Building research capacity and capability to enhance the quality of living and dying addressing advancing frailty through integrated care: the ALLIANCE partnership.

Background: Frailty affects around 10% of people aged over 65 years, increasing to 65% of those over 90 years. This number is increasing. Older people with frailty are projected to become the largest future users of care services as they near end of life.

Assessing the sensitivity and acceptability of the Royal Marsden Palliative Care Referral "Triggers" Tool for outpatients with cancer.

Purpose: To evaluate the use, acceptability, and experience of a seven-item palliative care referral screening tool in an outpatient oncology setting.

Methods: A two-phase convergent parallel mixed-methods study. Patient participants who met any of the "Royal Marsden Triggers Tool" criteria were compared with those who did not in terms of demographic data, palliative care needs (Integrated Palliative Outcome Scale, IPOS) and quality of life indicators (EORTC-QLQ-C30).

Registered nurse verification of expected adult death: new guidance provides direction.

Despite UK national guidance on care after death, it is clear that the bereaved family can experience distress while waiting for the patient's death to be verified. This distress can escalate if there is a delay in verification. Anecdotally, such delays particularly occur out of hours and in community settings.

Shifting mindsets: work in progress.

The past few months have seen a hive of activity related to the publishing of reports and documents in the UK. July heralded the arrival of the long-awaited final report on the Palliative Care Funding Review (Hughes-Hallett et al, 2011).

Treating cancer-related breakthrough pain: the oral transmucosal route.

Between 40 and 80% of patients with advanced cancer experience breakthrough pain (BTP), a sudden, rapidly escalating flare of pain occurring against a background of otherwise well-controlled persistent pain. Patients often have up to four episodes of BTP each day, with a typical episode reaching its peak intensity in three to five minutes and lasting about 30 minutes in total. It is essential to provide fast and effective relief since BTP reduces the quality of life of patients and their families, and increases health care costs.

Actiq: an effective oral treatment for cancer-related breakthrough pain.

As a result of improved survival in cancer and the transfer of care from hospital to primary care, community nurses are taking increasing responsibility for the management of patients at all stages of the disease. Persistent or background pain is common, but between 40% and 80% of patients with advanced cancer also experience breakthrough pain (BTP), a sudden, rapidly escalating flare of pain occurring against a background of otherwise well-controlled persistent pain. While background pain can be successfully managed in most patients, BTP presents a particular challenge to community nurses, because short-acting, 'normal release' oral opioid drugs are absorbed too slowly to treat the typical episode.

Fungating wounds: informing practice through knowledge/theory.

The assessment and management of fungating wounds is a challenging situation which necessitates nurses using many skills. Literature is limited, especially relating to the psychological issues that arise for the patient and his/her family. As nurses, we must begin to address this by considering how our philosophy, knowledge and theory impact on and inform our practice.

Lutrol gel: a potential role in wounds?

Excoriated skin from malignant wounds or from their effluent are uncommon but difficult situations. Many preparations are available that may relieve discomfort; however, difficulties arise because such wounds often occur in areas where dressings are difficult to apply and keep in place. Lutrol gel is a thermoreversible gel, first reported as a potentially useful base substance by MacGregor in 1994.