Children and young people can have a wide range of life limiting conditions and may sometimes live with such conditions for many years. This guideline recommends that end of life care be managed as a long term process that begins at the time of diagnosis of a life limiting condition and entails planning for the future. Sometimes it may begin before the child’s birth. It is part of the overall care of the child or young person and runs in parallel with other active treatments for the underlying condition itself. Finally, it includes those aspects related to the care of the dying.
The phase II double blind randomised clinical trial showed that patients who received the combination dextromethorphan hydrobromide and quinidine sulphate had lower occurrence and severity of agitation than patients who received placebo. This combination is approved in the United States and the European Union for treating pseudobulbar affect, a neurological disorder characterised by uncontrollable episodes of crying.
Bereaved people in England rate the care provided by hospitals at the end of their relative’s life lower than that provided by hospices, care homes, and services in the community, show the results of a survey published by the Office for National Statistics.
People who are underweight in middle age are at increased risk of developing dementia, while increasing weight and obesity offer protection against the condition, a large cohort study has found.
A number of previous studies have looked at the association between weight and dementia, and most have found that the risk of dementia increased among adults who are overweight or obese, although some studies have found the opposite. Most of these studies have been small, which led the present researchers to conduct a much larger analysis of the link.
Discontinuing treatment with statins in patients with terminal illnesses is safe, could improve quality of life, and could reduce costs, US research published in JAMA Internal Medicine concludes.
The pragmatic randomized trial looked at 381 patients with a mean age of 74.1 years. Half of the patients had cancer, and all had an estimated life expectancy of between one month and one year. The patients had been taking prescribed statins for three months or more for primary or secondary prevention of cardiovascular disease but had no recent active cardiovascular disease
NHS England has published a revised draft funding approach for palliative care featuring a ‘currency’ for ensuring services match patient needs, offer best value and that providers are reimbursed fairly. The revision is informed by feedback received through consultation, events and seminars since publication of the original document in October 2014.
Have you read any of these? Last week the top 5 most popular books on loan were:
- Making sense of the ECG
- Assessment, Supervision and support in clinical practice
- Clinical supervision in learning and mentorship in nursing
- Achieving evidence based practice: a handbook for practitioners
- Palliative care – the nurses role
Using a public health approach to improve end-of-life care: results and discussion of a health needs assessment undertaken in a large city in northern England
This extract was taken from BMJ Support Palliat Care doi:10.1136/bmjspcare-2014-000662
“A detailed health needs assessment (HNA) for end-of-life care (EoLC) services was led by public health in Leeds to inform a commissioning strategy. To answer the question: are we delivering the best possible EoLC services within the resources available? Mixed methods were used with three approaches: epidemiological, corporate and comparative” …
Read the full article at: http://spcare.bmj.com/content/early/2014/09/05/bmjspcare-2014-000662.abstract
This month in Eyes on Evidence
Acid-suppressive drugs and oesophageal adenocarcinoma in Barrett’s oesophagus
A systematic review and meta-analysis indicates that proton pump inhibitors reduce the risk of oesophageal adenocarcinoma and high-grade dysplasia in people with Barrett’s oesophagus.
Prescriptions for anxiolytics and hypnotics and risk of death
A population-based cohort study in UK primary care suggests that people who are prescribed anxiolytic and hypnotic drugs have a significantly increased risk of death from any cause over a 7-year period.
Assessment and treatment of dementia in older adults
A systematic review finds that brief cognitive assessment tools can adequately detect early dementia, but whether interventions for mild cognitive impairment or early dementia have a clinically significant effect is unclear.
Bedtime schedules and children’s cognition and behaviour
Two analyses of 7-year-olds in the UK Millennium Cohort Study suggest that not having a regular bedtime is associated with impaired cognition in girls and behavioural difficulties in both girls and boys.
Trained glycaemia alert dogs for people with type 1 diabetes
A small UK intervention study suggests that trained glycaemia alert dogs may be able to notify people with type 1 diabetes during blood glucose variations.
NICE opens consultation on the NICE Accreditation Process Manual Update
NICE is inviting comments on its proposals to update the NICE Accreditation Process Manual.
NICE has recently published Evidence Updates on:
- Physical activity and the environment
- Autism in adults
- Opioids in palliative care
This report sets out recommendations regarding the Liverpool Care Pathway and end of life care following an independent review of the LCP chaired by Baroness Julia Neuberger.
