bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of intravenous drugs in palliative care
Authors: Ahamed Ashique , Richardson Sian , Newell Julia , Ahmedzai Sam H 
Published: March 2012

BackgroundThe use of oral and subcutaneous medications is well established in palliative care. There are however certain situations where these routes may not be appropriate or effective in symptom control of patients. Below we illustrate three recent cases where intravenous administration of drugs helped relieve intractable symptoms and thus improve quality of life of patients. Case 1) 26-year-old male. Diagnosis Acute promeylocytic leukemia. Developed severe nausea and vomiting following chemotherapy. Symptoms not controlled on Metoclopramide, cyclizine or ondansetron. Patient very distressed by the symptoms. Commenced on IV Levomepromazine infusion. Significant improvement in symptoms after 3 hours. Nausea completely resolved after 4 days. Case 2) 55 year old male. Diagnosis :Advanced metastatic prostate cancer. Developed Intracerebral haemorrhage and splenic infarcts secondary to DIC. Severe pain, vomiting and in distress. Symptoms not well controlled on oral/s/c or transdermal medications. Also developed severe bruising at syringe driver sites. Commenced on Intravenous infusion of Oxycodone, Midazolam and Levomepromazine. Significant improvement in symptoms within a few hours. Further titration according to PRN requirements. Patients condition deteriorated after a few days but remained symptomatically well controlled. Case 3) 57-year-old male. Sickle cell disease. Chronic painful bilateral leg ulcers, oral analgesics ineffective. Commenced on s/c ketamine infusion. Initial mild improvement in symptoms but developed severe site reactions which persisted despite addition of steroids and frequent site changes. Commenced on intravenous ketamine infusion. Significant improvement in pain within 24 h.ConclusionIntravenous administration is an effective way of managing symptoms and should be considered in management of refractory symptoms where other method have been unsuccessful.
Achieving preferred priorities for care (PPC): an audit of hospital to home discharges
Authors: Wigmore Nicola , Brennan Tracie 
Published: March 2012

IntroductionIncreasingly more patients wish to die at home. However it has been identified patients and their carers experience poor hospital discharges as a result of fragmented communication and inadequate co-ordination of services. The anticipated outcome of this audit was to identify areas for improvement for patients and their carers.AimThe aim of this audit was to highlight both positive and negative aspects of hospital to home discharges and its emotional impact on patients and their carers. While identifying ways in which Hospice at Home (H@H) can improve the transition from hospital to home.MethodsThe audit contained a two part questionnaire, completed on 30 referrals to the H@H team. The questionnaire identified areas of particular interest for example district nurse involvement, medications and transport, including patients and carers perspective.ResultsNot all patients arrived home therefore did not achieve their PPC. For those that arrived home there were various contributing factors leading to patients encountering a fractured discharge, for example, medication, transport and time of arrival home. Overall, patients and their carers reported negative experiences of their discharges, however despite this carers agreed their decision to bring the patient home was the right one.ConclusionSignificant changes are needed to improve discharges from hospital to home. Services need to be more co-ordinated with an improvement in communication between the acute and primary setting. Delayed or unsupported discharges are memorable and have a long term impact on patients and their carers.RecommendationsA large number of recommendations were derived from the audit incorporating various areas, for instance, education, communication, transport and the extension of services like H@H. The recommendations from the audit can be applied nationally to any discharge regardless of setting.
Survivorship of the specialist palliative care team
Authors: Waldock Joy , Lambert Kath 
Published: March 2012

BackgroundMYSPC community team consists of six WTE CNSs supported by three consultants, covering a population of 360, 000. Long term sickness in the team and difficulties recruiting became an acute crisis with additional sickness in spring 2011. At most times from May 2011 we had less than 1/3 of our nurses. After discussion within the team a difficult decision was reached and we issued the following: It is with regret that the Mid Yorkshire Macmillan specialist palliative care team have to inform you that we are unable at this time to accept referrals for face to face consultations/domiciliary visits for community patients in Wakefield and North Kirklees. This is due to unprecedented sickness in the team and the decision has not been taken lightly. Please continue to send in referral forms and these will be reviewed each day by a consultant who will liaise with you by telephone to offer advice. Please accept our apologies for any inconvenience this causes and we will return to normal service as soon as we are able.AimsThe authors compare a 3 month period of staffing shortage with 3 months in the previous year demonstrating impact on the clinical service. Areas: • Referral numbers • Level of intervention • Face-to-face contacts • Re-referrals • Triage methods • Use of other services • Impact on non-clinical work • Emotional impact on the team.ConclusionThe impact has been significant and has resulted in changes in the way the team responds to referrals. Although this has been a difficult time it has ensured we reflect on the way we work with primary care colleagues. The authors have to utilise our skills and time to maximise effectiveness. The authors will be able to make recommendations for future models of working, not just at times of crisis.
Mind the gap: do tertiary cancer centres need 24 hour access to specialist palliative care services?
Authors: Pooley Owen , Coackley Alison , Noble Agnes , Griffiths Ann , Arundell Donna 
Published: March 2012

