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Pruritis (severe itching of the skin) is a relatively rare symptom in palliative care, but it can have a negative impact on patients' physical, psychological and social wellbeing. It can also be distressing for family members. Holistic assessment is needed to inform an individual plan of care to alleviate the itching, which will involve general skin-care measures and a combination of topical and systemic treatments.

This is the second in a two-part unit on persistent hiccups in advanced cancer. Part 1 explored the incidence, causes, physiology and adverse effects of hiccups. This part examines both their non-pharmacological and pharmacological management.

This is the first in a two-part unit on persistent hiccups in advanced cancer. It discusses the incidence, causes, physiology and adverse effects of hiccups. Persistent hiccups are a rare occurrence in patients with advanced forms of cancer. However, when they do occur, they can have a significant impact on patients' quality of life.

The opportunity for a patient with advanced cancer to travel abroad may, for some, be a life affirming event during a dark period in their life. For others, what they hoped to be a time of joy may become an unmitigated disaster if they become unwell while away from the safety net of local cancer services. The rise of low budget airlines and cheaper foreign travel has led to an increase in the number of people travelling by air. Health professionals are more likely to face requests by patients to advise them on travel plans. Although foreign travel is an unrealistic goal for some patients, appropriate forward planning and proactive management can allow some patients to make an important journey abroad. This paper looks at the practical issues facing cancer patients who intend to travel overseas and offers practical advice on considerations that need to be made.

Constipation is a common and debilitating symptom in patients with advanced cancer. If ignored, constipation will get worse. If left untreated, it can greatly reduce a patient's quality of life. An improved understanding of bowel function and knowledge of the recognised risk factors will lead to a greater appreciation of the signs and symptoms of constipation.

Nausea and vomiting are commonly experienced by people with advanced cancer. Nausea and vomiting can have an adverse effect on a patient's physical, psychological and social well-being. Knowledge of the physiology of nausea and vomiting will promote a rational choice of treatment. Nurses also need to be aware of non-pharmacological measures that can reduce these distressing symptoms.

The specialist palliative care service continues to evolve, with a growing emphasis on its advisory role to support colleagues in the community and hospital settings. Part of this role involves disseminating knowledge and experience of providing symptom control to patients with advanced malignant disease. As an aid to providing relief from distressing symptoms including pain, agitation, nausea and vomiting, the syringe driver has proven its worth. However, outside the field of palliative care there is often a misunderstanding as to what a syringe driver can offer and its limitations when used. This article aims to explain the role of the syringe driver and to provide practical guidance for its use.

The pathology of falls in older people is often complex and multifactorial. However, falls should not be viewed as an inevitable consequence of ageing. Risk factors can be identified and reduced by taking a multidisciplinary approach. The repercussions after a fall can be far-reaching for individuals, their support network and the NHS. The physical after-effects of a fall are well understood, but the subsequent threats to mental and social well-being are, arguably, more prevalent.

Objective: We evaluated menopausal symptoms, menstrual cycle bleeding characteristics and reproductive hormones for their associations with thyroid stimulating hormone (TSH) concentrations in women at the mid-life from five ethnic groups., Methods: This report is from the baseline evaluation of the Study of Women's Health Across the Nation (SWAN), a community-based multiethnic study of the natural history of the menopausal transition. Enrollees were 42-52 years old (pre- and early perimenopausal) African American, Caucasian, Chinese, Hispanic and Japanese women (n = 3242). Enrollees were interviewed about self-reported diagnosed hypo- and hyperthyroidism or thyroid treatment, menopausal symptoms and menstrual cycle bleeding characteristics. Serum was assayed for TSH, oestradiol, testosterone, FSH and SHBG., Results: There were 6.2% of women with TSH > 5.0 mIU/ml and 3.2% with TSH < 0.5 IU/ml, cutpoints that have been used to encompass clinical and subclinical hypo- and hyperthyroidism, respectively. African American women had significantly lower mean TSH concentrations than Caucasian, Hispanic and Chinese women. Of the more than 15 menopause symptoms evaluated, only fearfulness was associated with having a TSH value > 5.0 mIU/ml (P < 0.008) or < 0.5 mIU/ml (P < 0.02). Women with TSH values outside the range of 0.5-5.0 mIU/ml were more likely to report shorter or longer menstrual periods (P = 0.004 for both) than women within that range. FSH, SHBG, dehydroepiandrosterone sulphate (DHEA-S), testosterone, and oestradiol concentrations were not associated with TSH concentrations., Conclusion: In mid-aged women, there was a 9.6% prevalence of TSH values outside the euthyroid range of 0.5-5.0 mIU/ml. Although TSH was associated with bleeding length and self-reported fearfulness, it was not associated with indicators of the menopausal transition, including menopausal stage defined by bleeding regularity, menopausal symptoms or reproductive hormone concentrations.

Postural hypotension (PH) is a relatively common condition that particularly affects older people. As a symptom it is associated with a variety of conditions and may be a transient or long-term feature, depending on the underlying cause. This article aims to raise awareness of the condition and give practical advice for its treatment.