bluuebunny/crossref_metadata_2025_split huggingface dataset:
Triage: An innovation in practice
Authors: Flynn Fiona , Watson Barbara 
Published: September 2011

As the increase in demand for access to specialist palliative care services continues, methods to prioritise patients and carers with the greatest need becomes of increasing importance.AimThe aim of the project was to develop and implement a triage system for referrals into the Northern Ireland Hospice community specialist palliative care teams. One which would create a standardised process ensuring equity for patients irrespective of location, improve access to the service leading to prompt assessment based on patient need and overall improve the referral system to increase referrer satisfaction and the quality of patient care.MethodThe project consisted of two phases (1) a developmental phase and (2) an implementation and evaluation phase. During the developmental phase documentation design was required to capture essential information regarding patients and carers to aid identification of the patients prioity based on need. Using a triage assessment guide patients were scored using five categories- pain, symptoms, patient anxiety, psychosocial issues, and carer anxiety. A lower triage score indicated patients with less urgent needs are identified as priority three whereas a higher score indicates those patients whose needs are greater and identified as priority one.ResultsThe introduction of the triage system reduced the estimated waiting time from 1–7 to 1–5 working days. Patients identified as priority one are being assessed within two working days from triage with many being assessed within 24 h of receipt of referral in triage. Those who are identified as priority two are being assessed within three working days and the less urgent priority three patients are being assessed within five working days.ConclusionThis triage system established a consistent, reproducible assessment process and provides a useful tool to improve the community teams efficiency delivering tangible benefits for patients and carers.
The effectiveness of hypnotherapy in the treatment of anxiety in patients with cancer receiving palliative care
Authors: Plaskota Marek , Lucas Caroline , Pizzoferro Kathleen , Saini Treena , Evans Rosie Evans , Cook Karen 
Published: September 2011

IntroductionIn palliative care patients, anxiety is usually attributed to a reaction to diagnosis, treatment and its possible outcomes. Despite the support for hypnotherapy as a resource for the alleviation of psychological and emotional distress, there is a paucity of evidences to support the use of hypnotherapy for symptom relief.AimsAims of this study were to assess the benefits of hypnotherapy in the management of anxiety in palliative care patients and to ascertain if hypnotherapy could affect other symptoms including depression and sleep disturbance.MethodsParticipants received four sessions of hypnotherapy and completed the Hospital Anxiety and Depression Scale, Edmonton Symptom Assessment Scale, Verran and Snyder-Halpern Scale, and wrist actigraphy. Out of 21 patients recruited, eleven successfully completed the study.ResultsAfter the second hypnotherapy session there was a statistically significant reduction in patient-reported anxiety (p=0.0066) and symptoms (p=0.0094), but not in depression (p=0.2910) or sleep disturbance (p=0.0868). After the fourth hypnotherapy session, there was a statistically significant reduction in patient-reported anxiety (p=0.0016), depression (p=0.0466), symptoms (p=0.0329) and sleep disturbance (p=0.0081). Actigraphy did not show a statistically significant improvement in sleep quality.DiscussionHypnotherapy intervention appears to have a more immediate impact on anxiety and symptom severity whereas the improvement in depression and sleep quality is more slowly acquired. Actigraphy is a new tool to measure the quality of sleep. Its validation is still in progress and thus the sleep indicators chosen for this study are still a subject of debate. This could explain the result inconsistency.ConclusionThis study suggests that hypnotherapy can contribute to reduction in anxiety in palliative care patients with the added benefit of improving sleep and severity of psychological and physical symptoms.
Diversifying volunteer roles through the ‘Family Friend’ support service
Authors: Roberts Tina , Thompson Andrew 
Published: September 2011

IntroductionSerious illness brings stressful changes for patients and carers. Consultation with our carers identified a ‘gap’ between medical and social care, indicating regular help within the home would sustain coping. Locally, reduced employment opportunities harnessed to Big Society thinking, means there is greater capacity for volunteers to bring their individual skills to support patients' families.Aims▶Introducing a new role whereby volunteers provide individualised carer support within the home.▶Creating a robust and comprehensive training programme to support volunteer autonomy.Research methods▶Informal interviews with carers.▶Multi-disciplinary team's identification of carers' needs.▶Qualitative research within hospice sector - indicating concern over health and safety issues.▶Discussion and partnership with local Carer Liaison team.Results▶A successful proposal to local NHS Trust secured full funding for 1 year.▶Dedicated co-ordinator input enabled the implementation of a robust training programme and supporting policies.▶Development of a comprehensive risk assessment covering a broad range of supportive activities for volunteers to undertake.▶Family Friend volunteers express increasing confidence through required monthly support group meetings.DiscussionWith the project active for a full year, it has been formally evaluated with encouraging feedback. Volunteers state that they value working with greater autonomy and express increased role satisfaction. Carers have identified Family Friend support as contributory towards greater coping and confidence. The service's success is attributed to our ability to identify a shortfall in carer support and our faith in skilled and trained volunteers to meet it.ConclusionThe hospice believes that diversifying the volunteer role and providing enhanced training and supervision has increased satisfaction for volunteers, patients and families. This information could be used by hospices concerned about managing risk in home support volunteering.
Reflecting identities: using portraiture with people suffering from life threatening illnesses
Authors: Carr Susan 
Published: September 2011

