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2.
Sci Total Environ ; 929: 172536, 2024 Jun 15.
Article in English | MEDLINE | ID: mdl-38643886

ABSTRACT

Oil and gas exploitation introduces toxic contaminants such as hydrocarbons and heavy metals to the surrounding sediment, resulting in deleterious impacts on marine benthic communities. This study combines benthic monitoring data over a 30-year period in the North Sea with dietary information on >1400 taxa to quantify the effects of active oil and gas platforms on benthic food webs using a multiple before-after control-impact experiment. Contamination from oil and gas platforms caused declines in benthic food web complexity, community abundance, and biodiversity. Fewer trophic interactions and increased connectance indicated that the community became dominated by generalists adapting to alternative resources, leading to simpler but more connected food webs in contaminated environments. Decreased mean body mass, shorter food chains, and the dominance of small detritivores such as Capitella capitata near to structures suggested a disproportionate loss of larger organisms from higher trophic levels. These patterns were associated with concentrations of hydrocarbons and heavy metals that exceed OSPAR's guideline thresholds of sediment toxicity. This study provides new evidence to better quantify and manage the environmental consequences of oil and gas exploitation at sea.


Subject(s)
Biodiversity , Environmental Monitoring , Food Chain , Invertebrates , Water Pollutants, Chemical , Animals , Water Pollutants, Chemical/analysis , Aquatic Organisms , North Sea , Metals, Heavy/analysis , Oil and Gas Fields , Geologic Sediments/chemistry
3.
Front Microbiol ; 15: 1348171, 2024.
Article in English | MEDLINE | ID: mdl-38389541

ABSTRACT

Introduction: Intensive beef cattle production systems are frequently implicated as a source of bacteria that can be transferred to nearby humans and animals via effluent water, manure used as fertilizer, or airborne particulate matter. It is crucial to understand microbial population dynamics due to manure pack desiccation, antibiotic usage, and antibiotic alternatives within beef cattle and their associated feedyard environment. Understanding how bacterial communities change in the presence of antibiotics can also improve management practices for reducing the spread of foodborne bacteria. Methods: In this study, we aimed to compare the microbiomes within cattle feces, the feedyard environment and artificially produced airborne particulate matter as a function of pen change and treatment with tylosin or probiotics. We utilized 16S rRNA sequencing to compare bacterial communities among sample types, study days, and treatment groups. Results: Bacterial community diversity varied as a function of sampling day and pen change (old or new) within fecal and manure pack samples. Manure pack samples from old pens and new pens contained diverse communities of bacteria on days 0 and 84; however, by day 119 of the study these taxonomic differences were less evident. Particulate matter samples exhibited significant differences in community diversity and predominant bacterial taxa compared to the manure pack they originated from. Treatment with tylosin did not meaningfully impact bacterial communities among fecal, environmental, or particulate matter samples; however, minor differences in bacterial community structure were observed in feces from cattle treated with probiotics. Discussion: This study was the first to characterize and compare microbial communities within feces, manure pack, and airborne particulate matter from the same location and as a function of tylosin and probiotic treatment, and pen change. Although fecal and environmental samples are commonly used in research studies and other monitoring programs to infer public health risk of bacteria and antimicrobial resistance determinants from feedyard environments, our study suggests that these samples may not be appropriate to infer public health risk associated with airborne particulate matter.

4.
Glob Chang Biol ; 29(23): 6606-6619, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37814904

ABSTRACT

Many studies predict shifts in species distributions and community size composition in response to climate change, yet few have demonstrated how these changes will be distributed across marine food webs. We use Bayesian Additive Regression Trees to model how climate change will affect the habitat suitability of marine fish species across a range of body sizes and belonging to different feeding guilds, each with different habitat and feeding requirements in the northeast Atlantic shelf seas. Contrasting effects of climate change are predicted for feeding guilds, with spatially extensive decreases in the species richness of consumers lower in the food web (planktivores) but increases for those higher up (piscivores). Changing spatial patterns in predator-prey mass ratios and fish species size composition are also predicted for feeding guilds and across the fish assemblage. In combination, these changes could influence nutrient uptake and transformation, transfer efficiency and food web stability, and thus profoundly alter ecosystem structure and functioning.


