bluuebunny/crossref_metadata_2025_split huggingface dataset:
Life before death: Living Well, Leaving well
Authors: Lee P W , Foundation Lien 
Published: May 2011

The ‘Life Before Death’ initiative is conceived and spearheaded by a Singapore philanthropic foundation to advocate and create greater awareness of the need to improve care for the dying.First conceived as a local campaign in Singapore in 2006, ‘Life Before Death’ has evolved as an ongoing social experiment that harnesses unconventional online and offline initiatives to break the taboo of death and to foster ‘die-logues’ or conversations on end-of-life matters.The Singapore initiative reached out to the terminally ill and their caregivers using print advertisements, radio talk shows, newspaper editorial features, TV documentaries, and a caregiver's diary. A national street poll on death attitudes was conducted to spur ‘die-logues’ on end-of-life issues.Today, the initiative works with diverse partners to reach a wider global audience through social media, films, photography, cartoons and art, enthusing the public to view life and death differently. A recent project, ‘Happy Coffins’, allowed people to personalize coffins for themselves or a loved one, and by so doing, overcome the stigma of death.The Foundation commissioned the first-ever global Quality of Death index that ranked 40 countries on their provision of end-of-life care. In the pipeline is an international feature documentary that examines the global crisis of untreated pain and end-of-life care. Shot in 10 countries, the film has attracted diverse participation from 40 nationalities.This initiative demonstrates how a ground-up non-profit effort can create conversations and greater awareness of end-of-life care, as well as spur advocacy for better care for the dying.
Preliminary results of a formal advance care planning program in voluntary welfare nursing homes in Singapore
Authors: Siew C W , Onn Y , Koh M , Gan C M , Zainal R , Ng T W , Ismail H 
Published: May 2011

In Singapore, most voluntary nursing homes(VNHs) residents with next-of-kins(NOKs) do not receive advance care planning(ACP). A local hospital embarked on a pilot program, Project CARE (PC), to conduct formal ACP and enable enhanced palliative care delivery in selected VNHs.This pilot cohort study of six VNHs residents included those with advanced medical conditions(UK Gold Standards Framework criteria) with Modified Shah Barthel Index score <30. Excluded are residents <65 years old (unless satisfied inclusion criteria), without NOKs and decision making capacity(DMC), or on police evaluation. ACP were initiated with documentation of preferences on cardiopulmonary resuscitation (CPR), medical intervention(comfort, limited intervention, full treatment) and place of death. Residents would be enrolled into PC when preferences were for comfort care/limited intervention in nursing home without or with further treatment at hospital. Hospital team would co-manage with VNHs during residents' deterioration. Outcomes are evaluated from program inception on September 2009 till January 2011.Of a total of 1464 residents, female(55.1%), Chinese(88.8%) and age ≥75 years old(61.7%) predominated. 54.4% of residents fulfilled criteria for possible ACP. Of this latter group, 51.2% completed ACP with 46.3% enrolled into PC. 4 NHs with minimum 6 months of patient reviews in PC framework were further evaluated with 153 deaths recorded. Success in honouring preferences on medical intervention and death place while in PC were 89.4% and 66% respectively. Mortality rate among eligible residents but without ACP yet, had ACP and in PC/not in PC were 24.6%, 25.8% and 24.2% respectively.Care preferences could be honoured under PC framework.
Managing the quality of sleep among elderly patients using the Pittsburgh Sleep Quality Index
Authors: Cheah E , Rajaram S , Cheah E , Sidek N , Tan M H , Fadillah F , Zheng D , Hamid H 
Published: May 2011

IntroductionSleep is a necessary part of life. Assessment of sleep patterns enables the nurse to intervene immediately by implementing interventions with the client, or by referring the client for further assessment.MethodThe Pittsburgh Sleep Quality Index (PSQI) is an effective instrument created by Buysse et al in 1989. It differentiates ‘poor’ from ‘good’ sleep by measuring seven areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency and sleep disturbances, use of sleep medication and daytime dysfunction over the last month. The client self relates each of these seven areas of sleep. Scoring of the answers is based on a 0 to 3 scale, three reflects the negative extreme on the Likert scale. A sum of ‘5’or greater indicates a ‘poor’ sleeper.ResultSeven patients who had sleeping problems were assessed. Data using the PSQI was collected from the 18th of June till the 18th of July 2010. Out of these seven patients, four of them were found to a sum of 5 to 6 as their global PSQI score. Two of them were given sleep medication to improve their sleeping patterns and the other two of them were referred to a psychologist. Three of the patients were found to have subjective sleep problems; two of them were overweight and were asked to start an exercise program. The other patient was found to lead a sedentary lifestyle and was encouraged to be more active.ConclusionThe PSQI can be used for both initial assessment and ongoing comparative measurements with older adults across all health settings.
Developing a culture of medication safety in the rural palliative care home setting New South Wales (NSW) Australia
Authors: Short C 
Published: May 2011