The recommendations include:
- unless there is a very good reason, a decision to withdraw or not to start a life-prolonging treatment should not be taken during any ‘out of hours’ period
- an urgent call for the Nursing and Midwifery Council to issue guidance on end of life care
- a new system-wide approach to improving the quality of care for the dying
The Summer 2013 issue of the free journal for nurses caring for dying people at home, in hospitals and care homes is now available online. This issue is mobile-friendly making it easier to read on your mobile device or tablet. Articles include:
CLINICAL PRACTICE DEVELOPMENT
- St Christopher’s Hospice Clinical Guidelines: Anticipatory end-of-life care medication for the symptoms of terminal restlessness, pain and excessive secretions in frail older people in care homes
End of Life Journal is the free, online, peer-reviewed, quarterly journal that publishes articles on all aspects of nursing practice relating to end-of-life care. It is primarily aimed at generalist nurses working in hospital, community and care home settings. However, many articles will also be of interest to the specialist palliative care nursing audience as well as members of the wider multidisciplinary team. The journal focuses on care for patients with both malignant and non-malignant disease and their family and friends.
CLINICAL PRACTICE DEVELOPMENT
NURSING CASE REVIEW
NATIONAL END OF LIFE CARE PROGRAMME UPDATE
Brian Nyatanga, British Journal of Community Nursing, Vol. 18,
Iss. 2, 01 Feb 2013, pp 77
The health system-and palliative care in particular-are facing difficult financial times due to spending cuts. It seems that when times are this hard one of the first things to go is staff education, which is disturbing considering that it takes years to train community palliative care nurses to function at specialist level.
Click here to read the article – requires login details
The National End of Life Care Intelligence Network (NEoLCIN) has released the new version of its End of Life Care Quality Assessment (ELCQuA) tool, which is now structured around the NICE quality standard for end of life care for adults.
ELCQuA is a free, online self-assessment tool designed to support local service improvement and the commissioning of end of life care services. It can be used by any organisation caring for people at the end of life, across the health, social care, voluntary and private sectors. This includes commissioners, local authorities, acute hospitals, primary care, community, palliative care and ambulance services.
Read more about it by following the link at the top of this post.
Posted: 10 Dec 2012 12:00 AM PST
Source: Journal of Clinical Oncology
Purpose: To determine time trends and characteristics associated with opioid analgesic prescribing to patients with cancer who are approaching the end of life.
Patients and Methods: This population-based cohort study used data on 29,825 patients diagnosed with five common cancers – lung (34.2%), colorectal (19.9%), female breast (21.6%), prostate (19.1%) and head and neck (5.2%) – in the United Kingdom General Practice Research Database (GPRD) who died between 2000 and 2008. Opioid prescription rates in the last 3 months of life were described. Characteristics associated with opioid prescribing were investigated by using generalised estimation equation models. Results: In the last 3 months of life, 43.6% (95% CI, 43.0% to 44.2%) of patients received at least one prescription of opioids: morphine (33.4%; 95% CI, 32.8% to 33.9%), diamorphine (11.6%; 95% CI, 11.2% to 11.9%) and fentanyl family (10.2%; 95% CI, 9.8% to 10.5%). Over time, prescription rates …
Find your 1%: helping GPs to support people to live and die well
This resource pack has been developed to be a practical tool to help GPs identify those patients who may be in their last year of life and talk to them about their preferences. It contains information on: identifying people at the end of life; having end of life care conversations; putting plans in place; managing and co-ordinating care; and space for GPs to include local information such as the telephone numbers of hospices, palliative care teams and pharmacies which stock palliative care drugs.
The ACA training programme to improve communication between general practitioners and their palliative care patients: development and applicability
Source: BMC Palliative Care June 2012
Publication type: Web article
In a nutshell: This article describes the development of a new training programme on GP-patient communication in palliative care, and the applicability to GPs and GP Trainees. This ‘ACA training programme’ focuses on Availability of the GP for the patient, Current issues that should be raised by the GP, and Anticipating various scenarios. Evaluation results indicate the ACA training programme to be applicable to GPs and GP Trainees. The ACA checklist was appreciated by GPs as useful both in practice and as a learning tool, whereas GP Trainees mainly appreciated the list for use in practice.
Length of publication: 16 pages
Summer 2012 Vol 2 Issue 2
End of Life Journal is free, online, peer-reviewed, quarterly journal that publishes articles on all aspects of nursing practice relating to end-of-life care.
It is primarily aimed at generalist nurses working in hospital, community and care home settings. However, many articles will also be of interest to the specialist palliative care nursing audience as well as members of the wider multidisciplinary team.
The journal focuses on care for patients with both malignant and non-malignant disease and their family and friends.
End of life journal ISSN 2047-6361 (online)
Posted: 22 Jun 2012 12:00 AM PDT
Area: Health In Focus