Search

Background: Traditional models of palliative care have been tested by the challenges of caring for increasing numbers of people at the end stages of a chronic non-malignant illness. The COVID-19 pandemic and consequent reliance on telehealth services, has enabled the development of creative models of care. Aims: To improve home-based palliative care for people with chronic illness using telehealth, and this was demonstrated using quality-of-life measures. Methods: A total of 35 non-cancer referrals to a community palliative care service were recommended for the pilot project, with one specialist palliative care nurse as their contact. All were offered a telehealth service with a specially designed app to self-monitor their symptoms, a session on advance care directives, and self-rated quality-of-life measures using the RAND 36-Item Health Survey (Version 1.0), consisting of 36 items that cover nine domains. Statistical analysis was performed using SPSS software. Findings: Over the 21 months of the pilot study, 13 people chose to participate in the pilot. For participants, telehealth meant more control over their symptoms, fewer emergency presentations and appointment travel time was alleviated. Quality-of-life surveys highlighted physical impairments, which did not change over time. Conclusion: This pilot programme demonstrated an innovative approach to addressing the demands of people dying of chronic illness, with further work required to explore the place of telehealth consultations in the overall healthcare system. [ABSTRACT FROM AUTHOR]

Meeting the end-of-life care needs of particular groups in Australia remains challenging, especially those people who are culturally and/or religiously diverse. One such group is those adherents to Islam, whose communities come from many parts of the world. to develop connections with the Islamic community, to understand their end-of-life care needs. over 12 months palliative care staff and members of the Islamic community met to prepare for and deliver a seminar to assist understandings between the Islamic community and palliative care services. A seminar, attended by 79 participants, addressed issues like palliative care and Islam; how palliative care works; advance care planning; care coordination; and bereavement. Many commonalities emerged, to provide a foundation for further activities; and the process demonstrated the importance of working together, and highlighted opportunities for shared collaborative work. [ABSTRACT FROM AUTHOR]

Background: Palliative care is limited in Ethiopia, particularly in rural areas, where more than 78% of the population live. Current initiatives and research are focused on urban settings and are primarily donor dependent. This study aims to explore the status of palliative care, enabling factors and implementation challenges in Ethiopia's rural and regional health care settings. Methods: A qualitative regional case study was conducted with health professionals drawn from different health care settings, academic institutions and included health planners and practitioners. Focus groups were conducted with rural community members and face- to face- individual interviews were conducted with health professionals working in numerous roles as well as academic leaders. Results: Participants indicated that despite a few leaders being aware of the inclusion of palliative care in the Ethiopia national policies and guidelines, palliative care is not, integrated into the existing health care system. Other participants responded that palliative care is not well integrated into the undergraduate and postgraduate courses except for limited content in the diploma and a few postgraduate courses. Participants described the challenges for palliative care implementation as follows: many lacked awareness about palliative care; and chronically ill patients other than those with HIV received inadequate care, limited to physical care, some pain management, and psychosocial support rather than comprehensive palliative care. In addition, some participants perceived that palliative care was not within the remit of their service, so families and patients were forced to seek alternative or informal care, including from traditional healers. Conclusions: Enablers for the improvement of palliative care access in rural and regional health care were identified, including better integration of palliative care into the national health care plan and guidelines; palliative care content in university and college courses; and use of mobile phone technology to facilitate care. And policy makers and responsible stakeholders could consider the palliative care implementation in rural and regional health care settings through a combination of home, community and facility-based models. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) is a treatment for Parkinson's disease (PD) that can improve symptoms but may have cognitive effects. Recent studies have shown that mutations in the GBA gene, which encodes glucocerebrosidase, increase the risk of cognitive decline in PD. A new study examined cognitive performance in individuals with PD who underwent DBS and found that those with GBA mutations had worse response inhibition compared to those without mutations. However, there were no differences in episodic memory or processing speed. It is important to consider these findings when predicting cognitive changes in individuals with PD who undergo DBS. Shared decision-making and support for patients are crucial in this context. [Extracted from the article]

The grief associated with bereavement, while a natural response to loss, is usually a traumatic life event. The bereavement experience for a primary caregiver with the experience of caring for a loved one is complex, especially if this role has required them to relinquish aspects of their own life. The healing trajectory for the bereaved carer is often more complex than for many other bereavements, given the pre-death experience of caregiving. This paper describes the development of a bereavement model which arose from significant clinical experience of working with bereaved carers in a community palliative care environment. The model assists the bereaved carer in gaining insight into their experience and a focus for their psychological and emotional expression, thereby promoting adaptation to the transition and promoting a healthier grief trajectory. [ABSTRACT FROM AUTHOR]

Innate Lymphoid Cells (ILCs) are immune cells typically found on mucosal surfaces and in secondary lymphoid organs where they regulate the immune response to pathogens. Despite their key role in the immune response, there are still fundamental gaps in our understanding of ILCs. Here we report a human ILC population present in the follicles of tonsils and lymph nodes termed follicular regulatory ILCs (ILCFR) that to our knowledge has not been previously identified. ILCFR have a distinct phenotype and transcriptional program when compared to other defined ILCs. Surprisingly, ILCFR inhibit the ability of follicular helper T (Tfh) cells to provide B cell help. The localization of ILCFR to the germinal centers suggests these cells may interfere with germinal center B cell (GC-B) and germinal center Tfh cell (GC-Tfh) interactions through the production of transforming growth factor beta (TGF-β. Intriguingly, under conditions of impaired GC-Tfh-GC-B cell interactions, such as human immunodeficiency virus (HIV) infection, the frequency of these cells is increased. Overall, we predict a role for ILCFR in regulating GC-Tfh-GC-B cell interactions and propose they expand in chronic inflammatory conditions. Margaret O'Connor et al. report a new Innate Lymphoid Cell population in human tonsils and lymph nodes that inhibit the functional interaction of follicular helper T cells and germinal center B cells. They show that this cell population is expanded under chronic HIV infection and results in decreased antibody production, suggesting a potential role for these cells in diseases with dysregulated immune responses. [ABSTRACT FROM AUTHOR]

