bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metastatic prostate cancer to lung with normal prostate specific antigen levels
Authors: Lawrentschuk Nathan , Webb David R , Mitchell Catherine A 
Published: May 2014

A 77-year-old man presented with significant lower urinary tract symptoms, complaining of urinary frequency and poor flow. He had a normal feeling prostate. A cystoscopy was unremarkable apart from a polyp in the prostatic urethra that was biopsied. Histology revealed adenocarcinoma of the prostate, Gleason combined grade 8 (4+4). Transrectal ultrasound and biopsy was performed confirming adenocarcinoma in three of six cores. A bone scan and a computed tomography (CT) scan revealed no evidence of metastatic disease. Several weeks post cystoscopy his prostate specific antigen (PSA) level was raised at 8.1μg/litre (normal <4.0 μg/litre); however, this settled 2 weeks later at 3.3 μg/litre. After discussion, he was commenced on hormone ablation therapy (cyproterone acetate, a steroidal antiandrogen) because of ongoing voiding symptoms and a further normal cystoscopy. A biochemical response to treatment was achieved with his PSA falling to 0.6 μg/litre. This remained low 6 months later, so the antiandrogen was ceased, with a view to recommencing if symptoms developed or if his PSA rose. He presented to his GP 6 months after cessation of therapy with shortness of breath. His PSA remained low at 0.2 μg/litre. A CT scan of his abdomen was normal but the chest X-ray (CXR) revealed multiple pulmonary nodules, with no pleural effusion or pulmonary oedema (Figure 1). A CXR performed at diagnosis of his prostate cancer was normal. The thoracic unit was consulted, with the possibility of a new primary neoplasm raised, given his normal PSA and the fact that he was an ex-smoker. Bronchoscopy was performed with negative cytology and biopsy. A wedge biopsy of the right lung was then undertaken reporting positive histology consistent with metastatic prostatic adenocarcinoma, comparable to previous biopsies (Figure 2). Immunohistochemistry for PSA (Figure 2) and prostatic acid phosphatase were both positive, confirming the metastasis to be of prostatic origin. Upon review 1 month after his biopsy, a rapid acceleration was noted with his PSA climbing to 22 μg/litre. Hormone ablation treatment was commenced and a subsequent radionuclide bone scan revealed metastatic prostate cancer to his pelvis.
Neurogenic T waves after subdural haematoma
Authors: Kumar Rajeev , Fisher Miles 
Published: May 2014

A 63-year-old woman, living alone, was admitted following a fall. She had not lost consciousness and did not have a fit. Her only complaint was of dull headache. On arrival she was haemodynamically stable, did not have any external injury marks and there were no focal neurological findings. An electrocardiogram (ECG) revealed bifascicular block with widespread, deep, symmetrical T-wave inversions consistent with subendocardial ischaemia (Figure 1). The patient denied any chest pain, palpitations or cardiac symptoms. She had received a coronary artery bypass graft for triple vessel coronary disease 2 years before and was symptom free since. She did have bifascicular block in her previous ECGs, but the T wave changes were new developments. Her creatine kinase and cardiac troponin I, performed in proper time frame, were not elevated and she did not have any electrolyte abnormalities. Sequential ECGs continued to show similar T changes. In view of the history of fall she was not commenced on usual antiplatelet and antithrombotic therapy. An urgent computed tomography scan of the head was arranged which revealed a right parietal subdural haematoma about 1.1 cm in maximum thickness with no midline shift. Management was conservative on the advice of the neurosurgeon. An exercise thallium scan failed to show any significant perfusion defects and echocardiogram was normal. She made good progress and uneventful recovery. At outpatient clinic review 4 weeks later, all T-wave changes had resolved (Figure 2). It was concluded that ischaemic-appearing ECG changes were neurogenic, secondary to her head injury with subdural haematoma.
A collaborative approach to producing a patient information leaflet
Authors: Fletcher Heather 
Published: May 2014

