OP92 Non-Opioid Therapy For Pain Management – Health Technology Assessment In A Time Of Crisis

2018 ◽  
Vol 34 (S1) ◽  
pp. 34-34
Author(s):  
Janice Mann ◽  
Sohail Mulla ◽  
Sirjana Pant
Keyword(s):  
Public Health ◽  
Pain Management ◽  
Pain Treatment ◽  
Action Plan ◽  
Pharmacological Therapy ◽  
Guideline Recommendation ◽  
Knowledge Mobilization ◽  
Health Crisis ◽  
Inappropriate Use ◽  
Wide Range

Introduction:North America is facing a public health epidemic – the opioid crisis – part of which is attributed to the inappropriate use of opioids in pain management. As such, the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain recommends optimizing non-opioid pharmacotherapy or non-pharmacological therapy to treat chronic pain, before a trial of opioids. However, the Guideline itself is not designed to provide evidence on the effectiveness of these non-opioid alternatives, leaving a gap for those attempting to put the recommendation into practice.Methods:In collaboration with its partners, including clinicians and policymakers, the Canadian Agency for Drugs and Technologies (CADTH) identified the gaps in evidence, and developed an action plan to bridge the evidence gaps to support the optimization of non-opioid alternatives in pain management.Results:Since the release of the Guideline, CADTH produced over 20 Rapid Response reports that synthesize and appraise evidence on non-opioid alternatives in the management of a wide range of pain, both acute and chronic. Additionally, CADTH has also reviewed evidence on multidisciplinary pain treatment programs, and is developing environmental scan reports on the availability and access to non-pharmacological treatments for pain in Canada, and on drugs for emerging non-opioid pain. Further, CADTH developed knowledge mobilization tools based on the evidence reviews. The evidence reviews and tools are used as a resource by CADTH partners, including the Coalition of Safe and Effective Pain Management and McMaster University National Pain Center.Conclusions:This presentation will discuss the role of HTA and CADTH to fill the gaps in evidence for a crucial clinical practice guideline recommendation in a time of public health crisis, and help put the evidence into action. It will present the evidence synthesized by CADTH on various non-opioid alternatives for pain management, while highlighting the remaining gaps in evidence. Understanding the evidence on non-opioid alternatives will inform clinical and policy decisions and potentially reduce inappropriate use of opioids in pain management.

scholarly journals Pain Management Best Practices from Multispecialty Organizations During the COVID-19 Pandemic and Public Health Crises

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1331-1346 ◽  
Author(s):  
Steven P Cohen ◽  
Zafeer B Baber ◽  
Asokumar Buvanendran ◽  
Brian C McLean ◽  
Yian Chen ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Health Care Providers ◽  
Risk Mitigation ◽  
Health Administration ◽  
Care Providers ◽  
Health Crisis ◽  
Management Services

Abstract Background It is nearly impossible to overestimate the burden of chronic pain, which is associated with enormous personal and socioeconomic costs. Chronic pain is the leading cause of disability in the world, is associated with multiple psychiatric comorbidities, and has been causally linked to the opioid crisis. Access to pain treatment has been called a fundamental human right by numerous organizations. The current COVID-19 pandemic has strained medical resources, creating a dilemma for physicians charged with the responsibility to limit spread of the contagion and to treat the patients they are entrusted to care for. Methods To address these issues, an expert panel was convened that included pain management experts from the military, Veterans Health Administration, and academia. Endorsement from stakeholder societies was sought upon completion of the document within a one-week period. Results In these guidelines, we provide a framework for pain practitioners and institutions to balance the often-conflicting goals of risk mitigation for health care providers, risk mitigation for patients, conservation of resources, and access to pain management services. Specific issues discussed include general and intervention-specific risk mitigation, patient flow issues and staffing plans, telemedicine options, triaging recommendations, strategies to reduce psychological sequelae in health care providers, and resource utilization. Conclusions The COVID-19 public health crisis has strained health care systems, creating a conundrum for patients, pain medicine practitioners, hospital leaders, and regulatory officials. Although this document provides a framework for pain management services, systems-wide and individual decisions must take into account clinical considerations, regional health conditions, government and hospital directives, resource availability, and the welfare of health care providers.