Improving Medication Safety for Clients and their Carers in the Rural Palliative Care Home Setting Project commenced January 2008 in response to an error involving a carer administered medication. Clinicians identified that no formalised process existed within NSW for carer medication administration despite a widespread practice of carers administering subcutaneous medications at home, especially in the last few days of life. It was recognised that formalised protocols and standardised training for carers were required to ensure patient safety.The need to respect patient and carer choices is emphasised throughout care while providing effective symptom control in the palliative care home setting. The project consisted of evaluating a carer's preparedness to administer subcutaneous medications and provided education and structured support to the carer to administer these medications. A culture of medication safety emerged that was welcomed and embraced by patients, carers and families and the clinicians. The project developed a legal and ethical framework on which to base these standardised practices.This project was an initiative of a health promoting palliative care service as per Allan Kellehear's 1999 model with service delivery strategies based on the five major ‘action’ principles of the Ottawa Charter. The outcomes demonstrated that carers were trained to safely administer subcutaneous medication and there were no medication errors.Additional outcomes included improvements in After-Hours Occupational Health and Safety for staff, and improved the end of life decision-making abilities and processes for patients, carers and families enabling choice in place of care.
Launching ADVANCE care planning as a collabrative approach
Authors: Fowler C , Bettany A , White J , Finch J 
Published: May 2011

A multi-organisational/professional project group formed to implement advance care planning, to include the Preferred Priorities of Care document. An early outcome indicated the need to develop a communication pathway and engage with the out of hours providers.Consequently the group developed the use of The Lions ‘Message in a Bottle’ (MIB), a plastic bottle placed in a patients fridge to hold key information about an individual's ACP and contact numbers of health professionals involved with the patient.The purpose of the MIB was to ensure patients wishes and preferences were known, and to assist the Out of Hours GPs and Ambulance service in difficult decision making.The project identified other areas to address to ensure the implementation of advance care planning was robust;▶EoLC Education to Emergency Care Practitioners, (ambulance professionals with a remit to prevent admission).▶Advance care planning workshops for all health and social care professionals.▶A succinct transfer of information form▶Collaborative End of Life Care registers between in hours and out of hours.The project is being launched to an audience of 80 encompassing commissioners, GPs, user representation, Acute and Community staff, care home staff, Learning Disability and Mental Health nurses, Hospital Consultants, Adult Care Services, Hospice staff and many others.The impact of the launch will be measured using a confidence questionnaire.The longer term outcomes for commissioners will include;▶Increased home deaths▶Fewer hospital admissions.These will be monitored using vital signs data.
The end-of-life care for patients with advanced chronic obstructive pulmonary disease
Authors: Chen T R , Hu W Y 
Published: May 2011

Palliative care historically focuses on cancer patients. It is important to gain more insight into the end-of-life (EoL) care for chronic obstructive pulmonary disease (COPD) patients. The aim of this systematic review was to identify the EoL care needs of patients with advanced COPD. A computerized literature search was performed to identify relevant studies. Papers were obtained from searches of MEDLINE, CINAHL and PubMed databases (timespan: 2001 to November 2010). Studies were included that reported original data on EoL care in patients with advanced COPD. A total of 58 articles were identified in the different databases. 18 studies met the inclusion criteria.The findings reveal that advanced COPD patients have significantly poorer physical, psycho-spiritual and social functioning. They suffered from multiple complicated symptoms that are usually poorly controlled. They also experienced a high degree of emotional-spiritual distress and social isolation, but these usually managed to inadequately and may even be ignored. They had high levels of information need of the disease process regarding the illness itself, likely future symptoms and their management and information about EoL treatment options. In addition, health care professionals tend to avoid discussion of communication with these patients in order to explore clinical issues and end-of-life care issues. As a result, theses patients' needs in terms of EoL care are unmet. The findings of these studies all call for palliative care will benefit to advanced COPD patients.Future research should further assess how best to apply the palliative care to COPD patients.
Hoping for the best and preparing for the worst: end-of-life attitudes of the elderly
Authors: Kahana B , Kahana E , Lovegreen L , Brown J 
Published: May 2011