Communication and information giving are necessary and important activities to enable healthcare services to refect ‘best practice and care that focuses on the needs of the patient. The specialist ophthalmic nurse plays an important role in giving patients information and providing support in the clinical environment. Written patient information is a valuable communication tool that can be purely educative (a quick and easy method of giving medical information), produced to empower the reader to be able to access help or used to equip the reader with knowledge for making important decisions about health care and treatment. Leaflets are widely used to support clinical practice and are generally rated as useful by patients; however, a common and recurring criticism is that patients do not understand the content. Involving patients in the development of written information is advocated because it enables the users of services to express their views and concerns. Aim: To introduce a written patient information leaflet about ocular melanoma and referral to a specialist treatment centre. The provision of written information will be of benefit to patients by supporting the clinical consultation and enabling access to local services. Participants: Five males who had been referred to a specialist centre with melanoma of the eye, and two female relatives. Method: Participants were asked to complete a preliminary survey and were then invited to join a discussion-group meeting to express their views about information needs based on their past experiences. Results: Responses by the group revealed the distress and trauma of being diagnosed and the times when their information needs were not fully met. Being able to access help was rated as an important concern for the group. The views of the participants have been incorporated into a new patient information leaflet.
Comparison between non-contact and rebound tonometry in patients with acute eye symptoms
Authors: Borgenvik Helena , Ramsay Marika Wahlberg , Nilsson Maria 
Published: May 2014

Aim: To evaluate the agreement between three non-contact tonometric techniques in an emergency setting. Material: Two hundred and fifty eight patients were recruited from the emergency room at St Erik Eye Hospital in Stockholm during a 3 week period in March 2010. In 224 right eyes it was possible to obtain complete and reliable measurements from all techniques. Method: All patients were examined with the CT-80A, R7CR and Icare, by the same examiner, in a random order. For each patient the diagnoses for each eye and the presence of corneal lesions, if any, were recorded. A difference between measurements of more than 3 mmHg was considered as clinically relevant. Result: The correlations between the intraocular pressure (IOP) values obtained with the different techniques were high, r2ranged from 0.65 to 0.87 (p<0.0001 in all comparisons). There was a very small (median about 1 mm), but statistically significant difference between IOPCT-80A and both IOPG and IOPCC. A difference between the highest and lowest IOP value of more than 3 mmHg was found in 97 of the 224 patients (56.7%). Conclusion: All instruments for IOP measurement evaluated in this study proved to be useful for use in the emergency room. The corneal lesions in a small subgroup of patients did not seem to influence the biomechanical properties of the cornea enough to affect the IOP.
Optic disc imaging — the influence of quality on image analysis
Authors: Martin Lene , Vancea Lucian 
Published: May 2014

Aim: To evaluate the influence of image quality on the measurement of optic disc cupping in fundus photographs. Material: Data from 58 patients, aged 30 to 85 years, with suspected or manifest glaucoma were analyzed. Methods: Measures of the optic cup area were performed by a semi-automatic planimetric program, the Retinal Size Tool (RST), on the fundus photographs. The cup size measure was compared with corresponding value in the Heidelberg retina tomograph (HRT), using the Glaucoma Probability Score (GPS) program. The quality of the fundus photographs was graded by an Automated Quality Evaluation program (AQE), and by two independent observers. Results: Sixty-two percent of the fundus photographs were classifed as acceptable or better by the AQE, while the independent observers classified only one image (2%) as not acceptable for visual evaluation of the optic disc. RST cup size measures both from images with acceptable and poor quality showed good correlations with HRT GPS measures. Conclusion: Planimetric measurements of optic disc parameters could be performed also on images with low over-all quality according to automatic analysis of illumination and sharpness.
A comparison of the Canon TX-20P™ non-contact tonometer and pachymeter in healthy eyes
Authors: Jansson Ulrika , Brautaset Rune , Cerviño Alejandro , Nilsson Maria 
Published: May 2014

