bluuebunny/crossref_metadata_2025_split huggingface dataset:
WHAT DO NON-QUALIFIED STAFF IN A SPECIALIST HOSPICE IN-PATIENT UNIT FEEL ABOUT CARING FOR PATIENTS WITH ADVANCED DEMENTIA?
Authors: Salt Susan , Green Jennifer 
Published: February 2014

MethodIn preparation for a refurbishment, intended to improve the care environment for patients with end stage dementia, a paper questionnaire survey of healthcare assistants, domestics and catering staff was devised to explore the staff's understanding Their views about meeting their needs. Changes the organisation needed to make Each staff member was given the questionnaire at work by their line manager with a period of two weeks to return it to a collection point in the hospice reception.Results20 out of a possible 43 staff replied (46.5%)KnowledgeMost were aware of the number of people with dementia in UK but overestimated life expectancy and under estimated the length of their dependency on others for activities of daily living. The majority indicated a prognosis of 10 years or more from diagnosis (81%)Training needsWhilst well informed about symptoms a significant number of staff felt they would need training around meeting patient needs and particularly how to communicate effectively.Physical environment and impact on caring for other patientsStaff were concerned about the impact of patients with dementia on other patients and the fear of the patient “wandering off” Concern was also expressed by the majority that staffing levels would need to be increased to accommodate these patients.ConclusionsThe response rate to the questionnaire was disappointing but other literature suggests that the findings are in line with the views of qualified members of staff. Staff appeared to underestimate the palliative care needs of people affected by the disease. These staff members regularly encounter confused and disorientated patients, yet the label of dementia appeared to raise additional concerns. This needs further exploration.
INDWELLING URINARY CATHETER USE IN END OF LIFE CARE AT UNIVERSITY HOSPITALS SOUTHAMPTON NHS FOUNDATION TRUST
Authors: Farrington Naomi , Richardson Alison , Fader Mandy , Prieto Jacqui 
Published: February 2014

BackgroundPatients at the end of life often suffer from urinary difficulties. A systematic review (Farrington et al, in press) found minimal research to indicate how these difficulties should be managed at the end of life, representing a substantial knowledge gap.AimsThe audit aimed to evaluate existing catheter practice. Objectives were: to measure the prevalence of indwelling urinary catheters at the end of life; to measure the use of documentation for catheter insertion and care (as per Trust policy); and to measure the prevalence of continence screening on admission (as per Department of Health guidelines).MethodologyThis was a retrospective examination of the case notes of 64 patients who died on two oncology wards and a hospice from 08/03/13–16/05/13. Required information was extracted and collated using a pre-prepared data collection form.Results63% of patients had an indwelling urethral catheter during their admission, most commonly inserted due to ‘severe or terminal illness or disability that prevents toileting’, though reasons given were often vague or contradictory. Trust documentation was present in 75% of cases where catheters were inserted. 75% of patients received a continence assessment on admission. These were often brief, and not updated if the situation changed.ConclusionsIt appears confusion exists over when and why catheters should be inserted or removed at the end of life. Documentation is not updated when changes in care needs occur, and requirements are not reassessed once a catheter has been inserted. This indicates a lack of knowledge or understanding about what might be the best course of action.RecommendationsResearch is needed to explore why indwelling urinary catheters are inserted/removed at the end of life.Education and training are required on the importance of undertaking assessment and the maintenance of written records regarding catheter insertion and care.
ESTIMATING GLOMERULAR FILTRATION RATE IN PALLIATIVE CARE PATIENTS: COMPARISON OF THE COCKROFT- GAULT AND ABBREVIATED MODIFICATION OF DIET IN RENAL DISEASE FORMULAS-IS IT RELEVANT TO CLINICAL PRACTICE?
Authors: Patel Anoosha , Frame Karen 
Published: February 2014

