Implementing a Care-Based Nursing Workforce Model: Implications for Missed Care, Teamwork, and Satisfaction.

Background: Nursing care delivery models may serve as a significant factor contributing to nurse satisfaction, frequency of missed care, and patient outcomes.

Local Problem: The nursing leadership team at our institution sought to determine if an adaptation of our primary registered nurse (RN) nursing model would enhance satisfaction of bedside nurses and care of patients.

Methods: An improvement study introducing a care-based delivery model was implemented between January 2023 and January 2024 on a medical-surgical neurology/spinal unit at our organization.

Advance Care Planning in the United Kingdom - A snapshot from the four UK nations.

The United Kingdom (UK) as a whole has a long-established decades-old history as an early adopter of the concepts of Advance Care Planning (ACP), with significant integration into mainstream national policy and widespread implementation. The ACP term itself, its processes, means, inclusions and implementations vary considerably within the UK and between its four nations, but the overall impression is of a strongly uniting consensus on the positive impact, value and vital importance of ACP in enabling better care for people in the final years of life, and at earlier life stages. Though there is always more work to do and more lessons to learn, those of us who have watched this world-wide movement grow over recent decades, find the overall direction of travel of commitment to mainstreaming ACP in the UK to be inspiring and encouraging, and gives us hope for the future.

Evaluation of lung ventilation distribution using electrical impedance tomography in standing sedated horses with capnoperitoneum.

Objective: To determine changes in distribution of lung ventilation with increasing intra-abdominal pressure (IAP) from carbon dioxide (CO) insufflation in standing sedated horses.

Study Design: Prospective experimental study.

Animals: A group of six healthy adult horses.

The Gold Standards Framework Hospital programme: implementation and progress.

Aim: The implementation and impact of the Gold Standards Framework Hospitals (GSFH) service development programme is described.

Background: A third of hospital inpatients may be in their last year of life when admitted to hospital. Many will be repeat and unplanned admissions.

Sinocutaneous fistula repair with a masseter muscle transposition flap combined with wound matrix and cancellous bone graft in a horse: A new technique.

Objective: To describe a new technique to repair a sinocutaneous fistula with a masseter muscle transposition flap.

Study Design: Case report.

Animal: One 13-year-old thoroughbred stallion.

In vitro mechanical evaluation of three transfixation pin-cast constructs applied to equine forelimbs.

OBJECTIVE To compare strain at the bone-pin and cast-pin interfaces among 3 transfixation pin-cast constructs applied to equine forelimbs. ANIMALS 15 forelimbs from 15 adult horses. PROCEDURES Limbs were randomly assigned to 1 of 3 constructs.

Comparison of hand-sewn and oversewn stapled jejunojejunal anastomoses in horses.

The objective of this study was to compare the biomechanical properties of hand-sewn jejunojejunal anastomoses to those of oversewn stapled jejunojejunal anastomoses. Jejunojejunal anastomoses were constructed from harvested jejunal segments using a single-layer Lembert technique (1HS), double-layer simple continuous/Cushing technique (2HS), stapled side-to-side technique oversewn with Cushing pattern (SS), and closed 1-stage stapled functional end-to-end technique oversewn with Cushing pattern (FEE). Anastomosed segments were distended with fluid until the point of biomechanical failure.

Laparoscopic cryptorchidectomy with a vessel-sealing device in dorsal recumbent horses: 43 cases.

Objective: To document laparoscopic cryptorchidectomy with a vessel-sealing device in dorsal recumbent horses.

Study Design: Retrospective study.

Animals: Forty-three male horses.

Using the Gold Standards Framework to deliver good end of life care.

The aims of excellent end of life care (EOLC) and nursing are at the heart of healthcare. Chelsea and Westminster Hospital NHS Foundation Trust, a multi-site London teaching care provider, recognises and values the importance of good EOLC, and the quality of EOLC is used as one of the key metrics in assessing the quality of patient and family care across the trust. The principles of EOLC, including those enshrined in the Gold Standards Framework (GSF), are closely aligned with the trust's core values.

Comprehensive and Integrated Palliative Care for People With Advanced Chronic Conditions: An Update From Several European Initiatives and Recommendations for Policy.

The number of people in their last years of life with advanced chronic conditions, palliative care needs, and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% of mortality, and may account for up to one-third of total national health system spend.

Quality of Adhesions After Sutured Paramedian vs. Laparoscopic Toggle Abomasopexy in an Ovine Model.

