What do GPs and Bereaved Parents Think About Paediatric Oncologists and Palliative Care?

Aim The aim of the study was to examine the experiences of bereaved parents and general practitioners (GPs) following the death of a child with cancer within the family home. This presenta-tion focuses on one of the findings; the parent and GP views on the hospital consultants’ involvement in the palliative care. Design A community based qualitative study.Setting West Midlands region, UK. Participants Purposeful sample of 18 GPs and 11 bereaved families. The sample was drawn from the families and GPs of children who had been treated for cancer at a regional childhood cancer centre and who subsequently died within the family home. Methods One-to-one semi-structured tape-recorded interviews were undertaken with GPs and bereaved parents following the death at home of a child with cancer. GPs were contacted three months after the death of the child and the parents at six months. Thematic analysis of the transcriptions was undertaken. Findings Parents described feeling abandoned at the transition to palliation when management of care transferred to the GP. Families did not perceive a seamless service of medical care between hospital and community. Where offered consultant contact was valued by families and GPs. Text and email were used by families as a means of asking the consultant questions. The GPs lacked role clarity where the consultant continued involvement in the care. Conclusions The transition to palliation and the transfer of care to community services needs to be sensitively and actively man-aged for the family and the GP. Medical care between tertiary andprimary care should be seen as a continuum. Improving GP: consultant communication could aid role clarity, identify mecha-nisms for support and advice, and promote the active engagement of the GP in the care. Exploring opportunities for integrated con-sultant: GP working could maximise mutual learning and support and enhance care provision. The level, access and duration of ongoing contact between consultants and families/GPs require clarity.

Providing Palliative Care for the Child with Cancer: The Experience of GPs

Background Childhood cancers are rare and general practitioners (GPs) have limited experience in caring for these children and even less in providing their palliative care. Most families prefer that their child is cared for at home in the palliative phase of their illness, with professional support from those known to them (Chambers and Oakhill 1995, Vickers and Carlisle 2000, Craft and Killen 2007). A community based qualitative study examined the experiences of ten GPs following their involvement in the care of a child with cancer receiving palliative care within the family home. Methods Data collection was through 1:1 in-depth interviews and facilitated case discussion supported by field notes and grounded theory analysis (chronological comparative data analysis identifying generated themes). Social worlds theory was used as a framework to aid examination, and facilitate critical understanding, of the experiences of the GPs. Findings This presentation focuses on five of the findings relating to the experiences of the GP; the impact of minimal contact; lack of knowledge and experience, uncertain role, out of hours service provision and the emotional toll. Findings highlighted that GPs often have to re-establish their role at the child’s transition to palliative care. Factors hindering the GP in this process include a deficit of specialist knowledge and experience of paediatric palliative care and lack of role clarity. Conclusions/points of interest Strategies for enhancing the role of the Macmillan team in supporting GPs have been identified by this study, such as enhanced collaborative working. Findings have also provided further confirmation of the substantial variation in out of hours medical palliative care provision; with evidence that some GPs work beyond their remit in providing informal out of hours care. This presentation details the findings of one aspect (the experiences of GPs) of a wider study that explored the experiences of 54 community based health professionals (GPs, community nurses and allied health professionals) who had been involved in caring for a dying with cancer receiving palliative care at home (Neilson 2009).

GPs Experience of Caring for Children with Cancer Receiving Palliative Care at Home

Background The study being undertaken builds on earlier work that found general practitioners (GPs) were at times uncertain of their role in paediatric palliative care and questioned whether their involvement had been beneficial to the child and family. The rarity of childhood cancer makes it difficult for GPs to develop or maintain palliative care knowledge and skills yet the GP is perceived by the family as the gatekeeper of care within the community. Aim The study is examining GPs perception of their role in caring for an individual child with cancer receiving palliative care and comparing this with families' perceptions of their GP's roles. Methodology The methodology incorporates tape-recorded semi-structured interviews, thematic framework analysis and Q methodology (QM) to capture the experiences of GPs who have cared for a child with cancer receiving palliative care as well as the perspectives of care experienced by the families. The semi-structured interview sample comprises 10 families (parents/guardians) whose child has been treated at a regional childhood cancer centre and their GPs. A further 40–60 GPs will be involved in the QM. Findings Findings detailing GP experiences from the initial study along with the preliminary findings of the semi-structured interviews with parents and GPs will be presented. Papers' contribution The results will identify and clarify GPs perceptions of their roles, and what families perceive their GPs role to be, enabling development of strategies to support GPs roles. It is anticipated that findings will inform the wider field of palliative care generally and the practice of both hospital and community paediatricians.

