bluuebunny/crossref_metadata_2025_split huggingface dataset:
Job stress and burnout in hospital employees: comparisons of different medical professions in a regional hospital in Taiwan
Authors: Chou Li-Ping , Li Chung-Yi , Hu Susan C 
Published: February 2014

ObjectivesTo explore the prevalence and associated factors of burnout among five different medical professions in a regional teaching hospital.DesignCross-sectional study.SettingHospital-based survey.ParticipantsA total of 1329 medical professionals were recruited in a regional hospital with a response rate of 89%. These voluntary participants included 101 physicians, 68 physician assistants, 570 nurses, 216 medical technicians and 374 administrative staff.Primary and secondary outcome measuresDemographic data included gender, age, level of education and marital status, and work situations, such as position, work hours and work shifts, were obtained from an electronic questionnaire. Job strain and burnout were measured by two validated questionnaires, the Chinese version of the Job Content Questionnaire and the Copenhagen Burnout Inventory.ResultsAmong the five medical professions, the prevalence of high work-related burnout from highest to lowest was nurses (66%), physician assistants (61.8%), physicians (38.6%), administrative staff (36.1%) and medical technicians (31.9%), respectively. Hierarchical regression analysis indicated that job strain, overcommitment and low social support explained the most variance (32.6%) of burnout.ConclusionsPhysician assistant is an emerging high burnout group; its severity is similar to that of nurses and far more than that of physicians, administrative staff and medical technicians. These findings may contribute to the development of feasible strategies to reduce the stress which results in the burnout currently plaguing most hospitals in Taiwan.
Aspirin and clonidine in non-cardiac surgery: acute kidney injury substudy protocol of the Perioperative Ischaemic Evaluation (POISE) 2 randomised controlled trial
Authors: Garg Amit X , Kurz Andrea , Sessler Daniel I , Cuerden Meaghan , Robinson Andrea , Mrkobrada Marko , Parikh Chirag , Mizera Richard , Jones Philip M , Tiboni Maria , Rodriguez Raul Gonzalez , Popova Ekaterina , Rojas Gomez Maria Fernanda , Meyhoff Christian S , Vanhelder Tomas , Chan Matthew T V , Torres David , Parlow Joel , de Nadal Clanchet Miriam , Amir Mohammed , Bidgoli Seyed Javad , Pasin Laura , Martinsen Kristian , Malaga German , Myles Paul , Acedillo Rey , Roshanov Pavel , Walsh Michael , Dresser George , Kumar Priya , Fleischmann Edith , Villar Juan Carlos , Painter Tom , Biccard Bruce , Bergese Sergio , Srinathan Sadeesh , Cata Juan P , Chan Vincent , Mehra Bhupendra , Leslie Kate , Whitlock Richard , Devereaux P J ,   on behalf of the POISE-2 Investigators
Published: February 2014

IntroductionPerioperative Ischaemic Evaluation-2 (POISE-2) is an international 2×2 factorial randomised controlled trial of low-dose aspirin versus placebo and low-dose clonidine versus placebo in patients who undergo non-cardiac surgery. Perioperative aspirin (and possibly clonidine) may reduce the risk of postoperative acute kidney injury (AKI).Methods and analysisAfter receipt of grant funding, serial postoperative serum creatinine measurements began to be recorded in consecutive patients enrolled at substudy participating centres. With respect to the study schedule, the last of over 6500 substudy patients from 82 centres in 21 countries were randomised in December 2013. The authors will use logistic regression to estimate the adjusted OR of AKI following surgery (compared with the preoperative serum creatinine value, a postoperative increase ≥26.5 μmol/L in the 2 days following surgery or an increase of ≥50% in the 7 days following surgery) comparing each intervention to placebo, and will report the adjusted relative risk reduction. Alternate definitions of AKI will also be considered, as will the outcome of AKI in subgroups defined by the presence of preoperative chronic kidney disease and preoperative chronic aspirin use. At the time of randomisation, a subpopulation agreed to a single measurement of serum creatinine between 3 and 12 months after surgery, and the authors will examine intervention effects on this outcome.Ethics and disseminationThe authors were competitively awarded a grant from the Canadian Institutes of Health Research for this POISE-2 AKI substudy. Ethics approval was obtained for additional kidney data collection in consecutive patients enrolled at participating centres, which first began for patients enrolled after January 2011. In patients who provided consent, the remaining longer term serum creatinine data will be collected throughout 2014. The results of this study will be reported no later than 2015.Clinical Trial Registration NumberNCT01082874.
Improving communication of inpatient blood transfusion events to GPs
Authors: Robbins Timothy 
Published: February 2014

