Primary health care research & development
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Prim Health Care Res Dev · Oct 2014
ReviewPalliative and end of life care for people with dementia: lessons for clinical commissioners.
To synthesize information about management of end of life care in people with dementia using review papers. ⋯ Our critical synthesis generated five main themes from this review of the reviews: (1) carers' (family caregivers') experiences; (2) person-centred care; (3) practice (including advance care planning, pain and comfort, nutrition, medical complications and minimizing the distress of behavioural symptoms); (4) system factors, including ethical dilemmas, decision making, information, and training; and (5) research priorities. There appears to be good evidence on the care and management of patients with dementia at the end of life which can be used to influence policy development and emerging specificity about research priorities in palliative care practice for people with dementia.
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Prim Health Care Res Dev · Oct 2014
Primary care approaches to musculoskeletal multiple-site joint pain pharmacological therapy: a survey of general practitioners.
Chronic multiple-site joint pain (MSJP) due to osteoarthritis and soft tissue disorders is common in people over 50 years old and associated with poor outcomes. This study examined current pharmacological approaches to MSJP management in primary care. One hundred and fifty general practitioners (GPs) attending an educational seminar participated in an electronic survey (mean response rate 96%). ⋯ When optimising therapy, intra-class optimisation (increase NSAID dose 41%, change to another NSAID/COX-2 inhibitor 30%) was preferred to inter-class step up therapy (add opioid 23%, change to opioid 6%). For NSAID gastrointestinal intolerance, the preference was to add a gastro-protective agent (74%). There is a need to better characterise MSJP and examine optimal pharmacotherapy regimens.