Does humanity need palliative care?
Alejandro R Jadad and Murray W Enkin
pp 102-103
We have reluctantly come to accept our individual mortality and to embrace palliative care when cure is beyond reach. What if it is time to think of palliative care for our collective humanity?
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Ultimate companionship: the shared journey between patient and family caregiver
Fung Kei Cheng
pp 104-107
Fung Kei Cheng describes her contrasting experiences of bereavement with the deaths of her mother and father, discussing the concept of ultimate companionship and its importance for both patients and their family caregivers.
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Case study masterclass 91: A 39-year-old woman with advanced cervical cancer in resource-limited Malawi
Kate Markham and Jane Bates
pp 108-109
Like many of Malawi’s population of 17 million, Mary lives in a thatched hut, with access to water via a borehole in the village. She has no electricity and cooks using firewood inside her house. In February 2016, Mary starts to develop vaginal discharge and lower abdominal pain.
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Invasive mechanical ventilation: concerns over terminal extubation
Janete Maria da Silva and Ricardo Tavares de Carvalho
pp 110-113
Invasive mechanical ventilation is a common procedure for patients with respiratory failure during the dying process. Janete Maria da Silva and Ricardo Tavares de Carvalho discuss the issues surrounding the appropriate use of this aggressive therapy, the rationale for its timely withdrawal – terminal extubation (TE) – and the lack of protocols for TE.
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Psychological ideas in palliative care: diagnosis and formulation
Jenny Strachan
pp 114-118
One way of thinking about psychological difficulties is to take a diagnostic approach: which category of problem does this patient have? However, when we are working individually with a patient, we find it more helpful to take a formulation approach.
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Palliative care in the intensive care unit
David Oliver and Elena Stanton
pp 119-121
The Hospital Palliative Care Team can prove a valuable resource for the intensive care unit (ICU) for a variety of reasons. David Oliver and Elena Stanton discuss the findings of a study into referrals by the ICU at Medway Maritime Hospital.
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The New Health Foundation: transforming palliative care
Emilio Herrera Molina, Silvia Librada, Miguel Ángel, Tamen Jadad-Garcia, Zacarías Rodríguez and Alejandro R Jadad
pp 122-125
The New Health Foundation devotes its energies to the pursuit of the holy grail of the palliative care community: integrated palliative care. Emilio Herrera Molina, Silvia Librada, Miguel Ángel, Tamen Jadad-Garcia, Zacarías Rodríguez and Alejandro R Jadad explain the Foundation’s programmes and focus on the results emerging from their first national project, in Colombia.
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Diamorphine or alfentanil for subcutaneous use in hospice inpatients?
Paul Perkins, Chris Foy and Marie Fallon
pp 126-128
Opioid rotation is a common practice in palliative care in trying to balance analgesia with side effects. Paul Perkins, Chris Foy and Marie Fallon present the results of a feasibility study conducted to investigate the ability to recruit patients without renal dysfunction to a trial comparing diamorphine or alfentanil for subcutaneous use in hospice inpatients.
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Book review: To Comfort Always – A history of palliative medicine since the nineteenth century
Emily Adam
pp 129-129
Palliative medicine was first recognised as a speciality in 1987. Stretching back as far as the early 19th century, David Clark gives a detailed account of the history of palliative medicine up until today’s modern practice around the world.
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Case study masterclass 91 answers: A 39-year-old woman with advanced cervical cancer in resource-limited Malawi
Kate Markham and Jane Bates
pp 130-131
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Palliative care development and the debate around euthanasia in Portugal
Sara Ribeiro
pp 132-133
A recent manifesto from a left-wing political party in Portugal that set out a defence of the practice of euthanasia, and the emergence of proposed laws to legalise the practice, came as a surprise to some. Sara Ribeiro considers whether legalising euthanasia is an appropriate move in the context of Portugal’s current level of provision of palliative care services.
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Palliative care in Malawi: the current state of services and education
Kate Markham, Cornelius Huwa and Jane Bates
pp 134-139
As one of the world’s poorest countries, with a population beset by ill health and poverty, Malawi is not the first place to expect a surge in the quality of provision of palliative care – and yet that is what the country has seen in recent years, and will continue to see. Kate Markham, Cornelius Huwa and Jane Bates explain how this has come about.
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Information transfer for dying patients moving from home to hospital
Brian Ng, Zafar Iqbal and Marilyn Browne
pp 141-143
Brian Ng, Zafar Iqbal and Marilyn Browne discuss a pilot study that assessed how current practices regarding information transfer and advance care planning in end-of-life care in the UK measure up to the guidance recommended by the National Institute for Health and Care Excellence.
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