bluuebunny/crossref_metadata_2025_split huggingface dataset:
DYING IN A DGH
Authors: Cargill Tamsin , Turp Matthew , Wale Jane 
Published: February 2014

BackgroundIn Milton Keynes half of people die in hospital. It is not known how many patients and their families have the opportunity to discuss end-of-life care in hospital.MethodsReview of the electronic medical records of all those that died in Milton Keynes Hospital during November 2012.FindingsOf the 67 records analysed cancer, chronic obstructive pulmonary disease or left ventricular failure was the primary or secondary cause of death in 62% (n=42). 31% of patients (n=21) were seen by the palliative care team. Patients seen by palliative care were significantly more likely to have a signed Do Not Attempt Resuscitation form (95%; n=20 vs 78%; n=36; p=0.004), a discussion about end-of-life treatment (n=4; 19% vs. n=2; 4%; p=0.003), and more likely to state their preferred place of death (n=7; 33% vs. n=2; 4%; p=0.001). End-of-life issues were often discussed with the family rather than the patient themselves. End-of-life was discussed with the families of patients seen by palliative care in 90% of cases (n=19) compared to 54% (n= 25) of those not seen by palliative care.ConclusionsThe end-of-life wishes were not discussed in all patients.All aspects of end of life care were significantly more likely to be discussed with patients or families who had been seen by the palliative care team. End-of- life care decisions were discussed with the patient's family more often than the patient themselves. Often patients were too unwell during their last illness to meaningfully participate in end of life discussions.The AMBER initiative, soon to be piloted in Milton Keynes, promotes early identification of patients at risk of dying within 2–3 months and initiates end-of life care discussions with them. This and improved communication between primary and secondary care about a patient's end-of- life preferences should improve future care.
PUTTING RESEARCH INTO PRACTICE: MAKING A DIFFERENCE TO CARE
Authors: Pickard Jane , Feathers Luke 
Published: February 2014

BackgroundIn 2012 a study to explore hospice nursing and medical staff knowledge of, and attitudes towards, organ and tissue donation was undertaken. The study identified that the barriers to discussing tissue and organ donation were multiple and the results highlighted several recommendations:▸Increase staff awareness and knowledge▸Introduce guidelines onwhocan donatewhatandhow▸Increase patient awareness of the option of tissue donation▸Explorewhenis the right time to ask a patient about their wishes relating to organ and tissue donationPutting research findings into practiceTo address these, key links have been established with the National and local acute Trust Organ and Tissue Donation Teams. This has enabled the facilitation of a teaching and awareness session for clinical staff to enhance their knowledge about who can donate, which tissues can be donated, the process of donation, and what to do if a patient expresses a wish to be a donor.Exploring when to ask a patient about their wishes was also discussed at the Patient and Carer Participation Group. The general consensus was that it is acceptable to ask patients, but the timing of this needs to be sensitively considered. Ideally, the outpatient setting was seen as the most favourable environment as part of the patient's holistic assessment acknowledging that it is also acceptable to ask patients in discussions about dying.A simple question “Do you carry a donor card?”may provide a good opening to discussion.The next stepsThe implementation of change is ongoing. Currently we are considering written information for patients and carers, reviewing the most appropriate place to record the patient's wishes within the patient's electronic record and formulating clear guidelines for clinical staff to refer to.
‘IT'S NOT OVER ‘TIL IT'S OVER…’ CREATIVE THERAPY AND PARTNERSHIP WORKING AT WILLOWBROOK HOSPICE
Authors: Scriven Lucy , Gallagher Lisa 
Published: February 2014

