Comment: Clinical supervision can benefit palliative care
Alun Jones
pp 161-161
Understanding the psychological consequences of serious illness, including how they affect not only the sufferer and family members but also the professionals who provide care and treatment, is of critical importance to the safety and quality of healthcare provision.
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Is the WHO analgesic ladder active or archaic?
Jane C Mair
pp 162-165
In the 1980s, evidence emerged highlighting the alarming percentage of people with cancer who had uncontrolled, severe pain. Daut et al reported that only 25% of those with cancer pain rated it as mild; for the remaining 75%, it was moderate-to-severe. About this time, a group of highly motivated individuals working in the field of pain management, including John Bonica, Kathleen Foley and Vittorio Ventafridda, were campaigning to provide better assessment and control of pain in cancer patients.
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A case of life-threatening dermatological emergency
Nicholas Herodotou, Mandy Barnett, Elaine Riley and Kay Hill
pp 166-167
Toxic epidermal necrolysis (TEN), a severe form of Stevens-Johnson syndrome, is a dermatological emergency. It is a drug-induced or idiopathic mucocutaneous skin reaction characterised by erythema, a macular/purpuric rash, mucosal involvement, blistering of the skin, epidermal necrosis and skin desquamation, leading to massive fluid loss, sepsis and electrolyte imbalance.
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Methods for assessing physical functioning in cancer patients
Guro Birgitte Stene, Stein Kaasa and Jorunn Helbostad
pp 168-171
Most palliative care cancer patients experience a loss of physical functioning and, as death approaches, this has been found to decline sharply. Physical functioning is also an important component of health-related quality of life (HRQoL) and is linked to prognosis of survival. Disease- and symptom-related factors, adverse treatment effects and inactivity may all contribute to a decline in physical functioning, resulting in disability and dependence.
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Case study masterclass 39: Facing an ethical dilemma in a patient with head and neck cancer
Isabel Dosser and Jacqueline S Nicol
pp 172-173
Harry Ford is a 59-year-old man who was diagnosed four years ago with a malignant tumour of the salivary gland with lymph node involvement. He underwent extensive maxillofacial surgery, followed by adjuvant radiotherapy and chemotherapy. A few months ago he had more surgery for local recurrence. He has recently been found to have further recurrence that is invasive and beyond cure. Surgery, chemotherapy and radiotherapy are not an option. He is widowed, has no children and describes his closest friend as being his sister Morag, who lives 350 miles away on Orkney, an island north of mainland Scotland.
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Case study masterclass 38 answers: Severe tenesmus and anal pain as a result of radiotherapy
Zivai Nangati and Bernadette Lee
pp 174-174
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Resuscitation: knowing whether it is right or wrong
Madeline Bass
pp 175-178
The issue of whether, and at what stage, to resuscitate palliative care patients is a long-standing one in the UK. Decisions concerning resuscitation have become increasingly complex with the advance of medical technology and the introduction of more pertinent legislation and guidance, such as the Mental Capacity Act and the updated resuscitation guidelines produced in October 2007 by the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing.
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How are the carers being cared for? A review of the literature
Vanessa Convey, Jill Ede and Tanya Sealey
pp 182-185
The purpose of our study was to identify the information and support needed by carers of the terminally ill or those receiving palliative care. Carers, in this instance, are family members, friends or neighbours. A review of the literature was sponsored by Help
the Hospices’ four-year project, Care for the Carers of the Terminally Ill, funded by the Tubney Charitable Trust. The review was conducted in August 2006 and the content analysis was completed in October that year.
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Palliative care in Europe: experiences and the future
Lukas Radbruch
pp 186-189
Fifteen years ago, at the age of 35, Gisela was treated for cancer of the choroid membrane of the left eye. She had been disease-free after surgery, with enucleation of the eye, until liver metastases were discovered a year ago. Surgery and multiple courses of chemotherapy did not prevent progression, and lung metastases were discovered a few months later. She lost weight and suffered from severe fatigue. She was admitted to a palliative care unit because of severe pain from bone metastases in her lower back and left hip.
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Practices in paediatric palliative care in Lebanon
Huda Abu-Saad Huijer, Sarah Abboud and Hani Dimassi
pp 190-192
Continuous efforts have recently been made to improve paediatric palliative care in developing countries. In Lebanon, palliative care was initially introduced in 1995 through a national cancer control workshop supported by the Ministry of Health and the World Health Organization (WHO). Since then, there have been several workshops and training sessions.
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Ensure quality public health programmes: a Spanish model
Xavier Gómez-Batiste, Frank Ferris, Silvia Paz, Jose Espinosa, Josep Porta-Sales, Jan Stjernswärd and Joaquim Esperalba
pp 194-199
Palliative care public health programmes (PCPHPs) were proposed by the WHO in the 1990s, and have since been developed, to ensure that palliative care is a key element of any public healthcare system. Several programmes have shown good results in terms of coverage, effectiveness, efficiency and satisfaction with the service. When considering how to evaluate and improve the quality of a PCPHP, several approaches can be used, either quantitative or qualitative or both. This article reviews the aims of PCPHPs, the indicators needed to evaluate them and suggested areas for improvement.
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