Around the clock care for dying 'not good enough'

A national review of end-of-life care has found many hospitals are failing to provide face-to-face palliative care specialists around the clock. The review shows only 16 of 142 hospital sites offer specialists on site 24/7. The report is the first since the controversial Liverpool Care Pathway was scrapped. NHS experts acknowledge steady improvements in the last two years, but warn there is still work to do. 'Major deficiencies' The Liverpool Care Pathway was phased out amid criticisms it had been misused as a tick-box exercise, leaving some patients without food and water. In its place a series of guidelines has suggested moving away from a one-size-fits-all approach, instead focusing on individual care. This report, led by the Royal College of Physicians, shows there have been broad improvements in all areas. Researchers found, for example, that communication with patients and relatives had improved. But there were still a number of concerns. In 18% of the 9,000 patient notes researchers examined, there was no written evidence to suggest that do-not-resuscitate decisions had been discussed with relatives or friends. And in around 3,000 notes there was no evidence that the patient's ability to eat and drink had been assessed on the last day of life. But the researchers' main concern was that many patients and doctors did not have full access to on-site palliative care specialists at evenings and weekends. The majority of hospitals did offer a specialist telephone helpline at all times and 53 of 142 hospital sites offered face-to-face palliative care on Monday to Sunday between 9am to 5pm. But for 26 trusts there was no record of face-to-face specialist palliative care involving doctors at any time. Study-lead Dr Sam Ahmedzai, argues the situation is not good enough. He said: "We know that most front-line doctors and nurses giving end-of-life care do it to a very good standard. "But the problem happens when things start to go wrong and often they go wrong out-of-hours in the middle of the night and at weekends. "Then doctors and nurses who may be inexperienced need to be able to access specialists in palliative care." He says without this, patients with complex problems may not get the care they need. Julie Coombes' father found out he had bowel cancer in May 2015. He was in and out of hospital for three months. But Ms Coombes, 33, from Plymouth, says her father didn't feel he had good care there. She says his symptoms and sickness couldn't be controlled, so the family decided to take him out of hospital to die at home. She said: "While he was in hospital the palliative care team came for about five minutes, while he was in his bed with everyone around and just said you are going to die. "Apart from that we did not get any leaflets or any help... It is not something I would want anyone else to experience." 'Not right' Dr Kevin Stewart, of the Royal College of Physicians, said in general he was encouraged by the improvements. But he added: "We are disappointed that there are still major deficiencies in the provision of specialist palliative care at nights and weekends by many trusts; patients and their families deserve the same level of service whatever the day of the week." Dr Adrian Tookman, at the charity Marie Curie, which part-funded the review, said "We can't ignore the fact that the vast majority of dying people and those close to them still have limited or no access to specialist palliative care support when they need it in hospital. This is not right, nor good enough. "Care of the dying has no respect for time, so if we are to deliver a consistent 7-day service by 2020, it is critical that funding is directed towards recruiting and training doctors and nurses to provide specialist care now." NHS England, which commissioned the review, welcomed the improvements, but said it was clear that more could be done. A spokesperson added: "Although this audit presents a snapshot of end-of-life care within NHS hospitals, there are clear variations in the support and services received - and there are areas where improvements must continue to be made."

Cancer Symptoms Women Shouldn't Ignore

Women's bodies are always changing. Sometimes changes that seem normal can be signs of cancer, though.

The key is to pay attention to your body so you can notice when something's different, says Robyn Andersen, PhD, of the Fred Hutchinson Cancer Research Center in Seattle. "New symptoms indicate something has changed in your body, and you want to know what that means."

So, what should you watch for?

1. Breast changes

Most breast lumps aren't cancer, but your doctor should always check them. Let her know about these changes, too:

• Skin dimpling or puckering
• Nipples that turn inward
• Nipple discharge
• Redness or scaling of your nipple or breast skin

To look for the cause of your symptoms, your doctor will do a physical exam and ask you questions about your medical history. You may also have tests like a mammogram or a biopsy, when doctors remove a tiny piece of tissue for testing.

2. Bloating

"Women are natural bloaters," says Marleen Meyers, MD, an oncologist at NYU Langone Medical Center. "It's OK to wait a week or two to see if it goes away."

If your symptoms don't get better with time, or if they happen with weight loss or bleeding, see a doctor. Constant bloating can sometimes mean ovarian cancer. You'll have a pelvic exam as well as blood tests, and sometimes an ultrasound, to look for the cause of the problem, Andersen says.

3. Between-Period Bleeding

If you’re still getting periods, tell your doctor if you’re spotting between them. Bleeding that’s not a part of your usual monthly cycle can have many causes, but your doctor will want to rule out endometrial cancer (cancer of the lining of your uterus).

