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International Primary Care Association

Clinical Focus Volume 8 N1

Editor Admin

Editor Admin

Oral health problems are extensive and multi-factorial in nature. Patient outcome will be compromised if there is limited access to trained dental professionals for oral health issues. The increasing number of dental patients going to the General Practitioners (GP) costs the NHS ‡26 million per year. The reasons why patients visit their GP for oral health issues are numerous; however, GPs are not responsible for treating dental patients. GPs do play an important role in identifying patients with undiagnosed dental problems, and being aware of the ones caused by other medical problems. Therefore, inter-professional cooperation is required to reduce the global burden of dental diseases.

Early spring brought atrocious weather, The Beast from the East mingled with Storm Emma, putting pressure on public services across the board. It has illustrated again how much on the cusp such services are performing, particularly the NHS, as additional pressures could barely be accommodated.  

A 37 year old young lady attends the Emergency Department with cough, breathlessness and green phlegm of 3 days duration. She has never smoked and there was no significant past medical history. Her observations were as follows:

A 51 year old man had direct trauma to the left shoulder whilst playing rugby. He had swelling and tenderness around the clavicle. Breath sounds and percussion sounds were normal on both sides. There was no evidence of direct injury of the chest wall. The patient was haemodynamically stable and neurovascular examination was normal. Examine his shoulder X ray (Figure 1)

Within the last year of life many patients are likely to need an integrated palliative approach involving primary care, community nursing and when complex, specialist palliative care. Others may also need palliative care for symptom control and Advance Care Planning (ACP) alongside ongoing interventions for their underlying disease prior to the last year (especially in non-malignant disease when prognostication can be difficult). In these cases, patient need rather than prognosis should ultimately guide your approach.

Following an overview of the public health need for palliative care, trajectories of illness and ACP we present three case studies, identifying key learning points and providing relevant overviews of basic management approaches to common symptoms in palliative care.

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