bluuebunny/crossref_metadata_2025_split huggingface dataset:
HOW CAN CHILDREN USING HOSPICE SERVICES CONTRIBUTE TO UNDERGRADUATE MEDICAL EDUCATION? AN ACTION RESEARCH PROJECT
Authors: Spalding Jess , Yardley Sarah 
Published: February 2014

BackgroundPatients with life-limiting illnesses should have opportunities to contribute to medical education so that professional learning is relevant to their needs and priorities. The potential contribution of children and parents using hospice services to medical education has not been fully explored.Aims1. To explore perceptions of a ‘good doctor’ amongst children/parents using hospice services2. To collaborate with children/parents and staff to develop materials for educating medical students about living with life-limiting illnesses3. To assess feasibility of student-led action research projects in a children's hospiceMethodsAn INSPIRE Award from the Academy of Medical Sciences funded an undergraduate medical student to undertake this work with clinical and academic supervision. Prospective ethical approval was received. Children (n=7), parents (n=5), and staff (n=6) volunteers were recruited from a hospice to participate in audio-recorded semi-structured focus groups, individual interviews or activity workshops. Participants discussed what newly qualified doctors needed to know about caring for children with life-limiting conditions and what makes a ‘good doctor’. Data were transcribed for qualitative thematic analysis. Findings were refined by participant feedback.ResultsKey themes among participants included the importance of treating children as individuals, communicating honestly and sensitively, ensuring two-way dialogue between clinicians and families and actively listening to all involved in children's care. Staff, parents and children in the hospice were willing and able to make valuable contributions to undergraduate medical education by sharing their knowledge and experiences. This paper will present methodological insights, thematic findings, and educational materials (for undergraduate medical students and service development) created from the project.ConclusionsParents, children and staff in hospices are willing to participate in action research. This project provided the student researcher with transferable qualitative research skills. Further work is required to fully explore and understand opportunities for collaboration between children's hospices and medical schools.
ORGANISATION, FUNDING AND REVIEW OF UNDERGRADUATE PALLIATIVE CARE (PC) TEACHING IN UK MEDICAL SCHOOLS: A SURVEY OF EDUCATIONAL LEADS
Authors: Walker Steven , Gibbins Jane , Burnett Mandy , Adams Astrid , Paes Paul , Barclay Stephen , Chandratilake Madawa , Lodge Philip , Wee Bee 
Published: February 2014

BackgroundSome recently-qualified doctors report that undergraduate teaching has not sufficiently prepared them to manage PC patients. Individuals at UK medical schools trying to improve PC training may encounter obstacles1. Little is known about the current organisation, funding and review of courses nationally.AimsTo investigate the organisation, funding and review of PC teaching across medical schools in the UK from the perspective of educational leads.MethodsA web-based questionnaire was developed and sent to PC educational leads at all UK medical schools. This study received ethical approval.ResultsAll 30 medical schools responded. In 20/30 (67%) there is a formal PC component to the medical course. PC teaching most commonly occurs in years 4 and 5. Most (28/30, 93%) offer a Student Selected Course in PC, this is taken up by <25%. Insufficient places may be a factor in 11/27 (41%).In 20/30 (67%) development of the PC course was planned, in 33% development was ad hoc. In 26/30 (87%) a PC lead(s) co-ordinates the course whilst 4 (13%) report no clear lead. Sixteen of 28 (57%) respondents had a teaching qualification/specific experience. An academic department of Palliative Medicine exists in 12/30 (40%). The mean hours per week spent on PC education was 3.3 hours (22 respondents). Funding/ financial recognition is not provided for PC course leads in 12/22 (55%), their organisation in 10/21 (48%) or PC teaching providers in 6/24 (25%). The PC course is regularly reviewed internally in 25/29 (86%). All universities seek medical student feedback.ConclusionVariations exist in the organisation and development of PC training across UK medical schools. Lack of leadership and resource allocation may hinder ability to provide PC teaching to medical students.
WHAT'S THE ‘E’ IN E-LEARNING FOR SPIRITUALITY: A COMPARISON OF ONLINE AND FACE TO FACE COURSE VERSIONS FOR HEALTHCARE WORKERS
Authors: Groves Karen , Baldry Cath , Sherrat Cathy 
Published: February 2014

