A survey of recipient client physician satisfaction with teleoncology services originating from thunder bay regional health sciences centre.

The objective of this work was to investigate end user satisfaction and perceived efficacy on the part of client physicians for teleoncology services in Northwestern Ontario. A survey of 98 referring physicians from 17 remote communities in Northwestern Ontario was undertaken primarily to determine overall client physician satisfaction with the teleoncology process. The survey also investigated perceived problems and explored potential solutions. Overall client physician satisfaction was high for the majority of response fields. However, more than 50% of surveyed physicians felt that some aspects of the teleoncology process could be improved with an emphasis on more timely communication of interview results, continuity of care, and improving patients comfort level with the technologies involved. The success of this service is evidenced by its exponential growth since the original introduction in 2001. Ninety-eight percent of referring physicians would continue to use the teleoncology service process.

Single-dose intrathecal analgesia to control labour pain: is it a useful alternative to epidural analgesia?

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.

End-of-life issues for aboriginal patients: a literature review.

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.