Wednesday, August 27, 2014

Portex, Smiths Medical
Smiths Medical is committed to safety. When it comes to regional anesthesia solutions, the Portex® epidural portfolio has delivered on that commitment for more than 40 years. Designed with safety in mind from the tiniest details and the most miniscule movements, from pump to patient.

Pinpoint stability.

CSEcure® Spinal and Epidural Needle Assemblies

With a simple turn, the CSEcure® combined spinal epidural needle brings stability and safety to CSE procedures. It is intended to stabilize the needle set during injection of the spinal anesthetic, preventing movement of the spinal needle. It’s safety you can TWIST into.
CSEcure® epidural needle, hypodermic needle, medication delivery

Locking Mechanism

The epidural needle stabilizes the spinal needle and a quarter turn of the locking collar stabilizes the extension distance at the desired depth. To unlock and remove the spinal needle, turn the locking collar counterclockwise.

The feel of precision.

Pulsator™ Loss of Resistance Syringe, Portex Smiths Medical

Pulsator Loss of Resistance (L.O.R.) Device

The Pulsator Loss of Resistance (L.O.R.) device brings “sight to your fingertips.” The smooth GLIDE of the plunger is designed to consistently and reliably aid clinicians in finding the epidural space.

Smooth Accuracy

The smooth plunger action helps provide dependable epidural space detection.

Security that sticks.

LockIt Plus® Catheter Securement Device

The LockIt Plus® catheter securement device securely sticks to the insertion site while minimizing catheter migration and kinking with a CLICK.
LockIt Plus® catheter securement device, Portex Smiths Medical

Easy to Use

Open the securement device and thread it over the back end of the placed catheter. Close the device to secure the catheter. The large foam adhesive pad features easy-to-peel backing for an easy, straightforward application designed to minimize patient discomfort.

Connection in a snap.

EpiFuse® Epidural Catheter Connector, Portex Smiths Medical

EpiFuse® Epidural Catheter Connector

With the EpiFuse® catheter connector, safety is in the SNAP. It securely locks, easily unlocks, and features a color-coded design intended to increase safety by reducing the risk of tubing misconnections.

Secure Locking

The connector locks with a snap. Insert a Luer slip tip (such as a syringe) to unlock.

Single-handed protection.

Point-Lok® Needle Protection Device

A single hand is all it takes to LOCK the Point-Lok® needle protection device onto the sharp tip of a 16g to 30g anesthesia needle. Protecting your hands and helping reduce accidental needle sticks, from prep to disposal.
Point-Lok® Needle Protection Device, Hypodermic Needle

Designed to Reduce Needlesticks

Engage 16g to 30g needles with a simple, one-handed technique that keeps hands and fingers behind the exposed sharp. Once engaged, the sharp remains protected throughout disposal.
Jelco® Needle-Pro® Safety Device, Hypodermic Needle, Portex Smiths Medical

Jelco® Needle-Pro® Safety Device

LOCK the Jelco® Needle-Pro® safety hypodermic needle within the attached needle protection device using only one hand. The needle safety sheath helps prevent accidental needle sticks after the injection or aspiration of fluids.

One-Handed Safety

Enclose the needle within the attached needle safety sheath with a simple, one-handed technique that helps keep hands and fingers safe after use.

Safety linked in.

DuraFlex® Anesthesia Catheter

(Product not available globally. Available in USA and Canada Only) Having a choice in catheter softness and tip geometries provides completely customizable and effective medication delivery. All DuraFlex® anesthesia catheters combine flexible wire cores within soft nylon jackets, to LINK strength with flexibility.
DuraFlex® Anesthesia Catheter, Epidural Catheter, Catheter Connector, Portex Smiths Medical

Ease of Use

Available with a choice of stiffness to ease insertion and placement.
Primary Care

ISSUE: AUGUST 2014 | VOLUME: 12(8)

