St Barnabas Hospital

<h3>Introduction</h3> For patients with known malignancy, development of malignant pleural effusion (MPE) is a poor prognostic marker: median survival with effusion at presentation is five months (Zamboni <i>et al</i>., 2015), but for the majority of those developing MPE during active cancer management, prognosis is much worse. Management of pleural fluid in this setting should be individualised, depending on symptoms, functional status, prognosis and fully informed patients preferences. Pleural drainage whether single aspiration, short term drain or semi-permanent drain are all highly invasive procedures with risks attached. Locally, patients developing MPE were frequently referred to the respiratory service for insertion of an indwelling drain inappropriately (either too unwell, or single drainage preferable, or without understanding their prognosis) and were often not known to palliative care services. <h3>Aim</h3> To create a pathway ensuring patients developing MPE had a holistic palliative care assessment and creation of an effusion management plan appropriate to their symptoms, prognosis and informed preferences. <h3>Method</h3> Patients developing MPE are referred to the respiratory consultant and advised they will have a palliative care review as part of the assessment process. A hospice palliative care CNS who has undertaken additional training on assessing these patients, visits at home within five days – assesses palliative care needs, discusses prognosis and options for management (semi-permanent drain/single drainage/medical management of breathlessness) with patient/family. If drainage is appropriate, the palliative care CNS liaises with the respiratory team and the patient is booked in, as well as arranging on-going palliative care support. <h3>Results</h3> Patient and staff satisfaction results will be available at conference, along with the first six months of data from the pathway. <h3>Conclusion</h3> Collaboration between specialties and between services can ensure patients receive timely assessment of needs and are fully informed in order to make choices about potentially invasive interventions.

To compare microleakage under 3M Unitek's APC Flash-Free Adhesive Coated System bracket and the APC PLUS Adhesive Coated System bracket after thermal cycling. Forty freshly extracted human maxillary premolars were randomly divided into two groups and bonded with either a Flash-Free bracket or a PLUS bracket. After bonding, the samples were incubated in a water bath at 37°C for 24 hours and thermocycled for 5000 cycles between 5°C and 50°C. All teeth were immersed in a 2% methylene blue solution for 24 hours, embedded in acrylic and sectioned in a buccolingual direction at approximately the center of the bracket. Microleakage was observed at the enamel-adhesive interface from the occlusal and gingival margins of the bracket base. Statistical analysis was conducted using the Mann-Whitney U-test. The median microleakage was higher in the Flash-Free group, but the difference between the two groups was not statistically significant (P > .05). In a laboratory setting, there is no significant difference between the extent of microleakage under the APC Flash-Free Adhesive Coated System bracket and the APC PLUS Adhesive Coated System bracket after thermal cycling.

To evaluate the bonding time, shear bond strength (SBS), and adhesive residue index (ARI) of APC(TM) Flash-Free bonding system. Thirty-six extracted human maxillary premolars were randomly divided into three groups (12 per group) and used for this in vitro study: group 1, APC Flash-Free Adhesive Coated Appliance System; group 2, Clarity ADVANCED Ceramic Bracket pasted manually; group 3 (control group), 3M APC PLUS Adhesive prepasted brackets bonded with the extruded flash removed. Bonding time was measured using a stopwatch. Bond strength was measured using an Instron at a cross-head speed of 1 mm/min. The ARI was graded on a scale from 1 to 5. Repeated-measures analysis of variance and post hoc Tukey tests were used for statistical analysis. It took significantly (P < .001) less time to bond in the APC Flash-Free Adhesive group (30.7 ± 3.3 seconds) compared with the control group (41.8 ± 4.0 seconds) and the manual group (39.2 ± 2.8 seconds). The APC Flash-Free Adhesive coated bracket had significantly (P < .001) greater SBS (13.7 ± 2.2 MPa) compared with the control group (10.8 ± 2.0 MPa) and the manual group (10.4 ± 1.4 MPa). The ARI was significantly (P < .001) greater with the APC Flash-Free Adhesive coated bracket compared with that of the other two groups. Compared with other methods of bonding, the APC Flash-Free Adhesive Coated System can potentially reduce bonding time while increasing SBS.

Twelve hospices from the ECLIHP Regional group working with Skills for Health as part of a successful bid for £10,000 foa a supported project.The overall aim of this project will be to improve the quality of care for people with complex palliative and end of life care needs and their families by ensuring 24/7 direct admissions access to specialist inpatient hospice beds and emergency out of hours assessment in the community.The intention of this project is to support delivery of a flexible and responsive 24/7 hospice admission and assessment service through redesign of the existing workforce to introduce an Advanced Nurse Practitioner (ANP) role within the team.Impact will be measured by agreed Key Performance IndicatorsDesired Outcomea Transferable Role Template for the ANP in Hospice Care defining the skills, competence, learning and development needed to fulfil this role.an outline Business Case Template to build the case to commissioners of the benefits of the ANP role in improving the quality of care for people with complex palliative and end of life care needs and their families by ensuring 24/7 direct admissions access to specialist inpatient hospice beds and emergency out of hours assessment in the community.Deliverables:Development of an ANP Transferable Role Template within Hospice Care to be included in the Skills for Health Learning Bank.Development of a Education and Training Framework to underpin the role.An outline Business Case Template targeted at CommissionersWritten Job Description for the ANP Role in Hospice Care.How to achieve the deliverables?Define role, responsibilities and core job descriptionCreate a Clinical Reference Group and arrange workshopsDevelop formal partnership arrangement to support the projectIdentify evaluation processAgree scope of role and map competences/skills (NOS) sign offAgree core education programmeConduct baseline evaluationComplete clinical/technical skills training and competency sign offDefine role, responsibilities in preparing Business Case TemplateAgree Business Case and Sign offProduce project outcome report