Objective: Health providers frequently probe patients' recall of current and/or remote news items to determine the extent of memory loss. Impaired memory for transient events (i.e., in the news for a circumscribed time) may provide information regarding the onset of cognitive impairment. We utilized the Transient News Events Test (TNET) to explore how memory changes over time in older adults with cognitive impairment (CI) and non-cognitively impaired (NCI) individuals. We hypothesized that CI individuals would demonstrate reduced memory for transient events. We investigated the role of semantic and episodic memory on TNET performance. Participants and Methods: Participants completed the TNET as part a comprehensive neuropsychological evaluation. Analyses included t tests to evaluate group differences for TNET performance, and correlations between TNET and neuropsychological measures, including episodic and semantic memory tests. Results: NCI adults demonstrated better memory than CI participants for TNET items. The NCI and CI groups did not differ regarding memory for remote items; however, CI participants had worse memory for recent items. There was a significant association between TNET performance and capacity for episodic and semantic memory in people with CI. In the NCI group, the TNET was associated only with episodic memory. Conclusions: Findings support the use of news events to assess remote memories in older adults. Novel remote memory measures broaden the scope of memory assessment far beyond what is feasible within traditional neuropsychological assessment and provide insight into the onset of memory changes. Results enhance understanding of memory decline in older adults with cognitive impairment. [ABSTRACT FROM AUTHOR]

Most clinical and research investigations of memory focus on consolidation of information over relatively brief intervals of time (i.e., minutes, hours). However, in everyday life we are most interested in retaining experiences for much longer periods of time (days, weeks, years). Studies in cognitive psychology demonstrate that the survival of an engram is influenced by a variety of factors including contextual aspects at time of initial learning, the age of an event, frequency and distribution of exposure to the memory over time and, of course, the amnestic capacity of the learner. In the current symposium we examine the durability of new memories as well those from the past. Presentations focus on medical factors, such as epilepsy and stroke, that result in acceleration of memory loss. The longevity of old memories is examined in relation to age-related decline and the onset of dementia. Findings from these studies enhance our understanding of the cognitive and neural underpinnings of consolidation and, hence, they inform our ability to remember our past. [ABSTRACT FROM AUTHOR]

An editorial is presented on the privileged to be awarded a Winston Churchill Fellowship in 2019, which enabled travel to a number of countries where active assistance in dying is legally available. Topics include the opportunity afforded the time to reflect on 35 years of working with people at the end of their lives, and the influence of the world's religions on framing suffering and the difficult discourse about palliative care and its role in active assistance in dying.

Australia is one of the most successful multi-cultural countries in the world, resulting from continuous immigration for the last 70 years or so. Australia is home for people from almost 200 countries with more than one in five speaking a language other than English at home. Some people arrive in Australia seeking protection from conflict in their own country. They may seek protection as a refugee and in the meantime live in the community while awaiting the outcome of their asylum request. Drawing on a story of one asylum seeker, this paper describes some of the key considerations required in caring for an asylum seeker who is facing the end of their life, making recommendations for addressing their often-complex care needs. [ABSTRACT FROM AUTHOR]

Background: Staff working in community palliative care services are accustomed to the intimate conversations that a patient being at home can engender. Being at home can provide a safe space for a patient to express difficulties, including expressing a desire for hastened death. With the implementation of voluntary assisted dying in Victoria in mid-2019, palliative care services have needed to review and adapt policies and practices to incorporate this new procedure. While it was anticipated that a small percentage of people would request access to voluntary assisted dying, in the wake of such significant change, there were numerous implications for palliative care services to consider. This paper describes both the organisational and individual changes undertaken by one community-based palliative care service, in anticipation of legalised assistance in dying. The range of responses to the issues raised are discussed, in preparation for, and in the early days of, voluntary assisted dying. [ABSTRACT FROM AUTHOR]

