The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad news

AIMS: To explore the difficulties experienced by nurses and healthcare professionals when engaging in the process of breaking bad news BACKGROUND: The challenges faced by staff when breaking bad news have previously been researched in relation to particular settings or subjects. This study involved staff from diverse settings and roles to develop broader insights into the range of difficulties experienced in clinical practice. DESIGN: The study used a descriptive survey design involving self-reported written accounts and framework analysis. METHODS: Data were collected using a structured questionnaire containing a free text section that asked participants to describe a difficult experience they had encountered when involved in the process of breaking bad news. Data were collected from healthcare staff from hospital, community, hospice and care home settings attending training days on breaking bad news between April 2011 - April 2014. FINDINGS: Multiple inter-related factors presented challenges to staff engaging in activities associated with breaking bad news. Traditional subjects such as diagnostic and treatment information were described but additional topics were identified such as the impact of illness and care at the end of life. A descriptive framework was developed that summarises the factors that contribute to creating difficult experiences for staff when breaking bad news. CONCLUSION: The framework provides insights into the scope of the challenges faced by staff when they engage in the process of breaking bad news. This provides the foundation for developing interventions to support staff that more closely matches their experiences in clinical practice. This article is protected by copyright. All rights reserved

Geometric Phases in Graphitic Cones

In this article we use a geometric approach to study geometric phases in graphitic cones. The spinor that describes the low energy states near the Fermi energy acquires a phase when transported around the apex of the cone, as found by a holonomy transformation. This topological result can be viewed as an analogue of the Aharonov-Bohm effect. The topological analysis is extended to a system with $n$ cones, whose resulting configuration is described by an effective defect.Comment: 4 pages, revtex

Hoop conjecture for colliding black holes : non-time-symmetric initial data

The hoop conjecture is well confirmed in momentarily static spaces, but it has not been investigated systematically for the system with relativistic motion. To confirm the hoop conjecture for non-time-symmetric initial data, we consider the initial data of two colliding black holes with momentum and search an apparent horizon that encloses two black holes. In testing the hoop conjecture, we use two definitions of gravitational mass : one is the ADM mass and the other is the quasi-local mass defined by Hawking. Although both definitions of gravitational mass give fairly consistent picture of the hoop conjecture, the hoop conjecture with the Hawking mass can judge the existence of an apparent horizon for wider range of parameters of the initial data compared to the ADM mass.Comment: 15pages, 4 figure

Women, men and coronary heart disease: a review of the qualitative literature

Aim. This paper presents a review of the qualitative literature which examines the experiences of patients with coronary heart disease. The paper also assesses whether the experiences of both female and male patients are reflected in the literature and summarizes key themes. Background. Understanding patients' experiences of their illness is important for coronary heart disease prevention and education. Qualitative methods are particularly suited to eliciting patients' detailed understandings and perceptions of illness. As much previous research has been 'gender neutral', this review pays particular attention to gender. Methods. Published papers from 60 qualitative studies were identified for the review through searches in MEDLINE, EMBASE, CINAHL, PREMEDLINE, PsychINFO, Social Sciences Citation Index and Web of Science using keywords related to coronary heart disease. Findings. Early qualitative studies of patients with coronary heart disease were conducted almost exclusively with men, and tended to generalize from 'male' experience to 'human' experience. By the late 1990s this pattern had changed, with the majority of studies including women and many being conducted with solely female samples. However, many studies that include both male and female coronary heart disease patients still do not have a specific gender focus. Key themes in the literature include interpreting symptoms and seeking help, belief about coronary 'candidates' and relationships with health professionals. The influence of social roles is important: many female patients have difficulties reconciling family responsibilities and medical advice, while male patients worry about being absent from work. Conclusions. There is a need for studies that compare the experiences of men and women. There is also an urgent need for work that takes masculinity and gender roles into account when exploring the experiences of men with coronary heart disease

Classical self-forces in a space with a dispiration

We derive the gravitational and electrostatic self-energies of a particle at rest in the background of a cosmic dispiration (topological defect), finding that the particle may experience potential steps, well potentials or potential barriers depending on the nature of the interaction and also on certain properties of the defect. The results may turn out to be useful in cosmology and condensed matter physics.Comment: 5 pages, 4 figures, revtex4 fil

On the energy of charged black holes in generalized dilaton-axion gravity

In this paper we calculate the energy distribution of some charged black holes in generalized dilaton-axion gravity. The solutions correspond to charged black holes arising in a Kalb-Ramond-dilaton background and some existing non-rotating black hole solutions are recovered in special cases. We focus our study to asymptotically flat and asymptotically non-flat types of solutions and resort for this purpose to the M{\o}ller prescription. Various aspects of energy are also analyzed.Comment: LaTe

Telephone follow-up to identify incident lung cancer symptoms in COPD patients

Background: COPD patients are at very high risk of lung cancer, yet new respiratory symptoms of lung cancer may be particularly hard to identify. Aim: We sought to assess the feasibility of actively seeking lung cancer symptoms to improve the timeliness of diagnosis in this group. Design and setting: Observational study to evaluate the feasibility and practicability of the intervention. Patients were recruited from a primary care COPD register and were contacted by telephone 4-monthly over 12 months. Chest X-ray rates were assessed over the 20 months before, during the intervention and for 20 months following it, in both the study group and in patients on the register who did not volunteer for the intervention. Results: Most symptoms were identified at the first call, with 13 (17%) subjects admitting to a new persistent cough and 7 (9%) to a change in their cough. As a result of symptoms identified on the first call, 21 (27%) of the participating patients were referred for a chest X-ray and 4 (5%) were referred urgently to secondary care. Incident symptoms continued frequently to be identified at all subsequent calls, with an overall total of 49% of patients qualifying for and receiving a chest X-ray. Interestingly, the chest X-ray rate remained significantly elevated for the 20 months following the intervention, whilst there appeared to be little change in the non-study COPD patients. Conclusion: The intervention was readily practicable and lung cancer symptoms were frequently identified. The intervention may have resulted in a behavior change leading to a persistently higher chest X-ray rate, although the comparator group was not a formal control group and further assessment in a randomized control trial appears justified