Correction to: The impact of social-emotional context in chronic cancer pain: patient-caregiver reverberations

Abstract Purpose The main aim of the study was to assess the impact of individualized management of breakthrough cancer pain (BTcP) on quality of life (QoL) of patients with advanced cancer in clinical practice. Methods A prospective, observational, multicenter study was conducted in patients with advanced cancer that were assisted by palliative care units. QoL was assessed with the EORTC QLQ-C30 questionnaire at baseline (V0) and after 28 days (V28) of individualized BTcP therapy. Data on background pain, BTcP, comorbidities, and frailty were also recorded. Results Ninety-three patients completed the study. Intensity, duration, and number of BTcP episodes were reduced (p < 0.001) at V28 with individualized therapy. Transmucosal fentanyl was used in 93.8% of patients, mainly by sublingual route. Fentanyl titration was initiated at low doses (78.3% of patients received doses of 67 μg, 100 μg, or 133 μg) according to physician evaluation. At V28, mean perception of global health status had increased from 31.1 to 53.1 (p < 0.001). All scales of EORTC QLQ-C30 significantly improved (p < 0.001) except physical functioning, diarrhea, and financial difficulties. Pain scale improved from 73.6 ± 22.6 to 35.7 ± 22.3 (p < 0.001). Moreover, 85.9% of patients reported pain improvement. Probability of no ≥ 25% improvement in QoL was significantly higher in patients ≥ 65 years old (OR 1.39; 95% CI 1.001–1.079) and patients hospitalized at baseline (OR 4.126; 95% CI 1.227–13.873). Conclusion Individualized BTcP therapy improved QoL of patients with advanced cancer. Transmucosal fentanyl at low doses was the most used drug. Trial registration This study was registered at ClinicalTrials.gov database (NCT02840500) on July 19, 2016.

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Evaluation of an Educational Outreach Campaign (IMPACT) on Pain Management Delivered to General Practices in Walsall

International Journal of Pharmacy Practice ◽

10.1093/ijpp/riab015.059 ◽

2021 ◽

Vol 29 (Supplement_1) ◽

pp. i48-i49

Author(s):

S Visram ◽

J Saini ◽

R Mandvia

Keyword(s):

Data Analysis ◽

Pain Management ◽

Cancer Pain ◽

Educational Intervention ◽

Opioid Analgesics ◽

Educational Outreach ◽

Opioid Prescribing ◽

Prescribing Trends ◽

The Impact

Abstract Introduction Opioid class drugs are a commonly prescribed form of analgesic widely used in the treatment of acute, cancer and chronic non-cancer pain. Up to 90% of individuals presenting to pain centres receive opioids, with doctors in the UK prescribing more and stronger opioids (1). Concern is increasing that patients with chronic pain are inappropriately being moved up the WHO ‘analgesic ladder’, originally developed for cancer pain, without considering alternatives to medications, (2). UK guidelines on chronic non-cancer pain management recommend weak opioids as a second-line treatment, when the first-line non-steroidal anti-inflammatory drugs / paracetamol) ineffective, and for short-term use only. A UK educational outreach programme by the name IMPACT (Improving Medicines and Polypharmacy Appropriateness Clinical Tool) was conducted on pain management. This research evaluated the IMPACT campaign, analysing the educational impact on the prescribing of morphine, tramadol and other high-cost opioids, in the Walsall CCG. Methods Standardised training material was delivered to 50 practices between December 2018 and June 2019 by IMPACT pharmacists. The training included a presentation on pain control, including dissemination of local and national guidelines, management of neuropathic, low back pain and sciatica as well as advice for prescribers on prescribing opioids in long-term pain, with the evidence-base. Prescribing trends in primary care were also covered in the training, and clinicians were provided with resources to use in their practice. Data analysis included reviewing prescribing data and evaluating the educational intervention using feedback from participants gathered via anonymous questionnaires administered at the end of the training. Prescribing data analysis was conducted by Keele University’s Medicines Management team via the ePACT 2 system covering October 2018 to September 2019 (two months before and three months after the intervention) were presented onto graphs to form comparisons in prescribing trends of the Midland CCG compared to England. Results Questionnaires completed at the end of sessions showed high levels of satisfaction, with feedback indicating that participants found the session well presented, successful at highlighting key messages, and effective in using evidence-based practice. 88% of participants agreed the IMPACT campaign increased their understanding of the management and assessment of pain, and prescribing of opioids and other resources available to prescribers. The majority (85%) wished to see this form of education being repeated regularly in the future for other therapeutic areas. Analysis of the prescribing data demonstrated that the total volume of opioid analgesics decreased by 1.7% post-intervention in the Midlands CCG in response to the pharmacist-led educational intervention. As supported by literature, the use of educational strategies, including material dissemination and reminders as well as group educational outreach was effective in engaging clinicians, as demonstrated by the reduction in opioid prescribing and high GP satisfaction in this campaign. Conclusion The IMPACT campaign was effective at disseminating pain-specific guidelines for opioid prescribing to clinicians, leading to a decrease in overall prescribing of opioid analgesics. Educational outreach as an approach is practical and a valuable means to improve prescribing by continuing medical education. References 1. Els, C., Jackson, T., Kunyk, D., Lappi, V., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F. and Straube, S. (2017). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. This provided the statistic of percentage receiving opioids that present to pain centres. 2. Heit, H. (2010). Tackling the Difficult Problem of Prescription Opioid Misuse. Annals of Internal Medicine, 152(11), p.747. Issues with prescriptions and inappropriate moving up the WHO ladder.

