P157 A palliative care intervention for patients with advanced non-malignant respiratory illness
Identifieur interne : 002586 ( Istex/Corpus ); précédent : 002585; suivant : 002587P157 A palliative care intervention for patients with advanced non-malignant respiratory illness
Auteurs : Marjory Mackay ; Janice Christie ; Alison Moodie ; Deborah LynchSource :
- BMJ Supportive & Palliative Care [ 2045-435X ] ; 2013-10.
Abstract
Introduction Patients with advanced respiratory disease do not routinely access palliative care services and given that many are unable to attend hospital appointments, they are even less likely to receive quality palliative care support in their last year of life. This collaborative project between an NHS Respiratory Team and a Hospice aimed to address this inequity. Aims The specific project aims were to: improve symptom control; raise patient and carer awareness /understanding of illness and prognosis; explore patients’ wishes about future treatment and care and establish an advance care plan (ACP); communicate patients’ wishes across health care settings; reduce inappropriate hospital admissions and inappropriate treatments. Methods Using a convenience sample over a 12 month period, all patients who met inclusion criteria (adapted from Gold Standard Framework prognostic indicator guidance) were referred by the respiratory team to specialist palliative care (n = 49). The planned intervention comprised three visits to the patient’s home by a palliative care nurse specialist. Data collection aimed to evaluate the outcome of visits; the follow-through of ACP wishes during hospital admissions; patient experience; GP feedback; impact of project on specialist respiratory nurses and patterns of hospital admissions. Quantitative data was analysed using descriptive statistics and Qualitative data was collated into themes. A favourable ethical opinion was granted for the project. Results Results to date suggest that 1) selection criteria were effective, 2) the intervention had a positive effect on patients’ wellbeing and engagement with the ACP process, 3) purposeful communication and treatment across healthcare settings were enhanced. Some challenges are also emerging, all of which will help shape future service provision. It is anticipated that this collaborative model of service is transferrable to other non-malignant specialties and could be adapted by other hospices /palliative care servcies. Final results are due to complete by June 2013. The project was part funded by the Burdett Trust for Nursing.
Url:
DOI: 10.1136/bmjspcare-2013-000591.179
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">P157 A palliative care intervention for patients with advanced non-malignant respiratory illness</title><author><name sortKey="Mackay, Marjory" sort="Mackay, Marjory" uniqKey="Mackay M" first="Marjory" last="Mackay">Marjory Mackay</name><affiliation><mods:affiliation>Strathcarron Hospice, Denny, Scotland</mods:affiliation></affiliation></author><author><name sortKey="Christie, Janice" sort="Christie, Janice" uniqKey="Christie J" first="Janice" last="Christie">Janice Christie</name><affiliation><mods:affiliation>Strathcarron Hospice, Denny, Scotland</mods:affiliation></affiliation></author><author><name sortKey="Moodie, Alison" sort="Moodie, Alison" uniqKey="Moodie A" first="Alison" last="Moodie">Alison Moodie</name><affiliation><mods:affiliation>Strathcarron Hospice, Denny, Scotland</mods:affiliation></affiliation></author><author><name sortKey="Lynch, Deborah" sort="Lynch, Deborah" uniqKey="Lynch D" first="Deborah" last="Lynch">Deborah Lynch</name><affiliation><mods:affiliation>NHS Forth Valley</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:524888B201207F2B543E66791BB280D4FF0EA9E8</idno><date when="2013" year="2013">2013</date><idno type="doi">10.1136/bmjspcare-2013-000591.179</idno><idno type="url">https://api.istex.fr/document/524888B201207F2B543E66791BB280D4FF0EA9E8/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002586</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">002586</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">P157 A palliative care intervention for patients with advanced non-malignant respiratory illness</title><author><name sortKey="Mackay, Marjory" sort="Mackay, Marjory" uniqKey="Mackay M" first="Marjory" last="Mackay">Marjory Mackay</name><affiliation><mods:affiliation>Strathcarron Hospice, Denny, Scotland</mods:affiliation></affiliation></author><author><name sortKey="Christie, Janice" sort="Christie, Janice" uniqKey="Christie J" first="Janice" last="Christie">Janice Christie</name><affiliation><mods:affiliation>Strathcarron Hospice, Denny, Scotland</mods:affiliation></affiliation></author><author><name sortKey="Moodie, Alison" sort="Moodie, Alison" uniqKey="Moodie A" first="Alison" last="Moodie">Alison Moodie</name><affiliation><mods:affiliation>Strathcarron Hospice, Denny, Scotland</mods:affiliation></affiliation></author><author><name sortKey="Lynch, Deborah" sort="Lynch, Deborah" uniqKey="Lynch D" first="Deborah" last="Lynch">Deborah