“I look in the mirror and I say, ‘who’s that?' I don't really know who I am anymore! I have lost the person I thought I was.” Patient, Prospect Hospice.Arguably life threatening or chronic illness is not just an attack on the body, it is an attack on the embodied self, and identity, shattering the means by which a person experiences the world, and by which they also are experienced, contributing to a person's sense of powerlessness and ‘loss of self’ (Charmaz, 1983). Therefore negatively affecting a person's ability to continue with their pre-illness activities, relationships and future plans and contributing to their ‘total pain’.This paper will present case studies, drawn from the author's current PhD research, looking at how working collaboratively with an artist to co-design a portrait of themselves can help people suffering from life threatening or chronic illnesses to increase their self knowledge, build new identities and improve their ‘individual creative capacity’, to adapt to illness, therefore enabling the development of a more coherent sense of self and identity.When attempting to understand the complex emotions and feelings contained within experiences of illness and loss of self, the use of portraiture as identity work, provides an intervention within which discursive knowledge and non-discursive knowledge can be reintegrated into a more coherent whole. Portraits often capture the ‘essence’ or subjectivity of a person; the trace of a human presence left behind, and can enable people feeling detached from their body after invasive treatment, to recover a sense of autonomy over the bodily image they portray. This intervention also offers ‘time,’ for the building of a collaborative relationship, at a time when relationship is hard to sustain, acknowledging that identity is built and sustained in relationship with others.
‘Opening the electronic gate’: raising spiritual awareness online
Authors: Groves Karen , Baldry Catherine , Smith Brian , Sumner Ken , Rimmer Dominic 
Published: September 2011

BackgroundFollowing an audit of spiritual and religious needs assessment and care provision across one cancer network area in the Northwest of England in 2006 it was clear that most health professionals working within specialist palliative care services felt that they lacked confidence, and would benefit from further education, in spiritual support. The cancer network supported the development of an interactive learning package for staff. ‘Opening the Spiritual gate’, to meet this expressed need.AimsTo raise awareness of the spiritual and religious needs of patients and familiesTo help staff feel more confident in discussing and assessing them.To provide this education in a format which is easily accessible and available to staff.MethodA joint project between a cancer network and a university technology department in the Northwest of England resulted in the conversion of the interactive awareness raising course of four sessions, originally delivered face to face (on one day or as a series), into an online course based on a constructivist learning format.ResultsThe iterative process involved in the conversion, a description of the online instance and the resulting course along with the qualitative analysis of the pilot are described. The results show that the online platform allowed participants to access the course at a time to suit themselves, from anywhere which had internet access and allowed them to learn at their own pace with time for reflection.ConclusionClearly e-learning does not suit everyone, but this project has shown that conversion of even a course reliant on group interaction is possible as long as sufficient material and activity, to meet all learning styles and preferences, is built in and the course is organised to allow small cohorts of people to form a learning community for its duration.
‘Opening the gate’ – What's the difference?
Authors: Groves Karen , Baldry Catherine 
Published: September 2011

BackgroundNICE Supportive and Palliative Care Improving Outcomes Guidance 2004 states clearly that health professionals should be in a position to assess the spiritual and religious needs of patients and either meet these needs or facilitate others to do so. A cancer network audit in 2006 showed that staff felt quite unprepared for this role.AimTo see if a one day interactive course to raise awareness of spiritual and religious needs was effective in increasing staff confidence in this area of support.MethodA spiritual support education programme was developed, which could be rolled out across the cancer network. The course was then offered to participants who chose to attend. Each participant was asked to complete a pre and post course questionnaire and course evaluation.Results159 participants attended the first 12 courses. 156 completed pre and post course questionnaires and 104 completed pre and post course confidence visual analogue scales which were compared. Many of the items suggest improvement from before the course to immediately afterwards, for example, pre course only 6% participants felt that they understood the nature of spiritual assessment ‘very well’, 36% ‘quite well’, 57% ‘a little’ or ‘not at all’. After the course 57% participants scored the answer as ‘very well’, and 40% ‘quite well’ with only 3% ‘a little’. Pre course the mean visual analogue score for confidence in assessing spiritual needs was 4.00 and afterwards 6.76 (where 0 was no confidence) and for assessing religious needs pre course 4.71 and post course 7.07.ConclusionIt appears that this course was successful in raising awareness and understanding of the nature of spiritual assessment and raises the confidence of participants in assessing spirituals needs. It remains to be seen whether the improvement is maintained once the participants return to the workplace.
Transition to adult services for children and young people with palliative care needs: a systematic review
Authors: Doug M , Adi Y , Williams J , Paul M , Kelly D , Petchey R , Carter Y H 
Published: September 2011

