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Department of Health in England launches end of life survey

27 Oct, 11 | by Assistant Editor

A new survey commissioned by the Department of Health aims to gauge the quality of end of life care in England. The project, which is being administered by the Office for National Statistics (ONS) will involve sending a postal survey to 49,000 individuals who registered the death of a loved one between November 2010 and June 2011.

Questions will relate both to the quality of care that the loved one received and also the support available to the respondents themselves. The results of the survey will inform the DoH End of Life Care Strategy which aims to improve the care available to people dying from long-term illness.

The results of the survey should be made available in March 2012.

Read the 2008 End of Life Care Strategy here.

British GPs urged to “find their 1%”

25 Oct, 11 | by Assistant Editor

A new campaign by the Dying Matters Coalition is encouraging GPs to identify the 1% of their patients who are entering their last year of life.

The Find Your 1% project aims to promote discussion of end-of-life care in order to increase the number of people dying at home. A report released last year by the National End of Life Intelligence Network showed that whilst over 60% of people would prefer to die in their own home, only around 20% actually are.

A key goal of the campaign is to encourage people to think about where they would like to die, as well as to empower them to tell their carers and loved-ones where they would like to spend their final days.

In order to recognise individuals who may benefit from the scheme, GPs are urged to ask themselves the question “Would I be surprised if this person were to die in the next 12 months?” during routine consultations with patients.

However, accurately predicting someone’s life expectancy at any given age is generally very difficult (particularly if they haven’t been diagnosed with a serious illness) and some commentators, including Northumberland LMC secretary Dr Jane Lothian, have suggested that the ‘somewhat arbitrary’ selection of patients may be ethically unsound.

Find out more about the campaign here.

Increase in admissions to palliative care in Australian hospitals

21 Oct, 11 | by Assistant Editor

A new study by the Australian Institute of Health and Welfare (AIHW) shows that over the last decade the number of hospital admissions for palliative care services has increased by over 50%.

This news was well received by Palliative Care Australia (PCA), an organisation which promotes the provision of quality end of life care. Dr Yvonne Luxford, PCA Chief Executive said “This is a fantastic indicator that our hospital system is gaining an understanding of the need to refer people to palliative care. What we need to make sure, however, is that people are receiving high quality care, and one way to do this is by ensuring that education about palliative and end of life care is a standard provision for all health professionals.”

Maintaining quality of care is especially important in light of the study’s other main finding – that the average length of hospital stay for palliative care patients in Australia is 12.5 days – almost four times longer than the average for all admissions (3.2 days). With palliative care provision and utilisation on the rise, more funding may well be needed to keep care quality at a premium.

The study also showed that people with cancer are overwhelmingly referred to palliative care (69% of cancer patients in the study), but that only 21% of individuals suffering from heart failure and 20% from COPD were admitted to palliative care services, highlighting a discrepancy in the types of serious illness which are considered to benefit from palliation.

Read the full report here.

Access to palliative care in the US is improving but further work is needed.

14 Oct, 11 | by Assistant Editor

The US-based Center to Advance Palliative Care has issued a national ‘Report Card’ which upgrades the overall level of palliative care accessibility in the country to a B grade, up from C in 2008.

But whilst the number of hospitals with specialist palliative care units has increased significantly in recent years (more than doubling since 2000), there is still room for improvement, with Diane Meier, director of the Center, stating that “millions of seriously ill Americans still do not have access.”

As well as an overall national grade, the report marked states individually, with seven states (including Minnesota, Vermont and Washington) scoring an A – up from just three in 2008. Most states received a B grade, with only two – Delaware and Mississippi – given an F.

Read the full report and view the interactive map here.

WPCA Report Highlights Serious Shortcomings in International Palliative Care Provision

11 Oct, 11 | by Assistant Editor

A new report by the Worldwide Palliative Care Alliance shows that 32% of countries still have no known palliative care activity whatsoever.

The study, entitled “Mapping levels of palliative care development: A global update 2011”, compiled detailed information about the level of hospice and palliative care provision in every country worldwide. The results also showed that only 136 out of 234 countries (58%) had a dedicated hospice or palliative care service – up 9% since 2006 but still startlingly low.

The most improved region since the last report was Africa, largely due to the work of the African Palliative Care Association, who helped to build capacity and improve care provision in several countries, including Malawi, Tanzania and Zimbabwe. Some isolated services have also been established in the Middle East, providing limited care where before there was none.

Despite the small headway which has been made, however, the report raises serious concerns about the huge number of seriously ill people worldwide for whom palliative care is either highly inadequate or nonexistent. WPCA estimate that 100 million patients and caregivers would benefit from hospice and palliative care, but these figures show that only a fraction currently have access to it.

Read the report here.

A recent talk exploring current issues in palliative care research and practice.

10 Oct, 11 | by Assistant Editor

Dr Miriam Johnson, Senior Lecturer in Palliative Medicine at Hull York Medical School, explains why she believes that patients with non-malignant conditions are often excluded from access to effective palliative care. She also outlines current understanding of the best way to palliate breathlessness and to successfully plan for end of life care amongst patients with non-malignant conditions. Watch her talk at the Royal Society of Medicine here.

