bluuebunny/crossref_metadata_2025_split huggingface dataset:
A unique approach to teaching palliative care
Authors: Ting Ruth , McKenna Maria , Gunn Hannah , Srivastava Leena , Pennington Susan 
Published: March 2012

BackgroundPeer and near-peer teaching is now a recognised approach in medical undergraduate education with increasing evidence to support its efficacy.Aims(1) To establish a teaching day delivered by palliative care trainees for doctors-in-training in other specialties. (2) To show that trainees in palliative medicine are effective near-peer and peer-led tutors. (3) To demonstrate impact of teaching day on learners' knowledge and confidence.MethodsA programme was designed to cover core palliative care topics contained within the curricula of other specialties. Participants completed a pre and postcourse questionnaire of clinical scenarios to survey their knowledge and confidence; and a satisfaction questionnaire.ResultsThirty-five doctors attended the teaching day. Confidence and knowledge ratings increased at the end of the teaching day. Results of the satisfaction survey were overwhelmingly positive.LimitationsThis cohort was not fully representative of all doctors in training.DiscussionThis study does not determine whether there is sustained impact on knowledge and confidence of participants; this could be assessed in future teaching programmes using the same confidence and knowledge questionnaire 8 weeks postcourse. Participants' knowledge and perceived confidence in a learning environment may not translate into clinical ability.ConclusionA teaching day delivered by palliative care trainees for other doctors-in-training, is achievable and positively received. Feedback showed trainees are effective and approachable tutors. There was a demonstrable positive impact on knowledge and confidence immediately following the teaching day. This method of teaching enables both teachers and participants to achieve curriculum objectives. Further research is required to further explore whether peer and near peer teaching is more acceptable and effective than consultant teaching and reasons why this may be so.
NHS Scotland DNACPR and CYPADM integrated policies – development of quality measures
Authors: Spiller Juliet , Kiehlmann Peter , Davison Hilary , Murphy Dermot , Wilkie Rosalie 
Published: March 2012

BackgroundIn May 2010 National Health Service (NHS) Scotland published Europe's first fully integrated national policy for Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision making and communication in adults. The Scottish Government led the development of this policy, based on previous work from NHS Lothian, in response to a specific recommendation by the Public Audit Committee following the Audit Scotland publication ‘Review of Palliative Care Services in Scotland. Living and Dying Well’ the national action plan for palliative care in Scotland also requested an integrated approach to DNACPR. All Scottish Health Boards committed to implementation of the policy by October 2010. Shortly after this the Children/Young People Acute Deterioration Management (CYPADM) Policy was also published and implemented across Scotland.AimsThese integrated DNACPR policies aim to prevent inappropriate, futile and/or unwanted attempts at CPR. They are intended as a positive step to help a person's wishes to be followed at the end of life irrespective of whether they are being cared for in hospital, hospice, care home or in their own homes. This specific work aimed to develop measures to assess the impact of these policies on patient care across Scotland.MethodHealth Improvement Scotland undertook the ongoing review and evaluation of the DNACPR and CYPDM policies in consultation with a core multidisciplinary group including representatives from all Health Boards, the Scottish Ambulance Service, the Care Commission and NHS 24. Measures have been developed and agreed which will establish the extent to which these policies are impacting on patient care with regard to inappropriate CPR attempts, expected death and anticipatory care planning.ConclusionsPolicies which facilitate an integrated approach to DNACPR decision-making and communication in adults and children have been implemented across Scotland. Quality measures have been developed to assist Health Boards in establishing the impact of these policies on patient care.
An end of life resource pack to facilitate learning & delivery of end of life care in the community
Authors: Wenham Sarah , Au Gillian , Martin Michelle 
Published: March 2012

BackgroundEasily accessible training and education for all healthcare staff is essential to ensure ‘high quality care for all at the end of life (EoL)’ (EoLC Strategy 2008). With the projected increase in UK mortalitys and strategic drive to facilitate patients to be cared for and die at home, primary healthcare teams need to be up skilled to deliver good EoLC in the community. Provision of high quality, up-to-date resources, that are easily accessible at the point of patient contact, will facilitate the embedding of learning into everyday clinical practice and translate into tangible improvements in patient care.AimTo assess the impact of an EoL Resource Pack as an educational tool for GPs.MethodA multidisciplinary group of clinical experts developed an innovative EoL Resource Pack, containing core resources (including local prescribing guidance), EoL Care tools, and additional resources (regarding local voluntary agencies). The packs were distributed to every GP practice across the healthcare economy during an educational practice visit. In addition, each GP also received personal copies of the key guidance documents. The impact of these resources was assessed from feedback received, and the data was analysed using simple statistical methodology.ResultsGPs perceptions of the pack will be presented with regards to: • Educational usefulness • Impact on patient care • Role as a teaching tool Facilitating factors and barriers to implementation, along with the wider influence of the pack within the healthcare economy, will be discussed.ConclusionThe pack has been demonstrated to be an innovative, effective and sustainable educational resource that not only facilitates improved patient care at the EoL but is also a useful teaching tool. The success of the resource pack among GPs has lead to its distribution to all healthcare professionals across in locality, and its wider adoption across the region.
Does peer led education have a role in teaching medical students about palliative care?
Authors: Nwosu Amara , Mason Stephen , Roberts Anita , Hugel Heino 
Published: March 2012

