Background The prompt availability of medications to manage symptoms is key to high quality end-of-life care and anticipatory prescribing of these drugs is thought good practice. This study explored the challenges encountered by primary and community health professionals in Leicestershire and Rutland related to anticipatory prescribing when caring for terminally ill patients who wish to remain at home to die. Method A qualitative study was conducted using eight focus groups (54 participants) and nine individual interviews with a purposively sampled range of health professionals providing care for people who wished to die at home. Themes were identified iteratively via constant comparison. Results Challenges fell into four categories: resourcing concerns, professional expertise/ experience, professionals' relationships with patients, and professionals' relationships with other professionals. The latter included the most serious perceived challenges. Links between community and hospital care providers and between 'usual' hours and 'out-of-hours' care providers were seen as particularly unstable. Conclusions These findings suggest that building and maintaining trusting, responsive, personal links between professionals, both within and between teams, is essential when implementing good practice guidelines about anticipatory end-of-life prescribing in the community. The need for good communication and relationships between patients and professionals and maintaining expertise and confidence in end-of-life care are also key factors in the effective use of anticipatory prescribing for symptom management for dying patients.

Education and self-management for people newly diagnosed with type 2 diabetes: a qualitative study of patients' views. Chronic Illness, 4, 28-37. DOI: 10.1177/1742395307086673 Abstract Objectives: We explored the perceptions, views and experiences of diabetes education in people with type 2 diabetes who were participating in a UK randomised controlled trial of methods of education. The intervention arm of the trial was based on DESMOND, a structured programme of group education sessions aimed at enabling self-management of diabetes, while the standard arm was usual care from general practices.Methods: Individual semi-structured interviews were conducted with 36 adult patients, of whom 19 had attended DESMOND education sessions and 17 had been randomised to receive usual care. Data analysis was based on the constant comparative method. Results: Four principal orientations towards diabetes and its management were identified:'resisters', 'identity resisters, consequence accepters' 'identity accepters, consequence resisters' and 'accepters'. Participants offered varying accounts of the degree of personal responsibility that needed to be assumed in response to the diagnosis. Preferences for different styles of education were also expressed, with many reporting that they enjoyed and benefited from group education, though some reported ambivalence or disappointment with their experiences of education. It was difficult to identify striking thematic differences between accounts of people on different arms of the trial, though there was some very tentative evidence that those who attended DESMOND were more accepting of a changed identity and its implications for their management of diabetes. Discussion:No one single approach to education is likely to suit all people newly diagnosed with diabetes, though structured group education may suit many. This paper identifies varying orientations and preferences of people with diabetes both towards forms of education and self-management, which should be taken into account when planning approaches to education.Keywords: type 2 diabetes, qualitative research, diabetes self-management. Education and self-management for people newly diagnosed with type 2 diabetes: a qualitative study of patients' views.

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In this article, multiparous and primiparous women of White and Indian ethnicity were interviewed about their postnatal experiences. Low staff levels on hospital wards was apparent to new mothers, some of whom left hospital earlier than planned because of this perceived lack of support and care. There is an apparent mismatch between expectation and the service that can be provided. Provision of care by family and community midwife fills the needs of mothers after a short period of surveillance and practical advice received in hospital. Anxiety was expressed about going home. Comments on all issues revealed no particular difficulties according to ethnic or religious background or experience of motherhood.

Evidence concerning the incidence and nature of abuse of the elderly comes mainly from North America. We explored the experiences of abuse of older women and caretakers in three European countries and investigated services available to abused older women. Just less than 20% of our sample of women older than the age of 59 had experienced some form of financial, psychological, or physical abuse. Of those mistreated, 24% reported abuse ongoing over years, and 39% reported distressing effects persisting for years. European support services are only beginning to focus on this problem, and further research is needed to define the best practices.