Updated from Prodigy to new CKS Format:

• Anaemia - iron deficiency
• Immunizations - childhood
• Leg ulcer - venous
• Opioid dependence
• Palliative cancer care - constipation

Clinical summaries of the Topic Reviews issued in February 2008 please follow the links below:

• Clinical summary: Iron deficiency anaemia – assessment
• Clinical summary: Iron deficiency anaemia - management
• Clinical summary: Immunizations childhood programme
• Clinical summary: Immunizations childhood – children up to 1 year of age
• Clinical summary: Immunizations childhood – children 1-2 years of age
• Clinical summary: Immunizations childhood – children 2-10 years of age
• Clinical summary: Immunizations childhood – children over 10 years of age
• Clinical summary: Immunizations childhood – additional immunizations
• Clinical summaries: Leg ulcer venous – uncomplicated venous leg ulcer
• Clinical summaries: Leg ulcer venous – infected venous leg ulcer
• Clinical summaries: Leg ulcer venous – healed venous leg ulcer
• Clinical summaries: Leg ulcer venous – persistent venous leg ulcer
• Clinical summaries: Opioid dependence – new presentation
• Clinical summaries: Opioid dependence – Considering substitution therapy
• Clinical summaries: Opioid dependence –Starting and stabilizing on maintenance therapy
• Clinical summaries: Opioid dependence – Continuing maintenance therapy
• Clinical summaries: Opioid dependence – Detoxification – from maintenance therapy
• Clinical summaries: Opioid dependence – Detoxification – not on maintenance therapy
• Clinical summary: Opioid dependence – Missed or vomited doses
• Clinical summary: Opioid dependence – Acute withdrawal syndrome
• Clinical summary: Opioid dependence – Collapse due to opioid overdose
• Clinical summary: Opioid dependence – Travelling abroad
• Clinical summary: Opioid dependence – Unknown patient
• Clinical summary: Palliative cancer care – constipation

‘Better Care: Better Lives: Improving outcomes and experiences for children, young people and their families living with life-limiting and life-threatening conditions’ aims to improve the care and support given to children in England with life-limiting or life-threatening condition and their families. The strategy calls on commissioners, service providers, voluntary sector partners – to improve the experiences of young people and their families by:

• improving data sources

• building stronger joint working arrangements

• developing better needs assessments and support regimes

• tackling inequalities

• encouraging the delivery of care in the most appropriate setting.

Care provided by generalists at the end of life: scoping exercise on research priorities - Summary from the National Institute for Health Research considers the care that most people receive at the end of their lives from generalists  such as GPs, district nurses, hospital consultants and staff, nursing home staff and other health and social care professionals.

Key Findings:

• Generalist end of life care is care provided by many different practitioners who are not specialists in palliative care.

• The scope of generalist and specialist care is a matter for debate and variations in practice are evident. Definitions of ‘end of life’ care also vary, sometimes incorporating palliative care and sometimes referring just to the last few days of life.

• The limited research in this area has tended to describe existing services or needs, rather than to evaluate models of care or to examine health economic effects.

• Stakeholders are keen to see more research on models of care and place of care.

• Recommended priority areas for future research are:
  • defining and evaluating models of collaborative working in primary and secondary care
  • defining and evaluating models of out-of-hours provision
  • reviewing place of care and place of death for people dying from non-malignant disease
  • defining and evaluating models of care provided in different hospital settings.

• Research in each of these priority areas should include, in all settings, information on the:
  • patient and carer experience
  • resource and health economic effects and implications.

Three Final Reports have been produced.

• Report 1 - Overview and recommendations for future research in generalist end of life care,
• Report 2 - The literature scoping
• Report3 - The consultation report

National Care of the Dying Audit generic report 2006/2007 considers the care of the dying in five key areas and finds that:

Physical Comfort of the Patient 

• Medication was assessed and non-essential medication was stopped in 93% of patients.

• Anticipatory prescribing was undertaken for pain relief in 91% of cases, for agitation in 84% of cases, for the prevention of respiratory tract secretions in 80% of cases, for nausea in 80% of cases and for breathlessness in 67% of cases.

• Inappropriate blood tests and antibiotics were discontinued in 87% and 91% respectively, and recording of ‘not for Cardio Pulmonary Resuscitation’ (where appropriate) documented in 93% of patients.

• In regard to ongoing care the presence or absence of symptoms could be recorded for patients during the last 24 hours of life. The status was not recorded for 18% - 19% of those assessments. Where the status was recorded patients were assessed as being symptom controlled in 95% for pain; 94% for agitation; 91% for respiratory tract secretions and 99% for nausea and vomiting of occasions.