Lynch</name><affiliation><mods:affiliation>NHS Forth Valley</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ Supportive & Palliative Care</title><title level="j" type="abbrev">BMJ Support Palliat Care</title><idno type="ISSN">2045-435X</idno><idno type="eISSN">2045-4368</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2013-10">2013-10</date><biblScope unit="volume">3</biblScope><biblScope unit="issue">Suppl 1</biblScope><biblScope unit="page" from="A65">A65</biblScope></imprint><idno type="ISSN">2045-435X</idno></series><idno type="istex">524888B201207F2B543E66791BB280D4FF0EA9E8</idno><idno type="DOI">10.1136/bmjspcare-2013-000591.179</idno><idno type="href">bmjspcare-3-A65-3.pdf</idno><idno type="ArticleID">bmjspcare-2013-000591.179</idno><idno type="local">bmjspcare;3/Suppl_1/A65-c</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">2045-435X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Introduction Patients with advanced respiratory disease do not routinely access palliative care services and given that many are unable to attend hospital appointments, they are even less likely to receive quality palliative care support in their last year of life. This collaborative project between an NHS Respiratory Team and a Hospice aimed to address this inequity. Aims The specific project aims were to: improve symptom control; raise patient and carer awareness /understanding of illness and prognosis; explore patients’ wishes about future treatment and care and establish an advance care plan (ACP); communicate patients’ wishes across health care settings; reduce inappropriate hospital admissions and inappropriate treatments. Methods Using a convenience sample over a 12 month period, all patients who met inclusion criteria (adapted from Gold Standard Framework prognostic indicator guidance) were referred by the respiratory team to specialist palliative care (n = 49). The planned intervention comprised three visits to the patient’s home by a palliative care nurse specialist. Data collection aimed to evaluate the outcome of visits; the follow-through of ACP wishes during hospital admissions; patient experience; GP feedback; impact of project on specialist respiratory nurses and patterns of hospital admissions. Quantitative data was analysed using descriptive statistics and Qualitative data was collated into themes. A favourable ethical opinion was granted for the project. Results Results to date suggest that 1) selection criteria were effective, 2) the intervention had a positive effect on patients’ wellbeing and engagement with the ACP process, 3) purposeful communication and treatment across healthcare settings were enhanced. Some challenges are also emerging, all of which will help shape future service provision. It is anticipated that this collaborative model of service is transferrable to other non-malignant specialties and could be adapted by other hospices /palliative care servcies. Final results are due to complete by June 2013. The project was part funded by the Burdett Trust for Nursing.</div></front></TEI><istex><corpusName>bmj</corpusName><keywords><teeft><json:string>hospice</json:string><json:string>lymphoedema</json:string><json:string>ultrasound</json:string><json:string>carers</json:string><json:string>carer</json:string><json:string>lymphoedema service</json:string><json:string>palliative</json:string><json:string>symptom control</json:string><json:string>respiratory team</json:string><json:string>hospital admissions</json:string><json:string>palliative medicine</json:string><json:string>patient care</json:string><json:string>clinic</json:string></teeft></keywords><author><json:item><name>Marjory Mackay</name><affiliations><json:string>Strathcarron Hospice, Denny, Scotland</json:string></affiliations></json:item><json:item><name>Janice Christie</name><affiliations><json:string>Strathcarron Hospice, Denny, Scotland</json:string></affiliations></json:item><json:item><name>Alison Moodie</name><affiliations><json:string>Strathcarron Hospice, Denny, Scotland</json:string></affiliations></json:item><json:item><name>Deborah Lynch</name><affiliations><json:string>NHS Forth Valley</json:string></affiliations></json:item></author><articleId><json:string>bmjspcare-2013-000591.179</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>abstract</json:string></originalGenre><abstract>Introduction Patients with advanced respiratory disease do not routinely access palliative care services and given that many are unable to attend hospital appointments, they are even less likely to receive quality palliative care support in their last year of life. This collaborative project between an NHS Respiratory Team and a Hospice aimed to address this inequity. Aims The specific project aims were to: improve symptom control; raise patient and carer awareness /understanding of illness and prognosis; explore patients’ wishes about future treatment and care and establish an advance care plan (ACP); communicate patients’ wishes across health care settings; reduce inappropriate hospital admissions and inappropriate treatments. Methods