BackgroundCancer patients increasingly are among older age groups, but to date little work has examined the trends in cancer among older people, particularly in relation to end of life care and death. This study describes the older population who die of cancer and the factors which may affect their place of death.MethodsA Cross-sectional analysis of national data was performed. The study included all people aged 75 and over dying of cancer in England and Wales between 1995 and 1999. The population was divided into exclusive 5 year age cohorts, up to 100 years and over. Descriptive analysis explored demographic characteristics, cancer type and place of death.ResultsBetween 1995 and 1999, 315,462 people aged 75 and over were registered as dying from cancer. The number who died increased each year slightly over the 5 year period (1.2%). In the 75–79 age group, 55 % were men, in those aged 100 and over this fell to 16%. On reaching their hundreds, the most common cause of death for men was malignancies of the genital organs; and for women it was breast cancer.The most frequent place of death for women in their hundreds was the care home; for men it was hospitals. Those dying from lymphatic and haematopoietic malignancies were most likely to die in hospitals, those with head and neck malignancies in hospices and breast cancer patients in a care home.ConclusionThe finding of rising proportions of cancer deaths in institutions with increasing age suggests a need to ensure that appropriate high quality care is available to this growing section of the population.

Purpose Knowledge management (KM) is the central know how for the construction industry. However, the delivery of construction projects is often plagued by schedule delays and cost overruns due to lack of working knowledge of project personnel. Hence, the need to appraise the practices of knowledge management in the construction industry has become all the more germane. This paper aims to determine the awareness of KM practices in Malaysia-based construction small and medium enterprises, and to investigate the benefits, tools and techniques, and challenges associated with knowledge management implementation so that effective measures can be devised to address them. Design/methodology/approach The research data were gathered using a structured questionnaire survey disseminated in the Klang Valley region in Malaysia. Responses were collected from 107 industry practitioners. The quantitative data are subjected to descriptive statistics, and the ranking with category of significance of the hypothesised variables is determined using the relative importance index (RII) technique. Findings The key benefits of KM practices are predominantly raising efficiency, quality, productivity and decision-making. The most preferred KM techniques are “face-to-face interaction”, “mentoring” and “documents and reports”. The highly significant tools are “groupware” and “telephone”. The major organisational issue hampering the implementation of knowledge management practices is “lack of motivation” while the critical cultural issue is relating to “bureaucracy and hierarchical”, and the vital people issue concerns “lack of trust”. Research limitations/implications The respondents were limited to only small and medium construction enterprises located in the Klang Valley region in Malaysia, which makes generalisation challenging. Practical implications KM provides not only a pragmatic but also a proactive approach to raising the competitive edge and capabilities of a construction company. Identification of the critical attributes of KM provides the basis for project managers in formulating KM strategies to enhance the chances of successful delivery of future projects. Originality/value The study contributes to the debate on the knowledge agenda in the construction industry, particularly from a fast developing economy’s perspective, where an effective KM can further contribute to realising a reasonable level of competitiveness operation.

This narrative describes the experiences of an inner city respiratory unit that was transformed to treat COVID-19 patients with continuous positive airway pressure (CPAP) ventilation who were not scheduled for any further escalation in treatment. The high mortality rate and unconventional way of dying led to the creation of local guidance for removing assisted ventilation when the treatment ceased to be effective. We reflect on the specific challenges that caring for these patients holistically has presented and how we have learnt to deliver good palliative care in a unique set of circumstances. We also consider the impact of the pandemic on our team and how the development of a multidisciplinary support system has improved team dynamics and ultimately patient care.

Porokeratosis is a clonal epidermal disorder of keratinization characterized by annular lesions with an atrophic centre and a hyperkeratotic edge. The cornoid lamella is the histopathological hallmark. Six clinical variants are recognized: porokeratosis of Mibelli; disseminated superficial porokeratosis; disseminated superficial actinic porokeratosis (DSAP); porokeratosis plantaris et palmaris disseminata; punctate porokeratosis and linear porokeratosis. Linear porokeratosis is the type most frequently associated with malignant transformation into squamous cell carcinoma (SCC). It is thought to represent a mosaic form of DSAP and has an incidence of less than 1 in 200 000; treatment options are limited. We describe a patient with systematized linear porokeratosis and multiple SCCs who was successfully treated with bleomycin electrochemotherapy (ECT), a form of intralesional chemotherapy. In view of their large number, the individual SCCs were treated with bleomycin ECT. One year post-treatment the patient remains tumour free. To our knowledge, this is the first case of multiple SCCs treated by ECT in the context of systematized linear porokeratosis. Our case highlights the challenges associated with diagnosing and managing this unusual form of porokeratosis.

Systemic mastocytosis (SM) is a myeloproliferative disorder, characterized by a clonal proliferation of abnormal mast cells accumulating in internal organs and sometimes in the skin, leading to cutaneous and systemic symptoms. Mutations within the gene KIT, which encodes the receptor tyrosine kinase (KIT) on mast cells, is found in most patients with SM. We report a case of a 62-year-old woman presenting with a pruritic rash on her limbs and trunk. Several years later she developed gastrointestinal symptoms, associated with raised serum tryptase. Skin and bone marrow biopsies confirmed a diagnosis of SM, initially presenting with urticaria pigmentosa. Responses to multiple therapies, including potent topical steroids, oral antihistamines, phototherapy and the tyrosine kinase inhibitor, nilotinib, were inadequate. Treatment with cladribine (2-chlorodeoxyadenosine) produced a marked and sustained reduction in her symptoms and serum tryptase level.