bluuebunny/crossref_metadata_2025_split huggingface dataset:
Don't worry, be constructive: A randomized controlled feasibility study comparing behaviour therapy singly and combined with constructive worry for insomnia
Authors: Jansson‐Fröjmark Markus , Lind Marcus , Sunnhed Rikard 
Published: May 2011

Objectives. Based on the lack of research on interventions targeting intrusive and worrisome thinking for insomnia, the aim was to examine whether a constructive worry (CW) intervention adds to the effects of behaviour therapy (BT).Design. A randomized, controlled design was used. The design included a 2‐week baseline, a 4‐week intervention phase (sleep restriction and stimulus control [BT] or sleep restriction and stimulus control plus constructive worry [BT + CW]), and a 2‐week follow‐up.Methods. Twenty‐two patients with primary insomnia participated. The primary outcome was the Anxiety and Preoccupation about Sleep Questionnaire (APSQ), and secondary endpoints were subjective sleep estimates, the Insomnia Severity Index (ISI), and the Work and Social Adjustment Scale (WSAS).Results. Although both conditions produced significant improvements in subjective sleep estimates, no significant group differences over time were shown for total wake time (TWT) and total sleep time (TST). Both interventions resulted in reductions over time in insomnia severity, worry, and dysfunction. Compared to BT, BT + CW led to a larger decrease in insomnia severity at all three time points (controlled d= 1.10–1.68). In comparison with BT, BT + CW resulted in a larger reduction in worry at two of the time points (controlled d= 0.76–1.64). No significant differences between the two conditions were demonstrated for dysfunction. While more participants responded positively to treatment in the BT + CW (80–100%) than in the BT condition (18–27%), none of the participants remitted.Conclusions. The findings suggest that, compared to BT alone, CW might result in additional improvements in insomnia severity and worry. Given the small sample size and short follow‐up, future studies are warranted.
Effect of Bolt Spacing on the Circumferential Distribution of the Gasket Contact Stress in Bolted Flange Joints
Authors: Do Tan Dan , Bouzid Abdel-Hakim , Dao Thien-My 
Published: May 2011

Abstract
Bolted flange joints are part of pressure vessel and piping components and are extensively used in the chemical, petrochemical, and nuclear power industries. They are simple structures and offer the possibility of disassembly, which makes them attractive to connect pressurized equipment and piping. In addition to being prone to leakage, they often require maintenance while in operation in which case the bolts are either retightened as in hot torquing or untightened to be replaced. Although costly shutdowns are avoided, such maintenance work exposes the operator to a potential risk because the bolt load alteration can produce a gasket load unbalance, which results in the local gasket contact stress to drop below some critical value, causing major leak and hence jeopardizing the life of the worker. This paper addresses the issue of the contact stress level unbalance around the flange when the bolts are subjected to initial tightening. The study compares the contact stress distribution variations, an analytical developed model based on the theory of rings on elastic foundation, to those given by the finite element model and the simple beam on elastic foundation model developed by Koves (2007, “Flange Joint Bolt Spacing Requirements,” Proceedings of PVP2007, ASME Pressure Vessel and Piping Division Conference). This study is developed for the purpose of helping limit the degree of load increase in hot torquing or the maximum number of bolts to be replaced at a time and identify those flanges for which the bolt cannot be replaced in service.
Flow Past a Rotating Cylinder at Low and High Rotation
Rates
Authors: Kumar S. , Cantu C. , Gonzalez B. 
Published: May 2011