AbstractPatients who have had blood transfusions whilst in hospital must have this information communicated to their General Practitioner at discharge. Audit demonstrated that just 50% of patients (n=15) under medical specialties who had undergone a blood transfusion had this information included in their discharge letter. To improve this, a section was specifically designated on the e-discharge pro-forma for the documentation of blood transfusion events, and focused teaching was delivered to all new FY1 doctors at their induction. Post intervention, 80% of blood transfusions occurring in medical patients were documented on the e-discharge, with an improvement in how detailed this documentation was (n=40). This simple intervention is an easily reproducible, cost neutral method of ensuring that more blood transfusion events are communicated to patients' GPs; improving care and reducing risk.
INFLUENCING NURSES' COMMUNICATION STYLE THROUGH A TWO DAY INTERACTIVE COMMUNICATION SKILLS COURSE
Authors: Pilsworth Alison , Blankley Kerry , Faull Christina 
Published: February 2014

BackgroundAn audit of hospital notes of inpatients diagnosed with advanced pancreatic cancer on a tertiary heptobiliary unit found little evidence of end of life discussions and advance care planning. While patients were often told at diagnosis that their cancer was incurable, they were generally not told their prognosis. Few nurses had formal communication skills training and most had little confidence in having end of life discussions.AimsTo examine outcomes of a two day interactive communications skills course on perceived self reflection of band 5 registered nurses.MethodsAt the start and end of the course the nurses were asked to reflect on themselves as a communicator using three self awareness describers:Informer, Ignorer, Inquirerand to consider what patients required of them. Participants were asked to identify the communication challenges they had encountered and skills which may help their practice.ResultsOver 80% of the 24 nurses identified themselves asInformers. Some said that at times they were aware that they ignored patient statements because they did not what to say and one said ignoring is the “only way to survive”.Only two nurses identified themselves as inquirers, but they sometimes found this difficult and had both been “told about spending too long with patients”. The majority felt that their informer style matched patients' requirements.Two main areas of challenge and specific skills development were identified: dealing with patients with difficult questions and dealing with and angry patients and relatives.Following the course all participants said that they would be primarily an inquirer. The skills of listening, pausing, summarising and empathy were evaluated as the most useful enhanced skills. Confidence and knowledge increased in the specific challenges that were identified.ConclusionA two day interactive course may promote awareness, increase confidence and may enable change practice.
NO SUCH THING AS BAD PUBLICITY? QUALITATIVE STUDY OF STUDENTS AND DOCTORS LEARNING NEEDS FOR END-OF-LIFE CARE IN THE MEDIA LIMELIGHT
Authors: Edge Henrietta , Yardley Sarah 
Published: February 2014

