bluuebunny/crossref_metadata_2025_split huggingface dataset:
DEVELOPING MEANINGFUL OUTCOME MEASURES FOR ADVANCE CARE PLANNING IN THE CONTEXT OF END STAGE RENAL DISEASE (ESRD): GOING BEYOND RANDOMISED CLINICAL TRIALS (RCTS)
Authors: Effiong A 
Published: April 2013

BackgroundDespite the prevalence of aggressive end-of-life care for ESRD patients, there is paucity of data from RCTs of ACP interventions for ESRD patients. This is due in part to the dearth of RCTs utilising ACP as an outcome measure. Even when RCTs are used to assess ACP as an endpoint, results are often misleading, or too location-centric.MethodsIn an ongoing Cochrane Review, we attempt to elucidate primary and secondary outcomes of ACP for ESRD patients, by evaluating not only clinical outcomes, but also outcome measures that are relevant to patients, policy drivers, and the general populace. Because such objectives are difficult to evaluate with RCTs, the inclusion of observational studies is most meaningful. Therefore, a systematic review that will include non-RCTs as well as RCTs will be conducted. Contextual factors such as quality of life, social determinants of health, and cultural values, which influence prognoses will be examined. Specific domains will be applied to grade the strength of the evidence.ResultsPreliminary data extracted from these studies indicate that ACP is beneficial to the ESRD patient and may lower the likelihood of intractable conflicts between relevant parties. Furthermore, the inclusion of non-RCTs points to a more robust and logistically feasible analysis.DiscussionThis study will add to the evidence base and will highlight the importance of ACP in ESRD. It will also lay out the rationale for conducting systematic reviews of non-RCTs, in order to adequately capture the concerns of patients, their caregivers, policy makers, and gatekeepers.
FIFTY SHADES OF DYING: THE CHALLENGE OF ADVANCE CARE PLANNING ACROSS THE SPECTRUM OF DISEASE TRAJECTORIES IN ADVANCED HEART FAILURE
Authors: Beattie J M , Flynn T N , Davidson P M 
Published: April 2013

BackgroundChronic progressive heart failure due to left ventricular systolic dysfunction (LVSD) affects a burgeoning proportion of the multi-morbid ageing population. Those living and dying with LVSD decline along a roller coaster disease trajectory unique to each individual and prognostication is difficult. Patient preferences may be unexplored or undermined by widely espoused, guideline driven protocols, incorporating a technological imperative in the use of life-sustaining implantable electronic devices and cardiac surgical interventions.AimTo avoid possible barriers to patient choice along the dynamic course of LVSD and foster advance care planning (ACP) to better ensure patient-centred care at the end of life.MethodsWe shall describe factors potentially confounding patient choice across four domains—those linked to the disease, the patient, the clinician and to service provision. Overarching elements of risk include:the individuality of each patient's clinical coursethe intrinsic unpredictability of LVSDa lack of acknowledgment of mortality risk by both patients and healthcare professionals.the requirement for both active therapy and palliative carerecognition of transitions when goals of care require reviewDiscussionA lack of appreciation of the significance of LVSD and overrated perceptions about treatment option benefits may influence patient choice. Inconsistent study results also refute the common assumption that LVSD patients would trade-off burdensome longevity for a shorter, better quality life. Patient education and the use of discrete choice modelling may provide objectivity, promote consensus development, and facilitate ACP with appropriate treatment decisions towards the end of life.
INTERPRETING NOT JUST THE WORDS BUT THE MEANING INTENDED IN END OF LIFE AND ORGAN DONATION DISCUSSIONS WITH CULTURALLY AND LINGUISTICALLY DIVERSE (CALD) FAMILIES
Authors: Dowling M 
Published: April 2013

