bluuebunny/crossref_metadata_2025_split huggingface dataset:
CONSTRAINTS AND ENABLERS FOR CULTURALLY APPROPRIATE END-OF-LIFE CARE IN NEW ZEALAND
Authors: Batten Lesley , Holdaway Maureen , Clark Jean , Allan Simon , Randall Clare , Marshall Bridget 
Published: February 2014

BackgroundThe Liverpool Care Pathway for the Dying Patient was introduced into parts of New Zealand in 2005. Unique ‘cultural goals’ were added, in recognition of the importance of the provision of culturally appropriate care.AimsTo assess the use of the cultural goals in practice and to investigate stakeholders' experiences and perspectives of how the cultural goals influence culturally appropriate end-of-life care.MethodsA mixed method study including, in this phase, two clinical audits, semi-structured interviews with 20 stakeholders, and a focus group with 20 Maori clinical staff. Interview data were analysed thematically, and audit data were analysed using descriptive statistics and content analysis.ResultsParticipants identified many factors that acted as constraints or enablers in the provision of culturally appropriate care. These factors operated at multiple levels, including at the individual level of clinicians and carers, at the organisational level, the health sector level, and across cultural groups within our society. Constraints included staff discomfort in talking about cultural needs and providing cultural care, the increasingly multicultural health workforce with divergent understandings of cultural needs during the end-of-life phase, differing palliative care service contracts, and structural features of organisations that impeded staff meeting patients' and families' cultural needs. Enablers, such as in-service education programmes, addressed some, but not all of these constraints. Enablers operated mostly at the level of individual clinicians and services. Ongoing support and funding for development of these initiatives was relatively unstable.ConclusionsCulturally appropriate care is a core priority to reduce health inequities related to access to palliative care. However the increasing complexity of the cultural landscapes of patients and families, clinicians and carers, services, the health sector and society mean that a sustainable, multilevel approach is required to address cultural needs.
A SYSTEMATIC REVIEW AND GUIDELINES FOR PALLIATIVE CARE PROFESSIONALS ON SWITCHING TO ORAL METHADONE FOR THE TREATMENT OF CANCER PAIN
Authors: Rogers Alexandra 
Published: February 2014

BackgroundMethadone is a drug infrequently used in palliative care with complex pharmacokinetics and a risk of adverse effects (AEs) on switching. There is a paucity of evidence-based guidelines for methadone use within palliative care.AimsThis systematic review evaluated the evidence for the different methods used to switch to methadone and the need for ECG monitoring as part of this. Guidelines for switching were formulated on the basis of this.MethodsTwo systematic reviews were carried out by searching EMBASE, MEDLINE, Cochrane and DARE databases; journals and reference lists identifying randomised controlled trials (RCT) or prospective studies comparing different methods of switching to oral methadone and the need for ECG monitoring as part of this process. SIGN methodology was used to develop guidelines.ResultsTwelve studies met the inclusion criteria. Of these, only one compared two methods of switching. The remainder were low-quality studies with no comparison group. The ‘3-day switch’ method, where morphine is tapered and replaced over 3 days, had an inadequately powered RCT to support its use. The ‘Stop-and-Go’ method, where morphine is switched to methadone immediately, had inconsistent results on benefits and incidence of AE and serious adverse effects (SAE). Two poor-quality studies that lacked clarity on the incidence of AE and SAE were found on theAd Libitummethod, where methadone is given as required up to 3-hourly after stopping morphine, and then converted to a stable daily dose. A high quality prospective cohort study showed the incidence of clinically significant QT-prolongation to be low and no episodes of ventricular arrhythmia or death were seen on switching to methadone doses less than 100 mg.ConclusionsTheAd libitummethod of switching is recommended based on expert opinion. ECG monitoring is not required when switching patients to less than 100 mg methadone for treatment of cancer pain.
“It's a lot easier to say yes than no” - decision making in end stage kidney disease
Authors: Hussain Jamilla , Flemming Kate , Johnson Miriam 
Published: February 2014

