bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traumatic elbow luxation in 14 dogs and 11 cats
Authors: Mitchell KE 
Published: May 2011

Objective To report the presentation and treatment of traumatic elbow luxation and to evaluate success following closed or open reduction.Design Retrospective case series conducted between April 1999 and April 2009.Methods Records of 14 dogs and 11 cats were reviewed for signalment, history, radiographic findings and treatment; 14 owners were contacted via phone questionnaire to assess for limb function following treatment. Fisher's two‐tailed P test was used to evaluate potential risk factors for lameness.Results The majority of luxations were caused by car accident and 96% of the cases luxated in a lateral direction. Closed reduction was successful in all cats and 11 dogs; 3 dogs required open reduction. Owners rated the animals' limb function as excellent (71%), good (7%), fair (22%) or poor (0%). All cats were rated excellent. An excellent result following closed reduction was achieved in 67% of canine cases. All cases of open reduction achieved fair results. All owners were satisfied with the outcome. No risk factors were significantly associated with post‐reduction lameness.Conclusions Elbow joints with good stability following closed reduction have a favourable outcome. Poor stability following closed reduction is an indication for surgery. Results suggest that cats tolerate elbow luxation better than dogs.
Clamped-Free Single-Walled Carbon Nanotube-Based Mass Sensor Treated as Bernoulli–Euler Beam
Authors: Elishakoff I. , Versaci C. , Maugeri N. , Muscolino G. 
Published: May 2011

AbstractIn this study, we investigate the vibrations of the cantilever single-walled carbon nanotube (SWCNT) with attached bacterium on the tip in view of developing the sensor. This sensor will be able to help to identify the bacterium or virus that may be attached to the SWCNT. Two cases are considered: These are light or heavy bacteria attached to the nanotube. The problem is solved by the exact solution, the finite difference method, and the Bubnov–Galerkin method.
The extension of smoke-free areas and acute myocardial infarction mortality: before and after study
Authors: Villalbí Joan R , Sánchez Emília , Benet Josep , Cabezas Carmen , Castillo Antonia , Guarga Alex , Saltó Esteve , Tresserras Ricard ,   for the Barcelona Group for Smoking Regulation Policies Evaluation
Published: May 2011

ObjectivesRecent studies suggest that comprehensive smoking regulations to decrease exposure to second-hand smoke reduce the rates of acute myocardial infarction (AMI). The objective of this paper is to analyse if deaths due to AMI in Spain declined after smoking prevention legislation came into force in January 2006.DesignInformation was collected on deaths registered by the Instituto Nacional de Estadística for 2004–2007. Age- and sex-specific annual AMI mortality rates with 95% CIs were estimated, as well as age-adjusted annual AMI mortality rates by sex. Annual relative risks of death from AMI were estimated with an age-standardised Poisson regression model.ResultsAdjusted AMI mortality rates in 2004 and 2005 are similar, but in 2006 they show a 9% decline for men and a 8.7% decline for women, especially among those over 64 years of age. In 2007 there is a slower rate of decline, which reaches statistical significance for men (−4.8%) but not for women (−4%). The annual relative risk of AMI death decreased in both sexes (p<0.001) from 1 to 0.90 in 2006, and to 0.86 in 2007.ConclusionThe extension of smoke-free regulations in Spain was associated with a reduction in AMI mortality, especially among the elderly. Although other factors may have played a role, this pattern suggests a likely influence of the reduction in population exposure to second-hand smoke on AMI deaths.
Measuring symptoms at the end of life using the Edmonton Symptom Assessment System
Authors: Forbes K , Gibbins J , Burcombe M E , Bloor S J , Reid C M , McCoubrie R C 
Published: May 2011

