bluuebunny/crossref_metadata_2025_split huggingface dataset:
Communication barriers experienced by paediatric palliative care staff when interacting with children, young people and families: a literature review
Authors: Patel Reena , Coad Jane , Murray Sarah 
Published: March 2012

BackgroundA recent Department of Health funded evaluation of West Midlands Children and Young People's Palliative Care services disclosed that staff reported concerns about their ability to effectively communicate with children and families. Few studies have fully explored the problem of communication barriers in paediatric palliative care, particularly the detrimental effects of poor interaction between staff and families on children's health and well-being. A literature review was undertaken to expand the current body of knowledge about staff to patient communications in paediatric palliative care.AimFirst, to explore the literature surrounding communication barriers experienced by palliative care staff, children and families and second, to identify directions for future research.MethodsCombinations of selected key words were systematically applied to identify research on communication barriers experienced by paediatric palliative care staff and families. Articles meeting the inclusion criteria were read and descriptively summarised using a data extraction sheet. A narrative synthesis was conducted by examining commonly reported communication issues which were then condensed into five overarching themes.ResultsLimited research is available that explores the perspectives of staff, children and their families about perceived communication barriers in paediatric palliative care services. However, the primary issues to emerge from available literature included perceived lack of staff knowledge about emotional support, style in which staff conveyed diagnostic information, the constant change of professionals interacting with families and the lack of formal training and guidelines for staff to meet the needs of children and families with additional complex care needs.ConclusionThere is an under-representation of research in communicating with children, young people and families in palliative care. Improvements in staff education regarding communication skills and individualised palliative care plans for children and families may help to overcome some of the exacerbating communication barriers currently obstructing the attainment of high quality paediatric palliative care.
Priorities for global research into children's palliative care: a Delphi study
Authors: Downing Julia , Marston Joan 
Published: March 2012

ObjectivesThere is a need to develop an evidence base for children's palliative care globally. A review of children's palliative care in SSA highlighted a lack of evidence which can be seen globally. There is a need for evidence, guidelines on best practice and opportunities for collaboration. The research needs are great therefore the International Children's Palliative Care Network (ICPCN) is undertaking a Delphi study to identify the priorities for global research into children's palliative care which will have the greatest impact on quality of life.MethodFollowing a review of the literature, a research protocol was developed and submitted for IRB approval. The study is in four phases: Phase 1 – identifying a base line list of priority areas for research into children's palliative care: Phase 2 – identifying a list of participants from around the world; Phase 3 – the Delphi process where participants will rate areas for research in terms of priority, these will be reviewed followed by further rounds of Delphi as appropriate. Phase 4 – analysis of the ratings and finalisation of the priorities for Global research.ResultsThe Delphi process is currently underway and will be completed by the end of 2011. Results will be shared, along with the implications for practice.ConclusionThe priorities for global research into children's palliative care will inform a research agenda for ICPCN and its partners, in particular those areas which will benefit from regional and international collaboration. It is also hoped that the results will be used in advocating for funds for research into children's palliative care.
Specialised palliative care in a rural area
Authors: Papke Jens 
Published: March 2012

AimIn the last two decades in Germany some different projects for specialised outpatient palliative care (SAPV) were developed. Since 2007 it is benefit of health insurances; so the number of providers is growing. The main problem is heterogenity of structures and coverage of rural districts. The authors developed an independent palliative care network for provision of rural areas in Saxony, Germany.MethodsProspective documentation and assessment of achievements of the palliative care network from its beginning as accompanying research.ResultsIn the last year (7 January 2010 to 7 January 2011) Home Care Sachsen cared for 310 patients (pts); 234 pts. died. 192 pts (82%) could die at home. Average age was 69 years (between 32 and 91 years); 52% of pts were male.ConclusionBecause of lower density of pts, longer distances and poorer level of infrastructure provision of SAPV in rural regions is difficult. The construct of a multi-professional network is a useful way to provide specialised palliative care in an outpatient setting. The high rate of home deaths (82%) is a sign of good quality in outpatient palliative caring. Structure details of the palliative care network will be presented.
Using photovoice to study the experience of living with and beyond the diagnosis of a poor prognostic cancer
Authors: Balmer Claire , Griffiths Frances , Dunn Janet 
Published: March 2012