scholarly journals An Innovative Perioperative Pain Program for Chronic Opioid Users: An Academic Medical Center’s Response to the Opioid Crisis

2018 ◽  
Vol 34 (1) ◽  
pp. 5-13 ◽  
Author(s):  
Marie N. Hanna ◽  
Traci J. Speed ◽  
Ronen Shechter ◽  
Michael C. Grant ◽  
Rosanne Sheinberg ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Treatment ◽  
Preoperative Evaluation ◽  
Multidisciplinary Teams ◽  
Opioid Use ◽  
Health Crisis ◽  
Perioperative Pain ◽  
Surgical Pain ◽  
Opioid Users ◽  
Surgical Setting

Increased utilization of prescription opioids for pain management has led to a nationwide public health crisis with alarming rates of addiction and opioid-related deaths. In the surgical setting, opioid prescriptions have been implicated as a contributing factor to the opioid epidemic. The authors developed an innovative model to address aspects of pain management and opioid utilization during preoperative evaluation, acute surgical hospitalization, and postoperative follow-up for chronic opioid users. This program involves multidisciplinary teams that include acute and chronic pain specialists, psychiatrists, integrative medicine specialists, and physical medicine and rehabilitation services. It also features a novel infrastructure for triage and pain management education and treatment. Individualized patient plans are devised that can include preoperative opioid weaning, regional anesthesia that minimizes opioid use, and multimodal techniques for surgical pain treatment. Multidisciplinary programs such as this have the potential to both improve perioperative pain control and prevent escalation of opioid use among chronic opioid users.

scholarly journals China's Public Health Policies in Response to COVID-19: From an “Authoritarian” Perspective

2021 ◽  
Vol 9 ◽  
Author(s):  
Jinghua Gao ◽  
Pengfei Zhang
Keyword(s):  
Public Health ◽  
Crisis Management ◽  
Public Support ◽  
Political Legitimacy ◽  
Health Policies ◽  
Health Crisis ◽  
Public Health Policies ◽  
Authoritarian State ◽  
Public Health Crisis ◽  
Wide Range

Background: China is generally regarded internationally as an “authoritarian” state. Traditional definitions have assigned many negative connotations surrounding the term of authoritarian. We realize that it might not be considered value-neutral in other countries. But authoritarian in the Chinese context emphasizes more on centralized decision making, collectivism, coordinating all activities of the nation, and public support, which is considered a value-neutral term. Therefore, it is adopted in this paper. We would like to clarify this. Authoritarian governance is considered an important mechanism for developing China's economy and solving social problems. The COVID-19 crisis is no exception. Most of the current research on crisis management and government crises focuses on advanced, democratic countries. However, the consequences of crisis management by authoritarian governments have not been fully appreciated. Although prior research has addressed authoritarian initiatives to manage crises in China, authoritarian interventions have rarely been theorized in public health emergencies.Methods: Based on a literature review and theoretical analysis, we use a descriptive and qualitative approach to assess public health policies and mechanisms from an authoritarian perspective in China. In light of the key events and intervention measures of China's government in response to COVID-19, the strategic practices of the Communist Party of China (CPC) to construct, embody, or set political goals through authoritarian intervention in public health crisis management are discussed.Results: China's government responded to the COVID-19 pandemic with a comprehensive authoritarian intervention, notably by establishing a top-down leadership mechanism, implementing a resolute lockdown, rapidly establishing square cabin hospitals, enhancing cooperation between different government departments, mobilizing a wide range of volunteer resources, enforcing the use of health codes, imposing mandatory quarantine on those returning from abroad, and implementing city-wide nucleic acid testing. These measures ensured that China was able to contain the outbreak quickly and reflect on the unique role of the Chinese authoritarian system in responding to public health crises.Conclusions: Our paper contributes to expanding the existing understanding of the relationship between crisis management and authoritarian system. China's response to COVID-19 exemplifies the unique strengths of authoritarian institutions in public health crisis management, which is a helpful and practical tool to further enhance the CPC's political legitimacy. As a socialist model of crisis management with Chinese characteristics, it may offer desirable experiences and lessons for other countries still ravaged by the epidemic.

