Comment: A thought-provoking and stimulating Lisbon Congress
Jayne Wood
pp 161-161
On 18–21 May 2011, the 12th Congress of the European Association for Palliative Care (EAPC) was held in the vibrant city of Lisbon. The capital of Portugal, with its stunning architecture and historic centre, provided an exceptional backdrop for this important event held in high esteem by those involved in delivering evidence-based, quality palliative care. It was opened by rousing performances from Carminho, a fado singer, and the Orquestra Tocá Rufar. The Congress saw delegates come together from all over Europe and the world, keen to share their experiences and learn from others, with the goal of delivering optimal care to those with a diagnosis of life-limiting illness and optimal support to their carers.
|
How to manage the palliative care needs of a cancer patient who has porphyria
Rajeena Ackroyd, Rachel Sheils and Helen Dove
pp 162-165
Cancer patients often suffer from co-morbidities that have implications for the management of their malignancy. Porphyrias (from the Greek porphyra, meaning red or purple) are a group of rare metabolic disorders characterised by a specific defect in one of the enzymes of haem synthesis that disrupts normal haem production. This causes an overproduction of porphyrins (intermediates of haem synthesis), which accumulate to cause different clinical symptoms. Porphyrias are classified according to whether their effects occur predominantly in the liver – hepatic porphyrias – or in the red cell precursors of the bone marrow – erythropoietic porphyrias.
|
The role of cannabinoids in the management of pain: history and current insight
Jonathan Yen and Paul Farquhar-Smith
pp 166-169
There is increasing evidence that cannabis and cannabinoids are useful in the treatment of chronic pain, as well as in the treatment of other symptoms such as nausea and spasticity. Cannabis has been used in herbal remedies for thousands of years. It has attracted renewed attention since the late 1980s, when the endogenous cannabinoid system was discovered. This article will discuss the endocannabinoid system, explain its relationship with pain pathways, and examine the clinical evidence for treating pain with cannabinoids.
|
Case study masterclass 57: Managing a patient with diabetes at the end of life
Claire Magee
pp 170-171
David is a 75-year-old man who lives with his wife. He has a daughter, a son and four grandchildren who all live locally. He has had diabetes for many years and uses insulin. His control has often been poor. He also has a past medical history of ischaemic heart disease, osteoporosis and paranoid depression.
|
Case study masterclass 56 answers: Management of bleeding in a cancer patient with deep venous thrombosis
Ehab Ibrahim and Kim Steel
pp 172-172
|
How Lisbon reached out and the world reached back
Roman Rolke, Farina Hodiamont, Helmut Hoffmann-Menzel, Franco de Conno and Lukas Radbruch
pp 173-175
In her lecture at the opening ceremony of the 12th Congress of the European Association for Palliative Care (EAPC) in Lisbon, Dame Barbara Monroe, from St Christopher’s Hospice in London, told two stories. The first was that of a man in the final days of his life and his pregnant wife, bearing a child who might never be able to see his father. The baby was delivered before its due date so that the family could be together for at least a short while. The father died shortly afterwards. Barbara Monroe clearly and vividly described the newborn child with his father, mother and older sibling, and how the team at St Christopher’s accompanied this young family facing both death and birth.
|
Germany has adopted a charter for the care of the critically ill and the dying
Friedemann Nauck and Karin Dlubis-Mertens
pp 176-178
In September 2008, the Deutsche Gesellschaft für Palliativmedizin (DGP – German association for palliative medicine), the Deutscher Hospiz- und PalliativVerband (DHPV – German hospice and palliative association) and the Bundesärztekammer (BÄK – German medical association) jointly initiated a project focused on needs of the dying, which was funded by the Robert Bosch-Stiftung (Robert Bosch Foundation) and German cancer aid (Deutsche Krebshilfe e.V.). Two years later, after an intensive work process, the Charter for the care of the critically ill and the dying in Germany was consensually approved, on 17 August 2010.