AbstractIntroduction and aimsThe Edmonton Symptom Assessment System (ESAS) has been validated for patient-completed, caregiver-assisted and caregiver-rated scoring of patients' symptoms, enabling symptom recording to continue as patients deteriorate. However, it has not been used to assess symptoms at the end of life specifically. We aimed to assess the utility of ESAS in scoring symptoms in the dying patient.Methods70 patients were recruited; 40 before and 30 following the introduction of a simple end-of-life (EOL) care tool. Nursing staff were asked to complete 12 hourly ESAS scores from the time the ‘diagnosis of dying’ was made until death.Results249 of a required 418 (59%) ESAS were completed in the pre- and 140 of 302 (46%) in the post-implementation group. 29/40 (72%) and 25/30 (83%) patients had an ESAS completed in the last 24 h in pre- and post- groups respectively. Comparison of scores for EOL symptoms before and after the introduction of the tool showed less symptom burden in the group where the tool was used. The differences in scores with 95% CIs (0–100 scales) were: pain 12.4 (−2.3 to 27.1); shortness of breath 11.7 (−6.2 to 29.6); anxiety 7.3 (−7.8 to 22.5); nausea 5.9 (−2.6 to 14.5) and secretions 12.3 (−6.7 to 31.3).ConclusionThe amount of missing data suggests 12-hourly ESAS scoring was onerous for ward staff and would not therefore capture longitudinal symptom changes. However, ESAS was useful for assessing symptoms in the last 24 h of life, enabling comparison between the two groups.
Evidence driven practice and rapid learning in supportive and palliative care
Authors: Abernethy A P 
Published: May 2011

AbstractEvidence-Based Medicine, more broadly termed ‘evidence-based practice’, is now recognised throughout medicine as routine approach to care, whereby research-derived evidence is incorporated into clinical decisions. Care is based on systematic and explicit appraisal, synthesis of information and integration of new information within the context of individual patient circumstances. Many of the barriers to evidence-based practice in palliative care are surmountable, provided they are critically considered and practical solutions developed. First and foremost, we must have evidence; generating evidence in palliative care is achievable.Following on the heels of evidence generation is evidence implementation – the practical introduction of new information into clinical practice. Rapid learning is a model for systematic evidence development and implementation whereby the care of each individual patient is reinvested into linked continuously-accumulating databases so that the care of an individual person is informed by all people before her with similar circumstances, and lessons learned from her care are incorporated into aggregating knowledge of best practice for the future. Recent findings suggest that a rapid learning system for palliative and supportive care is feasible and acceptable to patients with advanced illness, helps monitor symptoms over time, facilitates study of the impact of novel interventions, and can identify unrecognised needs and concerns.
Treatment burden in end stage heart failure (ESHF): a qualitative study
Authors: Mair F S , Browne S , Morrison D , Gallacher K , Macleod U , May C R 
Published: May 2011

AbstractIntroduction and aimsHeart failure (HF) is as ‘malignant’ as many common cancers. It is known that end stage heart failure (ESHF) symptoms have a negative impact on the daily lives of patients who also feel unsupported. The aim of this study is to examine patient experiences of managing their condition, with a particular focus on their ‘treatment burden’, defined as the ‘work’ they do to manage their condition, including reference to the services they use and how they negotiate and mobilize these. It is essential to understand these issues if we are to be able to design more patient centred services.MethodsThis study involves semi-structured interviews with ESHF patients focusing on the work they do to manage and ‘live’ with their condition. Qualitative data analysed using framework methods informed by Normalization Process Theory. Inclusion criteria: at least Grade 3 or 4 NYHA classification HF; who have ongoing symptoms despite optimal therapy; and have a history of admissions for this condition.Results33 patients identified, 21 consenting to participation. 16 male; 5 female. Patients described a vast range of treatment burdens many which were secondary to the health care systems and the lack of a patient centred approach. Issues raised included: the work imposed by disorganised systems of care necessitating multiple attendances for check-ups and investigations; lack of continuity; inadequate communication between health professionals; polypharmacy; and difficulties accessing services.ConclusionsThis study has highlighted a range of challenges for patients posed by current health care systems, highlighting clear points for intervention.
Moving Forward – Developing an information resource for breast cancer patients at the end of hospital based treatment
Authors: Scanlon K , Reed E , Wray J , Fenlon D 
Published: May 2011

