Comment: Beacons in Eastern Europe
David Clark
pp 180-180
This issue contains the first in a series of five articles describing palliative care ‘beacons’ in Eastern Europe. Beacons serve as examples and sources of inspiration to others. They indicate what can be achieved when the ingredients are present for innovation and sustained development. Such palliative care beacons are not numerous, but have a great deal to teach us.
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Dry mouth and palliative care
Sebastiano Mercadante
pp 182-185
Xerostomia is defined as a subjective sensation of dryness of the mouth, usually associated with hyposalivation. Dry mouth is a very frequent, but rarely recognised symptom in advanced cancer patients. It has been reported to have an incidence rate of between 29–77%. This wide range can be explained by the different methods used to assess xerostomia, lack of homogeneity, and the stage of the illness. However, it seems to be one of the five most common symptoms in cancer patients.
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Diagnosis and treatment of depression in palliative care
Mari Lloyd-Williams
pp 186-188
Depression is the most frequent psychiatric illness in patients with terminal cancer. Depression not only lowers the quality of life for patients and their families, but patients who are depressed may also have physical symptoms that are difficult to palliate and which improve as their depression is appropriately treated. There are many antidepressants available with acceptable side-effect profiles and patients identified as depressed may still benefit from treatment even within the last four to six weeks of life.
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Case study masterclass 5: Fungating carcinoma of the breast
Carol Davis and Maureen Syed
pp 190-191
Mabel is a 78-year-old woman, widowed 15 years ago with one son from whom she is estranged. You are a community specialist palliative care nurse. She is referred to your palliative care service for psychological support. The GP referral letter explains that she saw Mabel for the first time in many years four months ago, complaining of back pain. On examination, there was no spinal or paraspinal tenderness but she had a fungating carcinoma of the left breast.
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Case study masterclass 4 answers: Chronic renal failure
Carol Davis and Tim Harrison
pp 191-191
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Patient-held records: ‘patient-led’ or ‘professionally led’?
Ilora Finlay and John Williams
pp 192-196
Patient-held record (PHR) is a generic term used for any format of record the patient has and in which information relevant to that patient’s health status is recorded. However, to understand the uses and applications of such records, a more refined classification is required. In essence there are two main categories: the patient-led record and the professionally led record.
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The dilemma of therapy
Madeleine Magnan
pp 197-201
This riddle may be familiar to you. Imagine an aircraft that crashes on the border between two countries, country A and country B. The passengers are described in full detail, with their departure point and destination and the aim of their voyage; the accident is described in full technical detail. All this detail, however, merely complicates the mystery, giving us no more than an illusion that we will find the solution. The real question is: where are the survivors buried, country A or country B?
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The development of palliative care in Brasov, Romania
Michael Wright and David Clark
pp 202-205
Romania is a country with widespread poverty, high infant mortality and lower life expectancy than many of its European neighbours. Since the revolution of 1989, there have been far-reaching changes to its political, economic and healthcare systems. In 1999, there were 37,840 deaths from cancer, 168.2 per 100,000. As Romanian hospitals rarely make provision for patients beyond the curable stages of disease, many are discharged home into the care of family members and the patchily distributed primary care services. Estimates indicate that around 90% of cancer patients die at home, 15% are treated with narcotic drugs and 50% suffer unrelieved pain.
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An overview of the Lyon Congress
Michèle Salamagne
pp 206-207
The 2nd Congress of the Research Network of the European Association for Palliative Care (EAPC) was held in France at Lyon from 23–25 May 2002. The summary that follows does not claim to be exhaustive and, with regard to the workshops attended, it is only a reflection of some of the papers. First, we should acknowledge the general quality of the congress. The level of the various contributions confirms the progress made in recent years in the field of research in palliative care. Whether we consider basic research, clinical research or research in the field of ethical studies, the papers open new perspectives: in future, palliative care will develop on more widely validated recommendations of good practice.
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To tell or not to tell
Simon Dein and Kalpana Thomas
pp 209-212
Attitudes towards informing patients that they are dying have changed dramatically over the last 30 years. One American study in 1961 documented that 90% of responding physicians preferred not to tell patients the diagnosis. When this study was repeated in 1979, 97% of responding physicians indicated a preference for telling cancer patients their diagnosis. All the physicians agreed that the patients had a right to know. One study of people’s wishes to be told if they had cancer indicated they themselves would prefer to be told, but were less in favour of recommending that others in a similar position should be informed.
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