• We show ADA enhances human DC differentiation and promote a TFH polarizing cytokines. • We have determined that ADA selectively enhances GC-TFH frequency in vivo. • ADA improves the quality of anti-HIV antibodies, generating neutralizing antibodies. Adenosine deaminase-1 (ADA-1) plays both enzymatic and non-enzymatic roles in regulating immune cell function. Mutations in the ADA1 gene account for 15% of heritable severe-combined immunodeficiencies. We determined previously that ADA1 expression defines and is instrumental for the germinal center follicular helper T cell (T FH) phenotype using in vitro human assays. Herein, we tested whether ADA-1 can be used as an adjuvant to improve vaccine efficacy in vivo. In vitro , ADA-1 induced myeloid dendritic cell (mDC) maturation as measured by increased frequencies of CD40-, CD83-, CD86-, and HLA-DR-positive mDCs. ADA-1 treatment also promoted the secretion of the T FH -polarizing cytokine IL-6 from mDCs. In the context of an HIV-1 envelope (env) DNA vaccine, co-immunization with plasmid-encoded ADA-1 (pADA) enhanced humoral immunity. Animals co-immunized with env DNA and pADA had significantly increased frequencies of T FH cells in their draining lymph nodes and increased HIV-binding IgG in serum. Next, mice were co-immunized with subtype C env gp160 DNA and pADA along with simultaneous immunization with matched gp140 trimeric protein. Mice that received env gp160 DNA, pADA, and gp140 glycoprotein had significantly more heterologous HIV-specific binding IgG in their serum. Furthermore, only these mice had detectable neutralizing antibody responses. These studies support the use of ADA-1 as a vaccine adjuvant to qualitatively enhance germinal center responses and represent a novel application of an existing therapeutic agent that can be quickly translated for clinical use. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disability that demonstrates impaired social interactions, communication deficits, and restrictive and repetitive behaviors. ASD has a strong genetic basis and many ASD-associated genes have been discovered thus far. Our previous work has shown that loss of expression of the X-linked gene NEXMIF/KIDLIA is implicated in patients with autistic features and intellectual disability (ID). To further determine the causal role of the gene in the disorder, and to understand the cellular and molecular mechanisms underlying the pathology, we have generated a NEXMIF knock-out (KO) mouse. We find that male NEXMIF KO mice demonstrate reduced sociability and communication, elevated repetitive grooming behavior, and deficits in learning and memory. Loss of NEXMIF/KIDLIA expression results in a significant decrease in synapse density and synaptic protein expression. Consistently, male KO animals show aberrant synaptic function as measured by excitatory miniatures and postsynaptic currents in the hippocampus. These findings indicate that NEXMIF KO mice recapitulate the phenotypes of the human disorder. The NEXMIF KO mouse model will be a valuable tool for studying the complex mechanisms involved in ASD and for the development of novel therapeutics for this disorder. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the association between performance on subtests of the Mini‐Mental State Examination (MMSE) and driving competence in people with cognitive impairment (CI) as well as those with no cognitive impairment (NCI). DESIGN: Retrospective observational study. SETTING: Participants referred for a DriveWise evaluation at Beth Israel Deaconess Medical Center in Boston, Massachusetts, were included in the study. PARTICIPANTS: A total of 419 participants referred for a DriveWise evaluation was studied. The average age of the sample was 77.69 years. In this study, people with an MMSE score lower than 25 were included in the CI group; 41% of participants had CI. MEASUREMENTS: All participants underwent mental status screening with the MMSE, and all underwent a 45‐minute road test modeled after the Washington University Road Test adapted for use in Boston streets. RESULTS: In both groups, poor road test performance was associated with low scores on the MMSE. In drivers with CI, MMSE total score and performance on the attention subtest were significantly lower for those who failed the road test. In drivers with NCI, the MMSE total score and orientation subtests were significantly lower for those who failed the road test. CONCLUSIONS: Clinicians working with older people should know that the MMSE is an effective tool to screen for driving safety, but MMSE subtests are differentially sensitive to driving safety in people with and without CI. Poor performance on specific MMSE subtests may prompt further evaluation of driving competence with a road test. J Am Geriatr Soc 67:790–793, 2019. [ABSTRACT FROM AUTHOR]

Many countries across the world have legislated for their constituents to have control over their death. Commonalities and differences can be found in the regulations surrounding the shape and practices of voluntary assisted dying (VAD) and euthanasia, including an individual's eligibility and access, role of health professions and the reporting. In Australia there have been perennial debates across the country to attempt legislative change in assisting a terminally ill person to control the ending of their life. In 2017, Victoria became the first state to successfully legislate for VAD. In describing the Victorian process that led to the passage of legislation for VAD, this paper examines the social change process. The particular focus of the paper is on the vital role played by a multidisciplinary ministerial advisory panel to develop recommendations for the successful legislation, and is written from their perspective. What is known about the topic?: VAD has not been legal in an Australian state until legislation passed in Victoria in 2017. What does this paper add?: This paper describes how the legislation was developed, as well as the significant consultative and democratic processes required to get the bill to parliament. What are the implications for practitioners?: In documenting this process, policy makers and others will have an understanding of the complexities in developing legislation. This information will be useful for other Australian jurisdictions considering similar legislative changes. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners have been well-established in many parts of the world and valued as a senior role in healthcare systems. This paper offers an appraisal of a palliative care nurse practitioner model of care project and augments an understanding of being a nurse practitioner (NP) in the Australian context. Aims: To enhance outcomes for people regardless of care setting; and to enhance professional relationships between hospital and community services. A secondary objective was to facilitate a seamless transition from one service to another. Methods: The setting was a home-based palliative care service and a tertiary acute hospital, between which the role was employed. This paper describes the role from the NP's perspective, using the NP's log of work and personal reflections. Results: Despite describing many challenges, an NP shared model of care has benefits not just for smoothing the client's journey through settings of care, but also for increased opportunities for clinicians to work together. Conclusions: There are opportunities for further research, including models of role implementation, the skills required by the clinician, and acceptance and respect of the NP role. [ABSTRACT FROM AUTHOR]

