Palliative care in general practice – a new initiative
David Butler
pp 8-10
In 1992, five GP facilitator posts were piloted as part of a new initiative developed by the Cancer Relief Macmillan Fund in partnership with the Royal College of General Practitioners (RCGP). Their objective was: ‘To enhance the continuity and quality of care for the person with an advanced disease, and their family, by providing an experienced General Practitioner to work as a Facilitator with Primary Health Care Teams, to help mobilise existing professional skills.’
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Nurse prescribing in the UK
Anne Williams and Ann Nash
pp 11-15
In 1989, the UK government’s report on nurse prescribing seemed to offer a promising new challenge for nurses. Published at a time of change within health and community care services, it offered an opportunity to improve the quality and continuity of patient care, particularly in specialist areas such as palliative care.
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Malignant bowel obstruction in advanced and terminal cancer patients
Carla Ripamonti
pp 16-19
Bowel obstruction is a frequent clinical complication in patients with advanced abdominal or pelvic cancer and with metastases to the peritoneal cavity. The incidence of bowel obstruction ranges from 5.5% to 42% in ovarian carcinoma and from 10% to 28.4% in colorectal cancer (Table 1). The causes of the obstruction may be benign postoperative adhesions, a focal malignant or benign deposit, relapse or carcinomatosis (Table 2). Benign causes range from 6.1% in ovarian cancer to 48% in colorectal cancer.
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The physiology of somatostatin and its synthetic analogue, octreotide
Marie T Fallon
pp 20-22
Somatostatin is a tetradecapeptide hormone that seems to have a number of different physiological roles in man. This is suggested by its widespread distribution. It was first discovered and characterised as a potent hypothalamic inhibitor of the release of growth hormone from the pituitary.
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Octreotide in terminal malignant obstruction of the gastrointestinal tract
Julia Riley and Marie T Fallon
pp 23-25
In spite of optimal management of terminal intestinal obstruction, in some patients vomiting and nausea frequently continue, resulting in much distress for the patient, relatives and carers. Octreotide may have a role in the management of this group of patients.
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A new treatment option for chronic cancer pain
Detlev F J Zech, Klauss A Lehmann and Stefan Grond
pp 26-30
Over the last 20 years orally administered opioids have become the standard pharmacological treatment for moderate to severe cancer pain. However, oral therapy is often impossible in patients unable to swallow because of head-and-neck or gastrointestinal malignancies, and in patients suffering from the adverse effects of oral opioids or from cancer-related nausea, vomiting or bowel obstruction.
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Assessment and treatment of pain in children in palliative care
Philippe A Poulain, Evelyne M Pichard-Léandri and Annie P Gauvain-Piquard
pp 31-35
Pain in children continues to be inadequately treated because, even in the palliative phase of diseases such as cancer, AIDS or neurological disorders, it tends to be poorly understood and underrated. The younger the child, the more this is so. Nevertheless, the treatment of pain is of prime importance because the efficacy of support and palliative care of the child and his family depends upon the quality of pain relief achieved.
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Octreotide in treatment of AIDS-related symptoms
Sebastiano Mercadante
pp 38-41
Although a number of organisms can be isolated from the faeces of AIDS patients with diarrhoea, evaluation of the role played by each specific organism is made more difficult by the high incidence of mixed infections. The pathogens most frequently isolated from the faeces of patients with AIDS-related diarrhoea are presented in Table 1.
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Children and bereavement – what are the issues?
Frances Sheldon and Julie Tribble
pp 42-44
Working with the children of a family in which someone is dying is one of the most challenging areas for any professional in palliative care. Both before and after the death children may be ignored or removed from the situation. Protecting vulnerable children is a natural, biologically-based impulse felt by most adults.
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Training volunteer trainers
C Fusco-Karmann and Marcello Tamburini
pp 50-51
Did voluntary service give birth to palliative care, or has palliative care created a new kind of voluntary service? Voluntary organisations, with their charitable and humanitarian approach, were the first to recognise the serious reality of terminal patients: they initiated new programmes of care which confronted this problem head on and attempted to resolve it.
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Education and training in palliative medicine in European Community member states
Derek Doyle
pp 52-53
The need for improved professional education and training in palliative medicine is widely recognised. From its founding in 1988, the European Association for Palliative Care (EAPC) has given this matter high priority and published two reports on the current state of education, not only for doctors (‘Palliative Medicine’) but also for nurses, social workers and clergy (‘Palliative Care’) throughout the countries represented in the EAPC.
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Pain and suffering as existential questions in palliative care
Kjell Kallenberg and Carl-Rheinhold Brakenhielm
pp 54-56
In a well-known essay, Albert Camus, the Nobel prizewinning author, examines the myth of Sisyphus. Sisyphus symbolises the human condition. Despite his suffering and endless adversity, he keeps on fighting. Each time he puts his shoulder against that hard rock, he is rebelling against his fate. In the course of his struggle he has no illusions, but he can still find a certain form of happiness.
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Regarding euthanasia
David J Roy, Charles-Henri Rapin and the Board of Directors of the European Association for Palliative Care
pp 57-59
There is currently an extensive debate in Europe concerning the legalisation of euthanasia. Palliative care has also been brought into this discussion because there is confusion in the minds of both the lay public and many professionals about what it is. The Board of Directors of the EAPC has accordingly decided to broach the subject and present a clear and coherent definition.
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