HOW DO GOLD STANDARD FRAMEWORK MEETINGS SUPPORT PALLIATIVE CARE DELIVERY AS PART OF PRIMARY CARE SERVICES? AN OBSERVATIONAL STUDY
Authors: Haraldsdottir Erna , Baughan Paul , Forbat Liz 
Published: February 2014

BackgroundWhilst uptake of the GSF is widespread there is a lack of evidence to demonstrate how it supports GPs and district nurses to deliver palliative care in primary care. This small study provides insight into the use of GSF meetings within 3 GP practices within NHS Forth Valley.AimTo identify how GP practices make use of GSF meetings in order to improve palliative care in primary care.MethodsGP practices that were considered as ‘good examples’, in relation to use of GSF, were invited to take part in the study. 8 GSF meetings were observed and tape recorded. Thematic analysis was used to analyse data, providing order to the data set and allowing for key themes to emerge and be identified.ResultsThere is ongoing uncertainty amongst GPs related to the criteria for when/what patients should be on the palliative care register, especially for patients with long term condition other than cancer.There was much variation between the GP practices in regards to how many patients they had on the register from 5–54 and this was not in the expected relation to size of practices.GSF meetings were constructed through informal dialogue without any use of formal documents for assessment or management plan.GSF meetings were used for a brief update on the patient condition and situation, key symptom and how they were coping at home.Only one of the three practices used GSF meetings systematically to check if documents related to Advance Care Planning were in place.ConclusionIt appeared that the main benefits of the uptake GSF was related to increased awareness, for those who attended the meeting, of the patients' current situation, possible supporting better coordination of care. However it is unclear how the information sharing benefitted patients in relation to clinical outcomes. Further research is needed to explore how uptake of the GSF improves clinical outcomes.
INTEGRATING PALLIATIVE CARE INTO A REGIONAL REFERRAL HOSPITAL IN KAMPALA THROUGH A LINK NURSE PROGRAMME
Authors: Downing Julia , Batuli Mwazi , Kivumbi Grace , Kabahweza Josephine , Leng Mhoira 
Published: February 2014

BackgroundIn order for palliative care to be provided to all in need, an integrated approach to service delivery is needed, where a mixture of specialist and generalist care is provided. A needs assessment in 2010 showed 40% of patients in Mulago hospital have palliative care needs. Thus the Makerere Palliative Care Unit (MPCU) developed a programme to train link–nurses across the hospital supported by a referral pathway and identification process.AimsTo integrate palliative care into all wards of Mulago Hospital through a link-nurse programme.Methods27 link nurses from 11 clinical areas, were trained and mentored over the past 2 years. An evaluation of the programme was carried out using quantitative and qualitative data collection methods including; pre and post course confidence ratings; course evaluation forms; review of link-nurse activity sheets and action plans; review of MPCU patient documentation; Most Significant Change (MSC); and focus group discussions (FGDs).ResultsLink nurses cared for 1,684 patients during 2012, of these, 336 (20%) were referred to MPCU for specialist input. Referral patterns suggest the complexity of patients referred to MPCU has increased with >75% of MPCU patients having complex needs requiring specialist input. Results of the evaluation suggest the link-nurse programme has helped integrate PC throughout the hospital. There has been a change in attitudes, the nurses have developed new skills and knowledge, there is improved relationships and better outcomes of care. Challenges identified include heavy work-load and the need for training for other staff.ConclusionThe link-nurses felt they were able to provide better PC to those that needed it, and had a stronger relationship with the MPCU both in terms of support, but also for referrals. The integration of PC throughout hospitals is vital, and the link-nurse programme demonstrates a successful model.
PROPOSAL OF A COMPREHENSIVE MODEL FOR PALLIATIVE CARE SERVICE DELIVERY IN THE REPUBLIC OF SERBIA
Authors: Downing Julia , Baskott Jo , Haraldsdottir Erna , Lukic Nina , Milicevic Natasa , Naylor Mike 
Published: February 2014