Undertaking Sensitive Interviews: a Researcher’s Experience of Interviewing Bereaved Parents and Family GPs

The presentation describes the researcher’s experience of undertaking sensitive interviews. Background The interviews form part of a current study that is examining bereaved parents’ experience of caring for their child at home as well as the experience of their GP. This study builds on earlier work that found general practitioners (GPs) were at times uncertain of their role in paediatric palliative care and questioned whether their involvement had been beneficial to the child and family. The rarity of childhood cancer deaths makes it difficult for GPs to develop or maintain palliative care knowledge and skills yet the GP is perceived as the gatekeeper for care within the community. Presentation aim To describe the process of both the preparation for, and undertaking of, sensitive interviews. Study methodology The methodology incorporates tape-recorded semi-structured interviews, thematic framework analysis and Q methodology (QM). QM will be used to capture the experiences of GPs who have cared for a child with cancer receiving palliative care as well the perspectives of care experienced by the families. The semi-structured interview sample comprises 10 families (parents/guardians) whose child has been treated at a regional childhood cancer centre and their GPs. A further 40-60 GPs will be involved in the QM. Findings The preparation for these interviews will be discussed and compared to the supportive bereavement visits undertaken within the researcher’s role as a paediatric Macmillan nurse. The experience of undertaking the interviews will be exemplified with findings from the initial and the current, study. Papers’ contribution The researcher’s experience of preparing for and undertaking sensitive interviews may prove beneficial to other researchers.

Do GPs Make Good Research Participants?

Background Childhood cancers cause the largest numbers of deaths by disease in children aged 0-14 years1 with more than 400 children a year dying from cancer in the UK.2 Parental preference for their child to die within the family home2 coupled with the speciality of children’s palliative care medicine being still in its infancy, highlights the importance of the GP’s role in this highly specialised area of clinical practice. An understanding of the GP’s role will help inform the development of this specialty and identify best collaborative practice. A NIHR/CAT CL funded study examined the role of the GP in paediatric oncology palliative and bereavement care from the perspective of both the GP and the bereaved parent. This presentation will detail how GPs were approached and recruited, the reasons GPs declined participation and factors influencing the actual data collection. Methods The mixed method study used both qualitative and quantitative data collection methods. Phase 1: Semi-structured interviews to explore the experiences of GPs and parents. Phase 2: Q methodology with GPs who had a child with cancer on their caseload. Q methodology is a research tool that uses statistical analysis to cluster participants’ experiences according to similarity of their viewpoint Results The method and effectiveness of recruiting GPs for both phases of the study will be presented. In addition factors influencing collecting such emotive and sensitive data will be discussed. Conclusions Researcher flexibility and perseverance in participant recruitment was rewarded by the rich data collected. Findings from this study have identified four different GP role viewpoints and have provided a new dimension in understanding GP viewpoints on their role in this arena.

Sistema de notificação e monitorização de acidentes para motociclos

A percentagem de utilização de motociclos tem vindo a crescer relativamente à utilização de veículos automóveis. Provavelmente, este número continuará a aumentar anualmente devido a diversos fatores: a mobilidade, a flexibilidade de circulação e o menor gasto de combustível. No entanto, um dos principais problemas da condução de motociclos é o elevado risco de acidente, comparativamente com os veículos automóveis. A segurança do condutor e passageiros, quando sujeitos a um acidente, merece total atenção. Convém, pois, encontrar soluções com capacidade de prevenir ou ajudar a minimizar o número de mortalidade que possam ocorrer diariamente. Uma maior atenção às medidas de segurança rodoviária veio diminuir o número de acidentes, no entanto, quando estes acontecem, a ajuda das unidades médicas demora algum tempo a chegar. Sabe-se que nestas situações, qualquer segundo pode fazer a diferença. Este é o problema que o autor deseja resolver. Na presente dissertação, o autor pretende demonstrar como desenvolveu um sistema para motociclos com a capacidade de reconhecer um acidente, enviando um alerta (SMS) com a informação do local da ocorrência (GPS). Este sistema foi preparado para operar em locais isolados com pouco ou nenhum tráfego rodoviário. Implementou-se no referido sistema uma tecnologia sem fios e fiabilizou-se um método capaz de ser utilizado em diversos modelos de motociclos. Procedeu-se à realização de interfaces que permitem monitorizar e possibilitar o reconhecimento da informação sobre o condutor e sobre o acidente, em tempo real.

Do GPs and psychiatrists recommend alternatives when prescribing anti-depressants?

This study explores whether a partial explanation for high antidepressant prescription rates is the failure of prescribers to recommend alternatives. 1,829 New Zealand adults were asked which of six non-pharmacological treatment approaches were recommended when prescribed anti-depressants. The majority (82%) received at least one recommendation and 32% received three or more, most commonly ‘Counsellor/Psychologist/Psychotherapist’ (74%) and Exercise Schedule (43%). It cannot, therefore, be concluded that failing to consider non-pharmacological treatments is a major cause of high prescribing rates. Being younger and more severely depressed were both positively related to number of recommendations. Psychiatrists made significantly more recommendations than GPs.

