Hospital doctors' experiences of caring for dying patients.

BACKGROUND: The aim of this study was to examine, by means of a postal questionnaire, the experience of all grades of doctors caring for patients dying in an acute hospital in Scotland. METHOD: A postal questionnaire was sent to 306 doctors working in inpatient medical and surgical specialties, emergency medicine, anaesthetics and intensive care medicine in an acute hospital. RESULTS: There was an overall 41% response rate (127/306). Of responding doctors 55% had cared for 10 or more patients in the previous year. A quarter of respondents had personal experience of bereavement outside of clinical practice within the previous year. A total of 65% of responding doctors agreed that their most memorable patient death had had a strong emotional impact upon them. Responding doctors reported benefit from peer support. There was no association between length of time as a doctor and difficulty rating for talking to patients about death (p-value: 0.203). There was no association between difficulty rating and length of time working as a doctor when talking to relatives about death and dying (p-value: 0.205). We considered the questionnaire responses in relation to Scottish Government policy and initiatives associated with the care of the dying, and the future training and support of doctors caring for this group of patients and their relatives. CONCLUSION: Doctors describe similar experiences in terms of communication difficulties and emotional effects of caring for dying patients irrespective of their length of time working as a doctor.

Relationships between age at first calving and first lactation milk yield, and lifetime productivity and longevity in dairy cows.

Lifetime records of 442 Holstein cows on one farm in North Queensland, Australia, were analysed to evaluate the effects of age at first calving (AFC) and first lactation milk yield on parities per lifetime, longevity, milk yield in subsequent lactations, lifetime milk production and the longevity index (LI), that is the proportion of a cow's life spent in active milk production. The mean daily yield in the first lactation was a reliable indicator of milk yield in subsequent lactations, estimated lifetime production, longevity and LI. The afc had no effect on lifetime days in milk. Neither the AFC nor the milk yield in the first lactation significantly affected the number of parities per lifetime. For the majority of cows, which produced less than 30 l/day in the first lactation, there was a significant positive relationship between longevity and AFC. However, none of the cows that produced more than 30 l/day in the first lactation survived for more than two lactations. The optimal AFC was thus two to two-and-a-half years, as these cows had the highest first lactation yield, estimated lifetime production and LI. The optimal mean daily yield in the first lactation was 20 to 30 l/day, as these cows lived longer and had a higher LI and lifetime production.