This article reviews how the presence of a bespoke assessment system can enable the measurement of what was previously 'unmeasurable' in a constructive and positive way. It highlights how tracking the small‐step progress of pupils with a diagnosis of special educational needs can support the identification of targets which not only support pupil progress but also increase understanding by professionals of how effective assessments can enable them to develop skills in planning and setting individual targets. This article shows how one school community has responded to the reforms implemented by central government by using them as an opportunity to draw on the strengths of the school, the experience they have in supporting SEND pupils and a deep commitment to providing all the pupils with the best possible education. The article reflects on the development of this system and its impact on teaching and learning across the whole school, using an illustrative case study. [ABSTRACT FROM AUTHOR]

Abstract: While the experiences of family members supporting a person with a terminal illness are well documented, less is known about the needs of carers of people with neurological diseases, in particular, Motor Neurone Disease (MND). This paper describes the qualitative data from a large Australian survey of family carers of people with MND, to ascertain their experiences of receiving the diagnosis. The aim of the study was to describe the experiences of family carers of people with MND in receiving the diagnosis in order to inform and improve ways in which the diagnosis is communicated. Anonymous postal surveys were sent to people with MND in Australia and their family carers respectively. The perceived ability/skills of neurologists was assessed using a five‐point scale from excellent to poor. Attributes of communication of bad news was measured by the SPIKES protocol. Each survey question invited further written responses. Eight hundred and sixty‐four questionnaires were posted to people with MND and their family carers, with assistance from MND associations. One hundred and ninety‐six family carers submitted responses, of which 171 (88%) were patient‐carer dyads. Analyses were conducted on 190 family carers. Five themes emerged from reading and re‐reading written responses: frustrations with the diagnosis; giving information; family carer observations of the neurologist; the setting; and what would have made the diagnosis easier? The delivery of the diagnosis is a pivotal event in the MND trajectory. Satisfaction for patients and their family carers is related to the neurologists showing empathy and responding appropriately to their emotions, exhibiting knowledge and providing longer consultations. Neurologists may benefit from education and training in communication skills to adequately respond to patients’ and families’ emotions and development of best practice protocols. [ABSTRACT FROM AUTHOR]

Background: The National Standards Assessment Program (NSAP) is an Australian initiative for monitoring and supporting specialist palliative care services to align with Standards for providing quality palliative care for all Australians. It comprises evaluation of 13 National Palliative Care Standards and their elements with the purpose of identifying priority areas to focus improvement activities; strategies include peer mentor visits (PMVs) and use of evidence-based resources. Monitoring of participants’ organizational quality is structured into the program. Aim: To explore the experiences of individual services participating in the Australian National Palliative Care Standards Assessment Program. Design: Case study evaluation. Data sources: Ten case studies from participating services; service self-assessment data; peer mentor reports; in-depth interviews. Analysis: Time point comparison; thematic analysis of interview data. Results: A key strength of NSAP was the cycle between data collection, identification of key improvement areas, and development of strategies for improvement. An understanding of NSAP as a continuous quality improvement process and the potential for the integration of other national programs were noted as key service improvement strategies. The use of resources to promote best practice largely relied upon access to the Internet. PMVs were considered successful, contingent on careful matching of mentors to services. The presence of a ‘champion’ within services was perceived as a success factor. Conclusions: This evaluation informs service improvement in specialist palliative care services through the alignment of continuous quality improvement with National Palliative Care Standards. This may assist development and ongoing revision of continuous quality improvement in the international context. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine, from the perspectives of enrolled nurses and registered nurses, the current scope of enrolled nurse practice and to identify the activities that most enrolled nurses frequently performed in their workplace. Background: Enrolled nurse scope of practice in Australia has evolved and expanded over the past decade. However, the unclear role, function and competency differentiation between enrolled nurse and registered nurse leads to role confusion and ongoing professional debate. Design: Exploratory Descriptive Study. Methods: A cross‐sectional online survey of enrolled nurses and registered nurses across Australia was conducted examining their levels of agreement on statements related to the scope of practice and the clinical and nonclinical activities that enrolled nurses were required to perform in their workplace. Results: Valid responses were received from 892 enrolled nurses and 1,198 registered nurses. Enrolled nurses mostly agreed that they understood their scope of practice; did not undertake roles for which they were unprepared; sometimes undertook activities other than direct patient care; and believed that they operated equally to many registered nurses. The majority of enrolled nurses reported that they performed tasks mostly related to basic patient care in their workplace. There were a number of significant differences between perspectives of registered nurses and enrolled nurses. Conclusions: Clarifying the roles and scope of practice between the registered nurse and the enrolled nurse is important, and explicit differences in responsibility and accountability between their roles must be clearly articulated to harmonise perceptions about role and capability. Health service providers, policymakers and education providers need to work collaboratively to ensure that facets of enrolled nurse education and scope of practice in line with regulation are affirmed by all concerned. Relevance to clinical practice: Health service providers, policymakers and education providers need to work collaboratively to ensure that facets of enrolled nurse education and scope of practice in line with regulation are affirmed by all concerned. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners (NP) are relatively new in Australia with national registration achieved in 2010. Most NP-related literature is about establishing models and scope of practice. This paper reports on the establishment and 12-month evaluation of an NP model of care, between inpatient and community palliative care services, developed to coordinate client care between hospital and home. Aim: To enhance patient outcomes, in hospital or home; to enhance professional relationships between services and facilitate effective discharges and admissions between services. Design and setting: Both services worked together to develop an evaluation framework, based on agreed key performance indicators. Results: The NP model contributed to earlier discharges from hospital and fewer hospital admissions for those being cared for at home. There are developing opportunities to strengthen professional relationships through clinical and educational collaboration. Conclusion: The model has benefited both patient care and clinical cooperation between services. [ABSTRACT FROM AUTHOR]