Subject(s)
Ecosystem , Food Chain , Animals , Climate Change , Bayes Theorem , Oceans and Seas , Fishes/physiology
5.
Sci Rep ; 13(1): 3110, 2023 02 22.
Article in English | MEDLINE | ID: mdl-36813881

ABSTRACT

It is important to decipher the diversity and distribution of benthic dinoflagellates, as there are many morphologically indistinct taxa that differ from one another in production of potent toxins. To date, the genus Ostreopsis comprises twelve described species, of which seven are potentially toxic and produce compounds presenting a threat to human and environmental health. In this study, isolates previously identified as "Ostreopsis sp. 3" were sampled from the area where it was first reported, Rarotonga, Cook Islands, and have been taxonomically and phylogenetically characterised as Ostreopsis tairoto sp. nov. Phylogenetically, the species is closely related to "Ostreopsis sp. 8", O. mascarenensis, "O. sp. 4", O. fattorussoi, O. rhodesiae and O. cf. siamensis. Previously, it was considered a part of the O. cf. ovata complex but can be distinguished from O. cf. ovata based on the small pores identified on this study, and from O. fattorussoi and O. rhodesiae based on relative lengths of the 2' plates. No known palytoxin -like compounds were detected in strains investigated in this study. Strains of O. lenticularis, Coolia malayensis and C. tropicalis were also identified and described. This study advances our knowledge of biogeography, distribution, and toxins of Ostreopsis and Coolia species.


Subject(s)
Dinoflagellida , Humans , Pacific Ocean , Polynesia , Antarctic Regions
6.
Biol Lett ; 17(3): 20200798, 2021 03.
Article in English | MEDLINE | ID: mdl-33726566

ABSTRACT

The relationship between body mass (M) and size class abundance (N) depicts patterns of community structure and energy flow through food webs. While the general assumption is that M and N scale linearly (on log-log axes), nonlinearity is regularly observed in natural systems, and is theorized to be driven by nonlinear scaling of trophic level (TL) with M resulting in the rapid transfer of energy to consumers in certain size classes. We tested this hypothesis with data from 31 stream food webs. We predicted that allochthonous subsidies higher in the web results in nonlinear M-TL relationships and systematic abundance peaks in macroinvertebrate and fish size classes (latter containing salmonids), that exploit terrestrial plant material and terrestrial invertebrates, respectively. Indeed, both M-N and M-TL significantly deviated from linear relationships and the observed curvature in M-TL scaling was inversely related to that observed in M-N relationships. Systemic peaks in M-N, and troughs in M-TL occurred in size classes dominated by generalist invertebrates, and brown trout. Our study reveals how allochthonous resources entering high in the web systematically shape community size structure and demonstrates the relevance of a generalized metabolic scaling model for understanding patterns of energy transfer in energetically 'open' food webs.


Subject(s)
Food Chain , Invertebrates , Animals , Body Size , Fishes , Rivers
7.
Glob Chang Biol ; 27(3): 521-535, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33159828