Using a convenience sample over a 12 month period, all patients who met inclusion criteria (adapted from Gold Standard Framework prognostic indicator guidance) were referred by the respiratory team to specialist palliative care (n = 49). The planned intervention comprised three visits to the patient’s home by a palliative care nurse specialist. Data collection aimed to evaluate the outcome of visits; the follow-through of ACP wishes during hospital admissions; patient experience; GP feedback; impact of project on specialist respiratory nurses and patterns of hospital admissions. Quantitative data was analysed using descriptive statistics and Qualitative data was collated into themes. A favourable ethical opinion was granted for the project. Results Results to date suggest that 1) selection criteria were effective, 2) the intervention had a positive effect on patients’ wellbeing and engagement with the ACP process, 3) purposeful communication and treatment across healthcare settings were enhanced. Some challenges are also emerging, all of which will help shape future service provision. It is anticipated that this collaborative model of service is transferrable to other non-malignant specialties and could be adapted by other hospices /palliative care servcies. Final results are due to complete by June 2013. 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For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</p></availability><date>2013</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">P157 A palliative care intervention for patients with advanced non-malignant respiratory illness</title><author xml:id="author-1"><persName><forename type="first">Marjory</forename><surname>Mackay</surname></persName><affiliation>Strathcarron Hospice, Denny, Scotland</affiliation></author><author xml:id="author-2"><persName><forename type="first">Janice</forename><surname>Christie</surname></persName><affiliation>Strathcarron Hospice, Denny, Scotland</affiliation></author><author xml:id="author-3"><persName><forename type="first">Alison</forename><surname>Moodie</surname></persName><affiliation>Strathcarron Hospice, Denny, Scotland</affiliation></author><author xml:id="author-4"><persName><forename type="first">Deborah</forename><surname>Lynch</surname></persName><affiliation>NHS Forth Valley</affiliation></author></analytic><monogr><title level="j">BMJ Supportive & Palliative Care</title><title level="j" type="abbrev">BMJ Support Palliat Care</title><idno type="pISSN">2045-435X</idno><idno type="eISSN">2045-4368</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2013-10"></date><biblScope unit="volume">3</biblScope><biblScope unit="issue">Suppl 1</biblScope><biblScope unit="page" from="A65">A65</biblScope></imprint></monogr><idno type="istex">524888B201207F2B543E66791BB280D4FF0EA9E8</idno><idno type="DOI">10.1136/bmjspcare-2013-000591.179</idno><idno type="href">bmjspcare-3-A65-3.pdf</idno><idno type="ArticleID">bmjspcare-2013-000591.179</idno><idno type="local">bmjspcare;3/Suppl_1/A65-c</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2013</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Introduction Patients with advanced respiratory disease do not routinely access palliative care services and given that many are unable to attend hospital appointments, they are even less likely to receive quality palliative care support in their last year of life. This collaborative project between an NHS Respiratory Team and a Hospice aimed to address this inequity. Aims The specific project aims were to: improve symptom control; raise patient and carer awareness /understanding of illness and prognosis; explore patients’ wishes about future treatment and care and establish an advance care plan (ACP); communicate patients’ wishes across health care settings; reduce inappropriate hospital admissions and inappropriate treatments. Methods Using a convenience sample over a 12 month period, all patients who met inclusion criteria (adapted from Gold Standard Framework prognostic indicator guidance) were referred by the respiratory team to specialist palliative care (n = 49). The planned intervention comprised three visits to the patient’s home by a palliative care nurse specialist. Data collection aimed to evaluate the outcome of visits; the follow-through of ACP wishes during hospital admissions; patient experience; GP feedback; impact of project on specialist respiratory nurses and patterns of hospital admissions. Quantitative data was analysed using descriptive statistics and Qualitative data was collated into themes. A favourable ethical opinion was granted for the project. Results Results to date suggest that 1) selection criteria were effective, 2) the intervention had a positive effect on patients’ wellbeing and engagement with the ACP process, 3) purposeful communication and treatment across healthcare settings were enhanced. Some challenges are also emerging, all of which will help shape future service provision. It is anticipated that this collaborative model of service is transferrable to other non-malignant specialties and could be adapted by other hospices /palliative care servcies. Final results are due to complete by June 2013. The project was part funded by the Burdett Trust for Nursing.