Objective: To understand some of the cross-cultural issues in providing palliative care to aborig... more Objective: To understand some of the cross-cultural issues in providing palliative care to aboriginal patients. Sources of information: MEDLINE (1966 to 2005), CINAHL, PsycINFO, Google Scholar, and the Aboriginal Health Collection at the University of Manitoba were searched. Studies were selected based on their focus on both general cross-cultural caregiving and, in particular, end-of-life decision making and treatment. Only 39 relevant articles were found, half of which were opinion pieces by experienced nonaboriginal professionals; 14 were qualitative research projects from nursing and anthropologic perspectives. Main message: All patients are unique. Some cultural differences might arise when providing palliative care to aboriginal patients, who value individual respect along with family and community. Involvement of family and community members in decision making around end-of-life issues is common. Aboriginal cultures often have different approaches to telling bad news and maintaining hope for patients. Use of interpreters and various communication styles add to the challenge. Conclusion: Cultural differences exist between medical caregivers and aboriginal patients. These include different assumptions and expectations about how communication should occur, who should be involved, and the pace of decision making. Aboriginal patients might value indirect communication, use of silence, and sharing information and decision making with family and community members.
Objective: To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcot... more Objective: To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) during labour. Quality of evidence: MEDLINE was searched and the references of 2 systematic reviews and a meta-analysis were reviewed to find articles on obstetric analgesia and pain measurement. The 33 articles selected included 14 studies, 1 meta-analysis, and 2 systematic reviews, all providing level I evidence. Main message: The literature supports use of ITN as a safe and effective alternative to epidural anesthesia. The recent decrease in rates of episiotomies and use of forceps during deliveries means patients require less dense perineal anesthesia. The advantage of single-dose ITN is that fewer physicians and nurses are needed to administer it even though its safety and effectiveness are comparable with other analgesics. Use of ITN is associated with a shorter first stage of labour and more rapid cervical dilation. A combination of 2.5 mg of bupivacaine, 25 microg of fentanyl, and 250 microg of morphine intrathecally usually provides a 4-hour window of acceptable analgesia for patients without complications not anticipating protracted labour. The evolution in dosing of ITN warrants a re-examination of its usefulness in modern obstetric practice. Conclusion: Physicians practising modern obstetrics in rural and small urban centres might find single-dose ITN a useful alternative to parenteral or epidural analgesia for appropriately selected patients.
Malcolm Brigden, MD, FRCPC, FACP is Provincial Practice Leader in Medical Oncology at the Saskatc... more Malcolm Brigden, MD, FRCPC, FACP is Provincial Practice Leader in Medical Oncology at the Saskatchewan Cancer Agency, and formerly was a Medical Oncologist at the Thunder Bay Regional Health Sciences Centre (TBRHSC); A. Minty, BSc is a pharmacy student at the University of Toronto School of Pharmacy; Susan Pilatzke, RN, BScN, MPH is director of Oncology Clinical Systems at the TBRHSC; Lori Della Vedova, BA, MA is Cancer Education Coordinator at the TBRHSC; Laurie Sherrington, RN is a Regional Program Manager at the Ontario Telemedicine Network; Karen McPhail, RN is a Telehealth Coordinator at the Ontario Telemedicine Network. Address for correspondence: Malcolm Brigden, MD, FRCPC, Department of Medical Oncology, Saskatoon Cancer Clinic, 20 Campus Drive, Saskatoon, SK S7N 4H4; Tel: (306) 655-2710; Fax: (306) 655-2639; Email: [email protected] Teleoncology is increasingly being used to provide specialized consultation services for remote cancer populations. This article ou...
Teleoncology is increasingly being used to provide specialized consultation services for remote c... more Teleoncology is increasingly being used to provide specialized consultation services for remote cancer populations. This article outlines typical requirements for such systems and describes one that has been organized in northwestern Ontario. The article reviews potential pros and cons of teleoncology and presents the results of a survey of user physician satisfaction. Possible solutions to a number of perceived problems with teleoncology services are explored. Additional training for physicians using teleoncology may help them improve skills for communicating in this medium. Many opportunities exist for better research in this rapidly expanding area.
Canadian Journal of Rural Medicine the Official Journal of the Society of Rural Physicians of Canada Journal Canadien De La Medecine Rurale Le Journal Officiel De La Societe De Medecine Rurale Du Canada, Feb 1, 2007
Canadian journal of rural medicine: the official journal of the Society of Rural Physicians of Canada = Journal canadien de la medecine rurale: le journal officiel de la Societe de medecine rurale du Canada
Canadian family physician Medecin de famille canadien, 2007
OBJECTIVE To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcoti... more OBJECTIVE To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) during labour. QUALITY OF EVIDENCE MEDLINE was searched and the references of 2 systematic reviews and a meta-analysis were reviewed to find articles on obstetric analgesia and pain measurement. The 33 articles selected included 14 studies, 1 meta-analysis, and 2 systematic reviews, all providing level I evidence. MAIN MESSAGE The literature supports use of ITN as a safe and effective alternative to epidural anesthesia. The recent decrease in rates of episiotomies and use of forceps during deliveries means patients require less dense perineal anesthesia. The advantage of single-dose ITN is that fewer physicians and nurses are needed to administer it even though its safety and effectiveness are comparable with other analgesics. Use of ITN is associated with a shorter first stage of labour and more rapid cervical dilation. A combination of 2.5 mg of bupivacaine, 25 microg of fent...