ABSTRACT

Conserving biogeographic regions with especially high biodiversity, known as biodiversity 'hotspots', is intuitive because finite resources can be focussed towards manageable units. Yet, biodiversity, environmental conditions and their relationship are more complex with multidimensional properties. Assessments which ignore this risk failing to detect change, identify its direction or gauge the scale of appropriate intervention. Conflicting concepts which assume assemblages as either sharply delineated communities or loosely collected species have also hampered progress in the way we assess and conserve biodiversity. We focus on the marine benthos where delineating manageable areas for conservation is an attractive prospect because it holds most marine species and constitutes the largest single ecosystem on earth by area. Using two large UK marine benthic faunal datasets, we present a spatially gridded data sampling design to account for survey effects which would otherwise be the principal drivers of diversity estimates. We then assess γ-diversity (regional richness) with diversity partitioned between α (local richness) and ß (dissimilarity), and their change in relation to covariates to test whether defining and conserving biodiversity hotspots is an effective conservation strategy in light of the prevailing forces structuring those assemblages. α-, ß- and γ-diversity hotspots were largely inconsistent with each metric relating uniquely to the covariates, and loosely collected species generally prevailed with relatively few distinct assemblages. Hotspots could therefore be an unreliable means to direct conservation efforts if based on only a component part of diversity. When assessed alongside environmental gradients, α-, ß- and γ-diversity provide a multidimensional but still intuitive perspective of biodiversity change that can direct conservation towards key drivers and the appropriate scale for intervention. Our study also highlights possible temporal declines in species richness over 30 years and thus the need for future integrated monitoring to reveal the causal drivers of biodiversity change.


Subject(s)
Biodiversity , Ecosystem , Conservation of Natural Resources
8.
Lett Appl Microbiol ; 70(4): 274-281, 2020 Apr.
Article in English | MEDLINE | ID: mdl-31883125

ABSTRACT

Enterococci are included in the United States National Antimicrobial Resistance Monitoring System to track antibiotic resistance among commensal Gram-positive enteric bacteria, largely due to their high abundance in food animals and in retail meat. In the U.S. cattle industry, macrolides are used to prevent and control liver abscesses, which cause significant economic losses. Previous studies have suggested that feeding tylosin and the intensity of the pen environment, both expand and sustain respectively the prevalence of multidrug resistance among enterococci in feedlot cattle. This has led to research into alternative feed supplements and improved stewardship practices. In a randomized controlled trial, we measured the impact of a probiotic and an altered pen environment on antimicrobial resistance among faecal Enterococcus spp. in cattle fed tylosin. Supplementing cattle with an Enterococcus faecium and Saccharomyces cerevisiae-based probiotic yielded the isolation of E. faecium of the probiotic sequence type (ST296) from faecal and environmental samples in treatment groups, as well as from cattle and the manure pack in nearby pens. Of importance, the probiotic strain also was found in a desiccated and milled manure pack sample taken 120 days after the initial trial ended. Phylogenetic and SNP analyses revealed clonal survival and spread compatible with faecal-environmental-oral recycling of the probiotic strain within and among cattle and pens. The increase in prevalence of the ST296 strain occurred concomitant with a decrease in ST240, the dominant sequence type associated with ermB and tet(M) resistance genes in this trial. SIGNIFICANCE AND IMPACT OF THE STUDY: We demonstrate that a macrolide-susceptible probiotic Enterococcus faecium ST296 strain fed to beef cattle becomes fully embedded in the microbial community cycling of bacteria via faecal-environmental-oral transmission within and among feedlot pens. An initial investment in feeding the probiotic is thereby leveraged into expanding numbers of susceptible bacteria in cattle and their environment, even among those cattle fed tylosin.


Subject(s)
Anti-Bacterial Agents/pharmacology , Enterococcus faecium/drug effects , Feces/microbiology , Macrolides/pharmacology , Probiotics/administration & dosage , Animal Feed/analysis , Animal Feed/microbiology , Animals , Cattle/metabolism , Cattle Diseases/microbiology , Dietary Supplements/analysis , Drug Resistance, Microbial , Enterococcus faecium/classification , Enterococcus faecium/genetics , Enterococcus faecium/isolation & purification , Meat/microbiology , Microbiota , Mouth/microbiology , Phylogeny , Probiotics/analysis , Protein Synthesis Inhibitors , Red Meat , Tylosin/metabolism , United States
9.
Nat Ecol Evol ; 3(6): 919-927, 2019 06.
Article in English | MEDLINE | ID: mdl-31110252