125 Management of Acute Pain in the Burn Patient: Reaching a New Guideline

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S84-S85 ◽  
Author(s):  
Kathleen S Romanowski ◽  
Joshua S Carson ◽  
Kate Pape ◽  
Eileen Bernal ◽  
Shelley A Wiechman ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Control ◽  
Pain Treatment ◽  
Injured Patient ◽  
Standard Of Care ◽  
Care Providers ◽  
Burn Care ◽  
Pain Medications ◽  
Wide Range ◽  
Level 1

Abstract Introduction The most recent ABA pain guidelines were developed over 13 years ago and have not been revised despite the changing practice of burn care. Coupled with the nationwide opioid epidemic there is a need to examine the available literature and revise the ABA practice guidelines for pain management. Methods A committee of a professional association was created to revise the previously published pain guidelines and consisted of a wide range of burn care providers including burn surgeons, burn nurses, anesthesiologists, a pharmacist, and a psychologist. A MEDLINE search of English-language publications from 1968 to 2018 was conducted using the keywords “burn pain,” “treatment,” and “assessment”. Selected other references were also used based on our evaluation of the greater pain literature. Studies were graded by 2 members of the committee using Oxford Centre for Evidence-based Medicine – Levels of Evidence (level 1 being the highest and level 5 the lowest). When there was a disagreement, a third member of the committee was used to resolve the disagreement. Our next step was to meet as a group and determine what our expert consensus was on a variety of topics related to treating pain in burn-injured patients. Finally, we assessed gaps in the knowledge that was available and determined research questions that would aid us in providing better recommendations for the care of the burn-injured patient. Results The literature search produced 189 papers, of which 95 were found to be relevant to the assessment and treatment of burn pain. From the greater pain literature, 115 references were included so a total of 210 papers were analyzed. The greatest number of papers were level 5 evidence (62, 29.5%) while only 30 (14.3%) were level 1. Following the review of the literature and meeting to establish consensus, 18 guidelines were established in the areas of pain assessment, opioid pain medications, non-opioid pain medications, regional anesthesia, and non-pharmacologic treatments. Conclusions While there is increasing research on various pain management modalities, the available studies are inadequate to create a true standard of care. Despite this, our committee reached a consensus using available literature from burn or other areas, expert experience and knowledge of pain physiology. Moving forward we call for more burn specific research into all modalities for burn pain control as well as research on multimodal pain control. Applicability of Research to Practice Burn pain is particularly difficult to manage and further study is needed to develop a standard of care for burn pain management.

scholarly journals Evaluation of national food and nutrition policy in Albania

2017 ◽  
Vol 56 (2) ◽  
pp. 115-123
Author(s):  
Ehadu Mersini ◽  
Jolanda Hyska ◽  
Genc Burazeri
Keyword(s):  
Public Health ◽  
Action Plan ◽  
Implementation Process ◽  
Monitoring And Evaluation ◽  
Nutrition Policy ◽  
Qualitative Assessment ◽  
Double Burden ◽  
Institutional Infrastructure ◽  
Wide Range ◽  
Food And Nutrition