BackgroundIndividuals with chronic advanced diseases such as end stage kidney disease (ESKD) are offered a growing number of choices regarding life-prolonging treatments. Health care teams (HCTs) play an important part in helping patients make decisions about with-holding and withdrawing such treatment.AimTo explore the similarities and differences in the decision-making process for patients with ESKD and their healthcare team (HCT), with regards to dialysis.MethodA systematic review of qualitative studies. The search strategy was peer-reviewed and two independent researchers were involved in screening, data extraction, quality appraisal and synthesis. The Hawker et al (2002) appraisal checklist was used to provide an assessment of quality. The synthesis was conducted using thematic analysis.ResultsEleven studies were eligible for inclusion, including 177 patients and 53 HCT members.With-holding dialysis:Factors weighed up by patients included peer experience, being a burden on family and wider society, and maintaining normal social roles. Some individuals instinctively opted for life-prolonging treatment at all costs, where as others accepted death as a natural course. HCTs on the other hand prioritised biomedical factors and relied on their own objective deliberation rather than patient preference. How individuals coped with their emotions was an important mediating factor. Problem-focussed copers sought various levels of input where as emotion-focussed individuals delegated choice.Dialysis withdrawalProblem-focussed individuals viewed the option to withdraw treatment as a ‘tremendous control’ to stop their suffering. Emotion-focussed copers however passively continued dialysis. HCTs struggled with the dilemma of determining when dialysis was prolonging suffering rather than improving quality-of-life and therefore continued to err on the side of life-prolonging treatment until dialysis was no longer physically possible.ConclusionsPatients and HCTs are influenced by different factors when making decisions about dialysis. Informed shared decision-making requires greater transparency of the impact of such factors on choice.
INFORMATION PROVISION AND THE WIDER EXPERIENCE OF CARE: A QUALITATIVE STUDY OF PATIENTS DIAGNOSED WITH LUNG CANCER FOLLOWING EMERGENCY ADMISSION AND THEIR CARERS
Authors: Caswell Glenys , Seymour Jane , Crosby Vincent , Freer Sarah , Freemantle Alison , Wilcock Andrew 
Published: February 2014

Background40% of patients with lung cancer are diagnosed following an emergency admission to hospital (DFEA), but little is known about this group. There are particular challenges in providing information in these circumstances. This paper reports preliminary qualitative findings from a mixed methods study seeking to describe the characteristics, needs and outcomes of patients with lung cancer DFEA admitted over one year to a University hospital.AimTo explore patients' and carers' experiences of lung cancer DFEA, focusing on reports about information provision and needs.MethodsThis study is in progress. Patients DFEA and their carers are invited to participate in a qualitative interview following completion of the Charlson co-morbidities index; Sheffield Profile for Assessment and Referral to Care holistic needs questionnaire and a modified 2012 National Cancer Patient Experiences Survey. Interviews usually take place following hospital discharge. Data are analysed using a grounded theory approach, aided by NVivo.FindingsFrom a target sample of 15 patients and 15 carers, to date we have recruited 10 patients (5m; 5f; aged 49–91) and 6 female carers (from 81 patients DFEA). One group of participants talk about their ‘need to know’; they report wanting information about all aspects of diagnosis, treatment and prognosis. A second group describe themselves as knowing ‘what the score is’, reporting no need for more information or not wanting to know ‘too much’. Some describe clinicians who respond well to their particular needs for information, while others reported non personalized responses: for example, the provision of information about treatment options when a cancer is too advanced for these. Where participants criticize information-giving, this influences wider perceptions of care.ConclusionHigh levels of morbidity present challenges when studying this group. The experience of information provision shapes wider experiences of care for patients DFEA with lung cancer and their carers.
DIFFICULT DECISION-MAKING AT THE END OF LIFE: STOPPING ORAL PALLIATIVE ANTICANCER TREATMENT. A SYSTEMATIC LITERATURE REVIEW AND NARRATIVE SYNTHESIS
Authors: Clarke Gemma , Johnston Simon , Corrie Pippa , Kuhn Isla , Barclay Stephen 
Published: February 2014

