Development of an online palliative care medicines training series for health and social care staff

Aim or goal of work: Frontline support staff working in General Practice (GP) (i.e. receptionists), Community Pharmacies (CP) and Care Homes are likely to face issues concerning palliative care medicines amongst their patient group. Previous service evaluations by the authors found a need for sustainable and accessible palliative care training for these staff. A national online training resource on palliative medicines for health and social care staff was subsequently developed and is currently being evaluated. Design, methods & approach taken: Various education and training materials for these staff groups were consolidated and re-developed into one interactive course, comprised of Core sessions for all staff (e.g. Introduction to Palliative Care) and discipline specific sessions i.e. Pharmacy (e.g. Dispensing Opioids) and Care Home (e.g. Palliative Medicines & Risk of Falls) staff. User feedback was obtained via a questionnaire measuring satisfaction, usefulness and impact. Results: All 50 participants (11 staff from GP Practices, Community Pharmacies (n=9) and Care Homes (n=30)) agreed that the training was useful and with the correct degree of difficulty. Participants liked the delivery format and felt the training was “informative” and “easy to access”. Staff also reported that managers were supportive of them undertaking the training. The training provided a good introduction and, for some, a refresher to palliative care. Some participants provided real-life examples of how the training had been beneficial to (and applied by) them in the workplace. Conclusions and lessons learned: This new training resource provides education in an engaging, accessible format to frontline health and social care multi-disciplinary teams. It will be available nationally from November 2016 to support the provision of palliative care by frontline staff at the point of need

Macmillan Rural Palliative Care Pharmacist Practitioner Project : Baseline Report 2013

The University of Strathclyde is funded to provide academic input into the NHS Highland project for 2 years (starting February 2013). The project is to be a demonstration project to inform national policy and will have direct relevance to the new proposal on the delivery of pharmacy services within NHS Scotland, ‘Prescription for Excellence’ (8). This opportunity gives NHS Highland access to the expertise developed through the previous Glasgow program and allows the University team to develop the evidence base for clinical practice within this area, and focus on developing rural pharmaceutical care capacity through the use of a community pharmacy - based practitioner

Cell wall arabinan is essential for guard cell function

Stomatal guard cells play a key role in the ability of plants to survive on dry land, because their movements regulate the exchange of gases and water vapor between the external environment and the interior of the plant. The walls of these cells are exceptionally strong and must undergo large and reversible deformation during stomatal opening and closing. The molecular basis of the unique strength and flexibility of guard cell walls is unknown. We show that degradation of cell wall arabinan prevents either stomatal opening or closing. This locking of guard cell wall movements can be reversed if homogalacturonan is subsequently removed from the wall. We suggest that arabinans maintain flexibility in the cell wall by preventing homogalacturonan polymers from forming tight associations

Development of the NES online palliative care medicines training series for health and social care support staff

Previous Macmillan Cancer Support and Health Board funded palliative care pharmacy service evaluations in NHS Greater Glasgow & Clyde (urban) and NHS Highland (rural) (1-4) observed a steady integration of the community pharmacy team into local palliative care services. Frontline staff in General Practice, Community Pharmacies and Care Homes in these areas were found to lack knowledge about palliative care medicines amongst their patient group. Both evaluations resulted in the development and testing of training materials in a variety of face-to-face and online formats and for different support staff

Mesophyll photosynthesis and guard cell metabolism impacts on stomatal behaviour

Stomata control gaseous fluxes between the internal leaf air spaces and the external atmosphere. Guard cells determine stomatal aperture and must operate to ensure an appropriate balance between CO2 uptake for photosynthesis (A) and water loss, and ultimately plant water use efficiency (WUE). A strong correlation between A and stomatal conductance (gs) is well documented and often observed, but the underlying mechanisms, possible signals and metabolites that promote this relationship are currently unknown. In this review we evaluate the current literature on mesophyll-driven signals that may coordinate stomatal behaviour with mesophyll carbon assimilation. We explore a possible role of various metabolites including sucrose and malate (from several potential sources; including guard cell photosynthesis) and new evidence that improvements in WUE have been made by manipulating sucrose metabolism within the guard cells. Finally we discuss the new tools and techniques available for potentially manipulating cell-specific metabolism, including guard and mesophyll cells, in order to elucidate mesophyll-derived signals that coordinate mesophyll CO2 demands with stomatal behaviour, in order to provide a mechanistic understanding of these processes as this may identify potential targets for manipulations in order to improve plant WUE and crop yield. © 2014 New Phytologist Trust