</p></abstract></profileDesc><revisionDesc><change when="2013-10">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2017-01-19">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/524888B201207F2B543E66791BB280D4FF0EA9E8/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="abstract" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">bmjspcare</journal-id><journal-id journal-id-type="nlm-ta">BMJ Support Palliat Care</journal-id><journal-id journal-id-type="publisher-id">bmjspcare</journal-id><journal-title>BMJ Supportive & Palliative Care</journal-title><abbrev-journal-title abbrev-type="publisher">BMJ Support Palliat Care</abbrev-journal-title><issn pub-type="ppub">2045-435X</issn><issn pub-type="epub">2045-4368</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">bmjspcare-2013-000591.179</article-id><article-id pub-id-type="doi">10.1136/bmjspcare-2013-000591.179</article-id><article-id pub-id-type="other">bmjspcare;3/Suppl_1/A65-c</article-id><article-id pub-id-type="other">bmjspcare;bmjspcare-2013-000591.179</article-id><article-id pub-id-type="other">A65.3</article-id><article-id pub-id-type="other">bmjspcare-2013-000591.179</article-id><article-categories><subj-group subj-group-type="heading"><subject>Help the Hospices, Poster Presentations</subject><subj-group subj-group-type="heading"><subject>Treatment, care and patient perspectives</subject></subj-group></subj-group></article-categories><title-group><article-title>P157 A palliative care intervention for patients with advanced non-malignant respiratory illness</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mackay</surname><given-names>Marjory</given-names></name><xref ref-type="aff" rid="AF0001"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Christie</surname><given-names>Janice</given-names></name><xref ref-type="aff" rid="AF0001"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Moodie</surname><given-names>Alison</given-names></name><xref ref-type="aff" rid="AF0001"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Lynch</surname><given-names>Deborah</given-names></name><xref ref-type="aff" rid="AF0002"><sup>2</sup></xref></contrib></contrib-group><aff id="AF0001"><sup>1</sup>Strathcarron Hospice, Denny, Scotland</aff><aff id="AF0002"><sup>2</sup>NHS Forth Valley</aff><pub-date pub-type="ppub"><month>10</month><year>2013</year></pub-date><volume>3</volume><volume-id pub-id-type="other">3</volume-id><volume-id pub-id-type="other">3</volume-id><issue>Suppl 1</issue><issue-id pub-id-type="other">bmjspcare;3/Suppl_1</issue-id><issue-id pub-id-type="other" content-type="supplement">Suppl_1</issue-id><issue-id pub-id-type="other">3/Suppl_1</issue-id><issue-title>Hospice Care: Fit for the Future 21st–23rd October 2013 Bournemouth International Centre Bournemouth, UK</issue-title><fpage seq="3">A65</fpage><permissions><copyright-statement>© 2013, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2013</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmjspcare-3-A65-3.pdf"></self-uri><abstract><sec><title>Introduction</title><p>Patients with advanced respiratory disease do not routinely access palliative care services and given that many are unable to attend hospital appointments, they are even less likely to receive quality palliative care support in their last year of life. This collaborative project between an NHS Respiratory Team and a Hospice aimed to address this inequity.</p></sec><sec><title>Aims</title><p>The specific project aims were to: improve symptom control; raise patient and carer awareness /understanding of illness and prognosis; explore patients’ wishes about future treatment and care and establish an advance care plan (ACP); communicate patients’ wishes across health care settings; reduce inappropriate hospital admissions and inappropriate treatments.</p></sec><sec><title>Methods</title><p>Using a convenience sample over a 12 month period, all patients who met inclusion criteria (adapted from Gold Standard Framework prognostic indicator guidance) were referred by the respiratory team to specialist palliative care (n = 49). The planned intervention comprised three visits to the patient’s home by a palliative care nurse specialist.</p><p>Data collection aimed to evaluate the outcome of visits; the follow-through of ACP wishes during hospital admissions; patient experience; GP feedback; impact of project on specialist respiratory nurses and patterns of hospital admissions.</p><p>Quantitative data was analysed using descriptive statistics and Qualitative data was collated into themes.</p><p>A favourable ethical opinion was granted for the project.