BackgroundFollowing the adoption of a national palliative care strategy by the government of the Republic of Serbia in 2009 it was decided to develop a comprehensive model of palliative care service delivery which is appropriate to the circumstances and resource constraints of Serbia.AimsTo develop a comprehensive model for palliative care service delivery that is appropriate and affordable for Serbia, in partnership with the Ministry of Health and key stakeholders.MethodsA model of care was developed in four phases: (1) Review of existing legislation and the context and provision of health services in Serbia (2) The development of service delivery standards, and instruments for palliative care implementation. (3) A participative field study in three sites to gather information and conduct discussions with stakeholders, Issues covered included the availability and use of existing resources; provision of health services at the different levels, and key deficits in service provision. (4) Drafting of model of palliative care service delivery. (5) Consultation with key stakeholders.ResultsA draft model of palliative care service delivery has been proposed using available Serbian practice & experience complemented with good practice from neighbouring countries & international PC. The proposed model includes the following resources: a policy, model implementation guide, resource plan, quality indicators, standards of care, instruments for implementation, and best practice guidelines. The consultation process is ongoing and due to be finalized by the end of the year.ConclusionThe development of a model of service delivery which sets out guidance for the provision of care at each level of the healthcare system is a vital component in operationalising palliative care. Whilst initial draft documents may be finalised, it is important to recognised that any model of palliative care service delivery needs to be fluid and respond to the ongoing needs within the country.
HEALTH PROFESSIONALS’ PERSPECTIVES ABOUT ADVANCE CARE PLANNING IN PARKINSON'S DISEASE: A QUALITATIVE STUDY
Authors: Jackson Timothy , Gerhard Alexander , Walshe Catherine 
Published: February 2014

BackgroundPeople with Parkinson's disease face repeated hospital admissions and medical interventions in the last year of life. Advance care planning (ACP) is advocated, aiming to empower patients by engaging them in decisions about their future. There is little evidence about the optimum timing and content of ACP or how this process should be coordinated for those with Parkinson's disease.AimTo discover the views of health professionals on best practice for ACP in Parkinson's disease and how organisations might better support multi-disciplinary teams to undertake ACP.MethodQualitative design, using semi-structured interviews with a purposive sample of health professionals, with experience of Parkinson's disease or ACP in other neurological conditions (n=16). Participants were recruited through neurology, elderly medicine, and palliative care departments at three organisations (a tertiary neurology centre, teaching hospital and a hospice). Interviews were audio-recorded and transcribed. Iterative thematic analysis comprised familiarisation, coding and categorisation. The study received all necessary governance approvals.ResultsThere was consensus that prognostic indicators and patient cues should prompt discussions at an appropriate time for each individual. Potential discussion areas included preferred place of care, artificial nutrition and hydration, and future hospitalisation. Participants felt the organisational approach to ACP should be better coordinated through improved collaborative working across different settings and use of tools such as electronic palliative care records. Some felt professionals should be offered further training, but most felt that different aspects of ACP could be undertaken by a range of medical, nursing and other staff.ConclusionACP should be a personalised, flexible and dynamic process for patients with Parkinson's disease. Organisations should support different staff groups to undertake ACP, providing appropriate tools, training and resources. Better joint working between palliative care, neurology and elderly care teams and allied health professionals should be encouraged and supported.
WHAT IS THE QUALITY OF END OF LIFE CARE FOR THOSE WHO DIE AT HOME? A STUDY TO EXPLORE THE VIEWS AND EXPERIENCES OF BEREAVED CARERS'
Authors: Lees Carolyn , Mayland Catriona , West Angela , Germaine Alison 
Published: February 2014