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Social-Emotional Difficulties in Irish Children Aged Five and Nine Years: A National, Longitudinal Study

Children ◽

10.3390/children8080656 ◽

2021 ◽

Vol 8 (8) ◽

pp. 656

Author(s):

Ann Swift ◽

Roy McConkey ◽

Philip Curry ◽

Edurne Garcia Iriarte

Keyword(s):

Social Services ◽

Family Relations ◽

Secondary Analysis ◽

Primary Caregivers ◽

Emotional Difficulties ◽

Children And Families ◽

Social Emotional ◽

Early Intervention Services ◽

Nationally Representative ◽

The Impact

A small proportion of children experience social-emotional difficulties from early childhood onwards. Longitudinal studies with nationally representative samples are needed to identify the prevalence and the characteristics of children and families persistently experiencing these difficulties. Secondary analysis of data collected on over 7500 Irish children and with the Strengths and Difficulties Questionnaire as the primary indicator, found that 6% of children when they were five year olds and 8% when they were nine-years, had above threshold scores that warranted further investigation. A smaller proportion—2.9% had elevated scores at both ages. Logistic regression analyses found that children with one or more developmental disabilities were up to six times more likely to have sustained difficulties. There were also significant associations with the lower education attainment of primary caregivers and the socio-economic deprivation of families. Primary caregivers and teachers reported higher conflict in their relationships with these children. Although the number of Irish children presenting with continuing social-emotional difficulties is small, they can present an ongoing and future societal cost in terms of the impact on family relations and demands placed on educational, health and social services. This study identified the children and families who are at greatest risk and for whom targeted early intervention services could be provided.

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The health and relationship dynamics of late-life couples: a systematic review of the literature

Ageing and Society ◽

10.1017/s0144686x08007903 ◽

2009 ◽

Vol 29 (3) ◽

pp. 455-480 ◽

Cited By ~ 62

Author(s):

RUTH B. WALKER ◽

MARY A. LUSZCZ

Keyword(s):

Systematic Review ◽

Marital Quality ◽

Late Life ◽

The United States ◽

Health It ◽

Social Emotional ◽

Marital Relations ◽

The Impact ◽

The Relationship ◽

Adequate Communication

ABSTRACTLate-life husband and wife relationships are increasingly recognised as an important factor in promoting wellbeing, particularly in terms of the health, social, emotional, financial and practical needs of older people. Knowledge of marital dynamics and how they affect both members of a couple remains scarce. This systematic review aimed to identify and appraise research that has focused explicitly on the dynamics of the relationship, as evinced by data frombothspouses. Implementing rigorous identification strategies, 45 articles were identified and reviewed. These studies were grouped into three broad thematic areas: marital relations and satisfaction; concordance in emotional state or physical health; and the interplay between marital quality and wellbeing. The issues found to affect marital relations and satisfaction in late life included equality of roles, having adequate communication, and transitions to living apart. There is strong evidence for couple concordance in depression, that marital relationships affect ill-health, longevity and recovery from illness, and reciprocally that ill-health impacts on the marriage itself. The research also suggests important gender differences in the impact of marital dynamics on health. It has led to the conclusion that there is a need for more diverse studies of late-life marriages, particularly ones that examine the dynamics of non-traditional elderly couples and that extend beyond a predominant focus on the Caucasian population of the United States.

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