Canadian family physician Médecin de famille canadien, 2007
To understand some of the cross-cultural issues in providing palliative care to aboriginal patien... more To understand some of the cross-cultural issues in providing palliative care to aboriginal patients. MEDLINE (1966 to 2005), CINAHL, PsycINFO, Google Scholar, and the Aboriginal Health Collection at the University of Manitoba were searched. Studies were selected based on their focus on both general cross-cultural caregiving and, in particular, end-of-life decision making and treatment. Only 39 relevant articles were found, half of which were opinion pieces by experienced nonaboriginal professionals; 14 were qualitative research projects from nursing and anthropologic perspectives. All patients are unique. Some cultural differences might arise when providing palliative care to aboriginal patients, who value individual respect along with family and community. Involvement of family and community members in decision making around end-of-life issues is common. Aboriginal cultures often have different approaches to telling bad news and maintaining hope for patients. Use of interpreters an...
Canadian family physician Médecin de famille canadien, 2007
To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) ... more To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) during labour. MEDLINE was searched and the references of 2 systematic reviews and a meta-analysis were reviewed to find articles on obstetric analgesia and pain measurement. The 33 articles selected included 14 studies, 1 meta-analysis, and 2 systematic reviews, all providing level I evidence. The literature supports use of ITN as a safe and effective alternative to epidural anesthesia. The recent decrease in rates of episiotomies and use of forceps during deliveries means patients require less dense perineal anesthesia. The advantage of single-dose ITN is that fewer physicians and nurses are needed to administer it even though its safety and effectiveness are comparable with other analgesics. Use of ITN is associated with a shorter first stage of labour and more rapid cervical dilation. A combination of 2.5 mg of bupivacaine, 25 microg of fentanyl, and 250 microg of morphine intratheca...
Canadian journal of rural medicine : the official journal of the Society of Rural Physicians of Canada = Journal canadien de la médecine rurale : le journal officiel de la Société de médecine rurale du Canada, 2007
Objective: To understand some of the cross-cultural issues in providing palliative care to aborig... more Objective: To understand some of the cross-cultural issues in providing palliative care to aboriginal patients. Sources of information: MEDLINE (1966 to 2005), CINAHL, PsycINFO, Google Scholar, and the Aboriginal Health Collection at the University of Manitoba were searched. Studies were selected based on their focus on both general cross-cultural caregiving and, in particular, end-of-life decision making and treatment. Only 39 relevant articles were found, half of which were opinion pieces by experienced nonaboriginal professionals; 14 were qualitative research projects from nursing and anthropologic perspectives. Main message: All patients are unique. Some cultural differences might arise when providing palliative care to aboriginal patients, who value individual respect along with family and community. Involvement of family and community members in decision making around end-of-life issues is common. Aboriginal cultures often have different approaches to telling bad news and maintaining hope for patients. Use of interpreters and various communication styles add to the challenge. Conclusion: Cultural differences exist between medical caregivers and aboriginal patients. These include different assumptions and expectations about how communication should occur, who should be involved, and the pace of decision making. Aboriginal patients might value indirect communication, use of silence, and sharing information and decision making with family and community members.
Objective: To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcot... more Objective: To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) during labour. Quality of evidence: MEDLINE was searched and the references of 2 systematic reviews and a meta-analysis were reviewed to find articles on obstetric analgesia and pain measurement. The 33 articles selected included 14 studies, 1 meta-analysis, and 2 systematic reviews, all providing level I evidence. Main message: The literature supports use of ITN as a safe and effective alternative to epidural anesthesia. The recent decrease in rates of episiotomies and use of forceps during deliveries means patients require less dense perineal anesthesia. The advantage of single-dose ITN is that fewer physicians and nurses are needed to administer it even though its safety and effectiveness are comparable with other analgesics. Use of ITN is associated with a shorter first stage of labour and more rapid cervical dilation. A combination of 2.5 mg of bupivacaine, 25 microg of fentanyl, and 250 microg of morphine intrathecally usually provides a 4-hour window of acceptable analgesia for patients without complications not anticipating protracted labour. The evolution in dosing of ITN warrants a re-examination of its usefulness in modern obstetric practice. Conclusion: Physicians practising modern obstetrics in rural and small urban centres might find single-dose ITN a useful alternative to parenteral or epidural analgesia for appropriately selected patients.