BackgroundThe number of medical students in the United Kingdom is increasing. An increase of medical students will invariably impact on palliative care institutions required to organise teaching sessions for students. Accordingly, novel studies have previously highlighted the educational benefits of peer-led learning and peer-marking of examinations. However, limited data exists about the educational value of students writing their own exam questions and sharing these with other students.AimTo evaluate the potential for medical students to learn about palliative care through the process of writing examination questions.MethodsFourth year medical students on a palliative medicine rotation were invited to write a short answer exam question in a similar format to the official examination run by the medical school at the University of Liverpool. Questions, selected by the teaching co-ordinator, were based around topics outlined in the palliative medicine syllabus. The questions were checked for accuracy and applicability by the co-ordinator and then distributed to students. The answers to the student generated questions were discussed in a feedback forum at the end of the rotation.FindingsFrom a possible sample of 36 participants, 20 students took part in the exercise. All students agreed the exercise was beneficial to their learning and was in-keeping with the problem-based learning (PBL) medical curriculum. When asked whether the task was too much additional work 18 (90%) disagreed and 2(10%) agreed. Eight (40%) of the students felt more confident in passing the official medical school examinations while 12 (60%) were not sure. Overall the students enjoyed the exercise with 19 (95%) indicating they were keen to repeat the exercise in the future.ConclusionThe evaluation of the Exam Writing task demonstrates that such exercises may be popular with medical undergraduates and could complement the delivery of palliative care teaching.
Enabling positive transition: innovative training to support adult specialist palliative care (SPC) teams to care for young adults with life-limiting conditions including complex needs
Authors: Lidstone Victoria , Marsh Sheila , Hayes Jo , Taubert Mark , Thompson Catherine 
Published: March 2012

BackgroundThe number of children with life limiting conditions surviving through childhood and requiring access to Adult SPC services has dramatically increased over the last decade. Previous research has identified that Adult services are willing but concerned about looking after these young adults, many of whom have non-malignant diagnoses and have needs unfamiliar to adult services. This paper describes the development of a programme to address this issue, to improve the experience of the young people accessing adult SPC services, and support the staff delivering the care.AimsTo develop an innovative programme of training to up-skill the multidisciplinary SPC teams. To involve young adults in the development and delivery of the programme. To ensure the content of the training is relevant and covers physical, psychological and social areas. To improve the experience of young adults accessing adult SPC services To create a programme that is potentially transferable and deliverable to other adult SPC teams across the UK.MethodsThe project is being taken forward through joint working between a Children's hospice and an Adult Hospice. The content of the programme is being developed through the use of focus groups including young people with SPC needs, their families, staff from a local residential school caring for young adults with complex disability, staff from Hospices for young adults, and from the local Children's and Adult Hospices involved in the project. The delivery of the programme will include formal and informal learning, guided reflection, shadowing placements and a’service change' project relevant to the attendees. Young people will be involved throughout, from development to delivery and evaluation. This study describes the process by which the programme was designed, and reports back on delivery of the first part of the pilot.
Moodling through: the virtual world of the palliative medicine trainee
Authors: Marley Kate , Gaunt Kathryn , Groves Karen , Coackley Alison 
Published: March 2012