North American Monsoon GPS Transect Experiment 2013

Ten GPS-Met stations were installed in northwest Mexico from June - September 2013. Each station included a Trimble NetR9 GPS receiver for PWV and a Vaisala WXT520 surface meteorological package measuring wind speed and direction, air temperature, humidity, pressure and precipitation. The geographic location, elevation and data period for each station are provided in Serra et al. (2016). The GPS receiver at Rayon failed on July 16, 21 days after installation, thus these data are not included in the archive but are available upon request (yserra@uw.edu). Data include 1-min surface meteorological variables, while the GPS PWV is calculated at 5-min intervals. A full description of the experiment can be found in Serra et al., 2016: Bull. Am. Meteor. Soc., doi: 10.1175/BAMS-D-14-00250.1.

Gestão de trajetos fora de estrada

Anualmente, realizam-se no país inúmeras iniciativas de Todo-Terreno Turístico (TTT) onde são automaticamente registadas as coordenadas de Global Positioning System (GPS) por aplicações de dispositivos móveis. Este tipo de informação pode ser utilizada, quer para fins de divulgação turística, quer por outro tipo de entidades que necessitem de circular nesses caminhos rurais, tipicamente no meio da montanha. Entre outras, são registadas a posição, velocidade e altitude do veículo, o que permite obter informações relevantes, tais como, se o percurso se encontra transitável ou qual a velocidade recomendada. Por exemplo, durante os combates a incêndios, os bombeiros e proteção civil poderão saber se estes percursos são utilizáveis no planeamento dos combates a incêndios com reduzida probabilidade de complicações relativa ao acesso dos veículos, melhorando assim o tempo de resposta. O presente documento discute como poderá ser concebida uma aplicação web mapping, de código aberto, que permita a partilha, utilização e valorização de dados relativos aos percursos todo-terreno dos praticantes de TTT. O presente documento descreve como a aplicação desenvolvida no âmbito da dissertação de mestrado permite selecionar e ordenar possíveis trajetos que incluem os trajetos de TTT, apresentando as caraterísticas do terreno de modo a auxiliar a tomada de decisão por membros das corporações de Bombeiros. Será igualmente apresentada a interface atual da aplicação que inclui um mapa dinâmico e um gestor de pontos de referência.

Sistema de monitorização de veículos de mercadorias

A presente dissertação expõe um sistema de monitorização de veículos de mercadorias, que permite obter a localização através do GPS instalado no veículo, registar a abertura/fecho de portas e a temperatura da mercadoria transportada no reboque do veículo. A comunicação entre o trator do veículo e o reboque é realizado por radiofrequência. A informação recolhida, localização, estado das portas e temperatura, é enviada via GPRS, através do módulo central presente no trator do veículo, para uma base de dados externa instalada na central. A nível de interação com o sistema, tanto a empresa da frota dos veículos (transportadora) como o cliente requerente dos serviços da transportadora, podem consultar a informação registada na base de dados através de uma página Web criada para o efeito. A página Web incorpora um sistema de login restrito à administração ou aos clientes registados e a selecção de opções variáveis com esse mesmo login. A localização e o percurso do veículo podem ser visualizados sobre o mapa do Google Maps presente na página Web. A temperatura pode ser consultada num gráfico de comparação entre a temperatura desejada e a temperatura registada ao longo do percurso. É também possível adicionar os dados dos novos clientes através da administração da página Web.

Perceção do papel dos Recursos Humanos no posicionamento estratégico da empresa

A história da sociedade humana sempre foi fiel ao retrato das diferentes etapas do seu desenvolvimento. O ser humano sempre sentiu a necessidade de realizar os seus propósitos de sobrevivência, conjugando os diferentes elementos inerentes a este processo. As organizações se destacam na manipulação de recursos valiosos, que exigem a busca permanente de equilíbrios sustentáveis. Para tal, estas elaboram estratégias, que permitam o alcance de seus objetivos, garantindo a sustentabilidade interna e externa. O presente trabalho de pesquisa centrou o seu exercício na perceção do papel que a Área de Recursos Humanos no processo definição da estratégia, focalizando os diferentes modelos que vão desde o RH estritamente operacional ao RH estratégico. Esta dimensão evidenciou o papel decisivo do alinhamento do RH à estratégia, como parte integrante da estratégia global da organização, desde a formulação até a implementação. Foi realizado um estudo de caso qualitativo na Empresa Nacional de Exploração de Aeroportos e Navegação Aérea (ENANA-EP), em Angola, caracterizado, pela recolha exaustiva de documentos relevantes da gestão da empresa, e concomitantemente a coleta de dados por via de um questionário escrito, que revelaram o estádio evolutivo da Área de RH, bem como o seu posicionamento ainda como órgão de consultoria interna, necessitando trabalhar novas ideias e estruturar procedimentos que integrem com maior facilidade a Área de RH no processo de definição da estratégia, configurando-a como gestora de talentos e competências, com foco no conhecimento e no capital humano.

