A weekend at St Christopher’s
Dame Cicely Saunders
pp 70-71
Some time ago I changed my role from Medical Director of St Christopher’s Hospice to that of Chairman of Council. Even before that, I gave up regular clinical commitments, although I continue to do a weekend on duty every month. The registrars with whom I share this duty (three in all) admit new patients and cover two of our four wards. I cover the other two wards and join the nurses’ handover round on a third.
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Working with children facing bereavement as individuals
Peta Hemmings
pp 72-77
The way in which children face bereavement depends upon a number of factors: their age, their relative maturity and previous experiences of separation and loss. Alongside these elements are those concerned with the relationship between the child, the dead person and, in the case of parental death, the surviving parent. When death is caused by cancer or other protracted illnesses, the child’s actual experience of the illness and level of involvement in the dying are significant factors. This cluster of historical and contemporary elements creates the environment for bereavement.
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Using radioisotopes for bone metastases
Peter Hoskin
pp 78-82
Radioisotopes are unstable and decay to daughter elements with the release of ionising radiation. They may occur naturally or be produced as a result of nuclear fission in a nuclear reactor. The rate of decay is constant and indicated by the half-life of the element, which may range from a few minutes to many years.
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Nutrition for terminally ill elderly patients
Charles-Henri Rapin
pp 84-87
Nutrition for terminally ill patients is an important ethical problem. The ethical discussion centres around sanctity of life versus quality of life, and generally the problems are discussed in legal or moral terms. There have been few clinical studies of nutrition in the terminal period of life that have examined the nutritional behaviour of elderly terminal cancer patients. The most common symptoms are loss of appetite, anorexia, weight loss, weakness and pain.
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Bedside manner revisited: teaching effective interaction
Ann Faulkner and William O’Neill
pp 92-95
Despite awareness of the benefits and pitfalls of interaction between patients and health professionals, the teaching of communication skills has until recently been given scant attention in undergraduate curricula. Most nurses and doctors are left to learn the necessary skills through personal experience and apprenticeship, often with less than adequate results.
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Palliative care in infectious diseases
Daniel Scevola
pp 88-90
Of the 50 million deaths throughout the world in 1990, approximately 18 million were caused by infectious diseases and six million by cancer. In Western countries, progress in laboratory diagnosis and the efficacy of antibiotic therapy have meant that acute infections are rarely fatal: chronicity and complications of infection, and not the disease per se, are the primary causes of death. In addition, cachexia, a characteristic pattern of many longterm diseases, contributes significantly to severe morbidity and mortality.
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Home assessment before discharge from a palliative care unit
Nathalie Stump
pp 96-97
The role of an occupational therapist in a palliative care unit or in the treatment of terminally ill patients is a new one in an already diverse profession. Traditionally, occupational therapists have treated patients with depression, confusion, psychiatric disorders, gait ataxia, muscle weakness, paralysis, pain, orthopaedic conditions and many other functional deficits associated with terminal cancer or, more recently, with HIV and AIDS.
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Catalonia’s five-year plan: preliminary results
Xavier Gomez-Batiste
pp 98-101
In 1989, the Catalan Health Department, in conjunction with the Cancer and Palliative Care Unit of the WHO, began a programme to develop palliative care services in Catalonia. Scheduled to run from 1990 to 1995, the programme was integrated with the ‘Life to the Years’ long-term geriatric programme. It is concerned with basic resources; education and training; the promotion and use of oral opioids; legislative measures, including the identification of resources; a specific financing system; and the elaboration of standards. Between January 1990 and October 1993, a total of 51 teams were set up (nine units, eight support teams in hospitals, and 34 teams in the community), to provide an estimated coverage of 30% by 1994.
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Decisions on life and death
Fiona Randall
pp 102-103
There are two Houses in the British Parliament – the elected House of Commons and the appointed House of Lords. Apart from hereditary Peers, there are, in the House of Lords, distinguished Members with wide knowledge and experience in different areas, including politics, business, law and medicine. If the Government needs advice on a complex topic, it can set up a Select Committee from either House to examine the problem and make recommendations.
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