BackgroundTrainees in Palliative Medicine in the Mersey Deanery require experience of a variety of work settings during training which leads to them being scattered within the region. Some services have only one trainee and there are few opportunities for the trainees to meet. Regular contact between trainee colleagues provides the benefit of peer support in an emotionally challenging specialty. Informal discussions and exchange of clinical and educational information can be maintained and there are opportunities to discuss new developments within the specialty with colleagues at a similar level to oneself. In the current economic climate UK health chiefs are striving to reduce cost in all areas of healthcare including study budgets and trainees must be creative in their efforts to fulfil their curriculum requirements. Addressing the problems: To enhance the educational and supportive contact between trainees, an online electronic learning platform has been developed specifically for Mersey Deanery Palliative Medicine trainees. The platform used is Moodle, a free and open-source virtual learning environment. Trainees have a personal login and password and are then able to access: • Links to resources and websites covering the Palliative Medicine curriculum and e-portfolio • A monthly journal club • Fora for discussion of challenging anonymised clinical cases and provision of peer support. • A revision area for trainees sitting the specialty examination • Calendar marking important dates for trainees Progress Report: The website is used regularly. Trainees have more contact with each other than previously and trainees in different locations are participating in online clinical discussions. There are over 200 trainee activity logs per month across the site and there have been over 2800 activity logs since the site was set up in March 2011. Formal evaluation will take place at the end of the first year of the site's use.
Sustainable impact through a network audit programme
Authors: Coackley Alison , Raj Julie , Mc Kenna Emer , Dickman Andrew , Ellershaw John 
Published: March 2012

BackgroundIt can often be difficult for audit to make a sustained difference to clinical practice across and between organisations. The Merseyside and Cheshire Palliative Care Network Group was initially formed in 1995 and consists of individuals involved in specialist palliative care across the network who are based in community, hospice and hospital settings. The strength of the group lies in the multi disciplinary representation and the on-going enthusiasm of the various teams to participate in the projects.MethodThere are bi-monthly audit meetings with five audits and one planning session each year. The audits are a combination of new audits, regional audits (which look at previously audited topics) and non symptom control subjects.ResultsEach meeting attracts approximately 60 healthcare professionals plus an external expert. The presentation includes a literature review, audit results and a discussion around standards and guidelines. Regional audits complete the cycle by assessing group performance against previously developed standards. Dissemination is achieved at national and international level. Every 3 years, the guidelines are collated into a book which is part of the core formulary for the Network. It is now in the 4th edition and contains 43 different topics. Each chapter is referenced with levels of evidence and grades of recommendation.ConclusionThe book acts as a resource for professionals and is applicable to those caring for cancer patients and other forms of advanced disease. It encourages the setting and monitoring of standards in palliative care and through the audit programme promotes clinical excellence in end of life care.
A training initiative to improve end of life care in the care home setting
Authors: Roberts Anita , Phillips Sharon , Howard Jan , Astley Ann 
Published: March 2012

BackgroundThe End of Life Care Strategy (DH, 2008) emphasised the need to raise the quality of care provided to people dying in care homes. Many residents die in hospital following unnecessary emergency admission hours or days before their death. Accordingly, there is a need for care home staff to receive necessary training and support to ensure the provision of good end of life care, reduce the number of unplanned hospital admissions and enable more people to die in their place of choice.AimsA model training programme was developed to provide education and training for care home staff to enhance their skills and knowledge. This provided the potential to improve the quality and standard of end of life care and reduce unnecessary hospital admissions.MethodAll care homes (n=97) within a North West PCT were invited to participate in the training programme. Selected staff (Key Champions) from participating care homes were surveyed to gain understanding of their knowledge and practice. Subsequently, the training programme consisted of a series of workshops and participants were required to complete consolidation tasks in between workshops. The tasks directly related to the topics covered within the workshop and provided opportunity for participants to demonstrate transfer of knowledge to the Care Home environment. Participants were encouraged to meet regularly with their Manager to discuss progress. The Project Team reviewed all tasks completed by participants and provided written and verbal feedback.ConclusionThe programme is due to complete at the end of the 2011 and will be evaluated to establish whether project aims have been achieved. The evaluation will include a Training Needs Analysis, Self Reported Confidence Scale, and Staff Questionnaire. It is anticipated that this initiative will increase care home staffs' ability and confidence in providing effective end of life care.
Prevalence of life limiting illness in children and young people in the UK
Authors: Fraser Lorna , Miller Michael , House Martin , Hain Richard , Norman Paul , McKinney Patricia , Parslow Roger 
Published: March 2012