BackgroundThe quality of end of life care has been the focus of much government policy. Collecting data from those who are dying is complex (Mitchell, 2002) but it appears that relatives and carers' views provide a valuable evaluation of the patient's end of life care, synergised with their own unique experiences as carers (Maylandet al, 2012).AimTo explore bereaved carers' experiences of end of life care for those who had died at home using a validated tool.MethodsA mixed method approach comprised of a self completed questionnaire allowing respondents to provide narrative to support their responses. Two hundred and ninety one patients who had an expected death at home were identified. Narrative data from the questionnaires were analysed using framework analysis identifying prominent words and phrases, expanded to include associated key words or themes (Richie & Spencer, 1994).ResultsFour main themes and associated sub themes emerged from the narrative data. The main themes were coordination and continuity of care, competence, compassion and communication. Quantitative data will not be presented here.DiscussionThe findings from this study reflect that generally good quality care was provided for those who died at home. There were examples of well orchestrated care with services working well together, but there were times when adequate support was not evident.ConclusionsWith the number of deaths globally set to increase there is a need to identify tools which measure the quality of end of life care for those who choose to die at home in order to improve the experiences of patients and carers. The CODE questionnaire represents a user friendly, comprehensive tool to achieve this.
DEPRESSION AMONG PALLIATIVE CARE INPATIENTS IN A SONGKHLA HOSPITAL, SOUTHERN THAILAND
Authors: Vichurangsri Teeraporn , Sae-Chit Kallaya , Nilmanat Kittikorn 
Published: February 2014

IntroductionDepression is common in patients with advanced disease. However depression remains under detected.ObjectiveThis retrospective study was aimed to describe depression among patients seen by an advanced practice nurse in Songkhla hospital.MethodsSubjects were hospitalized patients who were consulted to a palliative care service. In general, every patient consulted to a palliative care team received a routine first assessment by an advance practice nurse. A routine assessment included demographic data, clinical data and health profiles. The nurse administered two questions screening tool (2Q) for depression screening. “Do you feel depressed?” and “have you lost interest or pleasure or felt boring?” If it was found ‘positive result’ for depression, further 9Q–nine questions for depression and suicidal minds assessment was applied. Patients' palliative care nursing record were recruited into the study between January 2013 and June 2013. Descriptive statistics were used.ResultsA total of 188 nursing records were reviewed to estimate the incidence of depression. At a screening section, using 2Q short form Depression Screening Questions, 35.1% of the subjects had negative result while 18.6% had positive result or were risky for depression. The rest (46.3%) were not able to assess, because patients were unconsciousness or on ET tube. Those being at risk for depression were further assessed by 9Q. According to the original cut-off point of 9Q, .5 % of those assessed classified as severe depression (9Q>19), and 2.1% were at moderate level of depression (9Q 13–18) and 6.4% were at mild level of depression (9Q 7–12). 9.6% were at the borderline level of depression.ConclusionThe findings suggest that health professionals should recognize psychological distress among this population by providing an initial screening assessment and preventive intervention.
AFTER IWANTGREATCARE: SERVICE USER FEEDBACK AS A MEANS OF REFINING THE IWANTGREATCARE QUESTIONNAIRE
Authors: Bowyer Anna , Finlay Ilora , Byrne Anthony , McCarthy Jacqui , Harrop Emily , Sampson Catherine , Snow Veronica , Nelson Annmarie 
Published: February 2014