Background: The right of children to have their voice heard has been accepted by researchers, and there are increasing numbers of qualitative health studies involving children. The ethical and methodological issues of including children in research have caused worldwide concerns, and many researchers have published articles sharing their own experiences. Objectives: To systematically review and synthesise experts’ opinions and experiences about ethical and methodological issues of including children in research, as well as related solution strategies. Research design: The research design was a systematic review of opinion-based evidence, based on the guidelines by Joanna Briggs Institute. Methods: A search of five computerised databases has been conducted in April 2014 and 2271 articles were found. After screening the titles, abstracts, full texts and appraising the quality, 30 articles were finally included in the review. A meta-aggregative approach was applied in the data analysis and synthesis process. Ethical considerations: Ethical approval is not needed as it is a systematic review of published literature. Results: Six themes were identified, including evaluating potential risks and benefits, gaining access, obtaining informed consent/assent, protecting confidentiality and privacy, building rapport and collecting rich data. The similarities and differences between research involving children and that involving adults were indicated. Conclusion: All potential incentives should be justified when designing the study. Further studies need to research how to evaluate individual capacity of children and how to balance protecting children’s right to participate and their interests in the research. Cultural differences related to researching children in different regions should also be studied. [ABSTRACT FROM AUTHOR]

Background: Attempts to develop tools to measure client satisfaction in the palliative care sector have identified a number of challenges, including the lack of common definition of ‘satisfaction’. This paper reports on the utilization of the Victorian Palliative Care Satisfaction Instrument (VPCSI) in three Victoria-wide surveys over three years, of patient and carer satisfaction with palliative care provision. Aim: The VPCSI aimed to both meet the Australian Government performance indicator reporting and facilitate quality improvement for palliative care services. Setting/participants: All palliative services receiving funding from the Victorian Department of Health were invited to participate. Feedback via survey was captured from adult patients, carers, and bereaved carers in both inpatient and community palliative care settings. Results: Overall state-wide response rates averaged 26% over the three-year trial period. Satisfaction state-wide rated very high, ranging from 66% for patients to 74% for bereaved carers. Top five items given priority to improve varied across respondent type but overall included opportunities to talk to other carers; activities to pass the time; minimizing financial burden and training for carers to perform specific care tasks. The top five rated items overall were level of respect shown as an individual; nurse responses; expertise of staff; overall palliative care team performance; and support for physical care. Conclusion: These data demonstrate that the VPCSI is an important tool for the collection of consumer satisfaction data in the palliative care sector across a wide range of service providers. [ABSTRACT FROM PUBLISHER]

Over the past two decades in Australia, there has been significant change in the palliative care sector, the profile of the workforce and its educational requirements. This is reflective of worldwide developments, where educational aspects of palliative care have been integral to the development of service models. This paper describes a project undertaken by the Department of Health in Victoria Australia, to redirect its educational funding towards clinical scholarships to enable clinicians to undertake postgraduate academic studies. The aim of this project was to assess the impact of the Clinical Scholarship Program funding for recipients who undertook postgraduate studies in palliative care. As part of quality assurance, an online survey was distributed to Scholarship recipients across 2 cohorts spanning the years 2008-2010. Recipients were surveyed for the impact and outcomes of their participation in the program. Twenty one-year scholarships for each year (2008-2010), were available to medical, nursing, and allied health professionals currently working in Victoria's public palliative care service system, undertaking postgraduate study in approved courses. Analysis of the data indicated that of most significance was the benefit to the individual, in terms of the impact of study on their professional and personal life and the low rates of employment turnover. Participants also indicated their improved capacity to provide high-quality palliative care services. For the Department of Health this small investment has demonstrated great benefit; and for the palliative care sector it achieved a significant impact enabling an increase in educational opportunities to enhance capacity and capability of the workforce. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to systematically review and synthesise qualitative studies pertinent to male and female school-aged and adolescent children's experience when a parent is diagnosed with non-terminal cancer. Methods A rigorous systematic review and meta-synthesis process were conducted. Seven computerised databases were searched, and 2027 articles were retrieved. After screening the titles and abstracts, full texts of 24 articles were critically appraised, and finally, 16 articles were further analysed and synthesised with a thematic-synthesis approach. Results Five themes were identified: being informed of parental cancer, emotional concerns, changes in daily life, seeking factual information and seeking emotional support. As indicated in the results, most children had been informed of the parent's diagnosis of cancer. They suffered from a wide range of concerns when facing the situation, and their lives had been interrupted to different degrees. In order to cope with the event, children adopted various strategies. Their information and support needs were reported to have been poorly met. Conclusions This systematic review provides insight into the scenario of children living with a parent with non-terminal cancer and indicates some suggestions for future studies. The experience of children when the father has cancer should be further explored. Short-term and long-term impacts of parental cancer on children, especially young children within different cultural contexts, should be investigated to help health care professionals provide individualised assistance to those children. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Background: Evidence suggests that both motor improvement and decline in verbal fluency in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) may be attributed to a lead implantation effect. Objective: We investigated whether the number of microelectrode recording (MER) passes influenced either motor UPDRS scores just prior to stimulation initiation at 4 weeks or decline in verbal fluency 6–24 months after surgery. Methods: We retrospectively analyzed 50 PD patients who underwent bilateral STN DBS. Off medication UPDRS III motor scores were obtained before surgery and before stimulation was initiated. Neuropsychological testing was completed pre- and post-operatively in 28 patients at a mean of 377 days. Coordinates of lead tip and active stimulation site were calculated. Results: There was no improvement in off-medication UPDRS III motor scores at a mean 33.9 days following surgery, with mean change of 0.04 ± 10.48 (p = 0.98). There was no correlation between the number of MER passes and change in individual UPDRS motor score (r = −0.0001, p = 1.0). We observed significant decline in phonemic verbal fluency by 16% (p = 0.003) but it was not correlated with number of left hemisphere (r = −0.15, p = 0.46), or total number of passes (r = −0.02, p = 0.94) or coordinates of the lead tip or active stimulation site. There was a trend toward correlation with age (r = 0.38, p = 0.07). Conclusions: Significant decline in phonemic verbal fluency did not correlate with surgical passes nor with location of the lead tip or active stimulation site. These data suggest that age may influence verbal fluency decline more than surgical technique. [Copyright &y& Elsevier]