AbstractBackgroundFollowing completion of hospital based treatment breast cancer patients often feel isolated and abandoned and report a lack of information and support to address their recovery needs. Feedback from service users at Breast Cancer Care identified a need for a resource at the end of breast cancer treatment. In collaboration with our Service User Research Partnership (SURP) group we set about designing and delivering this study.AimsTo develop a resource for breast cancer survivors based on their identified unmet information and support needs and user feedback.MethodsA qualitative mixed method approach:Phase 1:▶Two Focus groups with 12 women at the end of hospital based treatment.▶Telephone interviews of 12 healthcare professionals.Phase 2:▶Reconvened focus groups and email review of healthcare professionals to critique a prototype resource.ResultsResource content was informed by the conceptual framework developed from interview analysis which identified a process of reconciliation – ‘reflection’, ‘isolation’, ‘loss of self’ and ‘moving forward in life’. Participants wanted a comprehensive resource that could be individually tailored and includes self management strategies Real-life experiences of patients, signposting to other resources and usefulness over time were also considered important.ConclusionThis is the first information resource for breast cancer survivors in the UK. It has considerable potential to improve the experiences of many living with breast cancer. Further, it will assist healthcare professionals in the care of their patients at the transition from active treatment to survivorship. SURP involvement has strengthened the quality of the research.
How good is palliative care at following the MRC new guidance on complex interventions?
Authors: Evans C J , Higginson I J 
Published: May 2011

AbstractIntroductionImproved and cost-effective palliative care services are required to advance care for patients, their families and society. Service developments are however, often ad hoc with limited evaluation and little research investment. MORECare (MRC/NIHR) is developing research methods to evaluate the effectiveness of such serviceshttp://www.csi.kcl.ac.uk/morecare.html.AimsTo systematically review the application of effectiveness research methods in evaluations on models of service delivery in palliative care To synthesis ‘best practice’ and identify contentions or uncertain areas that require methodological debate.MethodsWe drew on narrative synthesis to systematically search 6 electronic databases and the bibliographies of the included papers. We included systematic reviews on the effectiveness of palliative care services for patients and/or their families with advanced progressive malignant/non-malignant disease. The MRC New Guidance structured the data synthesis with quality assessment to examine robustness.Results35 systematic reviews met the inclusion criteria. The findings indicate a disparate application of the MRC guidance. Prominent areas include debate on evaluating effectiveness (eg, outcome measurement), while less attention is given to intervention development and modelling, leading to a prominence of weak trial design. The implementation of evidence into clinical practice is the weakest area.ConclusionThe MRC guidance is rarely used in its entirety. Application and development of some components is evident, but methodological discussions concern challenges to undertaking effectiveness research and the weaknesses of the research methods. Opportunities for innovation in trial design are apparent, particularly intervention development and modelling. Innovation in research methods is imperative to strengthen the evidence base.
Impact of information intervention on social distress; a randomised pilot study
Authors: Ingleson E J , Hector C , Campbell L , Bartlett Y , Brown J , Wright P , Velikova G 
Published: May 2011

AbstractIntroduction and aimsUnresolved social difficulties are prevalent in oncology patients, can impact on well-being and undermine ability to cope with the larger stressors of disease and treatment. Information may deal with psychosocial issues without over-burdening staff. A randomised pilot study investigated the impact of a specifically designed Support Services Information Pack (SSIP) on levels of social distress in routine practice.MethodsThe SSIP was designed and evaluated. Adult patients receiving active treatment were randomised to intervention or control group. The Social Difficulties Inventory (SDI-21) assessed the severity of social difficulties at baseline and after the last of four review consultations. The intervention group received the SSIP prior to the second consultation. The sum of 16 of the SDI-21 items was used to provide an overall index of social distress (SD-16, range 0 to 44). All participants were interviewed on completion. Counts were taken of the number that used the SSIP. Analysis of covariance tests compared mean SD-16 scores.ResultsParticipants: 165 patients were approached, 88 consented and 75 completed the study. Complete SD-16 data was available for 70 patients. The SSIP was not extensively used; the majority of patients read it but took no action, but may use it in future (67%). The mean SD-16 scores were 8.53 for the intervention group (95% CI 7.1 to 9.9) and 8.25 for the control group (CI 6.7 to 9.8).ConclusionDuring this pilot study the SSIP was not used. Timing of delivery of the intervention will be investigated in future trials.
Management of emotional distress in cancer patients: is there a role for antidepressants?
Authors: Holch P , Absolom K L , Pini S , Hill K , Liu A , Sharpe M , Richardson A 
Published: May 2011

