bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring hand size in patients with breast cancer related lymphoedema (BCRL)
Authors: Borthwick Yolande , Paul Lorna , Sneddon Margaret , McAlpine Lesley , Miller Claire 
Published: September 2011

Breast cancer related lymphoedema (BCRL) affects 24–42% of patients after treatment for breast cancer. The gold standard method to measure the hand swelling associated with BCRL is to submerge the hand/arm into water and measure the amount of water displaced. This method is not always possible clinically and the figure of eight method, which involves wrapping a simple measuring tape around the hand in a specific way, may be an alternative method of measurement.The aim of the study was to examine the reliability and validity of the figure-of-eight method of measuring hand size in women with BCRL.Methods24 people with BCRL had their affected hand measured by both the water displacement and tape measure methods by two novice therapists (testers). The figure of eight measurements were taken using a blank tape which was then measured against a meter stick by the recorder. For the water displacement method, subjects were asked to submerge their hand into the water filled volumeter. The volume of the water displaced was measured and recorded by the recorder. The therapists were therefore blind to the results. Each method was repeated three times and the order of testing was randomised between subjects and testers.Results24 full sets of data were available for analysis. In terms of intertester reliability the ICC values ranged form 0.825 to 0.854. For intratester reliability ICCs were 0.889 for tester 1 and 0.919 for tester 2. For validity Pearson's – moment correlation was 0.700 for tester 1 and 0.752 for tester 2 (both p<0.001).ConclusionThe figure of eight method was found to be a valid and reliable method of measuring hand swelling. The findings of this study would support the use of this simple clinical measurement for determining the extent of hand swelling in women with BCRL.
Providing culturally competent palliative care in Glasgow
Authors: Love Barbara 
Published: September 2011

BackgroundGlasgow's population consists of a significant number of people of South Asian origin for whom many barriers exist to accessing services. Traditional hospice services have not always been seen as acceptable to this population. In order to improve access to palliative care services, a strategic and collaborative approach within Glasgow's minority ethnic communities was required.MethodsA steering group was established, with representation from the multidisciplinary team, local ethnic communities and community healthcare partnerships. Awareness raising events were delivered across community groups, places of worship, cultural events, festivals, and local media. A nurse led drop-in service was implemented in a Sikh Gurdwara, Hindu Mandir, Islamic Mosque and an independent community centre. The drop-in service offered confidential consultation on issues relating to illness, treatments, referrals and support to both patients and families. Participant feedback was obtained. Ethnicity data was collected and analysed on new referrals to hospice services.ResultsPublic engagement events within each of the identified religious communities attracted an audience of approximately 200 at each event.Volunteers from the minority ethnic population were recruited to support the promotion of the project in their local areas.Local minority ethnic community elders participated in the development of a translated information booklet.A small increase in referral rates from ethnic minority communities has been noted.The nurse led drop-in service has been well received with an average of four consultations per session.ConclusionsRelationships with minority ethnic communities were strengthened raising awareness of palliative care services. Potential misconceptions and barriers were addressed.Educational initiatives have provided an understanding of cultural needs in order to provide culturally competent services.
An evaluation of a hospice at home service: a questionnaire survey of GP & district nurse referrers
Authors: Blanchard Hazel 
Published: September 2011

IntroductionNational recognition of services to provide end of life care and their importance has been increasing over recent years. A questionnaire survey of those referring to a trained nursing hospice at home service was completed as part of the X Hospice's service review.AimsAccording to professional referrers – does the hospice meet its objectives and provide appropriate services?MethodsA specifically designed questionnaire was pre-tested and piloted before posting to all professional referrers. The single A4 double sided questionnaire looked at referrer satisfaction, carer/family support and patient referrals.ResultsThe response rate was 72/110 (65%) but 6 referrers did not consent. 32/34 (94%) of GPs and 19/19 (100%) of District Nurses(DNs) were satisfied or very satisfied with the response time; 32/37 (87%) of GPs and 19/19 (100%) of DNs with team communication and 33/35 (94%) of GPs and 17/18 (94%) of DNs found the team to be always supportive to carers. 50/57 (88%) of referrers felt the service had enabled their patients to die at home. In the free text comments, the support, time and experience of the team were valued. The overnight on-call, night sits and team working with the DN teams were also recognised as strengths, though referrers wanted more night sit availability.DiscussionThe results correlate with the literature on Hospice at Home services to date. The evaluation has prompted meetings with GPs and DNs to give an update about the service. It has confirmed the value of the service within the community. The request for more night sits was deemed to be valid.ConclusionThis survey demonstrated that X-Hospice at Home is highly valued by referrers and has enabled appropriate service development in line with their feedback.
Setting up a community interest company alongside a hospice
Authors: Clitherow Rebekah 
Published: September 2011