BackgroundPhotovoice is a novel research method which allows the communication of experience through participant-produced photographs. It has the potential to ‘dig deeper’ by offering participants another way of expressing aspects of life that may be difficult to put into words. It also allows researchers access to participants' homes, workplaces and social events. It is firmly rooted in the concept of ‘participation’ as participants have control of their own data and can choose when they produce it and how they share it. So far, it has been used successfully in other areas of health and social research and tentatively in cancer research.AimsThe overall aim of the presented study was to explore the experience of living with and beyond cancer from the perspective of people diagnosed with a ‘poor prognostic’ cancer in a society that celebrates survival.MethodParticipants who have received a diagnosis of and treatment for a variety of ‘poor prognostic’ cancers (defined by site or stage) have been recruited nationally. Data have been gathered via interviews and participant-produced photographs. Participatory workshops have also been held in which participants have had an opportunity to be involved with the analysis of the photographs.ResultsAnalysis is still underway but consistent and interesting themes are emerging. The photographs are offering very strong and succinct portrayals of living with a poor prognostic cancer. Full results will be available to present at the conference.ConclusionThis study should provide much needed indepth information for professionals and policy-makers on the meaning of cancer for those with a likely limited survival and the positive and negative aspects of living with such a diagnosis.
Against physician assisted suicide in terminal illness: ethics from a theravada buddhist perspective
Authors: Brodrick Robert , Keown Damien 
Published: March 2012

BackgroundThe potential legalisation of physician assisted suicide (PAS) in the UK has become a hotly debated issue in recent years. Objections from the palliative care community have hitherto been largely based on Judeo-Christian and Humanistic perspectives. In this study the authors argue that the theoretical underpinnings of Buddhist practice also have the potential to add constructively to the debate, without reference to metaphysics.AimsThe aim of this study was to examine traditional Buddhist texts as a means of discovering an alternative set of arguments relevant to palliative care and PAS in terminal illness.MethodsAs traditional Buddhist texts make no specific reference to palliative care or PAS, all passages which mention death, dying, illness, killing, kindness, intentionality and moral precepts contained within the five volumes of the Pali Sutta Pitika (the earliest recorded discourses of the Buddha) were selected for analysis. Using an inferential approach, several arguments relevant to palliative care and PAS were revealed. These were then tested for validity by checking for internal consistency within the texts and by analysis using modern applied ethics methods, namely Kantian, consequentialist, virtue ethics and four principles approaches.ResultsSeveral valid arguments in favour of palliative care and against PAS were discovered. Of note are the arguments from karma (that to care for the terminally ill potentially has beneficial effects on carers for the rest of their lives and that to assist in helping others to die has opposite, negative effects), transience (that the inevitability of death makes PAS ultimately unnecessary) and understanding (that for patients embracing life, despite inherent suffering, it can support the cultivation of wisdom and compassion, which benefit the individual and their community).ConclusionsThe analysis of traditional Buddhist texts provides novel, strong and relevant arguments in favour of palliative care in terminal illness, and against PAS.
Qualitative study on Thai physicians prognostic disclosure to patients with advance-staged cancer
Authors: Nimmanworawong Ninlawan , Jaturapatpon Darin , Hathirat Saipin 
Published: March 2012