Objective: To evaluate adhesions created by abomasopexies using either chromic gut or polydioxanone suture through a right paramedian approach and determine whether a laparoscopic toggle technique is an acceptable alternative to open abomasopexy using an ovine model.

Study Design: Experimental study.

Animals: Mature ewes (n=30).

OA18 Population based end of life care - meeting the challenge of the ageing population.

Background: The key challenge for most developed countries is meeting the needs of our ageing population, in particular, those nearing the end of their lives - population-based end-of-life care. Building on a public health approach to meet needs of an area-wide population, and a practical approach of enabling generalist frontline staff care for all people in a variety of settings using the GSF Quality Improvement Programmes, we describe progress in a few GSF Cross-Boundary Care Foundation Sites taking a population-based view to meet the challenges of the ageing population.

Aims: Taking a whole-system view, we explore ways to ensure all people receive quality care towards the final stages of life in line with their needs and wishes in a way that is cost-effective, responsive and compassionate.

PA18 Heart of gold. integrating cross boundary care across different sectors with patients at the heart of care - a population-based public health perspective.

Background: In response to the growing challenge of over-hospitalisation and fragmentation of care for people nearing the end-of-life, a key factor is to develop an integrated cross-boundary care approach to meet the population's needs. Gold Standards Framework (GSF) quality improvement programmes are widely used in the UK in primary care, care homes, hospitals, domiciliary care and hospices. By working together to a common plan, GSF can help be a vehicle for improvement with patients at the heart of care.

The delayed onset of subharmonic and ultraharmonic emissions from a phospholipid-shelled microbubble contrast agent.

Characterizing the non-linear response of microbubble contrast agents is important for their efficacious use in imaging and therapy. In this article, we report that the subharmonic and ultraharmonic response of lipid-shelled microbubble contrast agents exhibits a strong temporal dependence. We characterized non-linear emissions from Targestar-p microbubbles (Targeson Inc.

An evaluation of the impact of the Gold Standards Framework on collaboration in end-of-life care in nursing homes. A qualitative and quantitative evaluation.

Background: In the United Kingdom approaching 20% of people aged 85 years and over live in care homes and most will die there. Improving end-of-life care is a government health priority and homes may work with primary care staff and specialist palliative practitioners to provide comprehensive end-of-life care. Consequently effective collaboration between care home and health service practitioners is vital to ensure high quality end-of-life care.

Use of the Distress Thermometer for the Elderly in the identification of distress and need in nursing and care homes.

Background: Previous studies have found high levels of undetected psychological distress and unaddressed need among care home residents. The aim of this study was to investigate the usability and usefulness of the Distress Thermometer for the Elderly (DTE; modified from a measure used in cancer care) in the identification of distress and need with older people in care homes.

Method: This was a single group, cross-sectional study.

Advance care planning for cancer patients in primary care: a feasibility study.

Background: Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging.

Aim: To assess the feasibility of implementing advance care planning in UK primary care.

Design Of Study: Mixed methods evaluation of a pilot educational intervention.

Palliative care beyond that for cancer in Australia.

Only a quarter of patients' deaths are due to cancer, but the vast majority of the patients of specialist palliative care services have cancer as a primary diagnosis. Almost two-thirds of patients dying of an expected illness do not receive specialist palliative care at all, and this proportion is likely to increase as the population ages. Australian health system care for dying people needs systematic change so that people who may require palliative care in the foreseeable future are systematically identified, and have proactive care plans developed to meet their complex needs.

Delivering 'Gold Standards' in end-of-life care in care homes: a question of teamwork?

Aim: This paper reports findings from a study which investigated the introduction of the Gold Standards Framework for improving end-of-life care into care homes in England.

Background: The Gold Standards Framework was developed in primary care to improve the care provided for people at the end-of-life. Following its successful introduction to this setting it was adapted and implemented in care homes.

Improving end of life care: a matter of life and death.

End of Life Care is important - it affects us allMost people die of co-morbidity/non-cancer conditions in old ageToo few people die in their place of choice, usually at homeHospital deaths are expensive and often preventableMost end of life care is from the usual generalist providerThere is much that can be done; we are all involved and can play an important part in the delivery of top quality care.

Implementing a service users' framework for cancer care in primary care: an action research study.

Background: We previously facilitated the development of a service-user designed framework for providing proactive care for people with cancer in the community.

Objective: To validate this framework in clinical practice.

Methods: We used an action research approach, helping five diverse general practices in the South of Scotland to implement the care framework.