Background & AimsThis creative therapy project raises awareness for the 2013 National Dying Matters Campaign. It's an experimental collaboration between hospice patient and artist Julie Williams, local artist Chantelle Townley, Advance Care Planning Facilitator, Lisa Gallagher and Holistic Therapist Lucy Scriven. Funding was kindly provided by St Helens Council. The artwork collage, entitled‘It's Not Over ‘Til It's Over…’depicts the richness of Julie's life using beautiful photographs, steeped in memories and personal story telling. Safety measures over the five outpatient sessions included: on-going discussion and emotional support, regular ‘time outs’ to reduce impact on lethargy, and positive reflection. The artwork was officially unveiled at a celebration, in essence a living wake, hosted at Willowbrook, attended by family, friends and the local press.ResultsStrengthened interdepartmental working within Willowbrook.Stronger links for partnership working in the local community.Promotion of the value of creative therapies for patients and families.Promotion of the Dying Matters Campaign, and advance care planning within the hospice, locally and nationally.ConclusionThis project has helped to raise awareness for the Dying Matters Campaign; it's also strengthened partnership working within the hospice and with the local community. Through artistic expression Julie was helped to share with the world everything she held dear and has been of great value in connecting positively with meaning in her life. Julie experienced the opportunity to develop her undiscovered artistic potential, and explore new coping strategies by moving away from denial into a place of acceptance. Importantly, through participation with the project, Julie actively engaged in her end of life care planning and inspired others to also engage. She also created a celebratory legacy that will now support her loved ones in their sadness and grief.
AN AUDIT TO EVALUATE THE ASSESSMENT OF SPIRITUALITY FOR PATIENTS ADMITTED TO WILLOW WOOD HOSPICE INPATIENT UNIT
Authors: Ragsdell Bethanie , Tapley Michael 
Published: February 2014

Palliative medicine entails a holistic approach to patient care. Spirituality is an important component and should be explored with terminally ill patients. Studies have demonstrated a link between increased spiritual well being and a decrease in physical symptoms and psychological distress in terminal care.An audit was undertaken to evaluate whether patient's spirituality was being assessed on admission to the inpatient unit at an adult hospice. The standard set for this audit was 80% and applied to both genders.The method employed was a retrospective cohort audit of 30 patients, using their admission pro formas. The quantitative data was collected assessed by whether the spirituality section in the admission pro forma had been filled in, and gender.From the data collected the results showed an average of 73.30% (n=22) of patients having a documented conversation about their spirituality and needs on the admission form. Further analysis highlighted that, when compared with the average, the percentage of female admissions that considered their spirituality rose to 89.47% (n=17). However for the men the results fell to 45.45% (n=5). The standard set in this audit was, on average, not achieved by the hospice. It is recognised that due to the limitation of a single cohort it restricted the opportunity for equal gender population samples.The lower results for the male gender could be attributed to gender specific barriers to discussing spirituality and may be a training issue for the team members. Therefore the main recommendations of this audit were for further education for all members of the healthcare team. NICE guidelines advocate the use of the ‘Marie Curie's competency levels for Spiritual care’ as an educational framework. In addition a spiritual assessment tool,FaithActiveCopingTreatment plan (FACT), has been identified that may be very useful in directing these conversations.
THE USE OF DENSOSUMAB IN HOSPICE PATIENTS AND ITS EFFECT ON CALCIUM LEVELS
Authors: Harvie Karen , Isherwood Ruth , Fraser Judith 
Published: February 2014

