Comment: Managing expectations
Professor the Baroness Ilora Finlay of Llandaff
pp 179-179
Palliative care has come of age. In the last 12 months, there have been 90 references to palliative care in the UK Parliament. It is worth noting that palliative care has featured in several Bills as well as in questions and statements. The Bills include the NHS Community Care (Delayed Discharges) Bill, Patients’ Protection Bill, Regional Assemblies (Preparations) Bill and the Patient (Assisted Dying) Bill. What are the implications of all this awareness about palliative care? Recognition brings with it responsibilities; expectations are high and the price of failing those expectations may also be high.
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Mesothelioma and asbestos – from magic mineral to public health disaster
Helen Clayson
pp 181-185
Mesothelioma is a fatal malignant disease of the mesothelial membranes – usually the pleura – but it may also affect the peritoneum and, rarely, the tunica vaginalis of the testis. It is caused by exposure to asbestos; this occurs mainly in the workplace, although paraoccupational and environmental exposures are responsible for a small proportion of cases. Mesothelioma is resistant to all treatment modalities and few patients survive for more than 18 months after diagnosis.
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Treating diabetes mellitus in palliative care patients
Caroline Usborne and John Wilding
pp 186-188
Diabetes mellitus (DM) is a syndrome arising from the absence of, or tissue resistance to, insulin resulting in chronic hyperglycaemia. Its prevalence (currently 2–4%) is increasing, particularly in Western ethnic immigrant minorities. Studies have suggested that there is a higher incidence of diabetes in the palliative care setting than in the general population. This probably reflects the age range of our patients and frequent use of diabetogenic drugs, such as corticosteroids, octreotide and diuretics.
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Case study masterclass 11: Sequelae of cauda equina compression
Carol Davis, Helen Kirk and Susan Collins
pp 190-191
Mr Cohen, a 73-year-old, retired, Jewish optician is referred to the specialist palliative care unit for rehabilitation following radiotherapy for cauda equina compression. He is a widower; his wife died eight years ago. His daughter married an American and has lived in America for ten years. His main family support is from his sister who lives locally.
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Case study masterclass 10 answers: Presentation of lung cancer and diabetes insipidus
Carol Davis, Helen Kirk and Susan Collins
pp 191-191
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The treatment of hiccups in terminal patients
Janet Hardy
pp 192-193
Ahiccup (or hiccough) is an involuntary spasmodic contraction of the diaphragm, causing a beginning of inspiration that is suddenly checked by the closure of the glottis, hence the characteristic sound. Hiccups can pose a major problem if they do not settle spontaneously after a brief period.
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Resuscitation in the media: does it matter?
John Tercier
pp 194-197
It has been pointed out that in terms of its influence on the general level of health in the population, ‘cardiopulmonary resuscitation (CPR) doesn’t matter much’. Despite the fact that CPR has very limited efficacy, it does matter, but in areas very different from medicine’s usual arena of action. The most striking success of CPR over the last 40 years has been less in its clinical efficacy than in its colonisation of the media – less in the number of lives saved on the street than in its ubiquity on the television screen.
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The relationship between palliative and intensive care
Nathalie Bailly, Michel Perrier, Marie-France Bougle, Christine Colombat and Philippe Colombat
pp 199-201
In intensive care units, where treatment failure is common and patients have very poor prognoses, nurses are confronted with the problem of patient support. Even though priority is, quite rightly, given to technology in these units, it is a great pity that the palliative aspect is not more often addressed. As Malacrida stresses, it is essential, whatever department is involved, to set up a three-cornered relationship between the patient, their family and the medical team to adapt the patient’s course of treatment as satisfactorily as possible.
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Palliative care at the Institut Català d’Oncologia, Barcelona
Xavier Gómez-Batiste, Josep Porta, Albert Tuca and colleagues
pp 202-205
Palliative care services have been established in all settings of the healthcare system, including hospices, hospitals, community health centres and at home, and have adapted to meet diverse needs, demands and cultural situations.
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Caring clowning as a healing art in palliative care
Jenny Thompson-Richards
pp 206-208
For people facing life-limiting illnesses, the need to honour and use humour can be pivotal. Humour helps many people to regain a good sense of self. A life-limiting illness still offers opportunities for the therapeutic use of humour.
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Caring for terminally ill children in the home setting
Angélique Sentilhes-Monkam, Marie-Pascale Limagne, Alain Bercovitz and Dominique Serrÿn
pp 209-211
Seriously ill children, especially terminally ill children, and their families often express the desire to stay at home rather than in hospital. However, what sort of care are they receiving? In June 1998, the François- Xavier Bagnoud Centre, in partnership with the Fondation de France, began a study to investigate the requirements necessary and the potential obstacles that need to be overcome to set up a home care system for terminally ill children. We wanted to find out where children live out the remainder of their lives and what can be done to improve the conditions for taking care of them at home.
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