The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad news

AIMS: To explore the difficulties experienced by nurses and healthcare professionals when engaging in the process of breaking bad news BACKGROUND: The challenges faced by staff when breaking bad news have previously been researched in relation to particular settings or subjects. This study involved staff from diverse settings and roles to develop broader insights into the range of difficulties experienced in clinical practice. DESIGN: The study used a descriptive survey design involving self-reported written accounts and framework analysis. METHODS: Data were collected using a structured questionnaire containing a free text section that asked participants to describe a difficult experience they had encountered when involved in the process of breaking bad news. Data were collected from healthcare staff from hospital, community, hospice and care home settings attending training days on breaking bad news between April 2011 - April 2014. FINDINGS: Multiple inter-related factors presented challenges to staff engaging in activities associated with breaking bad news. Traditional subjects such as diagnostic and treatment information were described but additional topics were identified such as the impact of illness and care at the end of life. A descriptive framework was developed that summarises the factors that contribute to creating difficult experiences for staff when breaking bad news. CONCLUSION: The framework provides insights into the scope of the challenges faced by staff when they engage in the process of breaking bad news. This provides the foundation for developing interventions to support staff that more closely matches their experiences in clinical practice. This article is protected by copyright. All rights reserved

Telephone follow-up to identify incident lung cancer symptoms in COPD patients

Background: COPD patients are at very high risk of lung cancer, yet new respiratory symptoms of lung cancer may be particularly hard to identify. Aim: We sought to assess the feasibility of actively seeking lung cancer symptoms to improve the timeliness of diagnosis in this group. Design and setting: Observational study to evaluate the feasibility and practicability of the intervention. Patients were recruited from a primary care COPD register and were contacted by telephone 4-monthly over 12 months. Chest X-ray rates were assessed over the 20 months before, during the intervention and for 20 months following it, in both the study group and in patients on the register who did not volunteer for the intervention. Results: Most symptoms were identified at the first call, with 13 (17%) subjects admitting to a new persistent cough and 7 (9%) to a change in their cough. As a result of symptoms identified on the first call, 21 (27%) of the participating patients were referred for a chest X-ray and 4 (5%) were referred urgently to secondary care. Incident symptoms continued frequently to be identified at all subsequent calls, with an overall total of 49% of patients qualifying for and receiving a chest X-ray. Interestingly, the chest X-ray rate remained significantly elevated for the 20 months following the intervention, whilst there appeared to be little change in the non-study COPD patients. Conclusion: The intervention was readily practicable and lung cancer symptoms were frequently identified. The intervention may have resulted in a behavior change leading to a persistently higher chest X-ray rate, although the comparator group was not a formal control group and further assessment in a randomized control trial appears justified

Hoop conjecture for colliding black holes : non-time-symmetric initial data

The hoop conjecture is well confirmed in momentarily static spaces, but it has not been investigated systematically for the system with relativistic motion. To confirm the hoop conjecture for non-time-symmetric initial data, we consider the initial data of two colliding black holes with momentum and search an apparent horizon that encloses two black holes. In testing the hoop conjecture, we use two definitions of gravitational mass : one is the ADM mass and the other is the quasi-local mass defined by Hawking. Although both definitions of gravitational mass give fairly consistent picture of the hoop conjecture, the hoop conjecture with the Hawking mass can judge the existence of an apparent horizon for wider range of parameters of the initial data compared to the ADM mass.Comment: 15pages, 4 figure

Geometric Phases in Graphitic Cones

In this article we use a geometric approach to study geometric phases in graphitic cones. The spinor that describes the low energy states near the Fermi energy acquires a phase when transported around the apex of the cone, as found by a holonomy transformation. This topological result can be viewed as an analogue of the Aharonov-Bohm effect. The topological analysis is extended to a system with $n$ cones, whose resulting configuration is described by an effective defect.Comment: 4 pages, revtex

The role of temperature in the detection and diagnosis of neutropenic sepsis in adult solid tumour cancer patients receiving chemotherapy

© 2018 Elsevier Ltd Purpose: The primary aim of this study was to examine the value of temperature as a diagnostic and prognostic indicator of infection and sepsis in neutropenic patients. A secondary aim was to gain insight into the presenting symptoms reported by these patients at home or on their initial admission assessment. Methods: A cohort study was carried out using a case note review of 220 emergency admissions to a regional cancer centre. All participants were neutropenic and were diagnosed with infection on admission. The main outcome measures were relationships between Early Warning Scores and temperature values at home, on admission and during the hospital stay. Results: 22% of patients who became acutely unwell did not have a fever. Pearson correlations showed only small associations between highest temperature value at any time point and highest early warning scores (r(202) = 0.176, P =.012). Temperature at home (B = 0.156, P =.336) and temperature on admission (B = 0.200, P =.052) did not predict highest Early Warning Scores. Conclusions: Body temperature is not a consistently reliable diagnostic or prognostic indicator for outcomes in patients with neutropenia and symptoms of infection. It can assist with early presentation and recognition of infection in many neutropenic patients. However, over-reliance on temperature risks missing the opportunity for early detection and treatment

Being Warm Being Happy: fuel poverty and adults with intellectual disabilities

Self-determination has been acknowledged as a criticalconstruct for people with intellectual disability (ID), given the benefits itspromotion entails towards an enhanced quality of life..

Classical self-forces in a space with a dispiration

We derive the gravitational and electrostatic self-energies of a particle at rest in the background of a cosmic dispiration (topological defect), finding that the particle may experience potential steps, well potentials or potential barriers depending on the nature of the interaction and also on certain properties of the defect. The results may turn out to be useful in cosmology and condensed matter physics.Comment: 5 pages, 4 figures, revtex4 fil