bluuebunny/crossref_metadata_2025_split huggingface dataset:
Depression following fracture in women: a study of age-matched cohorts
Authors: Williams Lana J , Berk Michael , Henry Margaret J , Stuart Amanda L , Brennan Sharon L , Jacka Felice N , Pasco Julie A 
Published: February 2014

ObjectivesHigh levels of disability, functional impairment and mortality are independently associated with fracture and depression, however the relationship between fracture and depression is uncertain. The aim of this study was to investigate whether fracture is associated with subsequent depressive symptoms in a population-based sample of women.DesignA study of age-matched fracture versus non-fracture cohorts of women.SettingBarwon Statistical Division, southeastern Australia.ParticipantsTwo samples of women aged ≥35 years were drawn from the Geelong Osteoporosis Study (GOS). The fracture cohort included women with incident fracture identified from radiology reports and the non-fracture cohort were randomly selected from the electoral roll during 1994–1996.Outcome measureSymptoms of depression for women with and without fracture during the 12-month period 2000–2001 were identified by self-report questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.ResultsA total of 296 women with fracture (12 hip, 48 vertebral, 91 wrist/forearm, 17 upper arm, 7 pelvis, 11 rib, 62 lower leg and 48 other fractures) and 590 women without fracture were included. Associations between fracture and depression differed between younger (≤65 years) and older (>65 years) women. Age and weight-adjusted odds ratio for depression following fracture among younger women was 0.62 (0.35 to 1.11, p=0.12) and 3.33 (1.24 to 8.98, p=0.02) for older women. Further adjustment for lifestyle factors did not affect the results.ConclusionsThis study demonstrated that differences in mood status exist between older and younger women following fracture and that fracture is associated with increased depression in older women. Assessment of mood status in both the short and long term following fracture in the elderly seems justified, with early detection and treatment likely to result in improved outcomes.
Planning ahead: Improving escalation plans before the weekend
Authors: Zarkali Angeliki , Black Duncan , Smee Elizabeth , Deshraj Anshul , Smallwood Nicholas 
Published: February 2014

AbstractHandover is the system by which responsibility for patient care is transferred between healthcare professionals. A significant aspect of handover is the existence of an escalation plan for each patient in case of deterioration over the weekend. According to the Royal College of Physicians, all patients should have a clear escalation plan documented in the notes before a weekend, since parent medical teams (Consultant team in charge of care) are best placed to make these decisions. If left to on-call teams, at a time of deterioration over a weekend, they might not have all available information, the patient might be unable to be involved in the decisions, and the family might not be consulted.With this is mind, we decided to analyse the existing handover process in a medium sized district general hospital, with the aim of improving the process and the documentation of escalation plans . The results from our retrospective analysis of the system in place revealed a significant lack of documentation of escalation plans in the medical notes.Three sample wards were selected to analyse the current handover system and test proposed measures before hospital-wide implementation. After trialling of a physical handover meeting in addition to the existing intranet system and a proforma for the Friday ward round, the documentation of escalation plans in the patients' notes improved from 9.1% to 41.1%. Based on these results, as well as formal feedback from junior doctors and informal feedback from other staff, the physical handover meeting and Friday ward round proforma will be implemented throughout the Trust.Our interventions led to an improvement in the documentation of escalation plans in our hospital, thus saving precious time in the event of a patient’s deterioration. This also ensures that families and patients are involved in the decision making process and kept informed, and reduces the burden for the weekend on-call teams.
Saving the NHS one blood test at a time
Authors: Akhtar Waqas , Chung Yooyun 
Published: February 2014

