bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘Me I feel proud in my uniform’: the personal value of being a palliative care community volunteer
Authors: Jack Barbara , Kirton Jennifer , Merriman Anne , Birakurataki Jerith 
Published: March 2012

BackgroundApprox 27 000 new cases of cancer are reported in Uganda in each year affecting 1.5% of the population. A shortage of Doctors, wide geographical distribution, and poor transport systems lead to many patients experiencing severe uncontrolled symptoms. Hospice Africa Uganda developed a community volunteer worker programme where local villagers are trained to identify patients with palliative care needs. The volunteers refer patients to the hospice and provide basic care and support for patients and families. A training course with ongoing support has resulted in 85 volunteers practicing out of the hospice in Kampala (40) and Hoima (45).The volunteers receive no payment, except for a bicycle enabling them to reach remote areas.AimTo explore personal impact of being a palliative care community volunteer.MethodologyA qualitative methodology using semi structured individual and group tape recorded interviews was adopted for the study. Data was collected from the volunteers based in two sites (Hoima and Kampala). A purposive sample of 32 volunteers participated in the study. Data was analysed for emerging themes using thematic analysis.ResultsThe volunteers all reported how they found the role to be of great value to themselves, including having an increased knowledge and satisfaction at helping the dying in their villages. Interestingly they all commented on the pride of being a volunteer, how they felt when they put on their uniform and the resulting respect they received.DiscussionThis paper will discuss these findings as well as the challenges that the volunteers are finding regarding language barriers and old bicycles.
From abstract to publication: the fate of research presented at the EAPC Congress Meeting
Authors: Hanchanale Sarika , Jordan Alice 
Published: March 2012

ObjectiveThe fate of oral presentations presented at a palliative meeting has not been assessed to date. Our aim was to determine the number of peer-reviewed publications arising from the abstracts presented at the European Association for Palliative Care (EAPC) Congress Meeting, Aachen (2005).MethodsAll abstracts (Oral and poster) presented at the EAPC Congress, Aachen (2005) were included in the study. Invited abstracts were excluded from the study. Pubmed search was performed to identify a matching journal article. Topics, country of origin, abstract type, type of journal and publication time (month–year) were tabulated and analysed.ResultsAt EAPC Congress Meeting, 661 abstracts were presented. After exclusion of 123 invited articles a total of 140 oral and 398 poster abstracts were presented EAPC Congress at Aachen in 2005. 230 (43%) abstracts were published as full paper in peer-reviewed journals (77 oral abstracts (55%) and 153 poster abstracts (38%)). Nearly fifth of articles were published in 6 months and quarter within 12 months. Thirty-nine per cent of articles were published within 36 months. Majority of articles were published in palliative journals (29%) followed by pain (18%), oncology (13%), medicine (8%) and psychiatry (4%) journals. Top five countries with maximum abstracts were UK (30%), Netherlands (9%), Germany (7%), Italy (5%) and Norway (5%). The conversion rate from abstract to publication for these countries was UK (43%), Netherlands (47%), Germany (40%), Italy (19%) and Norway (69%).ConclusionThe conversion rate from EAPC Care Congress Meeting presentation to peer-reviewed publication better than emergency medicine and rehabilitation medicine; and it was similar on other specialities. Oral presentations had better publication rate than poster presentations. The level of conversion from presentation at the EAPC to publication in peer reviewed journal highlights the conference's importance in promoting the palliative medicine research.
The use of the edmonton symptom assessment scale to measure symptoms at the end of life
Authors: Reid Colette , Gibbins Jane , Burcombe Melanie , Bloor Sophia , McCoubrie Rachel , Forbes Karen 
Published: March 2012

AimsThere is currently no tool available to capture symptom control in the dying. The Edmonton Symptom Assessment Scale (ESAS) has been validated for patient and care giver-rated scoring of patients' symptoms, enabling recording to continue as patients deteriorate. However, it has not been used specifically to measure symptoms in the last days of life. The aim was to assess the utility of ESAS in scoring symptoms in the dying patient as measured by completion rates in a ‘before and after’ study investigating the impact of an end-of-life (EOL) care tool.Methods70 patients were recruited; 40 before and 30 following the introduction of the EOL tool. Nursing staff were asked to complete 12-hourly ESAS scores from the time the ‘diagnosis of dying’ was made until death.Results54% of the ESAS forms were completed but some were not fully scored. 77% of patients recruited had an ESAS form completed in the last 24 h of life. The number of patients with a score for each of the individual symptoms within ESAS varied in both groups. Core EOL symptoms (pain, shortness of breath, nausea, chest secretions and agitation) were scored more frequently when the EOL tool was in place. The frequency of completion of these core symptoms ranged from 75–97% for patients receiving care directed by the EOL tool versus 28–58% for patients receiving usual care.ConclusionThe proportion of missing data suggests 12 hourly symptom scoring was onerous for ward staff. The improved completion rate for core EOL symptoms suggests either that the introduction of the tool improved the nurses' ability or confidence to measure symptoms, or that scoring improved because the task was ‘learnt’ during the study. A shortened ESAS containing only core EOL symptoms might have better utility as an outcome measure for the last days of life.
Does the distress thermometer work? A systematic review of the evidence for its use and validity
Authors: Stewart-Knight Kirsten , Parry Ruth , Abey Anne , Seymour Jane 
Published: March 2012