ObjectiveTo evaluate the evidence on the transition process from child to adult services for young people with palliative care needs.DesignSystematic review.SettingChild and adult services and interface between healthcare providers.PatientsYoung people aged 13–24 years with palliative care conditions in the process of transition.Main outcome measuresYoung people and their families' experiences of transition, the process of transition between services and its impact on continuity of care and models of good practice.Results92 studies included. Papers on transition services were of variable quality when applied to palliative care contexts. Most focussed on common life-threatening and life-limiting conditions. No standardised transition program identified and most guidelines used to develop transition services were not evidence-based. Most studies on transition programs were predominantly condition-specific (eg, cystic fibrosis (CF), cancer) services. CF services offered high-quality transition with the most robust empirical evaluation. There were differing condition-dependent viewpoints on when transition should occur but agreement on major principles guiding transition planning and probable barriers. There was evidence of poor continuity between child and adult providers with most originating from within child settings.ConclusionsPalliative care was not, in itself, a useful concept for locating transition-related evidence. It is not possible to evaluate the merits of the various transition models for palliative care contexts, or their effects on continuity of care, as there are no long-term outcome data to measure their effectiveness. Use of validated outcome measures would facilitate research and service development.
Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study
Authors: Pinnock Hilary , Kendall Marilyn , Murray Scott A , Worth Allison , Levack Pamela , Porter Mike , MacNee William , Sheikh Aziz 
Published: September 2011

ObjectivesTo understand the perspectives of people with severe chronic obstructive pulmonary disease (COPD) as their illness progresses, and of their informal and professional carers, to inform provision of care for people living and dying with COPD.DesignUp to four serial qualitative interviews were conducted with each patient and nominated carer over 18 months. Interviews were transcribed and analysed both thematically and as narratives.Participants21 patients, and 13 informal carers (a family member, friend, or neighbour) and 18 professional carers (a key health or social care professional) nominated by the patients.SettingPrimary and secondary care in Lothian, Tayside, and Forth Valley, Scotland, during 2007-9.ResultsEleven patients died during the study period. Our final dataset comprised 92 interviews (23 conducted with patient and informal carer together). Severe symptoms that caused major disruption to normal life were described, often in terms implying acceptance of the situation as a “way of life” rather than an “illness.” Patients and their informal carers adapted to and accepted the debilitating symptoms of a lifelong condition. Professional carers' familiarity with the patients' condition, typically over many years, and prognostic uncertainty contributed to the difficulty of recognising and actively managing end stage disease. Overall, patients told a “chaos narrative” of their illness that was indistinguishable from their life story, with no clear beginning and an unanticipated end described in terms comparable with attitudes to death in a normal elderly population.ConclusionsOur findings challenge current assumptions underpinning provision of end of life care for people with COPD. The policy focus on identifying a time point for transition to palliative care has little resonance for people with COPD or their clinicians and is counter productive if it distracts from early phased introduction of supportive care. Careful assessment of possible supportive and palliative care needs should be triggered at key disease milestones along a lifetime journey with COPD, in particular after hospital admission for an exacerbation.
Technical, angiographic and clinical outcomes of Neuroform 1, 2, 2 Treo and 3 devices in stent-assisted coiling of intracranial aneurysms
Authors: Kadkhodayan Yasha , Somogyi Christopher T , Cross DeWitte T , Derdeyn Colin P , Zipfel Gregory J , Chicoine Michael R , Rich Keith M , Grubb Robert L , Dacey Ralph G , Moran Christopher J 
Published: September 2011