BackgroundHealthcare staff feel unprepared for dealing with spiritual and religious needs of patients and families. Indeed many are uncertain whether it is part of their role at all. However the NICE Supportive & Palliative Care Improving Outcomes Guidance 2004, in dedicating a whole chapter to this topic, made it clear that this part of holistic assessment and care falls squarely within the remit of healthcare staff. Subsequent national documents confirm this.AimsTo assess the impact on frontline clinical staff, of face to face (F2F) and online versions, of a course designed to raise spiritual awareness.MethodA qualitative study involving thematic analysis of semi structured, mainly open question, interviews, offered to the last 100 each of online and F2F course attendees. Interviews were offered to 54 (27%) respondents and 24 agreed a mutually convenient time. This part of the evaluation reports the analysis of the interviews with 20 frontline clinicians (4 chaplain interviews form part of another study).ResultsSpiritual awareness was achieved independently of the mode of course delivery, although participants articulated preferences. A diverse participant group enjoyed varied learning methods, resources and discussion. Good IT support and lack of technical hitches was important to smooth running online. Positive use of grouping, skilled facilitation (crucial) and the flexibility and anonymity of online learning suits a mixture of clinicians regardless of role and hierarchy. Confidence and structure in conversations with patients, empowering patients to seek innate solutions and strategies for dealing with questions about personal beliefs helped clinicians to address spiritual needs.Conclusions‘e’=experiential regardless of mode of delivery. Enthusiastic, more confident, participants recognised significant barriers, requiring organisational recognition for training to address spiritual needs and provide compassionate care.
THE USE OF SEDATION FOR DYING PATIENTS: ETHNOGRAPHIC STUDY IN THREE HOSPICES
Authors: Arolker Milind 
Published: February 2014

Background and aimsPalliative care philosophy, which simultaneously promotes a symptom-control focus and a rejection of intentions to hasten death, underpins recent frameworks guiding sedative use. This PhD-based study explores three research questions: 1. How do hospice doctors and nurses use drugs with sedative effect for their inpatients nearing the end of life? 2. What rationale, or justifications, are necessary in the deployment of these drugs? 3. What are the similarities or differences between three different inpatient hospice units when prescribing and administering these drugs?MethodsThree datasets were used: ethnography, through 150 hours of participant observation, of inpatient ward work undertaken by doctors and nurses in each of three hospices; audio-recorded, semi-structured interviews arranged with individual doctors and nurses; and Â two focus groups organised at each hospice, one comprising doctors and one comprising nurses (6–10 participants in each). The stimulus materials used in the focus groups concern anonymised clinical case-vignettes based on observed data. The collection and analysis of all data has been underpinned by a thematic qualitative approach and took place between May 2011 and January 2013.Results and conclusionsThe empirical data reveal patterns in the repertoires and communication strategies clinicians use during clinical processes involving drugs with sedative effect: prescribing and administering drugs; handling of relatives' impressions; and discussing patients and/or relatives amongst themselves as a team. Differences were noted between hospices concerning the degree of latitude doctors gave to nurses when prescribing sedation, but an emergent theme uniting data from all hospices concerns the “emotion work” staff do with relatives to promote and maintain a state of calm in hospices. I argue that sedation is not necessarily solely deployed for the index patient, and that using drugs with sedative effect facilitates a negotiable need for nursing staff to keep ward order, helping to calm clinical situations which might threaten this.
HIGH FIDELITY SIMULATION: A MODALITY FOR TEACHING END OF LIFE CARE?
Authors: Reed Nikki , Boulstridge Lisa , Nelson Annmarie 
Published: February 2014