Bleeding after menopause is never normal and should be checked right away.

4: Skin Changes

A change in the size, shape, or color of a mole or other spot is a common sign of skin cancer. See your doctor for a thorough exam and perhaps a biopsy. This is one time you don't want to wait, Meyers says.

13 Scientifically Proven Signs You're in Love

Valentine's Day is approaching. You have a Valentine…but are you really in love with him or her? With your head spinning from all the heart-shape chocolates and red roses, it can be tough to figure out. Fortunately, scientists have pinned down exactly what it means to "fall in love."
Researchers have found that an in-love brain looks very different from one experiencing mere lust, and it's also unlike a brain of someone in a long-term, committed relationship. Studies led by Helen Fisher, an anthropologist at Rutgers University and one of the leading experts on the biological basis of love, have revealed that the brain's "in love" phase is a unique and well-defined period of time, and there are 13 telltale signs that you're in it.
1. "This one's special"
When you're in love, you begin to think your beloved is unique. The belief is coupled with an inability to feel romantic passion for anyone else. Fisher and her colleagues believe this single-mindedness results from elevated levels of central dopamine — a chemical involved in attention and focus — in your brain.
2. "She's perfect"
People who are truly in love tend to focus on the positive qualities of their beloved, while overlooking his or her negative traits. They also focus on trivial events and objects that remind them of their loved one, day-dreaming about these precious little moments and mementos. This focused attention is also thought to result from elevated levels of central dopamine, as well as a spike in central norepinephrine, a chemical associated with increased memory in the presence of new stimuli. [5 Surprising Animal Love Stories ]
3. "I'm a wreck!"
As is well known, falling in love often leads to emotional and physiological instability. You bounce between exhilaration, euphoria, increased energy, sleeplessness, loss of appetite, trembling, a racing heart and accelerated breathing, as well as anxiety, panic and feelings of despair when your relationship suffers even the smallest setback. These mood swings parallel the behavior of drug addicts. And indeed, when in-love people are shown pictures of their loved ones, it fires up the same regions of the brain that activate when a drug addict takes a hit. Being in love, researchers say, is a form of addiction.
4. "Overcoming the challenge made us closer"
Going through some sort of adversity with another person tends to intensify romantic attraction. Central dopamine may be responsible for this reaction, too, because research shows that when a reward is delayed, dopamine-producing neurons in the mid-brain region become more productive.
5. "I'm obsessed with him"
People who are in love report that they spend, on average, more than 85 percent of their waking hours musing over their "love object." Intrusive thinking, as this form of obsessive behavior is called, may result from decreased levels of central serotonin in the brain, a condition that has been associated with obsessive behavior previously. (Obsessive-compulsive disorder is treated with serotonin-reuptake inhibitors.)
6. "I wish we could be together all the time"
People in love regularly exhibit signs of emotional dependency on their relationship, including possessiveness, jealousy, fear of rejection, and separation anxiety.
7. "I hope we stay together forever"
They also long for emotional union with their beloved, seeking out ways to get closer and day-dreaming about their future together.
8. "I'd do anything for her"
People who are in love generally feel a powerful sense of empathy toward their beloved, feeling the other person's pain as their own and being willing to sacri?ce anything for the other person.
9. "Would he like this outfit?"
Falling in love is marked by a tendency to reorder your daily priorities and/or change your clothing, mannerisms, habits or values in order for them to better align with those of your beloved.
10. "Can we be exclusive?"
Those who are deeply in love typically experience sexual desire for their beloved, but there are strong emotional strings attached: The longing for sex is coupled with possessiveness, a desire for sexual exclusivity, and extreme jealousy when the partner is suspected of infidelity. This possessiveness is thought to have evolved so that an in-love person will compel his or her partner to spurn other suitors, thereby insuring that the couple's courtship is not interrupted until conception has occurred. [5 Strange Courting Rituals from Around the World]
11. "It's not about sex"
While the desire for sexual union is important to people in love, the craving for emotional union takes precedence.  A study found that 64 percent of people in love (the same percentage for both sexes) disagreed with the statement, “Sex is the most important part of my relationship with [my partner]."
12. "I feel out of control"
Fisher and her colleagues found that individuals who report being "in love" commonly say their passion is involuntary and uncontrollable.
13. "The spark is gone"
Unfortunately, being in love usually doesn't last forever. It's an impermanent state that either evolves into a long-term, codependent relationship that psychologists call "attachment," or it dissipates, and the relationship dissolves. If there are physical or social barriers inhibiting partners from seeing one another regularly — for example, if the relationship is long-distance — then the "in love" phase generally lasts longer than it would otherwise.