A randomised controlled trial was undertaken to assess the effectiveness of a hospital Palliative Care Team (PCT) on physical symptoms and health-related quality of life (HRQoL); patient, family carer and primary care professional reported satisfaction with care; and health service resource use. The full package of advice and support provided by a multidisciplinary specialist PCT ('full-PCT') was compared with limited telephone advice ('telephone-PCT', the control group) in the setting of a teaching hospital trust in the SW of England. The trial recruited 261 out of 684 new inpatient referrals; 175 were allocated to 'full-PCT', 86 to 'telephone-PCT' (2 : 1 randomisation); with 191 (73%) being assessed at 1 week. There were highly significant improvements in symptoms, HRQoL, mood and 'emotional bother' in 'full-PCT' at 1 week, maintained over the 4-week follow-up. A smaller effect was seen in 'telephone-PCT'; there were no significant differences between the groups. Satisfaction with care in both groups was high and there was no significant difference between them. These data reflect a high standard of care of patients dying of cancer and other chronic diseases in an acute hospital environment, but do not demonstrate a difference between the two models of service delivery of specialist palliative care.
Agate stones have been shaped and polished into beads and other decorative items for thousands of years in Khambhat, India. Agate is a silicate quartz that produces a fine dust when shaped and polished. The people who shape and polish the stones in workshops in their homes are being sickened with silicosis, as are their families and neighbors. These home-based workshops are unregulated and the workers and their families have no access to occupational health services or workers' compensation when they become ill. Occupational health activists have tried to find an effective strategy to confront these working conditions and protect the health and livelihood of the agate workers. They have had limited success, and huge challenges remain.
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