BackgroundThe National Institute for Clinical Excellence recommended that Cancer Networks should provide 24 h access to specialist palliative care telephone advice. The Manual of Cancer Services 2004 suggested that a telephone advice service should be available to core members of cancer MDTs. Clatterbridge Centre for Oncology is a tertiary cancer centre with more than 7000 new patients every year. A specialist palliative care service is available 7 days per week 9–5 but the 24 h access is provided by an informal arrangement with a single clinician. Healthcare professionals working in tertiary cancer centres often have an increased knowledge of palliative care and it has been suggested that 24 h access to specialist advice may not be as important as for district general hospitals.AimTo explore the views of healthcare professionals working in a tertiary cancer centre about the need for 24 h access to specialist palliative care advice.MethodA questionnaire was distributed to healthcare professionals in a tertiary cancer centre asking for their views on: areas of concern use of current informal advice provision impact of advice on patient care.ResultsThe questionnaire was distributed to 129 staff. The response rate was 47%. In the previous 4 weeks advice had been required on 46 occasions. 54% of staff had requested advice. 97% found the advice very helpful.100% felt that the advice had a positive impact on patient care.ConclusionThis survey demonstrated that staff in a tertiary cancer centre had palliative care educational needs and valued access to specialist palliative care advice believing that it had a positive impact on patient care.
Hospital based palliative care in subSaharan Africa; a 6 month review from Malawi
Authors: Tapsfield Julia , Bates Maya Jane 
Published: March 2012

BackgroundThe WHO recognises the importance of palliative care in an African setting. Despite this services are often patchy and inconsistent, and many operate at health centre and/or community level. Few reports from hospital based palliative care services in subSaharan Africa exist in the current literature. As part of its activities Tiyanjane Clinic has been providing hospital based palliative care to patients at Queen Elizabeth Central Hospital, a large government tertiary referral institution, in the Southern region of Malawi since 2003, caring for patients with HIV, cancer and other non-malignant palliative diagnoses.MethodsA retrospective review of case notes for all in-patients seen by Tiyanjane Clinic over a 6 month period (April–September 2009) was undertaken.ResultsA total of 177 patients were seen, for whom 137 case notes were available (77%). 58% of patients were male, 42% female. The average age of patients was 39.1 years (range 15–92 years). 54% of patients were HIV positive, with 34% on ARV drugs at the time of care. 42% of patients had HIV related diagnoses, including AIDS defining malignancies, 48% had (non-AIDS related) cancers and 9% had other palliative diagnoses. The mean age of patients with HIV related diagnoses was 34 years, for cancer patients it was 48 years. Pain was the most commonly reported symptom (74%), with 56% of patients requiring oral morphine. The mean daily dose of morphine was 30 mg/day (range 9–100 mg). 65% of patients were discharged home, 26% of patients died during admission.ConclusionThe palliative care population in this setting is relatively young, especially among patients with HIV related diagnoses. HIV and cancer are the main diagnostic groups. Pain is the most commonly reported symptom. Knowledge and experience of prescribing oral morphine is needed in order to provide appropriate assistance to patients.
The use of a modified ‘surprise’ question to identify and recruit dying patients into a research project in an acute hospital setting
Authors: Gibbins Jane , Bloor Sophia , Reid Colette , Burcombe Melanie , McCoubrie Rachel , Forbes Karen 
Published: March 2012

AimsTo determine the feasibility of recruiting patients into a study to examine their care as they died in an acute hospital trust.MethodsThe authors performed a prospective mixed-methods observational study of the care given to patients who were dying in hospital. All patients on five study wards were screened on admission using the question, ‘Is this patient so unwell you feel they could die on this admission?’ If the answer was ‘yes’ the patient (and/or family) was approached to give prior consent to being included in the study ‘should they become more unwell’. We calculated the sensitivity and specificity of the screening question and the proportion of patients providing consent.ResultsOver 2 years, 6703 patients were screened; staff answered ‘yes’ to the screening question for 327 patients (5%). The screening question had a sensitivity of 57% and a specificity of 98%. Prior consent (23) or relative assent (94) was obtained for 117 (36%) of these patients. 70 died within the study. Only 25 (7%) patients were considered too distressed to approach and only 17 (5%) declined to participate. Other reasons for non-participation included patient improvement (53), death very soon after screening (45) and logistical reasons for example, patient moved to a non-study ward.ConclusionTo our knowledge prior consent for research during the dying process has not been used before within an acute trust. While a large number of patients were screened, our screening question was helpful in identifying patients who could die during an admission. It was possible to gain consent from about a third of these patients, or assent from their relatives, for inclusion in a study to examine their end-of-life care.
Supporting staff wellbeing within the MND team
Authors: Powell Barbara 
Published: March 2012