AbstractAs a team of junior doctors our aim has been to save costs in day to day work so that money can be reallocated to improving nursing staff levels on our wards. Stem cell units have regular blood collection schedules in order to monitor organ response to chemotherapy and to look for complications in immunocompromised patients. We set out to reduce the number of biochemical investigations to a minimum that would be clinically indicated. We designed a new blood collection proforma for nursing staff to follow and audited all blood tests taken during a 2 week period before and after its introduction. The number of inappropriate blood tests were recorded as those that were not clinically indicated or not present on the collection schedule. After the introduction of the change the number of inappropriate tests were reduced by 937 over the 2 week period, with a cost saving of £1,478.42. Similar strategies for reducing unnecessary investigations and focusing on tests that will change management could help the NHS cope with a difficult financial future and provide continued safe staffing levels and quality care.
Palliative social media
Authors: Taubert Mark , Watts Gareth , Boland Jason , Radbruch Lukas 
Published: February 2014

AbstractThe uses of social media have become ubiquitous in contemporary society at an astonishingly fast-paced rate. The internet and in particular platforms such as Facebook, Twitter and YouTube are now part of most people's vocabulary and are starting to replace many face-to-face interactions. The online world, in particular, is alive with discussions, comments and anecdotes about the topics of illness, disease, hospitals, death and dying. The topic of death and dying had in the not too distant past been seen as taboo, but willingness and need to talk openly about it appears to be on the increase. In parallel to this, many public awareness campaigns are highlighting society's need to be more prepared for dying and death. This will have a significant impact on the way terminally ill patients and their families approach the last years, months and weeks of their lives and how they might expect palliative health and social care professionals working with them through these difficult periods to interact with them. We pay particular attention to the areas of digital posterity creation and memorialisation within the wider holistic context of end-of-life care.
ELECTRONIC COMPUTER SEARCHES IN PRIMARY CARE CAN LEAD TO GREATER IDENTIFICATION OF NON-MALIGNANT PATIENTS FOR PALLIATIVE CARE
Authors: Mason BL , Boyd K , Murray SA , Steyn J , Cormie P , Kendall M , Munday D , Weller D , Fife S , Murchie P , Campbell C 
Published: February 2014

IntroductionMost patients receive palliative care only in the last two months of life. The use of information technology currently in place in general practices provides an opportunity to identify people for supportive and palliative care at an earlier stage.Aim(s) and method(s)To assess the impact and acceptability of a primary care electronic record search to identify patients with unmet palliative care needs. Methods: A computer record search was developed and tested in fifteen general practices in two Scottish health boards. A sub-set of patients identified by the search were selected for further review and care planning by GPs. Quantitative and qualitative data were collected to assess the impact of the search results on practice behaviour and attitudes towards the search among professionals and patients.ResultsThe electronic record search successfully identified candidate patients for palliative care, some of whom the practice reviewed and identified for palliative care. Starting an Anticipatory Care Plan or electronic record sharing with Out of Hours services were the most common actions GPs took with patients who were reviewed after identification by the search.Conclusion(s)Electronic searching of primary care records can identify a shortlist of patients to assess for palliative care needs. Regularly producing such lists at team meetings should increase the number of non-malignant patients on palliative care registers. However GP and patient attitudes towards the taboo words “palliative care” mean that this will only lead to action if “supportive” care options that do not require the label “palliative care” are made available.
DEVELOPMENT AND VALIDATION OF A CROSS-CULTURAL EORTC MEASURE OF SPIRITUAL WELLBEING (SWB) FOR PALLIATIVE CARE PATIENTS WITH CANCER
Authors: Vivat B , Young T , Winstanley J , Arraras JI , Bennett MI , Brédart A , Costantini A , Fisher SE , Greimel E , Guo J , Irarrazaval ME , Kobayashi K , Kruizinga R , Navarro M , Omidvari S , Rohde GE , Serpentini S , van Laarhoven HWM , Yang G 
Published: February 2014