New guidelines drafted by the American Pain Society (APS) for the safe administration of methadone for the first time focus particular attention on the potential for abuse and misuse of the drug, highlighting the need for additional awareness and education within the pain management community, after a significant increase in deaths related to its use.
The new guidelines, which were published in the April issue of The Journal of Pain (2014;15:338-365), address several key areas, including patient assessment, patient education/counseling and treatment monitoring; in some cases, they also propose the use of alternative medications. Among other recommendations, the new guidelines call for stratification of patients based on their risk for substance abuse prior to methadone treatment, and suggest that the drug be administered at a low starting dose (30-40 mg daily; slow titration as needed) to reduce the incidence of unintended drug accumulation and accidental overdose.
The guidelines also address the cardiovascular risks associated with the drug. A statement released by the APS in conjunction with the new guidelines describes earlier methadone protocols as focusing primarily on these risks, while ignoring the potential for abuse and misuse. According to Roger Chou, MD, head of the APS Clinical Practice Guideline Program and associate professor of medicine at Oregon Health & Sciences, University in Portland, “alarming data” on methadone-related deaths prompted the society to change the focus. He cited Centers for Disease Control and Prevention (CDC) statistics that show an increase in deaths associated with methadone, from less than 1,000 in 1999 to nearly 5,000 in 2008. He added that although methadone accounts for “about 10% or less” of all opioids prescribed, the CDC has linked the drug with roughly one-third of all prescription opioid-related deaths.
“These trends occurred in the context of markedly increased prescribing of opioids in general for chronic pain, and increased use of methadone as a less expensive alternative to other long-acting opioids,” he said.
In addition to addressing its use in the management of pain, the new guidelines focus on methadone as a treatment for patients with opioid addiction. In this context, the authors recommend that routine patient monitoring include echocardiograms and urine drug testing. They also propose buprenorphine as an alternative for these patients.
Although the guidelines were written for use by all clinicians who prescribe methadone, Dr. Chou, who served as lead author, admitted that many of the recommendations were aimed at primary care physicians. “A lot of prescribing for chronic pain occurs in primary care settings, where some clinicians may perceive methadone to be interchangeable with other opioids, when that clearly isn’t the case due to its long half-life and potential for QTc prolongation,” he told Pain Medicine News. “It is important for clinicians to understand the unique properties of methadone that can increase risk, the steps that can be taken to reduce risks, and consider alternative opioids and other treatments before prescribing methadone.”
Family practitioner Louis Kurzitzky, MD, said that the “limitations of methadone are well recognized” at his clinic, but he acknowledged that some of his colleagues may not be aware of proper monitoring protocols for patients receiving the drug for the treatment of pain. His only concern is that not all primary care physicians read The Journal of Pain, and he recommended that the authors seek to publish the guidelines in other journals, with wider readership across specialties and disciplines.
“The guidelines are a critical step forward, [as they] put clinicians on notice that methadone deserves its own special categorization because of differences in administration and monitoring [compared with] other opioids,” said Dr. Kuritzky, who is also clinical assistant professor at the University of Florida in Gainesville. He was not involved in the development of the new guidelines.

Pain Patients Can Have Good Outcomes With Long-Term Opioids
Clinical Pain Medicine

ISSUE: AUGUST 2014 | VOLUME: 12(8)
Long-term opioid treatment can produce positive outcomes in chronic noncancer pain when physicians prescribe it carefully to individuals who have low risks for addiction and overdose, according to the results of a systematic review.
Andrea Furlan, MD, PhD, and her colleagues searched Medline, EMBASE, CINAHI, PsycINFO, Central and Business Source Premier for studies published since 2000 on function and quality of life (QOL) in patients taking long-term opioids for chronic noncancer pain.
The studies included in the analysis involved chronic noncancer pain that lasted longer than three months, opioid use for longer than three months, and outcomes that included measures of function and QOL. Most of the studies excluded patients who had comorbidities and psychiatric diagnoses. The majority of the patients were monitored closely by health care professionals, and were on doses of opioids that were less than approximately 200 mg per day.
The initial literature search by Dr. Furlan, a scientist at the Institute for Work & Health, and pain physician at University Health Network, Toronto, Canada, and her colleagues yielded 16,288 references. The studies focused on function and QOL, as well as outcomes of misuse, abuse, addiction, and falls and fractures. They then excluded all papers that lacked sufficient detail for a careful analysis.
Ultimately, the researchers performed a meta-analysis of pre–post results on eight randomized controlled trials, eight open-label extension studies from randomized controlled trials and nine observational controlled studies. These 25 studies included 4,719 patients, 3,160 of whom (67%) completed the studies. The analysis focused on these latter patients.
The investigators found that long-term opioid use resulted in significantly improved function, and physical and mental QOL.
Mark Sullivan, MD, PhD, professor, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, said that although Dr. Furlan and her collaborators do “careful work,” he had queries about the study, which was presented at the Canadian Pain Society’s 2014 annual meeting (poster 56).
“First, in pre–post studies without a control group, estimates of efficacy are strongly related to who drops out. Since almost all patients who drop out are not doing well on the drug, the mean pre–post differences can grossly overstate efficacy. We are told 67% were completers. How did this 67% compare with those who did drop out?” Dr. Sullivan noted in an email to Pain Medicine News. He also pointed out that the populations in the studies included in the systematic review were not typical.
Dr. Furlan said she and her team discussed at great length these points, and other potential critiques, while they were completing the systematic review.
She said that, for publication, the paper will include an uncertainty analysis that takes into account the worst-case scenario of a high dropout rate and the resulting underestimates of complications and overestimates of opioid effectiveness. Dr. Furlan also conceded that the patients in the systematic review represented a minority of typical chronic pain patients, because they did not have risk factors and were monitored carefully.
“It is true that most of these conditions are not followed in real-life opioid prescribing. [In clinical practice] I see a lot of careless prescribing, which can be characterized as ‘high-risk patients’ and/or ‘high-risk prescriptions.’ When you mix both, it is dangerous,” Dr. Furlan said in an interview with Pain Medicine News. “But when physicians and their teams take the time to carefully screen patients, keep them on as low a dose as possible and monitor them very regularly, our results show that the outcomes can be very satisfactory.”
—Rosemary Frei, MSc