BackgroundThe hospice model of care is held as the model of excellence for delivering high quality care to dying patients. However, only a small number of patients in the UK actually die in a hospice with the majority of patients dying in hospital. The major challenge faced by specialist palliative care services has been the transfer of best practice from the hospice setting to other care settings such as the acute hospital. At the Hollier Simulation Centre an end of life care course has been developed for all band 5 and 6 nurses within the Heart of England NHS Foundation Trust, using the novel teaching modality of high fidelity simulation.AimTo look at the impact high fidelity simulation teaching has on participant confidence and their perception of their knowledge and skills in end of life care.MethodThe study used a mixed method approach with a combination of pre and post course focus groups and pre and post course questionnaires. The focus groups transcripts were analysed using thematic analysis. The free text information from the questionnaires were used to support the themes developed from the focus group analysis. Two separate cohorts were used for this study.ResultsAnalysis of the data revealed that the use of high fidelity simulation to teach end of life care did have a significant impact on the participants confidence, knowledge and skills. Additionally, the facilitated debrief sessions within the course were found to be beneficial these encouraged self reflection, peer teaching and constructive feedback within a safe environment.ConclusionThe use of high fidelity simulation to teach end of life care does have a positive impact on the participants' confidence and their knowledge and skills. Further studies are needed to compare the use of high fidelity simulation to teach end of life care with other teaching modalities.
THE IMPACT OF BEING PART OF A THET LINKS PARTNERSHIP TO DEVELOP A PALLIATIVE CARE DEGREE PROGRAM IN SUB SAHARAN AFRICA
Authors: Jack Barbara , Kirton Jennifer , Frame Karen 
Published: February 2014

BackgroundIn Sub-Saharan Africa the need for palliative care provision is escalating with rising cancer rates and non-communicable disease burden. The shortage of trained health care professionals has highlighted the need for increasing the palliative care workforce. A THET Links Health Partnership was established between a UK Faculty comprising clinical and academic palliative care staff from across the UK and Hospice Africa Uganda, to support the development of a palliative care degree in Uganda. UK Faculty supported the Ugandan Faculty in the development and delivery of the degree programme.AimTo identify the impact on the UK Faculty of participating in the partnership.MethodsA pragmatic evaluation methodology was adopted for the study and data were collected in November 2012, using a confidential descriptive electronic survey, comprising open ended and closed questions. A total population sample approach was used and all 17 UK Faculty invited to participate. Data were analysed using thematic analysis and descriptive statistics for the closed questions. The project was reviewed by West London Research Ethics Committee and considered service evaluation.Result82% (n=14) UK Faculty participated, and no negative points were raised by any respondent. Several themes emerged from the data including the impact on their UK clinical practice. This included examples of improving their team working and leadership and enhanced diagnostic skills with reduced reliance on technology. The improvement in their teaching skills was widely reported. The personal impact of the experience was also noted including providing personal growth, influencing lifestyle choices and changing their perspectives on life.Conclusionthe impact of being part of this volunteer programme has shown multiple benefits for the participants, not only relating to their clinical work in the UK, but also the personal impacts on their lives. As well as the overarching goal of improved access to palliative care.
EDUCATION LEADS' VIEWS ABOUT UNDERGRADUATE PALLIATIVE CARE (PC) TEACHING IN THEIR MEDICAL SCHOOL: A UK WIDE SURVEY
Authors: Walker Steven , Gibbins Jane , Barclay Stephen , Barnett Mandy , Adams Astrid , Paes Paul , Lodge Philip , Chandratilake Madawa , Wee Bee 
Published: February 2014

BackgroundThe views of newly-qualified doctors regarding their readiness to care for PC patients have been investigated.1By comparison, less is known about the opinions of undergraduate PC leads concerning their course provision, role and institutional support.Strongly agree/agreeNo strong view/neutralDisagree/strongly disagreeFulfils GMC requirements19 (63%)9 (30%)2 (7%)Prepares students well for PC in Foundation Year 118 (60%)3 (10%)9 (30%)Overall delivers quality PC training22* (76%)2* (7%)5* (17%)Varies depending on where students are sent15 (50%)8 (27%)7 (23%)Is delivered by enthusiastic colleagues27 (90%)3 (10%)Is limited by availability of local services20 (67%)4 (13%)6 (20%)Enables each student to visit a hospice and see doctors care for the dying17 (57%)3 (10%)10 (33%)Is highly-rated by students26 (87%)4 (13%)My role in PC training is satisfying27 (90%)3 (10%)*29 responsesAimsTo investigate the views of undergraduate PC leads across all UK medical schools regarding teaching at their university.MethodsA 40 point web-based questionnaire was developed and sent to identified PC leads in all UK medical Schools. This study received ethical approval.ResultsResults were obtained from all 30 UK medical schools. Nineteen respondents (63%) consider that PC training should be a separate course partially integrated within the curriculum, 10 (33%) fully integrated and 1(3%) would prefer a completely separate course.A minority expressed concerns about PC training being recognised as important (5, 17%), support from university colleagues (5, 17%) dedicated teaching time (10, 33%) and funding (10. 33%).ConclusionThe views of PC leads are generally positive across UK medical school. It is suggested that negative opinions may be influenced by local organisational difficulties.
ENHANCING CONFIDENCE AND COMPETENCE IN END OF LIFE CARE: AN EDUCATIONAL PATHWAY FOR COMMUNITY NURSING STAFF
Authors: Steven Alison , White Gail , Marples Gwen 
Published: February 2014