IntroductionSpiritual care and spiritual wellbeing (SWB) are central to palliative care, but no measures of SWB have yet been developed cross-culturally.Aim(s) and method(s)In 2002 the EORTC Quality of Life (QL) Group began international development of an SWB measure for palliative patients. Three domains of SWB were initially hypothesised, and items developed accordingly. Data for Phase IV field-testing and validation of the measure were collected from January 2012 to July 2013. Participants completed the 36-item provisional SWB measure and a structured debriefing interview. EORTC QLQ-C15-PAL, socio-demographic and clinical data were also collected, and a sub-set of test-retest data. The scale structure was assessed using Principal Component Analysis (PCA) and Rasch analysis and further validity explored using known group comparisons.Results458 patients from 14 countries took part; 188 Christian, 50 Muslim, 23 Buddhist, and 158 with no religion. All items showed good score distribution. 275 patients (60%) found no items problematic, but small percentages indicated difficulties with 6 items. Combining patient feedback with PCA and Rasch analysis led to deletion of a few items. Four distinct domains explain 53% of the variance. No remarkable differential item functioning (DIF) was found for age, sex, geographical region or belief in God. Goodness of fit measures were within guidelines. Global SWB correlated weakly with global QL.Conclusion(s)This EORTC measure of SWB is available for use in palliative care research and practice, and has both measurement and intervention characteristics. Future studies will specifically recruit people in minority religious and/or ethnic communities under-represented in this already diverse sample.
RECRUITING PARENTS TO PAEDIATRIC PALLIATIVE CARE RESEARCH: IMPACT OF LOW INVITATION RATES ON SAMPLE BIAS
Authors: Crocker JC , Beecham EC , Kelly P , Dinsdale AD , Hemsley J , Jones L , Bluebond-Langner M 
Published: February 2014

IntroductionRecruitment in paediatric palliative care is widely reported as challenging, with low rates of invitation by clinicians. The impact of this on sample bias is unknown.Aim(s) and method(s)We studied recruitment to a qualitative interview study about parental decision making for children cared for by a specialist palliative care (PC) team. PC clinicians were encouraged to introduce the study to parents over 12 months. With ethical approval, we used information from the PC team database and feedback from clinicians to explore the impact of low invitation rates on sample bias.ResultsThe families of 519 living and 73 deceased patients were retrospectively identified as potentially eligible for recruitment. Clinicians invited parents of 28 (5.4%) living patients compared to 21 (28.8%) deceased patients (p=0.0001). On multivariable analyses, there was no association between patient demographics and invitation, but for living patients, total and out-of-hours contact time between family and PC team while eligible were independently associated with invitation (p<0.05). The most common reasons clinicians gave for not inviting parents of living and deceased patients were little or no contact with them and perceived burden.Conclusion(s)Invitation rates were especially low among parents of living patients. There was no evidence that this led to major demographic bias. However, the strong influence of family contact may have introduced bias potentially relevant to the project (e.g. patient stability and parent-clinician relationships) that we were unable to measure. We recommend that researchers consider levels of patient contact when planning studies requiring recruitment via clinicians.
CARING FROM HOME TO HOSPICE
Authors: Dunsmore-Dawson A , King N , Rodriguez A 
Published: February 2014

IntroductionCaring in the community for a person with a life limiting condition has consequences for the essential structure of the carer's life. Changes arising from this experience are processed by carers in idiosyncratic ways. Despite being accepted as care recipients in their own right, carers' experiences are often conceptualised as occurring alongside the illness experience of the patient. This study challenges the notion that the carer's experience mirrors the patients.Aim(s) and method(s)To explore the lived experiences of informal carers of patients .at home and in the transition to hospice. Method: Semi-structured interviews with seven bereaved informal carers. All had provided care in the home prior to hospice admission. An interpretive phenomenological approach was used, focusing on the uniqueness of each carer's account.ResultsCarers actively maintained a sense of ‘at homeness’; taking ownership of their environment by setting and maintaining personal boundaries. Working with professionals in their home had the effect of de-medicalizing the illness setting. Nevertheless, interaction between carers and professionals was shaped by the carer's own level of awareness or avoidance of illness or death related topics.Conclusion(s)In orienting themselves between the position of care provider and care user, carers described a sliding reality with an ever present awareness of living near to death. Vacillating between holding on to the familiar whilst accepting the uncertainty of the unknown, participants adjusted to entering into the carer role at home. This challenges current assumptions that the carers experience mirrors that of the patients.
CREATING GUIDANCE FOR THE USE OF PATIENT REPORTED OUTCOME MEASURES (PROMS) IN CLINICAL PALLIATIVE CARE
Authors: van Vliet LM , Harding R , Bausewein C , Payne S , Higginson IJ ,   on behalf of EUROIMPACT
Published: February 2014