BackgroundCurrent guidelines set out when to start anticancer treatments but not when to stop as disease progresses and death approaches. Older cytotoxic agents are administered intravenously. Most newer drugs, such as Tyrosine-Kinase Inhibitors (TKIs), are oral and widely used in incurable disease with evidence of a few months' survival benefit. New generation agents are considerably more expensive, typically around £5K per month, and perceived as easier to start than to stop.AimsSystematic literature review examining decisions to stop oral and parenteral anticancer agents in clinical practice, focusing on: a) How are decisions made? b) When are they made? c) Why are they made? d) Who makes them?MethodsSeven electronic databases (Embase, Medline, PsycINFO, CINAHL, ASSIA, Web-of-Knowledge, Cochrane Collaboration), grey literature, references and citations were searched.ResultsForty-nine eligible papers were located. No studies were found concerning criteria for stopping TKIs in practice: most studies examined palliative chemotherapy generally. Key findings: The complexity of chemotherapy regimes means that decisions are not one-off, but rather an on-going process, before all treatments are finally stopped. This may involve switching to alternative therapies and taking breaks. Treatment was stopped when side-effects or burdens became too great. Non-clinical factors were also influential, including physicians' personal experiences, emotions and history. While decision-making was part of the on-going physician-patient interaction, there was variation in who made the final decision: in some studies decisions to continue were patient-led, in others physicians continued treatment if there was evidence of benefit. Some studies presented stopping as ‘biological fact’, treatment being stopped when the patient became too ill.ConclusionsEvidence to inform decision-making concerning stopping palliative anticancer therapy is variable and absent for new generation oral agents such as TKIs. Further research is urgently needed in this area to inform optimal patient care decisions in a resource-constrained NHS.
CINDERELLA SESSIONS: CHALLENGES AND ISSUES IN TEACHING END OF LIFE CARE TOPICS AMONG HEALTHCARE LECTURES IN UNDERGRADUATE NURSING EDUCATION
Authors: Venkatasalu Munikumar Ramasamy , Jackson Susan , Walsh Anna 
Published: February 2014

BackgroundIn the UK, 4 out of 5 nurses lack basic pre-registration education and training in end of life care. Research shows an increased anxiety, lack of clinical skills, poor coping mechanisms among nursing students to deal with death and dying situations. Nevertheless, the reasons are unknown from the perspectives of healthcare lecturers about different end of life care teaching and learning strategies and its impact on clinical learning experiences on students.AimTo critically examine the experiences and attitudes of healthcare lecturers' on learning- teaching strategies on end of life care topics in pre-registration nursing programmes.MethodsAfter ethical approval, 10 ‘think aloud’ semi structured interviews were conducted with health care lecturers who were involved in teaching end of life care topics in one University in England. Phenomenography informed framework method was used to analyse the data.FindingsData analysis revealed 3 themes. The theme on ‘hidden death’ relates to the lack of explicit curricular objectives around end of life care topics results in limited exposure to death and dying topics in pre-registration programmes. Second theme on ‘protecting emotions’ relates to how participants deliver end of life care teaching in a shared emotional space'. Final theme on ‘Cinderella sessions’ relates to lack of explicit support mechanisms for dealing emotional outcomes of end of life care teaching sessions for both teachers and students.ConclusionsHealth care lecturers remains ‘cautious and over conscious’ on managing emotive topics that often makes end of life care topics as hidden curriculum. Despite using traditional teaching methods often trusted as beneficial in teaching end of life care topics, technology enhanced end of life care teaching-learning strategies yet unproven. Further research is urgently needed to evaluate diverse end of life care teaching strategies and its impact on clinical care outcomes.
INTEGRATION OF PALLIATIVE CARE INTO UNDERGRADUATE HEALTH AND SOCIAL CARE CURRICULA IN THE REPUBLIC OF SERBIA
Authors: Downing Julia , Haraldsdottir Erna , Milicevic Natasa , Bosjnak Vesna , Firth Pam , Lukic Nina , Baskott Jo 
Published: February 2014