BackgroundDeath and dying are an unavoidable part of medical practice but doctors continue to report lack of competence in end-of-life care. Negative news media has placed additional demands on doctors seeking to negotiate issues in end-of-life care.AimsThis study addresses three questions1. What is the awareness among final year students and newly qualified doctors of media attention to end-of-life care?2. Do these groups expect media attention to affect practice with respect to end-of-life care?3. What are the self-identified learning needs of these groups with respect to providing end-of-life care and responding to media attention?MethodsThis study draws on experiential learning theories, recognizing that learning of ‘good medical practice’ is influenced by context. Following a literature review we undertook a thematic analysis of coverage of the Liverpool Care Pathway in three purposively selected national newspapers. Volunteer students (n=8) and newly qualified doctors (n=8) are being recruited to participate in two sets of longitudinal focus groups. The first session explores research questions 1/2. The next introduces our media analysis to extend discussions. In the final session we will discuss the emerging analysis and specifically explore perceptions of learning needs. Data will be audio-recorded and transcribed verbatim. An iterative approach to qualitative thematic analysis concurrent with data generation will be used to describe and interpret the overall findings.ResultsWe will present our findings combining data from media analysis with longitudinal focus groups. Implications including the identification of learning needs with respect to end-of-life care and professional duties when responding to media attention will be discussed.ConclusionsExternal influences on medical practice, such as media attention, can influence understandings of a phenomenon, challenge or legitimize particular practices. This study provides important insights into perceptions and learning needs of students and newly qualified doctors regarding end-of-life care.
WITHDRAWAL OF VENTILATION AT THE PATIENT'S REQUEST IN MND: DOCTORS VIEWS ON THE ETHICAL CHALLENGES INVOLVED
Authors: Faull Christina , Phelps Kay , Regen Emma , Rowe-Haynes Cassy , Oliver David , McDermott Christopher 
Published: February 2014

BackgroundLittle is known about the withdrawal of NIV at the request of a patient. The NICE guidance on the use of NIV in MND (2010) identifies the lack of any clarity in how this process should be managed. NICE specifically suggests interviewing the professionals involved as a focus of research.AimsTo explore the ethical issues that arise for doctors who have been involved in the withdrawal of NIV at the request of a patient with MND.MethodsA retrospective qualitative interview study of 20 Doctors including specialists in palliative care, respiratory, neurology and general practice.ResultsParticipants were clear that patients have the right to withdrawal from treatment and it would be unethical to continue treatment. Despite this clarity, withdrawal of NIV where the result will be death in a short timescale, can feel challenging. In such cases doctors may feel the need for a second opinion and affirmation that withdrawal of ventilation is ethically sound.The challenge is augmented by the need for the doctor to spend considerable time discussing the ethics of each case with colleagues and family members. Even when doctors feel the ethics are clear there can be an underlying fear that colleagues and the public will not see it this way, and a fear that they will be seen as assisting death. Many doctors had experienced disagreement from colleagues who felt that assisting patients in their request and managing the consequent symptoms, was unethical.ConclusionsThough the ethics of withdrawal of treatment at the patient's request are clear, in a situation where the result will be immediate death it feels ethically challenging for many doctors. Open ethical discussions of these situations and written guidance on the ethics of withdrawal of NIV in MND would alleviate many doctors fears.
INVESTIGATION OF BIOLOGICAL CHANGES AT THE END OF LIFE—A SYSTEMATIC REVIEW
Authors: Coyle Seamus , Debattista Maria , Mason Stephen , Ellershaw John 
Published: February 2014

BackgroundDiagnosing when someone is in the last days of their life is an ongoing difficulty for clinicians. There is often significant clinical uncertainty and modern medical science is poor at predicting how or when patients will die.AimTo review the literature to assess the knowledge of the biology of dying - excepting sudden death.MethodA systematic review of the biology of dying excepting sudden death was performed. 2661 articles on MEDLINE and 3360 articles from EMBASE were identified. Titles and abstracts from each database were examined independently for relevance.Results18 articles were identified. Interleukin-2 is preferentially expressed in brainstem neuronal centres in critically ill aging adults and infant patients dying from various conditions. A number of papers suggested that there may be a final common pathway to dying.ConclusionThere are few studies investigating the biological changes during dying. Research into this area could have a potential impact on a dying persons care.
DO WE HAVE THE CORRECT HEALTH ECONOMICS METHODS TO EVALUATE END OF LIFE CARE? AN ANALYSIS OF STAKEHOLDER PERSPECTIVES
Authors: Kinghorn Philip , Coast Joanna 
Published: February 2014

