Adherence to cardiac rehabilitation guidelines: a survey of rehabilitation programmes in the United Kingdom

Two key recommendations of recent guidelines are that cardiac rehabilitation requires the skills of a range of professionals and that the patient should receive a menu based programme after an individual assess­ ment of needs. A previous survey of 25 cardiac rehabilitation programmes found little congruence with these guidelines and noted that physicians were particularly unlikely to be involved. We extended this inquiry to include all of the discoverable rehabilitation programmes in the United Kingdom

Erratum: A decadal decline in relative abundance and a shift in microphytoplankton composition at a long-term coastal station off southeast Australia

In this study, we examined 11 yr (1998-2009) of water samples collected from Port Hacking coastal monitoring station 8 km offshore from Sydney, Australia, to assess changes in the microphytoplankton in relation to climate-related trends in environmental variables. A total of 152 taxa (85 genera) were identified, with the small diatom Thalassiosira cf. partheneia and the tropical cyanobacterium Trichodesmium erythraeum being the dominant species over the past decade. Taxon richness showed a distinct seasonal pattern, peaking in the austral winter. Ordination analyses revealed significant seasonal and interannual trends in species composition, including a decadal decline in dinoflagellates relative to diatoms toward the present. This decadal shift in taxonomic composition was, in turn, significantly associated with declines in water temperatures over this time period. Total abundance varied by 12 orders of magnitude (8.5 X 10⁻⁸ to 7.4 X 10⁴ cells L⁻¹), with values separable into bloom and nonbloom regimes at an abundance threshold of 7.1 X 10⁻⁵ cells L⁻¹. Significant temporal declines in abundance were observed during both bloom and nonbloom regimes. Blooms occurred most consistently in March, September, and December.13 page(s

Incorporating residual temperature and specific humidity in predicting weather-dependent warm-season electricity consumption

Original content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI.Climate warming and increasing variability challenges the electricity supply in warm seasons. A good quantitative representation of the relationship between warm-season electricity consumption and weather condition provides necessary information for long-term electricity planning and short-term electricity management. In this study, an extended version of cooling degree days (ECDD) is proposed for better characterisation of this relationship. The ECDD includes temperature, residual temperature and specific humidity effects. The residual temperature is introduced for the first time to reflect the building thermal inertia effect on electricity consumption. The study is based on the electricity consumption data of four multiple-street city blocks and three office buildings. It is found that the residual temperature effect is about 20% of the current-day temperature effect at the block scale, and increases with a large variation at the building scale. Investigation of this residual temperature effect provides insight to the influence of building designs and structures on electricity consumption. The specific humidity effect appears to be more important at the building scale than at the block scale. A building with high energy performance does not necessarily have low specific humidity dependence. The new ECDD better reflects the weather dependence of electricity consumption than the conventional CDD method

Specialist palliative care nursing and the philosophy of palliative care: a critical discussion

Nursing is the largest regulated health professional workforce providing palliative care across a range of clinical settings. Historically, palliative care nursing has been informed by a strong philosophy of care which is soundly articulated in palliative care policy, research and practice. Indeed, palliative care is now considered to be an integral component of nursing practice regardless of the specialty or clinical setting. However, there has been a change in the way palliative care is provided. Upstreaming and mainstreaming of palliative care and the dominance of a biomedical model with increasing medicalisation and specialisation are key factors in the evolution of contemporary palliative care and are likely to impact on nursing practice. Using a critical reflection of the authors own experiences and supported by literature and theory from seminal texts and contemporary academic, policy and clinical literature, this discussion paper will explore the influence of philosophy on nursing knowledge and theory in the context of an evolving model of palliative care

Exploring the transition from curative care to palliative care: a systematic review of the literature.

BACKGROUND: UK policy guidance on treatment and care towards the end of life identifies a need to better recognise patients who are likely to be in the last 12 months of life. Health and social care professionals have a key role in initiating and managing a patient's transition from 'curative care' to palliative care. The aim of this paper is to provide a systematic review of evidence relating to the transition from curative care to palliative care within UK settings. METHOD: Four electronic databases were searched for studies published between 1975 and March 2010. Inclusion criteria were all UK studies relating to the transition from curative care to palliative care in adults over the age of 18. Selected studies were independently reviewed, data were extracted, quality was assessed and data were synthesised using a descriptive thematic approach. RESULTS: Of the 1464 articles initially identified, 12 papers met the criteria for inclusion. Four themes emerged from the literature: (1) patient and carer experiences of transitions; (2) recognition and identification of the transition phase; (3) optimising and improving transitions; and (4) defining and conceptualising transitions. CONCLUSIONS: The literature suggests that little is known about the potentially complex transition to palliative care. Evidence suggests that continuity of care and multidisciplinary collaboration are crucial in order to improve the experience of patients making the transition. An important role is outlined for generalist providers of palliative care. Incorporating palliative care earlier in the disease trajectory and implementing a phased transition appear key components of optimum care

Nurturing a cross-institutional curriculum planning community of practice

This paper focuses on academic skill-building through using cross-institutional collaborative approaches in developing quality learning and assessment tasks for experiential placements. A curriculum planning template was used for the collaborative work, with materials developed being disseminated on a specially designed online repository website. Results, analyzed within a community of practice framework, indicate the activities. There is potential evident for building a more mature community of practice given the value of the collaborative learning process involved. This would need additional opportunities and leadership over an extended timeline. Some longer term changes in curriculum planning and impacts on wider networks are also evident. This case study provides a model which is relevant across all disciplines and which highlights professional learning occurring through collaborative academic work focused on relevant practice

Olfactory sensitivity to changes in environmental Ca2 in the freshwater teleost Carassius auratus: an olfactory role for the Ca2+ -sensing receptor?

