Comment: Love and loss: a timely tribute
Andrew Hoy
pp 179-179
Many people, both within and outside the United Kingdom, will have marked the 40th birthday of St Christopher’s Hospice this year. One such celebration took place at the Royal Society of Medicine in London on 13 July. It was organised by St Christopher’s and took the form of a Festschrift for Colin Murray Parkes.
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Tramadol: a review of this atypical opioid
Andrew Dickman
pp 181-185
Tramadol was synthesised in 1962 and entered clinical practice in Germany in 1977. It was launched in the UK in 1994 and is now available in more than 80 countries. In the UK, it is available in immediate-release and modified-release formulations and as a solution for intravenous and intramuscular injection (although unlicensed, this can be given subcutaneously). In other countries, tramadol is available in a variety of additional formulations, including oral drops and suppositories.
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Treating cancer patients with anorexia-cachexia syndrome
Arnoud Templeton, Aurelius Omlin and Florian Strasser
pp 186-190
Most patients with advanced cancer are confronted with involuntary loss of weight (cachexia) and loss of appetite (anorexia). This anorexia-cachexia syndrome (ACS) is presently defined as loss of weight (³2% in two months or ³5% in six months) and appetite (³3/10 on a visual analogue scale), and reduced nutritional intake (<75% of normal).
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Spiritual care: making it happen
Marijtje Drijfhout and Catherine Baldry
pp 191-193
It has long been recognised that the spiritual needs of patients and carers may change over time and in response to clinical care. As patients may express their needs only once, it is important for those assessing need to be highly attuned to the spiritual dimension of patient care. Over the past 20 years we have moved from a situation where Dame Cicely Saunders encouraged nursing staff to take time to ‘share the silence’ with patients to one where we attempt to use tools to evidence staff competence in delivering spiritual care.
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Case study masterclass 34: Referring a patient with terminal breast cancer for genetic testing
Miriam Colleran, Aileen Butler and Liam O’Síoráin
pp 194-195
Mary*, a 46-year-old woman with breast carcinoma, extensive skeletal metastases and leptomeningeal disease, was admitted to your specialist palliative care unit. Mary was married and living with her husband. She had two daughters and a son, all in their twenties. She had received her most recent disease-modifying agent, intrathecal chemotherapy, approximately a month before. On admission, her main symptoms were severe anorexia, dysphagia, oral discomfort and ataxia, mild weight loss, weakness (in particular of her hips), drowsiness and dizziness. She had difficulty with oral hydration prior to admission. She had a history of falls at home. Mary’s mother had died of ovarian cancer at the age of 54. Of Mary’s three sisters, one had died of breast cancer, one had a history of bilateral breast cancer, and the other was currently receiving treatment for breast cancer.
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Case study masterclass 33 answers: Managing an elderly patient with motor neurone disease
Laura Booth and Bernadette Lee,
pp 195-195
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Caring for young adults with rare neurological conditions
Nicola King and Beverley Barclay
pp 200-203
Agrowing number of children with congenital conditions are now surviving into adulthood, thanks to advances in medical care. They suffer from rare metabolic or neurodegenerative conditions that most doctors may vaguely recall hearing about at medical school, but have never encountered in real life. Those with severe cerebral palsy or static brain damage are also living longer because the widespread use of percutaneous endoscopic gastrostomies has allowed them to benefit from better nutrition.
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Decision-making for renal patients at the end of life
Helen Noble, Julienne Meyer and Jackie Bridges
pp 204-207
The kidney was the first human organ to be replaced by a machine, when the ‘artificial kidney’ entered the medical arena with the first human dialysis in 1924. A practical artificial kidney, or dialyser, came about through advances in science, followed by the acquisition of new synthetic materials, which made the application of these ideas possible. The apparent high cost and limited availability of this form of treatment immediately raised new ethical questions about equity of access to treatment, when and if treatment could be denied, and the difficult decision of when, once established, it should be stopped.
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Pain control in peripheral arterial occlusive disease
Marie Joseph
pp 208-209
Age, smoking, diabetes mellitus, hypertension and hyperlipidaemia are predisposing factors for peripheral arterial occlusive disease (PAOD). If PAOD is not amenable to surgery, it leads to chronic limb ischaemia. This in turn leads to claudication pain, often in the calf muscles on exercise, ‘rest pain’ in the affected foot, chronic indolent skin ulceration and eventual gangrene. The ischaemic ulcer pain has a neuropathic component, due to ischaemia from the affected vasa nervorum, resulting in quite severe, unremitting pain, with ‘shooting’ or ‘burning’ characteristics. These clinical features lead to impaired quality of life.
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Did doctors defy Pope John Paul II’s wishes on treatment?
Tomasz Dangel and Marek Wichrowski
pp 210-213
Pope John Paul II’s terminal state deserves a thorough medical and bioethical enquiry, something this brief paper does not aspire to represent. Rather, it is our wish, on the basis of available materials, to voice our doubts regarding the use of a respirator and the resort to aggressive therapy when the Pontiff was terminally ill.
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