The British journal of general practice : the journal of the Royal College of General Practitioners
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Complexity theory has attracted considerable attention in recent years, both within medicine and in the wider world. Its themes of uncertainty and non-linearity resonate deeply with the experience of working in general practice. Describing the consultation as a complex, adaptive system provides a coherent theoretical basis for understanding the consultation, which has so far been lacking. Understanding the consultation as a complex, adaptive system offers insights into the consultation of that may prove to be of practical use to clinicians.
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Multicenter Study
Care of people dying with malignant and cardiorespiratory disease in general practice.
Provision of palliative care for people dying with malignant disease is a well-characterised aspect of general practice workload. The nature of end-of-life care of people with non-malignant disease is less well described. ⋯ People who died with cardiorespiratory disease were less likely to be in receipt of formally identified terminal care and were likely to have had fewer drugs prescribed for palliation than people with malignant disease, yet they make similar demands of practices. They are likely to have unmet needs with respect to palliation of symptoms.
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Although it is becoming acknowledged that pain management is generally poor for older people, little is known about pain management for nursing home residents in the United Kingdom, and the specific problems for those with cognitive impairments. ⋯ It is not clear why those with greater cognitive impairment received fewer analgesics than others. More research is needed into the relationships between pain assessment, pain experience, cognitive impairment, and analgesic provision. It is likely that improvements in carers' knowledge of pain assessment and the risks and benefits of commonly used analgesics could improve analgesic provision.
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Recent research shows that health professionals do not communicate about prognosis with patients with chronic obstructive pulmonary disease (COPD) as openly as with patients who have cancer. ⋯ A number of suggested strategies can be used to facilitate discussion of prognosis with patients who have severe COPD.