The presentation will describe the setting up of a Community Interest Company alongside a Hospice.We aimed to set up a Community Interest Company to explore a potential new income stream. The CIC also provided the opportunity to deliver projects that were complementary to our core purpose but without overt investment from the Hospice.We took various projects, such as a schools bereavement link project (offering advice, training to school staff and support for children facing serious illness or bereavement), which had grown beyond the remit and capacity of the Hospice Counselling Services into the Community Interest Company so that these services were available locally to be bought in.▶Many local schools are making service level agreements with the CIC and requesting that we develop services, such as group work for children affected by loss.▶Building partnerships locally has increased opportunities for the Hospice fundraising department.▶Volunteer counsellors now have opportunities for progression- this has improved recruitment and retention.▶We are building resilience and awareness of response to loss in the local community; the people benefiting from the projects are the patients, carers and relatives that will access the Hospice in the future.▶Managing the change with a new initiative and communicating the potential benefits across the Hospice has taken time.▶Keeping partner organisations on board as the project transferred to the CIC has been important, as has communicating the relationship between the Hospice and CIC.While Hospices are specialists in bereavement care the skill set that comes with supporting people emotionally is transferable to many situations and expertise in loss, Hospice values and approach is welcomed within other organisations.Our experience will be of interest to any Hospice considering setting up a Community Interest Company as a potential income stream.
A model of care in a children's hospice – report on an independent evaluation
Authors: Lindsay Bruce , Crozier Kenda , Leeson Janet , Wray Jo , Andrews Lauren 
Published: September 2011

This paper reports on a Department of Health funded independent evaluation of a Children's Hospice service model. Over 150 stakeholders; hospice staff, representatives from external agencies, children, young people and families; acted as participants. The findings and recommendations are widely applicable in children's hospice care, identifying issues of international relevance.A mixed methods approach was adopted, involving focus groups with family members and hospice staff, individual face-to-face or telephone interviews with family members, hospice staff and external staff and a web-based survey for parents. Topics covered included participants' perceptions of the service model and the provision of care, the use of assessment and outcome measures, and the current and potential use of emerging technologies within hospice care. Interviews were recorded and transcribed verbatim and analysed using thematic coding.FindingsPerceptions of the model were inconsistent: some respondents viewed the intent of the model positively but had concerns about its achievement in practice. Tensions between teams and the impact of end of life care on respite were identified as concerns. Families reported high levels of satisfaction with care, but the impact of late postponement or cancellation of respite care was a potentially serious problem. Transition to adult services was viewed as increasingly important as life expectancies increase.The evaluation of individual care episodes, rather than overall service provision, did not appear to be undertaken systematically. While emerging technologies have the potential to impact positively on care, their adoption was seldom noted by participants.Key recommendationsRevision of internal communication systems, to improve links between hospice centres, and between professional groups and teams; clearer definition of the model of service; evaluation of potential uses of emerging technologies and a review of the impact of end of life care on respite would all be of benefit to the effectiveness of care delivery.
Talking about dying and death
Authors: Kirshbaum Marilyn , Carey Ian , Conrad Laura 
Published: September 2011

ObjectivesThis presentation will report on research commissioned by a hospice in England and work done to promote meaningful discussion about this sensitive topic. Since 2008, the hospice has run a series of events to encourage people to be more open. Two panel discussions have been held, entitled ‘Dying & Death: Let’s Talk about It', which have resulted in good attendance and constructive dialogue. In addition, the local university was commissioned to identify perceptions surrounding talking about dying and death.Focus groupsTwo focus groups explored viewpoints from the general public and practitioners. The focus group sessions were facilitated, audio-recorded, transcribed, coded and analysed by researchers.Panel discussionThe panels consisted of people such as writers, poets, academics, vicars, medical consultants and journalists; the audience was invited to ask questions.ResultsFour conceptual themes were identified from the focus groups:▶Emotions, beliefs and behaviours▶Coping with adversity▶Difficulties, barriers and tensions▶Fostering a participative future.The panel discussions produced dialogue around issues such as the role of religion in death, what constitutes a good death and euthanasia.ConclusionsA lack of openness together with a ‘live forever’ mindset contributed to a cultural shift where the inevitable isn't discussed; which hinders advance care planning and adversely affects the grieving process. Dying and death was articulated as an upsetting and taboo topic. Some practitioners take the view that they “do not want to upset patients” and choose avoidance, while others are drawn to talking as an integral aspect of their role. Dying people often want the opportunity to talk through their wishes, though such discussions with the ‘general public’ can be more problematic.RecommendationsHospices are advocated to address the need for more outreach events in the community and wider education and training for all.
Breakthrough medication and implications for practice
Authors: Wright Angela , Tague Yvonne 
Published: September 2011

