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Dementia is the leading cause of death in England and Wales. Since the publication of the Dementia Strategy in 2009, there has been an increasing emphasis on advance care planning, with the aim of empowering people with dementia to express their wishes before mental capacity is lost, promoting a 'good death' and enabling them to 'die well'. This literature review of end-of-life care for people with dementia in UK care homes shows that dementia is still not widely regarded as a terminal condition, and that residents of care homes sometimes face unnecessary admissions to hospital in the dying phase. People with dementia at the end of their lives are still not accessing appropriate and timely palliative care, and advance care planning is still not part of routine dementia care despite the evidence and recommendations. This denies them the known benefits of reduced patient and carer distress, reduced hospital admissions and inappropriate treatments, the upholding of person-centred care principles, decision-making, and ensuring that people with dementia can expect a 'good death'. [ABSTRACT FROM AUTHOR]

The article examines the policy and practice interface in Great Britain on the issues of law, ethics and end-of-life care. Topics covered include how palliative care aims to provide support to people with advancing, incurable somatic illness, the moral impact of criminalisation, and examples of practice informing law and policy.

Background: Pain is an important issue in end of life care. Although musculoskeletal pain is common in older adults, it is rarely associated with the cause of death and may be overlooked as death approaches. Hence a major target for improving quality of life may be being missed. Methods: The aim of this study was to systematically search and critically review the literature on musculoskeletal pain at the end of life. Amed, Cinahl, Internurse, Medline, Psych Info, Web of Knowledge and Cochrane review databases were searched for relevant research up to September 2012. The search strategy combined key words expanding the terms 'palliative' for population, 'musculoskeletal' for exposure, and 'pain' for outcome. Predefined inclusion and exclusion criteria were applied. Results: Five relevant papers and one letter to the editor were found, including case studies and epidemiological research. Current evidence suggests musculoskeletal pain is common in older adults at the end of life and that it can have a substantial impact on individual experience. No information about community based treatment of musculoskeletal pain at the end of life was found. Conclusion: Priorities for future research include high quality epidemiological studies to establish the prevalence, natural history, impact, assessment, patient priorities and outcomes associated with musculoskeletal pain in the end of life period, and intervention research that provides an evidence base for treatment. [ABSTRACT FROM AUTHOR]

Leg ulcers caused by chronic venous insufficiency affect a great many of the population, costing the NHS an estimated £200 million per year. The clinical use of sterile maggots under the brand name LarveE has increased steadily in the UK since they were introduced in the UK in late 1995. Maggot therapy breaks down necrotic tissue within a chronic wound, transforming it into an acute wound; subsequently beginning the healing process a lot quicker, thus reducing overall costs to the National Health Service. A literature review was conducted on studies that explored the use of maggot therapy in the management of chronic wounds. Four key themes were identified and analysed from this search, including infection control, promotion of healing, cost-effectiveness and the 'yuk' factor. [ABSTRACT FROM AUTHOR]

There is a growing scientific understanding and increasing public awareness of the influence of genetics on the development of cancer. This article, which is based on a review of the literature, focuses on how the awareness of genetic predisposition to cancer is affecting patients and their families. It highlights the way that risk assessment for predisposition to cancer can conflict with traditional models of informed consent and can cause concern for families. It suggests that there is need for informed discussion within palliative care about how best to support families with concerns about a family history of cancer. [ABSTRACT FROM AUTHOR]

Aim To understand why healthcare professionals working in palliative care felt that pilgrimage to Lourdes could be a beneficial activity for the terminally ill. Design A qualitative study using a phenomenological framework. Methods Nine semistructured interviews with a purposive sample of hospice staff. Results The reasons given for accompanying the terminally ill to Lourdes reflected the general aims of palliative care. They included improving the quality of life through the provision of a holiday, maintaining patient choice and autonomy and enabling inner-transformations. The communitas, or altered relationships, formed during the pilgrimage were also seen as beneficial. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experience of volunteering for a week with Smile International at Kjudesi Paliativ in Gjakova, Kosovo, one of the poorest countries in Europe.