|
The meaning of suffering and death in Hinduism
Henry T Dom
pp 179-181
Hindu theology states that the real self (atman) is eternal, made of spirit (brahman), taking on a temporary material covering (that is, the physical body) and that, by identifying with matter (prakriti), it becomes entrapped in illusion (maya). Impelled by lust, greed and anger, the soul endures the cycle of repeated birth and death on its journey through creation, sometimes reaching a higher or lower birth. Human life gives it the opportunity to achieve liberation (moksha) from this perpetual cycle and to reidentify with the eternal Supreme through devotional service (bhakti yoga).
|
Granting access to deceased patients’ records: the practice of a UK hospice
Malcolm Payne
pp 182-185
Compared with hospitals and GP practices, where requests to access patients’ records are more likely to come from living patients, palliative care settings receive frequent requests for access to deceased patients’ records. Palliative care records can be a significant source of information for those going through bereavement. Should access to records be facilitated for family members (or others) after patients have died? Although each country has its own legal and administrative framework, the account of practice in a UK hospice given here identifies ethical and practical issues that are relevant everywhere. This paper reports on the 24 requests for access to the health records of deceased patients received in 2010 by St Christopher’s Hospice in London (which has an annual patient workload of around 2,000) and how the hospice responded.
|
Use of cardiopulmonary resuscitation in UK and Irish hospices: a postal survey
Alan McPherson, Max Watson and Scott A Murray
pp 186-189
Cardiopulmonary resuscitation (CPR) is an increasingly important, yet highly contentious, issue for hospice staff. Growing numbers of patients are now admitted to hospices earlier in their illnesses, and some still receive disease-modifying treatments when CPR may be clearly appropriate. This has led to the publication of guidance regarding the use of CPR in hospices, which in turn has given impetus and direction to CPR decision-making and ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) policies in hospices. It is now a requirement for all hospices to have a CPR/DNACPR policy in place.
|
Physiotherapy in palliative care: the interface between function and meaning
Andrew Goodhead
pp 190-194
In October 2010, St Christopher’s Hospice in London hosted ‘Physio Europe and Beyond’, a conference aimed at exploring the challenges faced by physiotherapists working in end-of-life care. I led a workshop that looked at the relationship between physical ability and meaning-making. This article expands on that presentation.
|
Introducing clinical psychology support into community palliative care
Sue Smith and Susan Hennessey
pp 195-197
In 2008, two clinical psychology posts were commissioned by Tower Hamlets NHS. The aims were to create a seamless psychology service; to provide psychology support closer to, or in, people’s homes; and to develop support for staff, for people living with a diagnosis of cancer (as well as other life-limiting conditions) and for other significantly involved persons. The creation of these posts occurred in the context of a number of key governmental policies, guidelines and initiatives. The posts have been created, and are currently occupied, by the authors of this article.
|
Identifying the risk of pressure sores: is the Waterlow scale a valid stand-alone tool?
Melissa Carson
pp 198-201
Within any community palliative care setting, the primary goal is to promote patients’ quality of life. Palliative patients often experience high levels of fatigue, significant weight loss and increased exposure to moisture (through, for example, incontinence or diarrhoea) – all factors which increase the risk of them developing pressure sores. Preventing pressure sores is imperative, as healing is improbable. The Waterlow scale is often used in the palliative setting to determine a patient’s risk of developing pressure sores, and to provide a rationale for the level of pressure-redistributing equipment required by a hospital or hospice. However, the question remains as to whether the Waterlow scale is adequate as a stand-alone instrument to measure the risk of pressure sores in the palliative population.
|
European insight: Access to opioids in Ukraine: an international meeting in Kiev
Lukas Radbruch
pp 202-203
In March 2011, a two-day workshop on ‘Ensuring Access to Opioids’ took place in Kiev, Ukraine, organised by the International Association for Hospice and Palliative Care (IAHPC), the European Association for Palliative Care (EAPC) and the Ukrainian League for Hospice and Palliative Care (LHPC). The LHPC, which has been formed recently, held its second meeting just before the workshop.
|