Abstract
Flow past a rotating circular cylinder is studied experimentally. The experiments are carried out in a water tunnel at Reynolds numbers of 200, 300, and 400 and nondimensional rotation rates (ratio of surface speed of the cylinder to the free stream velocity), α, varying from 0 to 5. The diagnostic is done by flow visualization using hydrogen bubble technique and quantitative measurements using a particle image velocimetry technique. We present the global view of the wake structure at the three Reynolds numbers and various rotation rates. Vortex shedding activity is observed to occur from α=0 to α~1.95, after which it is suppressed. Reynolds number is found to have a strong effect on the wake morphology near the suppression rotation rate, α=1.95. Interestingly, the vortex shedding activity again resumes in the range 4.34&lt;α&lt;4.70 as first discovered numerically (Mittal and Kumar, 2003, “Flow past a rotating cylinder,” J. Fluid Mech., 476, 303) for Re = 200. The shed vortices are of one sign in this range of rotation rates. Experimental evidence of this new vortex shedding mode is presented, for the first time, at α=4.45 in the newly discovered window of rotation rates, using flow visualization and particle image velocimetry measurements. Strouhal number measurements and global wake patterns agree well with the computations of Mittal and Kumar at a Reynolds number of 200.
Medical-device recalls in the UK and the device-regulation process: retrospective review of safety notices and alerts
Authors: Heneghan C , Thompson M , Billingsley M , Cohen D 
Published: May 2011

BackgroundMedical devices are used widely for virtually every disease and condition. Although devices are subject to regulation, the number of recalls, the clinical data requirements for regulation and the impact on patient safety are poorly understood.MethodsThe authors defined a device using European directives and used publicly available information on the Medicines and Health Regulatory Authority website to determine the number of devices recalled from January 2006 to December 2010. Two reviewers independently assessed Field Safety Notices and Medical Device Alerts. The authors wrote to manufacturers to obtain further information and clinical data, and summarised data by year, Conformité Européenne classification, indication, and Food and Drug Administration recall system of severity.ResultsIn total, 2124 field safety notices were issued over the 5-year period, an increase of 1220% (62 in 2006 to 757 in 2010). 447 Medical Device Alerts were issued in the same period, and 44% were assessed as a reasonable probability of causing serious adverse health consequences or death. The authors wrote to 192 manufacturers of withdrawn devices and received 101 (53%) replies; only four (2.1%) provided the clinical data the authors requested. A lack of available transparent data prevented full analyses of the safety impact. Of the highest-risk recalled devices, more than half were related to the cardiovascular system (25%) or musculoskeletal system (33%), and 88% (95% CI 80% to 97%) were assessed as a reasonable probability of causing serious adverse health consequences or death. For low-risk devices, the figure was 34% (95% CI 26% to 42%).ConclusionThe number of medical devices subject to recalls or warnings in the UK has risen dramatically. A substantial number of these devices may have caused serious adverse effects in patients and contributed to healthcare costs. Significant problems exist in the UK with a lack of access to transparent data and a registry of the highest-risk devices.
Symptom management research in cancer patients: state of the art
Authors: Kroenke K 
Published: May 2011

AbstractBoth physical symptoms (eg, pain, fatigue, insomnia) and psychological symptoms (eg, depression, anxiety) are prevalent in all types and stages of cancer, from newly diagnosed patients to disease-free cancer survivors to individuals with recurrent or progressive disease. Also, patients often have multiple symptoms, so programmes that focus on single symptoms often fail to optimize treatment outcomes. Additionally, effective treatments include both medications and nonpharmacological interventions, so that administration of only one type of treatment likewise may fail to optimize therapy.Key concepts in symptom management research derived from several practical clinical trials will be discussed, including:Management of patients with multiple as well as single symptoms;Integrated approach to physical and psychological symptoms;Measurement of outcomes relevant to symptom therapy;Use of technology (eg, automated home-based symptom monitoring) to augment clinical care;Adoption of a ‘treat-to-target’ approach;Decisions regarding medication versus nonpharmacological therapies;Roles of different types of clinicians in cancer symptom care;Focusing on specific cancers versus multiple types of cancer.Finally, several promising areas for future research in the management of cancer-related symptoms will be highlighted.
Co-ordination of generalist end of life care in the UK: a multi-site ethnographic study
Authors: Mason B L , Barclay S , Dale J , Daveson B , Donaldson A , Epiphaniou E , Harding R , Higginson I J , Kendall M , Munday D , Nanton V , Shipman C , Murray S A 
Published: May 2011