ABSTRACT

Predator-prey interactions in natural ecosystems generate complex food webs that have a simple universal body-size architecture where predators are systematically larger than their prey. Food-web theory shows that the highest predator-prey body-mass ratios found in natural food webs may be especially important because they create weak interactions with slow dynamics that stabilize communities against perturbations and maintain ecosystem functioning. Identifying these vital interactions in real communities typically requires arduous identification of interactions in complex food webs. Here, we overcome this obstacle by developing predator-trait models to predict average body-mass ratios based on a database comprising 290 food webs from freshwater, marine and terrestrial ecosystems across all continents. We analysed how species traits constrain body-size architecture by changing the slope of the predator-prey body-mass scaling. Across ecosystems, we found high body-mass ratios for predator groups with specific trait combinations including (1) small vertebrates and (2) large swimming or flying predators. Including the metabolic and movement types of predators increased the accuracy of predicting which species are engaged in high body-mass ratio interactions. We demonstrate that species traits explain striking patterns in the body-size architecture of natural food webs that underpin the stability and functioning of ecosystems, paving the way for community-level management of the most complex natural ecosystems.


Subject(s)
Ecosystem , Food Chain , Animals , Body Size , Predatory Behavior , Vertebrates
10.
J Anim Ecol ; 88(8): 1146-1157, 2019 08.
Article in English | MEDLINE | ID: mdl-31032898

ABSTRACT

Litter breakdown in the streambed is an important pathway in organic carbon cycling and energy transfer in the biosphere that is mediated by a wide range of streambed organisms. However, most research on litter breakdown to date has focused on a small fraction of the taxa that drive it (e.g. microbial vs. macroinvertebrate-mediated breakdown) and has been limited to the benthic zone (BZ). Despite the importance of the hyporheic zone (HZ) as a bioreactor, little is known about what, or who, mediates litter breakdown in this compartment and whether breakdown rates differ between the BZ and HZ. Here, we explore the relationship between litter breakdown and the variation in community structure of benthic and hyporheic communities by deploying two standardized bioassays (cotton strips and two types of commercially available tea bags) in 30 UK streams that encompass a range of environmental conditions. Then, we modelled these assays as a response of the streambed compartment and the biological features of the streambed assemblage (Prokaryota, Protozoa and Eumetazoa invertebrates) to understand the generality and efficiency of litter processing across communities. Litter breakdown was much faster in the BZ compared with the HZ (around 5 times higher for cotton strips and 1.5 times faster for the tea leaves). However, differences in litter breakdown between the BZ and the HZ were mediated by the biological features of the benthos and the hyporheos. Biomass of all the studied biotic groups, α-diversity of Eumetazoa invertebrates and metabolic diversity of Prokaryota were important predictors that were positively related to breakdown coefficients demonstrating their importance in the functioning of the streambed ecosystem. Our study uses a novel multimetric bioassay that is able to disentangle the contribution by Prokaryota, Protozoa and Eumetazoa invertebrates to litter breakdown. In doing so, our study reveals new insights into how organic matter decomposition is partitioned across biota and streambed compartments.


Subject(s)
Ecosystem , Rivers , Animals , Biomass , Invertebrates , Plant Leaves
11.
Ecol Lett ; 21(12): 1771-1780, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30257275

ABSTRACT

Body mass-abundance (M-N) allometries provide a key measure of community structure, and deviations from scaling predictions could reveal how cross-ecosystem subsidies alter food webs. For 31 streams across the UK, we tested the hypothesis that linear log-log M-N scaling is shallower than that predicted by allometric scaling theory when top predators have access to allochthonous prey. These streams all contained a common and widespread top predator (brown trout) that regularly feeds on terrestrial prey and, as hypothesised, deviations from predicted scaling increased with its dominance of the fish assemblage. Our study identifies a key beneficiary of cross-ecosystem subsidies at the top of stream food webs and elucidates how these inputs can reshape the size-structure of these 'open' systems.