Psychological and Spiritual Aspects of Care

On commencement of the LCP (Initial Assessment)

• Patient awareness of diagnosis and recognition of the dying phase was recorded as having been achieved in 57% and 45% of patients respectively. In one third of cases there was no documentation on the LCP suggesting a need for further education and training for healthcare staff.  Some hospitals, however, did achieve 100%.
• In over 80% of cases, carers were recorded as being aware of the diagnosis and dying phase, suggesting that healthcare staff find it easier to talk to carers
• The spiritual needs of patients and carers were recorded as being assessed in 34% and 53% (respectively) of appropriate cases

Communication with Patient,Carer and Healthcare Professionals

This is variable but carers were more likely to have had the care plan explained to them than the patient:

• At Initial Assessment, documentation confirmed that patients had the care plan communicated to them in over one third of cases, compared with 78% of carers.  It was recorded that 90% of those carers understood the care plan after it was explained to them.

• Communication with primary care (both on commencement of the LCP and after the death of the patient) was documented as having taken place in only about a third of cases, although there were pockets of good practice

Information Giving and Receiving

• Contact information about the most important person to contact in case the patient’s condition deteriorates was achieved at Initial Assessment in 79% of cases and Hospital information leaflets regarding facilities and access were given out in 59% of cases at that time
• Around the time of death or deteriorating condition of the patient (Initial Assessment), only half of families were recorded as having been given appropriate information about local and national procedures that may need to be followed.

Following Appropriate Procedures

• Following death, appropriate hospital procedures for laying out of bodies, storing of patient’s belongings and other activities were documented as having been followed in around half of cases.  However, the high level of care after death goals that are left blank at the point of delivery of care requires more investigation before firm conclusions can be made. 

Just into the library this special issue of Sociology of Health and Illness focus’ on Diversity, Inequalities and Ethnicity. You’ll need your NHS Athens password to access the full text articles. If you haven’t got one and you work for Liverpool PCT you can apply for one here.

Locating ethnicity and health: exploring concepts and contexts

Waqar I. U. Ahmad and Hannah Bradby

pages 795–810

• Abstract
• References

The Black diaspora and health inequalities in the US and England: does where you go and how you get there make a difference?

James Nazroo, James Jackson, Saffron Karlsen and Myriam Torres

pages 811–830

• Abstract
• References

Race and nutrition: an investigation of Black-White differences in health-related nutritional behaviours

Peter Riley Bahr

pages 831–856

• Abstract
• References

Describing depression: ethnicity and the use of somatic imagery in accounts of mental distress

Sara Mallinson and Jennie Popay

pages 857–871

• Abstract
• References

Hospice or home? Expectations of end-of-life care among white and Chinese older people in the UK

Jane Seymour, Sheila Payne, Alice Chapman and Margaret Holloway

pages 872–890

• Abstract
• References

Contextualising accounts of illness: notions of responsibility and blame in white and South Asian respondents’ accounts of diabetes causation

Julia Lawton, Naureen Ahmad, Elizabeth Peel and Nina Hallowell

pages 891–906

• Abstract
• References

Long-term health conditions and Disability Living Allowance: exploring ethnic differences and similarities in access

Sarah Salway, Lucinda Platt, Kaveri Harriss and Punita Chowbey

pages 907–930

• Abstract
• References

Interpreted consultations as ‘business as usual’? An analysis of organisational routines in general practices

Trisha Greenhalgh, Christopher Voisey and Nadia Robb

pages 931–954

• Abstract
• References

Retraction

Clive Seale

pages 955–955

• Summary

‘Racism, ethnicity, identity, and health: UK and US comparative perspectives’

Nancy Krieger

pages 956–956

• Summary

If you need some training to make the most of this or any other electronic resource available via the Fade Library and you work in Liverpool PCT, please contact us using the form below.

Delivering Choice - major palliative care service improvement plan, from Marie Curie Cancer Care, to provide greater choice for patients in end of life care. The programme has five projects underway across the UK - in Lincolnshire, Leeds, Tayside (Scotland), Barnet (north London) and south-east London.

End of Life Care Programme : the aim of the NHS End of Life Care Programme is to improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice.

National Council for Palliative Care: The National Council for Palliative Care is an independent umbrella body dedicated to keeping you up to date on all areas of palliative care.

Scottish Partnership for Palliative Care: The Scottish Partnership for Palliative Care is the national umbrella and representative body for palliative care in Scotland.

My Journals - Lists all e-journals currently available to you from the NHS, currently including journals like Palliative Medicine and Death Studies. You’ll need an NHS Athen password to use these. If you don’t have an Athens password and work for the NHS you can get one here

Just in time modules on BMJ Learning give you fast, evidence based updates? They go through the essentials on everyday conditions. Just added to BMJ Leanring is the

Whooping cough: a guide to diagnosis, treatment, and prevention

module.