BackgroundPalliative care remains a new discipline within Serbia, thus there is a need for a comprehensive programme of continuing education and formal higher education for palliative care (PC). Prior to 2011, there was no formal palliative care training incorporated into the undergraduate curriculum for health and social care professionals. Therefore the introduction of palliative care into the curriculum for doctors, nurses and social workers was a key component of the development of palliative care.AimThe aim was to integrate pc into the undergraduate curricula of medical, higher nursing and social work curriculum in Serbia.MethodsA team of national and international experts led the process. For each discipline, contact was made with the appropriate Deans, meetings held with representatives from the different faculties, and a curriculum development process established. Existing curricula were reviewed, where they existed e.g. for the medical schools and curricula drafted based on international guidelines/experience.ResultsComprehensive training materials have been developed, including facilitators guides, presentations and student handbooks, as there is no comprehensive Serbian PC book. The curriculum has been integrated into the undergraduate medical course in all five medical schools in Serbia i.e. the Universities of Belgrade, Novi Sad, Kragujevac, Nis, and the Military Medical Academy. The process of acceptance into the higher nursing schools is ongoing but it is anticipated that at least half of the schools will integrate palliative care as a mandatory course. For social workers, palliative care will be taught within the curriculum for the first time from October 2013.ConclusionIntegration of pc into the undergraduate curriculum for health and social care professionals is vital in the development of pc. Working in collaboration with the different faculties is key to integration, along with development of comprehensive training materials in accordance with European and International standards.
Impact of multiscale modelling on predicted porosity and permeability distributions in the fluvial deposits of the Upper Lunde Member (Snorre Field, Norwegian Continental Shelf)
Authors: Nordahl Kjetil , Messina Carlo , Berland Håvard , Rustad Alf B. , Rimstad Eivind 
Published: February 2014

Abstract
Models of hydrocarbon reservoirs are often used to support management decisions about field development and redevelopment. Typical modelling workflows result in a reservoir and simulation model with a property distribution generally comparable to the well data, and this is often considered sufficient. The current study tests this assumption on the fluvial reservoir in the Upper Lunde Member of the Snorre Field where sedimentary heterogeneities at multiple scales influence reservoir properties such as porosity and permeability. This work shows that, by describing and modelling the sedimentary heterogeneities at several length scales in the reservoir, and by using a flow-based local upscaling method, the resulting porosity and permeability distribution at the scale of the reservoir and simulation model are significantly different from porosity and permeability distribution at the well data scale; the variance tends to reduce and, for permeability, the distribution type is changed from log–normal to normal. Reservoir property distributions based on multiscale modelling, sensitive to the representative elementary volumes for permeability, and upscaled in a realistic sedimentological framework, give a better representation of the effective permeability architecture.
Exploration and appraisal of a 120 km
2
four-way dip closure: what could possibly go wrong?
Authors: Fielding K. D. , Burnett D. , Crabtree N. J. , Ladegaard H. , Lawton L. C. 
Published: February 2014

Abstract

Large four-way dip closures were obvious on multi-client 3D seismic data acquired during 1996–1998 over the unlicenced ‘White Zone’ between the Faroe and Shetland Islands. Cambo, located at the junction between the Westray and Corona ridges, is the largest of these features and covers an area of between 50 and 150 km
2
. As of October 2011, Hess and its co-venturers had drilled four wells on the Cambo structure. This paper represents a brief summary of the results of these wells as an Exploration Case study. Key conclusions from this case study include: (1) it is the subsurface setting and not the drilling environment that controls uncertainty level in recoverable oil and requirement for appraisal; drilling in an environment where wells are expensive does not imply you will need fewer of them prior to making a development decision; (2) a volumetrically small oil field requires at least as much delineation as a large one of equal complexity and lateral extent; indeed, more data may be required in order to mitigate risk of commercial failure; and (3) crestal locations for wildcat exploration wells are often not optimal; this is especially the case if reservoir presence or column retention is the key risk of the play type being tested. Efforts at Cambo now focus on constraining the remaining subsurface uncertainties to an acceptable level and moving the project forward towards development sanction. Despite the knowledge acquired from the extensive exploration and appraisal campaign completed to date by the Cambo co-venturers, at the time of writing the timing of development and preferred development solution at Cambo remains unclear.
The late Variscan HT/LP metamorphic event in NW and Central Iberia: relationships to crustal thickening, extension, orocline development and crustal evolution
Authors: Martínez Catalán José R. , Rubio Pascual Francisco J. , Montes Alejandro Díez , Fernández Rubén Díez , Barreiro Juan Gómez , Dias Da Silva Ícaro , Clavijo Emilio González , Ayarza Puy , Alcock James E. 
Published: February 2014

