bluuebunny/crossref_metadata_2025_split huggingface dataset:
Membrane Fusion-Mediated Autophagy Induction Enhances Morbillivirus Cell-to-Cell Spread
Authors: Delpeut Sébastien , Rudd Penny A. , Labonté Patrick , von Messling Veronika 
Published: May 2012

ABSTRACT

In the context of viral infections, autophagy induction can be beneficial or inhibitory. Within the
Paramyxoviridae
family, only morbilliviruses have been investigated and are reported to induce autophagy. Here we show that morbilliviruses rapidly induce autophagy and require this induction for efficient cell-to-cell spread. Coexpression of both glycoproteins in cells expressing one of the cellular receptors was required for autophagy induction, and LC3 punctum formation, indicative of autophagy, was mainly observed in syncytia. A similar correlation between syncytium formation and autophagy induction was also observed for other paramyxovirus glycoproteins, suggesting that membrane fusion-mediated autophagy may be common among paramyxoviruses and possibly other enveloped viruses.
Prostatic hyperplasia is highly associated with nocturia and excessive sleepiness: a cross-sectional study
Authors: Chartier-Kastler Emmanuel , Leger Damien , Comet Denis , Haab François , Ohayon Maurice M 
Published: May 2012

ObjectivesThe objective of this study is to assess the impact of nocturia on sleep in patients with lower urinary tract symptoms (LUTS)/benign prostatic enlargement (BPE) (nocturia≥2).DesignCross-sectional survey.Setting798 urologists and general practitioners randomly selected from the overall population of urologists and general practitioners of every French region.ParticipantsA total of 2179 LUTS/BPE men (aged 67.5±7.5 years old) were recruited.Primary and secondary outcome measuresValidated patients' self-administered questionnaires were used to assess the severity of LUTS/BPE (the International Prostate Symptom Score), sleep characteristics (sleep log) and sleep disorders (the International Classification of Sleep Disorders (ICSD-2) and the DSM-IV). Sleepiness was assessed with the Epworth Sleepiness Scale (ESS). The volume of 24 h diuresis (<or >1500 ml) was measured.ResultsParticipants had on average 2.9±0.9 nocturia episodes (three or more episodes in 67%) and the International Prostate Symptom Score of 15.8±5.7; 60.9% complained of insomnia according to the ICSD-2, 7.9% of restless leg syndrome and 6.4% of obstructive sleep apnoea. 32.3% had excessive sleepiness (ESS >10) and 3.1% severe excessive sleepiness (ESS >16). Insomnia was mainly nocturnal awakenings with an average wake after sleep onset of 89±47 min. The number of episodes of nocturia per night correlated significantly with wake after sleep onset and ESS but not with total sleep time and sleep latency.ConclusionNocturia is significantly associated with sleep maintenance insomnia and sleepiness in men with BPE.
What is the optimal level of population alcohol consumption for chronic disease prevention in England? Modelling the impact of changes in average consumption levels
Authors: Nichols Melanie , Scarborough Peter , Allender Steven , Rayner Mike 
Published: May 2012

ObjectiveTo estimate the impact of achieving alternative average population alcohol consumption levels on chronic disease mortality in England.DesignA macro-simulation model was built to simultaneously estimate the number of deaths from coronary heart disease, stroke, hypertensive disease, diabetes, liver cirrhosis, epilepsy and five cancers that would be averted or delayed annually as a result of changes in alcohol consumption among English adults. Counterfactual scenarios assessed the impact on alcohol-related mortalities of changing (1) the median alcohol consumption of drinkers and (2) the percentage of non-drinkers.Data sourcesRisk relationships were drawn from published meta-analyses. Age- and sex-specific distributions of alcohol consumption (grams per day) for the English population in 2006 were drawn from the General Household Survey 2006, and age-, sex- and cause-specific mortality data for 2006 were provided by the Office for National Statistics.ResultsThe optimum median consumption level for drinkers in the model was 5 g/day (about half a unit), which would avert or delay 4579 (2544 to 6590) deaths per year. Approximately equal numbers of deaths from cancers and liver disease would be delayed or averted (∼2800 for each), while there was a small increase in cardiovascular mortality. The model showed no benefit in terms of reduced mortality when the proportion of non-drinkers in the population was increased.ConclusionsCurrent government recommendations for alcohol consumption are well above the level likely to minimise chronic disease. Public health targets should aim for a reduction in population alcohol consumption in order to reduce chronic disease mortality.
End of life care in Wales: evaluation of a care pathway-based implementation strategy
Authors: Johnstone Rosalynde Patricia , Jones Angela , Fowell Andrew , Burton Christopher Richard , Rycroft-Malone Jo 
Published: May 2012