The article discusses the health workforce shortages in Australia which is exacerbated by a crisis in attracting and retaining nurses. It describes the challenges related to being OQN (Overseas Qualified Nurses) and the reconciling migration as a dynamic, ongoing and nonlinear process or transition drawn from the literature and personal experience of the first author. It notes that Australia can benefit from hosting OQN's who in turn can contribute to the enrichment of Australian life.

As palliative care has matured as a discipline, the impact of working with individuals at the end of life has become more visible. In turn, palliative care professionals have developed ways to share their respective experiences and a number of representative worldwide groups have emerged. These groups have become increasingly involved in advocacy and awareness- raising activities on behalf of the sector, using rights-based arguments and a public health framework to advocate for equitable access to palliative care. This article provides an overview of some of the work that has been undertaken by international groups. Although worldwide activities may differ in emphasis, there has been demonstrated benefit in coalescing the advocacy activities, in order to present a united global voice on issues. [ABSTRACT FROM AUTHOR]

A nurse’s personal reflection on a day in ‘Skid Row’ and Midtown Los Angeles (LA) highlighted issues related to homelessness and both public and not-for-profit sector solutions used in the United States (US). The experience not only raised awareness of the magnitude of the problem in that country, but also inspired consideration of the common issues and the potential for translating US strategies to reduce homelessness to the Australian context. A reflective cycle was used as the framework for this paper to highlight the component parts of the process for the author and the reader. The unexpected intensity of the experience highlighted the need to prepare the health workforce for practice in unpredictable environments and to deliver flexible service beyond simply providing food and shelter. It also served to more deeply personalise the relationship with the PhD research undertaken by the lead author (KR), exploring palliative care for homeless persons. [ABSTRACT FROM PUBLISHER]

A number of sources of grief, such as loss of home and independence, and loss of loved ones, have been identified as impacting on residents of aged care facilities and nursing homes. Little has been reported about the effect of the death of fellow residents. This study utilized semi-structured interviews to investigate the views of both residents with mild dementia and staff, about the impact of the death of residents on individuals and the residential community. Neither group considered the death of a resident to be a major source of grief. Reasons for this offered both in the data and the literature were considered. Most residents did not think that they had close relationships with their peers. Isolation, which may be structurally imposed by single rooms, disease, or medication-induced apathy, or consciously chosen as a defence mechanism or for other reasons, is likely to be a contributing factor. [ABSTRACT FROM AUTHOR]

Recruitment of participants from minority cultures is problematic for any type of research; but more particularly for palliative care research however, because of the perceived additional vulnerability of participants who are facing the end of their life. Even though the goal of palliative care is to improve the quality of the remaining life, the processes involving such vulnerable people require careful consideration. This consideration is doubly important when participants come from minority cultures. This study discusses the recruitment difficulties in a study focusing on the palliative care needs of Chinese people in Australia. Despite being part of Australian society for most of its' colonized history, Chinese people remain a minority culture and place great importance on their particular culture and traditions. Significant recruitment issues were experienced due to language and cultural constraints, including that death and dying are taboo subjects. The access and recruitment processes utilized in this research are discussed as well as diverse strategies used to achieve involvement. [ABSTRACT FROM AUTHOR]