Background and purposeSince 2002 the Neuroform stent has expanded endovascular treatment of wide-necked intracranial aneurysms. A study was undertaken to assess the technical success rates and angiographic and clinical outcomes in stent-assisted coiling with Neuroform 1, 2, 2 Treo and 3.MethodsPatients undergoing Neuroform stent-assisted coiling were enrolled in a prospective registry that included 156 stent deployment attempts in 113 consecutive patients (mean age 53, range 25–78). Deployment success and difficulty, stent movement, procedural complications, immediate/delayed aneurysm occlusion and in-stent stenosis on angiographic follow-up were compared among Neuroform 1, 2, 2 Treo and 3 stents using a log likelihood ratio χ2test.ResultsOf 156 stent attempts, 123 (79%) were deployed (Neuroform 1: 8/9 (89%), Neuroform 2: 50/66 (76%), Neuroform 2 Treo: 9/11 (82%), Neuroform 3: 56/70 (80%)) with a symptomatic complication rate of 1.9% (3/156; 2 transient ischemic attacks, 1 stroke, no deaths). Non-target stent placement (1/8 (13%), 6/50 (12%), 2/9 (22%), 3/56 (5%)), difficult placement (2/8 (25%), 10/50 (20%), 5/9 (56%), 6/56 (11%)), stent movement (1/8 (13%), 4/50 (8%), 0/9 (0%), 4/56 (7%)), procedural complications (1/9 (11%), 7/66 (11%), 2/11 (18%), 2/70 (3%)) and immediate near complete aneurysm occlusion (6/6 (100%), 24/37 (65%), 5/7 (71%), 40/45 (89%)) trended towards improvement with each generation. Improvements in difficult stent placement and immediate aneurysm occlusion were significant (p=0.01 and 0.03, respectively).ConclusionNeuroform stent-assisted coiling has evolved through four generations as a safe and effective means of treating wide-necked intracranial aneurysms.
Surface (sea floor) and near-surface (box cores) sediment mineralogy in Baffin Bay as a key to sediment provenance and ice sheet variations
Authors: Andrews John T. , Eberl D.D. 
Published: September 2011

To better understand the glacial history of the ice sheets surrounding Baffin Bay and to provide information on sediment pathways, samples from 82 seafloor grabs and core tops, and from seven box cores were subjected to quantitative X-ray diffraction weight percent (wt.%) analysis of the <2 mm sediment fraction. The samples were collected between 67°N and 78°N, in water depths of 155 to 2375 m and were retrieved on cruises between A.D. 1964 and 2009. Grain size, magnetic characteristics, and colour reflectance data were also obtained on many of the samples. Twenty-one non-clay and 10 clay mineral species were identified; the average wt.% of the non-clay minerals was 70% and was dominated by quartz, various feldspars, and dolomite, whereas the dominant clay minerals were 1 M illite, biotite, and chlorite. Cluster analysis on principal component scores identified three main mineral groups, which also had strong associations with grain size and sediment magnetic properties. Box cores from the deep central basin (>2000 m) all show an abrupt drop in calcite wt.% (post-5 cal ka BP?) following a major peak in detrital carbonate (mainly dolomite). This dolomite-rich detrital carbonate (DC) event in JR175BC06 is possibly coeval with the Younger Dryas cold event. Four possible glacial-sourced end members were employed in a compositional unmixing algorithm to gain insight into down core changes in sediment provenance at the deep central basin. Estimates of the rates of sediment accumulation in the central basin are only in the range of 2 to 4 cm/cal ka, surprisingly low given the glaciated nature of the surrounding land.
HIERARCHICAL MAPPING FOR HPC APPLICATIONS
Authors: CHUNG I-HSIN , LEE CHE-RUNG , ZHOU JIAZHENG , CHUNG YEH-CHING 
Published: September 2011

As the high performance computing systems scale up, mapping the tasks of a parallel application onto physical processors to allow efficient communication becomes one of the critical performance issues. Existing algorithms were usually designed to map applications with regular communication patterns. Their mapping criterion usually overlooks the size of communicated messages, which is the primary factor of communication time. In addition, most of their time complexities are too high to process large scale problems. In this paper, we present a hierarchical mapping algorithm (HMA), which is capable of mapping applications with irregular communication patterns. It first partitions tasks according to their run-time communication information. The tasks that communicate with each other more frequently are regarded as strongly connected. Based on their connectivity strength, the tasks are partitioned into supernodes based on the algorithms in spectral graph theory. The hierarchical partitioning reduces the mapping algorithm complexity to achieve scalability. Finally, the run-time communication information will be used again in fine tuning to explore better mappings. With the experiments, we show how the mapping algorithm helps to reduce the point-to-point communication time for the PDGEMM, a ScaLAPACK matrix multiplication computation kernel, up to 20% and the AMG2006, a tier 1 application of the Sequoia benchmark, up to 7%.