BackgroundIn all end of life and organ donation family conversations specific training of medical and nursing staff is considered essential. Interpreters are asked to deliver the healthcare professional's very challenging and often emotive discussions to grieving families without any specific training, or even awareness of the orientation of these conversations.AimInterpreters involved in end of life and organ donation situations need to feel supported in their role, to be familiar with the terms and concepts associated with end of life and organ donation, to have some understanding of the organ donation process and to have considered their own attitudes to, and assumptions about end of life and organ donation.MethodsThis DVD highlights the multiple conversations on end of life and organ donation that occur in the emergency department and in the intensive care unit (breaking bad news to families, futility of treatment and withdrawal of care, the very personal lifestyle questionnaire, the organ donation consent process). A number of CALD actors portray families participating in these conversations.ResultsSegments of difficult and sensitive conversations are highlighted eliciting a range of family responses. Experienced interpreters provide tips on the successful and effective utilisation of the interpreter when conducting face to face conversations and conversations through the Skype medium.DiscussionInformation on end of life and organ donation processes is provided in a logical and contextual formatConclusionThis DVD is a suitable educational tool for all people involved in end of life and organ donation situations—interpreters, pastoral care services, social work, nursing and medical staff.
ADVANCE CARE PLANNING, A STEP-BY-STEP GUIDE FOR HEALTH CARE PROFESSIONALS ASSISTING PATIENTS WITH CHRONIC CONDITIONS TO PLAN FOR CARE TOWARDS END OF LIFE
Authors: Greeve K , Bloomer S , Chellew-Hawley M , Clarnette R , Fortnum D , Garton-Smith J , Harney M , Ibrahim J , Kendall P , Koay A , Moody H , Porter S , Scarff Z , Trevaskis G , Yuen K , Walker H 
Published: April 2013

BackgroundAdvance Care Planning encourages people to think about, and discuss their preferred about future health care. Many patients rely on their health professionals to initiate ACP discussions, however most health professionals lack the skills required for such discussions.AimTo improve uptake of ACP amongst healthcare professionals in WA Health.MethodsAn ACP Chronic Disease Reference Group was established to provide leadership of the project. Interviews were conducted with reference group members to identify the barriers to ACP and identify patient groups who would benefit. A literature search was undertaken to identify prognostic indicators and issues relevant to target patient groups. These outputs were assessed against a multidisciplinary panel of stakeholders and the ACP reference group.ResultsChronic heart failure, chronic lung disease, renal disease and neurodegenerative conditions were identified as priorities for additional ACP resources. Specific and general prognostic indicators were identified which could act as triggers for initiating ACP conversations. Medical and lifestyle considerations relevant to specific conditions were identified and discussion prompts provided. Finally, guidance regarding documentation and dissemination of the outputs of these discussions was considered.DiscussionA guide on its own as a resource will not drive a culture change within health. A model of ACP, consistent with national and international literature, and acknowledging the barriers to ACP is required.ConclusionTo address issues in communication and education, an ACP model which assists in the identification of patients who may benefit from ACP and issues relevant to those with chronic diseases has been developed.
ESTIMATING THE IMPACT OF ADVANCE CARE PLANNING ON HOSPITAL ADMISSIONS, OCCUPIED BED DAYS, AND ACUTE CARE SAVINGS
Authors: Hunt R W , Jones L , Owen L , Seal M 
Published: April 2013

BackgroundApart from the ethical imperatives and improved client outcomes in support of advance care planning, a compelling argument for health care administrators is the containment of escalating health care costs in ageing communities. Advance care planning activity has repeatedly been shown to reduce hospital admissions.1–3In particular, care toward the end of life is expensive, and advance care planning reduces the use of invasive and expensive hospital treatments during terminal illness.AimTo estimate the impact of advance care planning activity on the number of hospital admissions, occupied bed days, and hospital costs in Adelaide, South Australia.MethodsWe apply the results of previous research on the impact of advance care planning,1–3to the number of advance care plans made following implementation of the Respecting Patient Choices (RPC) Program in community and hospital settings in Adelaide, to estimate the number of saved hospital admissions, occupied bed days, and costs.ResultsData records began in 2005 during The Queen Elizabeth Hospital RPC pilot. Data collection from community settings began in 2008, and then from other public hospitals in the Central and Northern Adelaide metropolitan area from 2010. A total of 2604 advance care plans were made and the estimated Occupied Bed Days saved was 23 957. The number of admissions to hospitals from the 42 Nursing Homes engaged in advance care planning was estimated to be reduced by 840 over the last 2–3 years.DiscussionSeveral assumptions are used in applying previous research to calculate the estimated hospital savings. The estimates suggest significant savings, which should be of interest to health administrators. Costs and savings will be detailed in the presentation. Further investment and evaluation of the impact of advance care planning is clearly warranted.ConclusionA relative small investment in advance care planning has the potential to reap considerable savings in hospital use, particularly at the end of life.
SUCCESS IN ADVANCE CARE PLANNING: THE CHANGING GOAL POST?
Authors: Knight K 
Published: April 2013

