Comment: Research and palliative care
Philippe Poulain
pp 48-48
Although the roots of palliative care lie in being human and the ethic of caring, there is, of course, the need to pay attention to research quality as well. Too many of our cherished ideas are based on experience which, although essential, must also be brought under rigorous evaluation.
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Tramadol and cancer pain
Wojciech Leppert, Jacek Luczak and David Oliver
pp 49-51
In most cancer patients pain can be treated successfully with opioid analgesics alone or in combination with adjuvant analgesics. Strong opioids, particularly morphine, are recommended in the treatment of severe cancer pain. Recently, there has been an increased interest in analgesics on step 2 of the WHO analgesic ladder. Tramadol is a weak opioid with a unique mechanism of action, high analgesic efficacy and a beneficial profile of adverse reactions which make it attractive for the treatment of moderate and severe cancer pain.
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The use of quality-of-life instruments in palliative care
Sam Salek, Nutjanee Pratheepawanit, Ilora Finlay and David Luscombe
pp 52-56
Palliative care in an oncology setting involves a broad spectrum of healthcare services. It provides good management of physical, psychological and existential issues of patients and helps those who are dying in achieving the best quality of their remaining life. Incorporating quality-of-life measurement has broadened the full spectrum of the effects of palliative care interventions and reflects true outcomes of a given care.
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Case study masterclass 2: Adenocarcinoma of the sigmoid colon
Carol Davis and Tim Harrison
pp 58-59
A 64-year-old man is referred to your specialist palliative care unit for assessment at home. He is of Indian origin, married with three grown-up children, has lived in England since the age of six and has a large extended family. He speaks English fluently and worked as an accountant until seven months ago – he has been on sick leave since then. He describes himself as a non-practising Hindu. Two years ago he underwent anterior resection of carcinoma of the sigmoid colon. A stoma was formed with a plan to re-anastomose at a later date.
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Case study masterclass 1 answers: Carcinoma of the gastric fundus
Carol Davis and Tim Harrison
pp 59-59
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Developing guidelines for resuscitation in terminal care
Rachel Newman
pp 60-63
In July 1999, a 67-year-old woman with stomach cancer, being treated at a hospital in the South of England, was distressed to see ‘inappropriate for resuscitation in the event of cardiac arrest’ entered in her notes. She complained, and her case received much media attention, alleging discrimination on the grounds of age. A subsequent British Medical Journal editorial on the topic precipitated considerable correspondence. In response, a Health Service Circular was issued requiring that all acute hospitals in the UK update and educate their staff about their resuscitation policies by April 2001.
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Building a specialist palliative care library
Denise Brady
pp 64-67
For those fortunate enough to have a library in their organisation, it is a valuable centralised resource. One can expect to find five main types of material – journals, databases, books, ephemeral or ‘grey’ literature, and access to the internet. There is some overlap. For instance some databases are available on the internet, but in this article they are considered as a resource distinct from databases such as Medline or the Cumulative Index to Nursing and Allied Health Literature.
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Learning to rest when in pain
Margaret O’Connor and Robert Webb
pp 68-71
The development of modern palliative care practice in Australia, akin to other countries, has been distinctive from other aspects of healthcare in addressing symptom management at the end of life, using a bio-psychosocial framework. Thus, access to holistic care delivered by a team of practitioners encompassing a range of disciplines, is the desired palliative care model.
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The UK Forum for Hospice and Palliative Care Services Overseas
Heather Richardson, David Praill and Avril Jackson
pp 72-73
The support of hospice and palliative care services overseas by UK-based organisations and individuals is not a new concept. Indeed, it is a long-established activity and spans a wide variety of input and help, including financial support, advice, training and education. Consequently, there is a growing body of expertise that exists in the UK and a burgeoning number of individuals and organisations who are working towards a common vision of accessible, high-quality palliative care for those who require it, regardless of where they live in the world.
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The view from a bridge
Richard Hain
pp 75-77
The Severn bridge links England and Wales. As one comes off the bridge, a sign says, ‘Welcome to England’. As one drives off the bridge in the other direction the sign reads, ‘Welcome to Wales’. The metaphysical driver may wonder about the nationality of the road between these two signs: the bridge itself. Is it in England or in Wales? Clearly, it is in both. Yet it is not wholly in either; recognisably separate, but identifiable as belonging to both. Specialist paediatric palliative care is a specialty which bridges a number of boundaries, some even more significant than that between England and Wales.
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Determining the need for terminal care for children
Sue Horrocks, Maggie Somerset and Chris Salisbury
pp 78-79
It is clear from Richard Hain’s article that paediatric palliative care is increasing in the UK. How is the level of need determined for children with nonmalignant life-threatening illnesses? The review below highlights a lack of information about prevalence and morbidity, with inconsistent recording and inaccuracies in the literature. It suggests more robust data relating to the need for healthcare are required.
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