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Research addressing the nature of hospice referrals focuses primarily on the effect of late referral and the majority of studies are based in North America. Using health care professionals as key informants, the goal was to describe the hospice referral system used in the Western Cape Province of South Africa from the perspective of nursing sisters, medical doctors, and social workers. Semi-structured interviews with 29 such individuals were conducted at 15 rural, urban and peri-urban sites, exploring their perceptions towards, and experiences with, patient referral to hospice programmes. Interpretative descriptive design allowed for a comprehensive description of the referral process as well as an extension of the data based on the perspectives of the three stakeholder groups. The majority of hospice referrals originated from either community-based clinics or state hospitals. Three main themes, centring around the process of referring, (lack of) standardization, and (lack of) knowledge, arose from the analysis of the transcripts. An interpretation of the themes led to the development of a model describing the ideal hospice referral system for South Africa.

The purpose of the study was to evaluate the role of an online resource for dying children, their family members, and health care providers from the perspective of pediatric palliative care experts. Semi-structured interviews with 12 leaders in pediatric palliative care in North America were conducted, exploring their perceptions and attitudes towards various aspects of Web-based resources for dying children and their care providers. Informants felt that an online resource may allow for a different form of expression, a connection between people undergoing a rare event, and an increase in education and support. Major challenges, such as accessibility, monitoring, and remaining current, would be ongoing. Other key themes included access, information, and anonymity. The data suggest that developing Web-based resources for dying young patients and their families may have merit. Should this take place, a feasibility study will be necessary to further determine the value of such a Web site for these vulnerable populations.

Relationships between bereavement following the death of a grandparent and adolescent death anxiety levels were examined using Hogan's Inventory of Bereavement and the revised Death Anxiety Scale within private schools. Of the 226 adolescent respondents (aged 11–18) who completed questionnaires, 124 had experienced the death of a grandparent. The regression model indicated that grief due to bereavement was found to be significantly associated with death anxiety. The factors of personal growth, gender, time since death, and numbers of deaths experienced were not found to be significant predictors within the model. The findings encourage further exploration into the nature of the grandparent–adolescent relationship as well as the impact of type of death experienced.

Chapter 14 expands on the role of palliative care within the framework of cancer control. In addition, the public health approach outlined by the WHO, including appropriate policy, adequate drug availability, education, and palliative care delivery at all levels of health care, will be discussed. Finally, the challenges in adapting these principles into high and low resource settings will be described.

Aim. We aimed to assess the postgraduate palliative care distance education programme of the University of Cape Town (UCT) in terms of its perceived ability to influence palliative care delivery. Methods. A mixed-methods approach, consisting of two surveys using open-ended and multiple-choice options, was conducted from January to December 2007 at the UCT School of Public Health and Family Medicine. All students registered in the programme from 2000 - 2007 were invited to participate; 83 (66.4% of all eligible participants) completed the general survey, and 41 (65.7%) of the programme’s graduates completed the graduate survey. The survey scores and open-ended data were triangulated to evaluate UCT’s palliative care postgraduate programme. Results. General survey scores of graduates were significantly higher in 5 of the 6 categories in comparison with current students. The graduate survey indicated that curriculum and teaching strengths were in communication and dealing with challenging encounters. Graduates also stressed the need to develop a curriculum that incorporated a practical component. Conclusions. In addition to current postgraduate training, palliative care education in South Africa should be extended to undergraduate medical students, as the benefits of UCT’s programme were limited to a small cohort of practitioners.

Possible relationships between bereavement and religiosity to death anxiety levels of adolescents were investigated. Scales measuring religiosity, bereavement, and death anxiety were incorporated into one questionnaire. Two hundred and twenty-six adolescents between the ages of 11 and 18 participated in the study based in urban and rural private schools within Manitoba. Females exhibited significantly higher death anxiety levels than did males; differences between the death anxiety levels of adolescents having a no-previous-death-experience death and those who had experienced a familial death were not significant; while religiosity levels were significantly higher for students attending religion-based schools, the relationships between measurements of religiosity and death anxiety were weak. Grief due to bereavement was the major factor in determining death anxiety for the adolescent.

s / Can J Diabetes 39 (2015) 529e547 547 063-2015. EPIDEMIOLOGY Cardiovascular Disease Increases the Risk of Mortality in Diabetes: A Population-Based Study NANCY YU*, MOSTIFAZUR RAHMAN, ROBERT WANG, PENNY KLASSEN, CARLA ENS

• Administration of intranasal fentanyl to newborns and infants at end-of-life is safe and effective in managing respiratory distress • Intranasal fentanyl is useful in a variety of care settings (hospital and home) for the management of symptoms in newborns and infants at end-of-life • Identified the need to address logistical issues, which include: development of a guideline for the availability of the medication; the use of an atomizer in nasal medication delivery; and supporting staff in this approach to managing symptoms in newborns and infants at end-of-life. Use of Intranasal Fentanyl in Palliative Care of Newborns and Infants

Background Health policy makers have stated that diabetes prevention is a priority; however, the type, intensity, and target of interventions or policy changes that will achieve the greatest impact remains uncertain. In response to this uncertainty, the Diabetes Population Risk Tool (DPoRT) was developed and validated to estimate future diabetes risk based on routinely collected population data. To facilitate use of DPoRT, we partnered with regional and provincial health-related decision makers in Ontario and Manitoba, Canada. Primary objectives include: i) evaluate the effectiveness of partnerships between the research team and DPoRT users; ii) explore strategies that facilitate uptake and overcome barriers to DPoRT use; and iii) implement and evaluate the knowledge translation approach. Methods This protocol reflects an integrated knowledge translation (IKT) approach and corresponds to the action phase of the Knowledge-to-Action (KtoA) framework. Our IKT approach includes: employing a knowledge brokering team to facilitate relationships with DPoRT users (objective 1); tailored training for DPoRT users; assessment of barriers and facilitators to DPoRT use; and customized dissemination strategies to present DPoRT outputs to decision maker audiences (objective 2). Finally, a utilization-focused evaluation will assess the effectiveness and impact of the proposed KtoA process for DPoRT application (objective 3). This research design utilizes a multiple case study approach. Units of analyses consist of two public health units, one provincial health organization, and one provincial knowledge dissemination team whereby we will connect with multiple regional health authorities. Evaluation will be based on analysis of both quantitative and qualitative data collected from passive (e.g., observer notes) and active (e.g., surveys and interviews) methods. Discussion DPoRT offers an innovative way to make routinely collected population health data practical and meaningful for diabetes prevention planning and decision making. Importantly, we will evaluate the utility of the KtoA cycle for a novel purpose – the application of a tool. Additionally, we will evaluate this approach in multiple diverse settings, thus considering contextual factors. This research will offer insights into how knowledge translation strategies can support the use of population-based risk assessment tools to promote informed decision making in health-related settings.