BackgroundSince its inception advance care planning (ACP) has generated passionate advocates and severe critics. In 2004 a Hastings Center Report publication claimed that the living will has failed, yet we gather at the 4th international conference of ACP suggesting that the idea is thriving. How can such adverse positions coexist?AimThis paper aims to clarify ideas of success in ACP in order to make sense of the disagreements.MethodLiterature review and critical reflectionResultsACP is promoted in pursuit of a combination of utilitarian, libertarian and/or compassionate aims and notions of ACP success vary considerably. In the empirical literature success either refers to successful programme implementation, the achievement of an ideological good for a patient or both. A historical evolution of types of success criteria is evident and ambitions as to what constitute adequate markers of success are diverse.DiscussionAs a complex multidisciplinary field ACP provides a fertile ground for partial successes and failures. A particular problem is that addressing shortcomings in one area can often only be achieved by reducing ambitions in others, leading to a dynamic shifting of ACP goals. Criticisms from one discipline are evaded through discipline specific research design or via different discipline specific goals and ambitions.ConclusionWhether ACP is seen as successful depends on how many and which goals ACP is meant to address at once. Although modern ACP has made many practical advances, it has done so at significant cost elsewhere and certain criticisms remain relevant.
COMMUNICATING MY VALUES, MY WISHES: ADVANCE CARE PLANNING IN COMMUNITY PALLIATIVE CARE
Authors: Tatlow K 
Published: April 2013

Background and AimAll people have the right to receive high-quality care; to be offered Advance Care Planning (ACP) opportunities and to have a dignified death in line with their spiritual and psychosocial wishes.With the recent dissemination of the National Framework for Advance Care Directives, it was timely that Eastern Palliative Care Association Incorporated (EPC) strengthen its ACP approach and develop a clearer process for it within its service.MethodA reference group was conducted that emphasised the need to produce something relevant to the needs of community palliative care clients. Staff expressed the desire for a ‘kit’ of resources that could be utilised according to client need.Following extensive research and consultation with other services, a Resource Kit was designed.ResultsThe Kit contains a staff guide; information brochure; conversation tools; legal forms and Statement of Wishes form.The conversation tools include the Coda Alliance ‘GoWish cards’ and EPC's ‘My Values, My Wishes prompt booklet’. These tools can be a less intrusive way of facilitating sensitive conversations.The Statement of Wishes form was designed to ensure clients' psychosocial and spiritual needs are included at the onset.Discussion and ConclusionEPC's ACP Resource Kit is a unique and innovative step forward in facilitating ACP with palliative clients, by incorporating aspects of care that are most important to them. A recent staff evaluation after 6 months in use, indicated that the kit ‘opened doors’ in assisting client's to reflect on and communicate things that they previously were unable to do.
ADVANCE CARE PLANNING FOR PATIENTS WITH HEART FAILURE IN A MULTIETHNIC SOUTH EAST ASIAN COHORT
Authors: Sim D K L , Tan S H , Tan B C , Neo C L , Wong G 
Published: April 2013