BackgroundBone is a common site of metastasis for many primary cancers. Denosumab is recommended for the prevention of complications in patients with bone metastases from solid tumours other than prostate cancer (NICE guideline 2012). In patients with breast cancer it has been found to be more effective, both clinically and economically, than alternative treatment options. It is administered as a subcutaneous injection 4 weekly. Hypocalcaemia is a known side effect of Denosumab occurring in 5.5% of patients overall, although little is known about who is most likely to experience this and the timing and severity of hypocalcaemia in relation to denosumab injection.AimsTo clarify prevalence and severity of the effect of denosumab on calcium levels in patients with breast cancer in our hospice population.MethodsWe identified all patients with breast cancer currently under the care of the hospice in all settings: in-patients, day hospice and community. A retrospective audit of case notes was performed to identify those who had received densosumab using a standardised data collection tool. Laboratory computer results system was used to detect subsequent changes in calcium levels.ResultsForty-three patients with breast cancer were identified, 29 of whom have bone metastases. Six have received denosumab, 3 had hypocalcaemia following its administration- one patient had NCIC grade 2 hypocalcaemia, 2 patients NCIC grade 1. All were initially managed with high-dose oral calcium supplementation but one required subsequent hospital admission for IV calcium. In this patient persistent hypocalcaemia precluded further denosumab doses. All had previously tolerated bisphosphonates.ConclusionsOur early experience with denosumab in this patient group suggests that hypocalcaemia may be more prevalent than thought. Further work is needed to clarify the timing of hypocalcaemia and need for blood monitoring and oral calcium supplementation.
AN AUDIT TO IDENTIFY PATIENTS AT RISK OF SEROTONIN SYNDROME AT TIME OF ADMISSION TO A SPECIALIST PALLIATIVE CARE UNIT
Authors: Luescher Kirsty , Powell Amanda , Isherwood Ruth , Wilson Anne 
Published: February 2014

IntroductionSerotonin syndrome is a potentially life-threatening condition caused by overstimulation of serotonin receptors. Clinical manifestations include altered mental state, autonomic dysfunction and neuromuscular abnormalities. Basal levels of serotonin are higher in malignancy and recent drug alerts have implicated some opioids in serotonin syndrome. Many of the drugs used by palliative medicine specialists also have the potential to affect serotonin. The palliative care patient population may therefore be at increased risk of serotonin syndrome.MethodsA retrospective audit was conducted of 100 consecutive patient admissions to the specialist palliative care unit. A data collection tool was designed to identify patients at risk of serotonin syndrome and if any of these patients demonstrated features of the condition.Results68 of the 100 patients audited were taking at least one drug implicated in serotonin syndrome, 34 patients were on two or more implicated medications. 59 of the 68 patients on a serotonergic medication had a least one symptom seen in serotonin toxicity, and 9 patients had at least 4 suggestive symptoms. None of the patients met existing diagnostic criteria for serotonin syndrome.On admission 12 patients had a serotonergic drug added to their regimen and at 48 hour review, 4 patients had developed new symptoms suggestive of serotonin toxicity.In all patients no documentation could be found that serotonin syndrome had been considered as a risk or possible diagnosis.ConclusionsThis study highlights a need for education about serotonin syndrome given its likely prevalence in the palliative care patient population and the potential for significant morbidity and mortality. Although the audit identified a significant proportion of patients were at risk of serotonin syndrome, clinical findings did not indicate definite diagnosis in any of these patients. A screening tool will now be developed to assist health care professionals in identifying at risk patients.
IMPROVING PREFERRED PLACE OF CARE OPTIONS FOR HOSPITALISED PATIENTS AT THE END OF LIFE
Authors: Saxby Carina , Wilson Christine , Katie Broadley 
Published: February 2014