AbstractIntroductionDepression is common in cancer patients and often associated with increased morbidity, hospitalisation and reduced quality of life. Current opinion supports the use of antidepressants (AD) for moderate and severe depression in physical illness. However, AD may be inadequately prescribed to oncology patients and factors other than need may influence prescribing practice.AimsTo explore oncology professionals views on the use of AD in the management of emotional distress in cancer patients.Methods18 randomly selected professionals from the Yorkshire Cancer Network (oncologists, surgeons, clinical nurse specialists and ward nurses) participated in a qualitative interview study. To explore their views on AD use in oncology they were asked: What leads you to prescribe AD? or Do you have any views on the use of AD? key themes were extracted via framework analysis.ResultsDespite recognising the value of AD in cancer care, professionals were reluctant to prescribe AD stressing a lack of knowledgeI would be very worried about my ability to do thatand overwhelmingly saw the general practitioner (GP) as most appropriate for this role. Overreliance on AD was voiced as were views that taking AD was defeatistmedicating them is a slippery slope.ConclusionThese findings highlighted a need for training on the use of AD in cancer care and to counteract negative views contributing to exclusion from treatment plans. A key prescribing role for the GP is described however it is unclear whether referrals are made. Future work should determine the role of the GP and map prescribing patterns elsewhere.
Comparison of clinicians' and advanced cancer patients' estimates of survival
Authors: Gwilliam B , Keeley V , Todd C , Gittens M , Roberts C , Kelly L , Barclay S , Stone P 
Published: May 2011

AbstractAimsTo determine whether doctors, nurses or the multi-professional team (MPT) are better at prognosticating in advanced cancer. To determine which clinician factors influence prognostic accuracy. To investigate patients' views about receiving prognostic information and to evaluate the accuracy of their own estimates.MethodsAs part of a large prospective multi-centre study to develop a novel prognostic scoring system for patients with advanced cancer, clinicians were asked to estimate whether patients were expected to live for ‘days’, ‘weeks’ or ‘months+’. Patients were asked whether and how they would wish to receive prognostic information and whether they would be willing/able to estimate their own prognosis. Survival was calculated from date of study entry. Prognostic accuracy of different groups was compared using linear weighted κ (LWK).Results1018 patients with advanced cancer were studied; 127 doctors, 281 nurses and 290 patients provided 829, 954 and 290 prognostic estimates respectively. MPT estimates were available for 987 patients. LWK varied between 0.14 (patients) and 0.46 (MPT). Patients' estimates were significantly worse than doctors', nurses' or MPT estimates (all p<0.001). Nurses' estimates were significantly worse than the MPT estimate (p=0.007). No clinician factors (age, gender, experience or grade) were consistently associated with better prognostic accuracy. Most patients (61.4%) wanted to know their prognosis of whom 48% wanted to know it ‘approximately’ and 52% wanted to know ‘exactly’.ConclusionMost patients wish to know their prognosis. Clinicians' predictions are inaccurate and patients' predictions are significantly worse. MPT estimates are the most accurate.
Palliative care delivery in Kenya and Malawi: a review of models
Authors: Grant L , Downing J , Leng M , Namukaya L , Murray S A 
Published: May 2011