IntroductionAn exercise which started out as an aide memoir for medication administration/documentation was recognised and adapted to become an audit tool to measure the amount of breakthrough medications given. It was recognised that administering these medications takes a huge amount of time on a daily basis and so has other implications.AimsThe purpose of this presentation is to highlight the issues surrounding breakthrough medication needs of patients in a hospice inpatient unit. This will highlight issues surrounding symptom control, drug rounds as well as quantifying a huge part of the nursing role making it easier to measure.MethodStaff document every breakthrough drug given over a 24 period, this includes the type of drug, time given and number of inpatients. Data it is divided in to 4 h blocks to give a clearer picture of when breakthrough medication is needed.ResultsA snapshot comparison between January 2010 and January 2011 is given. Although the results demonstrate a correlation between the number of patients and number of breakthroughs given, other patterns have emerged. Most breakthroughs consistently occurred between 10:00 and 14:00, the least between 02:00 and 06:00. Total number for January 2010 was 617, for January 2011 745. This on average equates to around 227 h of nursing time over the 2 months.ConclusionThe amount of breakthrough medications given is huge, the impact of which on patients is difficult to measure. Specific times when breakthrough needs are greater have been assessed and the morning drug round time changed. This has been helpful to quantify a complex part of the nursing role which may be helpful particularly to non-clinicians.RecommendationsFurther studies are recommended to include more detailed analysis of specific data. Suggestions are specific symptoms, methods of administration, effectiveness of end of life care, prescribing and implications for staff.
Improving practice through audit: administration of blood transfusions within a hospice setting
Authors: Waddell Jennifer , Hodgson Aruna , Wiseman Jenny 
Published: September 2011

BackgroundThe cause of anaemia in palliative care patients is often multifactorial. Symptom burden is important when deciding whether to transfuse or not. Although formal consent for transfusion of blood products is not legally required, it is good clinical practice to inform the patient of potential risks and benefits. Following the Safer Practice Notice 14 “Right patient, right blood” in November 2006, national competencies for clinical staff involved in blood transfusions were introduced. The hospice decided to look at the blood transfusion process.AimsTo assess whether aspects of the blood transfusion process were adequately documented, including consent, provision of patient information leaflets, symptomatic benefit following blood transfusion and decisions regarding the appropriateness of future blood transfusions.MethodsRetrospective audit of patients receiving a blood transfusion within the inpatient unit or day hospice, against hospice standards. Data collected included demographics, haemoglobin (Hb) and symptoms pre-transfusion, blood prescription details, documentation of consent and decisions about whether future transfusions would be appropriate. Initial data collection period June to November 2007. A blood transfusion proforma was developed and introduced. Repeat data collection period April to September 2010.ResultsA comparable number of blood transfusions were given in each period. Documentation of informed consent improved from 4% to 81% transfusions. Use of information leaflets increased from 0% to 29% transfusions. The number of transfusions that symptoms were not documented was reduced from 62% to 10%. Fatigue was the most common symptom reported in each cycle. Documentation of decisions about whether future transfusions were appropriate improved from 17% to 24%.ConclusionThe proforma has improved the documentation of symptoms, consent and use of information leaflets. Further improvement is needed in other areas. This will be achieved through dissemination of audit results, adjustments to current proforma and staff education. A re-audit is planned for the future.
Making volunteers count
Authors: Scott Ros 
Published: September 2011