We examined aesthetic preference for reproductions of paintings among frontotemporal dementia (FTD) patients, in two sessions separated by 2 weeks. The artworks were in three different styles: representa-tional, quasirepresentational, and abstract. Stability of preference for the paintings was equivalent to that shown by a matched group of Alzheimer's disease patients and a group of healthy controls drawn from an earlier study. We expected that preference for representational art would be affected by disruptions in language processes in the FTD group. However, this was not the case and the FTD patients, despite severe language processing deficits, performed similarly across all three art styles. These data show that FTD patients maintain a sense of aesthetic appraisal despite cognitive impairment and should be amenable to therapies and enrichment activities involving art. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To derive symptom clusters and their clinical meanings in Chinese patients with primary liver cancer (PLC), to examine the factors related to the identified symptom clusters, and to validate the impact of the identified symptom clusters on patients' quality of life (QOL).Design: Cross-sectional.Setting: Inpatient departments at a medical center for hepatobiliary disease in China.Sample: 277 patients with PLC, aged 18-77 years.Methods: Data were collected from a number of measures, including demographic and disease characteristics, the MD Anderson Symptom Inventory, six additional symptom items specific to PLC, and the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire. Factor analysis was used to derive symptom clusters, independent-samples t test or one-way analysis of variance was performed to identify the factors related to each symptom cluster, and multivariate regression models were applied to examine the predictive impact of the identified symptom clusters on PLC.Main Research Variables: Demographic and medical variables, symptom clusters, and QOL.Findings: Three symptom clusters were identified: gastrointestinal sickness, neuropsychological, and liver dysfunction. Patients who received liver protection treatment, received more than one kind of treatment, and had poorer physical performance, worse liver function, and more advanced cancer scored higher in severity across all three symptom clusters. All of the symptom clusters explained 48% of the QOL variance, and the liver dysfunction symptom cluster (adjusted R2 = 0.425) showed a superior influence.Conclusions: The liver dysfunction symptom cluster may be unique to Chinese patients with PLC. Patients with certain demographic and disease characteristics could be at risk for experiencing severe symptom clusters. In addition, a differential impact of the symptom clusters on QOL was noted in these patients.Implications for Nursing: The factors related to severity should be considered when managing symptom clusters. Because the predictive impacts of the three individual symptom clusters on QOL were varied and ordered in magnitude, healthcare providers should first alleviate the primary symptom cluster. This approach could be cost-effective and improve QOL. [ABSTRACT FROM AUTHOR]

Aim: This paper addresses issues arising in the literature regarding the environmental design of inpatient healthcare settings and their impact on care. Background: Environmental design in healthcare settings is an important feature of the holistic delivery of healthcare. The environmental influence of the delivery of care is manifested by such things as lighting, proximity to bedside, technology, family involvement, and space. The need to respond rapidly in places such as emergency and intensive care can override space needs for family support. In some settings with aging buildings, the available space is no longer appropriate to the needs-for example, the need for privacy in emergency departments. Many aspects of care have changed over the last three decades and the environment of care appears not to have been adapted to contemporary healthcare requirements nor involved consumers in ascertaining environmental requirements. The issues found in the literature are addressed under five themes: the design of physical space, family needs, privacy considerations considerations, the impact of technology, and patient safety. Conclusion: There is a need for greater input into the design of healthcare spaces from those who use them, to incorporate dignified and expedient care delivery in the care of the person and to meet the needs of family. [ABSTRACT FROM AUTHOR]

Staff members along with residents with mild dementia, in three different aged-care facilities, were interviewed about their experience of the death of another resident. Interview data indicated that residents and staff had differing views. Residents reported that the impact of the death of a co-resident was much less than staff thought. Generally they wanted to be told about the death of someone they knew and considered attempts to hide aspects of the death both unnecessary and disrespectful. Both groups agreed that the celebration of the life of a resident was important, although they differed in how this should be done. These outcomes have implications for staff education and practice. [ABSTRACT FROM AUTHOR]

There has been a great deal of attention focused upon the professional and faculty nursing shortage. Retirement rates of seasoned nurse faculty, fewer nurses pursuing academic roles as nursing faculty, and insufficient numbers of nurses in doctoral programs hinder the ability to educate willing students to become professional nurses. The aim of this descriptive, quantitative study in the New England region was to determine barriers to job satisfaction as reported by nurse faculty. A 32-item survey was used with questions about workload, satisfaction, and identified barriers to satisfaction. Responses from 226 nurse faculty support findings regarding factors essential to job satisfaction, including work environment and workload. Implications for the study findings include the need for attention to the complexity of the academic work environment, specifically in nursing education. [ABSTRACT FROM AUTHOR]

Aim: To explore the views of older Australian and English care home and inpatient hospice staff on the physical environment of their workplace. Method: The paper reports on an issue that was highlighted during a larger ethnographic study of the inpatient environments in which older people receive end-of-life care. During visits to sixteen care homes and inpatient hospices-seven in England and nine in Australia-informal discussions were held with staff in which they described the challenges posed by the physical environment of their workplace. Results: Several of the staff, who were predominantly older female nurses, described the difficulties of working in a care environment that was not always fit for current purpose. For example, they found it tiring to have to walk long distances between tasks, and experienced difficulty with maneuvering heavy equipment on unsuitable floor surfaces. Conclusions: In order to promote the health of older, experienced care home and hospice staff and encourage them to remain in employment, it is important that the physical environment of the care setting is designed in a way that meets their needs. Older staff should be included in decisions about the refurbishment and rebuilding of care environments. [ABSTRACT FROM AUTHOR]

The authors consider the need for improvement in the delivery and measurement of cultural sensitive palliative care, with special attention to migrants from Asian countries in Australia. They believe that there have been no clearly defined cultural indicators of quality care provided in the palliative care period and towards the end of life. They argue that quality indicators (CI) can be used to provide high quality of care to all patients.