Subject(s)
Food Chain , Rivers , Animals , Ecosystem , Fishes
12.
J R Coll Physicians Edinb ; 48(3): 217-224, 2018 Sep.
Article in English | MEDLINE | ID: mdl-30191909

ABSTRACT

BACKGROUND: Communication between professionals, patients and families about palliative and end-of-life care after stroke is complex and there is a need for educational resources in this area. METHODS: To explore the key learning needs of healthcare professionals, a multidisciplinary, expert group developed a short electronic survey with open and closed questions, and then distributed it to six UK multiprofessional networks and two groups of local clinicians. RESULTS: A total of 599 healthcare professionals responded. Educational topics that were either definitely or probably needed were: ensuring consistent messages to families and patients (88%); resolving conflicts among family members (83%); handling unrealistic expectations (88%); involving families in discussions without them feeling responsible for decisions (82%); discussion of prognostic uncertainties (79%); likely mode of death (72%); and oral feeding for 'comfort' in patients at risk of aspiration (71%). The free-text responses (n = 489) and 82 'memorable' cases identified similar themes. CONCLUSION: Key topics of unmet need for education in end-of-life care in stroke have been identified and these have influenced the content of an open access, web-based educational resource.


Subject(s)
Communication , Education, Medical, Continuing , Health Personnel/education , Needs Assessment , Stroke/therapy , Terminal Care , Allied Health Personnel/education , Humans , Internet , Medical Staff, Hospital/education , Nursing Staff, Hospital/education , Physician-Patient Relations , Professional-Family Relations , Social Work/education , Surveys and Questionnaires , Withholding Treatment
13.
Article in English | MEDLINE | ID: mdl-28145036

ABSTRACT

Colorectal cancer is the second highest cause of cancer deaths. There are significant physical and psycho-social effects on quality of life with advanced disease. Despite this, there are few accounts of the patient experience from advanced illness through to dying. We elicited the longitudinal experiences of living and dying with incurable metastatic colorectal cancer by conducting serial interviews with patients for 12 months or until they died. The interviews were analysed, using a narrative approach, longitudinally as case studies and then together. Thirty-six interviews with 16 patients were conducted. Patients experience metastatic colorectal cancer in three phases; (1) Diagnosis and initial treatment; (2) Deterioration and social isolation and (3) Death and dying. Many patients initially said they hoped to survive, but, as "private" and in-depth accounts of the experience emerged in further interviews, so did the understanding that this hope co-existed with the knowledge that death was near. Palliative chemotherapy and the challenge of accessing private accounts of patient experience can inhibit care planning and prevent patients benefitting from an active holistic palliative care approach earlier in the disease trajectory. This study has immediate clinical relevance for health care professionals in oncology, palliative care and primary care.


Subject(s)
Attitude to Death , Attitude to Health , Colorectal Neoplasms/psychology , Palliative Care/psychology , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Patient Care Planning , Qualitative Research , Quality of Life
14.
J Dent Res ; 96(11): 1298-1305, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28817352

ABSTRACT

Nonsyndromic cleft lip and/or palate (NSCL/P) is a prevalent birth defect of complex etiology. Previous studies identified mutations in ARHGAP29 associated with an increased risk for NSCL/P. To investigate the effects of ARHGAP29 in vivo, we generated a novel murine allele by inserting a point mutation identified in a patient with NSCL/P. This single-nucleotide variation of ARHGAP29 translates to an early nonsense mutation (K326X), presumably resulting in loss-of-function (LoF). Embryos from Arhgap29K326X/+ intercrosses were harvested at various time points. No homozygous Arhgap29K326X animals were found in the 45 analyzed litters, assessed as early as embryonic day 8.5 (e8.5). Coronal sectioning of e13.5 and e14.5 heads revealed that 59% of Arhgap29K326X/+ mice ( n = 37) exhibited improper epithelial contact between developing oral structures, while none were observed in wild types ( n = 10). In addition, Arhgap29K326X/+ embryos exhibited a significantly higher percentage of maxillary epithelium in contact with mandibular epithelium. Immunofluorescent analyses of the periderm and oral adhesions revealed the presence of Arhgap29 in periderm cells. These cells were p63 negative, keratin 17 positive, and keratin 6 positive and present at sites of adhesion, although occasionally disorganized. Oral adhesions did not appear to impair palatogenesis, as all analyzed Arhgap29K326X/+ embryos showed confluent palatal mesenchyme and epithelium at e18.5 ( n = 16), and no mice were found with a cleft at birth. Collectively, our data demonstrate that ARHGAP29 is required for embryonic survival and that heterozygosity for LoF variants of Arhgap29 increases the incidence and length of oral adhesions at a critical time point during orofacial development. In conclusion, we validate the LoF nature of the human K326X mutation in vivo and reveal a previously unknown effect of Arhgap29 in murine craniofacial development.