Alternatively why not undertake one of the modules on pain:

Palliative care in the community

Common migraine: how to treat an attack

The role of opioids in cancer pain: an up to date guide

Shingles: diagnosis and management of herpes zoster and postherpetic neuralgia

To use BMJ Learning you’ll need your Athens password from the NHS. (If you work in the North West and don’t have an NHS Athens Password this link will let you apply for one)

If you need training in the use of electronic resources and you work for Liverpool PCT use the contact form below to contact the library.

These are former Prodigy summaries that have been updated and are now in a CKS Summary format:

Infertility

Lacerations

Meniere’s disease

Otitis externa

Palliative cancer care — nausea & vomit

Clinical Knowledge Summaries are available via the National Library for Health. If you don’t have an Athens password from the NHS and you work for the NHS in the North West you can apply for one here.

Death’s dominion: ethics at the end of life
Woods S
Maidenhead : Open University Press, 2007
Link to Amazon Review

ABC of palliative care, 2nd ed.
Fallon M and Hanks G
Oxford : Blackwell, 2006
Link to Amazon Review

Loss, change and bereavement in palliative care
Firth P, Luff G,and Oliviere D
Maidenhead : Open University Press, 2005
Link to Amazon Review

Dying well: a guide to enabling a good death
Neuberger J
Abingdon : Routledge, 2004
Link to Amazon Review

Caring for dying people of different faiths, 3rd ed.
Neuberger J
Abingdon : Radcliffe, 2004
Link to Amazon Review

Palliative care nursing: Principles and evidence for practice
Payne S, Seymour J and Ingleton C
Maidenhead : Open University Press, 2004
Link to Amazon Review

Guide to symptom relief in palliative care, 5th ed.
Regnard C and Hockley J
Abingdon : Radcliffe Medical Press, 2004
Link to Amazon Review

Good death: On the value of death and dying
Sandman L
Milton Keynes : Open University Press, 2004
Link to Amazon Review

Higher medical training for palliative medicine
Joint Committee on Higher Medical Training
London : JCHMT, 2003

Palliative care nursing: a guide to practice
O’Connor M
Abingdon : Radcliffe Medical Press, 2003
Link to Amazon Review

Introducing palliative care, 4th ed.
Twycross RG
Oxford : Radcliffe Medical Press, 2003
Link to Amazon Review

Primary palliative care: dying, death and bereavement in the community
Charlton R
Abingdon : Radcliffe Medical Press, 2002
Link to Amazon Review

Communicating with dying people and their relatives
Lugton J
Abingdon : Radcliffe Medical Press, 2002
Link to Amazon Review

Supportive and palliative care in cancer : an introduction
Regnard, C and Kindlen M
Abingdon : Radcliffe Medical Press, 2002
Link to Amazon Review

E-Books

Handbook of palliative care
Johnson,J, Forbes K, Theobald N, Booth S, Zollman C and Goldman A
Oxford : Blackwell, 2005
Link to Amazon Review

Supportive and palliative care in cancer : an introduction
Regnard, C and Kindlen M
Abingdon : Radcliffe Medical Press, 2002
Link to Amazon Review

To use this resource you will need your NHS Athens password. If you haven’t got one and you work in the North West you can apply for one here.

National Knowledge Weeks aim to highlight best current knowledge and current issues for selected healthcare topics: the updates are presented in the Specialist Library as user-friendly summaries written by relevant experts, and are accompanied by links to guidelines, secondary research and primary research. All information included in the summaries has been subject to rigorous selection criteria.

‘Palliative care in children’ will take place between 15-19 Oct on the Child Health Specialist Library

‘Palliative and supportive care in chronic non-malignant diseases’ will take place between 22-24 Oct on the Palliative and Supportive Care Specialist Library.

National Library for Health - Palliative and Supportive Care Specialist Library brings together information on end of life and supportive care issues. As a result in addition to supporting palliative care it also focus’ on conditions like Chronic Fatigue Syndrome.

It is divided into seven sections that can be accessed from a menu on the left hand side of the screen (Conditions, Symptom management, Service provision, Populations and settings, Death, dying & bereavement, Policy and Ethics & law. Each is divided into more specific subsections which detail the Guidance & Pathways, Evidence, Education and CPD and Patient Information in the area.

For relevant information in this area the Specialist Library is a good place to begin, the library is chock full of valuable links.

For training in the use of NLH and other electronic information resources available to people from Liverpool PCT use the contact form below to contact the Fade Library.