BackgroundLimited data in our multi-ethnic South East Asian society on the feasibility of advance care planning (ACP) where different cultures have disparate beliefs with regards to death.AimA pilot study for the feasibility of basic ACP for patients with mild heart failure.MethodsPatients were recruited from a heart failure clinic over a 4 month period if they are in New York Heart Association class I/II with no readmission in preceding 6 months.ResultsOf 58 patients, 83% had formal ACP while 17% declined to participate. Mean age was 57 years with predominance of male (72%). Ethnic distribution followed the national demographic (84% Chinese, 9% Indian, 7% Malay). The participation rate among the different ethnic groups were 86% for Chinese, 100% for Indians and 25% for Malay. For the participants, 90% had more than one ACP session with a mean duration of 60 min per session, and 17% had completed the ACP forms upon enrolment of the last patient. Significant challenges faced were low awareness of ACP among patients and caregivers as well as need for coordination across multiple disciplines.DiscussionThere is a high acceptance of ACP among patients with mild heart failure. But there is a disparity in the attitudes of different ethnic groups towards ACP where Malay are less willing to discuss it compared to Chinese and Indian.ConclusionOur study highlights the feasibility of implementing ACP in South East Asian patients with heart failure, and the need for further research on the observed impact of ethnicity.
IMPLEMENTATION OF THE LIVERPOOL CARE PATHWAY IN THE ACUTE SETTING IMPROVED END OF LIFE CARE
Authors: Fullerton S , Bhagat Sandeep 
Published: April 2013

BackgroundThe care of dying patients and families represents an important aspect of health service provision. 1500 patients a year die in Eastern Health beds, only 40% of whom are seen by the hospital based palliative care consultation team (HBPCCT). There is room to improve the quality of care offered to dying patients and families outside a specialist palliative care setting.The Liverpool Care Pathway (LCP) is an integrated, evidence-based, multidisciplinary document representing the ‘Gold Standard’ in quality end-of-life-care provision.AimTo implement and evaluate the LCP in acute wards in EH.MethodsWards with the highest numbers of deaths were identified.After consultation, the LCP was implemented.Surveys of staff were carried out before and after implementation.ResultsMore than 200 patients and families have been cared for on the LCP. Some patients were discharged back to residential care and some to palliative care beds.Only 9% of the 88 surveyed staff who had used the LCP felt that it had not helped improve the care of dying patients and families in EH, and 6% of staff felt that the LCP had not helped staff in caring for dying patients.ConclusionsStaff feel that the introduction of the LCP improved end of life care at EH.Use of LCP did not prevent transfer from acute beds to specialist palliative care beds.
NORMALISING ACP IN THE COMMUNITY
Authors: Hammes B , Briggs Linda A 
Published: April 2013

BackgroundAdvance care planning is the process of coming to a greater understanding of future medical decisions; personally reflecting on those decisions; discussing the options and plans with others who are close; and creating a clear plan of action. This is a process that needs to be part not only of the health care system, but also of the community life.AimTo explore the way that the process of advance care planning can become part of family and community life.DiscussionWhile advance care planning is often focused on medical treatment decisions, for example, resuscitation, in reality such planning is more about values and goals of individuals. As such, it has as much to do with fundamental beliefs, obligations; relationships; and values as it does about information regarding a treatment. It is coming to a fuller and timely understanding of these aspects of an individual's life that the goals of medical care and the treatment decisions get shaped. In this regard advance care planning is a human activity that involves relationships and activities like religion and culture. Such conversations belong as much in the community as they do in the hospital. This broader approach, however, is not well understood by the larger community nor is it fully trusted. To have a highly successful advance care planning approach requires the engagement of a wide variety of organisations and institutions from the community. This presentation will explore effective methods of such engagement and consider how it improves outcomes.
Comparison of chest compressions in the standing position beside a bed at knee level and the kneeling position: a non-randomised, single-blind, cross-over trial
Authors: Oh Je Hyeok , Kim Chan Woong , Kim Sung Eun , Lee Sang Jin , Lee Dong Hoon 
Published: April 2013

