bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative care services in Britain and Ireland 1990 - an overview
Authors: Smith Anthony M , Eve Ann , Sykes Nigel P 
Published: November 2007

Objective: To describe and quantify the Hospice and Palliative Care services throughout Great Britain and Ireland, and staffing of those services, for the year 1990. Method: Questionnaires were sent to 428 units or teams in Great Britain and Ireland. A supplementary questionnaire was sent to inpatient units not replying to the first questionnaire. Replies were reviewed and analysed by the Hospice Information Service. Results: A total of 224 of the 428 (52%) palliative care services replied, including 116 of 156 (74%) inpatient units. The report details bed usage, staffing, services offered and volunteer involvement in the 116 inpatient units. It also describes staffing, caseload and the service offered by home care teams. We attempt to relate bed usage to populations served, size of hospice and staffing ratios. We also report on categories of patients served.
Palliative care in Catalonia 1990-95
Authors: Gomez-Batiste X. , Borras JM , Fontanals MD , Stjernswärd J. , Trias X. 
Published: November 2007

We present our basic and preliminary results of a global project to develop palliative care in Catalonia in five years, as part of a World Health Organization demonstration project on cancer. The project, which has already started, includes measures to implement specific resources at all levels of care simultaneously, measures to train target professionals through initiatives at both the pre-and the postgraduate level, measures to promote the use of oral morphine in primary care, and some proposed indicators for monitoring the services. At present in Catalonia there are six support teams in hospitals, four units in sociohealth centres, and almost 30 home care teams.
The stream flows on
Authors: Swann Donald 
Published: November 2007

All through the sixties, the two-man shows of Michael Flanders and Donald Swann were a byword even in the golden age of satire, and their revue 'At the drop of a hat' toured the world. This paper is adapted from the Coda added to Swann's Way, by Donald Swann and Lyn Smith, published as a paperback by Arthur James Limited, One Cranbourne Road, London N10 2BT, UK. In this, Donald Swann explains how he has recovered his creative spirit with the onset of late-stage cancer.
The influence of general practitioner community hospitals on the place of death of cancer patients
Authors: Thorne Christopher P , Seamark David A , Lawrence Clive , Pereira Gray Denis J 
Published: November 2007

All deaths from cancer were identified from death certificates in the Exeter Health District for a period of one year. Place of death, age, cancer type and access to general practitioner community hospital beds and the domiciliary hospice service were recorded. There were 1022 deaths attributable to cancer (parts 1 a, 1 b or 1 c of the death certificate) who were patients of general practitioners in the health district. The place of death for patients with access to community hospital beds were: home 173/590(29%), community hospital 232/590 (39%), specialist services unit 102/590 (17%), nursing or residential home 32/590 (5%), Marie Curie hospice 51/590 (9%). For patients without access to community hospital beds the place of death was: home 177/427 (41 %), specialist services unit 165/427 (39%), nursing or residential home 42/427 (10%), Marie Curie hospice 43/427 (10%). The presence of community hospital beds was associated with a significant reduction of deaths in the specialist service unit ( p<0.001) and with a smaller reduction in home deaths ( p<0.01). Access to the domiciliary hospice services in areas with community beds was not associated with any significant change in the place of death. General practitioners cared for 74% of cases at the time of death in areas with access to community hospital beds and for 51 % of cases without such access, which was a significant difference ( p <0.001). It therefore appears that community hospitals play a major role in the terminal care of cancer patients and access to such beds is associated with a decrease in cancer deaths occurring in specialist services beds.
Monitoring drug use in palliative care
Authors: Twycross Robert G , Bergl Stephen , John Sally 
Published: November 2007

A computerized system for monitoring drug use which makes use of the British National Formulary (BNF) drug categories and a departmental formulary (DF) has been developed. Data entry takes less than one week of secretarial time per annum. Details of drug use in 385 patients three weeks after referral to a National Health Service palliative care unit over five years form the basis of this report. The median number of drugs per patient was five, with a maximum of 11; 97% of the drugs were from the DF. Analgesics were the commonest category of drugs used. The 10 most commonly used drugs included three analgesics (morphine, co-proxamol, flurbiprofen), two laxatives (co-danthrusate, lactulose), dexamethasone, metoclopramide, ranitidine, temazepam and amitriptyline/dothiepin. Seventeen per cent of patients received two preparations from the same second level BNF category (analgesics excluded). The concurrence was questionable in about half of these, and mostly related to the use of laxatives or to hypnotics and anxiolytics. Several unexpected inclusions in the top 10 drugs illustrate the need for quantification rather than pontification about drug use in palliative care. Examination of duplicate prescribing provides a forum for examining ways of simplifying drug regimens.
Assessing the effectiveness of a hospital palliative care team
Authors: Ellershaw John E , Peat Sue J , Boys Lesley C 
Published: November 2007