Background: Palliative care in Malaysia developed in the 1990s to improve the quality of life of people with advanced cancer. Like many other countries, Malaysia faces its own challenges in providing palliative care to patients and their families. In Malaysian culture, families play a significant part in providing care to the dying. Connecting with families in patient care is therefore important. This paper reports a focused literature review evaluating studies on the care of the families of terminally ill people in palliative care environments in Malaysia. Method: The search engines CINAHL, Medline, PsycINFO, and Google Scholar were searched for literature published from January 2000 to April 2010 relating to family care in palliative care environments. Due to a paucity of research on family care in Malaysia, the search was broadened to include relevant studies on family care internationally. Results: Four themes were identified: delivering palliative care in Malaysia, communicating with families, crossing cultural boundaries, and the caring experience of nurses. Conclusion: The studies indicate the importance of the nurse- family interaction in providing optimal and culturally appropriate palliative care. This paper emphasizes the need for research into the nurse's role in family care and for developing a theory appropriate to the Malaysian culture and other countries with cultural diversity. [ABSTRACT FROM AUTHOR]

Background: Palliative care in Malaysia developed in the 1990s to improve the quality of life of people with advanced cancer. Like many other countries, Malaysia faces its own challenges in providing palliative care to patients and their families. In Malaysian culture, families play a significant part in providing care to the dying. Connecting with families in patient care is therefore important. This paper reports a focused literature review evaluating studies on the care of the families of terminally ill people in palliative care environments in Malaysia. Method: The search engines CINAHL, Medline, PsycINFO, and Google Scholar were searched for literature published from January 2000 to April 2010 relating to family care in palliative care environments. Due to a paucity of research on family care in Malaysia, the search was broadened to include relevant studies on family care internationally. Results: Four themes were identified: delivering palliative care in Malaysia, communicating with families, crossing cultural boundaries, and the caring experience of nurses. Conclusion: The studies indicate the importance of the nurse- family interaction in providing optimal and culturally appropriate palliative care. This paper emphasizes the need for research into the nurse's role in family care and for developing a theory appropriate to the Malaysian culture and other countries with cultural diversity. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore how head nurses perceive staff stress and needs of support, and to identify the available support systems in Japanese palliative care units. As part of a larger study on the loss and grief experience of nurses working in palliative care settings in Japan, this paper reports on an investigation of head nurses' perceptions of the palliative care nurses' experience and current support systems. [ABSTRACT FROM AUTHOR]

This paper describes the preliminary work required to understand cultural differences in palliative care in the United Kingdom and three countries in the Asia-Pacific region, in preparation for a cross-country study. The study is intended to address cultural understandings of palliative care, the role of the family in end of life care, what constitutes good care and the ethical issues in each country. Suggestions are then made to shape the scope of the study and to be considered as outcomes to improve care of the dying in these countries. It is anticipated that the method used to achieve consensus on cross-country palliative care issues will be both qualitative and quantitative. Identifying key priorities in the delivery and quality measures of palliative care will involve participants in focus groups, a Delphi survey and in the development of clinical indicators towards creating standards of palliative care common to the Asian Pacific region. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the effectiveness of crash history, family concerns, clinical condition, and cognitive function (the 4Cs, an interview-based screening tool for health providers working with older drivers) in identifying at-risk older drivers. DESIGN: Retrospective cohort study. SETTING: Clinical driving evaluation program at a teaching hospital in the United States. PARTICIPANTS: One hundred sixty patients who completed comprehensive driving evaluations between 2003 and 2009. MEASUREMENTS: Medical record information was used to identify component and total 4Cs scores. Other measurements included the Trail Making Test, the Mini-Mental State Examination, and brake reaction time. The outcome variable was performance on a 45-minute road test. RESULTS: Fifty participants passed the road test, 67 failed, and 43 demonstrated marginal driving skills. The relationship between 4Cs scores and road test outcome was statistically significant ( P<.001). The domains most strongly associated with road test outcome were cognitive function ( P<.001) and family concerns ( P=.01). Scores of 9 or greater-on the 4Cs identified 84% of participants who were at risk for poor road test performance. CONCLUSION: The 4Cs, an interview based screening tool, may be a useful marker to identify at-risk older drivers. [ABSTRACT FROM AUTHOR]

Language is used to achieve different outcomes. Discourse constructs social entities by words chosen and shared language. Patterns of discourse carry particular power relations. Language shows the influence of modernity on our view of death and dying. The multiple definitions of palliative care indicate different care models across services and different groups of individuals who qualify for services. Words chosen by palliative specialists may confuse the public. Palliative care language can separate or confuse people about the reality of palliative care and be exclusionary to other specialties who work outside the field. Certain phrases may be depersonalizing or reflect a hierarchy in types of treatment valued by individuals. Great care is needed in choosing words to describe palliative care, since words incarnate the service. [ABSTRACT FROM AUTHOR]

Australia's population is culturally and linguistically diverse, with approximately one quarter of the population born overseas (Australian Bureau of Statistics, 2005). Health-care research must be culturally sensitive and due consideration given to the unique ethical, cultural, and other issues that may arise. Issues in palliative care research have become more complex as the options of care at the end of life develop in respect to the requirements of different cultures. This paper highlights the issues that arose when conducting a qualitative study of the needs and experiences of Indian families with a relative requiring palliative care, and also proposes strategies to address the ethical and methodological problems that may arise when researching this vulnerable population. [ABSTRACT FROM AUTHOR]

Bereavement support services are recognised as an integral part of hospices and palliative care services. Exploratory surveys on the nature of such services have been conducted in recent years in several countries, including the USA, UK and Australia. The purpose of this paper is to compare the main findings of these surveys and to offer preliminary suggestions on how to improve this component of care both within and across these three countries. Through this comparison, a number of common aspects of service delivery were highlighted. Common difficulties were also found, including low numbers of paid staff, variations in specialist training, insufficient levels of funding, and the lack of the use of validated bereavement assessment tools. Bereavement support is an important aspect of hospice and palliative care service delivery. In all countries, further research and policy development is required to address the common difficulties. [ABSTRACT FROM AUTHOR]