BackgroundThe most common approach to health economic evaluation is based on the principle of maximising total health, with outcomes of value being gains in health and length of life, the ‘Q’ and ‘LY’ elements of quality adjusted life years (QALYs). Health is commonly defined in terms of: pain/discomfort; anxiety/depression; mobility; self care; and usual activities.Outcomes given intrinsic value in recent reviews of palliative care, such as patient dignity and bereavement support, are not explicitly incorporated within the QALY; they are therefore given zero weight in economic evaluation. It is also feared that interventions in the last few days of life will be deemed not cost-effective because of the value given to time.AimsTo explore: (i) What are the legitimate objectives of a healthcare system spending within a fixed budget? (ii) Should end of life care be considered a “special case” and, if so, what are the practical and theoretical implications?Methods20 semi-structured audio-recorded interviews with stakeholders (specialising in health economics, end of life care, ethics) analysed using constant comparative methods.ResultsEarly analysis suggests stakeholders have a number of issues with the QALY model in this context. These include the inevitability of decline, short remaining life expectancy and the importance to patients and families of broader outcomes. These concerns are not held by all informants, however, with some health economists feeling that health is the legitimate objective for health systems and that end of life care should not be treated differently.ConclusionAs currently operationalised, the QALY is narrow and restrictive, although there was little consensus about how or to what extent QALYs should be modified. The consequences of any refinement will be complex, but we argue this is inadequate justification for sticking with the status quo. We outline an agenda for future research.
THE VALUE OF LONGITUDINAL INTERVIEWS IN EXPLORING COPING STRATEGIES OF PATIENTS WITH ADVANCED CANCER AND THEIR CARERS
Authors: Roberts Diane , Grande Gunn , Williams Mari Lloyd , Calman Lynn , Appleton Lynda , Large Paul , Walshe Catherine 
Published: February 2014

BackgroundQualitative longitudinal methods, used successfully for research in chronic conditions, can potentially unpick the dynamics of coping with advanced cancer as both a skillset and process. Studies in palliative care commonly suffer from high attrition and raise challenges when exploiting the richness and utility of longitudinal data.AimsTo develop longitudinal methodology by learning from a successful study exploring how and when patients with advanced cancer and their informal carers develop coping strategies.Methods54 participants (n=27 patients, n=27 nominated carers) were recruited to a qualitative longitudinal serial interview study. Using a core topic guide and a semi-narrative, conversational format, two interviews with each participant (n=86 interviews) were scheduled 4–12 weeks apart to encompass a range of everyday challenges and life events. A multidimensional approach combined thematic coding and framework analysis to compare patients, carers, dyads and interview points.ResultsResearcher sensitivity, responsiveness and planning of second interviews resulted in low attrition between interviews (7.5%). Interviews were welcomed by participants and their timing was central to understanding how and when participants' developed coping strategies. Participants could reflect in ways which opened up the ‘black box’ of lived experience and researchers' were able to develop more relevant follow-up questions. This assisted participants to articulate how, why and when they had (or had not) developed particular coping strategies.ConclusionsSupporting the development of coping strategies which benefit patients and carers is both imperative and time critical in palliative care. This study shows that longitudinal qualitative research is valuable when exploring the complex ‘everyday realities’ of lived experience which are fundamental to quality of life but often develop, unremarked, over time. By integrating opportunities for participant reflection and focusing on ‘change over time’ this study was able to explore deeper patient-centred insights on which to develop robust evidence-based practice.
CHALLENGING CHANGE MANAGEMENT: LESSONS FROM THE CAMBRIDGESHIRE ELECTRONIC PALLIATIVE CARE COORDINATION SYSTEM
Authors: Petrova Mila , Merrick Ian , Barclay Stephen 
Published: February 2014

