Benefits and resource implications of family meetings for hospitalized palliative care patients: research protocol.

BACKGROUND:
Palliative care focuses on supporting patients diagnosed with advanced, incurable disease; it is 'family centered', with the patient and their family (the unit of care) being core to all its endeavours. However, approximately 30-50% of carers experience psychological distress which is typically under recognised and consequently not addressed. Family meetings (FM) are recommended as a means whereby health professionals, together with family carers and patients discuss psychosocial issues and plan care; however there is minimal empirical research to determine the net effect of these meetings and the resources required to implement them systematically. The aims of this study were to evaluate: (1) if family carers of hospitalised patients with advanced disease (referred to a specialist palliative care in-patient setting or palliative care consultancy service) who receive a FM report significantly lower psychological distress (primary outcome), fewer unmet needs, increased quality of life and feel more prepared for the caregiving role; (2) if patients who receive the FM experience appropriate quality of end-of-life care, as demonstrated by fewer hospital admissions, fewer emergency department presentations, fewer intensive care unit hours, less chemotherapy treatment (in last 30 days of life), and higher likelihood of death in the place of their choice and access to supportive care services; (3) the optimal time point to deliver FM and; (4) to determine the cost-benefit and resource implications of implementing FM meetings into routine practice.
METHODS:
Cluster type trial design with two way randomization for aims 1-3 and health economic modeling and qualitative interviews with health for professionals for aim 4.
DISCUSSION:
The research will determine whether FMs have positive practical and psychological impacts on the family, impacts on health service usage, and financial benefits to the health care sector. This study will also provide clear guidance on appropriate timing in the disease/care trajectory to provide a family meeting.

The pervasiveness and trajectory of methodological choices: A 20 year review of human resource management research

This paper examines the methodological choices of researchers studying the HR practices–outcome relationship via a content analysis of 281 studies published across the last twenty years. The prevalence and trajectory of change over time are reported for a wide range of methodological choices relevant to internal, external, construct, and statistical conclusion validity. While the results indicate a high incidence of potentially problematic cross-sectional, single informant, and single level designs, they also reveal significant improvements over time across many validity relevant methodological choices. This broad based improvement in the methodological underpinnings of HR research suggests that researchers and practitioners can view the findings reported in the HR literature with increasing confidence. Directions for future research are provided.

Evaluating Document Retrieval Methods for Resource Selection in Clustered P2P IR

Resource Selection (or Query Routing) is an important step in P2P IR. Though analogous to document retrieval in the sense of choosing a relevant subset of resources, resource selection methods have evolved independently from those for document retrieval. Among the reasons for such divergence is that document retrieval targets scenarios where underlying resources are semantically homogeneous, whereas peers would manage diverse content. We observe that semantic heterogeneity is mitigated in the clustered 2-tier P2P IR architecture resource selection layer by way of usage of clustering, and posit that this necessitates a re-look at the applicability of document retrieval methods for resource selection within such a framework. This paper empirically benchmarks document retrieval models against the state-of-the-art resource selection models for the problem of resource selection in the clustered P2P IR architecture, using classical IR evaluation metrics. Our benchmarking study illustrates that document retrieval models significantly outperform other methods for the task of resource selection in the clustered P2P IR architecture. This indicates that clustered P2P IR framework can exploit advancements in document retrieval methods to deliver corresponding improvements in resource selection, indicating potential convergence of these fields for the clustered P2P IR architecture.

Molecular characteristics and gene segment usage in IGH gene rearrangements in multiple myeloma.

BACKGROUND AND OBJECTIVES: Analysis of IgH rearrangements in B-cell malignancies has provided clinical researchers with a wide range of information during the last few years. However, only a few studies have contributed to the characterization of these features in multiple myeloma (MM), and they have been focused on the analysis of the expressed IgH allele only. Comparison between the expressed and the non-functional IgH alleles allows further characterizion of the selection processes to which pre-myeloma cells are submitted. DESIGN AND METHODS: We analyzed a cohort of 84 untreated MM patients in order to characterize their functional VDJH and non-functional DJH rearrangements. The pattern of mutations and gene segment usage for both types of rearrangements was analyzed by polymerase chain reaction and sequencing. RESULTS: VH3 and VH1 family members were over- and under-represented, respectively. VH3-30 and VH3-15 segments were the most frequently used, whereas VH4-34 was found only in non-functional or heavily mutated VDJH rearrangements. DH2 and DH3 family members were over-represented in both VDJH and DJH repertoires, while the DH1 family was under-represented only in the productive VDJH rearrangements. Finally, DH3-22 and DH2-21 gene segments were found to be over-represented in the functional repertoire while segments commonly used by less mature B-cell malignancies, such as DH6-19 or DH3-3, were under-represented. INTERPRETATION AND CONCLUSIONS: Data reported here help to identify the clonogenic MM cell as a post-germinal center B cell that has undergone selection processes during the germinal center reaction.