Tuesday, August 26, 2014

أروى تصارع الموت.. وتطلب العلاج

أروى في العناية الفائقة   (انتصار الدنان)
أروى في العناية الفائقة (انتصار الدنان)
انتصار الدنان

مع نهاية كل شهر، تطلق عائلة أروى صرخة استغاثة. تتصارع الفتاة مع الموت، أمام عيون عائلتها وزوجها العاجزين مادياً عن تقديم المساعدة لها، لكن ليس من سبيل أمامهم إلا طلب المساعدة علهم يحصلون على بعض منها.

ليست أروى الحالة المرضية المستعصية الوحيدة في عين الحلوة. وليست الوحيدة التي تنتظر أمام أبواب المستشفيات أو العيادات، لكي تحصل على العلاج اللازم لها، وتأمين ثمنه. كثيرون لا يستطيعون تأمين ثمن العلاج والدواء، بسبب الحال الاقتصادية المادية، لكنها الحالة التي صرحت عن نفسها، وطالبت المؤسسات الخيرية، والمعنيين، بتأمين العلاج لها، لأنه ضاقت بها الحال أكثر من المتوقع، ولأن مرضها يحتاج إلى علاج دائم، ومكلف جداً مادياً، بحيث تحتاج لعلبتي دواء كل شهر، وبعد الحسم الذي تقوم به «الأونروا» من ثمن الدواء، وتأمين سرير للمريض بالمستشفى، يبقى أن تدفع المبلغ المتبقي من جيبها، والذي يبلغ مليونين ومئتي ألف ليرة.