A prospective study was carried out of 125 hospital inpatients with malignant disease, referred to the King's College Hospital advisory palliative care team. A palliative care assessment (PACA) tool was developed in order to assess the outcome of interventions made within two weeks of referral with regard to: symptom control, change in the patients' and their relatives' insight regarding diagnosis and prognosis, and facilitation of patient placement. Reliability was assessed by cross-observer analysis, and validity by comparison with data obtained using the McCorckle symptom distress scale in a separate group of hospice inpatients. At initial assessment, the commonest symptom was pain, as reported by 74% of patients. One-third of the patients were unsure of their diagnosis and placement had not been decided in 61 %. In total, the team undertook 245 pharmacological interventions for symptom control, 165 interventions regarding insight and 114 interventions concerning placement. Analysis of the data showed statistically significant improvements in pain (p < 0.001), nausea (p < 0.009), insomnia (p < 0.004), anorexia (p < 0.001) and constipation (p < 0.02). Discussion regarding diagnosis significantly changed the insight of patients (p < 0.001) and relatives (p < 0.02). Appropriate placement was assisted by interventions undertaken by the team. This study shows that a hospital palliative care team is effective at improving symptom control, facilitates understanding of the diagnosis and prognosis, and contributes to the appropriate placement of patients.
Nurses in private nursing homes: a study of their knowledge and attitudes to pain management in palliative care
Authors: Gibbs G. 
Published: November 2007

Nurses working in private nursing homes may not have the same degree of access to support and education in palliative care as nurses in NHS 'care of the elderly' wards. A study was conducted comparing two groups of nurses working in these two environments in one health district. Twenty-four nurses underwent semistructured interviews focusing on pain management. Both groups showed equal enthusiasm for their work with elderly patients. However, those from the care of the elderly wards were able to offer many more treatment strategies to relieve pain than their colleagues from the private nursing homes. The study uncovered a sense of isolation and a lack of postbasic education opportunities for nurses outside the NHS. If this small local study reflects a national trend, then there are major implications for the educational activities of palliative care teams.
Dying from cancer: results of a national population-based investigation
Authors: Addington-Hall Julia , McCarthy Mark 
Published: November 2007

Objective: To describe the quality of care received in the last year of life by people who die from cancer, focusing particularly on symptom control, communication with health professionals, and care in the community. Design: Interview survey of family members or others who knew about the last year of life of a random sample of people who died in the UK in 1990, based upon methods used in nationally representative surveys by Cartwright in 1969, and Cartwright and Seale in 1987. Setting: Twenty district health authorities from a range of inner city, outer urban and rural settings. Although self-selected, districts were nationally representative in terms of social characteristics and on many indicators of health service provision and usage. Participants: Interviews were obtained for 2074 cancer deaths out of a random sample of 2915, a 71 % response rate. Main results: At some stage in the last year of life, 88% were reported to have been in pain, 66% were said to have found it to be'very distressing', and 61 % to have experienced it in their last week. Treatment that only partially controlled the pain, if at all, was said to have been received by 47% of those treated for pain by their GPs and by 35% of hospital patients. Other common symptoms experienced by more than half the sample in their last year were loss of appetite, constipation, dry mouth or thirst, vomiting or nausea, breathlessness, low mood, and sleeplessness. Half of the respondents (51%) were unable to get all the information they wanted about the patient's medical condition when they wanted it. Relatives bore the brunt of caring for 81 % of the sample. Of respondents who had helped to care for the deceased, 65% said that their activities had been at least fairly restricted, but 53% had found it rewarding. District nurses had helped 60% of the deceased, 20% had had a home help, and 9% had received'meals on wheels'. More help with activities of daily living was reported to have been needed by 31 %; 24% were reported to have needed more help with domestic chores; 25% were reported to have needed more financial help, and 29% were reported to have needed either more care from district nurses (if had some) or some care (if had none). Conclusion: There is still some way to go before all dying cancer patients receive high quality care. Education in the principles of palliative care is needed at all levels of the NHS if high standards are to be reached. In addition, adequate resources are required to meet the social and health care needs of cancer patients at home. There is, as yet, no room for complacency about the care of dying cancer patients.
Epidural diamorphine and bupivacaine stability study
Authors: Kreeger Louisa , Cowin Peter , Noble-Gresty Jocelyn , Naysmith Anne 
Published: November 2007