Background: The aim of this study was to compare the intraocular pressure (IOP) and the central corneal thickness (CCT) measurements obtained with the Canon TX-20P™ with IOP measured with Goldmann applanation tonometer (GAT) and the CCT measured with ultrasound (US) pachymetry in healthy eyes. Methods: Thirty one healthy voluntary subjects participated in the study, age ranging from 16 to 81 years (mean age 50.9 years). In total 58 eyes were selected for analysis. All measurements were performed by the same examiner. The measurements were taken in the same order in all subjects: Canon IOP and CCT, Goldmann IOP and US CCT. Results: A strong correlation was found between IOP for both CCT compensated and raw values (R2 0.79 and 0.71 respectively) and CCT (R2 0.80) readings from GAT and US pachymetry as compared with the Canon TX-20P™, however, a small but statistically significant difference was found in both IOP and CCT measurements. Conclusions: The Canon TX-20P™ is a compelling two-in-one non-invasive instrument that allows both IOP and CCT measurements. The Canon TX-20P™ has acceptable agreement for IOP measurements, especially the CCT compensated IOP, as compared with GAT and for CCT when compared with US in healthy subjects. However, it remains to be evaluated if such an agreement can be found in subjects with abnormal IOP and CCT.
Loss of appetite: a poetic exploration of cancer patients’ and their carers’ experiences
Authors: Souter Jill 
Published: May 2014

Aim To explore the experience of loss of appetite among palliative care cancer patients and their carers supported by a specialist palliative care team in the community. Method Semistructured interviews were conducted with seven palliative care cancer patients and their carers in the community. A poetic transcription of participants’ words was made to capture and communicate the essence of each person’s experience before the thematic analysis was undertaken. Findings Six common themes emerged from the data: a fickle phenomenon; the cost of caring; facing uncertainty and death; adaptations; accepting limitations; and what patients want: ‘listen to me’. These were illustrated by the poetic transcriptions. Conclusion Meeting the differing needs of palliative care patients with loss of appetite and their carers is challenging. It demands a thorough assessment of symptoms, an understanding of the underlying pathophysioloigy and of the role food plays in society. An understanding of the experience of loss of appetite is essential to the provision of appropriate care and support to those affected by it. The study demonstrated that, although unusual, poetic transcriptions can be an effective method of presenting data in terms of acceptability to participants and communicating their experience to others.
Nursing documentation: non-physical dimensions of end-of-life care in acute wards
Authors: Hegarty Meg , Hammond Lynne , Parish Karen , Glaetzer Karen , McHugh Annie , Grbich Carol 
Published: May 2014

Aim To explore discrepancies between nurses’ knowledge and their documentation of issues of psychosocial, spiritual and cultural aspects of palliative care, evidenced clearly in recent nursing research into end-of-life care in an acute care, teaching hospital. Design The study involved a retrospective patient case-note audit of an opportunistic sample of 20 patients deceased recently and interviews of the two nurses most involved in the care of each patient (n=40). Findings This research indicates that nurses in acute care settings often recognize, sometimes explore, but infrequently document psychosocial, spiritual and cultural aspects of care. Conclusion There is a strong need for: (1) education about both the impact of non-physical dimensions of patients’ lives and the effective documentation of these dimensions; and (2) up-grading of documentation tools to better facilitate documentation of non-physical aspects of palliative care.
A research study to identify facilitators and barriers to outcome measure implementation
Authors: Dunckley Maria , Aspinal Fiona , Addington-Hall Julia M , Hughes Rhidian , Higginson Irene J 
Published: May 2014

Aim To identify facilitators and barriers to implementing outcome measures. Methods An action-research approach within a hospice and nursing home was used. Staff took part in semistructured interviews pre- and post-implementation of the Palliative Care Outcome Scale (POS), completed diaries and participated in monthly meetings. Findings Qualitative content analysis identified barriers to implementation including: a top-down decision-making approach; outcome measures perceived as time-consuming to use; limited resources for data analysis; and a lack of knowledge of the importance of outcome measures. Facilitators to successful implementation include: involving all staff in decisions about implementation; and using a measure that can be adapted to organization needs and clinical practice. The benefits of using the measure are rapidly noticeable. Conclusions Given the need to evaluate services and the role outcome measures can have within clinical governance, this article indicates methods by which measures may be more successfully implemented.
Continuing bonds: a human response within paediatric palliative care
Authors: Foster Terrah L , Gilmer Mary Jo 
Published: May 2014