BackgroundMany hospices owe their origins to volunteers. Volunteers' involvement today is still integral and vital to the success of the hospices they support. However the strategic importance of volunteers is often overlooked and the role of volunteers and their contribution to the cost effectiveness and sustainability of hospices is rarely considered. However if volunteers are to be fully recognised as a strategic asset we must be brave enough also to describe volunteers in business terms.Purpose of projectThe purpose of the project is to:▶Determine the economic value of volunteers and return on investment▶Demonstrate volunteering as a strategic asset.▶Explore the use of the economic value of volunteers to influence funders.MethodsVolunteer hours may be collected in many different ways depending on the way volunteering is structured. Hours are calculated on a monthly basis and recorded on a spreadsheet. Staff equivalent roles and hourly rates are then listed for each volunteer role. These are then multiplied by the number of volunteer hours and a percentage added for on costs. Once the total has been calculated the return on investment can be calculated.One hospice's experience Volunteer value in CHAS is calculated and reported on an annual basis. In the year 2009–2010, 900 volunteers donated 83,100 h, with an economic value of £1.25 m. The return on investment was 7:1. The information is disseminated in many ways and is used for many purposes, including as part of the charity's annual report.ConclusionsIn this time of challenging and uncertain economic circumstances, measuring the value of volunteer time has many benefits to hospices and can be used in many ways. These include monitoring and demonstrating the cost effectiveness of services and influencing funders.
Introducing the accufuser: a new solution for ambulatory continuous epidural infusion
Authors: Thompson Anthony , Barton Greg , Coackley Alison , Finnegan Clare , Hyland Charlie , Levshenkov Kosta 
Published: September 2011

IntroductionEpidural analgesia is useful for some patients with refractory cancer pain. However delivering a continuous epidural infusion can raise some challenges regarding safety and practicality. We present our experience of using the Accufuser Elastomeric Vacuum pump.Aims▶To identify a delivery method for continuous epidural infusion for ambulatory patients in the Hospice and Community setting.▶To develop policies and procedures and facilitate staff training.▶To facilitate discharge of ambulatory patients with continuous epidural infusions.MethodsThe Integrated Pain service performs joint consultations and has monthly meetings to develop Policies and Procedures and discuss complex cases. In response to patient need we performed a literature review to select a device that was portable, light, easy to fill, has long duration of action and was safe. We met with the manufacturer to evaluate it fully prior to use.ResultThe Accufuser is an elastomeric device delivering a near linear infusion with a patented piston preventing under or over dosing. It has variable infusion rates and volumes. It is filled aseptically in the hospital pharmacy in the aseptic unit and we used a device which lasts 5.7 days. It was used for a patient with severe perineal pain despite maximal tolerated oral therapy who had benefitted from bolus epidural analgesia. Following titration of diamorphine, clonidine and levobupivacaine the patient was discharged and returned to the hospice for renewal.DiscussionIntroduction of the accufuser required an integrated approach from the Pain team, Pharmacy and the Specialist Palliative Care Team. Development of a policy and patient leaflets alongside intensive staff training was required. We feel this is innovative practice and opens up the choices for Units and Pain teams dealing with Epidural infusions. This device is unique in its mechanism and patented technology and offers a better patient experience.
Meeting the need of general practitioners for palliative care education
Authors: Coackley Alison , Powell Paula , Thompson Anthony , Clare Littlewood 
Published: September 2011

IntroductionThe care of patients with advanced illness is now shifting into the community setting. As a result general practitioners will provide the majority of care for these patients but often lack the confidence and experience to deal with increasingly complex problems. Local GPs identified the need for education in palliative care. However workload can make the provision of education in an acceptable format with good attendance can be a challenge.The aim of this educational initiative was to offer an up to date, relevant and enjoyable course for doctors which improved knowledge, developed skills and influenced practice. The format was also designed to develop closer working relationships between specialists and generalists.Method of deliveryA survey was conducted among local doctors asking for opinions on the need for palliative care education and optimum methods of delivery. The resulting education course was delivered by specialist palliative care professionals one evening a month for 6 months. Each session focused on a different aspect of symptom control and included pain, vomiting, emergencies, agitation, depression/anxiety/dyspnoea. A seminar was followed by small group workshops for case discussion.Results42 doctors registered for the course and 75% attended all 6 sessions. There was evaluation of individual sessions and the course as whole. Results for relevance and appropriateness were excellent. Each session influenced practice for the majority of delegates and fully met the expectations of the participants. The course allowed extensive networking and has resulted in closer working relationships.ConclusionThere is a demand for education in symptom control among generalists working in the community. Traditional ways of delivering education can be extremely successful in terms of acceptability and impact. Consultation with local practitioners is key in providing a successful education initiative.