The importance of developing workforce knowledge, skills and attitudes in the health and social care workforce in order to improve the quality of end of life care is central to the provision of high quality patient care at the end of life. Community nurses deliver end of life care frequently and are required to be confident and competent in the delivery of this care, although how this is achieved is less clear.The aim of this project was to offer a pathway of learning to community nurses to explore what enhances confidence and competence. The pathway took a learner centred approach underpinned by principles of adult education and built on the 4 competency areas for end of life care.The philosophy underpinning the pathway development was based upon the belief that education and learning are complex social processes which take place in complex settings. A purposeful sample of eight community nurses followed a pathway which involved the participants being linked with a mentor; undertaking a learning needs assessment; then planning a course of action by choosing from a menu of educational activities, both formal and in formal.Participants were interviewed at three points during the process and mentors interviewed once. Interviews were transcribed verbatim, anonymised and analysed using an iterative approach drawing on grounded theory principles of constant comparative analysisA multi facet realistic evaluation methodology was employed allowing exploration of the context, mechanisms and outcomes for the pathway. This approach offers the opportunity of getting inside the ‘black box’ of what actually happens when an initiative is translated into practice, and to unpick what works for whom and in what circumstances.After participating in the educational activities the Training Needs Analysis results indicated significant changes in perceptions of confidence and competence by the end of the project.
The Mortality Peer Review Panel: a report on the deaths on operations of UK Service personnel 2002–2013
Authors: Russell Robert , Hunt N , Delaney R 
Published: February 2014

IntroductionReview of adverse outcomes is an essential element of healthcare governance. For each operational death, the post-mortem is attended by a member of Academic Department of Military Emergency Medicine and the case is assessed by a Mortality Peer Review Panel comprised of Defence Professors and other clinical and technical experts.MethodsA search was conducted of the Joint Theatre Trauma Registry (JTTR) for all UK military death reviews held from January 2002 to November 2013 and the judgement made by the Mortality Peer Review panel. Cases are awarded a ‘salvageability’ rating between S1 (salvageable) and S4 (not salvageable). Cases graded S1–3 are then assessed further for tactical, clinical or equipment factors that affected the outcome.ResultsThere were 621 deaths recorded on the JTTR and 517 (83.3%) were due to hostile action. The Killed in Action to Died of Wounds ratio is 6.28 : 1. Explosive mechanisms of injury were responsible for 55.65% of combat deaths and penetrating mechanisms 28.71%. An average of 10.56 injuries was recorded per casualty and the mean number of body regions affected was 3.34. The Peer Review Panel decided that 91.1% cases were not salvageable (S4); this figure is 93.5% if the deaths due to hostile action are considered separately.ConclusionsThe severity of modern military trauma is overwhelming in nature and, along with trauma scoring systems, clinical peer review is an essential part of healthcare governance. The process also helps inform and direct research within clinical and force protection fields.
Data capture for multiscale modelling of the Lourinhã Formation, Lusitanian Basin, Portugal: an outcrop analogue for the Statfjord Group, Norwegian North Sea
Authors: Keogh Kevin J. , Leary Simon , Martinius Allard W. , Scott Anthony S. J. , Riordan Sarah , Viste Ingunn , Gowland Stuart , Taylor Andrew M. , Howell John 
Published: February 2014