BackgroundThe Distress Thermometer is the most widely used rapid screening tool for assessing psychological distress in people affected by cancer. Use of such tools to assess patients emotional and physical needs is a requirement of the NICE guidelines for supportive and palliative care.AimsTo explore the assumption that the Distress Thermometer improves clinicians' understanding of the concerns of people affected by cancer. Two questions were posed: 1. In what settings and with what populations has the Distress Thermometer been used? 2. What evidence concerning validity exists for this tool and what is the strength of evidence?MethodsA systematic review using a framework for mixed evidence (Hawkeret al. 2005) across 11 databases. Inclusion criteria: Question 1: papers documenting use of the Distress Thermometer with people affected by cancer, in English, published in peer reviewed journals after 1st January 1998. Question 2: papers (ie, subset of the main search) reporting assessments of the validity of the Distress Thermometer.ResultsThe authors identified 86 papers reporting use of the Distress Thermometer. Populations included: patients with a specific tumour site, older people, children, adult survivors of childhood cancer, caregivers, relatives/partners of cancer patients and people with new diagnoses and advanced disease. Of 86 papers, 33 examined the validity of the Distress Thermometer, with most comparing the tool with other measures, most commonly the Hospital Anxiety and Depression scale.ConclusionsAlthough the Distress Thermometer is widely used in cancer supportive and palliative care across a diverse range of settings and in many populations, there is little evidence to support its validity and little is known about what the tool actually measures. Future research must compare the Distress Thermometer with qualitative interviews and the true ‘gold standard’ of asking patients how distressed they feel and what concerns are contributing to that distress.
iWantGreatCare Survey: analysis of free text responses by patients and carers
Authors: Finlay Ilora , Byrne Anthony , Sampson Cathy , Nelson Annmarie 
Published: March 2012

BackgroundPalliative care is based on the principles of holistic care, incorporating pain and symptom management, provision of psychological, social and spiritual support and achievement of the best quality of life for the patient and their family (NICE 2011). The iWGC survey is designed to measure patient satisfaction with palliative care in Wales. In addition to nine questions on a Likert scale it includes a free text box within which a patient or family member is invited to write about any aspect of their care. This acknowledges that measuring satisfaction is predicated on an understanding of care from the perspective of the patient and their family.AimsTo analyse free text data from a Wales-wide questionnaire survey of patient satisfaction with care.MethodsAnalysis of free text responses (n=595) using qualitative methods allowed for the emergence of key themes from the point of view of service users, rather than based upon prior assumptions or hypotheses.ResultsAnalytic themes related to concerns, features, resources and consequences of care. This led to a focus on the emotional experience of care, and the language used by respondents to construct their understanding of palliative care. Patients and family members, usually also carers, recognised and prioritised good palliative care and highlighted the significance of the palliative care service in facilitating as well as providing care.ConclusionsAnalysis highlighted that respondents distinguished between their personal experiences and their concerns about continued funding of palliative care, provision of more palliative care staff, better resources and facilities and a desire for access to palliative care on a continuous basis.
Effects of opioids on cellular immunity: implications for palliative care
Authors: Boland Jason , Foulds Gemma , Ahmedzai Sam , Pockley Graham 
Published: March 2012

BackgroundOpioids are commonly used in the management of pain, diarrhoea, cough and dyspnoea. However, their ability to modulate the ubiquitous endogenous opioid system can lead to many side effects. A potentially covert side effect which has been attracting increasing interest relates to opioid-induced immune suppression. This may be of particular importance in patients with cancer or infection. The immunomodulatory effects of opioids require an increased awareness within palliative care given that patients are potentially living longer with a palliative diagnosis.AimsTo systematically evaluate the in vitro effects on opioids on human immune system.MethodsPeripheral blood was obtained from healthy volunteers and the influence of clinically relevant concentrations of morphine, tramadol, fentanyl, buprenorphine, methadone oxycodone codeine and diamorphine on innate and adaptive immunity were evaluated. These tests included investigation of neutrophil and monocyte bacterial defence mechanisms, the capacity of natural killer (NK) cells to kill tumour cells and T cell responsiveness to stimulation.ResultsNone of the opioids had a consistent effect on any of the immune parameters tested when analysed on a group basis. However, there was marked variability between individuals, both in their baseline and the effect of opioids. This was particularly evident with respect to the influence of morphine, tramadol, fentanyl and buprenorphine on neutrophil and monocyte bacterial defence mechanisms.ConclusionThese in vitro findings suggest that although morphine, tramadol, fentanyl and buprenorphine have little direct effect on anticancer or antiviral protection they could influence the susceptibility to bacterial infection. Clinical studies aimed at assessing the in vivo effects of opioid administration on innate and adaptive immune capacity in relevant patient groups are required in order to assess the potential clinical significance of opioids used for palliation.
An evaluation of hospice staffs' knowledge of organ and tissue donation
Authors: Wale Jane , Faull Christina 
Published: March 2012

