The use of hospital-based services by heart failure patients in the last year of life: a discussion paper

Individuals with chronic heart failure have high utilisation of hospital-related services towards the end of life and receive treatments that provide symptom relief without improving life expectancy. The aim of this discussion paper is to determine chronic heart failure patients’ use of acute hospital-based services in their last year of life and to discuss the potential for palliative care to reduce service utilisation. A systematic search of the literature was conducted. Medline, Cumulative Index for Nursing and Allied Health (CINAHL) and SCOPUS databases were used to systematically search for literature from database commencement to September 2016. Specific inclusion criteria and search terms were used to identify relevant studies on heart failure patients’ use of hospital services in their last year of life. There were 12 studies that evaluated the use of hospital-based services by chronic heart failure patients at the end of life. In all studies, it was found that chronic heart failure patients used acute hospital-based services as death approached. However, only two studies examined if palliative care consultations were obtained by patients, and neither study assessed the impact that these consultations had on service utilisation in the last year of life. Heart failure negatively impacts health status, and this is a predictor of service utilisation. Further research is needed to determine the efficacy of both primary and secondary palliative care in reducing resource use towards the end of life and improving the quality of end of life care.</p

Transfer Across the Air-Sea Interface

The efficiency of transfer of gases and particles across the air-sea interface is controlled by several physical, biological and chemical processes in the atmosphere and water which are described here (including waves, large- and small-scale turbulence, bubbles, sea spray, rain and surface films). For a deeper understanding of relevant transport mechanisms, several models have been developed, ranging from conceptual models to numerical models. Most frequently the transfer is described by various functional dependencies of the wind speed, but more detailed descriptions need additional information. The study of gas transfer mechanisms uses a variety of experimental methods ranging from laboratory studies to carbon budgets, mass balance methods, micrometeorological techniques and thermographic techniques. Different methods resolve the transfer at different scales of time and space; this is important to take into account when comparing different results. Air-sea transfer is relevant in a wide range of applications, for example, local and regional fluxes, global models, remote sensing and computations of global inventories. The sensitivity of global models to the description of transfer velocity is limited; it is however likely that the formulations are more important when the resolution increases and other processes in models are improved. For global flux estimates using inventories or remote sensing products the accuracy of the transfer formulation as well as the accuracy of the wind field is crucial