Volume 16, Number 1
 

An update on the Budapest Commitments

Carl Johan Fürst, Liliana de Lima, David Praill and Lukas Radbruch share some of the commitments already made by European palliative care organisations – from the Czech Republic, Norway, Croatia and Austria – and explain how others can participate in the initiative

APM: still much to be done to improve the delivery of care in the UK

The Association for Palliative Medicine of Great Britain and Ireland (APM) was founded 22 years ago and the UK medical specialty of palliative medicine is now 21 years old. This year, the APM published a strategy to take stock of our progress and to plan our activity in the years to come. I have reproduced some of the document in this article and included the summary that encapsulates our ideas.

Are abdominal X-rays useful in palliative medicine?

Ruth L Lagman and Declan Walsh look at how abdominal X-rays could be used more effectively in the general medical and surgical population, and consider their role in acute care palliative medicine, where abdominal symptoms are prevalent

Borderline personality disorder: challenges in the palliative care setting

Tonia M Mezzini and Gregory B Crawford discuss why, in cases of coexisting malignancy and borderline personality disorder (BPD), there needs to be co-ordinated medical and psychiatric care, as well as a management plan, to minimise harm to both patient and staff

Decision-making and the law for patients who lack capacity

Fiona Randall considers the principles of the Mental Capacity Act implemented in 2007, including features that may be controversial when dealing with patients at the end of life

Homage to Vittorio Ventafridda

Andrew Hoy pays homage to Vittorio Ventafridda, who was born in Ragogna, Italy, 29 October 1927 and died in Milan, 23 October 2008

Palliative care at home in cancer patients in Milan

Antonio Bonaldi, Fabio Parazzini, Oscar Corli and Laura Lodetti, on behalf of the Gruppo di Studio Progetto Piano Urbano, report on the results of a study looking at the outcomes on pain, pressure ulcers and dyspnoea in patients treated at home in the last days of life

Palliative care is no longer the Cinderella specialty

For as long as I can remember, palliative care has been the Cinderella specialty. This is not a surprise, as death is taboo in Western cultures. Recently, however, things have begun to change – at local, national and international levels. This is a hugely exciting time to be involved in palliative care, as it gains widespread recognition and acceptance.

The case study masterclass: Case 41 Answers. A patient with advanced oesophageal malignancy who requires tracheal stenting

Grace, a 62-year-old retired publisher, was admitted to the hospice for symptom control. Over the last six weeks, she had developed increasing difficulty in breathing and also in speaking and swallowing. She had a history of oesophageal carcinoma, having presented 18 months earlier with difficulty in swallowing, particularly solid foods. An upper gastrointestinal endoscopy at the time demonstrated a lesion at 28 cm, extending for a distance of 5 cm.

The case study masterclass: Case 42. An elderly patient with opioid-induced constipation

Jean Tremlett was admitted to the palliative care unit as an emergency. She is 79 years old and, 18 months ago, was diagnosed with lung cancer, which was treated with palliative radiotherapy. She has mild-to-moderate dementia and lives in an elderly mentally infirm (EMI) registered home. She has been getting a lot of back pain and is known to have bone metastases in her ribs and thoracic spine. These were diagnosed on a radio-isotopic bone scan. She refused any further anticancer treatment and is not being followed up by the oncologists.

The national end-of-life care strategy: a summary

Maureen McGinn broadly describes England’s first national strategy on end-of-life care, published in July 2008 – in her view, an encouraging document promoting a responsive, accessible service

The value of art therapy – case studies from France

In a French palliative care unit, an art therapy workshop has given patients and their families a tool to express their emotions. Wadih Rhondali, Mario Barmaki and Marilène Filbet have witnessed profound results, as their poignant case studies reveal

Use of microsurgery in lymphoedema management

Ailsa Mitford and Stephen Mason review the current literature to determine whether microsurgery is feasible for patients with lymphoedema who are receiving palliative care