Abstract Introduction The paper aims to describe the progress that has been made in the implementation of the Albanian food and nutrition policy since 2003, so as to consider its impacts to date, and to identify strategic priorities/critical areas and priorities for Albania’s future policy on improving the national food and nutrition situation. Methods In 2011-2012, an expert group applied an intersectoral participatory approach to evaluate the implementation of Food and Nutrition Action Plan 2003-08 in Albania. The experts employed the quantitative method, using a 9 question logical assessment matrix to measure the achievements of the individual goals of the Plan, and a qualitative tool for the interview of an interdisciplinary sample of 68-key informants-persons operating in public health nutrition, food safety and food availability related subfields, from a wide range of pertinent institutions and stakeholders. Results The quantitative and qualitative assessment revealed that the implementation process has faced serious barriers linked to the design of the plan, which did not accurately anticipate a theoretical framework, or structured methods for its implementation. Other impeding factors included the lack of institutional/infrastructure support, lack of intersectoral coordination and motivation, as well as insufficient capacities and know-how. Intersectoral response to the multifaceted nature of double burden of malnutrition is of key importance to improve nutritional wellbeing and health outcomes in Albania. Conclusions Participatory approaches that involve all relevant sectors and actors in the development, monitoring and evaluation of the implementation of public health policies based on comprehensive action-oriented assessments are promising and should be further supported.

scholarly journals Women in power: Female leadership and public health outcomes during the COVID-19 pandemic

2020 ◽  
Author(s):  
Luca Coscieme ◽  
Lorenzo Fioramonti ◽  
Lars F Mortensen ◽  
Kate E Pickett ◽  
Ida Kubiszewski ◽  
...  
Keyword(s):  
Public Health ◽  
Women Leaders ◽  
Female Leadership ◽  
Female Leaders ◽  
Health Crisis ◽  
Human Needs ◽  
Wide Range ◽  
Per Capita ◽  
Restrictive Measures ◽  
Better Than

Some countries have been more successful than others at dealing with the COVID-19 pandemic. When we explore the different policy approaches adopted as well as the underlying socio-economic factors, we note an interesting set of correlations: countries led by women leaders have fared significantly better than those led by men on a wide range of dimensions concerning the global health crisis. In this paper, we analyze available data for 35 countries, focusing on the following variables: number of deaths per capita due to COVID-19, number of days with reported deaths, peaks in daily deaths, deaths occurred on the first day of lockdown, and excess mortality. Results show that countries governed by female leaders experienced much fewer COVID-19 deaths per capita and were more effective and rapid at flattening the epidemic's curve, with lower peaks in daily deaths. We argue that there are both contingent and structural reasons that may explain these stark differences. First of all, most women-led governments were more prompt at introducing restrictive measures in the initial phase of the epidemic, prioritizing public health over economic concerns, and more successful at eliciting collaboration from the population. Secondly, most countries led by women are also those with a stronger focus on social equality, human needs and generosity. These societies are more receptive to political agendas that place social and environmental wellbeing at the core of national policymaking.

scholarly journals Rapid, collaborative generation and review of COVID-19 pandemic-specific competencies for family medicine residency training

2020 ◽  
Author(s):  
Eric Wooltorton ◽  
Edward Seale ◽  
Denice Lewis ◽  
Kendall Noel ◽  
Clare Liddy ◽  
...  
Keyword(s):  
Public Health ◽  
Family Medicine ◽  
Phase 1 ◽  
Health Crisis ◽  
Quality Improvement Process ◽  
Collaborative Editing ◽  
Global Pandemic ◽  
Wide Range ◽  
Competency Based ◽  
Teaching Learning