Diamorphine and bupivacaine are commonly used together for spinal analgesia, although stability data relating to the mixture of the two drugs have not actually been established. We therefore performed a stability study using high performance liquid chromatography for both drugs and the British Pharmacopoeia 2,6-dimethylaniline limit test for bupivacaine, over a period of eight days and at room temperature. Diamorphine and bupivacaine were combined in various concentrations in 100 ml bags for use with the Bard patient controlled analgesia pump. We found no significant change in concentration of either drug, and the 2,6- dimethylaniline limit test was well within set limits. We therefore conclude that it is safe to combine these two drugs in this way.
The role of embolization in palliative care
Authors: Broadley KE , Kurowska A. , Dick R. , Platts A. , Tookman A. 
Published: November 2007

Transcatheter arterial embolization (TCAE) is a well recognized radiological technique that has been used for over 25 years. It is a method of diminishing blood flow through selected vessels by inserting haemostatic material under angiographic control. The procedure is performed under local anaesthetic through a femoral or, occasionally, an axillary approach. We present our experience of the use of TCAE in the management of pain and haemorrhage in three hospice inpatients in whom other options had been exhausted. The use of TCAE as a technique for the palliation of these symptoms in the hospice setting is discussed.
Disclosure of concerns by hospice patients and their identification by nurses
Authors: Heaven Cathy M , Maguire Peter 
Published: November 2007

As part of an evaluation of the training of hospice nurses in communication skills, the selectivity of patients in disclosing their concerns and the ability of nurses to register all the concerns disclosed were studied. Forty-two nurses were recruited from two hospices in the north of England. They were asked to determine and write down patients' current concerns before and after training, and nine months later. Their interviews were tape recorded to permit rating of the concerns disclosed. After each interview a research nurse used a semistructured interview and the Concerns Checklist to elicit patients' concerns. The Spielberger State Anxiety Scale and Hospital Anxiety and Depression Scale were then administered to assess patients' mood. In total, 87 patients were thus assessed. Patients were highly selective in what they disclosed and showed a strong bias towards disclosing physical symptoms. Overall, 60% of concerns remained hidden and concerns about the future, appearance and loss of independence were withheld more than 80% of the time. Patients who were more anxious or depressed were less likely to disclose concerns. The nurses registered only 40% of the concerns disclosed to them at interview, and less than 20% of patients' concerns were identified approprately. The nurses were selective in the categories of concerns that they registered. Pain, family worries, appetite and weight loss, nausea and vomiting were noted most frequently, while concerns about cancer, bowel function, treatment and emotional worries were not registered. The patients' main concern was identified and recorded in only 45% of cases. Overall, it was found that hospice patients selectively disclosed physical symptoms while nurses did not elicit or register patients' concerns accurately. Nurses therefore need to improve their ability to elicit and register all of their patients' concerns and to pay particular attention to those who are anxious and depressed.
Beach sediment budgets and coastal modification
Authors: Clayton Keith M. 
Published: November 2007

In recent years a start has been made in developing the concept of the coastal sediment compartment because of a growing interest in the question of sediment budgets. In many ways the coastal compartment is the equivalent of the drainage basin in terrestrial geomorphology-a unit within which it is theoretically possible to compute sediment gains and losses and so arrive at a quantitative budget statement. On coasts of relatively free transport where natural 'sediment-tight' compartments do not exist it is necessary to define notional compartments or longshore drift cells, the boundaries of which may be placed where transport rates are reduced, change significantly or are more easily measured. Hierarchies of compartments may be identified where large exclusive compartments may contain smaller non-exclusive subcompartments. Again the analogy is with different orders of drainage basins in the terrestrial situation (Davies, 1979).
Fluvial facies models: a review of Canadian research
Authors: Hickin Edward J. 
Published: November 2007

Canadian river scientists made significant contributions to the early development (1960-80) of fluvial facies models, particularly to those for braided rivers. More recent Canadian studies (1980-92) have centred on understanding the facies sedimentology of anastomosed and wandering gravel-bed rivers. River planform facies models are distinctly limited as indicators of fluvial style because of: (1) spurious environmental correlations; (2) the difficulty of river planform definition; (3) differential preservation potential of facies; (4) inadequate and unsystematic field sampling; (5) flawed statistical testing; and (6) the inappropriate space scale adopted for analysis. The scale problems of facies analysis may be overcome by employing architectural element analysis in conjunction with modem geophysical methods such as shallow reflection seismology and ground-penetrating radar. Future research should focus on devising specific tests of element-scale sedimentological relationships based on the contemporary fluvial enrivonment.
Landscapes of cold-centred Late Wisconsinan ice caps, Arctic Canada
Authors: Dyke Arthur S. 
Published: November 2007

