Comment: Alternatives and complements
Andrew Hoy
pp 48-48
Can complementary and alternative medicine (CAM) be regarded as an aspect of clinical practice which should be welcomed and provided for all? The commonsense answer to such a question is to collect and review as much information about alternatives to orthodox medicine as possible, so that a balanced judgement can be made when considering treatment options.
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Terminal cancer pain
Caroline Guindon, Véronique Averous, Hervé Jami and Elisabeth Albanesi
pp 49-53
Oral morphine, by international consensus, is the opioid of choice in the treatment of cancer pain. However, 10% of patients presenting with cancer-related pain and identified as being suitable for morphine treatment will not find appropriate relief. Some patients present with persistent side-effects from morphine (sedation, dysphoria, hallucinations, confusion, nausea and vomiting, multifocal myoclonia, and exacerbation of pain), despite the use of suitable treatment to alleviate these symptoms. Opioid rotation, where one opioid is replaced with another in an attempt to strike a better balance between analgesia and side-effects, presents an interesting strategy for overcoming this problem.
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Gabapentin as an analgesic
Javier Rocafort and Jesús Viguria
pp 54-56
A tumour infiltrating or compressing nervous tissue may produce neuropathic pain and is a common cause of difficult pain problems. In palliative care, this problem is treated with drugs (analgesics, tricyclic antidepressants, anticonvulsants, antiarrhythmics and corticosteroids) and nondrug therapy (transcutaneous electrical nerve stimulation (TENS), acupuncture, physiotherapy or occupational therapy).
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Palliative care in Italy in the new millennium
Oscar Corli
pp 58-60
The development of palliative care in Italy, after almost 20 years of moderate spontaneous growth, has shown a remarkable surge in the last three years. This is due to two main factors. The first concerns the increased awareness of problems regarding terminal patients, for whom it has become common jargon to speak of palliative care and, above all, common practice to turn to organised centres able to provide such care.
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The National Health Service and the care for the dying
Furio Zucco and Annette Welshman
pp 61-65
In these last three years, the palliative care movement in Italy has undergone a particularly exciting phase. Never before has the unnecessary suffering of the terminally ill been such a social issue. The general public and the national and regional health authorities have finally realised that the dying have not been adequately cared for within the welfare state. Italy, with a population of 57 million,
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Insight into palliative care: an audience with the Dalai Lama
Wendy Bainbridge and Elizabeth Baines
pp 66-69
His Holiness the 14th Dalai Lama, Tibetan spiritual leader and exiled head of state, is recognised by Tibetan Buddhists as the manifestation of Chenrezig, the bodhisattva of compassion. He has achieved world renown for his humanitarian views and writings on many subjects including ethics, suffering and dying. His Holiness has been awarded the Nobel Peace Prize for his efforts to find a peaceful solution to the Tibetan issue with China.
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Do-it-yourself funerals and The Natural Death Centre
Stephanie Wienrich
pp 70-72
The Natural Death Centre, a leading light of the UK’s natural death movement, is a charitable project which supports those dying at home and their carers, and helps with the arranging of funerals. It aims to improve the quality of dying (guaranteeing choice for individuals and helping to change attitudes) and runs seminars, workshops and consultations on the broad themes of, ‘Accepting Death and Living Fully’ and, ‘Living with Dying’. Workshops are conducted by two of the centre’s directors, Josefine Speyer and Christianne Heal, who are both psychotherapists by training. The centre’s main resource is The New Natural Death Handbook, which advises on how to care for someone dying at home, how to organise a funeral and how to come to terms with bereavement.
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Improving aspiration technique
Simon Noble, Wendy Leach and Peter Hargreaves
pp 73-73
Malignant pleural effusions are frequently encountered in the hospice setting and are often symptomatic, requiring drainage. Transthoracic needle aspiration is a common procedure, but is not without complications. Pneumothorax, the most serious complication, is life-threatening. A proportion of morbidity may result from poor technique, inability to identify landmarks adequately, poor patient positioning and improper use of needle catheter apparatus.3 Complications from pleural aspiration can be minimised by optimal patient positioning, technique and experience.
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Do companion animals have therapeutic value?
Elizabeth Ockleford and Julia Berryman
pp 75-78
Pets and people have a long association and many believe that pets are beneficial for our health. Pets have been used as therapeutic aids in diverse contexts; for example, psychiatry, nursing homes, intensive care and palliative care, although some argue that their presence in healthcare settings may be dangerous. Experimental studies to ascertain the effects of pets on health have yielded mixed results and are fraught with practical difficulties.
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