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Issue 90 - Wednesday 29 April 2009

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1. In this issue
Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1287

Overview of the contents of this issue, with abstracts

2. Youthful Exuberance
by Von Gunten, Charles F. Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1288
The article offers an analysis on the continuous expansion of palliative care in the hospitals and the development of hospice care in the U.S. It states that the rapid expansion of the two fields is traced to the constructive responses on the results of the trial in 1995 that tested the ability of advance care planning to the care for seriously ill patients. It also notes that such advances in medicine implies the acceptability of advance care planning by the public.

3. Faust in Mourning
by Everett Makowski, Suzana K. Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1289
The article presents the poem "Faust in Mourning," by Suzana K. Everett Makowski. First Line: She cannot bear to let her husband go, Last Line: her husband's last remaining breaths.

4. Clinical Scholars Program: Providing Palliative Medicine Education and Training for Physicians at Eight Sites
by Weir, Sally A. Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1290

Abstract: The article provides information on the Clinical Scholars Program offered by the American Academy of Hospice and Palliative Medicine (AAHPM) in the U.S. The AAHPM's objective is to help physicians with clinical experience in hospice and palliative medicine meet the demands of working in hospices and hospital-based palliative care programs. It notes that AAHPM chose eight training sites including Capital Hospice in Falls Church, Virginia and Medical College of Wisconsin in Milwaukee, Wisconsin.

5. Number Needed to Harm
by Herbst, Laurel. Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1291
Letter to the editor
is presented regarding the therapeutic concept of "number needed to treat

6. Palliative Care in Jordan: Culturally Sensitive Practice
by Bushnaq, Mohammad. Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1292
Letter to the editor
is presented in response to the article that inquires on the application of medical knowledge in palliative care in harmony with culture.

7. Center to Advance Palliative Care Palliative Care Consultation Service Metrics: Consensus Recommendations
by Weissman, David E et al. Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1294-1298
The need to standardize the prospective collection and analysis of data has been a cornerstone of education and technical assistance provided by the Center to Advance Palliative Care (CAPC). Data analysis is vital for strategic planning, quality improvement, and demonstration of program impact to hospital administrators, private funders, and policymakers. To develop a set of core measures, CAPC convened a consensus panel in 2008 to focus on the topic of operational metrics for consultation services. Operational metrics, as distinct from clinical, customer and financial metrics, describe the characteristics of patients seen on the consultation service, such as age, disease, location, referring service and disposition. The panel arrived at 12 metric domains, all but one of which can be used for either internal programmatic use or for external comparisons of service characteristics/impact between different hospitals. In an effort to ensure access to reliably high-quality palliative care data throughout the nation, hospital palliative care consultation teams are encouraged to collect and report outcomes for each of the twelve metric domains described here. [ABSTRACT FROM AUTHOR]

8. The Touch of Empathy
by Rousseau, Paul C. Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1299-1300
The authors reflect on medical education and physician-patient interaction. The authors believe that there is a major loss in the education of medical trainees such as medical students, residents and interns. The authors assert that lessening the number of hours of medical trainees may help decrease the gradual decline of humanistic attitudes in the physician-patient interaction. The authors affirm that role modeling is the only method to bring back the healing qualities of physicians.

9. Pediatric Cancer Deaths: Curative or Palliative?
by Menon, Bina Sharine et al. Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1301
The aims of this study were to review the deaths of Malaysian pediatric oncology patients in order to determine the major causes and the proportion of patients who received palliative care.
Subjects and methods: This was a retrospective review from 2001–2007 of deaths at the Pediatric Institute, General Hospital Kuala Lumpur. Clinical data such as age gender, disease, cause, and place of death were collected. The patients were divided into two groups: those who received palliative care and those who received curative
Results: Two hundred forty-seven patients were included. There were 148 males and 99 females. The age ranged from 2 months to 22 years (median, 4 years). One hundred  thirty cases (53%) were still in the curative phase of treatment at the time of death. The most common cause of death was septicemia (62%), followed by hemorrhage (18%) and underlying cancer (14%). One hundred seventeen cases (47%) were in the palliative phase at the time of death. All palliative care deaths occurred in the oncology ward  with one exception.
Conclusion: Nearly half of all inpatient pediatric cancer deaths were palliative in nature. Septicemia and hemorrhage were the major causes of death in the others.