BackgroundThe latest version of the Liverpool Care Pathway directs staff to confirm whether or not the dying patient has previously expressed a wish to donate organs. Staff require basic knowledge of organ and tissue donation to be able to answer any questions that may arise as a result of such a discussion.AimsThe study aims to explore the knowledge hospice staff have of organ and tissue donation.MethodsA questionnaire based on the knowledge and attitude questionnaire developed by Vitris1 was mailed to all hospice doctors, nurses and healthcare assistants. Staff were then invited to participate in focus groups so their knowledge could be explored in greater depth.Results76/94 questionnaires were completed. 35/76 people who replied had known someone who had needed an organ donation. Most (93%) staff realised that patients with metastatic malignant disease could donate their corneas for transplantation and some also thought that these patients could donate heart valves (13/76) and bones (10/76). Staff were less sure about what patients dying of non-malignant disease could donate. 39/76 people realised that the corneas needed to be retrieved within 24 h of death. 20/76 were unsure whether the procedure would cause disfiguration. Only 24/76 people realised that a patients' family can override the patients' wishes to donate.ConclusionsThis study has identified gaps in hospice workers knowledge of organ and tissue donation. This may be a contributing factor to why the subject is not routinely discussed at LOROS and very few patients donate.
Talking to patients in a hospice
Authors: Gadoud Amy , Adcock Yousef , Jones Lesley , Koon Sim , Johnson Miriam 
Published: March 2012

BackgroundMedical students have opportunities to learn about palliative care from talking to patients in a hospice (1). This resource is not fully used, in part due to concerns about patient and student welfare(2). The authors aimed to explore the perceptions and experiences of students talking to patients in a hospice.MethodSemistructured ‘indepth’ interviews of 14 medical students, from a medical school in the North East of England, who had spoken with hospice patients as part of their undergraduate education.FindingsOverall students found the experience very valuable. Themes arising from the data included: student emotional and personal issues; effect of the hospice environment, staff and patients; learning opportunities and impact of the experience. Despite prior anxieties that the hospice would be depressing and that they would struggle emotionally talking to hospice patients, the visit transformed this view. Other concerns included facing death and dying. After their experience the students felt they would be more able to care for people at the end of life when they qualified. They found that the hospice staff and patients were very supportive and contributed to this change. Opinion varied about the best time to attend hospice during their training but the overall view was that this was less important than the availability of adequate support. The main criticism was that there was insufficient time in the programmed hospice visit and there was a preference for the immersion possible during the longer placement of a student selected component. Illustrative quotes will be used throughout.ConclusionStudents are overwhelmingly positive about communicating with patients in a hospice and see it as unique environment in which they can learn vital skills.
Evaluation of a distance learning tool to teach GPs about metastatic spinal cord compression
Authors: Seaman Siwan , Pease Nikki 
Published: March 2012

BackgroundA delay in diagnosis/treatment of metastatic spinal cord compression (MSCC) adversely influences functional outcomes and a significant proportion of this delay is attributable to its recognition in primary care. Delays in diagnosis and treatment were the drive behind development of the 2008 NICE guideline. In the process of implementing the NICE guidance locally we recognised that increasing awareness and delivering education to GPs was key to implementing changes. A distance learning tool that would also serve as a continuing reference was proposed as a cost-effective means of achieving this goal.AimsTo measure the effectiveness of introducing a distance learning workbook on MSCC to GPs as a method of providing information on the recognition and management of suspected MSCC.MethodsA 45-page stand alone interactive workbook was designed covering spinal anatomy, pathophysiology, diagnosis and management of MSCC. The workbook was issued to 39 Welsh GPs attending a short course in palliative medicine in 2011. They were asked to complete pre and post workbook questionnaires to record competence on a scale of 1 to 5.Results62% (n=24) completed postworkbook questionnaires were returned. There was a statistically significant (p<0.05) increase in average pre and post scores in all domains assessed (anatomy, assessment, diagnosis, pharmacological and non-pharmacological management, ability to communicate information). The greatest increases were recorded in ‘ability to communicate information to patients, carers and healthcare staff’. Of participants who had managed a patient with suspected MSCC in the past 5 years 92.8% (n=13) reported that they would ‘do things differently’ next time as a result of completing the workbook.ConclusionsParticipants reported increases in competence across all areas questioned. The findings support the roll out of this education tool to GPs across the Principality and opens up the possibility of using a similar tool for teaching other palliative care topics.
Mineralogic evidences of a mid-Paleozoic tectono-thermal event in the Zonguldak terrane, northwest Turkey: implications for the dynamics of some Gondwana-derived terranes during the closure of the Rheic Ocean
Authors: Bozkaya Ömer , Yalçın Hüseyin , Göncüoğlu Mehmet Cemal 
Published: March 2012

