bluuebunny/crossref_metadata_2025_split huggingface dataset:
Introduction and evaluation of a ‘pre-ART care’ service in Swaziland: an operational research study
Authors: Burtle David , Welfare William , Elden Susan , Mamvura Canaan , Vandelanotte Joris , Petherick Emily , Walley John , Wright John 
Published: March 2012

ObjectiveTo implement and evaluate a formal pre-antiretroviral therapy (ART) care service at a district hospital in Swaziland.DesignOperational research.SettingDistrict hospital in Southern Africa.Participants1171 patients with a previous diagnosis of HIV. A baseline patient group consisted of the first 200 patients using the service. Two follow-up groups were defined: group 1 was all patients recruited from April to June 2009 and group 2 was 200 patients recruited in February 2010.InterventionIntroduction of pre-ART care—a package of interventions, including counselling; regular review; clinical staging; timely initiation of ART; social and psychological support; and prevention and management of opportunistic infections, such as tuberculosis.Primary and secondary outcome measuresProportion of patients assessed for ART eligibility, proportion of eligible patients who were started on ART and proportion receiving defined evidence-based interventions (including prophylactic co-trimoxazole and tuberculosis screening).ResultsFollowing the implementation of the pre-ART service, the proportion of patients receiving defined interventions increased; the proportion of patient being assessed for ART eligibility significantly increased (baseline: 59%, group 1: 64%, group 2: 76%; p=0.001); the proportion of ART-eligible patients starting treatment increased (baseline: 53%, group 1: 81%, group: 2, 81%; p<0.001) and the median time between patients being declared eligible for ART and initiation of treatment significantly decreased (baseline: 61 days, group 1: 39 days, group 2: 14 days; p<0.001).ConclusionsThis intervention was part of a shift in the model of care from a fragmented acute care model to a more comprehensive service. The introduction of structured pre-ART was associated with significant improvements in the assessment, management and timeliness of initiation of treatment for patients with HIV.
A question–answer pair (QAP) database integrated with websites to answer complex questions submitted to the Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS): a descriptive study
Authors: Schjøtt Jan , Reppe Linda A , Roland Pål-Didrik H , Westergren Tone 
Published: March 2012

ObjectiveTo assess a question–answer pair (QAP) database integrated with websites developed for drug information centres to answer complex questions effectively.DesignDescriptive study with comparison of two subsequent 6-year periods (1995–2000 and 2001–2006).SettingThe Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS).ParticipantsA randomised sample of QAPs from the RELIS database.Primary outcome measureAnswer time in days compared with Mann–Whitney U test.Secondary outcome measureNumber of drugs involved (one, two, three or more), complexity (judgemental and/or patient-related or not) and literature search (none, simple or advanced) compared with χ2tests.Results842 QAPs (312 from 1995 to 2000 and 530 from 2001 to 2006) were compared. The fraction of judgemental and patient-related questions increased (66%–75% and 54%–72%, respectively, p<0.01). Number of drugs and literature search (>50% advanced) was similar in the two periods, but the fraction of answers referring to the RELIS database increased (13%–31%, p<0.01). Median answer time was reduced from 2 days to 1 (p<0.01), although the fraction of complex questions increased from the first to the second period. Furthermore, the mean number of questions per employee per year increased from 66 to 89 from the first to the second period.ConclusionsThe authors conclude that RELIS has a potential to efficiently answer complex questions. The model is of relevance for organisation of drug information centres.
Non-response in a nationwide follow-up postal survey in Finland: a register-based mortality analysis of respondents and non-respondents of the Health and Social Support (HeSSup) Study
Authors: Suominen Sakari , Koskenvuo Karoliina , Sillanmäki Lauri , Vahtera Jussi , Korkeila Katariina , Kivimäki Mika , Mattila Kari J , Virtanen Pekka , Sumanen Markku , Rautava Päivi , Koskenvuo Markku 
Published: March 2012