BackgroundLife-limiting illness describes conditions with no reasonable hope of cure that will ultimately be fatal. There is little national or local data are available to estimate the burden of these conditions.MethodsAn extract of inpatient Hospital Episodes Statistics (HES, England), Scottish Morbidity Records Inpatient activity database (Scotland, SMR 01), inpatient Patient Episode Database (PEDW, Wales) and Hospital Inpatient Statistics (HIS, Northern Ireland) were obtained (2000/01–2009/10). Children (0–19 years) with life-limiting conditions were identified within these datasets by applying a customised coding framework of ICD-10 disease codes. Prevalence per 10 000 population (0–19 years) was calculated by age, diagnostic group, ethnicity, deprivation and region for each year.ResultsOverall prevalence in England in 2010 was double previous estimates at 33 per 10 000 population (0–19 years). Prevalence was highest in the under 1 age group and decreased through the age bands. Male prevalence was significantly higher than in the female prevalence in all years. The highest prevalence was of congenital anomalies with the lowest prevalence in circulatory and gastrointestinal diagnoses. The overall prevalence rates differed between the countries within the UK but the patterns seen for age, sex and diagnostic group were similar. The ethnicity data was only available for England: prevalence (per 10 000) in the South Asian (50), Black (43) and Chinese and other (34) populations were significantly higher compared to the White population (28). The effect of ethnicity is not completely accounted for by deprivation as ethnicity exerts a strong influence in the most affluent category, especially in the South Asian population.ConclusionsIn 2010 the prevalence of life-limiting conditions in children and young people in England was double the previously reported estimates and had increased annually in all areas over the last decade. This clearly identifies an escalating need for specialist paediatric palliative care services.
Living and dying well with advanced kidney disease: the future is tomorrow…?
Authors: Highet Gill , Crawford Debbie , Drummond Iain , Murray Scott , Boyd Kirsty 
Published: March 2012

BackgroundPatient identification and care planning are central to UK end-of-life policies. For patients on renal replacement therapy, dialysis withdrawal is the main cause of death. Most die in hospital after multiple admissions.AimsAn indepth, case study of a 24-bedded general renal ward explored the admission, assessment and discharge planning processes of patients identified after an unplanned admission as having unmet palliative care needs and a limited prognosis.MethodsThe multi-disciplinary renal team worked with the researcher for two months to generate data from multiple perspectives. Patients were screened with a checklist of indicators for advanced disease. 58 (44%) were identified and followed for 3 months. A purposive sample of five patient – carer – GP triads were interviewed at home, soon after discharge. Patients completed a patient outcome score and staff a semistructured questionnaire. The researcher used the Workplace Culture Critical Analysis Tool for ward observations.FindingsAdvanced kidney disease is punctuated by unplanned hospital admissions due to complications of treatment or co-morbidities. Death often followed an acute deterioration that triggered dialysis withdrawal. Patients demonstrated fluctuating ambivalence about their illness and the future, using avoidance and disavowal to maintain hope. Professionals strived to balance patient wishes with ethical decisions about treatment. ‘Palliative care’ had negative connotations and advance ‘planning for dying’ was not a helpful construct.ConclusionsPatients receiving renal replacement therapy focus on short-term goals as they try to ‘live well’ with complex illnesses and treatment. Clinical indicators can be used to identify advanced kidney disease, but prognosis and likely mode of death are uncertain. Anticipatory care planning needs to engage patients and carers in ‘planning for uncertainty’ and could consider levels of intervention for the next acute episode. Making a planned transition to end-of-life care before the patient is dying can be complex and challenging.
Palliative care consultations in a tertiary hospital Emergency Department
Authors: Cassel J Brian , Luckholm Laurie , Coyne Patrick , Korshin Timur 
Published: March 2012

BackgroundIn the USA, our Palliative Care (PC) program is unique in its early intervention in the Emergency Department (ED).AimsOur goals for this study were to (1) describe PC involvement in the ED at our hospital; (2) describe the typical reasons for PC involvement; and (3) describe what happened to patients following initial consultation.MethodsWe analysed the ‘tracking sheets’ documenting PC consultations from the years 2006–2011 that occurred in the ED. For the years 2008–2011 we matched the consult data to hospital billing and administrative databases for the ED visit and/or eventual hospitalisation.ResultsSince 2006, 429 patients received a palliative care consultation during an ED visit. This increased from 36 in 2006 to more than 90 in each of the past two years. Reasons for consultation included pain (52%), other symptoms (54%), and goals of care (54%); 17% were solely for pain, 11% were solely for other symptoms and 21% were solely for goals of care. Hospital data were available for 252 cases seen since July 2008. Six died in the ED, 31 were released from the ED, twelve were held in the hospital as ‘observation’ cases and 203 (81%) were admitted. Fifty-one (25%) of those hospitalisations ended in death and another 25% ended in discharge to hospice. 162 (80%) were admitted to the PC Unit, for an average of 3.9 days, almost all directly from the ED. Only seven were admitted into intensive care units (ICUs), for an average of 3 days; only one died in the intensive care unit (ICU).ConclusionsCompared to inpatient consultations for our PC program, consultations in the ED have a higher frequency of goals of care reasons, and lower for pain-only or symptoms-only. For those hospitalised following consultation, length of stay and ICU utilisation are quite low by US standards.