None, absolute, if titrated carefully to effect, though avoidance in children and adolescents has been advised. Codeine might be the only opioid which is not not recommended in those 12-18 years of age, whose breathing might be compromised, eg in those with neuromuscular disorders, sever cardiac or respiratory conditions, chest infection, multiple trauma, extensive surgical… — read more

Repeated rejection in PACES has led me to recall events from my life that were better left forgotten. Of late, my mind has developed this dangerous tendency to create a mental picture of my examiners and try to understand their antagonism by forming nefarious, nebulous connections. So the Consultant who made me forget my neurological… — read more

I recently came across an article by Pask et al on Palliative care : whats the evidence? published in Clinical Medicine which I would encourage everyone interested in navigating the narrow, circuitous and somewhat treacherous lanes of this exacting discipline to consume. The articles seems to be aimed towards addressing the differences between Specialist and… — read more

Like the silent but determined minority, I have been deeply disturbed by the phrase “does not prolong life” in the WHO definition of Palliative care. I have often looked at the passiveness of the experienced and wondered whether I was supposed to emulate them. I have tried but failed spectacularly in not trying to let… — read more

A middle-aged female with advanced cancer admitted for long-term care with poor functional status and lack of a peripheral venous access, who denies any physiological symptoms arising from anaemia, does not receive a transfusion for three months while asymptomatic. The decision to transfuse is made later when she develops signs of breathlessness and swelling in… — read more

Why a clinician, who implores a patient with malignant bowel obstruction on optimal medical management with existential distress to draw upon their inner reserves of strength as a means of coping might be in the wrong. Understanding why the avoidance of moralizing of resilience in an environment of heightened biological constraint might be essential. MBO… — read more

Named after a well known children’s tale involving the eponymous character and three mammals, this principle enquires what is to be considered “just right” in clinical decision making at the end of life. When viewed as a clinical ethical framework for proportionate decision making under demanding circumstances it signifies an attempt aimed towards striking a… — read more

Murray and colleagues were the first to suggest that clinicians might take to prevaricating on end of life issues, when faced with prognostic uncertainty, a phenomenon more likely to be encountered in non-malignant diseases. The absence of a prognostic estimate might lead clinicians to defer decisions related to advanced care planning, palliative care referrals and… — read more

The number of bisphosponate doses before refractoriness can be labelled, has not been defined in standard guidance. Recurrence within days to weeks, despite suitable guideline based medical management should prompt a consideration of this diagnosis. Primary treatment failure, early relapse and recurrent episodes might all be considered in this category. Failure to respond to first-line… — read more

An inadequate response is defined as opioid-induced constipation symptoms of at least moderate severity in at least one of the four stool symptom domains — incomplete bowel movements, hard stools, straining, or false alarms — while taking at least one laxative class for at least 4 days during the past 2 weeks. Prevailing guidelines do… — read more