Comment: How quick are palliative care doctors to adopt new evidence?
David Currow and Carol Davis
pp 213-213
For palliative care clinicians to incorporate new evidence into their practice, behaviour or beliefs is generally a slow process. There is abundant literature showing that, once a practitioner has qualified, change in practice slows down substantially.
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Understanding the role of cytokines in cancer cachexia
Muhammad Shams Ul Islam and Samina Naz Malik
pp 214-217
Cancer cachexia poses a dilemma over treatment. Cachexia is a complex metabolic syndrome. It is a progressive wasting disease associated with an underlying illness and characterised by the loss of lean body mass (LBM), with or without loss of fat mass. It differs from starvation, where LBM is generally preserved until near death.
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Continuous interscalene nerve block as analgesia for neoplastic brachial plexopathy
Emmanuel Bäckryd, Jan Sörensen and Björn Gerdle
pp 218-220
Neoplastic invasion of the brachial plexus can give rise to severe, intractable pain. Apical lung cancer (or ‘Pancoast tumour’, named after radiologist Henry Pancoast), axillary lymph node metastases, and osteosarcoma of the proximal humerus are examples of cancers that can lead to this severe neuropathic pain condition
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Case study masterclass 52: An unusual case of nausea and vomiting
Felicity Morgan and Philippa Baker
pp 221-222
Gemma is a 78-year-old lady who has oesophageal cancer. Around the time of her diagnosis, ten months ago, she had an oesophageal stent inserted, as she was at risk of developing dysphagia. Gemma lives on her own with her cat. Her nearest relative is her sister, who lives 200 miles away and is herself very frail. Gemma attends the day centre at the local hospice, which she enjoys and finds a source of great support.
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Case study masterclass 51 answers: Low albumin in a woman with metastatic malignancy
Claire Magee
pp 223-223
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The right to the highest attainable standard of health
Peter Hall
pp 224-226
In 1948, in the wake of a second world war marked by incredible atrocities, the newly formed United Nations (UN) adopted the Universal Declaration of Human Rights (UDHR), the foundational document of human rights for the world. It recognises that everyone is entitled to human rights, irrespective of their gender, religion, race, ethnicity or national origin. Human rights are primarily rights that individuals have in relation to governments. In 1966, the two great international covenants, the International Covenant on Civil and Political Rights (ICCPR) and the International Covenant on Economic, Social and Cultural Rights (ICESCR), were adopted by the UN. The former deals mainly with so-called negative rights, such as the right to be free from slavery or torture; the latter focuses on positive rights, such as the right to social security, education and health. These covenants made the rights in the UDHR legally binding.
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'A good death': how does this relate to the national End of Life Care Strategy?
Anne-Marie Raftery and Carole Willard
pp 228-231
In recent years, there has been increasing concern about the quality of care offered to those at the end of life, as well as renewed interest in the idea of dying well and achieving what is commonly referred to as ‘a good death’. In the UK, this has led to the NHS National End of Life Care Programme and, in 2008, the Department of Health’s End of Life Care Strategy. This strategy sets out an ambitious framework to eliminate inequality of care for the dying and promote ‘high quality care across the country for all adults approaching the end of life’. High-quality end-of-life care incorporates notions of dying well and accomplishing a good death, both of which gave the impetus for the development of the hospice movement and continue to be central principles underpinning all palliative care services, regardless of locality.
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Measuring quality of life in end-of-life care: the ADA audit tool
Keri Thomas and Collette Clifford
pp 232-236
'Measuring care is vital if we are to be able to improve it.' This applies to end-of-life care as well as to other areas, and yet palliative/end-of-life care has always been an intrinsically difficult area to measure in any meaningful sense. There have been particular difficulties in knowing which outcomes and processes in end-of-life care can be realistically measured, and in developing a simple, user-friendly means to do so. We can all fall into the trap of making important what can be measured, rather than measuring what is important, not least in this sensitive area around death and dying, where clinical deterioration is the norm, ethical minefields abound, and individual variations mean that what is right for one person may be wrong for another.
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White Paper on improving support for family carers in palliative care: part 1
Sheila Payne and the EAPC Task Force on Family Carers
pp 238-245
This is a two-part paper: Part 1 provides the background and context of the challenges facing family carers of dying patients, Part 2 makes some recommendations for improving support and services to carers. The purpose of this European Association for Palliative Care (EAPC) White Paper is to highlight the contribution of family carers to the care of patients in the palliative phase of illness. It is written for clinicians, managers, educators and policy-makers working in, or responsible for, palliative care and hospice services in Europe. The information presented in this White Paper is the result of a scoping of the literature that focused on the situation of, and issues faced by, carers in palliative care settings internationally. It offers an integrative review of the most relevant, significant and oftcited papers from the palliative care literature published between 2004 and 2009 by recognised researchers.
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Budapest commitments in China: from desire to action
Mei Qi, Chen Yuan, Qin Shukui, Xie Guangru, Wang Jiejun, Liu Aiguo, Yin Jiliang, Qiu Hong, Cheng Yi, Sheila Payne and Yu Shiying
pp 246-248
The Budapest Commitments are a joint initiative launched in Budapest in 2007 by the European Association for Palliative Care, the International Association for Hospice and Palliative Care and the Worldwide Palliative Care Alliance to provide a mechanism for setting goals to improve palliative care. Now these Commitments have come to China.
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A day in the life of Rebecca Callanan, Nurse Specialist
Rebecca Callanan
pp 250-251
My day starts at 8am. Today, I have three visits booked, a meeting at a local GP practice to discuss the Gold Standards Framework (GSF), and a list of phone calls to make to patients and district nurses. I must also call Diana, whose partner Edward died yesterday at the hospice. In addition, I have a ‘to do’ list of referrals to be made and paperwork to be completed. I check my caseload list: currently, I am responsible for 36 patients.
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Homage to Eric Wilkes
Michelle Winslow, Ruth Ostrovskis-Wilkes and Bill Noble
pp 252-253
Apioneer of the UK hospice movement, Professor Eric Wilkes died at the age of 89 on 2 November 2009 at his home in Calver, Derbyshire. He built the first modern hospice outside London, invented the day hospice and was instrumental in setting up two national organisations that shaped UK palliative care. In the early years of the hospice movement, Eric aimed for palliative care to be integrated with other health services, in hospital wards, day care units and at home. His early vision of palliative care as a public health priority is echoed in the 2008 End of Life Care Strategy for England.
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European insight: International Observatory on End of Life Care: researching palliative care
Sheila Payne and Michael Bennett
pp 254-256
The International Observatory on End of Life Care (IOELC) was established by Professor David Clark and Reverend Dr Michael Wright in 2003 to map palliative care developments throughout the world. Based at Lancaster University, it is now a globally recognised centre of excellence for research in palliative and end-of-life care. It is one of the leading international academic centres in end-of-life studies and plays a major role in delivering research that influences the strategic direction of service development nationally and internationally. It is unique in that its focus is on research that has a practical impact, linked to the development of supportive relationships with a range of service providers across the world.
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