ObjectiveTo examine difference in mortality between postal survey non-respondents and respondents.DesignA prospective cohort study with baseline survey in 1998 and comprehensive linkage to national mortality registers until 2005, the Health and Social Support study.SettingA population-based postal survey of the working-aged population in Finland in 1998.ParticipantsThe original random sample comprised 64 797 working-aged individuals in Finland (20–24, 30–34, 40–44, 50–54 years of age; 32 059 women and 32 716 men), yielding 25 898 (40.0%) responses in the baseline postal survey in 1998.Primary outcome measureRegistry-based primary causes of death encoded with the International Classification of Diseases (ICD-10).ResultsIn women, HR for total mortality was 1.75 (95% CI 1.40 to 2.19) times higher among the non-respondents compared with the respondents. In men, non-response was associated with a 1.41-fold (1.21–1.65) excess risk of total mortality. Non-response associated in certain age groups with deaths due to diseases in women and with deaths due to external causes in men. The most prominent excess mortality was seen for total mortality for both genders and for mortality due to external causes among men.ConclusionsPostal surveys result in slight underestimation of illness prevalence.
Job strain among blue-collar and white-collar employees as a determinant of total mortality: a 28-year population-based follow-up
Authors: von Bonsdorff Mikaela B , Seitsamo Jorma , von Bonsdorff Monika E , Ilmarinen Juhani , Nygård Clas-Håkan , Rantanen Taina 
Published: March 2012

ObjectivesTo investigate the effect of job demand, job control and job strain on total mortality among white-collar and blue-collar employees working in the public sector.Design28-year prospective population-based follow-up.SettingSeveral municipals in Finland.Participants5731 public sector employees from the Finnish Longitudinal Study on Municipal Employees Study aged 44–58 years at baseline.OutcomesTotal mortality from 1981 to 2009 among individuals with complete data on job strain in midlife, categorised according to job demand and job control: high job strain (high job demands and low job control), active job (high job demand and high job control), passive job (low job demand and low job control) and low job strain (low job demand and high job control).Results1836 persons died during the follow-up. Low job control among men increased (age-adjusted HR 1.26, 95% CI 1.12 to 1.42) and high job demand among women decreased the risk for total mortality HR 0.82 (95% CI 0.71 to 0.95). Adjustment for occupational group, lifestyle and health factors attenuated the association for men. In the analyses stratified by occupational group, high job strain increased the risk of mortality among white-collar men (HR 1.52, 95% CI 1.09 to 2.13) and passive job among blue-collar men (HR 1.28, 95% CI 1.05 to 1.47) compared with men with low job strain. Adjustment for lifestyle and health factors attenuated the risks. Among white-collar women having an active job decreased the risk for mortality (HR 0.78, 95% CI 0.60 to 1.00).ConclusionThe impact of job strain on mortality was different according to gender and occupational group among middle-aged public sector employees.
Seasonal Influenza Vaccine Effectiveness in the community (SIVE): protocol for a cohort study exploiting a unique national linked data set
Authors: Lone Nazir I , Simpson Colin , Kavanagh Kimberley , Robertson Chris , McMenamin Jim , Ritchie Lewis , Sheikh Aziz 
Published: March 2012

IntroductionSeasonal influenza vaccination is recommended for all individuals aged 65 years and over and in individuals younger than 65 years with comorbidities. There is good evidence of vaccine effectiveness (VE) in young healthy individuals but less robust evidence for effectiveness in the populations targeted for influenza vaccination. Undertaking a randomised controlled trial to assess VE is now impractical due to the presence of national vaccination programmes. Quasi-experimental designs offer the potential to advance the evidence base in such scenarios, and the authors have therefore been commissioned to undertake a naturalistic national evaluation of seasonal influenza VE by using data derived from linkage of a number of Scottish health databases. The aim of this study is to examine the effectiveness of the seasonal influenza vaccination in the Scottish population.Methods and analysisA cohort study design will be used pooling data over nine seasons. A primary care database covering 4% of the Scottish population for the period 2000–2009 has been linked to the national database of hospital admissions and the death register and is being linked to the Health Protection Scotland virology database. The primary outcome is VE measured in terms of rate of hospital admissions due to respiratory illness. Multivariable regression will be used to produce estimates of VE adjusted for confounders. The major challenge of this approach is addressing the strong effect of confounding due to vaccinated individuals being systematically different from unvaccinated individuals. Analyses using propensity scores and instrumental variables will be undertaken, and the effect of an unknown confounder will be modelled in a sensitivity analysis to assess the robustness of the estimates.Ethics and disseminationThe West of Scotland Research Ethics Committee has classified this project as surveillance. The study findings will be disseminated in peer-reviewed publications and presented at international conferences.
Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review
Authors: Lawton Rebecca , McEachan Rosemary R C , Giles Sally J , Sirriyeh Reema , Watt Ian S , Wright John 
Published: March 2012

