The British journal of general practice : the journal of the Royal College of General Practitioners
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Sleep disturbance (SD) is common among people living with dementia (PLwD) or mild cognitive impairment (MCI). It has a significant impact on the wellbeing of PLwD and caregivers, and makes care at home more difficult. Within primary care, assessment and management of SD for this population is complex and challenging. ⋯ Increasing awareness, knowledge, and confidence in diagnosis and assessment of SD is needed. Primary care-specific assessment tools may help. Long-term medication use is the default option in absence of pragmatic and effective non-pharmacological interventions that can be easily incorporated into routine general practice.
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Type 2 diabetes causes poor health outcomes if management is ineffective. Day-to-day self-management of type 2 diabetes is associated with diabetes distress, anxiety, and depression. This is also true for family members and informal (unpaid) carers, albeit the knowledge base about their lived experience is under-developed. ⋯ The research gave voice to this group of carers, many of whom experienced stress in their roles. They reduced stress about lifestyle change through a variety of strategies that have implications for effective management of diabetes within dyads and future health outcomes.
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Haematological malignancies are the fifth most common cancer in the UK. Aggressive subtypes are potentially curable; chronic variants (the most frequent diagnoses) are incurable, although can be successfully managed for many years with observation, interspersed with treatment if required, or with long-term oral therapy. Chronic subtypes involve uncertain pathways, long-term symptoms and psychological distress, which may emerge in primary care. ⋯ Given the rising prevalence of haematological malignancies, pressure on acute services and UK survivorship policy, care may be increasingly shared between secondary and primary care-settings. Challenges include complex shared-care models that lack guidance, workforce issues, and knowledge of haematological malignancies. However, the value patients placed on primary care, coupled with difficulties experienced in hospital clinics, indicate shared care could succeed.
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Death is inevitable. When, however, is bound by uncertainty in frailty. A purely proactive approach to dying - exemplified by the DNACPR (do not attempt cardiopulmonary resuscitation) form - is unrealistic. What does a good death look like - and who decides? ⋯ You only get one chance to die well. Thoughtful and empathetic decision-making in a reactive and complex environment is crucial to supporting patients, loved ones, and clinicians. A one-size-fits-all proactive 'death conveyor belt' is unrealistic.
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Understanding the general public's view about Domestic Violence and Abuse (DVA) is vital, as it would help with the development of targeted interventions and effective public policies to tackle this rising problem in society. ⋯ Community-dwelling adults acknowledge the impacts of abuse, but many fail to recognise specific instances or events in their daily lives contributing to DVA. Raising public awareness, particularly in children through the school curriculum, highlighting existing support services and introducing the routine use of short screening tools for DVA in health and social care settings can increase awareness, early identification and signpost to effective interventions. Sustained, multi-level community-facing interventions are recommended to reduce the stigma and fears associated with DVA.