AbstractIntroduction and aimsThere is an urgent need to develop serviceable models of palliative care. A case study evaluation of eight palliative care programmes in Kenya and Malawi was undertaken to define the current models, understand their context, identify challenges and explore transferable lessons.MethodsA desk based review was conducted on the health environment and systems. Eight sites were visited and interviews held with staff, community and local health leaders.ResultsModels of palliative care fell into three categories – specialist, district hospital, and rural health clinic/community level. Staffing levels and the type of work undertaken were influenced by the model, but lack of support systems meant that all models ended up delivering a mix of services. All consistently emphasised pain relief, symptom management and comprehensive care, but differed in their integration into mainstream services, and ability to understand and actively respond to dynamic patient need. This was influenced by staff knowledge, and level of clarity on staff roles. Questions arising in terms of the models of care include ‘who shapes the work?’, ‘who delivers the work?’, ‘who plans the working day?’, ‘who defines what palliative care is?’, ‘who manages changing patient needs? and ‘is the model patient or professional centred? ‘Challenges include the diversity of diseases and need, limited referral options, the tendency to ‘be everything for everyone’, and the speed of scaling up of services.ConclusionStand alone models of palliative care have evolved, but many are trying to deliver beyond capacity. When developing a programme, questions on defining the role of palliative care, who and how work is delivered, and support networks need to be asked.
Determining cost-effectiveness of advanced cancer care: a systematic review of economic models
Authors: Hulme C , Browne C , Mansfield J , Pavitt S , Hall P S , Bennett M I 
Published: May 2011

AbstractAimTo determine the strengths and limitations of current approaches used in economic analyses of advanced cancer care.MethodsWe conducted a systematic review of EMBASE, AMED, PsycINFO, CINAHL, and MEDLINE from inception to June 2010 using search terms advanced or terminal illness, cancer, and cost or economic studies. We included studies that reported economic evaluations using decision analytical models, within patients with advanced cancer, with any intervention and published in English. We extracted data on health system context, model type, model time horizon and model outcomes.Results28 papers were eligible for inclusion, the majority of these were undertaken in Europe or USA. 17 Markov models and 10 decision trees were identified. Most (z) models used lifetime horizons but (x) used curtailed horizons without any clear rationale between studies for time horizon selected. Model outcomes varied; most used quality of life (QOL), but some used survival, and one estimated the likelihood of effective pain management. Measurement of QOL was the most commonly cited limitation in all models. (Z) studies relied on healthcare professionals' valuations of QOL rather than patients' own valuations.ConclusionWe found no consistent model type or time horizon used in studies assessing cost effectiveness of interventions in advanced cancer. In models with shorter durations, additional future costs such should be considered such as those related to further operative procedures, or palliative treatments. The validity of these models may be weakened by using utility values that are not derived directly from patients with advanced cancer.
A checklist for reporting factor analysis in palliative care research
Authors: Ramsenthaler C , Siegert R J , Higginson I J 
Published: May 2011

AbstractBackgroundFactor analysis (FA) is a statistical technique that analyses underlying relationships in a data set. It is mainly used in the development and validation of questionnaires. Since valid outcome measures have become important in palliative care, criteria to judge the quality of FA are needed.AimsTo systematically review the current use and reporting of either exploratory or confirmatory FA and recommendations for FA, in order to design a checklist for reporting FA in the field of palliative care.MethodsIn this systematic literature review, a hand search identified all studies using factor analytical techniques published in the four peer-reviewed journals Palliative Medicine, Journal of Pain & Symptom Management, Journal of Palliative Medicine, and the Journal of Palliative Care (inception – Mai 2010). Included were studies of any design, except reviews, reporting the results of one or several exploratory or confirmatory FA.ResultsIn 575 issues screened, 189 factor analytical studies were identified. Since the year 2000, FA has increasingly been applied in palliative care. It is mainly used in the development of new measures, to create subscales and to assess the multidimensionality of a measure, or in the evaluation (eg, translation) of an existing measure. The frequencies of different criteria (eg, ratio of sample size to number of items, factor extraction models, criteria for retaining factors, rotation techniques) will be analysed. On this basis, recommendations will be designed.ConclusionThe checklist developed provides guidance for journal editors, clinicians and researchers who need to judge or report a FA in palliative care.