ObjectiveThe aim of this systematic review was to develop a ‘contributory factors framework’ from a synthesis of empirical work which summarises factors contributing to patient safety incidents in hospital settings.DesignA mixed-methods systematic review of the literature was conducted.Data sourcesElectronic databases (Medline, PsycInfo, ISI Web of knowledge, CINAHL and EMBASE), article reference lists, patient safety websites, registered study databases and author contacts.Eligibility criteriaStudies were included that reported data from primary research in secondary care aiming to identify the contributory factors to error or threats to patient safety.Results1502 potential articles were identified. 95 papers (representing 83 studies) which met the inclusion criteria were included, and 1676 contributory factors extracted. Initial coding of contributory factors by two independent reviewers resulted in 20 domains (eg, team factors, supervision and leadership). Each contributory factor was then coded by two reviewers to one of these 20 domains. The majority of studies identified active failures (errors and violations) as factors contributing to patient safety incidents. Individual factors, communication, and equipment and supplies were the other most frequently reported factors within the existing evidence base.ConclusionsThis review has culminated in an empirically based framework of the factors contributing to patient safety incidents. This framework has the potential to be applied across hospital settings to improve the identification and prevention of factors that cause harm to patients.
Sustaining improved end of life care in care homes
Authors: Moyes Rhona , Stevensony Barbara , Oxenham David , Finucane Anne 
Published: March 2012

BackgroundUK policy calls for care homes to provide reliably good palliative and end of life (EOL) care (Care Commission, Better Care Every Step of the Way, 2009). Consequently an intervention was designed to enhance the quality of palliative and EOL care provided by seven care homes in Midlothian, Scotland. Phase 1 consisted of a high facilitation model led by a palliative nurse specialist. This involved inhouse training of care home staff and visits to care homes every 10–14 days which resulted in significant improvements in end of life care outcomes (Hockleyet al, 2010; Palliative Medicine, 24(8)). Phase 2 attempted to sustain the positive outcomes with a lower level of facilitation.AimTo establish the extent to which a lower facilitation model would sustain the results achieved during the high-facilitation period.MethodTwo palliative care nurse specialists each spent 1 day per week providing support and training to care home staff and GPs over an 18 month period.Results96% of patients who died during Phase 2 had an advance care plan; an increase from 53% following Phase 1 and from 4% at baseline. 57% of patients were on the Liverpool Care Pathway; up from 30% following Phase 1 and 3% at baseline. 86% of patients had a DNACPR status, up from 72% after Phase 1 and 15% at baseline. Inappropriate hospital deaths were 4%, down from 8% following Phase 1 and 15% at baseline.ConclusionsA lower facilitation model managed to sustain and build on the outcomes achieved during Phase 1. Two specialist nurses were able to strategically support and train staff to provide a high standard of end of life care to care home residents. This model will now be used to introduce a palliative approach in a much wider group of care homes throughout the region.
What evidence is being used to inform clinical practice and palliative care? A comparison between Sub Saharan Africa and the UK
Authors: Jack Barbara , O'Brien Mary , Mwebessa Eddie 
Published: March 2012