أروى ميالي، هي شابة فلسطينية، تبلغ من العمر عشرين عاماً، من مخيم عين الحلوة، أم لطفلة تبلغ من العمر ثلاث سنوات، أصيبت منذ عامين بمرض السرطان الذي انتشر بشكل مفاجئ في جسمها، وبعد إصابتها بهذا المرض بدأت رحلتها الطويلة مع المعاناة، فمن مستشفى إلى مستشفى، بحثاً عمن يؤمن لها العلاج بتكلفة أقل، بسبب عدم استطاعة عائلتها وزوجها الذي يعمل في محل لبيع المفروشات أجيراً بمبلغ خمسمئة ألف ليرة.
والد أروى، يوجه «صرخة استغاثة لكل من يهتم بالأمر، ولأصحاب الأيادي البيضاء، للوقوف إلى جانب ابنتي، ومساعدتنا في تأمين العلاج لها». يضيف «لم نتعب من رحلة العلاج الشاقة من مستشفى لآخر، لأن كل ما يعنينا علاج ابنتنا، وبتنا لا نملك سوى رحمة الله. فقد دفعنا كل ما نملك لعلاج ابنتنا، واليوم نقف مكتوفي الأيدي، بسبب عدم وجود الإمكانيات المادية». يتابع «نحن أبناء الشعب الفلسطيني نموت على أبواب المستشفيات، لأننا لا نملك تكاليف علاج أولادنا، وإذا ما تعرض أحدنا للمرض، فإننا نعاني الأمرّين لتأمين العلاج اللازم، ذلك إن استطعنا تأمينه». أما والدتها، فتدعو لها وتقول: «ليس أمامنا إلا انتظار رحمة الله».
زوج أروى، مصطفى أبو غنيم، الذي يكبرها بثلاثة أعوام، ضاقت به السبل في تأمين علاج زوجته. يقول: «لم أعد أستطيع تحمل عبء تكلفة العلاج، لأنني بالأساس لا أملكه. وقد أرسلت نداءات عدة لأصحاب الأيادي البيضاء، كانت تلاقي آذاناً، وتقدم لنا العلاج، لكن علاج زوجتي طويل ودائم، ولا نستطيع أنا وعائلتها تأمينه». ويسأل: «لماذا المريض الفلسطيني يموت على أبواب المستشفيات طلباً للعلاج، لماذا لا تقوم الجهات المعنية بتأمين العلاج، فأنا كل شهر أقف على أبواب المستشفيات، أستجدي ثمن العلاج لزوجتي. وهي اليوم في المستشفى منذ اثني عشر يوماً، بانتظار تأمين بدل مالي للعملية، التي من الضروري جداً إجراؤها لها، حتى تتم عملية إنقاذ حياتها، وإعطاؤها الجرعات اللازمة من العلاج، وهو مستشفى الراعي بغرفة العناية الفائقة، تنتظر الجهات المعنية أن تنقذها من الموت».

Sunday, August 24, 2014

Pain issues in disorders of consciousness.

Brain Inj. 2014;28(9):1202-8.


Abstract Background: The assessment of pain and nociception in non-communicative patients with disorders of consciousness (DOC) is a real challenge for clinicians. It is, therefore, important to develop sensitive standardized tools usable at the bedside.


This review aims to provide an overview of the current knowledge about pain processing and assessment in patients with DOC.


A search was performed on PubMed using MeSH terms including vegetative state, unresponsive wakefulness syndrome, minimally conscious state, consciousness disorders, pain, nociception, neuroimaging and pain assessment.


Neuroimaging studies investigating pain processing in patients with DOC and their implication for clinicians are reviewed. Current works on the development of standardized and sensitive tools for assessing nociception are described.


The suggested pain perception capacity highlighted by neuroimaging studies in patients in a Minimally conscious state (MCS) and in some patients in a vegetative state VS/unresponsive wakefulness syndrome UWS supports the idea that these patients need analgesic treatment and monitoring
The first tool which has been developed to assess nociception and pain in patients with disorders of consciousness (DOC) is the Nerve Conduction Studies
NCS. Its revised version represents a rapid, standardized and sensitive scale which can be easily implemented in a clinical setting. 
 Complementary pain assessments are also under validation in order to offer more options to clinicians.


Minimally conscious state; nociception; pain assessment; unresponsive wakefulness syndrome; vegetative state
aura Eggertson, Ottawa, Ont.
August 19, 2014

All doctors have the right to follow their conscience when deciding whether to assist dying patients physically or to provide them with the means to end their lives — within the bounds of legislation, delegates to the Canadian Medical Association's annual meeting have voted. 

As Canada considers changingits laws concerning assisted death, Canada's doctors considered their stance on the second day of the Canadian Medical Association's (CMA) 147th annual meeting in Ottawa. In the end, they voted 91% in favour of allowing individual physicians to follow their conscience in deciding whether or not to provide assistance.
The association's current 2007 policy states that physicians should not provide such assistance, but as laws change, most recently Bill 52 in Quebec, CMA decided to revisit its policy. CMA President Dr. Louis Hugo Francescutti says general council's wishes will be discussed by the CMA Board of Directors later this week or in October. "I can't predict what is going to come out of it, but I am hopeful." 

CMA's French-language spokesperson Dr. Pierre Harvey explained that it's not up to physicians to take a stance for or against the issue; that's the responsibility of society. However, physicians can say what they want to do. "The motion was inspired by respect for our diversity," he said. 
The motion represents major progress over last year, when delegates at the annual meeting couldn't even agree on terminology. In the intervening months, CMA hosted a series of town hall meetings across Canada on the topic. "The town halls galvanized our view around this," said Francescutti.
The terminology was changed to physician-assisted death at this year's meeting and doctors were encouraged to voice their views during a nearly three-hour session. The complex ethical issue involves the physician's ability to meet terminal patients' requests to end their suffering or expected loss of control; the effectiveness of and access to palliative care; and their own legal liabilities and responsibilities.
Canadians need better, more equitable access to palliative care, doctors agreed. But even a national strategy and better access to pain relief will not negate the need for medical aid in dying, many doctors concluded. 