BackgroundThe National Kidney Foundation, Kidney Disease Outcomes Quality Initiative recommends the Cockcroft Gault (CG) or abbreviated modified diet in renal disease (aMDRD) formulas for estimating Glomerular Filtration Rate (GFR). Clinical laboratories routinely use the aMDRD equation, which is not recommended for patients with extremes in muscle mass or diet, common in palliative care populations whose risk of renal impairment increases with older age, polypharmacy and nephrotoxic drug exposure.AimTo compare the aMDRD and CG formulas for estimating GFR in palliative care patients, and determine the prevalence of renal impairment and impact on clinical practice.Audit MethodRetrospective case note review of 69 patients referred to a hospital specialist palliative care team. Patients with Chronic Kidney Disease (CKD) identified on aMDRD and CG eGFR. Standardised proforma used for data collection.Results37/69 patients identified with CKD (eGFR <90).24/37 had a difference between aMDRD and CG estimation of GFR resulting in a change in CKD staging category.CG eGFR improved staging category in 4, 3/4 weighed390 kg.CG eGFR worsened staging category in 20.17/20 deteriorated a single staging category. 11/17 weighed 50–69 kg.3/20 deteriorated >1 staging category. All weighed less than 44 kg, with a serum creatinine <110 micromol/L.10/37 required renal drug dose adjustments for eGFR. In 3 patients the method used to estimate GFR would change dose of medication prescribed.ConclusionCKD is prevalent in palliative care patients, and affects prescribing.The aMDRD formula could overestimate GFR in underweight patients and underestimate GFR in overweight patients relative to CG. The CG formula may be a better method of assessment of eGFR in palliative care patients.Ultimately comparison of CG and aMDRD formulas to renal inulin clearance (the gold standard assessment method for GFR) is required to determine the best method for estimating GFR in a palliative care population.
A RETROSPECTIVE REVIEW OF ANTIMICROBIAL PRESCRIBING AND INFECTION PREVALENCE IN A PALLIATIVE CARE UNIT
Authors: McKane Jill , Addie Susan , McGowan Mairi-clare 
Published: February 2014

IntroductionHospice patients are highly susceptible to infections of the urinary and respiratory tract.1 2 3 4The use of antimicrobials for symptom control should be considered against the burden of treatment for the patient as well as antimicrobial resistance.1 3 5 6 7The Scottish Antimicrobial Prescribing Group produce guidance and targets for hospital based empirical prescribing. The aim is to reduce clostridium difficile infection.7Empirical prescribing standards state 95% of antimicrobials prescribed should be in line with local policy with rationale for use documented.7These hospital targets are applicable to the hospice setting.8MethodA consecutive retrospective case note audit was completed for a four month period at St Vincent's Hospice in Howwood. An audit proforma with data collection parameters was developed during this process.ResultsThirty-three case notes were audited: 76.7% of patients received at least one course of antimicrobials during their admission. The main indications for antibiotics were urinary tract(34%) and lower respiratory tract infections (60%). Indications for prescribing were specified in 88% and duration specified in 68% of cases. Of these 38% completed the course, 35% were continued longer and 26% were discontinued early. Antimicrobial selection, dosing and route were in line with the Greater Glasgow and Clyde policy in 78% of prescriptions; however only 51% also included documentation of duration. Of these prescriptions 91% were prescribed empirically without microbiology culture data.DiscussionThe prevalence of infection rate, antibiotic use and improvement of symptom burden is variable within the literature.1 2 3 4 5There is scope to improve practice surrounding antimicrobial initiation and documentation. Existing local guidelines are not specific to hospice care and should be adapted. We recommend and are working towards:▸ Palliative Antimicrobial Guideline development and liaison with local antimicrobial stewards.▸ Development of St Vincent's Hospice antimicrobial toolkit with inclusion of medical handover tools.Re-audit and education.
PATIENT CHOICE OF LAXATIVE MEDICATION FOR TREATMENT OF OPIOID INDUCED CONSTIPATION (OIC). A SERVICE EVALUATION AT SHEFFIELD CENTRAL CAMPUS
Authors: Fingas Samuel , Hurst Sarah , Davies James , Newell Julia , Ahmedzai Sam H 
Published: February 2014