BackgroundThe internet ensures rapid access to information that nurses can use to inform clinical practice. In the western world, guidelines, protocols and pathways are all readily available and driven by the promotion of evidence based practice. In the developing world where internet access is at best patchy and access to journals poor, nurses are limited in what information they can obtain.AimsTo explore what registered nurses perceived to be the best evidence to use to underpin clinical practice in the UK and Sub Saharan Africa.Method30 registered nurses from two groups, one in the UK (17) and Uganda (13), undertaking a research methods module as part of their degree in health studies /palliative care, individually ranked the statements of the hierarchy of evidence in order of strength. All respondents were based in clinical practice and had been registered nurses for between 3 and 32 years. Data was collected on the commencement of the modules, in 2011.ResultsOnly one student (from Uganda) got all elements of the hierarchy of evidence correct. 29% (5) of the UK and 33% (5) of the Ugandan students correctly scored the highest level of evidence. Yet, 88% (15) UK and 38% (5) Ugandan, scored level 5 (opinions from respected authorities as the highest level of evidence.ConclusionIn both countries it appears that the opinion from respected authorities is influencing clinical practice generally and also within palliative care. This poster discusses all of the results and suggestions are made for the findings. However it is essential that researchers are cognisant of this fact when considering the dissemination of research findings.
What are the impacts of communication skills in a foundation degree for support workers?
Authors: Faull Christina , Phelps Kay , Handsley Stephen , Wale Jane , Noguera Anita 
Published: March 2012

BackgroundUnregistered health and social care workers arguably provide the bulk of end of life care. They spend more time with people than trained staff, undertake more personal care and are often seen as the closest ally and friend by the people who may entrust them with unique confidences and share fears and hopes. Eleven support workers taking a 2 year foundation degree in palliative and supportive care participated in an evaluation study. Communication skills training including role play was embedded in two modules.MethodsMixed quantitative and qualitative methods were used at 4 time points over 2 years. Responses to the FATCODb, meaninglessness questionnaire and PERT self assessment of efficacy were analysed descriptively and interviews thematically.ResultsConfidence increased in responding to a patient who says ‘I can see no meaning in life’ for those who felt unconfident in this at the start of the degree. Although some still reported ‘feeling uncomfortable talking about impending death with the dying person’ there was decreased agreement with ‘I would feel uncomfortable if I entered the room of a terminally ill person and found him/her crying’. The median score for self evaluated effectiveness in communicating with patients with advanced and terminal illness and their families increased from 5 to 8.5 on an 11 point scale. Interviews identified much greater confidence in working with communication scenarios that students previously would have found challenging and would have avoided or disengaged with. Use of silence was a key new strategy.ConclusionStudents felt more able to deal with challenging situations and self-reflective as well as externally reported practice indicated a greater competence in key end of life communication tasks. Students identified the pivotal importance of confidence and competence in communication which underpinned the outcomes for all aspects of end of life care.
Experiences of nursing and postgraduate medicine students during a 1 week's clinical placement
Authors: Namukwaya Elizabeth , Dunn Joanna , Batuli Mwazi , Leng Mhoira 
Published: March 2012

Training students in medical and nursing schools at undergraduate and postgraduate levels in palliative care is crucial in the integration of palliative care services in hospital settings. It can be challenging to find time in busy curricula for a new subject and even more challenging to ensure there is a strong clinical modelling as part of the training. The authors achieved time for training in palliative care at undergraduate and postgraduate level which includes classroom lectures, a 1 week clinical placement and summative assessment. However it was not clear if this duration of training makes a difference for the students.AimTo describe the experience of nursing students and post graduate medicine students during a 1 week's clinical attachment to a hospital palliative care unit and its impact.MethodsA Qualitative study was carried out. Twelve nursing students and ten postgraduate doctors training in internal medicine who previously had been on placement in the hospital palliative care unit were interviewed using semistructured questions. Interviews were recorded and transcribed. The transcripts were subjected to thematic analysis and thematic saturation was achieved.ResultsStudents reported improved understanding of palliative care, when and to whom it should be given and felt more confident to help dying patients and to break bad news. The clinical placement dispelled their fears towards use of opioids. They felt that their practice had changed towards those with terminal illnesses and all other patients and their families in general.ConclusionThis study demonstrated that even short training can have an effect on changing students' knowledge and views towards palliative care. Therefore Palliative care trainers should try to maximise the time they have in the curriculum and ensure clinical modelling is included. This is hoped to have long term impacts on clinical practice and will be the subject of further study.
Palliative sedation – a snapshot of current practice
Authors: Harrison Tim , Robertshaw Carolyn 
Published: March 2012