10. Financial Impact of Palliative Care Consultation in a Public Hospital
By Bendaly, Edmond A et al. Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1304-1308
Palliative care programs assist with prognostication, symptom control, and communication with patient and family. Hospitals often require financial justification for new programs.
Objective: Study the financial impact of the palliative care consultation (PCc) service in a public hospital
Setting/Subjects: From January to December 2005, 258 deaths occurred on the medicine service. Of those deceased patients, 116 were studied.
Design: Inclusion criteria were 50 or more years of age, length of stay (LOS) 3 days or more, admission to an internal medicine service, and death during that hospitalization.
Measurements: Charges, diagnosis-related groups (DRGs), DRG weights, and demographic variables were examined.
Results: Of the 116 deceased patients studied, 61 patients received a PCc, while 55 did not. Most patients had Medicare or Medicaid (82.8%). Both groups were similar in terms of demographic characteristics. Average LOS was 14.4 days for patients with a PCc versus 12.2 days for those without ( p = 0.57). Median charges for the group without a PCc were $42,731, versus a median of $35,824 for those with a PCc. There was no significant variation of DRG weights within the same DRG. DRG weight was significantly positively correlated with charges. Both PCc and DRG weight were significant predictors of charges, with 36% of charges variability explained by PCc and DRG weight.
Conclusions: PCc significantly reduced charges in adult patients who died during their last hospitalization, even though the average LOS was higher for those who received a PCc versus those who did not. [ABSTRACT FROM AUTHOR]

11. How I Wish to be Remembered: The Use of an Advance Care Planning Document in Adolescent and Young Adult Populations
by Wiener, Lori. Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1309-1313
Discussing end-of-life (EOL) issues is difficult with any population. These conversations are even more challenging with adolescents and young adults due to the poignancy of the situation and the need for developmentally appropriate language.
Objective: To explore whether adolescents and young adults living with a life-limiting illness find it acceptable and helpful to have a planning document to share their wishes and thoughts regarding EOL care. If so, to learn about specific concerns adolescents and young adults feel are important to include in such a document.
Methods: Adolescents and young adults with metastatic cancer or pediatric human immunodeficiency virus (HIV)-1 infection were presented Five Wishes, an advance directive document for adults. Each participant was asked to critically evaluate each wish in terms of whether the concepts within were considered (1) appropriate to ask individuals the participant's age; (2) helpful for other people the participant's age to think about; (3) helpful to the participant to think about; (4) stressful to contemplate. Participants were also asked to suggest modifications and additions to the document.
Results: Twenty patients completed the survey. Ninety-five percent of the participants reported that an advance directive like Five Wishes would be “helpful” or “very helpful” to themselves, 90% stated that the document would be helpful to others, and no patients found talking about the issues in Five Wishes “stressful” or “very stressful.” Participants were more interested in items concerning how they wanted to be treated and remembered than items concerning
medical decision-making.
Conclusions: An advance care planning document may be appropriate and helpful for adolescents and young adults living with a serious illness. Future research should further validate the preferences identified by... [ABSTRACT FROM AUTHOR]