Abstract
Current recovery from the Statfjord Group in the majority of the fields on the Tampen Spur is less than 50%. A contributing factor to this is an incomplete understanding of multiscale heterogeneities, their distributions within a range of fluvial geobodies and their lateral extent and morphology in inter-well areas. Sedimentary heterogeneities have been modelled, together with petrophysical parameters, at a variety of scales. The modelled properties at a given scale were upscaled to the next level of heterogeneity, thus better honouring effective property values. The use of outcrop analogues is still a key tool for understanding facies relationships and the stratigraphic development of subsurface hydrocarbon-bearing reservoirs. The Lourinhã Formation, Portugal, was used as an analogue to collect both qualitative and quantitative data consistently following a three-phase workflow to capture data at various scales of heterogeneity. Traditional field data collection techniques have been supplemented with the collection of LiDAR data. A digital workflow utilizing interlinked datasets facilitates rapid data analysis and better data visualization with results that are more easily utilized in multiscale modelling studies. These scaled models were used to increase our understanding of the effect on flow of lithofacies and facies association distributions together with internal architectural elements and heterogeneities.
Using formation micro-imaging, wireline logs and onshore analogues to distinguish volcanic lithofacies in boreholes: examples from Palaeogene successions in the Faroe–Shetland Basin, NE Atlantic
Authors: Watton Tim J. , Cannon Steve , Brown Richard J. , Jerram Dougal A. , Waichel Breno L. 
Published: February 2014

Abstract
Formation micro-imaging (FMI) is a tool that produces micro-resistivity images of the sidewall of the well bore. FMI logging used in conjunction with conventional well logging techniques (e.g. GR, Gamma Ray/RES, Resistivity/NPHI, Neutron Porosity/SONIC, Velocity tools) allows detailed analysis of volcanic lithofacies variation and informs a robust interpretation of volcanic sequences. This methodology is of particular use where rock core data are limited or not present. Examples are presented from the Rosebank Field in the Faroe–Shetland Basin (West of Shetland, UK continental shelf) where the re-establishment of fluvial activity between phases of effusive volcanism resulted in a complex sequence of siliciclastic sedimentary rocks and basaltic lavas. We demonstrate how high-resolution FMI images through this sequence can differentiate internal basalt lava flow features, such as vesicular zones, brecciated intervals, sediment–lava contact relationships and joint/fracture networks. If FMI data exist through volcanic packages and if assessed and calibrated properly via core, sidewall core and field analogue comparisons, it can provide additional constraints on the interpretation and classification of reservoir (siliciclastic) and non-reservoir (volcanic) rocks.
Structural and stratigraphical significance of U–Pb ages from the Mora and Saldanha volcanic complexes (NE Portugal, Iberian Variscides)
Authors: Dias Da Silva Ícaro , Valverde-Vaquero Pablo , González-Clavijo Emilio , Díez-Montes Alejandro , Martínez Catalán José R. 
Published: February 2014

Abstract
Geological mapping and structural investigations were carried out in the eastern rim of the Morais Allochthonous Complex in NE Portugal (NW Iberian Massif) along the first-order tectonic boundary between the lower part of the Galicia–Trás-os-Montes Zone (the parautochthonous Schistose Domain) and the autochthonous Central Iberian Zone. The aim was to correlate the Palaeozoic stratigraphic pile of both domains, and to establish their pre- and synorogenic Variscan evolution.

An Early Palaeozoic volcanic complex forms part of the pre-orogenic record of the parautochthonous Schistose Domain. It includes two volcanic units, the oldest of which is described for the first time in this work and is named the Mora Volcanics. It is a bimodal volcanic suite with basic to acid rocks which has yielded a late Cambrian age (
c.
493 Ma).

Above the Mora Volcanics, the Saldanha Volcanics show petrographic, geochemical and age (
c.
483 Ma) similarities to the Ollo de Sapo Formation, a volcano-detritic ensemble found in the autochthonous domain of NW and Central Iberia. The stratigraphic record and the geochemical signatures of both volcanic units indicate that they were originated by fast partial melting induced by extension along the northern Gondwana margin at the Cambro-Ordovician boundary, coeval with the opening of the Rheic Ocean.