BackgroundThe use of sedatives in palliative care is under increasing scrutiny. Many different drugs are used and, although midazolam is often the preferred choice, there is no established consensus as to best practice. At a recent course on symptom control delegates were asked a series of questions in order to provide a snapshot of current practice.AimsTo ascertain preferred choices of drugs used in sedation in order to facilitate development of a ‘sedation ladder’ to guide practice. When midazolam is used as first choice sedative, to establish at what dose addition of a second agent is considered.Method250 delegates were presented with a list of nine choices of drug that may be used for palliative sedation. Using an electronic feedback system they were asked to indicate their usual first, second and third choice. In the scenario of midazolam being used as first choice sedative they were also asked ‘What dose (of midazolam) do you consider adding a second agent?’ResultsThe 250 delegates included 127 doctors, 115 specialist nurses and 3 pharmacists. Midazolam was the first choice sedative for 81% of the delegates responding. Levomepromazine was the second choice sedative for 82%. Third choice sedative was more evenly balanced between haloperidol and phenobarbital at 42% and 36.9% respectively. When subcutaneous midazolam is first choice sedative 30% would add an additional drug at 30 mg/24 h whereas 4.8% would not consider this until doses exceeded 100 mg/24 h.ConclusionsCurrent practice suggests a hierarchy of drug choice in sedation. Midazolam is the most frequent first choice, levomepromazine the second choice and either haloperidol or phenobarbital third choice. This order of preference can be presented as a ‘Sedation Ladder’ to guide practice.
Doctors and nurses training needs for children's palliative care
Authors: Downing Julia , Boucher Sue , Marston Joan 
Published: March 2012

ObjectivesChildren's palliative care (CPC) represents a special, albeit closely related, field to adult palliative care and in many parts of the world, training on CPC is minimal or non-existent. Thus the ICPCN undertook a survey to understand training needs for CPC.MethodAn online survey was developed addressing training needs alongside availability of CPC training programmes. The survey was online for four months from April 2011 and all ICPCN members were invited to participate.ResultsOf the 253 respondents, 72 (28%) were doctors and 96 (38%) nurses. Doctors were most knowledgeable, on a scale of 1-5, in pain assessment and management (x=4.17) and the basics of CPC (x =4.15) and least knowledgeable about HIV/AIDS (x=2.83), dermatology (x=3.19) and development of CPC services (x=3.19). They felt most confident in communicating with children (x=3.93) and working with families (x=3.93) and least confident in HIV/AIDS (x=2.79) and therapies such as play (x=2.78). They prioritised their training needs as communicating with children, psychological aspects and setting up and managing services. Their least priority included feeding and hydration, cancer and dermatological issues. Nurses felt most knowledgeable in working with families (x=4.02) and self care (x=3.9), and least knowledgeable about HIV/AIDS (x=2.91) and Ethics and the Law (x=3.02). However they felt most confident about communicating with children (x=3.88) and working with families (x=3.92) and least confident about HIV/AIDS (x=2.79) and Dermatological issues (x=3.15). They prioritised Ethics and the Law, Neurological symptoms and setting up and managing services, with basics of CPC, communication and gastrointestinal symptoms being seen as least priority in terms of training needs.ConclusionFurther analysis is on-going to assess how priorities differ according to the regions in which respondents live, however understanding the training needs of doctors and nurses in CPC will help shape the development of an international training strategy within ICPCN.