BackgroundPhysicians who take care of advance-stage cancer patients always face the question ‘Doc, how much time do I have left?’ which make them feel awkward to answer the question.PurposeTo understand how Thai physicians disclose prognosis to advance-staged cancer patientsDesigns and methodsA qualitative indepth interview with purposeful sampling was conducted among 15 residents from six different departments in Faculty of Medicine, Ramathibodi Hospital from January to February, 2011. Content analysis was performed independently by three researchers.ResultsThere were five attitudes that affected the prognosis disclosure in advanced-stage cancer patients including perceptions of inadequate skill and competency, attitudes toward prognosis in case of their own cancer diagnosis, attitudes toward own concepts of medical professionalism, attitudes toward death and attitudes toward prognosis disclosure in different groups of Thai patients. All five attitudes affected the feeling of each physician which in turn lead to the way physicians formed patterns in prognosis disclosure. Furthermore, prognosis disclosure patterns depended on the following factors including doctors, patients, doctor-patient relationship and working settings. There were several forms of prognosis disclosure, for example, obscure disclosure, ‘range of time’ disclosure,'exact time' disclosure, ‘statistical and technical-term’ disclosure, and patient-centred disclosure. However, some physicians chose to answer in either an optimistic or pessimistic way based on their own opinions. Some physicians disclosed relatives their actual estimation, but gave patients better hope, while some physicians only told relatives without discussing with patients.ConclusionPrognosis disclosure in advance-staged cancer patients is a challenge for Thai physicians. Different styles in prognostic disclosure were not only from physicians' attitudes, patients' status, but also the relationship between doctor and patient.
A critical appraisal of ethical sedative use for dying patients: comparative ethnographic study of three palliative care units
Authors: Arolker Milind , Epstein Miran , Seale Clive 
Published: March 2012

Background and aimThe frequency and indications of use of drugs with sedative effect, for example, midazolam, for dying patients has been widely explored. Some authors have sought empirical evidence to argue a rationale that secures an ethical basis for sedation use by distinguishing it from euthanasia. A palliative care philosophy, that simultaneously promotes a symptom-control focus and a rejection of intentions to hasten death, underpins recent frameworks guiding sedative use. The authors present here empirical evidence to analyse the professional and clinical contexts influencing doctors and nurses when making ethical decisions to treat dying patients with sedatives.MethodsEthnographic methods in each of three UK palliative care units (PCUs): participant-observation of inpatient ward care for approximately 100–150 h, writing field notes after observing staff managing dying patients; 10–12 recorded interviews and two focus groups with doctors and nurses. Use of NVivo9 to thematically analyse transcribed data, and support cross-comparison of observations between PCUs. Data collection and analysis will be complete by January 2012, and data deposited with the UK Data Archive thereafter.Results and conclusionsThe main ethical justification for sedative use is that a dying patient's condition requires this. The degree of latitude given to nurses to administer doses of sedatives differs between PCUs; appearing related to the seniority of available nurses and the degree of medical control over nurses' practice generally. Staff actively manage relatives' impressions about sedation, often aiming to refute the intention of hastening death. Sedative drugs appear unique, compared to other end-of-life care drugs, facilitating the ‘emotional labour’ nurses must do to maintain a calm and orderly ward atmosphere and assisting in the production of an apparently ‘natural’ death. This in turn suggests that a dying patient's condition is not the only consideration that is relevant when choosing to use sedatives.
PREDICTION OF UNSTEADY STATES IN LID-DRIVEN CAVITIES FILLED WITH AN INCOMPRESSIBLE VISCOUS FLUID
Authors: HAMMAMI FAYÇAL , BEN-CHEIKH NADER , CAMPO ANTONIO , BEN-BEYA BRAHIM , LILI TAIEB 
Published: March 2012

In this work, a numerical study devoted to the two-dimensional and three-dimensional flow of a viscous, incompressible fluid inside a lid-driven cavity is undertaking. All transport equations are solved using the finite volume formulation on a staggered grid system and multi-grid acceleration. Quantitative aspects of two and three-dimensional flows in a lid-driven cavity for Reynolds number Re = 1000 show good agreement with benchmark results. An analysis of the flow evolution demonstrates that, with increments in Re beyond a certain critical value Rec, the steady flow becomes unstable and bifurcates into unsteady flow. It is observed that the transition from steadiness to unsteadiness follows the classical Hopf bifurcation. The time-dependent velocity distribution is studied in detail and the critical Reynolds number is localized for both 2D and 3D cases. Benchmark solutions for 2D and 3D lid-driven cavity flows are performed for Re = 1500 and 6000.
ENTROPY SOLUTIONS OF A CHAPMAN–JOUGUET COMBUSTION MODEL
Authors: SUN MEINA 
Published: March 2012