Subject(s)
Cleft Lip/genetics , Cleft Palate/genetics , GTPase-Activating Proteins/genetics , Alleles , Animals , Blotting, Western , Cell Adhesion , Cleft Lip/embryology , Cleft Palate/embryology , Codon , Codon, Nonsense , Embryonic Development , Exons , Genome-Wide Association Study , Humans , Mice , Mice, Inbred Strains , Phenotype , Point Mutation , Polymorphism, Single Nucleotide
16.
BMJ Open ; 6(9): e012340, 2016 09 19.
Article in English | MEDLINE | ID: mdl-27645556

ABSTRACT

OBJECTIVES: 2 innovative concepts have lately been developed to radically improve the care of patients with advanced chronic conditions (PACC): early identification of palliative care (PC) needs and the 3 end-of-life trajectories in chronic illnesses (acute, intermittent and gradual dwindling). It is not clear (1) what indicators work best for this early identification and (2) if specific clinical indicators exist for each of these trajectories. The objectives of this study are to explore these 2 issues. SETTING: 3 primary care services, an acute care hospital, an intermediate care centre and 4 nursing homes in a mixed urban-rural district in Barcelona, Spain. PARTICIPANTS: 782 patients (61.5% women) with a positive NECPAL CCOMS-ICO test, indicating they might benefit from a PC approach. OUTCOME MEASURES: The characteristics and distribution of the indicators of the NECPAL CCOMS-ICO tool are analysed with respect to the 3 trajectories and have been arranged by domain (functional, nutritional and cognitive status, emotional problems, geriatric syndromes, social vulnerability and others) and according to their static (severity) and dynamic (progression) properties. RESULTS: The common indicators associated with early end-of-life identification are functional (44.3%) and nutritional (30.7%) progression, emotional distress (21.9%) and geriatric syndromes (15.7% delirium, 11.2% falls). The rest of the indicators showed differences in the associations per illness trajectories (p<0.05). 48.2% of the total cohort was identified as advanced frailty patients with no advanced disease criteria. CONCLUSIONS: Dynamic indicators are present in the 3 trajectories and are especially useful to identify PACC for a progressive PC approach purpose. Most of the other indicators are typically associated with a specific trajectory. These findings can help clinicians improve the identification of patients for a palliative approach.


Subject(s)
Chronic Disease/therapy , Palliative Care/methods , Terminal Care/methods , Aged, 80 and over , Cross-Sectional Studies , Disease Progression , Female , Humans , Male , Severity of Illness Index , Spain , Surveys and Questionnaires
18.
Bone Joint J ; 97-B(9): 1284-90, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26330598