For some patients, doctors who provide morphine and sedatives are not only giving pain relief, "we are actively facilitating their death," said Dr. Paul Parks, an emergency physician from Medicine Hat, Alberta.
The stories doctors related on August 19 were as personal as they were professional. They acknowledged the often agonizing dilemmas patients, their families and their doctors face.
Dr.  Sarah Bates, a Calgary family doctor, addressed delegates as a caregiver and potential future patient, she said. "My Mom developed familial Alzheimer's in her early 50s. My sister has just been diagnosed — she is 43. So these issues weigh very heavily on my mind," Bates told about 250 delegates and close to 400 observers.
"There are conditions, we all know, where no level of oxygen, morphine or supportive counseling is going to provide relief of suffering. Just because we have a respiratory drive, a swallowing reflex and a beating heart doesn't mean we have a life. '' 

The CMA is discussing the issue of end-of-life care in the context of an upcoming Supreme Court of Canada decision that is expected to rule in October on the legality of physician-assisted death. The CMA has been granted status to intervene as a "friend of the court" in the case, and will be presenting the complexities of these issues from doctors' perspectives, Dr. Jeff Blackmer, the association's executive director of ethics, professionalism and international affairs told delegates.
Quebec has passed legislation permitting medical aid in dying, under particular circumstances and after consultation with more than one doctor. That law is expected to take effect in late 2015 unless it is the subject of a federal constitutional challenge.
The bill may well make Dr. Angela Genge, who heads the Montreal Neurological Institute's amyotrophic lateral sclerosis (ALS) clinic, the first doctor in Quebec asked to comply with the law. That's because her patients with ALS and other terminal neurodegenerative diseases regularly ask her to help them end their lives.
"My ALS patients are very bright," Genge told delegates. "They can be any one of you in the room." Her patients fear loss of control, suffering, and being a burden on their families. Most of all, they want permission to discuss how and when they want to die.
Every patient has the right to have that discussion, Genge said, and Quebec's law provides clarity around that right and ensures it can take place, even if it doesn't alter how a doctor responds to these requests.
"The minute I do not allow my patient to discuss their desire to be in control of their death, I actually break the patient-physician relationship," she added. "My patients are as intelligent as you and I are and they have the right to have that discussion."
All of her patients have, however, ultimately "changed the goalposts" they initially set for themselves about what point in their illness they would choose to end their life. That's the reason Genge hopes the regulations that accompany the Quebec legislation will not fix a time period in which physicians have to respond to a patient's request for help ending their life.
In addition to passing a motion supporting physicians' right to act according to their conscience, the delegates also instructed the CMA to investigate and communicate Inuit, Metis and First Nations' perspectives on euthanasia, physician-assisted death and end-of-life care. Physicians must be sensitive to the experience of many Aboriginal communities already coping with high levels of suicide, and in particular teen suicide, Dr. David Pontin, the president of the Northwest Territories Medical Association, pointed out.
It is also critical that the CMA develop a strategy to make sure there are enough doctors trained to deliver palliative care across Canada. Currently, Canada needs at least another 300 palliative care specialists, Dr. Doris Barwich of the Canadian Society of Palliative Care Physicians told delegates. In addition, 75% of doctors have identified their need for further palliative care help and education, she added.
Other family physicians, however, described their current cradle-to-grave practices involving palliative care and suggested that with greater education and support, more doctors could provide these services that Canadians have repeated stated they want and need. 

"All doctors want is a little bit of help, mostly around prescribing narcotics," said Dr. Suzanne Strasberg, a family physician in Toronto. "What we need is: we need education. I think we should be ready to do this work."
The CMA will support the development of an advanced care planning, palliative and end-of-life care strategy in all provinces and territories, delegates agreed, while leaving it to the broader Canadian public and legislators to change the laws around medical aid in dying.
The 269 delegates voted to "support the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying."
Barbara Sibbald, CMAJ
August 22, 2014
Medical marijuana and senior's care were extensively

 debated at the Canadian Medical Association (CMA) 147th annual meeting in Ottawa Aug. 17–20, but physician-assisted death was the main action-item.
The 269 delegates voted to "support the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying." That resolution, which was approved by 91% of delegates, will now be considered by CMA's Board of Directors. 

