Comment: New horizons
Andrew Hoy
pp 136-136
A vibrant discipline will not remain static. Palliative care is no exception to this rule. This is the first issue of the European Journal of Palliative Care (EJPC) after the 2nd EAPC Research Network Congress at Lyon. This was a highly successful meeting, which brought together a fascinating mix of researchers from different backgrounds.
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Sustained-release morphine sulphate in cancer pain
Ans Vielvoye-Kerkmeer, Harm van Tinteren, Carlien Mattern, Johann Schüller and Allan Farnell
pp 137-140
Oral use of morphine (step 3 of the analgesic ladder of the WHO) is the main treatment for chronic cancer pain. The efficacy, safety and dosing frequency of opioid analgesics, and the need for rescue medication, are important considerations in assessing the patient’s quality of life. Oral administration of morphine is simple, convenient, effective and inexpensive, and is preferred, provided that a long duration of action and a stable steady state concentration can be maintained with minimal adverse events. To achieve this specific profile, several sustained-release formulations of morphine sulphate have been developed.
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Can we provide effective palliative care for adults with cystic fibrosis?
Karen Lowton
pp 142-144
At the turn of the 21st century there were around 7,750 people with cystic fibrosis (CF) living in the UK. The improvement in median survival age, from less than one year in the late 1930s to a predicted 40 years for those born in 1990, increases the prevalence of adults living with the disease. In 1997 it was estimated that 2,600 people with CF in the UK were over the age of 16; this figure is growing by about 150 adults per year. Although progress has been made in understanding and treating the disease, three young people die from CF each week.
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Case study masterclass 4: Chronic renal failure
Carol Davis and Tim Harrison
pp 146-147
Mr Bradley is a 54-year-old computer analyst with chronic renal failure secondary to glomerulonephritis. He is married; his wife is a pharmacist. They have two daughters. He was diagnosed eight years ago and was leading a normal life until nine months ago when his renal function deteriorated. Despite interventions, it has continued to deteriorate. At his last outpatient appointment, his urea was 19 and creatinine 280.
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Case study masterclass 3 answers: Small cell lung cancer
Carol Davis and Rachel Newman
pp 147-147
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Training in palliative care
Michel Andrien, Caroline Franck, Isabelle Joslet and Carine Lénaerts
pp 148-149
In 1997, the Belgian legislature expressed a desire to support the palliative care movement by bringing in ‘palliative care associations’, which are also known as ‘platforms’. The palliative care platform in Liège province brings together all the care organisations that include a palliative element. The aims of the platform are to create awareness of opinions, inform professionals, train charitable organisations and encourage teaching in palliative care, and on a wider basis, encourage the sharing of thoughts in multidisciplinary committees.
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Palliative care in psychiatric institutions
Wanda Cabaret, Yacine Krerbi and Djéa Saravane
pp 150-152
All forms of care are required to have a physical and psychiatric dimension. In practice, most medical departments tend to give priority to one or other of these two dimensions, as though monitoring physical health is not compatible with psychiatric examination. It was with the idea of providing ‘total’ patient care that a medical department was created in a psychiatric hospital seven years ago.
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Hospice day care
Simon Noble and Peter Hargreaves
pp 153-155
Day hospices in the UK have seen a massive expansion in numbers over the past 20 years, from 11 in 1980 to 243 in 2002. Those who work in and attend these units give their testimony to the qualitative benefits of such services. In addition to offering patients the chance to socialise and maintain their quality of life it also gives carers an opportunity for respite.
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Spiritual care and spirituality in the hospice movement
Henry Dom
pp 156-159
Spiritual care, as partly practised in the hospice environment, should not be associated exclusively with patients and the terminally ill but should form an integral part of life before and during conception, pregnancy, birth, life, death, and the preparation for eternal life for those who believe in the transmigration of the soul (reincarnation). Spiritual care has to do with the way we view, interrelate with, respond to, and treat God, ourselves, the environment (Mother Nature) and all living entities.
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Developing a multi-agency bereavement service
Barry Wright, Heather Elvans, Philippa King, Jacquie Schneider, Rosemary Thompson and Helen Gillance
pp 160-163
Bereavement may take a healthy course for young people, although in some instances they may feel rejected or isolated, or fear that they will not be understood or might upset others. Role and family changes are common after bereavement and strong emotions and loss of routine may be present. The child’s functioning at school may be affected. Some children suffer significant psychological and behavioural difficulties up to three years after a bereavement and probably beyond.
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What relevance do community hospital beds have for palliative care patients?
Jim Brockbank
pp 164-166
The pressures on the NHS, particularly on acute hospital beds and local authority social services, and the spiralling expenditure and inefficient use of scarce resources have focused the debate on hospital beds. Times are changing and the development of intermediate care services (including beds) has emerged as a policy priority in the current UK government’s plans to modernise health and social care.
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