We consider the Riemann problem for a Chapman–Jouguet combustion model which comes from Majda's model with a modified, bump-type ignition function proposed in [G. Lyng and K. Zumbrun, Arch. Rational Mech. Anal. 173 (2004) 213–277; Physica D 194 (2004) 1–29]. The unique Riemann solutions are obtained constructively under the pointwise and global entropy conditions. Furthermore, we prove rigorously that these solutions are the limits of the Riemann solutions for the corresponding self-similar Zeldovich–von Neumann–Döring model as the reaction rate goes to infinity. Finally we analyze the ignition problem for this Chapman–Jouguet combustion model, and the solutions show that the unburnt state is stable (respectively unstable) when the binding energy is small (respectively large), which is the desired property for a combustion model. We can also observe the phenomenon of the transition from a weak deflagration to a strong detonation which cannot occur for the Chapman–Jouguet combustion model corresponding to Majda's model with a step-type ignition function.
Requirements to Assess Feasibility of Phase 0 Trials during Major Abdominal Surgery: Variability of PARP Activity
Authors: Heitz Florian , du Bois Andreas , Rochon Justine , Scheil-Bertram Stefanie , Hils Rita , Fisseler-Eckhoff Annette , Barinoff Jana , Kaub Christine , Harter Philipp 
Published: March 2012

Abstract
Purpose: The aim of this study was to evaluate the feasibility of phase 0 trials in the setting of a routine surgical procedure. Logistic considerations, tissue sampling and tissue handling, and variability of a biomarker during surgery, in here PARP, were evaluated.
Experimental Design: Patients with highly suspicious or proven diagnosis of advanced ovarian cancer, planned for debulking surgery were asked to allow sequential tumor biopsies during surgery. Biopsies were frozen immediately and PARP activity was measured subsequently.
Results: Baseline biopsies were obtained from eight patients after a median time of 88 minutes (minimum of 50 to maximum of 123 minutes). Second and third biopsies were obtained after a median of 60 (32–96) and 101 (79–130) minutes, respectively. Mean tumor load was 44% (5%–100%), with a cellular viability of 98% (85%–100%). Median baseline PARP activity was 1035 pg/mL (range, 429–2663 pg/mL). The observed interpatient variability at baseline was large: SD was 0.59 after natural logarithm transformation.
Conclusions: Conducting phase 0 trials during surgery seems to be feasible in terms of logistic considerations. In preparation of a phase 0 trial during surgery, a feasibility study like this should be conducted to rule out major interactions of the surgical intervention with respect to the targeted biomarker. Clin Cancer Res; 18(9); 2632–7. ©2012 AACR.
Phase I Trial of Intraperitoneal Pemetrexed, Cisplatin, and Paclitaxel in Optimally Debulked Ovarian Cancer
Authors: Chambers Setsuko K. , Chow H-H. Sherry , Janicek Mike F. , Cragun Janiel M. , Hatch Kenneth D. , Cui Haiyan , Laughren Cynthia , Clouser Mary C. , Cohen Janice L. , Wright Heather M. , Abu Shahin Nisreen , Alberts David S. 
Published: March 2012

Abstract
Purpose: This phase I trial evaluated intraperitoneal (i.p.) pemetrexed, cisplatin, and paclitaxel in optimally debulked ovarian cancer.
Experimental Design: Dose escalation of day 1 i.p. pemetrexed accrued three patients to each of five dose levels (60–1,000 mg/m2), along with day 2 i.p. cisplatin (75 mg/m2) and day 8 i.p. paclitaxel (60 mg/m2). The goals were to determine maximum tolerated dose (MTD), 18-month progression-free survival (PFS), and pharmacokinetics of i.p. pemetrexed.
Results: Cycles, given every 21 days, had an 80% 6-cycle completion rate. There was minimal grade III toxicity in the first 4 dose levels and remarkably an almost complete absence of peripheral neuropathy and alopecia. At the highest dose level, two of three patients experienced ≥grade III and dose-limiting toxicity (DLT; hematologic, infection, gastrointestinal). There was a pharmacokinetic advantage for i.p. pemetrexed with an intraperitoneal:plasma area under the concentration–time curve ratio of 13-fold. Neither analysis of pharmacokinetic nor homocysteine levels explains the unexpected severity of toxicity in those two patients. On the basis of plasma C24h levels, the 42 cycles at ≥500 mg/m2 i.p. pemetrexed without DLT, the MTD appears to be 500 mg/m2. Median PFS is 30.1 months; 18-month PFS is 78.6% (median follow-up 22.4 months).
Conclusions: This i.p.-only regimen in front-line ovarian cancer is feasible with PFS in line with recent literature. We suggest phase II trials of this regimen in this population with i.p. pemetrexed at 500 mg/m2. The favorable toxicity profile at doses &lt;1,000 mg/m2, which needs to be confirmed, appears to compare well with standard combination i.v./i.p. platinum/taxane chemotherapy in this disease. Clin Cancer Res; 18(9); 2668–78. ©2012 AACR.
Hyperinsulinemia Does Not Change Atherosclerosis Development in Apolipoprotein E Null Mice
Authors: Rask-Madsen Christian , Buonomo Erica , Li Qian , Park Kyoungmin , Clermont Allen C. , Yerokun Oluwatobi , Rekhter Mark , King George L. 
Published: March 2012

