BackgroundCurrent models of end-of-life care (EOLC) have been largely developed for cancer and may not meet the needs of heart failure patients. AimTo review the literature concerning conversations about EOLC between patients with heart failure and healthcare professionals, with respect to the prevalence of conversations; patients' and practitioners' preferences for their timing and content; and the facilitators and blockers to conversations.

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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.

In the UK, strategies to improve retention of the mental health workforce feature prominently in health policy. This paper reports on a longitudinal national study into the careers of mental health nurses in the UK. The findings reveal little attrition during the first 6 months after qualification. Investigation of career experiences showed that the main sources of job satisfaction were caregiving opportunities and supportive working relationships. The main sources of dissatisfaction were pay in relation to responsibility, paperwork, continuing education opportunities, and career guidance. Participants were asked whether they predicted being in nursing in the future. Gender and ethnicity were related to likelihood to remain in nursing in 5 years time. Age, having children, educational background, ethnic background, and time in first job were associated with likelihood of remaining in nursing at 10 years. Associations between elements of job satisfaction (quality of clinical supervision, ratio of qualified to unqualified staff, support from immediate line manager, and paperwork) and anticipated retention are complex and there are likely to be interaction effects because of the complexity of the issues. Sustaining positive experiences, remedying sources of dissatisfaction, and supporting diplomats from all backgrounds should be central to the development of retention strategies.

When describing a crystal containing an arbitrary distribution of dislocation lines it is often convenient to treat the distribution as continuous, and to specify the state of dislocation as a function of position. Formally, however, there is then no ‘good crystal’ anywhere, and difficulties arise in defining Burgers circuits and the dislocation tensor. The dislocated state may be defined precisely by relating the local basis at each point to that of a reference lattice. The dislocation density may then be defined; it is important to distinguish this from the local dislocation density. The geometry of the continuously dislocated crystal is most conveniently analyzed by treating the manifold of lattice points in the final state as a non-Riemannian one with a single asymmetric connexion. The coefficients of connexion may be expressed in terms of the generating deformations relating the dislocated crystal to the reference lattice. The tensor defining the local dislocation density is then the torsion tensor associated with the asymmetric connexion. Some properties of the connexion are briefly discussed and it is shown that it possesses that of distant parallelism, in conformity with the requirement that the dislocated lattice be everywhere unique.