The Zonguldak terrane is a Gondwana-derived continental microplate along the Black Sea coast in northwest Anatolia. It includes a Cadomian basement, with oceanic- and island-arc sequences, unconformably overlain by siliciclastic rocks of Ordovician to Middle Silurian age. After a period of deformation and erosion, late Lower Devonian (Emsian) quartzites and shallow-marine limestones unconformably cover Middle Silurian (Wenlock) graptolitic shales. Along several cross sections across the unconformity plane, the mineralogical characteristics of the Paleozoic sedimentary rocks in the Zonguldak terrane are studied to check whether this regional unconformity is only of epeirogenic nature or the result of a thermal event. In addition to the appearance of kaolinite in Devonian units, crystal-chemical data of illites show a sudden jump at the unconformity plane. The b cell dimension values of illites of Ordovician–Silurian units are somewhat higher than those of Devonian–Carboniferous units and show a drastic drop between the Silurian and Devonian units. The new mineralogic data indicate that the pre-Emsian rocks in the Zonguldak terrane experienced a thermodynamo event, prior to the Emsian transgression. This Caledonian-time event is also reported in east Moesian terrane but not noticed in the neighboring Istanbul–Zonguldak and in the west Moesian – Balkan – Kreishte terranes. By this, it is suggested that Zonguldak and east Moesian terranes behaved independently from the Istanbul–Balkan terranes during the closure of the Rheic Ocean. They very likely docked to Laurussia during Emsian by strike-slip faults and remained thereon at its platform margin, where the Middle–Late Devonian shallow-platform conditions were followed by fluvial (lagoon and delta) conditions and deposition of coal during Late Carboniferous.
The Cabot Head Archipelago: evidence of glacial Lake Algonquin on the Northern Bruce Peninsula, Ontario
Authors: Kor Philip S.G. , Cowell Daryl W. , Karrow Paul F. , Kristjansson F.J. Rik 
Published: March 2012

The occurrence of abandoned shoreline bedrock erosional features at the edge of the Niagara Escarpment at Cabot Head indicates the existence of a group of islands in glacial Lake Algonquin during early postglacial time, referred to herein as the Cabot Head Archipelago. The abandoned shoreline features are situated as much as 80 m above the level of contemporary Georgian Bay. The range of abandoned shoreline bedrock erosional features, including shoreline cliffs, adjacent wave-cut platforms, wave-cut notches, shore stacks, shore caves, and other features, are described. The occurrence of these features is thought to be the result of the interaction between wave action in glacial Lake Algonquin and two distinct lithological facies representing the Wiarton – Colpoy Bay and Lions Head members of the Amabel Formation. The exceptional development of the abandoned shoreline bedrock erosional features in massive reefal dolostone between elevations of ∼250 and 255 m above sea level (asl) is interpreted as representing the relatively long-lived and stable Main stage of glacial Lake Algonquin (∼11 000–10 200 years BP). Shoreline erosional forms at elevations between ∼240 and 250 m asl may be indicative of declining lake levels partially controlled by bedrock structural factors. The final abandonment of the glacial Lake Algonquin shoreline in this area occurred when the eastern outlets of the lake became ice-free and its level dropped rapidly some 10 200 years BP. The Cabot Head Archipelago and the associated suite of raised and abandoned shoreline bedrock erosional features represent a rare assemblage of landforms within the Great Lakes basin, and possibly within Canada.
Shedding Light on Melanocyte Pathobiology In Vivo
Authors: Zaidi M. Raza , De Fabo Edward C. , Noonan Frances P. , Merlino Glenn 
Published: March 2012

Abstract
Cutaneous malignant melanoma is rapidly increasing in the developed world and continues to be a challenge in the clinic. Although extensive epidemiologic evidence points to solar UV as the major risk factor for melanoma, there is a significant gap in our knowledge about how this most ubiquitous environmental carcinogen interacts with the largest organ of the mammalian body (skin) at the microenvironmental and molecular level. We review some recent advances that have started to close this gap. Cancer Res; 72(7); 1591–5. ©2012 AACR.