ObjectivesThe All Wales Care Pathway for the End of Life Pathway aims to ensure evidence-based end-of-life care is available across Wales. Implementation of end-of-life care processes was evaluated in a national audit of deaths between July 2007 and June 2009.MethodsUp to 60 records of deceased patients were reviewed by two researchers from hospital (24), community localities (20), hospice and specialist inpatient (9) settings. Data extraction using a standard template was carried out at all sites to indicate whether end-of-life care processes had been implemented. A total of 1184 records were retrieved. 202 records were excluded due to sudden death (eg, cardiac arrest) or incomplete data. Sampling included 580 decedents (59%) who had received end-of-life care through the pathway.ResultsPathway use was associated with improved implementation of all evidence-based clinical standards other than for daily review, where implementation was consistently high with (84.5%) or without the pathway (81%). Differences in achievement were most evident for the implementation of bereavement and spiritual support where the pathway was used. Implementation within hospice and specialist inpatient care settings was consistently high.ConclusionIntegrated care pathway use is associated with the implementation of best practice in end-of-life care. However, variation in implementation across sites and the influence of setting type highlights the mediating effect of organisational context which, together with different methods of feedback, may provide a useful agenda for implementation research within end-of-life care.
Advance care planning for subjects with early dementia – a pilot study
Authors: Binte Ali N , Chan M , Anthony P , Lim WS , Chong MS 
Published: May 2012

Lack of research in our multi-racial society, where different cultures have disparate beliefs with regards to death and dying, prompted us to conduct a pre-implementation feasibility study for the role of ACP on 9 patient-caregiver dyads from a memory clinic in Singapore.Subjects were recruited if they had mild dementia (global Clinical Dementia Rating of 0.5-1), no significant mood disorders or behavioural problems, and had an identified caregiver. Patients and their caregivers were surveyed individually for their understanding of ACP, and experience of communicating their end-of-life treatment preferences to their loved ones, before and after ACP counselling conducted by a trained ACP facilitator.Prior to ACP counselling, only 22% patients and 55% caregivers had heard of ACP. While 77% of patients rated their health status as good and 77% had thought of their healthcare proxy, only 22% made future care plans. After ACP counselling, 75% patients are keen for further ACP discussions and none admitted to barriers to communication compared to 62.5% caregivers who acknowledge barriers to communication. The percentage of patients who wished to receive therapy decreased as the likelihood of an adverse outcome (especially cognitive) increased.There is a disparity in the attitudes of patients and caregivers towards ACP where patients are more willing to discuss it compared to caregivers.Our study highlights the need for further education and dissemination of information on ACP among subjects with early dementia and their caregivers. We are intending to incorporate ACP and disseminate information on ACP in future dementia workshops.
Cultural concordance in advance care planning discussions: a blessing or a curse
Authors: Deamant C , Liu E , Mackie O , Shariff R 
Published: May 2012

Culture narrowly defined is the learned or shared beliefs, values and behaviours of a group. However, concepts of culture are complex and influenced by many factors, such as ethnicity, socioeconomic status, gender, education, sexual orientation, or immigration status.Health care professionals are expected to demonstrate cultural competency, and possess some knowledge of cultural values, beliefs and practices and practice proficient communication skills. Cultural sensitivity reflects a health care professional's awareness and respect for the patient's cultural viewpoint. Cultural concordance between health care professionals and patients and families has the potential to provide a framework of expectations about communication and complex decision-making in the setting of end of life care.The literature reflects the disparities in end of life care for minority and vulnerable populations, with underutilisation of hospice care, higher likelihood of using life-sustaining treatment at the end of life and dying in the hospital. Most of the literature focuses on the different cultural perspectives about communication, death and end-of-life care decision-making. There is a paucity of literature about the impact of cultural concordance between health care professionals and patients/families in palliative care and end of life care.Through several case studies, we will identify potential benefits and challenges for health care professionals who have ethnic, language or racial concordance with patients and families. Using components of effective communication strategies for advance care planning with seriously ill patients, we will add new insight for providing patient-centred, culturally effective care within a culturally diverse health care setting.
A public health initiative around advance care conversations and end of life Care
Authors: Matthiesen M , Ashton J , Froggatt K 
Published: May 2012

The critical need for family, carer, and community conversations about end of life issues ahs never been more significant. Although most adults would prefer to live their last days at home with support, only 22% of people in Cumbria currently do. Caring for patients outside their preferred place incurs significant costs to the NHS and recently published national statistics cite 54% of NHS complaints are around end of life care. Yet as is pointed out in the national End of Life Care Strategy, “In the absence of open discussions, it is difficult or impossible to elicit peoples needs and preferences and to plan accordingly.'The aim of this collaborative and integrated public health campaign was to support the public to break the taboo of talking about death and dying while healthy in order to consider options, access resources, and have a say in their future care (advance care planning). Increasing awareness of available options and resources was a key focus.Project outcomes, evaluations and national endorsements will be shared. As a first step in achieving longer-term goals, the pilot showed that a community-based public awareness campaign on end of life issues can reach the public and achieve greater awareness/educational outcomes.
Does physician remuneration improve advance care planning and end of life discussions in primary care?
Authors: Gill Andrew , Waugh Jan , Simon Jessica 
Published: May 2012