Implementación del servicio de datos GPS de la Escuela de Topografía, Catastro y Geodesia

En la Escuela de Topografía, Catastro y Geodesia (ETCG) se ha implementado el Servicio de Datos GPS (SDG), el cual es un dominio en Internetque ofrece a los diferentes usuarios el acceso a información técnica y la posibilidad de descargar los archivos de datos generados diariamente por la estación GPS de operación continua de la ETCG. Los archivos disponibles en el SDG incluyen dos tratamientos previos a su publicación: un control de calidad al archivo rinex de observación con el programa Teqc y posteriormente la aplicación de la compresión de los tres archivos rinex (observación,navegación y meteorología) con el algoritmo de Hatanaka. Los dos procesos están totalmente automatizados y se ejecutan de forma diaria por medio de batch files. Con base en la puesta en operación del SDG, los archivos son procesados diariamente por uno de los centros de análisis de datos de SIRGAS y desde la semana 1501 GPS, los archivos de soluciones semanales generados por el DGFI de Alemania incorporan oficialmente los datos de la ETCG.

A comparison of the physiological demands of rugby union match-play when determined by absolute (ABS) or individual (IND) velocity bands in Global Positioning System (GPS) analysis

Since turning professional in 1995 there have been considerable advances in the research on the demands of rugby union, largely using Global Positioning System (GPS) analysis over the last 10 years. A systematic review on the use of GPS, particularly the setting of absolute (ABS) and individual (IND) velocity bands in field based, intermittent, high-intensity (HI) team sports was undertaken. From 3669 records identified, 38 studies were included for qualitative analysis. Little agreement on the definition of movement intensities within team sports was found, only three papers, all on rugby union, had used IND bands, with only one comparing ABS and IND methods. Thus, the aim of this study was to determine if there is a difference in the demands within positions when comparing ABS and IND methods for GPS analysis and if these differences are significantly different between the forward and back positional groups. A total of 214 data files were recorded from 26 players in 17 matches of the 2015/2016 Scottish BT Premiership. ABS velocity zones 1-7 were set at 1) 0-6, 2) 6.1-11, 3) 11.1-15, 4) 15.1-18, 5) 18.1-21, 6) 21.1-15 and 7) 25.1-40km.h-1 while IND zones 1-7 were 1) <20, 2) 20-40, 3) 40-50, 4) 50-70, 5) 70-80, 6) 80-95 and 7) 95-100% of player’s individually determined maximum velocity (Vmax). A 40m sprint test measured Vmax using OptaPro S4 10 Hz (catapult, Australia) GPS units to derive IND bands. The same GPS units were worn during matches. GPS outputs analysed were % distance, % time, high intensity efforts (HIEs) over 18.1 km.h-1 / 70% max velocity and repeated high intensity efforts (RHIEs) which consists of three HIEs in 21secs. General linear model (GLM) analysis identified a significant difference in the measurement of % total distance covered, between the ABS and IND methods in all zones for forwards (p<0.05) and backs (p<0.05). This difference was also significant between forwards and backs in zones 1, shown as mean difference ± standard deviation (3.7±0.7%), 6 (1.2±0.4%) and 7 (1.0±0.0%) respectively (p<0.05). Percentage time estimations were significantly different between ABS and IND analysis within forwards in zones 1 (1.7±1.7%), 2 (-2.9±1.3%), 3 (1.9±0.8%), 4 (-1.4±0.8%) and 5 (0.2±0.4%), and within backs in zones 1 (-10±1.5%), 2 (-1.2±1.1%), 3 (1.8±0.9%) and 5 (0.6±0.5%) (p<0.05). The difference between groups was significant in zones 1, 2, 4 and 5 (p<0.05). The number of HIEs was significantly different between forwards and backs in zones 6 (6±2) and 7 (3±2). RHIEs were significantly different between ABS and IND for forwards (1±2, p<0.05) although not between groups. Until more research on the differences in ABS and IND methods is carried out, then neither can be deemed a criterion method. In conclusion, there are significant differences between the ABS and IND methods of GPS analysis of the physical demands of rugby union, which must be considered when used to inform training load and recovery to improve performance and reduce injuries.