BackgroundCaring for patients with MND is an emotional intense area of care. Little attention has been paid to the needs of staff for support and other ways to avoid stress and burnout. Phase 1: Assessing the need A questionnaire was sent to all members of the care team, including the core MDT, who support patients and carers in the outpatient clinic, in the community, in hospice IPU and day unit. (46 responses) The questionnaire sought comment on the difficulties of caring for people with MND, the perceived need for support of some sort and the response to suggested types of support. Phase 2: Acting on the findings. Two actions are underway: First an education and staff development task group has been brought together to develop and appropriate action plan. Secondly we have now had three out of four TIME OUT sessions for the core MDT. Each 3 h session has had two parts: a reflection of patients who have died and a focus on personal wellbeing. An after death analysis tool has evolved to provide key information to assist reflection on the care we have provided. Four different approaches were chosen to focus on personal wellbeing, each having different facilitators; • Mindfulness • Laughing Yoga • Expressive Art • Soul Space Phase 3: Conclusion: Feedback has been encouraged after each session. Overall evaluation of the usefulness and benefits of the TIME OUT program will take place after session four (November 2011).
Stress and burnout – a novel approach to an age old problem
Authors: Salt Susan , Watt Carolyn , Matty Rosalind 
Published: March 2012

BackgroundIn a fast changing and unpredictable speciality stress related issues are increasingly common resulting in higher sickness levels and poor performance. There are many courses available for managing stress but none aimed at palliative care. Recognising that attending courses is often problematic we devised a day around exploring the issue to see this may help individuals be more aware of stress and how to manage it for themselves and in their teams.MethodA study day was devised for professionals to look at the underlying mechanisms of stress from psychological factors to the impact of organisational structures and team dynamics. It explores what may tip stress into burnout. There was guidance on ways individuals could identify their stress and manage it more effectively. The facilitators came from a variety of backgrounds including from the civil service. The day consisted of lectures, workshops, sharing of own experiences and discussion. This culminated in all the delegates engaging in a creative task of building a space in a box to hold what was most precious to them. (An outline of the day will be shown on the poster).Results18 delegates attended the day and there were 8 contributors who also joined in the sessions they were not leading. The evaluation of the day was overwhelmingly positive. People appreciated being able to share their stress as well as identifying possible precipitating factors. A number commented on being with people from other organisations and learning from each other.ConclusionAll the delegates would recommend the day to their colleagues, all felt that they have been given ways to identify and manage stress. What impact this had in the long term is unknown. However, the day is easily reproducible and a cost effective way to at least raise awareness of the issue.
Improving nursing handover in a specialist palliative care unit
Authors: Smith Louise , Gale Sue , Glynn Jayne , Tank Shila , Newberry Leanne , Graham Mel 
Published: March 2012

BackgroundNursing handover plays a pivotal role in the continuity of patient care. Having recognised limitations in their own handovers, nurses in a 16-bed inpatient unit embarked on a multi-phased project aimed at redressing problems.AimsTo identify Healthcare Professionals' (HCPs) opinions about their handovers, gain a better understanding of the impeding factors and identify opportunities for improvement.MethodsQuantitative and qualitative data were collected via observation, survey and audit. A survey was undertaken in Phase 1 to identify HCPs' beliefs, preferences and ideas on how their handover could be improved. Phase 2 comprised an audit and assessment of handover structure and content. Based on emergent themes contemporaneous changes to practice were made.FindingsPhase 1 shows that 91% of respondents said handover should not exceed 30 min, 70% wanted clarity on what information should be included/excluded, 74% wanted a dedicated ‘question time’ to avoid verbal interruptions. Respondents also wanted to introduce deterrents to reduce staff lateness, physical interruptions and utilise a preprinted pro-forma. Guidelines were developed and audited. By the end of Phase 2 the duration of handover had halved to 20 min. Staff lateness and interruptions had significantly reduced. Use of the pro-forma became standard practice as it facilitated the delivery and recording of pertinent patient information and reduced note-taking. The naming of drugs (+/- dose) ceased as inaccuracies were common. However, key patient information was frequently omitted and factual errors occurred for varying reasons including; inaccurate source documents, illegible writing, and poor communication.ConclusionA high level of adherence to the guidelines was achieved, duration halved and handover was more succinct, structured and patient focused. The main emergent theme related to the quality of the information given and this is subject to further enquiry.
Evaluation of the specialist palliative care team ‘a colleagues perspective’
Authors: Steele Emma 
Published: March 2012