IntroductionRoutine use of Patient Reported Outcome Measures (PROMs) in clinical practice can influence care but is not always achieved. One reason for this seems to be a lack of guidance on how to use PROMs in palliative care practice. This project aimed to provide such guidance.Aim(s) and method(s)The 8-steps of implementing PROMs in clinical practice proposed by the International Society for Quality of Life Research were used as a framework. Recommendations within each step were created based on several sources including the booklet ‘Outcome Measures in Palliative Care: The Essentials’ and the EAPC White paper Outcome Measures.ResultsFor the following steps, recommendations (including the provided examples) were created: i) identify the goals for collecting PROMs (e.g. screening versus monitoring of changes); ii) select patients, setting and timing of assessment (e.g. assess families' own needs); iii) determine which questionnaire to use (e.g. choose questionnaire based on evidence); iv) choose a mode for administering/scoring the questionnaire (e.g. self-administration versus computer-administration); v) design processes for reporting results (e.g. share results with patient/practitioners); vi) identify aids to facilitate score interpretation (e.g. determine the minimum clinically important difference); vii) develop strategies for responding to identified issues (e.g. integrate PROM data with other clinical data); viii) evaluate the impact of measuring PROMs on practice (e.g. conduct benchmarking).Conclusion(s)As PROMs are increasingly used in palliative care, the proposed guidance is essential and timely. Future work will integrate this guidance with more questionnaire-specific guidance to optimise its usability and impact in clinical care.
CONFIDENT CARING: AN INNOVATIVE APPROACH TO EDUCATING AND SUPPORTING LAY CARERS OF PATIENTS WITH PALLIATIVE ILLNESS
Authors: Swan S , Shaw K 
Published: February 2014

IntroductionThe National Health Service in Glasgow depends on 56,400 unpaid carers to support and provide care for unwell friends or family. Presently, the majority of deaths are in those aged over 65 and are often following a prolonged period of illness and frailty. This has huge implications on care resources and places increasing responsibility on lay carers.Aim(s) and method(s)The pilot project ‘Confident Caring’ was developed in an effort to address some of the consequences of this. Two Community Clinical Nurse Specialists researched, designed and delivered a supportive educational programme within the community. Relevant topics were identified through lay and professional consultation and included defining palliative care, caring for the carer, symptom management and end of life care. These were delivered over eight weekly sessions at which an average of eight carers attended.ResultsThe course was evaluated by written weekly questionnaires and an independently led audio recorded focus group. A validated Carer Support Needs Assessment Tool was administered pre and post course. This global evaluation demonstrated that overall confidence and awareness of the carers was heightened, whilst sharing their experiences with people in a similar situation was beneficial and helped reduce feelings of isolation. Tangible outcomes were identified through the completion of ‘Do Not Attempt Cardiopulmonary Resuscitation’ forms for two carers and the prescribing of appropriate medications for one carer.Conclusion(s)Providing carer support for the palliative population in this way has shown significant benefits and positive outcomes and further work is planned to validate these encouraging findings.
TRANSFERRING CRITICALLY ILL PATIENTS HOME TO DIE: DEVELOPMENT OF A GUIDELINE FOR CLINICAL PRACTICE
Authors: Darlington ASE , Long-Sutehall T , Richardson A , Coombs M 
Published: February 2014