Cloak and Needles

6 Oct, 11 | by Assistant Editor

I can see:  a frozen nose and few veins in the same place.

The bird without a beak outside of the window flutters and goes away.

I wish that outside of the window things will happen without a bird, not now…

His existential pain is growing like tree amidst baroque music.

This is new for him.

This is the room where the lions will come to eat his liver full of inflammable cells.

Now he knows how stiff the bone is upon the flesh.

Here things get in and out, in and out with no names or desire.

We can’t have eyes for this silence around his head made of memories.

We can’t even go after the marriage of the sunset.

Perhaps if I touch his flesh right now, everything will be like inside of a lamp: infinite, no more pain…

No one has ever opened the door at night to see the stones awaken by his disease.

You may think too much, you still wonder how to cure, how to comfort, but he knows: he already knows more…

He couldn’t find the fallen principles made of other lives to surprise the obstacles, the tact, the hand, the living.

He is the appetite of a simple chest fabricating particles and blood.

His lymphoma of darkness it’s now like a forest each time he breathes.

If I go inside I will never be back again…

by Rafael Bloise

New resource aims to advance measurement in palliative care

29 Jun, 11 | by BMJ

Patients are set to benefit from the new Palliative Care Outcome Scale (POS), a tool developed to assist clinicians, researchers and other healthcare workers in measuring physical symptoms; psychological, emotional and spiritual needs; and provision of information and support at the end of life.

Developed by Professor Irene J Higginson, POS is a free resource available in 12 languages.

More information on POS is available here.

News and updates from palliativedrugs.com

27 Jun, 11 | by BMJ

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website.

Safety Updates

McKinley T34 extension sets: UK Medicines and Healthcare products Regulatory Agency (MHRA) issue recall

All T34 syringe pump extension sets manufactured by CME (McKinley Medical UK) before 1 January 2011 have been recalled due to the potential for leakage at the female luer syringe connector. Product codes affected are: 100-172S, 100-170S, 100-172SLL, 100-172SB, 100-172SC. Returns and replacement stock can be obtained by contacting Paul Fletcher (McKinley Medical UK, 01253 894646, email: pfletcher@cme-mckinley.co.uk). The manufacturer states that other syringe sets can be used in the interim (ensuring local guidelines and practice are adhered to). For more information click here.

European Medicines Agency (EMEA) complete review of potential interaction between alcohol and opioid modified-release mechanisms

This review was undertaken following reports of the risk of alcohol dissolving the modified-release coating leading to a more rapid release of drug than intended. The conclusions are that for the majority of modified-release products the risk is minor but that the SPC and PIL across the whole class should be updated with consistent warnings that the concomitant use of alcohol with opioids may enhance the pharmacodynamic effect and should be avoided. However, for modified-release drugs which use a ‘polymethacrylate-triethylcitrate controlled release system’, the EMEA concluded that the marketing authorizations should be suspended until formulations which are more stable in alcohol are produced. The affected product appears to be Ethirfin (morphine sulphate, prolonged-release capsules, 20, 60, 120 and 200mg) previously available in Denmark. For more information click here.

Lenalidomide: UK Medicines and Healthcare products Regulatory Agency (MHRA) safety warning

Lenalidomide (Revlimid, Celgene) is authorised in combination with dexamethasone for multiple myeloma in patients who have received at least one previous treatment. However, evidence from clinical trials and case reports suggest that lenalidomide further increases the already elevated risk of venous and arterial thrombo-embolism in these patients, including myocardial infarction and cerebrovascular accident. The SPC has been amended accordingly. For more information click here.

US Food and Drug Administration (FDA) limits the amount of acetaminophen (paracetamol) to 325mg per dosage unit

The US FDA has asked manufacturers to reformulate prescription products containing acetaminophen (paracetamol) so that a single dosage unit contains a maximum of 325mg acetaminophen. This includes combination products of acetaminophen and opioids. Dosage recommendations will not change and the maximum dose remains 4g/day. For more information click here.

US Food and Drug Admnistration (FDA) announces Risk Evaluation and Mitigation Strategy (REMS) for modified-release opioids

The US FDA has published its REMS for all modified-release opioid drugs which aims to reduce their inappropriate prescribing, misuse, and abuse. Manufacturers are required to develop an educational program for prescribers and patients. For more information click here.

Prepared by Sarah Charlesworth and Andrew Wilcock

Call for abstracts – Palliative Care Congress, 2012

4 May, 11 | by BMJ

The 9th Palliative Care Congress is to be held at The Sage, Gateshead, Newcastle-upon-Tyne between 14-16 March, 2012.

Further information will be available shortly and details will be emailed to all those who attended the Congress in 2010.

The Palliative Care Congress is now calling for abstract submissions. For more information on the 2012 Congress and guidelines for submitting an abstract, please visit the website of the PCC Congress.

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