80 research outputs found
The development, validity, reliability and practicality of a new measure of palliative care: the Support Team Assessment Schedule.
Hospices and support teams offering palliative care have
increased by over four fold in the U.K. during the last decade.
However, evaluations have been limited, often because of a lack
of suitable outcome measures. This study aimed to develop and
test the validity and reliability of a measure of palliative care
provided by support teams.
Through detailed discussion of work objectives with care staff,
assisted by review of the literature, the Support Team Assessment
Schedule (STAS) was developed. STAS has 17 items, each scaled 0
(best) to 4 (worst), with definitions for each scale point.
Median time to complete a STAS rating was 2 minutes (range <1-
15). Face validity was demonstrated by use in five settings.
Criterion validity was assessed by comparing team ratings with
ratings from patients and family members (or other carers)
collected through interview. Patient and team ratings showed
moderate correlations (rho ranging 0.45 - 0.66 for 5 out of 7
items): team ratings were usually closer to those of patients
than those of family members. As a test of construct validity,
quality of life (HCRA-QL) index items were shown to correlate
with similar STAS items in patients more than four weeks before
death (a STAS sub-scale of six items was correlated with the
total HRCA-QL, Spearman rho -0.45).
Reliability of STAS was assessed by comparing the ratings of
different staff. Out of a total of 45 patient assessments, 16 items showed agreement or ratings within one score in 88% or more
cases, Cohen's Kappas were greater than 0.48 (up to 0.87) and
were highly significant (p < 0.0005). There were high
correlation coefficients (Spearman's rho ranged 0.65 - 0.94).
Split-half reliability and internal consistency was assessed
using Spearman Brown coefficients and Cronbach's alpha for
ratings at referral, at death or discharge, and on all weeks
(combined). The coefficients ranged 0.68 - 0.89: slightly higher
than the coefficients found for the HRCA-QL index.
Serial scores of patients that improved (the majority) and
deteriorated (a minority) under care, and results from first and
last assessments of patients under the care of five support
teams, indicate that the STAS was discriminating in practice.
Although STAS was used to audit support team care the items are
relevant to the assessment and evaluation of palliative care in
other settings
Mirtazapine for chronic breathlessness? A review of mechanistic insights and therapeutic potential
Introduction: Chronic breathlessness is a common and distressing symptom of advanced disease with few effective treatments. Central nervous system mechanisms are important in respiratory sensation and control. Consequently, drugs which may modify processing and perception of afferent information in the brain, may have a role. Antidepressants have been proposed, however current evidence is limited. Of potentially suitable antidepressants, mirtazapine is an attractive option given its tolerability profile, low cost and wide availability, along with additional potential benefits.Areas covered: The paper provides an overview of the physiology of breathlessness, with an emphasis on central mechanisms, particularly the role of fear circuits and the associated neurotransmitters. It provides a potential rationale for how mirtazapine may improve chronic breathlessness and quality of life in patients with advanced disease. The evidence was identified by a literature search performed in PubMed through to October 2018.Expert commentary: Currently, there is insufficient evidence to support the routine use of antidepressants for chronic breathlessness in advanced disease. Mirtazapine is a promising candidate to pursue, with definitive randomised controlled trials required to determine its efficacy and safety in this setting
Establishing key criteria to define and compare models of specialist palliative care : a mixed-methods study using qualitative interviews and Delphi survey
Background:
Specialist palliative care services have various configurations of staff, processes and interventions, which determine how care is delivered. Currently, there is no consistent way to define and distinguish these different models of care.
Aim:
To identify the core components that characterise and differentiate existing models of specialist palliative care in the United Kingdom.
Design:
Mixed-methods study: (1) semi-structured interviews to identify criteria, (2) two-round Delphi study to rank/refine criteria, and (3) structured interviews to test/refine criteria.
Setting/participants:
Specialist palliative care stakeholders from hospice inpatient, hospital advisory, and community settings.
Results:
(1) Semi-structured interviews with 14 clinical leads, from eight UK organisations (five hospice inpatient units, two hospital advisory teams, five community teams), provided 34 preliminary criteria.
(2) Delphi study: Round 1 (54 participants): thirty-four criteria presented, seven removed and seven added. Round 2 (30 participants): these 34 criteria were ranked with the 15 highest ranked criteria, including setting, type of care, size of service, diagnoses, disciplines, mode of care, types of interventions, ‘out-of-hours’ components (referrals, times, disciplines, mode of care, type of care), external education, use of measures, bereavement follow-up and complex grief provision.
(3) Structured interviews with 21 UK service leads (six hospice inpatients, four hospital advisory and nine community teams) refined the criteria from (1) and (2), and provided four further contextual criteria (team purpose, funding, self-referral acceptance and discharge).