12. Evaluating a Palliative Care Case Management Program for Cancer Patients: The Omega Life Program
by Seow, Hsien et al. Journal of Palliative Medicine, Dec 2008, Vol 11 Issue 10:p1314-1318
This study evaluated a cancer case management pilot program focusing on palliative care, the Omega Life Program (OLP), by assessing whether the program was associated with reduced hospital utilization.
Methods: A retrospective observational study of patients with cancer who enrolled in the OLP (intervention) compared to those who chose not to enroll (comparison) from January 1, 2005 to February 28, 2007. Patients were included in the primary analyses if they died by the end of the study period and were enrolled in the program at least 1 week before death. Patients were followed from the time of referral until death. Outcomes included whether or not the patients had any admissions during this period and, for patients with at least one admission, the total number of inpatient hospital admissions, inpatient days, and hospital costs.
Results: Approximately 75% of eligible patients enrolled in the OLP; 60% were older than 50 and 60% were female. Of included patients in the intervention group ( n = 69), 59% had no admissions compared to 15% of patients in the comparison group ( n = 20). However, among patients who had at least one admission, the mean number of hospital admissions, inpatient days, and hospitals costs were not significantly different between the groups.
Conclusions: In this pilot study, patients in the OLP had significantly reduced odds of having any hospital admissions compared to those in usual care. This type of program may improve outcomes for patients, but further research is needed to evaluate outcomes using larger samples and more rigorous study designs.

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Journals - Table of Contents

10. From Nursing Times, 17-23 March 2009
10A. Nursing applicants to face compassion test
10B. Nurses could run care aspects of social services, says Brown
10C. Leadership event aids senior nurses; NMC lists care standards for elderly; Laming - hire more health visitors; Trusts fail on child protection training
10D. Directors urged to work on ward; Homes get free defibrillators
10E. Nurses raise postmortem consent; Drug marketing 'confuses' nurses; New health science centres promise greater research and education role
10F. Eat well to succeed; Nurses to lead in remote e-care
10G. Scoring tool offers quick and simple way to assess atrial fibrillation risk; 'Smart' homes for dementia patients; BME women face pregnancy risks;
Project to cut pre-surgery smoking
10H. First response to PM's review
10I. Do we need a national approach to alcohol advice?
Delivering mental health awareness training to police officers
NPSA issues guidance to reduce risks linked to bowel-cleansing solutions
10L. Emergency oxygen delivery in adults 1: updating nursing practice
10M. Q. Does oxygen need to be prescribed? [The answers are provided in this article]
10N. New NICE rheumatoid arthritis guideline offers a key role for specialist nurses
10O. Are breathing exercises an effective strategy for people with asthma?
10P. Nursing must make sure it is ready to take on increased control and influence
10Q. We must value learning disability nursing skills; Nurses are luckier than many, despite poor pay; Most patients would welcome prayer; Nurse managers feel as if they've sold out
10R. On the conservatives' vision for health visiting
10S. 'We're sophisticated but not necessarily civilised'
10T. Managers will lead NHS changes

11. From Australian Nursing Journal, Volume 16 No 9, April 09
11A. Editorial [This month we bring you news of the launch of Because we care: quality care for older Australians]
11B. Because we care [The ANF launched its first ever national campaign in Canberra last month, with the aim of securing pay equity for nurses and carers working in the aged care sector and ensuring that the quality of care provided to older Australians in nursing homes around the country]
11C. ANF call to license workers; Call to act on climate change
11D. Health financing under fire; Nurses have their say on primary care; E-learning goes live for practice nurses
11E. Practice nurse for every GP; Practice nurses respect bushfire victims
11F. VTE scholarships now open; Compensation for breast cancer linked to night duty; New Commonwealth health alliance formed
11G. ACT - Nurses campaign for aged care; SA - ANF members underpaid; TAS - Tasmanian nurses say no to wage restraint
11H. QLD - safe housing by Easter, says Premier; Nurses run the gauntlet; VIC - Nurses in aged care hit by sanctions
11I. Bushfire disaster: a rural nurses's perception
11J. Nurses call for universal healthcare in US; Push for pay parity for Māori and iwi health workers; Key role for nurse specialists in dementia strategy
11K. Recordkeeping essential
Interim report misses the mark on workforce
Fair Work Bill debated
11N. Developing our profession
11O. Shopping centres hub for older people; Nurse educators - an endangered species?; Bird flu vaccine may be within reach
. Expanding nursing horizons in general practice: the primary health care revolution
11Q. Health reform begins locally
11R. The clinical effectiveness of Gelclair in the management of oral mucositis
The cost of major trauma in NSW: implications for health planning
11T. For the love of nursing
11U. Big advances in technology and treatment
11V. Unmasking patient responses
11W. Strength in unity [by Geraldine (GED) Kearney - ANF national Secretary]