IntroductionTransfer home to die from critical care is rare despite health policy supporting patient choice concerning preferred place of care at end of life. A clinical guideline to inform decision making about the rapid transfer of critically ill patients home was developed based on data from a two year mixed methods study.Aim(s) and method(s)In a multi-phased study, data was sequentially gathered from a) focus groups with health professionals and service users b) national survey of critical care doctors and nurses, c) interviews with critical care staff, d) audit of patients who had died on critical care units and e) a national stakeholder event. Data was then used to inform development of a clinical guideline, which then underwent initial review and refinement.ResultsThe aim of the guideline was to aid health professionals in making decisions about the rapid transfer of patients from critical care home to die. The guideline was structured to incorporate four discrete phases: 1) potential for transfer focussing on patient characteristics and patient/ relatives' preference, 2) pre-transfer arrangements focussing on equipment, documentation, and communication with other agencies 3) peri-transfer and 4) post-transfer focussing on follow-up contact with relatives and community health professionals, and staff debriefing.Conclusion(s)The clinical guideline was developed based on robust evidence collected through this comprehensive study. The guideline requires further testing in clinical practice but initial feedback from experienced clinicians has indicated that it may be helpful in terms decision-making, organisation and discussions with patients and families.
UNDERSTANDING PALLIATIVE AND END OF LIFE CARE THROUGH STAKEHOLDER AND COMMUNITY ENGAGEMENT
Authors: Layden J , Connelly M , Sandeman K , Hekerem D , Alexander H , McLoughlin P , Tyrrell P 
Published: February 2014

IntroductionThe pressures on palliative and end-of-life care, including the increasing elderly population; changes in illness and mortality trends; and public finances, have been well documented. Three Marie Curie palliative care service redesign initiatives in Argyll and Bute, Lanarkshire and Lothian are using a range of methods to effect improvements, including stakeholder and community engagement. Health promoting palliative care is an important concept within this changing environment.Aim(s) and method(s)Stakeholder workshops were held to identify innovative options for raising public awareness of, and promoting community involvement in death, dying and bereavement.ResultsA total of 155 people attended the workshops with over 125 ideas generated. These ideas were themed and 25 are being further developed into possible service initiatives.Conclusion(s)By creating opportunities discuss to discuss death, dying and bereavement, local stakeholders were able to engage with each other to develop innovative ideas to raise public awareness of, and promote community involvement in death, dying and bereavement.
A COMPARISON OF IMPROVING CONFIDENCE IN ADVANCE CARE PLANNING FOR SENIOR HOSPITAL AND COMMUNITY CLINICIANS
Authors: Rayment C , Holmes S , Daley A 
Published: February 2014

IntroductionVarious national strategies and standards in end of life care emphasise that generalists should identify those in the last year of life, and be able to have advance care planning (ACP) discussions with these patients. We identified that local clinician's lack confidence in doing this.Aim(s) and method(s)Our aim was to increase confidence in discussing advance care planning (ACP). We delivered 3 hour long education sessions to senior doctors and nurses in the hospital and community using role play with actors. The hospital videoed the role play in a dedicated simulation suite. Pre and post course questionnaires on confidence in communication were completed.ResultsThere were 3 hospital sessions to 9 senior doctors and 8 senior nurses, and 5 community sessions to 31 senior nurses and 11 GPs. Confidence across all domains improved post course. On average those community clinicians who rated their confidence as good or very good rose from 25.5% to 50.7% and the hospital clinicians from 37.4% to 76.7%. The hospital clinicians rated themselves as more confident than community clinicians in 3 questions before the course and in all domains after the course.Conclusion(s)All clinicians improve their confidence in discussing ACP after the course. On average hospital clinicians were more confident both before and after the course. Different teaching environments may account for some of this but conclusions are limited by the different numbers in each group. Those delivering ACP communication sessions should consider potential differences in confidence between the 2 groups and adapt sessions accordingly.