MRCGP and palliative medicine.
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Biomedical subjects
Publications and source records attributed to I Finlay.
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This study of 20 hospice patients provided baseline information on oral and dental status in the terminally ill. For each patient, a questionnaire was completed, the mouth was examined, and an oral rinse and imprint cultures were collected to establish the prevalence and intra-oral density of yeasts, staphylococci and coliforms. Oral symptoms reported included disturbance of taste (26%), dysphagia (37%), soreness (42%), and dryness (58%). Of the 75% who wore dentures, 71% had difficulty with their prosthesis (es). A clinical diagnosis of oral candidiasis was made in 70% of subjects. The high prevalence of oral symptoms, denture problems, and candidiasis clearly affect the quality of remaining life in terminally ill patients.
No two patients and no two clinical situations are identical. Clinical complexities in care occur in the physical and psychosocial domains, often confounded by the family's views. An ethical framework for clinical decision making is essential to underpin robust management of difficult situations.