BackgroundFollowing the move of two hospitals into one large new hospital Queen Elizabeth Hospital, Birmingham the author was interested to reflect on the service Specialist Palliative Care Team provided for patients, carers and staff throughout the acute setting.AimsThe author proposed to collect views from referring staff to evaluate the work of the Specialist Palliative Care Team, to ascertain how accessible and effective the team are and main reasons for referral. The author also aimed to determine if the team is visible within clinical areas and look for areas of improvement and guidance for future working.MethodThe author devised a set of questions designed to explore the opinions that health professional colleagues working within the Trust had about the Specialist Palliative Care Team. The author handed out five questionnaires to thirty clinical areas and asked any clinical staff to complete.ResultsThe analysis of the survey suggests that the Specialist Palliative Care Team does provide a good service and supports staff and patients. The team members generally respond to a referral within an appropriate timescale and recognise the referring health professionals skills. 89% of respondents felt that the team could provide more education and many suggested that the service could be extended to 7 days a week. 18 members of staff felt the teams communication skills were ‘satisfactory’ and 7% answered ‘poor’.ConclusionA number of themes arose for the Specialist Palliative Care Team to consider and discuss including provision of education, communication skills, extending the service and raising the teams profile.
Development of a screening and referral process for occupational therapy (OT) intervention with chemotherapy day unit patients
Authors: Thompson Carole 
Published: March 2012

BackgroundMany patients referred to OT in the final stage of the cancer pathway report long standing functional difficulties which could have been addressed earlier in the treatment pathway. Rehabilitation is well established in conditions such as cardiac and stroke diseases and needs to be for cancer. (National Cancer Action Team 2009). Timely referral to OT can allow more time to plan appropriate support. (National End of Life Care Programme 2011) This project is devised to try and reach these patients in a timely way.AimsTo develop a screening and referral process for OT intervention with patients referred for chemotherapy.MethodsA screening tool was provided by the OT to the chemotherapy nurses. The nurses completed the tool with each new patient from 1 January 2011 and forwarded the completed proforma to the OT. All proformas recorded ‘yes’ or ‘no’ to the suggestion of OT referral. Proformas marked ‘yes’ were allocated within the OT team for assessment. Proformas marked ‘no’ were recorded.ResultsResults were analysed after the first 50 patients had been screened. 23 were referred for assessment by OT. 27 were not referred. Five of the patients not referred by the chemotherapy nurses were referred to the palliative care OT team by other agencies further down the cancer pathway.Conclusion56% of patients referred for treatment in chemotherapy day unit benefited from intervention by OT. The screening tool used by the chemotherapy nurses was not sensitive enough to identify all patients in need of OT.
Reliability and validity of a thai version of the edmonton symptom assessment system (ESAS – Thai)
Authors: Chinda Montharat , Jaturapatporn Darin , Kirshen Albert J , Udomsubpayakul Umaporn 
Published: March 2012

BackgroundThe Edmonton Symptom Assessment Scale (ESAS), created by the Edmonton Group in 1991, is an instrument assessing symptom control commonly used in palliative care. It asks patients to rate nine items on an eleven-point numeric rating scales.ObjectiveThe aim of this study was to translate the ESAS to Thai and validate its final version with transcultural adaptation for Thai palliative care patients. The original ESAS was translated into Thai with the Edmonton group`s permission. The translation process followed the cross-cultural adaptation of self-report measures` standard guidelines, including forward translation, synthesis of the translation, back translation, cross-cultural adaptation and pre-testing.MethodsThis cross-sectional study was first undertaken with 44 end-stage cancer patients in the inpatient setting, which led to the final version. The reliability and validity of the final version, with a sample of 37 end-stage cancer patients, was then examined in the out-patient department at Ramathibodi hospital. The face validity was evaluated through patient interviews, using guide questions. The internal-consistency reliability was calculated by using SPSS program.Results91.8% of patients declared that the ESAS-Thai questionnaire was generally clear. It yielded a Cronbach's α of 0.7458 in the inpatient setting. After modifying the words ‘appetite’ and ‘well-being,’ 37 cancer patients, who were cared for by the Departments of Medicine, Surgery, Gynaecology and Otolaryngology, self-administered the questionnaire in the out-patient department. The mean age was 52.2 (10.8) with a 0.8904 Cronbach's α in the validation sample.ConclusionAfter the translation and cross-cultural adaptation, the Thai version of the ESAS achieved good levels of face validity and internal-consistency reliability. It is now available as a patient-administered instrument to evaluate symptoms among palliative care patients in Thailand.