This paper describes findings from research based on 514 elderly persons (mean age=76.7, SD 8.0) living in a US metropolitan community about their attitudes toward and plans for end of life care. Individual interviews reveal that most respondents were not afraid to die but feared suffering near the end of life. End of life plans were typically undertaken to protect family members from feeling burdened. The most frequently reported plans included living wills, durable power of attorney and funeral arrangements. Elders were far more likely to discuss plans with adult children and other family than with physicians or other health care professionals.Attitudes of respondents regarding death and dying may be characterized by the adage ‘hope for the best and prepare for the worst.’ Accordingly, only a small minority reported often worrying about their health (13.2%). When facing a hypothetical incurable illness, 80.3% endorsed remaining hopeful and planning activities unrelated to their illness. Similarly, 80.6% felt that people who have in incurable illness should focus on preparing for end of life issues. These elders also valued preservation of comfort through pain medications (85.6%), being surrounded by friends and family near the end of life (90.3%), and having others pray for them (91.8%). The vast majority of respondents preferred to die at home, if possible (92.3%). These data point to determination and planfulness, coupled with optimism, as elders consider the end of life.
Making health choices: advance care planning in aged care. Perception versus reality
Authors: Sjanta R , Jackson L , Fullam R , Silvester W 
Published: May 2011

IntroductionThe Making Health Choices pilot project being undertaken within Residential Aged Care Facilities in Victoria (Australia) by the Respecting Patient Choices team is currently undergoing evaluation. This presentation will provide insight into pre-existing knowledge and perceptions of advance care planning (ACP) in a group of residential aged care staff, prior to a major ACP education program.Project evaluation methodsWe conducted a pre-implementation survey of staff knowledge attitudes and behaviours around ACP. Feedback from ACP debrief sessions held during the course of the education program was examined for significant themes.ResultsThe staff survey revealed disparities between staff perceptions of their skill and confidence in conducting ACP conversations and findings relating to the accuracy of their ACP knowledge and attitudes towards ACP. Nearly half of staff surveyed indicated they were comfortable (46%) and skilled (45%) with ACP/End-of-life discussion. However, the majority of participants reported a lack of confidence in their knowledge of key areas such as surrogate decision makers (75%) and of state laws regarding ACPs (88%). Responders performed at just above chance on a true/false test of ACP knowledge.ACP Debrief sessions reflected participants concerns about the challenging nature of ACP discussions and general ACP provision within the Australian aged care context.DiscussionThe findings of the evaluation to date will be discussed in terms of ACP sustainability, future education models and in the context of systemic challenges facing the Australian Residential Aged Care.
Advance care planning in Japanese nursing homes
Authors: Nishikawa M , Nakashima K , Miura H , Endo H , Toba K 
Published: May 2011

BackgroundJapan has the highest rate of ageing worldwide. In Japan, the Ministry of Health, Labour and Welfare is concerned that there are insufficient doctors to care for the elderly in nursing homes and also insufficient advance care planning (ACP). In Japan, the study of the ACP at the nursing home just still started.PurposeThe study aim was to evaluate the utility of ACP at the nursing home, supported by an ACP clinician trained in the National Centre for Geriatrics and Gerontology in Japan.MethodsOut of 80 families of nursing home residents, 51 participated in this study with all attending a lecture about ACP.We investigated the following:Do the families of the residents prefer the nursing home as the place for the residents' last moments?Would the families like the residents to use mechanical ventilators, gastric feeding tubes, blood transfusion, intravenous infusion or sedative drugs in their terminal states?Do the families prefer to care for the residents on their deathbeds at the nursing home, even if death certificates are not promptly issued because the nursing home does not have any full-time doctors?ResultsIntervention by a trained ACP clinician significantly increased the number of families who chose terminal care at the nursing home, and the nursing home as the place for the residents' last moments, even if death certificates are not promptly issued (p<0.01).ConclusionA trained ACP clinician is useful for ACP in the nursing home.
Management of depression among the elderly patients in ward 3 Geriatric ward using the Geriatric Depression Scale (GDS)
Authors: Cheah E , Rajaram S , Chua H C , Ng H L , Tim H M , Fadillah F , Zheng D 
Published: May 2011

AimThe geriatric trained nurses in Khoo Teck Puat Hospital wanted to assess the degree of depression in the elderly patients. Thus they used the geriatric Depression scale (GDS) created by Yesavage et al. to assess the patients.MethodThe GDS created by Yesavage et.al (1986) has been tested and used extensively in the older population. The GDS created in 1983 had 30 questions but this was simplified in 1986 to 15 questions with scores above 5 representing depression of ascending severity. Score of 0–4 are considered normal, complaints of 5–8 indicate mild depression, 9–11 moderate depression and 12–15 indicate severe depression. This short form was used on 12 elderly patients aged between 75–83 in Geriatric ward. The data collection was for 1 month.ResultFive of the patients had earlier referral to a psychologist. This led the psychologist to assess and find these patients moderately depressed. They received outpatient psychologist appointments. Four were found to be severely depressed and had earlier referral to psychiatrists and Medical Social workers. All 4 had to be institutionalized in the Institute of Mental Health in Singapore. All of these patients were also started on anti-depressants. 2 were found to be mildly depressed receiving a score of 5–8. Both these patients were not started on anti-depressants but were given outpatient referrals to psychologists.ConclusionThe GDS is a brief, non-somatically focused and can be either an observer or self-administered. The nurses could assess this tool easily and found it a good tool to administer.
Managing functional decline among the elderly patients in ward 3 Geriatric ward using the Katz Index of Independence in Activities of Daily Living (ADL)
Authors: Cheah E , Rajaram S , Chua H C , Ng H L , Tim H M , Fadillah F , Zheng D 
Published: May 2011

