Anaemia is common in advanced cancer, may develop for several reasons, and is not always symptomatic. Our observations of the seemingly indiscriminate prescription of iron-replacement therapy (IRT) ...for anaemic palliative care patients, and our practice of discontinuing IRT in patients with normal red-cell indices, prompted a study to determine (1) the prevalence of anaemia in our patients, (2) what proportion had iron deficiency, (3) the prevalence and benefits of IRT and (4) the prevalence of side effects attributable to IRT. The prevalence of anaemia was 65%. We found a 9% prevalence of iron deficiency, and suggestive but inconclusive evidence of iron deficiency in a further 41%, but only three (27%) of these patients had typical iron deficiency red-cell indices. Only two patients within the study population were taking IRT. Haemoglobin increased significantly in one, but fell in the other, and both experienced side effects attributable to iron. IRT should neither be indiscriminately prescribed nor withheld for anaemic palliative care patients, and the decision should not be based on red-cell indices alone. When symptomatic anaemia is found in patients whose general condition indicates that IRT would be acceptable, iron status should be fully assessed. A therapeutic trial of IRT may be justified where ferritin is elevated, but other parameters suggest iron deficiency.
The anniversary of a death is perceived as a difficult time by the majority of closely bereaved relatives and friends. Bereavement anniversary cards are supportive and useful in the context of wider ...follow-up. This study identified no strong predictors to indicate those for whom such a card would be inappropriate. Several recipients thought that the card solicited financial support for the hospice.
The long term storage of hospital clinical records is becoming a big problem. A great reduction in the bulk of case notes can be achieved by compartmentalizing unstructured case notes. Such a system ...has many advantages for medical staff, and its widespread use would do much to alleviate storage problems in future years.
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