13 e-Letters

published between 2011 and 2014

  • Palliative Care research in the Francophone world.
    David M Fearon

    Dear Editor,

    We read with great interest the paper by Rhondali et al.(1) and we thank them for their contribution to a very worthwhile topic. We are involved in palliative care research in Mauritania, West Africa, and we appreciate this piece of research coming from France and we hope it will stimulate more palliative care research, not just in France but throughout the francophone world. As the likes of Uganda...

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  • Withdrawal of life sustaining medical devices at the end of life.
    James M. Beattie

    I read with interest the letter from McKenna and others describing the evolution of an algorithm to aid decision making in the withdrawal of life-sustaining medical devices (LSMDs) (1). The briefly described scenario involving the development of cancer in a patient with a left ventricular assist device (LVAD) as a bridge to transplantation is familiar to us in cardiovascular medicine, as is the resulting need for decis...

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  • Choice of oral transmucosal fentanyl for breakthrough cancer pain
    Gary J McCleane

    I am perplexed why this paper by Jandhyala and Fullarton has concluded that "FBT (fentanyl buccal tablet) may have some efficacy advantages over ODT (sublingual oral transmucosal fentanyl) and OTFC (compressed lozenge oral transmucosal fentanyl)..." in the management of breakthrough cancer pain when a paper published at the same time in another journal (Smith H, A comprehensive review of rapid-onset opioids for breakthr...

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  • Opinions of patients with cancer on the relative importance of place of death in the context of a 'good death'
    Akon E. Ndiok

    Re: Opinions of the patients with cancer on the relative importance of place of death in the context of 'good death'. By: Melaine Waghorn, Holly Young and Andrew Davies: BMJ Support Palliative Care 2011:1 310-314

    I am grateful for the opportunity to respond to Waghorn et al, 2011 study on opinion of patient with cancer on the relative importance of place of death. Having looked at the four highlighted domains ass...

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  • End of Life discussion in Heart Failure
    Catherine J Doherty

    This study generated discussion in our hospice about the importance of breaking bad news well and also the importance of these discussions in non cancer related disease. It was interesting the study showed 'people with heart failure had engaged in much less discussion about their condition, and most did not recall a specific conversation with their doctor about their prognosis'. I recently reviewed the literature on chr...

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  • Have no fear, morphine is here!
    Catherine J Doherty

    I welcome this small but useful study highlighting the fear and reluctance of patients and practitioners in using morphine in the setting of chronic heart failure. Over 50% of chronic heart failure patients suffer from pain and caution is needed with nearly all analgesics- NSAIDS and COX2 are contraindicated, neuropathics agents can trigger arrhythmias, steroids exacerbate salt and water retention, soluble drugs such as c...

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  • Individual budgets: Avoiding exploitation and postcode lottery
    Santhanam Sundar

    Many patients are ill because of wrong choices they made in their life (eg smoking, excessive drinking, poor diet etc). How are we going to ensure that they make the 'right choices' with their individual budgets particularly if direct cash payments are made? How do we prevent the exploitation of these individuals? This is not a 'paternalistic 'concern. The checks and balances needed would be no more different from havin...

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  • Clarification regarding Milford Care Centre's Compassionate Communities Project
    Dr Kathleen E McLoughlin

    Dear Editor,

    I am delighted to read Abel et al's conceptual paper regarding a social model of care, utilising a compassionate communities framework. As the paper has outlined, Milford Care Centre, Limerick, Ireland commenced a Compassionate Communities pilot project in 2011. This project aims to empower communities and reduce fear and stigma associated with death, dying, loss and care. The project is being led...

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  • Authors' response
    James M Beattie

    We would like to thank Drs Satchithananda, Hookey and Sister Ingram for their interest in our editorial. We welcome this opportunity to respond. We framed our discussion in the setting of left ventricular systolic dysfunction as this is where the robust evidence base for heart failure therapy has evolved. The evidence base for effective therapy for the clinical syndrome of heart failure with preserved systolic functio...

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  • o Response to: 1 Subcutaneous furosemide in advanced heart failure: has clinical practice run ahead of the evidence base? James M Beattie, Miriam J Johnson BMJ Support Palliat Care 2012;2:5-6
    Duwarakan K Satchithananda

    We read the editorial concerning the use of subcutaneous furosemide in heart failure with interest. We feel that there is a substantial opportunity for misinterpretation of the editorial by readers not as familiar with the issues raised as the eminent authors themselves. This particularly relates to: 1 The heart failure syndrome It is important to emphasize that the editorial relates to the treatment of congestive symptom...

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