BackgroundOpioid-induced constipation is common in palliative care. The evidence base for most laxatives and rectal interventions is poor, but for sc methylnaltrexone is good. Patient choice is important for individualising treatment.AimsTo identify if patients want to choose their laxative treatment from current options. To identify acceptability of different routes of administration and what factors are important to patients when making a decision.MethodPatients were recruited who were on regular opioid and laxative medications, could give informed consent and had sufficient English. Bowel obstruction or stoma were exclusion factors. A piloted structured interview elicited views and experiences. Patients were asked to rank treatment options, with reasons, in a clinical scenario where they had not opened their bowels for 7 days. They were given written information about the three options of oral, rectal and sc injection (methylnaltrexone) with opportunity to ask questions.Results30 patients (20 male) took part, mean age 61 years (range 29–88). 50% had previously been ≥7 days without a motion. 17/30 (57%) had experience of rectal measures, none of injection. Awareness of treatments was: oral 100%, rectal 70%; injection 7%. 87% of patients would prefer to be offered a choice, but in only 3/67 treatments previously received was choice offered. 4/17 (24%) receiving a rectal intervention had a bad experience and would not consider this again. First choice was injection for 40%, oral 30% and rectal 30%. Rectal route was ranked last choice by 53%, a common reason being embarrassment.ConclusionPalliative care patients are not being offered choice in OIC management. In the absence of evidence-base for oral and rectal measures, patients should have information about methylnaltrexone and be allowed to choose.
THE PROCESS OF IDENTIFYING A STANDARD ANALGESIA CONVERSION CHART FOR USE IN PALLIATIVE CARE
Authors: Evans Caroline , Aslett Michelle 
Published: February 2014

BackgroundSpecialist palliative care doctors and nurses calculate breakthrough and opioid conversion doses of analgesia for patients as routine clinical practice. It was identified that different specialists and individuals used different opioid charts varying in format and content. It was considered whether there was a preferred chart to standardise best practice and reduce variability and clinical error.AimTo identify an analgesia conversion chart which could be recommended for standard practice in a palliative care Hospice in-patient unit (IPU) and community setting.MethodThe study team comprised of a Hospice IPU nurse and a specialist pharmacist. Five commonly used conversion charts were identified (sourced from local guidelines and http://www.palliativedrugs.com/). A questionnaire comprising five routine scenarios of breakthrough doses, with two conversions per chart, was distributed to 40 Hospice clinicians working in either IPU, community or both settings. Recipients were asked to anonymously complete calculations and feedback their opinion on the chart format, style and ease of use of each chart. A non-healthcare professional participated to contribute a non-specialist opinion and identify “assumed” information. Responses were analysed from a perspective of mathematical accuracy and usability.ResultsA response rate of 40% was achieved (16/40). No one style of conversion chart was the preferred chart; some charts did not generate consistent conversions. Some participants highlighted that their learning style required illustrations rather than a tabular format. A reliance on a background clinical knowledge was identified.ConclusionWhilst each of the conversion charts had merits, no one conversion chart was preferred by all participants or professional discipline or in a setting . The experiences, preferences and learning styles of palliative care professionals should be considered in devising training of drug conversions.
PROVISION OF SPECIALIST PALLIATIVE CARE SUPPORT TO PATIENTS AND CARERS BY TELEPHONE
Authors: Dale Tim , Wee Bee 
Published: February 2014