It is not known how remuneration for advance care planning and end of life issues (ACPEL) discussions influences physician practice. In Calgary, AB family physicians get remunerated for completing a comprehensive annual care plan proforma (CACP) with patients who have complex care needs. The CACP prompts the physician to ACPEL discussions, with a tickbox answer of yes, no or not applicable.. The local “goals of care designation” (GCD) policy communicates treatment intent, based on medically appropriate care and the patient's own goals. Although not part of the CACP, if discussing ACPEL, determining a GCD is often appropriate.From a practice of 4000, 59 patients were identified by searching all CACP billing codes submitted from April 1st, 2011 through September 30th. A retrospective notes analysis revealed the percentage of charts with the ACPEL question completed was 49%. Of those that were completed 17% had discussed ACPEL, 17% had not and 66% selected not applicable. Only 1 out of 59 patients had a GCD and that was not determined during their CACP.Despite being part of a defined, remunerated plan, ACPEL and GCD discussions are not occurring. This baseline data will inform interventions in an audit feedback cycle, including practice-based physician education and mentoring on facilitating ACP conversations and improved clinic processes to ensure patient access to ACP material and to attach GCD documentation to the CACP. In addition it suggests the need for more effective links between remuneration to ACPEL discussions.
Integration of advanced care planning into an undergraduate nursing programme
Authors: Smith G 
Published: May 2012

Advanced care planning should be something all health professionals consider when interacting with their patients/clients. It should be a consideration when people are well; something that is encouraged to be discussed in the home amongst family members; and amongst the health care team in the event of chronic or terminal illness diagnosis. Accordingly, this poster will support the premise of the undergraduate educators at Edith Cowan University, that Advanced Care Planning must be integrated into the undergraduate pre-registration nursing education programme.The findings to date are anecdotal and relate purely to student and graduate nurse feedback to lecturers. Integrating Advanced Care Planning into the undergraduate programme:▶assists in encouraging student and beginner-level nurses to consider the appropriateness of care for patients/clients▶assists in enabling nurses to encourage discussion about advanced care planning amongst the health care team, patients (and their families), and student families▶assists in encouraging student and beginner-level nurses in advocating for their patient/client wishes toward the end of life.
Sowing seeds and building collaborations: challenges faced and learning points in starting systematic advance care planning in a tertiary hospital in Singapore
Authors: Chong RKP , Oh JSY , Ng RHL , Poi CH , Chau HYC 
Published: May 2012

This poster aims to describe challenges and learning points in endeavours at starting systematic advance care planning (ACP) in Tan Tock Seng Hospital, a 1200-bed tertiary hospital in SingaporeBased on the model of ACP espoused by Respecting Choices of Wisconsin, USA, a disease-specific pilot project was initiated in the department of cardiology in 2010 and a POLST-like pilot project in the departments of respiratory medicine, neurology and neurosurgery.28 staff comprising nurse clinicians, case managers and medical social workers were trained in the Respecting Choices model of ACP facilitation. Less experienced facilitators were mentored by senior staff with experience in ACP facilitation. The facilitators also met regularly to share experiences. 5 patients with advanced heart disease, 5 with advanced chronic obstructive pulmonary disease and 2 patients with advanced neurological diseases underwent facilitated ACP discussions by trained facilitators. Outcomes were documented and scanned into the hospital medical records system.Significant challenges faced were relatively low awareness of ACP among the general public and healthcare professionals as well as the need for clear workflows and co-ordination across multiple disciplines. There are ongoing endeavours at continual quality improvement through forums aimed at engaging the staff and the public, workshops to enhance the skills of facilitators, audits and improvement in resource allocation.A systematic approach to ACP faces significant challenges in the initial stages of the endeavour in a complex hospital environment. ACP is resource intensive and a clear vision, high level support as well as a multi-pronged approach are paramount for successful implementation.
Values and the advance care planning framework in New Zealand
Authors: Chan H.Y. 
Published: May 2012