The concept of continuing bonds (CB) is a human response to health and illness within paediatric palliative care. This literature review aims to: define and explain the significance of CB; describe the history of the concept; critically analyze the literature related to CB; and make recommendations for future research. Exploration of CB as a response to life-threatening illness and to losing a child is significant in terms of improving care for children and their families living with life-threatening illness. This paper focuses on children with a life-threatening illness, but CB also needs to be studied with other populations, such as those with life-limiting conditions.
Nurses’ decision-making in pressure area management in the last 48 hours of life
Authors: Searle Christina , McInerney Fran 
Published: May 2014

Aim: To report on an aspect of a study that explored nurses’ clinical decision-making in pressure area management of people in the last 48 hours of life. Design: A qualitative approach of interpretive description was used to collect and analyse 12 semi-structured interviews with registered nurses working in a palliative care unit and two haematology/oncology wards. Findings: In this study nurses described their experiences of providing pressure care management for the patient in the last 48 hours of life. Nurses experienced difficulties with determining the frequency of turning the patient, especially during the last phase of life. Factors such as clinical assessment of the patient, ensuring patient comfort, use of pressure relieving aids, patient and family wishes and the influence of professional colleagues were variously valued and prioritised in importance. The context of care informed clinical practice and complicated decisions, which went beyond the consideration of clinical needs. Conclusion: Nurses need to strive for consensus in clinical practice on the best care for the patient and, where possible, include the patient and family in the discussions. The development of further evidence on the options available for pressure management practices at the end of life can assist in clinical decision-making.
Maintaining hope when close to death: insight from cancer patients in palliative home care
Authors: Olsson Louise , Östlund Gunnel , Grassman Eva Jeppsson , Friedrichsen Maria , Strang Peter 
Published: May 2014

Purpose This article reports the social and psychological processes that 11 cancer patients receiving palliative home care used to keep their hope alive. Method The patients described their ways of dealing with hope in interviews and diaries, and it was from these accounts that the processes were extracted, using a grounded theory methodology. Results Two main processes emerged: maintaining life and preparing for death. When the patients focused on maintaining life, they tried to preserve its meaning and to communicate with others about life and death. They found it helpful to shift their focus and to involve fellow ‘travellers’ in their journey. To prepare for death was to take responsibility for the future and to see possibilities of living on even after death. Conclusion This paper revealed two parallel and interdependent processes used by patients in the palliative care phase to maintain hope and respond to living close to death.
Multidisciplinary palliative care teams' understanding of Mental Capacity Act 2005 ‘best interest’ determinations
Authors: Harris Denise , Fineberg Iris Cohen 
Published: May 2014

Aim: To explore multidisciplinary palliative care teams' implementation of the concept of ‘best interests’ as stated in the Mental Capacity Act 2005 (MCA). Background: The MCA for England and Wales provides a statutory framework to protect people who are unable to make their own decisions. No previous research has tackled the specific aim of this investigation. Method: Qualitative research methods were used to interview professionals from two multidisciplinary palliative care teams. The interviews were audio-recorded and thematically analysed. Results: Participants reported that the best interests concept is part of their daily practice, but they had limited understanding of the MCA formulation of best interests. Team location influences the setting and process of best interests decision making. Conclusion: Palliative care professionals' process of considering their patients' best interests may not directly refect the specifc guidance of the MCA.
Hard choices: a qualitative study of influences on the treatment decisions made by advanced lung cancer patients
Authors: Thornton M , Parry M , Gill P , Mead D , Macbeth F 
Published: May 2014