BackgroundThe iWantGreatCare (iWGC) questionnaire was developed by the Palliative Care Implementation Board and aims to evaluate palliative care service provision in Wales, through the appraisal of care, as encapsulated in 10 questions and a free text box.In order to fully reflect patients' and families' experiences of care, we previously undertook a qualitative analysis of the free text comments of 596 patients and carers, which highlighted areas not fully assessed in the scored results. Following this analysis, we are undertaking a further project to refine the questionnaire to accommodate patients' and carers' priorities and concerns.MethodsThe questionnaire was refined via an expert consensus day with healthcare professionals, researchers and a lay representative, utilising the qualitative free text analysis, and is now being tested using face–to-face, semi-structured, cognitive interviews with patients (n=10) and carers (n=10), who use palliative care services at two hospices in South Wales. The questionnaire comprehensively encompasses the elements of palliative care previously identified as important to patients and carers. Interviews aim to test whether the questions are understandable and pertinent to those completing the questionnaire. Interview transcripts from recorded data are to be analysed using a six phase thematic analysis.ResultsIt is expected that the interviews will inform the final questionnaire revision prior to being presented to the Palliative Care Implementation Board for their consideration. The results of these cognitive interviews and the refined questionnaire will be outlined and discussed in this presentation.
DO HOSPITAL NURSES ADMINISTER NASAL FENTANYL SPRAY CORRECTLY? – A SERVICE EVALUATION
Authors: Fingas Samuel , Bourke Anne-Marie , Spawton Vanessa , Richardson Sian , Miller Elizabeth , Ahmedzai Sam H 
Published: February 2014

BackgroundPecFent®is a powerful fast-acting fentanyl nasal spray which is used for breakthrough cancer pain. When it is not administered correctly or titrated quickly enough, we suspect aspects of patient care may suffer, with sub-optimal pain control, loss of confidence in the medication, and unnecessary cost to the health service.AimsTo assess hospital nurses' confidence and competence in administering PecFent®. To identify specific needs for further training.MethodsWe used a convenience sample of 5 nurses (who had previously administered PecFent®) per ward or hospice unit in Sheffield where PecFent®is commonly prescribed. A guided questionnaire-based interview, involving a standardised scenario using placebo PecFent®, was piloted on 4 specialist nurses. The scenario required the nurse to titrate the dose from 100 to 200 mcg and administer it to an actor, followed by questions on confidence, previous experience, training, and understanding of PecFent®.ResultsA total of 35 nurses were interviewed from 7 wards/units. 29% (10/35) chose the correct dose of 200mcg. Commonest reasons for reluctance to titrate the dose up were: “long interval since previous dose” (n=16); and “only had 100mcg doses previously” (n=8). Only 40% enquired about effectiveness of the previous dose. 34% gave a spray effectively (primed device, aiming at nasal septum, no deep inhalation, one nostril/spray). 6% gave the correct dose effectively. 69% of nurses had given PecFent®>10 times previously. 54% rated their confidence as ≤7/10. Only one nurse had received formal training; 80% of nurses had learnt through observing a colleague. 77% wanted further training.ConclusionWe have demonstrated lack of confidence and competence in administering and titrating PecFent®effectively. We are making a training video to cover priming, direction of spay, instructions for breathing, and dispelling the myths about titration.
VARIATIONS IN METHADONE PRESCRIBING AND OUTCOMES — A SERVICE EVALUATION IN SHEFFIELD AND CHESTERFIELD
Authors: Bourke Anne-Marie , Theobald Rebecca , Ahmedzai Sam H 
Published: February 2014

BackgroundMethadone is a synthetic opioid used in refractory pain. There is increased awareness of methadone related adverse events including respiratory depression and QTc prolongation. In our region several methods exist for methadone initiation, falling into two categories: switching one opioid to methadone (stop and go — SAG) and adding methadone to another opioid (addition — ADD).AimsTo characterise how methadone is being used locally. To quantify the nature and frequency of methadone induced side effects.MethodsAll patients prescribed methadone by the palliative care teams in Sheffield and Chesterfield over an eight month period were included. Data were prospectively collected on diagnoses, indication(s) for methadone, method of conversion, ECG recording, pain scores and side effects.Results25 patients were prescribed methadone, all as inpatients. 20 patients had malignancy, the remainder chronic pain. Methadone was chosen in all cases due to persistent pain and/or medication side effects. A SAG method was used for 72% and ADD for 28%. The median daily oral morphine equivalent dose prior to initiation was 240 mg (range 50 mg – 1000 mg). 92% had an ECG prior to commencing methadone.Following titration, the median methadone dose was 10 mg BD (range 4 mg – 40 mg BD). Average pain scores reduced from 7/10 to 3/10 in both groups.28% reported side effects of sedation, nausea, confusion or hallucinations. 2 patients required naloxone and 3 developed QTc prolongation, all in the SAG group.72% were discharged home, 8% were transferred to another hospital and 20% died. None of the deaths were attributable to methadone.ConclusionLocally, methadone is prescribed for patients with chronic pain as well as those with malignancy. Methadone results in clinically meaningful pain relief regardless of method of initiation. A SAG method is used most frequently. All five clinically significant adverse events were reported in the SAG group.
CHALLENGES OF PROVIDING PALLIATIVE CARE IN A CRITICAL CARE SETTING
Authors: Davies James , Vora Vandana 
Published: February 2014

