Comment: Electronic patient records will benefit palliative care
Michael Thick
pp 265-265
Accountants are catching up with what palliative care physicians already knew: that the direct or indirect spending on end-oflife care now accounts for over 25% of the English health budget. The introduction of an end-of-life care register will provide a mechanism for a much more precise measure of activity involving palliative care services. Given the state of the English economy, there will be considerable pressure to examine the efficiency of service delivery, and the necessary service redesign will have to produce both measurable savings and an increase in quality and safety.
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Medical emergencies – hospice versus hospital
Declan Cawley and Kath Mitchell
pp 266-269
Acute medical emergencies, such as an overdose, whether accidental or intentional, are generally managed within the acute hospital setting. On the other hand, there is a drive to manage patients with advancing disease in a community or non-acute setting, thereby averting acute hospital admissions. However, when such patients present with acute medical emergencies, wider issues regarding preferences and priorities for care, along with the place of care, are important considerations.
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Development of a renal palliative care service
Rajeena Ackroyd and Lynne Russon
pp 270-273
In the UK, end-of-life care for renal patients has been inadequate due to poor patient access to services, difficulties in predicting the disease trajectory and poor links between renal and palliative care physicians. However, it is recognised that there is a growing need for specialist palliative care for patients with advanced chronic kidney disease (CKD).
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Case study masterclass 53: Management of malignant bowel obstruction
Ehab Ibrahim and Carole Willard
pp 274-275
Lilly is a 41-year old woman, married with two children – a 16-year old daughter and an eight-year old son. Before her illness, she was working full-time running a family business with her husband Matthew. In February 2007, Lilly presented with a short history of rapid-onset abdominal distension and pain. Computed tomography (CT) showed bilateral complex ovarian masses with infiltration of the omentum, and a blood test showed that the tumour marker CA 125, a protein, was abnormally high. In March 2007, a radical ovarian tumour resection was performed and histological examination revealed signet ring appearances, consistent with gastrointestinal (GI) tract primary cancer.
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Case study masterclass 52 answers: An unusual case of nausea and vomiting
Felicity Morgan and Philippa Baker
pp 276-276
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Palliative care development is well under way in Portugal
Isabel Galriça Neto
pp 278-281
Portugal is one of the oldest European countries and has been an independent nation since the 12th century. It has 10.6 million inhabitants, of which few are from ethnic minorities. There is only one main language and Catholicism is the dominant religion. The current demographic trend is towards a decrease in the size of the indigenous population. However, the increasing number of immigrants makes up for this.
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Spiritual assessment: more than just ticks in a box
David J Southall
pp 282-284
In the health-related literature in recent years, increased attention has been given to the development of spiritual assessment tools (SATs) relating to supportive palliative care and end-of-life care. The impetus behind such a development may well have come from the increasing prominence of spirituality within palliative care and end-of-life pathways.
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White Paper on improving support for family carers in palliative care: part 2
Sheila Payne and the EACP Task Force on Family Carers
pp 286-290
This is the second part of a two-part paper. In part 1, we considered the definitions and roles of family carers in Europe. In particular, we explored the context of providing care at home, the places of care and death, and the impact of caring on family carers. In part 2, we will consider some of the types of interventions or services that seek to address carers’ support needs, and we will make recommendations for future service provision, research and policy development.
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Towards better and wider palliative care education in the Republic of Ireland
Mary Clodagh Cooley, Orla Keegan and Philip Larkin
pp 292-295
The Republic of Ireland has a long and rich history of palliative care provision, pre-dating the modern hospice movement to the 19th century, when the first hospices outside mainland Europe were established by the religious orders in Dublin and Cork. In 1995, the Republic recognised palliative medicine as a distinct medical specialty, the second European country to do so. Palliative care provision is of a high standard and innovative, with a recent study, Palliative Care in the European Union, ranking the Republic of Ireland second out of the 27 EU member states for vitality and availability of resources for palliative care development.
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Qualitative interviews: introducing the SPEAK tool
Dylan G Harris
pp 296-299
The interview is a widely employed method of data collection in qualitative research. The qualitative research interview attempts to understand the world from the subject’s point of view and to unfold the meaning of their experiences. It has been used extensively in the palliative care setting, for example to explore palliative cancer patients’ views about receiving bad news, and the perspectives of patients with heart failure and lung cancer (and their carers) on their needs and available services. Qualitative interviewing is a craft that requires specific skills on the part of the interviewer.
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A collaborative stent insertion project in Malawi
Elizabeth Fullerton, Alexander Thumbs, Leo Vigna, Jane Bates and Adam Kushner
pp 300-302
Oesophageal cancer is the eighth most common cancer in the world. There were an estimated 529,000 new cases worldwide in 2007. The same year, about 442,000 people died from oesophageal cancer, with 85% of these deaths occuring in developing countries.
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Pain prevalence in advanced cancer patients in Egypt
Samy A Alsirafy, Salah M El Mesidy, Enas N Abou-Elela and Yasmin I Elfaramawy
pp 303-305
In Egypt, a country of almost 79 million people, the estimated number of deaths from cancer exceeded 50,000 in 2008. Although palliative care is the only realistic management approach for cancer patients nearing the end of life, in Egypt, these patients continue to have very poor access to it. This is shown by the very low figures for morphine consumption and the paucity of palliative care activities in the country.
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European insight: Palliative care in Austria: slow start, but great progress since
Herbert Watzke
pp 306-308
Palliative care in Austria started at a slow pace in the mid-1990s, when several hospices were opened and earlier isolated initiatives were acknowledged by the medical community and governmental authorities. Until then, palliative care services had been delivered in nursing homes or run by voluntary organisations.
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