Abstract
The Variscan metamorphic evolution of the autochthonous domain of NW and Central Iberia is characterized by a Barrovian gradient followed by a high-temperature–low-pressure (HT/LP) event associated with voluminous granite magmatism. The structural, metamorphic and magmatic histories of the region are described briefly and the relations between them are explained. A coherent model for evolution of the continental crust is proposed using published radiometric ages, thermal models and seismic reflection profiles. The metamorphic evolution, including the high-temperature event, is explained by crustal thickening resulting from the Gondwana–Laurussia collision followed by a period of thermal relaxation and a long-lasting extensional stage. The fact that the highest temperatures were reached in the core of the Central Iberian arc, partly occupied by remnants of a huge allochthonous nappe stack, is discussed in relation to both the emplacement of the allochthon and subsequent oroclinal bending. The overburden provided by the allochthonous pile was decisive in triggering the high-temperature event. Orocline development mostly occurred later and had no significant effect on the metamorphic evolution, although it was important for the present localization of gneiss domes and granitoids. The possible role of the mantle in supplying additional heat to explain the HT/LP event is also discussed. It would seem that little mantle contribution was needed and there are no strong arguments for mantle delamination, although some kind of mantle–crust interaction is expected beneath the hot regions presently occupying the core of the Central Iberian arc.
The G Protein–Coupled Receptor GALR2 Promotes Angiogenesis in Head and Neck Cancer
Authors: Banerjee Rajat , Van Tubergen Elizabeth A. , Scanlon Christina S. , Vander Broek Robert , Lints Joel P. , Liu Min , Russo Nickole , Inglehart Ronald C. , Wang Yugang , Polverini Peter J. , Kirkwood Keith L. , D'Silva Nisha J. 
Published: February 2014

Abstract
Squamous cell carcinoma of the head and neck (SCCHN) is an aggressive disease with poor patient survival. Galanin receptor 2 (GALR2) is a G protein–coupled receptor that induces aggressive tumor growth in SCCHN. The objective of this study was to investigate the mechanism by which GALR2 promotes angiogenesis, a critical oncogenic phenotype required for tumor growth. The impact of GALR2 expression on secretion of proangiogenic cytokines in multiple SCCHN cell lines was investigated by ELISA and in vitro angiogenesis assays. Chemical inhibitor and genetic knockdown strategies were used to understand the key regulators. The in vivo impact of GALR2 on angiogenesis was investigated in mouse xenograft, chick chorioallantoic membrane, and the clinically relevant mouse orthotopic floor-of-mouth models. GALR2 induced angiogenesis via p38-MAPK–mediated secretion of proangiogenic cytokines, VEGF, and interleukin-6 (IL-6). Moreover, GALR2 activated small-GTP-protein, RAP1B, thereby inducing p38-mediated inactivation of tristetraprolin (TTP), which functions to destabilize cytokine transcripts. This resulted in enhanced secretion of proangiogenic cytokines and angiogenesis in vitro and in vivo. In SCCHN cells overexpressing GALR2, inactivation of TTP increased secretion of IL-6 and VEGF, whereas inhibition of p38 activated TTP and decreased cytokine secretion. Here, we report that GALR2 stimulates tumor angiogenesis in SCCHN via p38-mediated inhibition of TTP with resultant enhanced cytokine secretion. Given that p38 inhibitors are in clinical use for inflammatory disorders, GALR2/p38-mediated cytokine secretion may be an excellent target for new adjuvant therapy in SCCHN. Mol Cancer Ther; 13(5); 1323–33. ©2014 AACR.