Background: In March 2020, the COVID-19 pandemic disrupted competency-based medical education in Family Medicine programs across Canada. Faculty and residents identified a need for clear, relevant, and specific competencies to frame teaching, learning, supervision and feedback during the pandemic. Methods: A rapid, iterative, educational quality improvement process was launched. Phase 1 involved experienced educators defining gaps in our program’s existing competency-database, reviewing emerging public health and regulatory guidelines, and drafting competencies. Phase 2 involved translation, member-checking, and anonymous feedback and editing of draft competencies by residents and other educational leaders. Phase 3 involved wider dissemination, collaborative editing and feedback from residents and faculty throughout the department. Results: A total of 44 physicians including residents and faculty from multiple contexts provided detailed feedback, review, and editing of an ultimate list of 33 competencies organized by CanMEDS-FM roles. Broad agreement was obtained that the competencies form reasonable learning outcomes during the COVID-19 pandemic. Conclusions: These competencies represent learning objectives reflecting the initial educational mindsets of a wide range of teachers and learners experiencing a global pandemic. The project illustrates a novel collaboration across educational portfolios as a rapid educational response to a public health crisis.

scholarly journals From 30 million to zero malaria cases in China: lessons learned for China–Africa collaboration in malaria elimination

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jun-Hu Chen ◽  
Jun Fen ◽  
Xiao-Nong Zhou
Keyword(s):  
Public Health ◽  
Malaria Control ◽  
Malaria Elimination ◽  
Malaria Parasite ◽  
Disease Burden ◽  
Action Plan ◽  
Lessons Learned ◽  
Wide Range ◽  
Parasite Populations ◽  
First Time

AbstractMalaria was once one of the most serious public health problems in China, with more than 30 million malaria cases annually before 1949. However, the disease burden has sharply declined and the epidemic areas has shrunken after the implementation of an integrated malaria control and elimination strategy, especially since 2000. Till now, China has successfully scaled up its efforts to become malaria-free and is currently being evaluated for malaria-free certification by the WHO. In the battle against malaria, China’s efforts have spanned generations, reducing from an incidence high of 122.9/10 000 (6.97 million cases) in 1954 to 0.06/10 000 (7855 cases) in 2010. In 2017, for the first time, China reached zero indigenous case of malaria, putting the country on track to record three consecutive years of zero transmission by 2020, accoding to the National Malaria Elimination Action Plan (2010–2020). China’s efforts to eliminate malaria is impressive, and the country is dedicated to sharing its lessons learned in malaria elimination—including, but not limited to, the application of novel genetics-based approaches—with other nations through new initiatives. China will promote international relationships and establish collaborative platforms on a wide range of topics in roughly 65 countries, including 20 African nations. China’s experience in applying innovative genetics-based approaches and tools to characterize malaria parasite populations, including surveillance of markers related to drug resistance, categorization of cases as indigenous or imported, and objective identification of the likely sources of infections to inform efforts towards malaria control and elimination in Africa could offer game-changing results when applied to settings with ongoing transmission.

Eating NAFTA

2018 ◽  
Author(s):  
Alyshia Gálvez
Keyword(s):  
Public Health ◽  
Chronic Disease ◽  
Low Income ◽  
Food System ◽  
Dietary Habits ◽  
Trade Agreement ◽  
Well Being ◽  
Health Crisis ◽  
The North ◽  
The World

In the two decades since the North American Free Trade Agreement (NAFTA) went into effect, Mexico has seen an epidemic of diet-related illness. While globalization has been associated with an increase in chronic disease around the world, in Mexico, the speed and scope of the rise has been called a public health emergency. The shift in Mexican foodways is happening at a moment when the country’s ancestral cuisine is now more popular and appreciated around the world than ever. What does it mean for their health and well-being when many Mexicans eat fewer tortillas and more instant noodles, while global elites demand tacos made with handmade corn tortillas? This book examines the transformation of the Mexican food system since NAFTA and how it has made it harder for people to eat as they once did. The book contextualizes NAFTA within Mexico’s approach to economic development since the Revolution, noticing the role envisioned for rural and low-income people in the path to modernization. Examination of anti-poverty and public health policies in Mexico reveal how it has become easier for people to consume processed foods and beverages, even when to do so can be harmful to health. The book critiques Mexico’s strategy for addressing the public health crisis generated by rising rates of chronic disease for blaming the dietary habits of those whose lives have been upended by the economic and political shifts of NAFTA.

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