ABSTRACT

Patients who have limb amputation for musculoskeletal tumours are a rare group of cancer survivors. This was a prospective cross-sectional survey of patients from five specialist centres for sarcoma surgery in England. Physical function, pain and quality of life (QOL) outcomes were collected after lower extremity amputation for bone or soft-tissue tumours to evaluate the survivorship experience and inform service provision. Of 250 patients, 105 (42%) responded between September 2012 and June 2013. From these, completed questionnaires were received from 100 patients with a mean age of 53.6 years (19 to 91). In total 60 (62%) were male and 37 (38%) were female (three not specified). The diagnosis was primary bone sarcoma in 63 and soft-tissue tumour in 37. A total of 20 tumours were located in the hip or pelvis, 31 above the knee, 32 between the knee and ankle and 17 in the ankle or foot. In total 22 had hemipelvectomy, nine hip disarticulation, 35 transfemoral amputation, one knee disarticulation, 30 transtibial amputation, two toe amputations and one rotationplasty. The Toronto Extremity Salvage Score (TESS) differed by amputation level, with poorer scores at higher levels (p < 0.001). Many reported significant pain. In addition, TESS was negatively associated with increasing age, and pain interference scores. QOL for Cancer Survivors was significantly correlated with TESS (p < 0.001). This relationship appeared driven by pain interference scores. This unprecedented national survey confirms amputation level is linked to physical function, but not QOL or pain measures. Pain and physical function significantly impact on QOL. These results are helpful in managing the expectations of patients about treatment and addressing their complex needs.


Subject(s)
Amputation, Surgical/rehabilitation , Bone Neoplasms/surgery , Lower Extremity/surgery , Quality of Life , Soft Tissue Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Amputation, Surgical/adverse effects , Amputees/psychology , Amputees/rehabilitation , Artificial Limbs , Cross-Sectional Studies , Female , Health Surveys , Humans , Male , Middle Aged , Pain Measurement/methods , Pain, Postoperative/etiology , Psychometrics , Recovery of Function , Young Adult
19.
Heart ; 101(13): 1002-7, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25900977

ABSTRACT

Palliative care is recommended for patients with end-stage heart failure with several recent, randomised trials showing improvements in symptoms and quality of life and more studies underway. Future care planning provides a framework for discussing a range of palliative care problems with patients and their families. This approach can be introduced at any time during the patient's journey of care and ideally well in advance of end-of-life care. Future care planning is applicable to a wide range of patients with advanced heart disease and could be delivered systematically by cardiology teams at the time of an unplanned hospital admission, akin to cardiac rehabilitation for myocardial infarction. Integrating cardiology care and palliative care can benefit many patients with advanced heart disease at increased risk of death or hospitalisation. Larger, randomised trials are needed to assess the impact on patient outcomes and experiences.


Subject(s)
Heart Diseases , Palliative Care/methods , Quality of Life , Terminal Care/methods , Advance Care Planning , Disease Progression , Heart Diseases/classification , Heart Diseases/physiopathology , Heart Diseases/psychology , Heart Diseases/therapy , Humans , Severity of Illness Index
20.
J R Coll Physicians Edinb ; 43(1): 24-8, 2013.
Article in English | MEDLINE | ID: mdl-23516686

ABSTRACT

OBJECTIVE: To establish whether Foundation Year 1 (FY1) doctors in Edinburgh are sufficiently prepared to deliver generalist palliative care, with a view to informing developments in undergraduate and postgraduate medical education. METHODS: Questionnaires were sent to FY1 doctors and to supervising consultants. Semi-structured interviews were conducted with five FY1 doctors. RESULTS: A total of 60 FY1 doctors and 31 consultants replied. The majority of FY1 doctors did not feel well-prepared to deliver basic palliative care, especially when managing distress and social issues. Consultants agreed that FY1 doctors were underprepared. Junior doctors reported high levels of distress themselves, with few seeking support from senior colleagues. Both sets of respondents made suggestions for curricular improvements. CONCLUSIONS: Newly qualified doctors were not adequately prepared to deliver generalist palliative care and lacked first-hand experience of end-of-life issues. Current reviews of palliative care education should address the learning and supportive needs of our most junior doctors more effectively.


Subject(s)
Attitude of Health Personnel , Clinical Competence , Consultants , Palliative Care , Physicians , Terminal Care , Curriculum , Education, Medical , Humans , Interviews as Topic , Stress, Psychological , Surveys and Questionnaires
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