Objective: Most patients with non-small cell lung cancer (NSCLC) present with an incurable, advanced disease, and treatment decisions may be hard. This study explored the factors that influence patients' choice of treatment during the oncologist–patient consultation. Design: Semi-structured interviews conducted within 1 month of a consultation with an oncologist. Participants: Five patients newly diagnosed with incurable NSCLC and facing a treatment decision following a consultation with an oncologist. Setting: A regional oncology unit in the UK. Results: Some of the participants who opted for chemotherapy had made a decision before seeing the oncologist, presented with fewer symptoms, had been more active in seeking information before the consultation, and were willing to accept the risk of side effects. Participants opting for radiotherapy were not willing to accept the risk of side effects for the possibility of a small survival gain and instead focused on symptom relief. Conclusion: Some participants sought information before the consultation from various formal and informal sources. This may undermine the oncologist–patient consultation as the information may be incomplete or inaccurate. Patients vary in their willingness to accept risks for small potential gains. More research is required into methods to communicate the extent of the risks of treatment. The Clinical Nurse Specialist performed a valuable role for the patients and was seen as a trusted source of information.
Supporting dignified dying in the Philippines
Authors: Doorenbos Ardith Z. , Perrin Margot E. , Eaton Linda , Abaquin Carmencita , Balabagno Araceli O. , Rue Tessa , Ramos Rita 
Published: May 2014

Purpose: This study aimed to assess the appropriateness of the International Classification for Nursing Practice (ICNP) Palliative Care for Dignified Dying catalogue for palliative nursing in the Philippines. Methods: The study recruited 230 nurses to complete the ICNP Dignified Dying survey. Participants rated ICNP nursing intervention items and identified additional interventions for promoting dignified dying. Results: All of the intervention items were scored on average as being at least ‘slightly important’. The three top-ranked nursing intervention categories were providing social support, maintaining privacy boundaries, and relieving psychological distress. Conclusions: The ICNP Palliative Care for Dignified Dying catalogue lists nursing interventions that are appropriate to promoting dignity at the end of life in the Philippines.
The experiences of patients undergoing blood transfusion in a day hospice
Authors: Orme Jacquie , Still Duncan , Day Rebecca , Evans Joanne , Perkins Paul 
Published: May 2014

Aim To explore patients' views on living with anaemia and undergoing blood transfusions in a day hospice. Methods This was a qualitative study using semi-structured interviews. Ten patients who between them had received 90 transfusions were purposively sampled from the hospice day unit. The interviews were digitially recorded, transcribed anonymously, and the transcripts analysed using a phenomenological analysis framework. Findings Tiredness was the most common symptom of anaemia. Participants liked attending the day hospice instead of hospital for their transfusions owing to differences in transport, parking, waiting time, and space to ask questions. The majority had no concerns about hospice transfusion and would be happy to return for further treatment. Conclusions Haematologypatients can have a good experience when undergoing blood transfusion at a day hospice. Hospices should perhaps offer this procedure more widely.
Impact of an educational pain management programme on nurses' pain knowledge and attitudes in Kenya
Authors: Machira Gladys , Kariuki Hellen , Martindale Linda 
Published: May 2014

Introduction: Pain is a common symptom for patients receiving palliative care, but can be relieved by effective pain management. Nurses play a critical part in implementing pain management effectively and must therefore have a solid foundation of knowledge and a positive attitude toward it. Aim: The purpose of this study was to implement and evaluate an educational pain management programme (PMP) for nurses in Kenya. Methods: The effects of the PMP were measured using a quasi-experimental pre-post test design. Twenty seven nurses from two units in a single health institution in Kenya participated in a baseline assessment using the Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP). Nine randomly selected nurses then received 7 hours of focused education. This group completed the assessment again both immediately after and 2 weeks after the PMP. Results: A deficit in knowledge and attitudes related to pain management was prominent at baseline. The nurses who received the PMP scored significantly higher on the NKASRP following the PMP: mean scores were 18.44, 28.00, and 27.56 at baseline, first follow-up, and second follow-up assessment respectively. Conclusion: The PMP appears to be effective in improving nurses' pain knowledge and attitudes.