Olfactory sensitivity to changes in environmental Ca2+ has been demonstrated in two teleost species; a salmonid (Oncorhynchus nerka) and a marine/estuarine perciform (Sparus aurata). To assess whether this phenomenon is restricted to species that normally experience large fluctuations in external ion concentrations (e.g. moving from sea water to fresh water) or is present in a much wider range of species, we investigated olfactory Ca2+ sensitivity in the goldfish (Carassius auratus), which is a stenohaline, non-migratory freshwater cyprinid. Extracellular recording from the olfactory bulb in vivo by electroencephalogram (EEG) demonstrated that the olfactory system is acutely sensitive to changes in external Ca2+ within the range that this species is likely to encounter in the wild (0.05–3 mmol l–1). The olfactory system responded to increases in external calcium with increasing bulbar activity in a manner that fitted a conventional Hill plot with an apparent EC50 of 0.9±0.3 mmol l–1 (close to both ambient and plasma free [Ca2+]) and an apparent Hill coefficient of 1.1±0.3 (means ± S.E.M., N=6). Thresholds of detection were below 50 mmol l–1. Some olfactory sensitivity to changes in external [Na+] was also recorded, but with a much higher threshold of detection (3.7 mmol l–1). The olfactory system of goldfish was much less sensitive to changes in [Mg2+] and [K+]. Preliminary data suggest that Ca2+ and Mg2+ are detected by the same mechanism, although with a much higher affinity for Ca2+. Olfactory sensitivity to Na+ may warn freshwater fish that they are reaching the limit of their osmotic tolerance when in an estuarine environment. Olfaction of serine, a potent odorant in fish, was not dependent on the presence of external Ca2+ or Na+. Finally, the teleost Ca2+-sensing receptor (Ca-SR) was shown to be highly expressed in a subpopulation of olfactory receptor neurones by both immunocytochemistry and in situ hybridisation. The olfactory sensitivity to Ca2+ (and Mg2+) is therefore likely to be mediated by the Ca-SR. We suggest that olfactory Ca2+ sensitivity is a widespread phenomenon in teleosts and may have an input into the physiological mechanisms regulating internal calcium homeostasis

Extent of palliative care need in the acute hospital setting: A survey of two acute hospitals in the UK

Background: In common with international health policy, The End of Life Care Strategy for England has highlighted the delivery of high quality palliative care in the acute hospital setting as an area of priority. Aim: The aim of this study was to explore the extent of palliative care need in the acute hospital setting, and to explore agreement between different sources in the identification of patients with palliative care need. Design: A cross-sectional survey of palliative care need was undertaken in two UK acute hospitals. Hospital case notes were examined for evidence of palliative care need according to Gold Standards Framework (GSF) prognostic indicator criteria. Medical and nursing staff were asked to identify patients with palliative care needs. Patients (or consultees) completed assessments of palliative care need. Participants: Of a total in-patient population of 1359, complete datasets were collected for 514 patients/consultees. Results: 36.0% of patients were identified as having palliative care needs according to GSF criteria. Medical staff identified 15.5% of patients as having palliative care needs, and nursing staff 17.4% of patients. Patient self-report data indicated that 83.2% of patients meeting GSF criteria had palliative care needs. Conclusion: The results reveal that according to the GSF prognostic guide, over a third of hospital in-patients meet the criteria for palliative care need. Consensus between medical staff, nursing staff and the GSF was poor regarding the identification of patients with palliative care needs. This has significant implications for patient care, and draws into question the utility of the GSF in the hospital setting

Barriers to providing palliative care for older people in acute hospitals

Background: the need for access to high-quality palliative care at the end of life is becoming of increasing public health concern. The majority of deaths in the UK occur in acute hospitals, and older people are particularly likely to die in this setting. However, little is known about the barriers to palliative care provision for older people within acute hospitals. Objective: to explore the perspectives of health professionals regarding barriers to optimal palliative care for older people in acute hospitals. Methods: fifty-eight health professionals participated in eight focus groups and four semi-structured interviews. Results: participants identified various barriers to palliative care provision for older people, including attitudinal differences to the care of older people, a focus on curative treatments within hospitals and a lack of resources. Participants also reported differing understandings of whose responsibility it was to provide palliative care for older people, and uncertainly over the roles of specialist and generalist palliative care providers in acute hospitals. Conclusions: numerous barriers exist to the provision of high-quality palliative care for older people within acute hospital settings. Additional research is now required to further explore age-related issues contributing to poor access to palliative care