BackgroundAlthough most people die in hospital, most would prefer to die elsewhere. Ensuring that people's preferred priorities of care are achieved is a key aim for the End of Life Care Strategy.InnovationThis CCG funded, joint initiative between Scarborough Hospital and St. Catherine's Hospice has enabled dying patients, regardless of diagnosis, to be transferred from the hospital to a nurse-led bed (NLB) in the last days of life if that is their preference.Eligibility criteria (assessed by the hospital specialist palliative care team):Estimated prognosis of one weekDefined ceiling of care including DNACPRPatient's needs can be met by hospice nursing care in a more suitable environmentFollowing transfer (aim within 24hrs), patients were clerked and assessed daily by hospice nursing staff with support from the medical team as requested.EvaluationRetrospective analysis of consecutive referrals for NLB between 5/2/13 to 5/513 (assessed N=24; died awaiting transfer N=5; admitted N=18). The median age was 83, 10/18 had a non cancer diagnosis and 13/18 were not previously known to specialist palliative care services. The median length of stay was 1 day and the mean 5.8 days. Following ongoing assessment, 5 patients were transferred to a specialist palliative care bed. Feedback from relatives was very positive. Hospice nurses report that the initiative is empowering but carries a significant emotional impact.ConclusionThis collaboration initiative has improved access to preferred place of care for dying patients regardless of diagnosis or previous eligibility for hospice care. Feedback has been very positive although the emotional cost to staff has been recognised. Improving same day access to NLB needs to be improved.
HOW A DIGNITY CARE INTERVENTION CAN IMPROVE CARE BY COMMUNITY NURSES TO PEOPLE IN THE LAST MONTHS OF LIFE
Authors: Johnston Bridget , Buchanan Deans , Papdopolou Constantina , Andrew Jane , Chochinov Harvey 
Published: February 2014

BackgroundThis study has developed, implemented and tested a complex intervention, the Dignity Care Intervention (DCI), providing an evidence based approach to providing person centred dignity conserving, palliative care to patients and their families receiving end-of-life care at home by community nurses (CNs).AimsThe primary aim was to explore the feasibility and acceptability of the DCI from the patients' and carers' perspectives. A secondary aim was to explore the ability of the DCI to allow individual dignity related needs to be assessed and subsequently met, by community nurses.MethodsA qualitative, evaluation design underpinned by the philosophy of Merlau-Ponty was employed for the evaluation of the DCI. Data collection included focus groups with CNs (39) at the beginning and end of the study; individual interviews with patients (30); informal carers (4). Interview data were analysed using framework analysis.ResultsThe analysis of the interviews resulted in four theme categories and 16 subthemes. Experience of DCP; responding to my illness concerns, how illness affects me as a person and how illness concerns affect my relationships. Patients and family members identified that the use of the DCI by nurses beneficial, as they were given the opportunity to discuss concerns that might have not been raised otherwise.ConclusionsThe DCI helps CNs deliver psychosocial care, previously identified as a difficult area for CNs in practice. CNs use of the DCI helps patients receive individualised care, which directly relates to the issues they have identified as most distressing and/or important and their preferred measures to address these issues, allowing increased information and support to carers. The use of the PDI facilitated patient's communication of their dignity-related needs to community nurses, which highlighted increased satisfaction with the support they received.
THE USE OF QTC PROLONGING MEDICATIONS & DRUG INTERACTIONS IN PALLIATIVE CARE PATIENTS: AUDIT OF PRESCRIBING IN A TERTIARY CANCER CENTRE
Authors: MacKay Helen , Edgecombe Jane 
Published: February 2014

BackgroundUse of medications which prolong the QTc interval in Palliative Care is under scrutiny due to risks of provoking potentially fatal arrhythmias. Risks are increased by drug interactions involving Cytochrome P450 enzymes (CYP450). Prescribing guidance recommends risk assessment when using such medications. Palliative care patients may represent a particularly vulnerable group.AimsThis audit aims to establish prescribing practice of the Hospital Specialist Palliative Care Team (HSPCT) in Beatson West of Scotland Cancer Centre (BWoSCC) regarding prescription of QTc prolonging medications and/or those with clinically significant CYP450 enzyme interactions.MethodsCases were identified through the HSPCT patient database. Snapshot review of case notes and prescription charts was undertaken for patients seen by HSPCT in BWoSCC over a two-week period. First & second consultations by HSPCT members were assessed.A database was created to collate information including: patient demographics, presence of risk factors for QTc prolongation, QTc prolonging medications prescribed, CYP450 enzyme inducing/inhibiting drugs prescribed, ECG review & documentation of risk assessment.ResultsTwenty-nine case notes & prescription kardexes were reviewed. Majority of patients were female (n=20), with gynaecological malignancies being most common. Twenty seven patients possessed risk factors for QTc prolongation, with 21 having two or more risk factors.Twelve patients were receiving at least one QTc prolonging medication, with most (9 of 12) established on these prior to HSPCT review. Three patients were co-prescribed QTc prolonging & CYP450 inhibiting drugs, increasing the risk of harm.Documentation of risk assessment was poor–recorded in one case only.ConclusionsThis audit suggests that many patients reviewed by the HSPCT received QTc prolonging and/or CYP interacting drugs, despite possessing multiple risk factors for QTc prolongation/CYP450 interactions. Patient numbers were small and the majority reflected non-HSPCT prescribing.Interventions involving HSCPT, other prescribers, & ward pharmacists have taken place to improve awareness, risk assessment & prescribing practice. Second round data collection is in progress.
TEAM-BASED LEARNING: TEACHING THE HEART AND MIND OF PALLIATIVE CARE
Authors: Middleton-Green Laura 
Published: February 2014