BackgroundThe community team at Sobell House needed to find ways of managing increasing numbers of referrals. It was felt that one person exclusively undertaking telephone support would free more time for others to visit patients with the greatest need at home. The idea was viewed by some with scepticism –“palliative care by phone? How does that work then?”. In December 2009 an advanced nurse practitioner was appointed on a six month trial.ProcessThe telephone support nurse holds a caseload of 80-100 patients. Call frequency is agreed individually and ranges from weekly to monthly. Patients or others can also phone for advice or to discuss changes. Home visits, outpatient appointments or admissions can be arranged as needed. Aspects of care covered include psychological support, symptom management, medication changes, coordination with other services, the provision of information, suggesting ‘coping strategies’, and so on.ResultsThe role rapidly proved its worth and the post was made substantive after three months. Feedback from patients and carers from three surveys using detailed questionnaires has been unequivocally positive:We find it very reassuring that help, support and understanding is just a phone call away … Thank you for being there for us and making a difference …[has]taken a positive holistic view outside the treatment regimes … They[other services]are more task & treatment orientated, this provides something which supports living my life.More detailed feedback is available for presentation.ConclusionRegular telephone contact in palliative care can work safely and effectively in providing support at all levels. The role is fully integrated into and valued by the community team and service as a whole. Key is an open, empathic and unhurried approach.
HOW ACCEPTABLE IS MEDICALLY ASSISTED NUTRITION AND HYDRATION IN PATIENTS APPROACHING THE END OF LIFE? – A SERVICE EVALUATION
Authors: Ahamed Ashique , Fingas Sam , Beech Adam , Nock Catherine , Newell Elizabeth , Newell Julia , Ahmedzai Sam 
Published: February 2014

BackgroundPatients nearing the end of life can have difficulty in eating and drinking due to variety of reasons. Currently there are differences of opinion in perceived benefits of medically assisted nutrition and hydration (MNH) for dying patients who have inadequate oral intake.AimsWe conducted a study of patients with advancing disease but not yet at end of life, to assess their attitudes towards MNH if they became unable to have adequate oral intake. A structured interview was developed and piloted before being used. It detailed four different methods of MNH: nasogastric tube feeding, PEG feeding, intravenous drip (IV) including total parenteral nutrition, or subcutaneous hydration (SC). Photographs and samples of the devices were shown. The study was approved as a service evaluation and was conducted in one Sheffield hospital during March-June 2012.Results36 patients were identified who were suitable to enter the study, of which 5 declined. 31 patients completed the study (19 females). 17 responded that they will consider MNH if they became unable to eat or drink. IV and SC route were the most favoured methods, mainly because of familiarity. NG tube feeding was the least favoured route. Most patients felt that maintaining nutrition and hydration was a necessary part of their life. Patient's previous experiences also played a part in their accepting or rejecting MNH.ConclusionsThis preliminary study suggests that MNH is likely to be accepted by many patients who may need it near the end of life (although these subjects were not at that stage). It also highlighted the benefit of discussion using visual aids to help patients make an informed choice about having MNH and the method. We are preparing a larger multicentre study in order to assess whether these findings are replicable in a variety of settings.
HOW COMMON IS DELIRIUM IN PALLIATIVE CARE INPATIENT UNITS AND WHAT IS THE OUTCOME FOR THESE PATIENTS?
Authors: Porteous Anna , Dewhurst Felicity , Grogan Eleanor , Lowery Lucy , MacCormick Fiona , Paxton Ann , Vidrine Jennifer , Walmsley Rowan 
Published: February 2014

BackgroundDelirium affects up to 50% of patients on medical wards (NICE), however the impact in palliative care units is unclear, with prevalence estimates ranging from 13–64%. Use of delirium screening tools in palliative care is inconsistent and consensus opinion is lacking. The short-CAM is a well-researched, observational tool, recommended by NICE in high-risk in-patients. It is often favoured for its ease of use and inter-rater reliability and is one of a limited number to be validated in the palliative care setting.AimTo identify the prevalence, incidence and outcome of delirium in five specialist palliative care inpatient units (SPCUs) in the North East using the short-CAM.MethodsAdult patients admitted to five SPCUs were screened for delirium using the short-CAM. Patients with significant communication barriers were excluded. Screening occurred on admission, weekly and if clinical change raised the suspicion of delirium. Anonymised patient data was collected by clinical staff based on the units between April and August 2013.ResultsTwo hundred and ninety-one patients were screened for delirium using the short-CAM during the study period. Thirty-four (11.7%) patients were delirious (CAM-positive) on admission to the SPCUs. Twenty-four patients (8.2%) became delirious during their admission. Resolution of delirium occurred in 38.6% of cases. Of 126 patients who died during their admission, 58 (46%) had been delirious prior to death.ConclusionOverall, delirium (as identified by the short-CAM) affected 20% of patients included in this study. Our findings demonstrate a lower prevalence and incidence of delirium amongst palliative care patients than many published studies. This may relate to diagnostic limitations of the short-CAM, as well as variations in the sensitivity of screening tools employed in these studies. It is clear that delirium is associated with poor prognosis. Further studies to explore the impact and management of this distressing condition are warranted.
OPIOID PRESCRIBING IN A COHORT OF DISCHARGED HOSPICE PATIENTS
Authors: Ackroyd Jeena , Hassell Joseph , Khalid Irfan , Rachel Sheils 
Published: February 2014

