Problem/Issue and significance: Intimate partner violence [IPV] is a critically urgent public health issue worldwide. Violence and trauma have multiple short- and long-term health effects including pain, which is a complex, highly subjective experience that can have profoundly negative impacts on both “body and soul.” Untreated pain can become chronic and debilitating, leading to a lower quality of life, decreased employment opportunities, and increased mental health concerns. Addressing pain is an important aspect of the health care professional’s role, and the failure to do so can exacerbate existing health disparities and worsen health outcomes. Current approaches to understanding and managing pain are primarily based on a Westernized view of health and illness. Diversity in knowledge and perspectives is missing from clinical practice, nursing education, and research, and is needed to improve pain assessment and management practices. Approach or innovation: While health care practitioners recognize that more holistic approaches to understanding, assessing, and treating pain are required, the significance of women’s chronic pain experiences in the context of IPV has been largely unexplored. This paper proposes the creation of “pain profiles” using an approach that draws of multiple sources of information and types of knowledge to gain new insights and to develop a richer understanding of women’s pain experiences. The unique circumstances and experiences of Indigenous women are used to illustrate the usefulness of the pain profiles as a case in point. In Canada, Indigenous women experience higher levels of violence and trauma as a result of interpersonal violence, historical trauma, and ongoing socioeconomic inequities and systemic racism than non-Indigenous women. When Indigenous women seek health care for pain, they often report a lack of culturally safe and appropriate services and are often labeled as “drug-seeking” which can cause further delays or avoiding seeking care. Few existing health services address pain arising from violence and trauma for women, especially services that focus on cultural safety and trauma-and-violence informed care. Lessons and implications: Pain profiles provide a novel and more nuanced approach to understanding, and addressing, pain in women who have experienced violence by using a holistic approach that draws on various perspectives and multiple sources of information, including the women’s own words. This approach may help to guide the implementation of more culturally safe, trauma-and-violence informed health practices and services, strengthen nursing curriculum around pain assessment and management, and help improve the overall well-being and quality of life of all women who have experienced violence.
Acetaminophen is a widely used analgesic that can cause acute liver failure when consumed above a maximum daily dose. Certain patients may be at increased risk of hepatocellular damage even at conventional therapeutic doses. We report a case of a 34-year-old man on carbamazepine for complex partial seizures who developed acute liver and renal failure on less than 2.5 grams a day of acetaminophen. This raises caution that patients on carbamazepine should avoid chronic use of acetaminophen, and if required use at lower doses with vigilant monitoring for signs of liver damage.
Indigenous women are subjected to high rates of multiple forms of violence, including intimate partner violence (IPV), in the context of ongoing colonization and neo‐colonization. Health promotion interventions for women who experience violence have not been tailored specifically for Indigenous women. Reclaiming Our Spirits (ROS) is a health promotion intervention designed for Indigenous women living in an urban context in Canada. In this paper, we describe the development of the intervention, results of a pilot study, and the revised subsequent intervention. Building on a theory‐based health promotion intervention (iHEAL) showing promising results in feasibility studies, ROS was developed using a series of related approaches including (a) guidance from Indigenous women with research expertise specific to IPV and Indigenous women's experiences; (b) articulation of an Indigenous lens, including using Cree (one of the largest Indigenous language groups in North America) concepts to identify key aspects; and (c) interviews with Elders (n = 10) living in the study setting. Offered over 6–8 months, ROS consists of a Circle, led by an Indigenous Elder, and 1:1 visits with a Registered Nurse, focused on six areas for health promotion derived from previous research. Pilot testing with Indigenous women (n = 21) produced signs of improvement in most measures of health from pre‐ to post‐intervention. Women found the pilot intervention acceptable and helpful but also offered valuable suggestions for improvement. A revised intervention, with greater structure within the Circle and nurses with stronger knowledge of Indigenous women's experience and community health, is currently undergoing testing.
Purpose: Cost analysis and patient satisfaction with telemedicine in epilepsy care. Methods: This controlled study included out-of-town epilepsy patients coming to follow-up at the University of Alberta hospital epilepsy clinic. After an informed consent, patients were randomized to either conventional (n = 18) or telemedicine (n = 23) clinics. Patients or caregivers filled patient satisfaction and travel cost questionnaires in both alternatives. Cost per visit analysis included costs of traveling, lodging, and lost productivity. Results: Average age of the population was 41 years (range 19-73; 45% women). Eighty-three percent of patients preferred their next visit through telemedicine. About 90% of patients indicated a need for companion travel (mainly by car) to conventional clinic. For the conventional group patients the value of lost productivity was CAD $201, hotel cost CAD $8.50, and the value of car mileage CAD $256.50, totaling about CAD $466.00. Patient costs for telemedicine were CAD $35.85. Telemedicine production costs are similar to the patients' savings in traveling and lost productivity. About 90% of patients in both groups were satisfied with the quality of the service. Conclusion: Telemedicine can play a role in follow-up care of epilepsy patients, reduce patient costs, and improve patient satisfaction. This is the first full-time epilepsy telemedicine clinic in Western Canada.
