Comment: Respecting culture near the end of life
Rod MacLeod
pp 57-57
In New Zealand, as in several other countries, death is ‘conspicuous mainly by its relative absence’ in the medical curriculum. Nevertheless, palliative care practitioners are attempting to influence the way people there are cared for.
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Renal failure in palliative care patients
Inger Karin Lægreid and Stein Hallan
pp 58-62
The field of palliative care has expanded substantially during the past 20 years. While initially it focused exclusively on pain in cancer patients, the concept of palliative care has now also been introduced to other categories of terminally ill patients. With the recognition that patients on chronic dialysis have a reduction in life expectancy comparable to that of patients with colorectal cancer, breast cancer and prostate cancer, palliative care in patients with renal failure has received at lot of interest during the past ten years.
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Tracheostomy ventilation in motor neurone disease
Gordon Jackson-Koku, David Oliver and Jackie Fisher
pp 63-66
Providing effective respiratory support in patients with motor neurone disease (MND) is an important aspect of symptom management because death in this condition is invariably the result of respiratory failure. Respiratory support is usually in the form of non-invasive positive pressure ventilation (NIPPV) or tracheostomy ventilation (TV). TV is not as common as NIPPV because it is expensive and can be fraught with complications. This article discusses the use of TV in a patient with MND within a hospice setting. It also discusses epidemiology, clinical presentation, respiratory muscle function and some ethical aspects of TV in MND.
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Case study masterclass 37: A patient with severe opioid-induced pain
Joanne Droney, Sophy Gretton, Wolfgang Koppert and Julia Riley
pp 68-69
A 52-year-old man with a one-year history of metastatic prostate cancer was admitted acutely to an oncology hospital with worsening back pain. He was known to have widespread bone metastases throughout his spine, ribs, iliac joints and shoulders.
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Case study masterclass 36 answers: A complex patient with a thymoma and severe paraneoplastic cerebellar syndrome
Jane Grant and Carol Davis
pp 70-70
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Has Ireland’s national policy benefited palliative care?
Eugene Murray
pp 72-76
In planning for the future of specialist palliative care services, Ireland has been fortunate to have a number of distinct advantages, listed below. It is a relatively developed economy with a high level of per capita income. In 1995, building on a long tradition of hospice care, it became the second country in Europe to recognise palliative medicine as a medical specialty. It is generally committed to international best practice in medical services and works to European and world standards.
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Childhood deaths in Italy
Franca Benini, Anna Ferrante, Silvia Buzzone, Manuela Trapanotto, Paola Facchin and Paolo Cornaglia
pp 77-81
Paediatric life-limiting or life-threatening conditions are defined as progressive, incurable and possibly long-term diseases with which a child will survive, at best, only into young adulthood. Children with life-limiting or life-threatening conditions form a particular population: less than half of them have malignancies, while the majority have a variety of often rare conditions, including congenital abnormalities and chromosomal and neurodegenerative disorders.
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Symptom assessment in terminally ill cancer patients
Giovanni Borrelli, Lorenza Garrino, Alessandro Valle and Mariangela De Pascalis
pp 83-87
Good symptom control is one of the most important factors in an effective, specific palliative care intervention. To determine the ability of a palliative care unit to reduce both physical and psychological distress, it is necessary to measure efficacy. A useful evaluation must include information concerning changes in different symptoms.
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Using restraints – definition, understanding and challenges
Rhidian Hughes
pp 88-90
The restraint of a patient may affront the very purpose and principles of palliative care. However, restraint is an important but under-recognised issue. Practitioners face a difficult situation when delivering care that raises the need to consider restraining a patient. The restraint of people using palliative care services is not only the preserve of care workers and professionals but may also be undertaken by, or at the request of, informal carers and patients’ families.
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Dying without pain: nurses giving morphine in Uganda
Barbara Jack and Anne Merriman
pp 92-95
About 375,000 new cases of cancer are reported in Uganda each year. It is estimated that 95% of these people will experience pain in the terminal phase of their disease. There is a growing number of patients with HIV/AIDS, among whom a number of cancers commonly occur, including lymphoma, cervical cancer and Kaposi’s sarcoma. Furthermore, the disease trajectory of HIV/AIDS can result in approximately a quarter of these patients experiencing severe pain.
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