Objective—
To determine the contribution of hyperinsulinemia to atherosclerosis development.

Methods and Results—

Apolipoprotein E (
Apoe
) null mice that had knockout of a single allele of the insulin receptor (
Insr
) gene were compared with littermate
Apoe
null mice with intact insulin receptors. Plasma insulin levels in
Insr
haploinsufficient/
Apoe
null mice were 50% higher in the fasting state and up to 69% higher during a glucose tolerance test, but glucose tolerance was not different in the 2 groups. C-peptide levels, insulin sensitivity, and postreceptor insulin signaling in muscle, liver, fat, and aorta were not different between groups, whereas disappearance in plasma of an injected insulin analog was delayed in
Insr
haploinsufficient/
Apoe
null mice, indicating that impaired insulin clearance was the primary cause of hyperinsulinemia. No differences were observed in plasma lipids or blood pressure. Despite the hyperinsulinemia, atherosclerotic lesion size was not different between the 2 groups at time points up to 52 weeks of age when measured as
en face
lesion area in the aorta, cross-sectional plaque area in the aortic sinus, and cholesterol abundance in the brachiocephalic artery.

Conclusion—
Hyperinsulinemia, without substantial vascular or whole-body insulin resistance and without changes in plasma lipids or blood pressure, does not change susceptibility to atherosclerosis.
Very Urgent Carotid Endarterectomy Confers Increased Procedural Risk
Authors: Strömberg Sofia , Gelin Johan , Österberg Torun , Bergström Göran M.L. , Karlström Lars , Österberg Klas ,   for the Swedish Vascular Registry (Swedvasc) Steering Committee
Published: March 2012

Background and Purpose—
Current Swedish guidelines recommend that carotid endarterectomy should be performed within 14 days of a qualifying neurological event, but it is not clear if very urgent surgery after an event is associated with increased perioperative risk. The aim of this study was to determine how the time between the event and carotid endarterectomy affects the procedural risk of mortality and stroke.

Methods—
We prospectively analyzed data on all patients who underwent carotid endarterectomies for symptomatic carotid stenosis between May 12, 2008, and May 31, 2011, with records in the Swedish Vascular Registry (Swedvasc). Patients were divided according to time between the qualifying event and surgery (0–2 days, 3–7 days, 8–14 days, 15–180 days). Stroke rate and mortality at 30 days postsurgery were determined.

Results—

We analyzed data for 2596 patients and found that the combined mortality and stroke rate for patients treated 0 to 2 days after qualifying event was 11.5% (17 of 148) versus 3.6% (29 of 804), 4.0% (27 of 677), and 5.4% (52 of 967) for the groups treated at 3 to 7 days, 8 to 14 days, and 15 to 180 days, respectively. In a multivariate analysis, time was an independent risk factor for perioperative complications: patients treated at 0 to 2 days had a relative OR of 4.24 (CI, 2.07–8.70;
P
<0.001) compared with the reference 3- to 7-day group.

Conclusions—
In this study of patients treated for symptomatic carotid disease, it was safe to perform surgery as early as Day 3 after a qualifying neurological event in contrast to patients treated within 0 to 2 days, which has a significantly increased perioperative risk.