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Conferences, training and seminars 

12. Medical Council Consultation Papers and Roadshow
Guaranteeing Professional Standards
During May this year (2009) the Medical Council will be undertaking meetings with doctors throughout New Zealand on two major initiatives:
- Consultation on the proposed use of practice visits by peers as part of CPD
- Online feedback form for practice visit
- Implementation of a new framework for supervision of IMGs
- Online feedback form for supervision of IMGs
Feedback must be received at Council by 1 June 2009
More information:

13. UNANZ National Conference
United Nations Association of New Zealand

Date: Friday 22 May 2009
Venue: Parliament's Beehive Theatrette, Wellington
More information:

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News - National

14. Mexican Swine Influenza Updates
Ministry of Health - 28 April 2009

15. Best flu help close to home
The Press - 28 April 2009
The next flu pandemic to hit New Zealand will be fought in neighbourhoods and in the home, says Christchurch historian Geoffrey Rice. Hospitals and the
public health system would be quickly overwhelmed, he said. Rice, a professor of history at Canterbury University and author of Black November the 1918 Influenza Epidemic in New Zealand, said: "The main lesson is that in a major pandemic you can't rely on health boards and hospitals. It comes back to home nursing and neighbourhood support.

16. Shoppers steer clear of pork products
New Zealand Herald -
Health experts may have confirmed that swine flu viruses cannot be transmitted by eating pork or pork products, but some Asian supermarket shoppers remain concerned that Chinese pork luncheon meat sold here could still spread the virus.

17. Kenepuru closure stuns staff
Kapi-Mana News - 28 April 2009
The Medical Assessment Unit (MAU) at Kenepuru Hospital is to be closed in just over a month but patients will benefit from the service shifting to Wellington Hospital in Newtown, the district health board claims. The unit mainly caters to elderly people with mental health issues, providing care for up to 24 hours. Staff diagnose and assess patients before directing them to a bed in the hospital, sending them to Wellington hospital, or home.

18. Norovirus numbers steady
Wanganui Chronicle - 28 April 2009
The spread of the highly contagious norovirus in Wanganui city appears to have been arrested - for the meantime at least - with numbers yesterday holding at the levels reported from the weekend. Jo Priestley, communications adviser for the Whanganui District Health Board, told the Chronicle that as of late yesterday a total of 28 people - 14 staff and 14 patients - at Wanganui Hospital had been infected. Only nine of those patients remained in the hospital.

19. SIT union bid fails to get support
Southern Institute of Technology students have failed in their latest bid to establish a compulsory students' association, citing the widespread nature of SIT as a factor. SIT students collected signatures last year in the hope they could force the institute to undertake a referendum on the issue, but fell
673 votes short.

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News - International

20. Alcohol shock-ads missing the mark
The Australian - 28 April 2009
SCARE campaigns designed to tackle problems such as alcohol abuse do not work, according to a prominent communications expert who is now a director of DrinkWise Australia. Noel Turnbull, adjunct professor in the School of Applied Communications at RMIT University, says young people "think they're immortal".,25197,25396564-23289,00.html

21. Research team cracks genetic code of virus
The Australian - 28 April 2009
The World Health Organisation's emergency committee is expected to decide as early as today whether to issue a pandemic alert, warning nations to prepare for a worldwide outbreak of the new swine flu. Already scientists with the US Centres for Disease Control in Atlanta, Georgia, have cracked the genetic code of the virus, which is spreading worldwide at an alarming rate. Experts fear the new strain of H1N1 swine flu -- which first emerged in Mexico last month and
has appeared in the US, Canada, Spain and possibly New Zealand and France -- has developed the ability to spread from person to person.,25197,25396606-23289,00.html

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