Comment: Beyond the borders
Carol Davies
pp 51-51
The palliative care movement has always looked beyond conventional boundaries. During the mid-twentieth century, a frame of reference was developed outside the orthodox biomedical model. Not only was symptom control as opposed to disease control embraced as a legitimate aspiration, but the professional oligarchy was challenged by the idea of the expert patient. Patient-centredness became a reality. Consumerism was applied to healthcare. The patient’s social milieu gained importance, and family and bereavement care was accepted as an obligatory part of whole person palliation. These were breaches of biomedical, professional and social borders.
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Oral ketamine in patients with difficult cancer pain
Imke Strohscheer
pp 54-56
Pain is one of the most frequent symptoms among cancer patients with advanced disease. Nearly 90% of these patients can be treated well using the principles of the WHO pain ladder. However, there remains a group of cancer patients with difficult pain syndromes. Around half of these problems are caused by neuropathic pain, opioid tolerance or opioid-induced pain.
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A review of the management of malignant ascites
Nancy Preston
pp 57-60
Ascites is the build-up of fluid in the peritoneal cavity. It can result from both malignant and non-malignant causes. Ascites is associated with a number of symptoms, including abdominal distension, fatigue, indigestion and shortness of breath
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Case study masterclass 19: A complex patient with metastatic renal cell carcinoma
Jane Grant
pp 62-63
A 54-year-old woman, registered disabled, with a complex medical history of rheumatoid arthritis and ischaemic heart disease presents with metastatic renal cell carcinoma. The hospital palliative care team receives a referral from the oncology team requesting symptom control advice for the patient. Her problems relate both to her chronic disease state and to her new diagnosis of metastatic malignancy.
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Supporting palliative care in care homes – the way forward?
Annette Edwards and Pat Hirst
pp 64-68
In the UK, as in many countries in the world, we are living longer. Improved social conditions, such as sanitation and better healthcare, as well as falling fertility, have all contributed to changing the demographics of our society. In 1901, males born in the UK could expect to live to around 45 years of age and females to around 49 years. By 2002, male life expectancy at birth had risen to almost 76 years and for females to just over 80 years. There were 380,000 people aged 90 and over in Great Britain in 2002, more than triple the number in 1971. Projections suggest this trend will continue, with an estimated 497,000 in 2012.
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Legal matters concerning euthanasia at European level
Charlotte Coblence, Eytan Ellenberg, Marc Guerrier and Emmanuel Hirsch
pp 69-73
In October 2002, an examination of the Commission for Social Issues, Health and Family Matters from the Parliamentary Assembly of the Council of Europe revealed that 32% of doctors had granted a request for euthanasia.
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Bereavement visiting in the community
C Paul Lyttle
pp 74-77
According to Byrne and Raphael, there have been few published descriptions of the specific nature of bereavement reactions in older people. An even greater paucity of material exists in the literature dealing specifically with older people’s and community nurses’ experiences of bereavement visiting. Literature specifically relevant to district nurses and health visitors will be the subject of this review. It will also include critical comment related to the delivery of spiritual healthcare.
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Nurse-led home care services for children in Germany
Stefan Friedrichsdorf, Sandra Brun, Andrea Menke, Christine Wamsler and Boris Zernikow
pp 79-82
More than 1,500 children die in Germany each year from life limiting conditions. Little is known about the provision of paediatric palliative care by nurse-led home care services on a nationwide scale. A survey among 132 German nurse-led home care services for children identified 37 services that have gained experience in caring for dying children between 2000 and 2002. Details were disclosed about the respective services (including number of staff, funding and provision of care) and their paediatric patients (such as diagnoses, reasons for referral to a paediatric hospital and place of death).
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Communicating palliative care through images
Sylvia Sauter and Carl Johan Fürst
pp 83-84
In Eastern and Central Europe, there are many unmet needs with regard to medical care in general. The need for palliative care is immense, but it is at the lower end of the priority list. This unethical attitude within a society with very small resources spent on healthcare is displayed by this cynical quotation from a physician not working in palliative care, ‘Why bother to waste resources on the ones dying when there is not enough to take care of those surviving?’ This gives some perspective on the complications caused by economic difficulties, limiting attitudes and ethical dilemmas.
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