</p></sec><sec><title>Results</title><p>Results to date suggest that 1) selection criteria were effective, 2) the intervention had a positive effect on patients’ wellbeing and engagement with the ACP process, 3) purposeful communication and treatment across healthcare settings were enhanced. Some challenges are also emerging, all of which will help shape future service provision. It is anticipated that this collaborative model of service is transferrable to other non-malignant specialties and could be adapted by other hospices /palliative care servcies. Final results are due to complete by June 2013.</p><p>The project was part funded by the Burdett Trust for Nursing.</p></sec></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>P157 A palliative care intervention for patients with advanced non-malignant respiratory illness</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>P157 A palliative care intervention for patients with advanced non-malignant respiratory illness</title></titleInfo><name type="personal"><namePart type="given">Marjory</namePart><namePart type="family">Mackay</namePart><affiliation>Strathcarron Hospice, Denny, Scotland</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Janice</namePart><namePart type="family">Christie</namePart><affiliation>Strathcarron Hospice, Denny, Scotland</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alison</namePart><namePart type="family">Moodie</namePart><affiliation>Strathcarron Hospice, Denny, Scotland</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Deborah</namePart><namePart type="family">Lynch</namePart><affiliation>NHS Forth Valley</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="abstract" displayLabel="abstract"></genre><originInfo><publisher>British Medical Journal Publishing Group</publisher><dateIssued encoding="w3cdtf">2013-10</dateIssued><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Introduction Patients with advanced respiratory disease do not routinely access palliative care services and given that many are unable to attend hospital appointments, they are even less likely to receive quality palliative care support in their last year of life. This collaborative project between an NHS Respiratory Team and a Hospice aimed to address this inequity. Aims The specific project aims were to: improve symptom control; raise patient and carer awareness /understanding of illness and prognosis; explore patients’ wishes about future treatment and care and establish an advance care plan (ACP); communicate patients’ wishes across health care settings; reduce inappropriate hospital admissions and inappropriate treatments. Methods Using a convenience sample over a 12 month period, all patients who met inclusion criteria (adapted from Gold Standard Framework prognostic indicator guidance) were referred by the respiratory team to specialist palliative care (n = 49). The planned intervention comprised three visits to the patient’s home by a palliative care nurse specialist. Data collection aimed to evaluate the outcome of visits; the follow-through of ACP wishes during hospital admissions; patient experience; GP feedback; impact of project on specialist respiratory nurses and patterns of hospital admissions. Quantitative data was analysed using descriptive statistics and Qualitative data was collated into themes. A favourable ethical opinion was granted for the project. Results Results to date suggest that 1) selection criteria were effective, 2) the intervention had a positive effect on patients’ wellbeing and engagement with the ACP process, 3) purposeful communication and treatment across healthcare settings were enhanced. Some challenges are also emerging, all of which will help shape future service provision. It is anticipated that this collaborative model of service is transferrable to other non-malignant specialties and could be adapted by other hospices /palliative care servcies. Final results are due to complete by June 2013. The project was part funded by the Burdett Trust for Nursing.</abstract><relatedItem type="host"><titleInfo><title>BMJ Supportive & Palliative Care</title></titleInfo><titleInfo type="abbreviated"><title>BMJ Support Palliat Care</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">2045-435X</identifier><identifier type="eISSN">2045-4368</identifier><identifier type="PublisherID">bmjspcare</identifier><identifier type="PublisherID-hwp">bmjspcare</identifier><identifier type="PublisherID-nlm-ta">BMJ Support Palliat Care</identifier><part><date>2013</date><detail type="title"><title>Hospice Care: Fit for the Future 21st–23rd October 2013 Bournemouth International Centre Bournemouth, UK</title></detail><detail type="volume"><caption>vol.</caption><number>3</number></detail><detail type="issue"><caption>no.</caption><number>Suppl 1</number></detail><extent unit="pages"><start>A65</start></extent></part></relatedItem><identifier type="istex">524888B201207F2B543E66791BB280D4FF0EA9E8</identifier><identifier type="DOI">10.1136/bmjspcare-2013-000591.179</identifier><identifier type="href">bmjspcare-3-A65-3.pdf</identifier><identifier type="ArticleID">bmjspcare-2013-000591.179</identifier><identifier type="local">bmjspcare;3/Suppl_1/A65-c</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2013, Published by the BMJ Publishing Group Limited. 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