As a domain of knowledge for healthcare professionals, palliative care is complex and demanding; not least for educators. Effective teaching in palliative care relies on educators both being able to develop and encourage interpersonal skills, and also to capture an authentic sense of the real world in teaching clinical aspects of care. The recommendations of the Francis Report present a challenge to educators: how do we "educate" (literally, "to develop the faculties and powers of") the palliative care providers of the future? How do we ensure they are competent, compassionate communicators?Team-based learning is currently being piloted in at the University of Bradford as a means of achieving these goals. This technique, developed by Larry Michaelson and colleagues in the United States, uses sound pedagogical principles to encourage debate and dissent between small teams related to complex and ambiguous areas of knowledge. The role of the educator is to guide and facilitate discussion, and challenge preconceptions and assumptions. There is minimal use of lectures other than to consolidate conclusions. It was decided to pilot the technique within the palliative care content of the curriculum, because of the opportunities to develop students skills of critical thinking, awareness and compassion.Initial analysis of questionnaire and focus group data within Bradford is overwhelmingly in support; students are demonstrating evidence of increased critical thinking, more effective teamwork, evolving listening skills, and satisfaction at learning in a way which they perceive to be much more akin to clinical practice than didactic lectures and seminars. This presentation will look at the structure of team-based learning, review the evidence, and examine how it was applied specifically to palliative care using scenarios based on Patient Journeys in the last year of life. The opportunities for its use in clinical, interprofessional and post-registration palliative care education will be explored.
LET US SHOW THEM THAT THEY CAN! — INVOLVE THE YOUTH IN PALLIATIVE CARE PROVISION IN THE RURAL COMMUNITIES
Authors: Njama Martha 
Published: February 2014

BackgroundThe emerging cases for people who need palliative care is so overwhelming and it would not be right to leave the whole burden to the nurses only. It is important to involve other players; family members, community members, local leaders, church leaders and more importantly, the youth. Equipping the players with palliative care skills would drastically reduce the burden that is currently on the shoulders of the nurses.AimsTo educate and train the youth in the rural areas. To equip the youth with basic skills of palliative care provision aimed at enhancing palliative care provision within the communities and to show the youth that they have a big role to play in the community. To make the communities be less dependent on the nurses except for emergencies. Download some of the burden from the nurses. Increase community knowledge and understanding on how to handle patients with different terminal illnesses.ResultsIn Prometra Kenya youth program, 378 have been trained on various aspects of palliative care including communication skills. The youth have proved to be good learners and that they can effectively disseminate the information and pass the skills to their peers. They are being used by the communities as care providers.ConclusionsThe youth are very energetic and they can be an important asset to the community if given the tools. They can be used to take care of the patients at home while the adults do other family activities. They appreciate the recognition by the communities. The adults are more productive as they use the time they would have used with the patients for other economic activities. The youth have a lot of untapped energy that can be helpful to the communities. The youth are cooperative, reliable and able to work closely with the adults and nurses.