AbstractIntroduction and aimsAppropriate, effective and timely generalist care for patients and their families towards the end of life is recognised as an essential component of high quality, equitable care. Improving coordination of care is one of the core objectives of the UK Department of Health End of Life Care Strategy. We aimed to identify the contextual complexities and challenges to well co-ordinated care delivery for people towards the end of life in different generalist settings.MethodWe used organisational ethnography among staff who were not specialist palliative care providers in three locations; an acute receiving unit, a respiratory outpatient clinic, and a primary care practice. The protocol included sustained interactions with health providers and interviews with patients and their carers over 9 months. The integrated datasets offer an understanding of how end-of-life care co-ordination is understood, initiated and conducted within patient trajectories and in the context of everyday healthcare provision.ResultsThe patient-centred, long term focus of primary care drives individual and team activity and requires flexibility and collaboration. In the secondary care short-term, acute setting, role boundaries and a clearly defined process, in which time constraints are paramount, may result in a less personalised experience for patients.ConclusionsCoordination of care for patients and their families with advanced progressive diseases undergoing emergency admissions or transition across settings is important. The level of coordination and the systems in place influences people's experience of coordination of generalist settings. Further research regarding how collaboration influences coordination of care is required.
National snapshot study of end of life care in the community for cancer and non-cancer patients
Authors: Thomas K , Clifford C M , de Silva D 
Published: May 2011

AbstractIntroductionPrimary care provision of end-of-life care is crucial in achieving high quality care and reducing hospitalisation. The 2009 National Primary Care Snapshot Audit in End-of-Life Care provided the largest assessment of community provision, revealing key areas for further improvement.AimsTo realistically assess current provision and explore differences between cancer and non-cancer patients, those on the palliative care register, and other factors leading to quality end-of-life care.Methods502 General Practitioner practices in 15 PCTs (60% uptake ) submitted data from 4500 patients for every death over a 2 month period. The GSF After Death Analysis Audit Tool providing outcome data for individual patients, and compared with recommended best practice standards.ResultsOnly 27% of patients who died were included on the palliative care register, of these 23% were non-cancer, 17%unknown and 69% cancer, compared with 26% patient deaths from cancer. Those on the register were more likely to receive well coordinated care but 42% were considered unpredictable.ConclusionThis snapshot provides an objective overview of current community end-of-life care, demonstrating key areas for further improvement. Patients on the register received more proactive, better coordinated care than those not on the register, and cancer patients were well represented on the registers and more likely to receive good end-of-life care, in contrast to non-cancer patients. Only a quarter of all patients who died were on the register, suggesting a need for earlier recognition and better coordination of care, particularly for non-cancer patients.
Development of guidelines for oncologists to manage emotional distress in cancer patients
Authors: Holch P , Velikova G 
Published: May 2011

AbstractIntroductionEmotional distress (ED) is a significant unmet need experienced by up to a third of cancer patients. Many oncologists are reluctant to broach these issues perhaps due to (i) lack of awareness of referral pathways and (ii) a perception that it may increase the length of the consultation length. We propose that a clearly defined referral pathway to services and interventions to manage ED would help to overcome these barriers.AimsTo develop brief, accessible, evidence based guidelines for oncologists outlining local interventions and services to support the management of distress.MethodsGuidelines were developed using the National Institute of Clinical Excellence stepped psychosocial care and support model. This constituted a consensus based iterative approach involving:▶literature review▶local information gathering on services▶consultation with both professionals and patient groups.ResultsEvidence based guidelines have been produced which reflect the range of interventions and services available and provide oncologists with clear pathways for management of ED. They and are now being disseminated for independent review and the resulting feedback will be incorporated to make further improvements.ConclusionIt has been possible to incorporate the views of professionals, service users and existing information services within the guidance. The efficacy of the guidelines will be evaluated via an audit of referrals to services, consultation analysis, assessment of patient centeredness and completion of outcome measures.
A novel intervention for post-treatment oxaliplatin chemotherapy-induced neuropathy
Authors: Storey D J , Colvin L A , Boyle D , Fallon M T 
Published: May 2011

