eLetters

29 e-Letters

  • 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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  • 'Compassionate community networks: supporting home dying ': useful parallels from previous practice
    Clare M Carolan
    The introduction of a novel scheme in Weston-super-Mare described by Abel et al.,[1] which utilises a health care mentor to assist palliative care patients identify supportive networks within their communities and seeks to foster the development of compassionate community networks is to be congratulated. While the scheme is undoubtedly innovative in a palliative care setting a comparable model was initiated in a generalist commun...
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  • Re:A response to 'Increased mortality in parents bereaved in the first year of their child's life': Statistical points and possible extensions
    Mairi Harper

    We are grateful for the opportunity to respond to Chu and Percy's interesting comments on our paper. We accept that older and younger age may be associated with more medical problems in mothers and this could explain some of the higher mortality in bereaved parents versus non- bereaved parents, however the increased mortality findings were demonstrated for fathers as well as mothers. Although the age of the mother may ex...

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  • A response to 'Increased mortality in parents bereaved in the first year of their child's life': Statistical points and possible extensions
    Wing B Chu

    We read with interest the article by Harper et al in the last edition of this journal (2011;1:306-309). By establishing a correlation between infant mortality and the increased mortality risk of the parents, the article speaks, albeit indirectly, to the possible links between emotional and physical states - a topic of important and growing interest. However, two points present themselves about the authors' analysis - the f...

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