CMA's 2007 policy states that doctors should not participate in euthanasia or assisted suicide. The new position prepares physicians for the possibility that laws may be changing in light of a recent Quebec bill and an upcoming case at the Supreme Court of Canada. 

In a related move, delegates asked CMA to develop a strategy to ensure there are enough doctors trained in palliative care.

The annual meeting began with the release of a survey and a call for a national seniors' health care strategy. The survey of 1000 Canadians (aged 45 and older) found that 95% saw the need for a pan-Canadian Seniors' care strategy — a percentage outgoing CMA president Louis Hugo Francescutti called "astonishing." "Federal politicians should worry about this if they want to stay federal politicians," he told CMAJ.

CMA's new president, Dr. Chris Simpson from Kingston, Ont., said the failure to address seniors' needs "impacts every single component of the health care system." For example, "warehousing of seniors in hospital beds" wastes about $2.3 billion annually

In his inaugural address, Simpson also slammed the federal government for its inaction on medicare. He cited a recent report from the Commonwealth Fund indicating that Canada's health system ranks second last on virtually every measure of quality and access. Top-ranked countries all have "strong leadership" from a committed federal government. He urged the federal government to begin with a comprehensive seniors care strategy. 

Federal Health Minister Rona Ambrose said a national strategy is "valid, but only possible if the provinces and territories want it." So far, "there's been no call for one, except from certain groups." 

Ambrose also spoke about the need for government and physicians to work on practical solutions to Canada's prescription drug abuse problem. A "frightening" number of Canadians — some 410 000 — abuse prescription drugs, she said. "Doctors are prescribing too much." 

She also responded to concerns about Canada's new medical marijuana law, which puts physicians in a "precarious situation." "The majority of doctors don't want to prescribe and I would encourage them not to do it if they don't want to," she said. At the same time, she insisted that doctors are the best gatekeepers to marijuana. 

Francescutti said the new law, which came into effect Apr. 1, 2014, "strains the physician-patient relationship."

"It's just plain bad medicine to prescribe a product when we don't know how it works; we don't know when it works, who it works for, how it interacts or how much to prescribe."
The CMA's long-standing position is that there is insufficient evidence supporting marijuana's use as a therapeutic agent. Delegates approved a motion calling for the CMA to speak out against smoking any plant material, clearly aimed at marijuana. Respirologist Dr. Deborah Hellyer noted that smoking one joint is the equivalent of up to 10 cigarettes.
A second motion called for licensing bodies to develop comprehensive regulatory standards to guide physicians in prescribing marijuana. Currently the information available and policies vary.  "We need clear and consistent standards," said Francescutti.

New president elect

Delegates confirmed the election of CMA President Elect Dr. Cindy Forbes, a family physician from Waverley, Nova Scotia. Her term as president begins August 2015. Forbes has practiced as a family physician for 28 years in Nova Scotia and British Columbia. 
"My goal as president is to identify and promote innovative solutions and positive change for health care," she stated in a media release. She identified seniors care and the health care transformation initiative as two areas of engagement.
Forbes is the former president of Doctors Nova Scotia (1996/97) and has chaired CMA's Council on Health Care and Promotion.
During the meeting, CMA also received the Canadian Forces Medallion for Distinguished Service. It recognizes CMA's long-time support for the Canadian Forces, from the creation of the first permanent military medical service in 1899 to recruitment of physicians during the recent mission in Afghanistan.
And last but not least, for the first time in 15 years, there will be no increase in CMA fees; they stand at $495 annually.
Visit for extensive news coverage of the annual meeting.
Need for palliative care at all levels in health sector


I attended the Networking Conference just completed and listened carefully to comments and calls for an action plan on recommendations from these gatherings. I heard the Hon Minister of Foreign Affairs and Foreign Trade giving clear indication that she heard the call and also suggesting that action on specific areas may have already begun.

My focus is on the session promoting palliative care and a hospice for the island. While the session was well done (American style), there was no time for questions or discussion and as we would say in Quebec ,”c’est domage” – it’s a pity. While supporting our government in the commitment to a facility that will provide appropriate care those in the end-of-life stage, let me also support the call for full integration of palliative care into the health sector at all levels and focus the debate beyond a hospice.

