There is a lack of evidence to draw a conclusion about the effectiveness of drug therapy for symptoms of anxiety in adult palliative care patients. To date, we have found no studies that meet the inclusion criteria for this review. We are awaiting further information for two studies which may be included in a future update. Randomised controlled trials which assess management of anxiety as a primary endpoint are required to establish the benefits and harms of drug therapy for the treatment of anxiety in palliative care.

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Sir Á/ There has been a rapid expansion in Consultant numbers in Palliative Medicine in recent years in the UK. We were interested to see whether current specialist training prepared new consultants sufficiently for their new role, and whether any additional management training was necessary. We surveyed Palliative Medicine Consultants appointed in the last five years (n0/99), and 3rd and 4th Year Specialist Registrars (SpRs, n 0/73). Consultants were questioned on their current contracts, job plans and aspirations, and asked to identify the most stressful areas of consultant practice, from a list of 20 items. SpRs were asked to state their career aspirations and the management training experience that they had received, and to identify from the same list of 20 items the components of the consultant role which they anticipated would be the most stressful. The response rate was 66% for consultants and 57% for SpRs. New consultants largely held NHS contracts (83%), in newly created posts (68%), with 47% working full time. Few worked single-handedly (32% hospital; 15% hospice). Most new consultants (94%) managed other doctors, with 67% acting as educational supervisors for SpRs, 62% for Senior House Officers and 53% for non-career grade doctors. Only half of the consultant respondents had an induction period at the beginning of their post. Those who had an induction period largely perceived it to have been useful. Sixty-five per cent were aware of the national APM mentoring scheme, however only two respondents had participated in the scheme. Only 56% reported ongoing support from their employer. The preferred job location for SpRs was a combination of hospital and hospice (26%); hospital alone (14%); hospice (14%); hospice and community (7%); hospice, community and hospital (7%); hospital and university (5%); other (13%); and didn't know (14%). Most (97%) hoped to train junior doctors. Ninety-three per cent had already received some form of management training. This training took diverse forms: a taught course (78%); shadowing a consultant (80%); interviewing (49%); tutorials (41%); and other (14%). Management training courses attended were largely generic (n 0/18), with fewer accessing training specific to Palliative Medicine

To examine the use of palliative care services by patients affected by human immunodeficiency virus (HIV) in hospices which do not specialize in the care of HIV patients, a tape-recorded, semistructured interview was carried out in 12 hospices in the UK. The interview explored concerns about such provision, as well as actual issues encountered. The study revealed that all 12 hospices accepted referrals for people affected by HIV and had clear working practices on infection control. between 1990 and 1996, 48 individuals affected by HIV had contact with the hospices. The number of referrals was not related to the size of the hospice. Thirty-nine individuals had a total of 655 days of inpatient care (range 1-35 days); mean length of stay 12.7 days. Twenty-four (62%) died during their first admission. Referrals came from disparate sources and this affected the amount and type of specialist HIV support available to the hospice. The paucity of referrals raised concerns in most of the units as to how to maintain skills. Issues about maintaining confidentiality of diagnosis in a multiprofessional team, and after death were highlighted. All units expressed concerns about the impact on fundraising of HIV-related admissions. Overall it was felt that the hospice units were failing to meet the palliative care needs of the majority of people affected by HIV or acquired immunodeficiency syndrome (AIDS) in the region. Possible reasons for this are given.

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