Comment: Routinisation and medicalisation
Andrew Hoy
pp 178-178
In the last EJPC of the old millennium, let us reflect on the history of the hospice and palliative care movement. Just over thirty years ago, St Christopher’s Hospice in South West London opened after a long, 19-year gestation. Dame Cicely Saunders had found it necessary to create the model modern hospice outside the National Health Service.
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How long have I got? – prognostication and palliative care
Alison Rich
pp 179-182
As professionals, we are frequently asked by patients, ‘How long have I got?’, as if we could see into the future. We are always taught never to give an amount of time to patients – I don’t know how many times I have heard patients say, ‘I was told I’d only live for three months and here I am, six months later’. However, if our patients want information, we have to tell them something. So, what do we say at these times and on what do we base our hunches when we say, ‘weeks rather than months to live’, or ‘days rather than weeks’? Are there any better tools available to inform our predictions, or is there nothing to beat an experienced clinically-based prediction?
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The treatment of sweating
Faeqa Hami and Ivan Trotman
pp 184-187
Sweating (diaphoresis/hydrosis) is a function of the skin by which humans regulate body temperature by evaporative heat loss. The control centre for sweating is in the preoptic area of the anterior hypothalamus. Sweat secretion occurs from two types of sweat gland: apocrine and eccrine. Apocrine glands are found in the scalp, axillae and around the nipples, and secretion occurs in response to circulating humoral factors released in states of arousal.
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Evidence-based palliative care?
Irene J Higginson
pp 188-193
Evidence-based practice is the conscious, explicit and judicious use of current evidence in making decisions about the care of individual patients and is an important aspect of palliative care. However, concerns arise with the use of systematic reviews as a main source of evidence, particularly with their strong reliance on randomised trials.
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Hospice management – translating the vision
Rod MacLeod and Mary Schumacher
pp 194-197
The evolution of the hospice approach to care has been well documented in many books and articles, and numerous overviews of services worldwide have been published. It has been pointed out that with any new development in the approach to healthcare comes a responsibility not just to challenge healthcare professionals in their ways of practice but also to challenge and debate with governmental agencies and their policies.
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The evolution of palliative medicine education in Canada
Doreen Oneschuk
pp 198-202
Unlike other medical specialities, medical education opportunities in palliative medicine have been slow to evolve. This article documents the historical trajectory of palliative medicine education in Canada from 1980 to present day.
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Assessing the outcome of palliative care
Jean-Christophe Mino
pp 203-205
Palliative care seeks to satisfy the needs of patients and their families in several different domains, including the physical, psychological, social and spiritual. Medical literature states that in comparing palliative care with a more ‘conventional’ approach, we refer initially to the traditional procedure for evaluating structures, processes and results, based primarily on an assessment of the care provided. However, medical authors emphasise the difficulty of applying these same analytical methods to palliative care.
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