Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Patients with end-stage head and neck cancer have particular problems because of the impact of the tumour on the airway, the upper gastrointestinal tract and the major senses. Patients referred for palliative care were identified from the hospice database and the nature, incidence and management of their problems, and the role of the hospice in their care, was reviewed from in-patient and home care notes and patient-generated problem lists. Thirty-two male and six female patients with a median age of 64 years were identified. Locoregional recurrence was present in 79% of patients. Pain, weight loss, feeding difficulties, dysphagia, respiratory symptoms, xerostomia, oral thrush and communication difficulties were the major problems. The management of each, and of the terminal events encountered in the group, is discussed.

Academic performance among students studying in rural and urban settings is comparable.

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Two hundred women (148 shared care patients and 52 clinic patients) completed a questionnaire about care received during pregnancy and the use of a patient-held record. Women receiving shared care reported higher levels of satisfaction with their care than clinic patients (p < 0.0001). Thirty-six percent of the women in shared care forgot to take their record to an appointment on at least 1 occasion. During the pregnancy, over half of the respondents in both groups made contact with the hospital for reasons other than for their regular visit. For both groups, convenience was the most frequently reported reason for choosing their model of care. Other important issues for shared care patients were that the service was more personal and more information was provided. Among clinic patients, safety and quality of care were identified as important. Problems involved with the patient holding the only complete pregnancy record are discussed.

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This paper aims to highlight the gap in nursing literature of discussion of the definition of human death--to show that nurses should engage in such discussion. For the nursing role in the care of brain dead patients and their relatives may unwittingly promote and foster a definition of human death which is fundamentally flawed. A person can be warm, pink, have an independently beating heart and be breathing, yet still be diagnosed as brainstem dead. Nursing literature which discusses issues surrounding brain death (as opposed to brain death itself), proposes that nurses should suppress any reservations which they may have in accepting that a patient with the characteristics described is dead; and that they should try to allay any reservations which relatives of such dead patients might have. But what if the concept of brainstem death is flawed? Surely, as accountable professionals, nurses should not accept the role just referred to without satisfying themselves that the concept of brainstem death is coherent and robust. This paper tries to show that, on examination, this is not the case. The definition of human death which guides practice in the UK and elsewhere is fundamentally flawed. Instead of suppressing their own intuitions, and the intuitions of patients' relatives in the management of patients diagnosed as brainstem dead, nurses should critically examine the definition of death which currently informs clinical practice. Our conclusion is that this definition is false.

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