AbstractIntroduction/aimsOxaliplatin chemotherapy-induced peripheral neuropathy (OxCIPN) is a common post-treatment toxicity. Many patients are left with long-term pain and disability. Available systemic agents have limited efficacy, cause significant side-effects and take several weeks/months to work. Colleagues' preclinical work showed analgesic effects of topical transient receptor potential melastatin receptor activators in neuropathic pain. We therefore conducted a proof-of-concept study using menthol in patients with OxCIPN.Methods21 patients a median of 19 months post-treatment (range 3–35) applied 1% topical menthol, twice daily to affected areas and skin overlying corresponding dorsal root ganglia. At baseline, 2 and 6 weeks, patients completed: Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale and underwent objective assessments of gait (electronic walkway), hand dexterity (peg-board) and Quantitative Sensory Testing. Analysis: Wilcoxon signed-rank test and Pearson product-moment correlation.ResultsBetween baseline and 6 weeks, total BPI scores decreased (median 3.6 (range 1.1–7.9) versus 0.7 (0–8.3), p=0.002). 83% described less pain and 52% had ≤30% BPI decrease (deemed clinically significant). There were corresponding improvements in mood (r=0.442, p=0.045), walking velocity (r=-0.797, p=0.026) and cadence (r=-0.823, p=0.012) and trends for improved hand dexterity (r=0.487, p=0.065) and mechanical pain thresholds (r=0.447, p=0.072). Four patients discontinued treatment after 2 weeks: two had difficulty applying the cream, two described worse pain. BPI changes were predicted by pre-treatment mechanical detection thresholds (r=0.534, p=0.027).ConclusionTopical menthol appeared to improve OxCIPN pain and physical function. It also seems to be well tolerated, have minimal side-effects, works relatively quickly and warrants further study.
Community pharmacists' contribution to the management of cancer pain in the community
Authors: Savage I , Blenkinsopp A , Bennett M I 
Published: May 2011

AbstractAimTo explore community pharmacists' role in educating and advising cancer patients and their carers on optimum use of opioids for pain relief.MethodsSemi-structured interviews with a maximum diversity sample of 25 community pharmacists in three areas of England.ResultsPharmacists had no reliable method to identify a patient with cancer, had few face to face contacts with patients and no means of accessing relevant medical information. Patients' medicines were often collected by carers or delivered to their homes, and reliable access to palliative care medicines remains problematic. Pharmacists reported that a wide range of issues are raised with them by carers but these rarely included questions about opioid medicines. For some pharmacists, proactive involvement appeared to be inhibited by fear of discussing emotional and wider social aspects. Many pharmacists assumed information had already been provided by another clinician and felt isolated from other members of the care team. Medicines Use Reviews for cancer patients regarding their analgesia were rarely undertaken.ConclusionsCommunity pharmacists felt that their potential contribution to cancer pain management is constrained but they aspired to do more. Since they generally did not know which patients have cancer their provision of information and advice was ad hoc. There was little evidence of routine communication about patient care in relation to analgesia either from or to pharmacists. People with cancer and their families may currently have less access to information and support from community pharmacists than people with other conditions.
The supportive care needs of the partners and family members of long-term survivors of breast, colorectal and prostate cancer
Authors: Watson E K , Turner D , Adams E , Boulton M , Harrison S , Khan N , Rose P , Ward A 
Published: May 2011