Conclusion:
In this innovative study, we derive 20 criteria to characterise and differentiate models of specialist palliative care – a major paradigm shift to enable accurate reporting and comparison in practice and research
Origins of the Ambient Solar Wind: Implications for Space Weather
The Sun's outer atmosphere is heated to temperatures of millions of degrees,
and solar plasma flows out into interplanetary space at supersonic speeds. This
paper reviews our current understanding of these interrelated problems: coronal
heating and the acceleration of the ambient solar wind. We also discuss where
the community stands in its ability to forecast how variations in the solar
wind (i.e., fast and slow wind streams) impact the Earth. Although the last few
decades have seen significant progress in observations and modeling, we still
do not have a complete understanding of the relevant physical processes, nor do
we have a quantitatively precise census of which coronal structures contribute
to specific types of solar wind. Fast streams are known to be connected to the
central regions of large coronal holes. Slow streams, however, appear to come
from a wide range of sources, including streamers, pseudostreamers, coronal
loops, active regions, and coronal hole boundaries. Complicating our
understanding even more is the fact that processes such as turbulence,
stream-stream interactions, and Coulomb collisions can make it difficult to
unambiguously map a parcel measured at 1 AU back down to its coronal source. We
also review recent progress -- in theoretical modeling, observational data
analysis, and forecasting techniques that sit at the interface between data and
theory -- that gives us hope that the above problems are indeed solvable.Comment: Accepted for publication in Space Science Reviews. Special issue
connected with a 2016 ISSI workshop on "The Scientific Foundations of Space
Weather." 44 pages, 9 figure
Do guidelines influence breathlessness management in advanced lung diseases? A multinational survey of respiratory medicine and palliative care physicians
Background
Respiratory medicine (RM) and palliative care (PC) physicians’ management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) and lung cancer (LC), and the influence of practice guidelines was explored via an online survey.
Methods
A voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists.
Results
450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all p < 0.001) and significantly more PC physicians indicated routine use of benzodiazepines for COPD (33% vs. 10%) and fILD (25% vs. 12%) (both p < 0.001). Significantly more RM physicians reported routine use of a breathlessness score (62% vs. 13%, p < 0.001) and prioritised exercise training/rehabilitation for COPD (49% vs. 7%) and fILD (30% vs. 18%) (both p < 0.001). Overall, 40% of all respondents reported reading non-cancer palliative care guidelines (either carefully or looked at them briefly). Respondents who reported reading these guidelines were more likely to: routinely use a breathlessness score (χ2 = 13.8; p < 0.001), use opioids (χ2 = 12.58, p < 0.001) and refer to pulmonary rehabilitation (χ2 = 6.41, p = 0.011) in COPD; use antidepressants (χ2 = 6.25; p = 0.044) and refer to PC (χ2 = 5.83; p = 0.016) in fILD; and use a handheld fan in COPD (χ2 = 8.75, p = 0.003), fILD (χ2 = 4.85, p = 0.028) and LC (χ2 = 5.63; p = 0.018).
Conclusions
These findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled
Language translation of outcome measurement tools: views of health professionals
Assessing the outcome and effectiveness of treatment is extremely important in nursing practice and it is vital that outcome measures are available to non-English speakers. We investigated health professionals’ views on translating outcome measures for use in nursing practice. Semi-structured interviews were conducted with a purposive sample of 10 health professionals. Content analysis of data identified the following two broad themes: meeting need and cultural considerations. Specific palliative care issues were also identified. Low literacy levels among ethnically diverse communities and the need to ensure cultural equivalence were perceived as major challenges for palliative nursing practitioners when translating outcome measures. Given increasing cultural diversity within the UK, health professionals considered clinical tool translation worthwhile because it helps to address inequalities in health-care provision for ethnically diverse communities. A consideration of the cultural context is needed when interpreting responses on translated outcome measures. However, translations into appropriate languages can help overcome communication barriers and minimize the need for family members to act as interpreters for patients with palliative care needs
Translating clinical tools in nursing practice
Background. The widespread use of clinical tools in nursing practice reflects their usefulness in guiding patient care, evaluating treatment effectiveness and conducting audit. Cultural awareness and the provision of culturally competent care is a high priority for nurses in the United Kingdom (UK), given patterns of increasing ethnic diversity. However, meeting the individual needs of patients can be difficult when language barriers hinder communication. One way to address these difficulties is to translate existing clinical tools.Aim. The aim of this paper is to appraise the potential for, and limitations of, translating clinical tools for use in nursing practice.Discussion. Drawing on a range of studies from the disciplines of health and social science, this review describes and discusses some key considerations relevant to translating clinical tools in nursing. These considerations include the need to ensure cultural equivalence, lack of familiarity with clinical tool formats in some cultures and its impact on responses, and low literacy levels in some populations.Conclusion. Clinical tools provide benefits in identifying patients' problems, guiding patient care, and evaluating treatments and interventions. Translating these tools can help to bridge the language gap that hinders good communication between nurses and patients. Translated clinical tools can be of acceptable cultural equivalence and validity if high quality translation methodologies are employed, together with an awareness of culturally relevant issues when interpreting the information gained from the tools
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