Malcolm Brigden, MD, FRCPC, FACP is Provincial Practice Leader in Medical Oncology at the Saskatc... more Malcolm Brigden, MD, FRCPC, FACP is Provincial Practice Leader in Medical Oncology at the Saskatchewan Cancer Agency, and formerly was a Medical Oncologist at the Thunder Bay Regional Health Sciences Centre (TBRHSC); A. Minty, BSc is a pharmacy student at the University of Toronto School of Pharmacy; Susan Pilatzke, RN, BScN, MPH is director of Oncology Clinical Systems at the TBRHSC; Lori Della Vedova, BA, MA is Cancer Education Coordinator at the TBRHSC; Laurie Sherrington, RN is a Regional Program Manager at the Ontario Telemedicine Network; Karen McPhail, RN is a Telehealth Coordinator at the Ontario Telemedicine Network. Address for correspondence: Malcolm Brigden, MD, FRCPC, Department of Medical Oncology, Saskatoon Cancer Clinic, 20 Campus Drive, Saskatoon, SK S7N 4H4; Tel: (306) 655-2710; Fax: (306) 655-2639; Email: [email protected] Teleoncology is increasingly being used to provide specialized consultation services for remote cancer populations. This article ou...
Teleoncology is increasingly being used to provide specialized consultation services for remote c... more Teleoncology is increasingly being used to provide specialized consultation services for remote cancer populations. This article outlines typical requirements for such systems and describes one that has been organized in northwestern Ontario. The article reviews potential pros and cons of teleoncology and presents the results of a survey of user physician satisfaction. Possible solutions to a number of perceived problems with teleoncology services are explored. Additional training for physicians using teleoncology may help them improve skills for communicating in this medium. Many opportunities exist for better research in this rapidly expanding area.
Canadian Journal of Rural Medicine the Official Journal of the Society of Rural Physicians of Canada Journal Canadien De La Medecine Rurale Le Journal Officiel De La Societe De Medecine Rurale Du Canada, Feb 1, 2007
Canadian journal of rural medicine: the official journal of the Society of Rural Physicians of Canada = Journal canadien de la medecine rurale: le journal officiel de la Societe de medecine rurale du Canada
Canadian family physician Medecin de famille canadien, 2007
OBJECTIVE To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcoti... more OBJECTIVE To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) during labour. QUALITY OF EVIDENCE MEDLINE was searched and the references of 2 systematic reviews and a meta-analysis were reviewed to find articles on obstetric analgesia and pain measurement. The 33 articles selected included 14 studies, 1 meta-analysis, and 2 systematic reviews, all providing level I evidence. MAIN MESSAGE The literature supports use of ITN as a safe and effective alternative to epidural anesthesia. The recent decrease in rates of episiotomies and use of forceps during deliveries means patients require less dense perineal anesthesia. The advantage of single-dose ITN is that fewer physicians and nurses are needed to administer it even though its safety and effectiveness are comparable with other analgesics. Use of ITN is associated with a shorter first stage of labour and more rapid cervical dilation. A combination of 2.5 mg of bupivacaine, 25 microg of fent...
Canadian family physician Médecin de famille canadien, 2007
To understand some of the cross-cultural issues in providing palliative care to aboriginal patien... more To understand some of the cross-cultural issues in providing palliative care to aboriginal patients. MEDLINE (1966 to 2005), CINAHL, PsycINFO, Google Scholar, and the Aboriginal Health Collection at the University of Manitoba were searched. Studies were selected based on their focus on both general cross-cultural caregiving and, in particular, end-of-life decision making and treatment. Only 39 relevant articles were found, half of which were opinion pieces by experienced nonaboriginal professionals; 14 were qualitative research projects from nursing and anthropologic perspectives. All patients are unique. Some cultural differences might arise when providing palliative care to aboriginal patients, who value individual respect along with family and community. Involvement of family and community members in decision making around end-of-life issues is common. Aboriginal cultures often have different approaches to telling bad news and maintaining hope for patients. Use of interpreters an...
Canadian family physician Médecin de famille canadien, 2007
To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) ... more To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) during labour. MEDLINE was searched and the references of 2 systematic reviews and a meta-analysis were reviewed to find articles on obstetric analgesia and pain measurement. The 33 articles selected included 14 studies, 1 meta-analysis, and 2 systematic reviews, all providing level I evidence. The literature supports use of ITN as a safe and effective alternative to epidural anesthesia. The recent decrease in rates of episiotomies and use of forceps during deliveries means patients require less dense perineal anesthesia. The advantage of single-dose ITN is that fewer physicians and nurses are needed to administer it even though its safety and effectiveness are comparable with other analgesics. Use of ITN is associated with a shorter first stage of labour and more rapid cervical dilation. A combination of 2.5 mg of bupivacaine, 25 microg of fentanyl, and 250 microg of morphine intratheca...
Canadian journal of rural medicine : the official journal of the Society of Rural Physicians of Canada = Journal canadien de la médecine rurale : le journal officiel de la Société de médecine rurale du Canada, 2007
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