Comment: Palliative care teams are good at asking the right questions
Carol Davis
pp 57-57
On the ward, someone is crying out in pain. She is the person I have come to see, and has been referred to our hospital palliative care team for urgent advice about pain from a gangrenous leg. Attached to a cardiac monitor, she is having a blood test.
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Epidural steroid injections for the relief of cancer back pain
Rajesh Gupta, Jonathan Yen and Paul Farquhar-Smith
pp 58-60
Back pain is estimated to affect approximately 70–80% of adults at some point during their lifetime. Overall, 1% of people who present to primary care with back pain have a neoplasm. Most patients with epidural metastases experience pain at some point during the course of their disease and, in 10% of cases, back pain is the only symptom at the time of diagnosis. Pain results from vertebral fracture, spinal instability or nerve root involvement.
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Use of permanent tunnelled catheter drains for pleural effusion and ascites
Muhammad Shahzad Rauf, Richard Casasola and Michelle Ferguson
pp 62-64
Rapidly recurring pleural effusion and ascites are common end-stage complications of many intrathoracic, intra-abdominal and gynaecological malignancies, including various lung cancers, mesothelioma and metastatic disease. They can significantly decrease the quality of life of patients, who are troubled by symptoms such as shortness of breath, abdominal distension, cough and pain. These patients are usually at the end of effective systemic chemotherapy and radiation therapy and have a very poor prognosis.
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Case study masterclass 55: A middle-aged man with opioid-induced hyperalgesia
Nicola Loveday
pp 65-66
Joe is a 46-year-old builder. He has epilepsy and mild hypertension. He is married to Patricia, a 37-year-old teaching assistant. They have two children, aged 11 and eight. A year ago, Joe presented with a testicular lump and was diagnosed with a testicular teratoma that had metastasised to his lung. He was treated with chemotherapy and responded well. A year on, he is being seen regularly in the oncology outpatient department, and appears to have stable disease. However, three weeks ago, Joe presented to his GP with headaches, vomiting and perianal numbness.
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Case study masterclass 54 answers: Complicated home discharge of an elderly patient with hypercalcaemia
Catherine Thomas
pp 67-67
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Is the integration of services good or bad news for palliative care?
Rhidian Hughes
pp 68-71
Integrated services. Inter-professional. Multidisciplinary. Continuous. Whole system. Seamless services. Inter-agency working. Care pathways. And so on … There are a number of terms that have, in recent years, collectively been used to describe better integrated services. Growing attention has been given to integrated services, largely on the grounds of improving the delivery of person-centred care and increasing the efficiency and effectiveness of services.
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The meaning of suffering and death in Buddhism
Robert Jones
pp 72-75
Although often called a religion, Buddhism is different from world faiths like Christianity, Hinduism, Islam and Judaism. Neither is it strictly speaking a philosophy, although in understanding that everything – including the human being – is in a continuous flux, it does share some elements with existential philosophy. Nor is it a psychology, although Buddhist psychology had been developed by the year 500. That said, one is content to leave Buddhism among the generally accepted world religions.
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Why not set up dedicated palliative care units for the elderly in acute hospitals?
Deepak Jain, Karen Bartlam and Evguenia Galinskaya
pp 76-78
The demographics of hospital admissions in the UK have changed significantly over recent years, with elderly patients, particularly the very elderly, accounting for a much greater proportion. Over the ten years to April 2009, inpatient hospital admissions have increased by 35% to 16.2 million. During the same period, the number of admissions of patients aged 65 and over has risen by 54%, and the number of admissions of patients aged over 85 has risen by 84%.
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Developing counselling skills to support bereaved children: an educational initiative
Ann French and Linda Smith
pp 80-82
According to the Childhood Bereavement Network, 78% of children aged 11–16 have experienced the death of a first- or second-degree relative or a close friend. By the age of 16, 4–7% of young people will have experienced the death of a parent. The death of a loved one can have a devastating effect on a child, and many studies have made a link between bereavement following the death of a parent or caregiver in childhood, and psychological and mental health issues in adulthood.
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Tissue donation in palliative care: a review of the literature
Rasha Al-Qurainy and Wendy Prentice
pp 83-85
Tissue donation after death is possible for many palliative care patients. However, anecdotal reports suggest that donation rates are low in this patient population. Previous research in other settings (especially acute medical settings) has often pointed to the failure of healthcare professionals to initiate donation discussions with patients’ relatives, rather than the relatives’ refusal, as the cause for low donation rates in general.
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Spiritual care in palliative care: working towards an EAPC Task Force
Steve Nolan, Philip Saltmarsh and Carlo Leget
pp 86-89
The WHO defines palliative care as ‘an approach that improves the quality of life of patients and their families facing the problem[s] associated with life-threatening illness, through the prevention and relief of suffering’. The definition specifies that palliative carers attempt to achieve this outcome through ‘early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’.
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A medical student’s perspective on ethnic minorities in palliative care
Catriona McNicol
pp 90-92
The city of Leeds has a large black and minority ethnic (BME) population: nearly 11% of the city’s population identify themselves as belonging to a BME group, compared with 7,9% in the UK as a
whole. In 2009, during a five-week hospice placement in Leeds as an undergraduate medical student, I was surprised to not meet a single patient from a BME group. The hospice’s records show that, from April 2008 to March 2009, only 3.2% of referred patients were from a BME group.
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Setting up a palliative care service in Pakistan
Haroon Hafeez and Muhammed Aasim Yusuf
pp 93-96
Palliative care has seen a great deal of development worldwide in the last ten years, and is prominent in WHO programmes for cancer and AIDS. It is estimated that the number of deaths in developing countries will soon reach 50 million per annum, and that at least two-thirds of those 50 million people would benefit from palliative care. India and some African countries have recognised the need for palliative care and, in those countries, considerable progress has been made. However, the advancement of palliative care in many resource-poor countries, including Pakistan, leaves much to be desired.
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European insight: Malta Hospice Movement: palliative care in a tightly knit community
Jacqueline H Watts and Jurgen Abela
pp 97-99
Hospice care is always contextually situated, and the history of the global hospice movement points to different pathways of development across the world. In Malta, hospice care is a relatively recent innovation. Founded in 1989, the Malta Hospice Movement (MHM) introduced hospice care in the country. The aim of this article is to inform readers about the MHM and chart some of the challenges that lie ahead for the provision of palliative care in this tightly knit society.
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