BackgroundWhen rescuers perform cardiopulmonary resuscitation (CPR) from a standing position, the height at which chest compressions are carried out is raised.ObjectiveTo determine whether chest compressions delivered on a bed adjusted to rescuer's knee height are as effective as those delivered on the floor.Materials and methodsA total of 20 fourth-year medical students participated in the study. The students performed chest compressions for 2 min each on a manikin lying on the floor (test 1) and on a manikin lying on a bed (test 2). The average compression rate (ACR) and the average compression depth (ACD) were compared between the two tests.ResultsThe ACR was not significantly different between tests 1 and 2 (120.1 to 132.9 vs 115.7 to 131.2 numbers/min, 95% CI, p=0.324). The ACD was also not significantly different between tests 1 and 2 (51.2 to 56.6 vs 49.4 to 55.7 mm, 95% CI, p=0.058).ConclusionsThe results suggest that there may be no significant differences in compression rate and depth between CPR performed on manikins placed on the floor and those placed at a rescuer's knee height.
Four-wheeled walker related injuries in older adults in the Netherlands
Authors: van Riel K M M , Hartholt K A , Panneman M J M , Patka P , van Beeck E F , van der Cammen T J M 
Published: April 2013

BackgroundWith ageing populations worldwide, mobility devices are used more than ever. In the current literature there is no consensus whether the available mobility devices safely improve the mobility of their users. Also, evidence is lacking concerning the risks and types of injuries sustained while using a four-wheeled walker.ObjectiveTo assess injury risks and injury patterns in older adults (≥65 years) who presented at Emergency Departments (ED) in the Netherlands with an injury due to using a four-wheeled walker.Design and settingIn this study, the Dutch Injury Surveillance System was used to obtain a national representative sample of annual ED visits in the Netherlands in the adult population (≥65 years) sustaining an injury while using a four-wheeled walker. The numbers of four-wheeled walker users in the Netherlands were obtained from the national insurance board. The numbers of ED visits were divided by the numbers of four-wheeled walker users to calculate age- and sex-specific injury risks.ResultsAnnually 1869 older adults visited an ED after sustaining an injury while using a four-wheeled walker. Falls were the main cause of injury (96%). The injury risk was 3.1 per 100 users of four-wheeled walkers. Women (3.5 per 100 users) had a higher risk than men (2.0 per 100 users). Injury risk was the highest in women aged 85 years and older (6.2 per 100 users). The majority of injuries were fractures (60%) with hip fracture (25%) being the most common injury. Nearly half of all four-wheeled walker related injuries required hospitalisation, mostly due to hip fractures. Healthcare costs per injury were approximately €12 000.ConclusionsThis study presents evidence that older adults experiencing a fall while using a four-wheeled walker are at high risk to suffer severe injuries.
Transcriptional basis of the acclimation to high environmental temperature at the olfactory receptor organs of Drosophila melanogaster
Authors: Riveron Jacob , Boto Tamara , Alcorta Esther 
Published: April 2013

AbstractBackgroundEnvironmental temperature directly affects the concentrations of chemicals in the gas phase. Therefore, if the olfactory system does not physiologically adapt to environmental conditions, it may provide inadequate information about the distance to or direction of odor sources. Previous reports have shown at the behavioral level that temperature induces changes in olfactory sensitivity inDrosophila melanogaster. These changes are initiated in the main olfactory receptor organs, the antennae. In this work, we attempted to identify the particular genes responsible for olfactory adaptation to increasing temperatures in these organs based on current knowledge of the molecular basis of olfactory reception.ResultsWhole-genome transcriptional responses to transitory temperature shifts from 21-30°C were analyzed in the third antennal segments ofDrosophila. More than 53% of the genome was expressed in these organs; this percentage increased slightly (55%) after heat treatment. However, the expression levels increased for 26%, decreased for 21% and remained constant for 53% of the expressed genes. Analysis of the changes produced in 389 genes related to heat response and olfactory reception, according to the current functional annotations of theDrosophilagene set, showed significant differences in 95 of these genes, which are involved in the heat response (23), perireceptor events in olfaction (50), olfactory and gustatory receptors (18) and G-proteins and transduction cascades (4).ConclusionsGene expression was altered in response to environmental heat in the antennae ofDrosophilaby increasing or decreasing expression. Different acclimation patterns emerged for reception through the basiconic, trichoid and coeloconic sensilla. Changes in genes with a central role in olfactory reception, such asorco, may account for part of the acclimation reported at the behavioral level.