IntroductionThe Katz Index of Independence in Activities of Daily Living commonly referred to as Katz ADL by Katz et al (1970) is the most appropriate instrument to assess functional status as a measurement of the person's ability to perform acts of daily living independently.MethodThis Katz ADL was used in 15 geriatric patients aged between 78–84. The instrument employs a dichotomous (yes or no) scale, with 1 point given for each ADL in which the patient is independent. Six signifies independence in all ADLs: the lowest is 0 t full assistance is needed. The index ranks adequacy in performance in the six functions of bathing, dressing, toileting, transferring, continence and feeding. Six indicates full function, four indicate moderate impairment and two or less indicates severe impairment. 15 assessed, 9 had moderate impairment and 6 severe impairment, none of them had full function.ResultNine had moderate impairment were given extensive rehabilitation. Physiotherapists and occupational therapists assessed them twice a day. Five continued to improve and were discharged with therapy appointments. Four worsened had to be downgraded to severe impairment. They also were not able to look after themselves and were discharged to long term care (nursing homes) 6 had severe impairment, 2 after a month of rehab were upgraded to moderate impairment and discharged with occupational therapy and physiotherapy appointments. Four were not able to manage on their own and had to be transferred to nursing homes.ConclusionThe Katz Index has emerged as an especially useful tool in assessing older adults, in determining nursing load and predicting length of hospitalisation, morbidity and mortality over time. The Katz Index has determined accuracy in predicting functional outcome over time among older adults.
Managing the cognitive impairment of elderly patients using the Mini Mental State Examination (MMSE)
Authors: Cheah E , Rajaram S , Chua H C , Ng H L , Tim H M , Cinnappan S , Lim S T 
Published: May 2011

IntroductionCognitive impairment is no longer considered a normal and inevitable change of ageing. Although older adults are at a higher risk than the rest of the population, changes in cognitive function often call for prompt and aggressive function. In older patients cognitive functioning is especially likely to decline during illness or injury. The nurses' assessment of an older adult's cognitive status is instrumental in identifying early changes in physiological status, ability to learn and learning responses to treatment.MethodThe Mini Mental State Examination created by Folstein et al in 1975 (MMSE) is a tool that can be used to systematically and thoroughly assess mental status. It is a 11 –question measure that tests five areas of cognitive function: orientation, registration, attention and calculation, recall and language. The maximum score is 30. A score of 23 or lower is indicative of cognitive impairment. The MMSE only takes 5–10 min to administer and is therefore practical to use repeatedly and routinely.Result10 patients were assessed. 3 of the patients were found to have problems with orientation, 2 of them with registration, 2 of them with attention and calculation, 2 of them with recall and 1 of them with language. 9 patients out of the 10 were assessed and had to be placed in nursing homes and this was reflected in their application for nursing homes. Assessment of the older adult's cognitive function is best achieved when it is done routinely, systematically and thoroughly.ConclusionThe MMSE is effective as a screening instrument to separate patients with cognitive impairment from those without it. In addition when used repeatedly the instrument is able to measure changes in cognitive status that may benefit from intervention.
Compensatory growth of Euphorbia peplus regenerating from a bud bank
Authors: Latzel Vít , Malíková Lenka , Klimešová Jitka 
Published: May 2011

Tolerance to very severe disturbance by the annual herb Euphorbia peplus L. was examined. We explored the role of disturbance timing, competition, and site productivity on the performance of disturbed plants. Ninety-three percent of disturbed plants survived following disturbance 14 d after plant emergence, whereas only 48% of disturbed plants survived disturbance 42 d after emergence. Early disturbed plants compensated for biomass loss and had higher fecundity than undisturbed plants, but this was not the case for plants that were disturbed at later times following emergence. Field assessment revealed that disturbed plants were, in general, of the same height as undisturbed plants, even under competition. Undisturbed plants had very conservative architecture across various conditions (competition and nutrients), whereas disturbed plants had more branched architecture under moderate competition and nutrient availability. Accordingly, we suggest that E. peplus utilizes a bet-hedging strategy where adventitious meristems are reserved for regrowth after a severe disturbance event that removes all dormant axillary meristems. Moreover, we propose that the tolerance to disturbance in short-lived species could play an important role in the ecology of disturbed communities. Finally, the tolerance to disturbance could be one of the prerequisites of invasibility of E. peplus in non-native ranges. We also speculate about the potential costs and benefits related with the tolerance to disturbance in short-lived species and about a mechanical control of E. peplus in invaded ranges.