Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

The population of older people with multimorbidity has not been routinely recognized as having specialist palliative care needs. However, this evaluation shows that, at first contact, the symptoms and concerns across both service populations was surprisingly similar. Nevertheless, patterns of symptoms may differ between populations over time. Longitudinal prospective data are needed to examine these changes overtime, and the relationship with multimorbidity.

The St. Christopher's Hospice Palliative Care in Dementia Project, funded for 3 years by the King's Fund, aims to investigate the palliative care needs of patients with advanced dementia and their families; to clarify the role of specialist palliative care for this patient group; and to examine the usefulness of one model of working. This interim report outlines findings from the first 50 patients taken on by the project. Early results indicate that both patients and their carers have a high level of unmet need. The model of care chosen for this project appears to meet many of these needs, and appears to be both cost efficient and effective in terms of improving end of life care for dementia patients and their carers.Keywords advanced dementia, end of life care; palliative care Background and rationale At present the Alzheimer's Society estimates that 1.1% of the British population suffer from cognitive impairment, and the figure is set to more than double over the next 50 years due to an ageing population. Some patients die of unrelated causes but a large number die of advanced dementia, or associated co-morbidity. Due to a limited amount of research in this area, we know little of the real symptomatic burden that late stage dementia places on patients or how the care burden impacts on their carers.The Palliative Care in Dementia Project is a three year study which provides specialist palliative care advisory, supportive and educational input to patients with severe dementia, their carers and professionals delivering services to them. It is primarily a clinical project, but has also been used to collect data about people with end stage dementia. Because the area is so little explored, we evaluated this project in some depth. Aims• To investigate the palliative care needs of patients with advanced dementia and their families. • To clarify the role of specialist palliative care for this patient group. • To examine the usefulness of one model of working. Referral criteriaThe project used two types of referral criteria: a combination of general and dementia specific criteria set out for the Gold Standards Framework 435 innovative practice

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in cancer, yet they are also responsible for many, often serious, adverse effects. This review examines the various mechanisms through which NSAIDs work. It looks at the experience built up in using NSAIDs in cancer pain in general, but then particularly examines whether the evidence available supports the claim often made that these drugs have a specific role in relief of pain from bony metastases. Criteria for choosing one NSAID over another, including adverse effect profiles, efficacy and tolerability, are considered, as are methods for improving the safe use of these drugs.

A search of the rat tumor literature revealed no papers on naturally occumng primary osteosarcoma of meninges. In humans, this tumor, arising primarily from the meninges, is unusual; only two cases have been reported. We report on a spontaneously occurring osteosarcoma arising from meninges in a 2-year-old female albino rat. The diagnosis was made on the basis of gross, microscopic, and ultrastructural findings. The diagnosis of this neoplasm is supported by the fact that a primitive mesenchymal cell in the meninges is capable of giving rise to a wide variety of neoplasms.