Pain that varies with time, referred to here as episodic pain, is a commonly encountered but under-investigated clinical problem. Previous studies of cancer patients have found that a significant proportion of their pains are episodic. To establish the prevalence and characteristics of episodic pains in hospice in-patients we assessed 245 consecutive admissions to four hospices in Yorkshire. The admitting doctor completed a questionnaire, detailing the characteristics of all pains experienced by the patient in the previous 24 h. Two hundred and forty-two questionnaires were entered into the study. One hundred and thirty-two patients reported pain in the preceding 24 h, of these 93% had at least one episodic pain. In total, 228 pains were described, of which 211 were episodic with a wide variation in their temporal characteristics, intensities and limitation. One hundred and fifty-two episodic pains had a precipitating factor; movement and weight bearing being the most frequent precipitants. One hundred and sixty-eight episodic pains had a relieving factor, medication improving 54%. Ninety-five pains were related to the malignancy and 47 to concurrent illness. The study confirms that episodic pain is extremely common in cancer patients referred for in-patient hospice care and highlights the need for further evaluation of its management.

Despite positive staff attitudes towards corneal donation, many barriers to discussing donation were identified, which may reduce donation rates. This could be improved by local policies encompassing further education, prompts in documentation and availability of leaflets.

American studies suggest that appropriate measures of abusive behaviours can be achieved. However, pilot studies with in depth interviews at our hospital found several methodological problems. These included the obtaining of informed consent to participate in research on family violence, access to potential respondents, and ethical dilemmas about procedure if abuse is uncovered during research. Further British research will therefore need to address these problems before large scale studies of elder abuse are conducted.We acknowledge the support of Channel 4 and the Office of Population Censuses and Surveys omnibus survey team in undertaking this survey.

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Sir, In England and Wales, the National Institute for Clinical Excellence Guidance on Cancer Services 1 states that specialist palliative care (SPC) teams in hospitals and in the community should be staffed to a level sufficient to undertake face-to-face assessments between 09.00 and 17.00 seven days a week. This was not supported by clear evidence of need.