BackgroundLocality Registers, later EPaCCS (Electronic Palliative Care Coordination Systems), were advanced as key to improving care coordination by the 2008 End of Life Care Strategy. EPaCCS were strongly supported by the National End of Life Care Programme and continue to be a Department of Health priority. In spite of some high-profile successes, most UK localities are struggling to develop their EPaCCS.AimsThis presentation will look into difficulties accompanying the development (ultimately successful) of “Share my Care”, the Cambridgeshire EPaCCS. It will discuss “the small, vague, messy and bad things” which the project team had to manage – issues that are commonly ignored by models of change and project management or addressed by solutions that are frequently ineffective.MethodsAnalysis of field notes, minutes of team meetings, email communications and interviews with project team members, with reference to social psychology and sociological theory.ResultsKey difficulties identified included: precarious balance of different stakeholder groups' visions for the system and the “common” vision; limited interoperability of IT systems; huge challenges of information governance; the dark side of expert knowledge; subtle games of power and need for credit in an ostensibly equal and collaborative playing field; the worm of silent ignorance; the many faces of “good logic” and “highest priority”; the politics of communication, among others.ConclusionsAlthough the rollout of “Share my Care” across the whole Clinical Commissioning Group is still ahead of us, the developmental project in one Local Commissioning Group has succeeded. This paper, which combines an objective analysis of preceding difficulties with an engaged perspective, self-probing yet self-compassionate, is aimed to motivate colleagues working on EPaCCS. We also aim to enrich models of change and project management in healthcare through attending to some of the non-rational factors involved.
The Use and Correlation of Patient Reported Outcome Measures (PROMs) in a Hospital Outpatient Setting
Authors: Farrington Clare , Noble Bill 
Published: February 2014

BackgroundConsultation And Relational Empathy (CARE) and Patient Enablement Instrument (PEI) PROMs were highlighted by a task group of the association of palliative care as useful research tools for assessment of the consultation process.AimsAssess the feasibility and acceptability of using CARE and PEI PROMs in a hospital outpatient setting. Also the correlation between these PROMs.MethodsSet within a feasibility study to examine the effect of Advanced Communication Skills Training ACST on PROMs. Two data collections of 75 questionnaires posted to sequential outpatients following a consultation with a participating doctor.Data analysed using descriptive statistics and Spearman rank correlation to test PROMs association.ResultsPatients returned over half the questionnaires (802, 53.5%). Respondents were representative of outpatient population with regard age and gender. Majority of questionnaires were evaluable: CARE 801 (99.9%), PEI 712 (88.8%). Spearman's rank correlation coefficient (r=0.33 p=0.01) showed a moderate positive correlation between CARE measure and PEI score in hospital outpatients. The proportion of consultations that were defined as enabling (PEI score six or more) tended to increase, and those with poor enablement (PEI score two or less) decrease, as CARE measure score increased. No full enablement occurred (PEI maximum score =12) when CARE score was 30 or less (CARE measure items averaging poor-good). Enablement occurred most frequently (52.3%) when a maximum CARE measure score (50) was assigned.ConclusionsThe postal method of administering these PROMs appears a feasible and acceptable method to assess hospital outpatient consultations. As patients' rating of their doctors communication skills and empathy (CARE scores) increase the tendency is for greater patient enablement (PEI scores) though not uniformly. Not all consultations where doctors were scored as having excellent communication skills and empathy were enabling. This indicates that empathy is a necessary but not sufficient condition for enablement.
THE ROLE OF INTERCULTURAL MEDIATION IN PROVIDING PALLIATIVE CARE IN A MULTICULTURAL SOCIETY
Authors: Van den Eynden Bart , Scheers Joke , Verrept Hans , Elseviers Monique 
Published: February 2014

IntroductionIll persons from ethnical minorities are not cared for optimally in our healthcare system. Intercultural mediation aims to improve the accessibility and the quality of care for ethnical minorities. Due to the aging of the first generation of migrants, more and more migrants in Flanders will face an growing need for palliative care. Migrants elderly and palliative services are still rather unknown to each other. So it is not unthinkable that the intercultural mediator can play a significant role when in the future undoubtedly the number of migrant patients with palliative care needs will increase. While in the past interventions of intercultural mediators occurred rather on general wards, they now more often face palliative care.Research questionWhat could be the role of intercultural mediation in providing palliative care in a multicultural society?Research MethodThis study used a qualitative descriptive method from a phenomenological research perspective where for the thematic analysis the coding paradigm of grounded theory was used.ResultsAlthough a palliative care process must always be considered as an individual process, there are nevertheless many cultural differences. Both intercultural mediators and palliative care providers have less experience in guiding and supporting an intercultural palliative care process. The cooperation that currently exists, is considered as positive, although there are still many points waiting for improvement.ConclusionThe framework supporting intercultural mediators in guiding a palliative care process, is currently inadequate. This aspect should be paid for more attention in the near future.