BackgroundMorphine is recommended by NICE (2012) as the gold standard first line oral step 3 opioid for managing pain in palliative care patients. Alternative opioids are used e.g. if patient has renal failure or due to intolerable side-effects.AimsAssess which strong opioids are prescribed for patients on discharge from a specialist palliative care inpatient unitLook at the reasons why patients are discharged on alternative opioidsObserve which opioids are prescribed for patients with renal impairmentMethodRetrospective review of the case notes and drug charts of 50 patients discharged from Overgate Hospice (October 2010 to November 2011).Results42/50 patients (82 %) were discharged on a strong opioid. 31/50 (62%) required a regular opioid. 15 patients were on regular morphine, 14 were on alternative opioids and 2 patients were on both regular morphine and an alternative opioid. 8 patients who were discharged on a strong regular opioid had an eGFR (estimated glomerular filtration rate) of less than 60, and 7 (88%) were prescribed an alternative opioid, most frequently oxycodone.The most common reason for patients being discharged on alternative opioids was renal impairment 8/14 (57%). Other reasons included nausea and vomiting, inadequate analgesia and tablet burden.ConclusionsIn a specialist palliative care population morphine continues to be effective as a first line treatment as recommended by NICE (2012). The most commonly cited reason for alternative opioid use was renal impairment. However further research would provide evidence for when to use alternative opioids first-line for patients with renal impairment.
CANCER CARERS MEDICINES MANAGEMENT: A FEASIBILITY TRIAL OF AN EDUCATIONAL INTERVENTION FOR MANAGING END OF LIFE PAIN MEDICATION
Authors: Hopkinson Jane , Hughes Jacki , Lowson Elizabeth , Richardson Alison , Duke Sue , Anstey Sally , Bennett Mike , Smith Peter , May Carl , Latter Sue 
Published: February 2014

BackgroundCancer accounts for 1 in 4 deaths in the UK. A majority of people with advanced cancer will experience pain and family carers play an important role in managing pain medication at home. There is evidence carers need support with this, yet no research in the UK has developed and tested theory-driven interventions to help them manage pain medicines. We are conducting a Phase I-II feasibility study (as defined by the Medical Research Council guidelines for developing a complex intervention) to develop a new intervention: Cancer Carer Medicines Management (CCMM).AimTo summarise the development of CCMM, outlining the process of intervention development.MethodA staged multi-method approach was used to obtain current evidence to inform CCMM's development: a systematic literature review of interventions for carer end of life medicines management; a scoping exercise concerning practice and theoretical contexts; interviews and user involvement group consultations with patients, carers, and health professionals with palliative care experience. This information informed two workshops which used participatory action research processes to design and develop an intervention which will be further refined through a consultative review process.ResultsTo date we have found that this staged approach is appropriate and successful in enabling an evidence based intervention to be designed collaboratively. This also provides a means by which the clinical applicability of the intervention can be refined as it develops.ConclusionsRefining this intervention as it develops will ensure that it reaches the feasibility trial stage with a robust grounding in carer experience, clinical practice and research evidence. In turn, the intervention will have the potential to enhance the practice of nurses in the community to meet carers' needs in pain medication management. This project is funded by the Dimbleby Marie Curie Cancer Care Research Fund; grant number DCMD-RF-12-05.