Volume 16, Number 3
 

Adapting the Liverpool Care Pathway for intensive care units

At The Royal Liverpool and Broadgreen University Hospitals NHS Trust, the Liverpool Care Pathway for the Dying Patient (LCP) has been adapted for use in the intensive care environment. Laura Chapman explains the project and its value

Book review: Palliative Care Formulary Third Edition

The Palliative Care Formulary first appeared in 1998. It has become the distillation of many years of collective wisdom from Sir Michael Sobell House Hospice in Oxford, and Hayward House Macmillan Specialist Palliative Care Cancer Unit in Nottingham.

Hospice and palliative medicine in the USA: the road to recognition

Dale Lupu, Dorothy N Moga, Russell Portenoy and Steven Radwany describe the process of certification and accreditation that has culminated in the formal acceptance of hospice and palliative medicine as a medical subspecialty in the USA

It is our responsibility to promote care, not killing

Those of us who work in palliative care units, looking after many terminally ill patients, aim to mitigate their suffering and help them to live with dignity until they die. However, a vocal media campaign has been promoting assisted suicide as the only sensible way to deal with the uncertainty of dying from terminal illness, the fear this brings and the suffering it engenders. ‘Dignity in Dying’, the new name of the Voluntary Euthanasia Society, reinforces this; and Ludwig Minelli, founder of Dignitas, a ‘centre for assisted dying’ in Switzerland, claims that, to die with dignity, we should be able to determine our ‘date with death’.

NPTN: palliative care comes under the spotlight in the Netherlands

Palliative and end-of-life care in the Netherlands has blossomed since the 1980s, and the Dutch government has drawn up a National Programme for Palliative Care for 2008–2010. Arianne Brinkman and Jaap Gootjes, from the Netherlands Palliative Care Network for Terminally Ill Patients (NPTN), explain the developments

Opioid use in the last days of life: what is good practice?

There has been speculation that some doctors practise a form of euthanasia by escalating the opioid doses of terminally ill patients, effectively hastening their deaths. M Ruth Philp, Marlise Poolman, Nigel P Martin and Matthew K Makin carried out research to see whether there was any foundation to this belief

Recording lives: the benefits of an oral history service

Patients at the Sheffield Macmillan Unit for Palliative Care are invited to produce audio recordings of their life histories. Michelle Winslow, Karen Hitchlock and Bill Noble describe the benefits of this oral history service for patients and professionals alike

Reform and modernisation: developing a new service model for palliative care

Against the background of major changes affecting palliative care, Sonja J McIlfatrick, Donna Fitzsimons, Gail Johnston, Roy McConkey, Margaret Cupples, Owen Barr and Felicity Hasson present an integrated service model that was developed in Northern Ireland to make palliative care more accessible and effective

Summary Care Record – the Bury experience

The NHS is developing a new, electronic model for sharing patient information that will help co-ordinate complex care at the end of life. Caroline Tait, Gillian Braunold, Rob Jeeves, Lynn Hopwood and Michael Thick explain what they hope to achieve by implementing the Summary Care Record (SCR) at NHS Bury

The case study masterclass: Case 43 answers. Fulfilling a patient’s wish to go home from intensive care

Les is a 58-year-old married man with Ebstein’s anomaly, a congenital heart disease, which was diagnosed when he was a young man. The condition encompasses a wide spectrum of anatomical and functional abnormalities of the tricuspid valve. His main problem is long-standing tricuspid valve regurgitation and right ventricular failure. Over recent months, this has worsened and Les has developed chronic renal and liver failure, and rhythm problems. He also suffers from gout, insulin-dependent diabetes and peripheral neuropathy. He is normally an active man who loves the outdoors and working on his allotment.

The case study masterclass: Case 44. A recurrent case of pseudomembranous candidosis

Mary, a 68-year-old woman with advanced metastatic carcinoma of the thyroid, has been admitted to the palliative care unit for symptom control. On admission she complains, among other things, of a ‘dry mouth’, with associated oral discomfort. Examination of the oral cavity reveals clinical features of salivary gland hypofunction (that is, dryness of the mucous membranes and no pool of saliva in the floor of the mouth) and of pseudomembranous candidosis (that is, confluent lesions on the dorsal surface of the tongue and discrete lesions on the remaining oral mucosa). In addition, Mary has poor oral hygiene with overwhelming oral malodour (halitosis).

Where do cancer patients in Taiwan tend to die?

In Taiwanese culture, a ‘good death’ should take place in the main hall of the dying person’s house. Is this happening in modern Taiwan? Ming-Hwai Lin, Heng-Liang Yeh, Szu-Ying Chu, Tzeng-Ji Chen and Shinn-Jang Hwang look at the trends in the place of death of cancer patients over two decades