BackgroundAn ageing population with complex co-morbidities and rising public expectation for high quality life sustaining treatment has seen a rising demand for critical care. End of life care strategy (2008) recommends delivery of high quality service in all locations including acute hospitals.Aim and methodTo retrospectively review all referrals to Hospital Palliative Care Team (HPCT) over a 12 month period from specialist and general critical care units of a large teaching hospital. The objectives were:1) to identify reasons for referral, 2) to assess impact of palliative care interventions on patient care and 3) to identify the unique challenges of providing palliative input into critical care. Information was extracted from Infoflex, an electronic patient database that captures details of referral, diagnosis, patient assessment and palliative care interventions.Results36 patients (22 male, 14 female) median age 65.5 (range 39–94) from critical care facilities were referred to HPCT over 12 months. 21 had a diagnosis of malignancy. Reasons for admission included sepsis, multi organ failure and post-operative care/complications. The reasons for referral were symptom control, support with withdrawal of therapy and management of terminal care including support to carer. 32 out of 36 patients have died. Of these, only 11 died in a critical care unit. The HPCT was able to facilitate and achieve preferred place of death outside acute hospital for 11 patients. The biggest challenge was communication as the combination of critical illness and invasive interventions often diminished the capacity of patients to make decisions. Discontinuity of care and accepting the shift in goals from intensive treatment to palliative care was emotionally difficult for staff and family.ConclusionDespite the challenges, it is possible and appropriate to give compassionate palliative care to dying patients and their carers in a critical care setting through good interdisciplinary team working and communication, adopting a proactive approach.
FIVE YEARS ON: THE INCREASING USE OF ULTRASOUND IN A HOSPICE
Authors: Lee Bernadette 
Published: February 2014

BackgroundSince 2008, several new doctors have attended the Focused Abdominal UltraSound in Palliative Care course. The course taught the examination protocols for ascites, liver, urinary tract and deep vein thrombosis (DVT). A log book was kept with the scanner.LocationYearNew doctors trainedNumber of doctors doing scansNumber of scansNumber of patientswardOPDhomenursing home200863241624000200903151315000201014221620200201147242017250201216402930721total12–125941061171AimsThe aims were to audit:the frequency of usewhether the course examination protocols were followedthe impact of having ultrasoundwhether cleaning of the transducer was recordedInformation from the log book and patient records were used to complete the audit.ResultsIn the last 3 years, the number of scans increased from 22 to 40. There was a trend for patients who might need paracentesis to be assessed before admission was requested.All 125 scans followed examination protocols.The clinical indications were confirmation of ascites (97), urinary bladder (14), hydronephrosis (3) and groin DVT (1). Each scan had been helpful in the clinical decision making: paracentesis were done on 22 occasions, prescription of diuretics (1), referral for PleurX drain (1) and insertion of urine catheter (12). 92% (115/125) log entries recorded cleaning of transducer.ConclusionsThere has been increasing and appropriate use of ultrasound last 5 years. The use of inpatient beds were optimised. Cleaning of the transducer needs to be done each time and recorded. Annual audit of ultrasound use is planned.