A state-of-the-art review and feasibility analysis of high altitude wind power in Northern Ireland

In many countries wind energy has become an indispensable part of the electricity generation mix. The opportunity for ground based wind turbine systems are becoming more and more constrained due to limitations on turbine hub heights, blade lengths and location restrictions linked to environmental and permitting issues including special areas of conservation and social acceptance due to the visual and noise impacts. In the last decade there have been numerous proposals to harness high altitude winds, such as tethered kites, airfoils and dirigible based rotors. These technologies are designed to operate above the neutral atmospheric boundary layer of 1,300 m, which are subject to more powerful and persistent winds thus generating much higher electricity capacities. This paper presents an in-depth review of the state-of-the-art of high altitude wind power, evaluates the technical and economic viability of deploying high altitude wind power as a resource in Northern Ireland and identifies the optimal locations through considering wind data and geographical constraints. The key findings show that the total viable area over Northern Ireland for high altitude wind harnessing devices is 5109.6 km2, with an average wind power density of 1,998 W/m2 over a 20-year span, at a fixed altitude of 3,000 m. An initial budget for a 2MW pumping kite device indicated a total cost £1,751,402 thus proving to be economically viable with other conventional wind-harnessing devices.

Situation Background Assessment Recommendation (SBAR): Undergraduate Perspectives

Situation Background Assessment and Recommendation (SBAR): Undergraduate Perspectives C Morgan, L Adams, J Murray, R Dunlop, IK Walsh. Ian K Walsh, Centre for Medical Education, Queen’s University Belfast, Mulhouse Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6DP Background and Purpose: Structured communication tools are used to improve team communication quality.1,2 The Situation Background Assessment and Recommendation (SBAR) tool is widely adopted within patient safety.3 SBAR effectiveness is reportedly equivocal, suggesting use is not sustained beyond initial training.4-6 Understanding perspectives of those using SBAR may further improve clinical communication. We investigated senior medical undergraduate perspectives on SBAR, particularly when communicating with senior colleagues. Methodology: Mixed methods data collection was used. A previously piloted questionnaire with 12 five point Lickert scale questions and 3 open questions was given to all final year medical students. A subgroup also participated in 10 focus groups, deploying strictly structured audio-recorded questions. Selection was by convenience sampling, data gathered by open text questions and comments transcribed verbatim. In-vivo coding (iterative, towards data saturation) preceded thematic analysis. Results: 233 of 255 students (91%) completed the survey. 1. There were clearly contradictory viewpoints on SBAR usage. A recurrent theme was a desire for formal feedback and a relative lack of practice/experience with SBAR. 2. Students reported SBAR as having variable interpretation between individuals; limiting use as a shared mental model. 3. Brief training sessions are insufficient to embed the tool. 4. Most students reported SBAR helping effective communication, especially by providing structure in stressful situations. 5. Only 18.5% of students felt an alternative resource might be needed. Sub analysis of the themes highlighted: A. Lack of clarity regarding what information to include and information placement within the acronym, B. Senior colleague negative response to SBAR C. Lack of conciseness with the tool. Discussion and Conclusions: Despite a wide range of contradictory interpretation of SBAR utility, most students wish to retain the resource. More practice opportunities/feedback may enhance user confidence and understanding. References: (1) Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality & Safety in Health Care 2004 Oct;13(Suppl 1):85-90. (2) d'Agincourt-Canning LG, Kissoon N, Singal M, Pitfield AF. Culture, communication and safety: lessons from the airline industry. Indian J Pediatr 2011 Jun;78(6):703-708. (3) Dunsford J. Structured communication: improving patient safety with SBAR. Nurs Womens Health 2009 Oct;13(5):384-390. (4) Compton J, Copeland K, Flanders S, Cassity C, Spetman M, Xiao Y, et al. Implementing SBAR across a large multihospital health system. Jt Comm J Qual Patient Saf 2012 Jun;38(6):261-268. (5) Ludikhuize J, de Jonge E, Goossens A. Measuring adherence among nurses one year after training in applying the Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments. Resuscitation 2011 Nov;82(11):1428-1433. (6) Cunningham NJ, Weiland TJ, van Dijk J, Paddle P, Shilkofski N, Cunningham NY. Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting. Postgrad Med J 2012 Nov;88(1045):619-626.