Uplands of the Canadian Arctic Islands supported Late Wisconsinan ice caps that developed two landscape zones reflecting basal thermal conditions regulated by long-sustained ice flow patterns. Central cold-based zones protected older glacial and preglacial landscapes while peripheral warm-based zones scoured and otherwise altered their beds. Some geomorphic effects are independent of ice cap scale, others vary with scale. For ice caps of 30 km radius or more, scour-zone width remains proportionally constant to flowline length under similar flow conditions. But intensity of scouring, ice moulding of drift and rock eminences, size and abundance of subglacial meltwater features, and development of end moraines increase with ice cap size. Ice caps became entirely cold based early in retreat as the boundary between warm and cold ice shifted outward, probably because ice thinned and flow slackened. The frozen margins deflected meltwater, thus maximizing formation of lateral meltwater channels throughout retreat. The landform record of cold-based glaciers in this region is easily interpreted. Hence, regional ice sheet models invoking or based on the premise that cold-based ice leaves no geomorphic record seem untenable.
Chronostratigraphy of glaciations and permafrost episodes in the Cordillera of western North America
Authors: Harris Stuart A. 
Published: November 2007

Glaciations in the Cordillera of western North America began during the Late Miocene in the St Elias Range and coastal ranges near Anchorage, Alaska. Radiometric dating of the tephra and lava flows intercalated in the succession of older tills, loesses and outwash deposits permits the reconstruction of the probable early glacial sequence along the Cordillera. No one site shows the complete sequence, but the available data suggest synchroneity of the major glacial events throughout the region. The first evidence for cold conditions at low elevations at midlatitudes is from 3.5 Ma BP. By 2.8 Ma, alpine glaciations may have occurred in the Sierra Nevada and ice wedges had formed in bedrock near Fairbanks, Alaska. Three more major glaciations complete with contemporary periglacial and permafrost landforms had occurred by 1.65 Ma, while at least six more major cold events can be recognized during the Quaternary period. Once again, expansion of permafrost conditions occurred during each event and forms an integral part of the evidence for climatic change.
Stratospheric ozone depletion - an overview of the scientific debate
Authors: Drake Frances 
Published: November 2007

For almost half a century it was widely believed that the photochemistry of the stratosphere and hence ozone distribution were well understoood. As observations revealed a gap between observed and predicted values it was recognized that a number of substances acted as catalysts thereby increasing the destruction of ozone and that humanity could augment those catalysts and affect the ozone layer. Initial concern focused on nitrogen oxides from the exhausts of supersonic transport, but attention switched in the mid-1970s to chlorofluorocarbons (CFCs). Although the theory of anthropogenic ozone depletion by CFCs found widespread scientific support the perceived threat was minimized in particular by successive model predictions downgrading the amount of depletion. The appearance of the ozone hole over Antarctica in the mid-1980s reopened the debate as to whether such depletion was anthropogenic or natural in origin. It also highlighted the model's inadequate treatment of the processes occurring in the stratosphere and the importance of dynamics and radiative transfer in stratospheric ozone destruction. Scientific consensus again favours the anthropogenic depletion of the ozone layer. In conclusion it is considered that the degree of consensus outweighs the image of scientific uncertainty that is often portrayed in relation to the issue of stratospheric ozone depletion.
Antinuclear Antibody Profile in Italian Patients with Connective Tissue Diseases
Authors: Neri R. , Tavoni A. , Cristofani R. , Levanti C. , Sodini G. , D'Ascanio A. , Vitali C. , Ferri C. , Bombardieri S. 
Published: November 2007

In the present work we report data on the specificity of antinuclear antibodies (ANA) in a large series of Italian patients suffering from a broad spectrum of connective tissue diseases (CTD), by using a series of homogeneous and validated techniques. The present study confirms, on the one hand, generally accepted concepts, i.e. that certain autoantibodies are strictly associated to certain disease states (such as anti-PCNA and anti-Sm in systemic lupus erythematosus, Jo1 in polymyositis, and ACA and Scl-70 in scleroderma); the presence of 'marker' antibodies is, however, restricted to a relative minority of CTD patients. The application of a new methodological approach that considers the entire profile of ANA can greatly augment their diagnostic relevance and may provide useful indications for their interpretation, allowing us to establish for the first time the diagnostic usefulness not only of marker autoantibodies but also of certain associations between non-marker autoantibodies. Finally, the application of a more appropriate and powerful statistical tool (multiple correspondence analysis) has further emphasized the clear relationship existing between antibody specificities and certain disease states.