The socioecological benefits and consequences of oil palm cultivation in its native range: The Sustainable Oil Palm in West Africa (SOPWA) Project.

Agriculture is expanding rapidly across the tropics. While cultivation can boost socioeconomic conditions and food security, it also threatens native ecosystems. Oil palm (Elaeis guineensis), which is grown pantropically, is the most productive vegetable oil crop worldwide. The impacts of oil palm cultivation have been studied extensively in Southeast Asia and - to a lesser extent - in Latin America but, in comparison, very little is known about its impacts in Africa: oil palm's native range, and where cultivation is expanding rapidly. In this paper, we introduce a large-scale research programme - the Sustainable Oil Palm in West Africa (SOPWA) Project - that is evaluating the relative ecological impacts of oil palm cultivation under traditional (i.e., by local people) and industrial (i.e., by a large-scale corporation) management in Liberia. Our paper is twofold in focus. First, we use systematic mapping to appraise the literature on oil palm research in an African context, assessing the geographic and disciplinary focus of existing research. We found 757 publications occurring in 36 African countries. Studies tended to focus on the impacts of palm oil consumption on human health and wellbeing. We found no research that has evaluated the whole-ecosystem (i.e., multiple taxa and ecosystem functions) impacts of oil palm cultivation in Africa, a knowledge gap which the SOPWA Project directly addresses. Second, we describe the SOPWA Project's study design and-using canopy cover, ground vegetation cover, and soil temperature data as a case study-demonstrate its utility for assessing differences between areas of rainforest and oil palm agriculture. We outline the socioecological data collected by the SOPWA Project to date and describe the potential for future research, to encourage new collaborations and additional similar projects of its kind in West Africa. Increased research in Africa is needed urgently to understand the combined ecological and sociocultural impacts of oil palm and other agriculture in this unique region. This will help to ensure long-term sustainability of the oil palm industry-and, indeed, all tropical agricultural activity-in Africa.

Managing pain in advanced cancer: a survey of United kingdom general practitioners and community nurses.

CONTEXT: General practitioners (GPs) and community nurses (CNs) have a central role in palliative care. With health policy focusing more and more on enabling patients to die at home, primary health care professionals are increasingly responsible for symptom management of patients near the end of life. OBJECTIVES: 1) To investigate GPs' and CNs' training and knowledge in palliative care and 2) to identify the characteristics of GPs and CNs with lower levels of palliative care knowledge. METHODS: A postal questionnaire was sent to all GPs and CNs in two areas of the U.K. A panel of doctors and nurses with palliative care expertise rated the response categories with regard to correctness and questions with regard to importance for their professional group. These weightings were combined and applied to answers to assess knowledge levels. RESULTS: Response rates were 54% and 35% for GPs and CNs, respectively. Respondents reported receiving training in most areas of palliative care throughout their careers, with the exceptions of syringe driver use and bereavement care. High levels of knowledge concerning pain management and syringe driver use were found, with no significant differences in the overall knowledge between the professions. Some important gaps were identified for future educational focus. Regression analyses did not identify characteristics that explained the variation in knowledge scores. CONCLUSION: Both groups had a high level of knowledge concerning key issues in pain management and syringe driver use that should equip them well for their central role in palliative care. Recommendations for the focus of future education sessions are made.

Discussing an uncertain future: end-of-life care conversations in chronic obstructive pulmonary disease. A systematic literature review and narrative synthesis.

BACKGROUND: Guidelines recommend open discussions between patients and healthcare professionals as the end-of-life (EOL) approaches. Much of the knowledge about the EOL is based on the needs of patients with cancer and the applicability of this to other diseases is often queried. A literature review was undertaken concerning EOL care (EOLC) conversations in chronic obstructive pulmonary disease (COPD). DESIGN: A systematic literature review and narrative synthesis obtained papers reporting on EOLC conversations between patients with COPD and their healthcare professionals with respect to the prevalence of conversations; each party's preferences for timing and content; and the facilitators and blockers. Inclusion criteria were articles published in peer-reviewed journals, written in English, reporting studies of adult patients with COPD and/or their healthcare professionals concerning discussions of care at the EOL. RESULTS: 30 papers were identified. Most patients reported that they have not had EOLC discussions with healthcare professionals. While many patients would like these conversations, a potentially large minority would not; the proportions varied among studies. Healthcare professionals find these discussions difficult and many prefer patients to initiate them. CONCLUSIONS: Patients' preferences for EOLC conversations vary greatly. Healthcare professionals need to respect the wishes of those not wanting to discuss EOLC and provide multiple opportunities for those who do wish to have these discussions. Recommendations on how to approach the conversation are made.