AbstractIntroduction and aimsThere are an estimated 2 million cancer survivors in the UK today, with earlier diagnosis and improved treatments leading to an increasing number of long-term survivors. Partners and/or close family members are often a key source of support to the patient, and yet they themselves may experience significant levels of distress and have unmet needs. The main aim of this study was to describe the supportive care needs of the partners/ family members of patients who had survived breast, colorectal or prostate cancer for at least 5 years.MethodThis study was linked to a study of cancer survivors, recruited via cancer registries in the Thames Valley and North Yorkshire areas. Patients were asked to invite their partner or close family member to participate in a postal questionnaire. The questionnaire measured health status (EQ5D), levels of anxiety and depression (HADS), unmet needs (CASPUN) and positive outcomes.Results257 (78%) completed questionnaires were returned. Overall, levels of anxiety and depression were comparable with population norms. Accessible hospital parking (20%), information about familial risk (18%), managing fear of recurrence (16%) and co-ordination of care (14%) were the most cited unmet needs.ConclusionsMost partners/family members of long term survivors report few ongoing issues. However, a minority do have high levels of anxiety and/or moderate or strong unmet needs. Strategies are required to identify and support those with needs, while allowing the majority to resume normal life beyond cancer.
Evaluating a training package for health professionals and community workers to spread breast cancer awareness messages
Authors: Atkins L , Forbes L , Scanlon K , Jupp D , Carroll L , Ramirez A-J 
Published: May 2011

AbstractIntroduction and aimsDelayed presentation in breast cancer leads to more advanced stage at diagnosis and ultimately poorer survival. Delays in presentation are associated with low breast cancer awareness.Breast Cancer Care delivers the Train the Trainer: Breast Health Promotion programme to train people across England to deliver messages to increase breast cancer awareness: knowing how breasts normally look and feel and what breast changes to look for; encouraging regularly looking and feeling for breast changes; early symptomatic presentation and breast screening uptake. We measured trainees' knowledge and confidence to deliver these messages in a before and after observational design.MethodsWe recruited 126 trainees attending nine courses over 6 months. Trainees included volunteers, community workers and health professionals. They completed the Cancer Research UK Breast Cancer Awareness Measure at baseline and 1 and 6 months after attending. We also collected information about recipients of the breast cancer awareness messages during the 6 months after training.ResultsAt baseline, 46% trainees identified five or more non-lump symptoms of breast cancer; 21% identified a 70-year-old woman as at higher risk of breast cancer than a 30 or 50 year old. 50% reported looking and feeling their breasts at least monthly. These proportions are higher than the general population (18%, 14% and 23% respectively).1 Follow-up will finish in March 2011.ConclusionBreast cancer awareness at baseline was higher than in the general population. We will present 1-month follow-up data at the meeting. The findings will provide the rationale for future investment and improvements in the programme.
Identifying patients with chronic heart failure who may benefit from palliative care: a comparison of the Gold Standards Framework with a clinical prognostic mode
Authors: Haga K K , Denvir M A , Reid J , Ness A , O'Donnell M , Yellowlees D , Murray S A 
Published: May 2011

AbstractIntroductionHeart failure has a worse survival rate than many cancers, yet few patients receive palliative care. The aim of this project was to evaluate the use of Gold Standards Framework (Seattle Heart Failure (SHF)) criteria and the SHF Model in patients with heart failure.MethodsChronic heart failure patients, in NYHA class III or IV, who were being managed by a heart failure nursing service, were identified. The GSF criteria were assessed by interviewing the specialist nurse responsible for each patient's care. The SHF data were used to estimate mean life expectancy and predicted mortality at 1 year. Patients were followed up after 1 year, to evaluate; (1) all-cause mortality and (2) the sensitivity and specificity of the GSF and SHF to predict death at 1 year.Results138 patients were identified through our search. GSF criteria identified 119/138 (86%) patients that met the minimum requirement for palliative care input. However, the SHF model predicted that only 6/138 patients (4.3%) had a predicted life expectancy of less than 1 year. At follow-up, 43/138 patients had died (31%). The sensitivity and specificity for the GSF and SHF model were 22%/83% and 98%/12% respectively.DiscussionNeither the GSF nor the SHF accurately predicted which patients were in the last year of life. The implementation of palliative care in heart failure patients may require a shift away from the traditional ‘end of life’ model used in cancer, and focus on the patient's increasing needs, understanding that death, itself, may remain unpredictable.