Comment: Do we need Europe in everyday palliative care?
Augusto Caraceni,
pp 183-183
In the last 18 years, the development of the European Association for Palliative Care (EAPC) has paralleled my education, training and professional experience in palliative care, beginning with its foundation in 1988 in Milan, until recently when I had the privilege of being elected a member of the Board of Directors of this association.
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Delirium in terminal illness
James George and Simon Lee
pp 185-187
Delirium, or acute confusional state, is common in terminal illness and occurs in 25–85% of cancer patients before death. The incidence of delirium is increasing because of the aging population. Delirium is an acute, potentially reversible, disorder of cognition and attention caused by physical illness or drugs.
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Methadone: the analgesic
Dean Blackburn
pp 188-191
Methadone is an exciting opioid for a pain or palliative care specialist. There are dramatic accounts of pain relief in patients with previously drug resistant pains. However, its use can be associated with problems, which has led some to view it with suspicion. This paper looks at both sides of the methadone story, including conversion regimes from other opioids and how to manage the potentially difficult problem of breakthrough pain. It suggests that flexibility with and between conversion regimes is probably essential, and that breakthrough dosing should be individualised to suit the patient.
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Case study masterclass 22: A patient with acute myeloid leukaemia
Sue Haig
pp 192-193
Mrs Cooper* was diagnosed in 2001 with myelodysplasia; this transformed to acute myeloid leukaemia (AML) in 2002. She is 37 years old, separated and lives with her two children. They still have contact with their father. Up until recently she was working as a GP’s receptionist; she is also one of the practice patients.
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Case study masterclass 21 answers: A patient with multiple medical problems
Anjali Mullick
pp 193-193
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A neurological respite programme in a specialist palliative care setting
Emma Owen and Miriam Johnson
pp 194-197
A hospice provides specialist inpatient facilities for terminal care and symptom control in terminally ill patients. To varying degrees, it will also provide respite care for patients with chronic degenerative disorders. Recent changes in palliative care services have led to a greater emphasis on short-term admissions for complex symptom control or end-of-life care, rather than longer-term terminal care.
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A review of the literature on hospice or palliative day care
Donna Wilson, Janice Kinch, Christopher Justice et al
pp 198-202
Day care programmes for people who are terminally ill are well established in the UK, and there are examples, in many other countries. A systematic review of the literature was undertaken to gain an evidencebased understanding of hospice or palliative day care. A literature search yielded only 15 research articles. A systematic review and analysis of the content of these articles revealed two predominant areas of research to date: the nature of hospice or palliative day care, and evaluations of the care provided.
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Medically futile resuscitation: can it ever be justified?
Rajeena Ackroyd
pp 207-209
The British Medical Association has said that the primary goal of medicine is to benefit the patient by maintaining his or her health within the limits of ‘maximising benefit and minimising harm’. Therefore, if a treatment does not provide a ‘net benefit’ or fulfil its goal, it is justifiable not to provide it. A treatment that is futile is one that is unlikely to be successful (that is, statistically, the odds of its success are remarkably small).
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A model palliative care organisation in Sweden
Lena Hjelmérus
pp 210-211
At the 2003 EAPC congress at the Hague, Kathleen Foley held a plenary session titled, ‘How much palliative care do we need?’ Her own answer to this question was, ‘Much more than we think.’ She categorised palliative, or end-of-life care as a public health concern. The question she posed is a leading one in many countries, as are the issues it prompts, such as how to deliver advanced medical care, how to ensure access to appropriate drugs, and how to ensure high standards of care.
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Caring for the body at the end of life
Brigitte Eugene
pp 212-214
The palliative care nurse’s role can be enriched by developing a creative spirit in caring for, and building a relationship with, the patient. The definition of palliative care is paying attention to the small details that can improve the patient’s quality of life. The maintenance and continuity of life is the basis of an approach towards creative palliative care. Healthcare professionals who choose to work with terminally ill people promote the care of the body.
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A philosophical consideration of attitudes towards death
Jaime Sanz-Ortiz, Ma Eugenia Vega Villegas, Fernando Rivera, Francisco Javier Ramos and colleagues
pp 215-217
At some point, most healthcare professionals will have to care for patients who are at the end of their lives. Treating people who are dying imposes certain psychological demands that can create disturbing inner conflicts in both patients and professionals, because of a lack of the necessary skills. These conflicts can only be addressed, understood and resolved with proper training.
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UK bereavement services for children and young people
Liz Rolls
pp 218-220
No records are kept of the number of children and young people who are bereaved in the UK, although estimates of those aged from five to 15 who experience the death of a parent or sibling vary from more than 1.4 million a year1 to the more conservative 500,000.2 What is certain, however, is that a significant number of children and young people, together with their families, have to make sense of this experience while still in their developmental stage, and regardless of family and social circumstances.
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