Care of the dying patient in the community

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4085 (Published 3 July 2013)
Cite this as: BMJ 2013;347:f4085
 CME
General practice / family medicine
End of life decisions (ethics)
End of life decisions (geriatric medicine)
Extract from BMJ:The consensus from international studies of patient preferences is that, given adequate support, most people would prefer to die at home. However, more than half of all deaths in the United Kingdom occur in hospital, with only 18% of people dying in their own home. Suggested reasons for this include a lack of anticipatory care planning, poor coordination between healthcare agencies, and insufficient community resources. National and local policies now focus on facilitating home deaths, and recently there has been a small increase in the proportion and absolute number of people dying at home.

The demographics of deaths across Europe are changing with the ageing population, with deaths from dementia, cancer, and chronic diseases becoming more common.  Caring for such patients in hospital will probably become unsustainable in terms of capacity, cost, and patient satisfaction. The focus of end of life care is therefore shifting to the community—to homes and care homes—where the role of the general practitioner, with support from the community palliative care team, is key. The onus is on all health and social care professionals to work collaboratively across settings to enable patients to receive high quality end of life care in the place of their choice.

BMJ Clinical Review: Ulcerative colitis

CLINICAL REVIEW

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f432 (Published 5 February 2013)

Summary points

  • Ulcerative colitis affects one in 200 people in developed nations

  • The condition commonly presents in young adults

  • Most people with ulcerative colitis will have a normal life expectancy

  • 5-aminosalicylates and thiopurines are effective at preventing relapse of disease activity

  • Patients are at increased risk of colorectal cancer and should undergo regular surveillance colonoscopy

  • Bone densitometry is recommended in patients who need repeated courses of glucocorticosteroids and those at high risk of osteoporosis

  • Most drugs used to treat ulcerative colitis are safe during pregnancy