BMJ supportive & palliative care
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BMJ Support Palliat Care · Mar 2014
Case ReportsA rare non-malignant cause of spinal cord compression in a young patient.
In the context of palliative medicine, spinal cord compression occurs in around 5% of patients with cancer. Ten per cent of patients with spinal metastases are affected; the commonest causes are breast, prostate, lung cancer and multiple myeloma. ⋯ Symptoms occur when the adipose tissue enlarges, encroaching on the spinal canal. In this case, the aetiology was long-term exogenous dexamethasone use.
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BMJ Support Palliat Care · Mar 2014
Palliative care in people with idiopathic Parkinson's disease who die in hospital.
The UK National Institute for Health and Clinical Excellence guidelines state that palliative care options for people with Parkinson's disease (PD) should be discussed. ⋯ For those dying in hospital, there are few previously documented end-of-life care discussions with patients or their relatives. The use of end-of-life pathways and access to specialist palliative care is variable. Following the Neuberger report, the Liverpool Care Pathway is to be replaced with individual end-of-life care plans. It is important to engage patients, and their relatives, in decision making regarding preferences at the end of life.
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BMJ Support Palliat Care · Dec 2013
Circles of care: should community development redefine the practice of palliative care?
Specialist palliative care, within hospices in particular, has historically led and set the standard for caring for patients at end of life. The focus of this care has been mostly for patients with cancer. More recently, health and social care services have been developing equality of care for all patients approaching end of life. ⋯ Within this article, we propose a model of care which identifies a person with an illness at the centre of a network which includes inner and outer networks, communities and service delivery organisations. All of these are underpinned by policy development, supporting the overall structure. Adoption of this model would allow individuals, communities, service delivery organisations and policy makers to work together to provide end of life care that enhances value and meaning for people at end of life, both patients and communities alike.
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BMJ Support Palliat Care · Dec 2013
ReviewWhat tools are available to identify patients with palliative care needs in primary care: a systematic literature review and survey of European practice.
It can be difficult to identify when a palliative care approach should be started both in malignant, and particularly, in non-malignant disease, ideally to run alongside disease-modifying care. A structured method or tool may be useful to help general practitioners (GPs) identify patients for early palliative care and trigger assessment and care planning. ⋯ Although several identification tools have been developed, none of these have been validated or widely implemented in Europe. Further collaborative international development, implementation and evaluation of such tools are recommended.