Comment: Certainties and questions
Bernard Wary
pp 92-92
The comment by Stein Kaasa, President of the European Association for Palliative Care (EAPC), in the previous edition of the European Journal of Palliative Care, emphasised the development and spread of palliative care in Europe.
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Palliative management of fungating wounds
Wayne Naylor
pp 93-97
When patients have advanced cancer, they often have a number of associated symptoms and problems. One such problem, which occurs in around 5–10% of patients with metastatic cancer, is the presence of a fungating wound. These lesions can present a number of challenging symptoms, such as malodour, high exudate, bleeding and pain, in addition to leading to significant psychological and social difficulties. One aspect of fungating wounds, which makes them particularly problematic, is that they very rarely heal unless the causative malignancy is amenable to treatment with anticancer therapy. In fact, due to the malignant component, a fungating wound is more likely to deteriorate over time.
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End-stage respiratory failure
Charles Shee
pp 98-101
There is increasing awareness that patients with end-stage respiratory disease have significant non-respiratory symptoms in addition to respiratory symptoms. This review will concentrate on people with severe chronic obstructive pulmonary disease (COPD), with particular reference to their last year of life. The term COPD includes chronic obstructive bronchitis and emphysema. The disease predominantly affects the elderly and is usually related to the smoking of tobacco.
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Case study masterclass 9: Rapidly progressing prostatic cancer
Carol Davis and Val Lewington
pp 102-103
Mr Wilson, a 54-year-old patient who has hardly ever seen a doctor prior to this occasion, presents to his GP with two stone (12.5 kg) of weight loss over the past year; feelings of fatigue for several months; low back pain for the past two months; and increased bruising for a week.
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Case study masterclass 8 answers: Is palliative care always helpful?
Carol Davis
pp 103-103
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WHO analgesic ladder – or lift?
Josep Porta-Sales, Xavier Gómez-Batiste, Albert Tuca-Rodriguez, Federico Madrid-Juan, José Espinosa-Rojas and Jordi Trelis Navarro
pp 105-109
Some authors have questioned the validity of the studies used to substantiate the WHO analgesic ladder, and studies that question the usefulness of step 2 on the ladder have added to this criticism. Recently, there has been speculation about whether some opioids have differing therapeutic profiles. Tramadol is not only a mu-agonist opioid but it also inhibits the reuptake of noradrenaline and serotonin, and, hypothetically, this may have added value in controlling neuropathic pain.
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Error management in palliative care
Steffen Eychmueller, Renate Praxmarer, Mirjam Schaller and Paul Glare
pp 110-112
If the engineers of aircrafts dealt with error detection in the same way as the ‘engineers’ of patient’s health do, only adventurers would use aircrafts’ – this statement, or one similar, can be drawn from an article entitled ‘Error in medicine’.
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The Gold Standards Framework in Community Palliative Care
Keri Thomas
pp 113-115
Improving home care for the dying has long been recognised as an important piece of the jigsaw in delivering quality palliative care. Even before the establishment of home care services, generalists provided the mainstay of care at home, and today, especially in rural areas, most are still doing so.
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Advance directives – the ethical pros and cons
Rajeena Ackroyd
pp 116-118
Decision-making can be hard in palliative care, particularly if the patient is incompetent, which means that the patient has lost the ability to understand, reason and retain information in order to make a decision.
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The development of paediatric palliative care in Warsaw, Poland
Michael Wright and David Clark
pp 120-123
In Poland (population 38.7 million) around 1,200 children aged one to 19 years with life-limiting conditions died each year between 1985 and 1996, making a rate of 10.4 deaths per 100,000 children. Seventy-four percent of these child deaths occurred in hospital, while 26% occurred at home; around half of the children died from cancer. At present, 29 palliative care services (five independent, 24 attached to adult services) provide home care for children; two of these services have paediatric inpatient units.
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