Diagnosing dying in the acute hospital setting--are we too late?

Studies have shown that end-of-life care within the UK hospital setting is variable, and care pathways are now being advocated in the UK. This report presents results from an audit revealing that it is possible to anticipate a large proportion of deaths within an acute setting, but this is generally achieved very close to the end of life. Forty-nine per cent of patients were recognised as dying 24 hours or less before death, 17% between 24 and 36 hours before death, 21% between 36 and 72 hours before death, and 13% greater than 72 hours before death. It discusses the challenges around making the 'diagnosis of dying' and highlights that if clinicians do not feel confident in performing such a diagnosis, then patients cannot benefit from end-of-life care pathways. Instead of asking healthcare professionals to make accurate prognoses or diagnose dying, an environment needs to be created where teams feel comfortable in actively managing patients (appropriately) alongside considering their symptom control and planning for possible end-of-life care.

Pharmacological dissociation between the reinforcing, sensitizing, and response-releasing functions of reward in honeybee classical conditioning.

Reserpine depletes biogenic amines from their stores in the honeybee (Apis mellifera carnica) brain and leads to impaired appetitive conditioning using sucrose as a reinforcer. Compensatory injection of octopamine or dopamine directly into the brain restores these behavioral losses. Dopamine rescues the slowing-down effect on motor patterns, but not sensitization or conditioning. Octopamine leaves the motor patterns as well as sensitization unchanged but rescues conditioning. Specifically, octopamine rescues acquisition but not retrieval. Serotonin has no significant effect on sensitization but impairs conditioning. The authors conclude that octopamine is involved in selectively mediating the reinforcing but not the sensitizing or response-releasing function of the sucrose reward, whereas dopamine is selectively involved in the expression of the motor response.