End of life happens in private homes, long-term care facilities and hospitals across the island every day. The principles of the palliative care approach must be integrated wherever care is being given. Here I am suggesting that holistic care where the family and their needs are taken into consideration, choice, respect, dignity, privacy, and compassion, are all required in every environment that cares for this clientele. A culture of caring should transcend the operations and be promoted by those in governance.

Realistically, we cannot move all of our terminal patients, residents or whatever title we want to give to those in care, to a hospice, but appropriate care should not be denied. Let us assure that those providing care have the required knowledge, tools and attitude for the service.

As the debate continues, I respectfully suggest that those at the policy level look further north to Canada and the various approaches that are being taken to deal with this very issue for examples. My home province (Quebec), where an integrated approach to palliative care and hospices exist, has taken a step that few other jurisdictions dare take and passed Dying with Dignity legislation that gives the person choice in when they may die.

As one who teaches management in long-term care and has managed or inspected these facilities for the Canadian Council of Health Serviced Accreditation (Accreditation Canada) for more than two decades, I would feel remiss if I did offer my comments while on the island.

Gus A. Hollingsworth
President, Barbados House (Montreal) and Educational Consultant with Health Canada
Email us your comments. | Top
West Island Palliative Care

Friday, August 22, 2014

Introduction of a national herpes zoster (shingles) immunization programme and impact on neuropathic pain

  1. H. Murdoch1,
  2. A. Potts1,
  3. L. Colvin2,
  4. J.C. Cameron1 and
  5. K.G. Pollock1
Article first published online: 19 AUG 2014
European Journal of Pain.

Thursday, August 21, 2014

German spirituality – spirituality in Germany  

Lukas Radbruch, President of the German Association for Palliative Care, and Chair of Palliative Medicine at the University of Bonn, Germany.
Prof Lukas Radbruch
Prof Lukas Radbruch
Rev Joep van de Geer, co-chair of the EAPC Task Force on Spirituality, recently contributed a post about the translation of the Dutch Guideline on Spiritual Care into German following a German course on spirituality in Mainz. The EAPC task force has translated the guideline as an example of the myriad of valuable tools and documents that are available in various countries, albeit only in the native language.
Without doubt, this translation will be very useful for palliative care or spiritual care professionals in Germany. However, reading the guideline I’d like to point out that there is a vibrant development in spiritual care in Germany, and a number of tools on spiritual care are already available. Here is some information on other German resources, with a rather random selection by me.
  • There is a Task Force on Spiritual Care within the German Association for Palliative Care, and the task force has published a paper on “What is spiritual care?” that is available online. This position paper from 2007 describes what spiritual care is, what are the tasks in clinical palliative care, in education and research, and in media work.
  • Traugott Roser has an academic chair for spiritual care in Munich, and he cooperates closely with the chair for social care (Maria Wasner) and the chair for palliative medicine (Claudia Bausewein) in the same city. There is a lot of education and research going on in his department. Traugott Roser is also the editor of an online journal on spiritual care. The latest issue in 2014 includes original papers on knowledge and opportunities for volunteers in psychosocial crisis intervention, on behaviourial therapy and spirituality as well as on the competencies of emergency spiritual care givers.
  •  Traugott Roser has also written an excellent German textbook entitled ‘Spiritual Care’ and, together with Thomas Hagen, Hermann Reigber and Bernadette Fittkau-Tönnesmann, a curriculum on palliative care for spiritual care givers.
  • Another excellent book is by Monika Müller, with many stories and reflections on how to accompany dying or grieving people as a spiritual pathway (‘Dem Sterben Leben geben: Die Begleitung sterbender und trauernder Menschen als spiritueller Weg’). I often use this for training courses of physicians.
There is a lot more in German language out there and I am sure that I have missed out on some important resources. Spiritual care really seems to be a most interesting topic in palliative care in Germany, as well as elsewhere.
I agree completely with Joep van de Geer that it is worthwhile to compare tools and resources between countries, languages and cultures. I hope the EAPC task force will continue with the translation of other material to facilitate exchange and comparison. There is so much to be gained from this exchange!
Links and resources
  • You can read more posts about spiritual care in palliative care on the EAPC blog, including Joep van de Geer’s post published on 18 August.