End-of-life care is that which is provided to patients experiencing a progressive final decline in their lives, usually with a prognosis of less than a year. End-of-life care in non-cancer illness may be challenging for GPs because of the uncertainty about disease trajectory. Patients with non-cancer illness often experience similar symptoms to patients with cancer but for longer hence with a greater impact on quality of life. Only a minority of such patients need specialist palliative care input so the generalist needs to be confident in assessing, treating and supporting patients and families. This article offers suggestions to overcome the challenges along with practical guidance on managing symptoms in the most common non-cancer illnesses.

BackgroundAgitation is a common symptom at the end of life; without prompt assessment and management it can cause significant distress to patients and relatives. Clinical practice in the pharmacological management of intractable terminal agitation varies, particularly if the commonly used agents (benzodiazepines and antipsychotics) have failed to be effective. These difficult clinical scenarios require a robust approach to control symptoms effectively. This review aims to facilitate production of an evidence-based guideline for the use of Phenobarbital for intractable agitation at the end of life, for use within a Specialist Inpatient Palliative Care Unit.MethodA literature search was carried out through EMBASE, Medline, CINAHL and PubMed databases, using synonyms of ‘Phenobarbital’?, ‘Palliative’? and ‘Agitation’? as search terms.Two researchers reviewed the search results. Articles specifying doses of injectable Phenobarbital were included for review. Additionally, in the case of review articles, the original sources stating dosage were reviewed where available.Results11 of the 25 articles from the initial search met inclusion criteria. Of these, 6 were excluded as they lacked sufficient detail. With the inclusion of one further source referenced in a review article, a total of 6 core sources were used. They described various doses of Phenobarbital used for end-of-life agitation.ConclusionsThis review of the current evidence base provided no standard or optimal dosing regime. However, based on the available evidence, a clinical guideline will be produced for use of Phenobarbital in intractable agitation at the end of life in our unit: with an IM loading dose of 200 mg followed by a continuous subcutaneous infusion of 800 mg-1600 mg/24 hrs. Due to the infrequency of this presentation and the use of Phenobarbital; sharing and evaluating the guideline at a regional level would facilitate more rapid efficacy assessment and refinement.

Currently the world is dealing with the infection of COVID-19 which has recently been declared as Pandemic by WHO. The quick spread everywhere throughout the world has raised worries about the chance of transmission of the infection from individual to individual. The present study is aimed to review the information available about COVID19 and similar diseases in Ayurveda literature such asCharakaSamhita, SushrutaSamhita, AshtangaHrudayaandvarious research studies related to the topic.Ayurveda an antiquated clinical science has unmistakably depicted Aupsargikarogas (Communicable diseases), their mode of transmission, cause, cure and prevention too.Janapadodhwamsa,  thediseases which affect a major part of population and itsfour causative factors such as pollution of Vayu(Air) and Jala (Water) along with the changes inKala(Time) andDesha(Region)explained in Ayurveda. With respect to treatment, Ayurveda advocates prevention as the first step and then cure of diseases, through Nidana Parivarjana (Avoidance of causes),Shodhan (Bio purification) and Shaman(Curative and Palliative care). With the help of Panchakarma (Five bio purificatory therapies)and Rasayana (Rejuvenation therapy), these diseases can be prevented well. Ayurveda can be helpful to reduce the morbidity and mortality.The current review portrays how Ayurveda can assist with combatting the developing challenges of communicable infections.

BackgroundA recent report commissioned by Marie Curie found significant inequalities at the national level in the provision of palliative care across several domains, including social deprivation. Given the national inequalities, it is important to explore local variations in service use. Our hospice accepts referrals from areas including some of the 20% most deprived in the country.AimTo determine whether social deprivation influences service uptake at a hospice in south east England.MethodA review of computerised records was conducted for all patients (n=634) referred to the hospice inpatient unit or hospice at home service over a 12 month period (01/10/14–30/09/15). Indices of Multiple Deprivation (IMD) data were used to identify patients from the most deprived quintile. Data collected included demographic background, diagnosis, and referrer, and median scores were compared between the overall patient population and most deprived for duration of service use, preferred and actual place of death.Results14% (n=107) of referred patients were from the most socially deprived IMD quintile of the population. Overall access to hospice services appeared broadly equitable between groups. For patients from the most deprived areas, median time under the care of hospice at home was lower (three vs five days). Once admitted, a stay over 21 days was more likely in the most deprived areas (25% vs 19%). Preferred place of death (PPD) was less likely to be recorded for the most deprived (68% vs. 63%) and home death was less likely (47% vs. 50%). PPD was achieved more commonly in those from deprived areas (87% vs 82%) although place of death was less likely to be recorded. Full statistical analysis to follow.ConclusionsDespite small variations, service use at our hospice appears less inequitable on the basis of social deprivation than the national picture. Investigating local audit data can provide insights regarding current variations between regions of the UK, and these findings require further investigation.

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