There is growing interest around the world in more effectively linking public payments to the provision of public goods from agriculture. However, published evidence syntheses suggest mixed, weak or uncertain evidence for many agri-environment scheme options. To inform any future “public money for public goods” based policy, further synthesis work is needed to assess the evidence-base for the full range of interventions currently funded under agri-environment schemes. Further empirical research and trials should then focus on interventions for which there is mixed or limited evidence. Furthermore, to ensure the data collected is comparable and can be synthesised effectively, it is necessary to reach agreement on essential variables and methods that can be prioritised by those conducting research and monitoring. Future policy could then prioritise public money for the public goods that can most reliably be delivered, offering better value for taxpayers and improving the provision of ecosystem services from agricultural landscapes.
There is growing interest around the world in more effectively linking public payments to the provision of public goods from agriculture. However, published evidence syntheses suggest mixed, weak or uncertain evidence for many agri-environment scheme options. To inform any future “public money for public goods” based policy, further synthesis work is needed to assess the evidence-base for the full range of interventions currently funded under agri-environment schemes. Further empirical research and trials should then focus on interventions for which there is mixed or limited evidence. Furthermore, to ensure the data collected is comparable and can be synthesised effectively, it is necessary to reach agreement on essential variables and methods that can be prioritised by those conducting research and monitoring. Future policy could then prioritise public money for the public goods that can most reliably be delivered, offering better value for taxpayers and improving the provision of ecosystem services from agricultural landscapes.
Dermatofibroma, also known as "fibrous histiocytoma", is a benign dermal or subcutaneous poorly circumscribed proliferation of spindle-shaped fibroblasts and macrophages in the dermis. Although it is commonly present as a brownish nodule the legs of females, it may also arise on the upper extremities, trunk, and rarely on the head. The exact pathogenesis is unclear. However, it is widely believed that the originating insult to the dermis is a folliculitis, an arthropod bite, or an unspecified initial inflammatory condition. Giant dermatofibromas of greater than 5 cm in diameter are rare, with only 22 cases reported in the literature. We present a case of a rapidly evolving pedunculated mass in the groin of a male patient. Histological examination confirmed this to be a giant dermatofibroma. Though this specimen cannot is not confirmed as such, the cellular subtype is sometimes present as a larger lesion with anecdotal reports of local recurrence and distant metastases. The clinical and radiological features which were somewhat suspicious of malignancy are considered in the context of the definitive pathological diagnosis of a benign lesion.
Abstract Purpose Many patients living beyond cancer experience significant unmet needs, although few of these patients are currently reviewed by specialist palliative care teams (SPCTs). The aim of this narrative review was to explore the current and potential role of SPCTs in this cohort of patients. Methods A search strategy was developed for Medline, and adapted for Embase, CINAHL, and PsycInfo. Additionally, websites of leading oncology, cancer survivorship, and specialist palliative care organisations were examined. The focus of the search was on individuals living beyond cancer rather than other groups of cancer survivors. Results 111 articles were retrieved from the search for full text review, and 101 other sources of information were identified after hand searching the reference lists of the full text articles, and the aforesaid websites. The themes of the review encompass the definition of palliative care/specialist palliative care, current models of specialist palliative care, core activities of SPCTs, relevant expertise of SPCTs, and potential barriers to change in relation to extending their support and expertise to individuals living beyond cancer. The review identified a paucity of evidence to support the role of SPCTs in the management of patients living beyond cancer. Conclusions Individuals living beyond cancer have many unmet needs, and specific services are required to manage these problems. Currently, there is limited evidence to support the role of specialist palliative care teams in the management of this cohort of people, and several potential barriers to greater involvement, including limited resources, and lack of relevant expertise.
Treatment success in leukaemia is impacted by patient resistance to chemotherapy including cytarabine (ara-C) and the anthracycline daunorubicin (DNR) requiring rapid pre-screening testing. DNR is converted to daunorubicinol (DNRol) by carbonyl reductase (CR1) in resistant patients leading to cardiomyopathy. A major mechanism for DNR resistance is p-glycoprotein (p-gp) over-expression, however the exact substrate for p-gp is unknown. The aim of this study was to characterise a novel anthracycline-resistant (K562R) cell line for mode of resistance and assess intracellular drug kinetics in a novel combined fluorescence/bioluminescence assay. IC50 values for DNR treatment were significantly higher for K562R (8.4 μM) compared to wildtype (4.8 μM) (p
Palliative care has traditionally focused on end-of-life care for patients with advanced cancer. This has since expanded to include symptom management and quality-of-life improvement from the moment of cancer diagnosis. Specialist palliative care teams work across community and inpatient settings and focus on dealing with complex problems whilst supporting healthcare colleagues in providing generalist palliative care. This article will outline the principles of palliative care, models of palliative care delivery, the distinctions between palliative care and supportive care, and the role of specialist palliative care in cancer survivorship.
Simulation-based medical education recreates challenging end-of-life scenarios to teach key palliative medicine skills, enhance patient safety and promote participant psychological safety. A palliative medicine week for Queen's University Belfast final year medical students was designed to support application of the palliative medicine undergraduate curriculum, incorporating blended learning of communication skills, simulation, and clinical immersion.
Methods
A multidisciplinary teaching faculty of consultants, registrars and specialist nurses developed four simulation scenarios on opioid toxicity, breathlessness, constipation, and agitation. Learning outcomes were mapped to Outcomes for Graduates (General Medical Council, 2018) and the Palliative Medicine Curriculum for Undergraduate Medical Education (Association for Palliative Medicine, 2014). Facilitators received simulation instruction and ran practice sessions with volunteer simulation staff and students. Each scenario includes a debrief and opportunity for repeat simulation, reinforcing skills and boosting confidence. The simulation session is delivered using high quality manikins on simulated wards and contemporaneous feedback is collated.
Results
Expert advice, scenario practice and volunteer feedback enhanced scenario development, identifying a key focus for each, therefore spotlighting main learning outcomes and maximising impact. Early qualitative feedback has been unanimously positive. Students identified that scenario complexity and novelty increased value and engagement. Students felt facilitators were supportive, the feedback mechanism was safe, and multidisciplinary input added benefit. Facilitators found the students enthused and engaged. The opportunity to repeat challenging simulations saw students develop confidence and skill in palliative care competencies.
Conclusions
Expert advice and trialling scenarios enhance simulation development and promote alignment with student expectations and priorities. Facilitator training, especially debriefing, and opportunities to repeat simulations maximise the learning experience and may be particularly important in palliative care simulation. A multidisciplinary approach highlights the significance of effective interprofessional competency and collaboration. Feedback is crucial in enriching the quality of palliative care simulation in education.
References
Association for Palliative Medicine (2014, February). Association for Palliative Medicine curriculum for undergraduate medical education. https://www.apmuesif.phpc.cam.ac.uk/apm-curriculum/ General Medical Council (2018, June). Outcomes for Graduates. https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates/outcomes-for-graduates
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