Compassion: a scoping review of the healthcare literature

BACKGROUND: Recent concerns about suboptimal patient care and a lack of compassion have prompted policymakers to question the preparedness of clinicians for the challenging environment in which they practice. Compassionate care is expected by patients and is a professional obligation of clinicians; however, little is known about the state of research on clinical compassion. The purpose of this scoping review was to map the literature on compassion in clinical healthcare. METHODS: Searches of eight electronic databases and the grey literature were conducted to identify empirical studies published over the last 25 years. Eligible studies explored perceptions or interventions of compassionate care in clinical populations, healthcare professionals, and healthcare students. Following the title and abstract review, two reviewers independently screened full-texts articles, and extracted study data. A narrative approach to synthesizing and mapping the literature was used. RESULTS AND DISCUSSION: Of 36,637 records, 648 studies were retrieved and 44 studies were included in the review. Less than one third of studies included patients. Six themes emerged from studies that explored perceptions of compassionate care: nature of compassion, development of compassion, interpersonal factors related to compassion, action and practical compassion, barriers and enablers of compassion, and outcomes of compassion. Intervention studies included two compassionate care trials with patients and eight educational programs that aimed to improve compassionate care in clinicians and students. CONCLUSIONS: This review identifies the limited empirical understanding of compassion in healthcare, highlighting the lack of patient and family voices in compassion research. A deeper understanding of the key behaviors and attitudes that lead to improved patient-reported outcomes through compassionate care is necessary

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Dose-response effects of a new growth hormone receptor antagonist (B2036-PEG) on circulating, hepatic and renal expression of the growth hormone/insulin-like growth factor system in adult mice

The effects of growth hormone (GH) in regulating the expression of the hepatic and renal GH and insulin-like growth factor (IGF) system were studied by administering a novel GH receptor antagonist (GHRA) (B2036-PEG) at different doses (0, 1.25, 2.5, 5 and 10 mg/kg/day) to mice for 7 days. No differences were observed in the groups with respect to body weight, food consumption or blood glucose. However, a dose-dependent decrease was observed in circulating IGF-I levels and in hepatic and renal IGF-I levels at the highest doses. In contrast, in the 5 and 10 mg/kg/day GHRA groups, circulating and hepatic transcriptional IGF binding protein-3 (IGFBP-3) levels were not modified, likely resulting in a significantly decreased IGF-I/IGFBP-3 ratio. Hepatic GH receptor (GHR) and GH binding protein (GHBP) mRNA levels increased significantly in all GHRA dosage groups. Endogenous circulatory GH levels increased significantly in the 2.5 and 5 mg/kg/day GHRA groups. Remarkably, increased circulating IGFBP-4 and hepatic IGFBP-4 mRNA levels were observed in all GHRA administration groups. Renal GHR and GHBP mRNA levels were not modified by GHRA administration at the highest doses. Also, renal IGFBP-3 mRNA levels remained unchanged in most GHRA administration groups, whereas IGFBP-1, -4 and -5 mRNA levels were significantly increased in the 5 and 10 mg/kg/day GHRA administration groups. In conclusion, the effects of a specific GHR blockade on circulating, hepatic and renal GH/IGF axis reported here, may prove useful in the future clinical use of GHRAs

Microbial diversity in the floral nectar of seven Epipactis (Orchidaceae) species

Floral nectar of animal-pollinated plants is commonly infested with microorganisms, yet little is known about the microorganisms inhabiting the floral nectar of orchids. In this study, we investigated microbial communities occurring in the floral nectar of seven Epipactis (Orchidaceae) species. Culturable bacteria and yeasts were isolated and identified by partially sequencing the small subunit (SSU) ribosomal RNA (rRNA) gene and the D1/D2 domains of the large subunit (LSU) rRNA gene, respectively. Using three different culture media, we found that bacteria were common inhabitants of the floral nectar of Epipactis. The most widely distributed bacterial operational taxonomic units (OTUs) in nectar of Epipactis were representatives of the family of Enterobacteriaceae, with an unspecified Enterobacteriaceae bacterium as the most common. In contrast to previous studies investigating microbial communities in floral nectar, very few yeast species (mainly of the genus Cryptococcus) were observed, and most of them occurred in very low densities. Total OTU richness (i.e., the number of bacterial and yeast OTUs per orchid species) varied between 4 and 20. Cluster analysis revealed that microbial communities of allogamous species differed from those of autogamous and facultatively autogamous species. This study extends previous efforts to identify microbial communities in floral nectar and indicates that the floral nectar of the orchids investigated mainly contained bacterial communities with moderate phylogenetic diversity

Effect of pollination strategy, phylogeny and distribution on pollination niches of Euro-Mediterranean orchids

International audiencePollination niches are important components of ecological niches and have played a major role in the diversification of Angiosperms. In this study, we focused on Euro‐Mediterranean orchids, which use diverse pollination strategies and interact with various functional groups of insects. In these orchids, we investigated the determinants of pollination niche breadth and overlap by analysing the orchid–pollinator network and the factors that may have shaped it. We constructed a database reporting 1,278 interactions between 243 orchid and 773 pollinator species based on a thorough literature review. We then focused on 153 orchid species for which phylogenetic data were available. We used Bayesian phylogenetic mixed models to study the relationship between specialisation (as estimated by the degree and degree in the projected network), pollination strategy and breadths of orchids’ spatial and temporal distributions, while correcting for the effect of phylogenetic relationships among orchid species and sampling effort. We then used a singular value decomposition of the orchid–pollinator matrix combined to a redundancy and variation partitioning analyses to investigate the determinants of similarity in pollination niches between orchids. Specialisation was higher in deceptive than in nectar‐producing orchids and decreased with the breadth of orchids’ spatial distribution. When interactions were considered at the insect family level, similarity in pollination niches between orchids was solely explained by their pollination strategy and phylogeny. By contrast, when they were considered at the insect species level, this similarity was primarily explained by their geographical range and flowering time, although other factors had significant effects as well, with orchids using the same pollination strategy, being closely related and growing in the same habitats sharing more insect species than expected. Synthesis. Specialisation in orchid–pollinator interactions depends on orchids’ pollination strategy and geographical range. The pool of insect families with which orchids interact depends on their pollination strategy and phylogeny, with consistent associations between some functional or phylogenetic groups of orchids and some families of pollinators. By contrast, the pool of insect species with which orchids interact depends on their spatio‐temporal distribution, suggesting that at a finer scale, orchid–pollinator interactions are more opportunistic than previously thought