New Zealand (NZ) is in the early stages of introducing and implementing ACP to the public. There is growing awareness of the values of ACP and the NZ Ministry of Health recently published two guides – one for the healthcare workforce (modelled after the UK ACP: Guide for health and social care staff) and another for the public/consumers.This presentation explores whether the new policy framework supports or hinders ACP measures within a pluralistic society. It adds to the policy debate on key components essential in ACP policy framework for countries that are at the early stages of rolling out ACP programmes.The content and scope of the NZ sample care plans and the Guide is analysed and compared against the UK model. The early observation emerging from this review highlights supportive elements crucial to a positive ACP measure. A supportive framework places a premium on personal values in the ACP process. This distinctive recognition is crucial within a multicultural setting, as recognising what matters to people and seeking to incorporate them in care plans means keeping the person at the centre of care. Requiring doctors' involvement in discussing care planning options encourages informed choices and in the long run, cements the trust between doctors and patients.This presentation draws on preliminary findings from work in progress exploring how elements in an ACP framework contribute to a supportive end-of-life care measures. It informs policy knowledge on distinctive framework which can be replicated in other countries intending to establish ACP programmes.
Sorry, but it's my business!
Authors: Wighton M 
Published: May 2012

Aboriginal people generally do not think about or have much input into their advanced care plans or end of life business. In some areas it was taboo to speak of someone's death or journey to death, whether it was for cultural, personal, or spiritual reasons. With consideration to peoples beliefs and customs, more evidence has shown the need for Aboriginal people to be personally involved in their end of life planning, or as it is called, their “Sorry Business”. A program through Mungabareena Aboriginal Corporation was initially developed to support people to:Think about their end of life needs.Talk and discuss ideas and wishes.Act upon personalising a plan through practical application.The program aims to bring together clients and families, service providers and community people over a period of time, allowing information and discussion to be exchanged in a positive way. Groups and individual sessions are held allowing participants to gain information and share thoughts and experiences. The positive outcomes have been the desire for Aboriginal people to have personal involvement in their care plans and own Sorry Business. End of life choices are now known in regards to funeral funds, burials and cremations, organ donations, pets, wills & estates and other wishes that may be carried out whilst limiting the stress and uncertainty for families. Whilst primarily focusing on the elderly and the sick, the long term goal would be to see all Aboriginal people give consideration to their own “Sorry Business”.
Advanced Care: Why We Need New Clinical Model
Authors: Stuart B 
Published: May 2012

Health care in the developed world is fractured across 3 distinct dimensions: space, time, and treatment. Poor handoffs between settings fragment care in the spatial dimension. As illness advances, evolving personal choices are not tracked in real time, so care becomes disconnected from patient preference. Finally, “curative treatment” and “comfort care” have become mutually exclusive. Seriously ill patients undergo hospitalizations, procedures and tests that confer little benefit until they no longer respond. At this point they are declared “terminal,” “treatment” ceases, and they become eligible for hospice. Palliative care alone cannot heal these splits, because it is confined mainly to the hospital setting, and it suffers from the same stigma of dying that afflicts hospice.Advanced Care proposes a new clinical model that coordinates care across all settings, documents personal choice over the whole course of late-stage illness, and provides a customized mix of treatment and comfort care that gives seriously ill people a chance to stay at home, stable and safe, for as long as possible. Advanced Care is person-centered, not patient-centered. In fact, it allows people with serious illness to avoid becoming patients. Data from innovative programs show that's what most of them want. Significant cost savings are a fortunate but unintended byproduct. A standardized model and metrics, along with systematic evaluation through a multi-site national pilot, are needed to provide access to the growing number of people who would benefit from this approach.
How do we train professionals to deliver a new model of care?
Authors: Hylton-Rushton C 
Published: May 2012

New models of healthcare delivery focusing on persons with advanced illness require alignment of education and training with clinical outcomes. The centerpiece of an advanced care model is a person-centered, holistic approach that is provided by members of the inter-professional team, family caregivers, and community across settings and continuum of care. Qualities such as respect, dignity, empathy, compassion, and resilience must be cultivated within and among members of the inter-professional team to achieve the desired clinical outcomes. When successful, patient goals are aligned with appropriate technology and treatment, values, and resources.The Coalition to Transform Advanced Care (CTAC) is developing an inter-professional learning laboratory that leverages current educational curricula and resources with innovative new curricula that address gaps in education and training. The goal of the learning laboratory is to offer diverse professionals an opportunity to assess their learning needs in relation to the outcomes of the CTAC clinical model, design unique curricula, and use related resources to become proficient in the knowledge and skills needed to provide high quality care to people with advanced illness. Similarly, clinicians will need additional tools to simultaneously deliver personalized care and intentionally shift the systems of care surrounding the person with advanced illness. The learning laboratory will offer diverse, flexible methods of learning, including experiential, cognitive, technology enabled and skills based options. A unique feature of the learning laboratory is the inclusion of patients living with advanced illness and their families in the inter-professional teaching-learning process.