scholarly journals Re-assessing the Validity of the Opioid Risk Tool in a Tertiary Academic Pain Management Center Population

Pain Medicine ◽  
2018 ◽  
Vol 19 (7) ◽  
pp. 1382-1395 ◽  
Author(s):  
Meredith R Clark ◽  
Robert W Hurley ◽  
Meredith C B Adams
Keyword(s):  
Pain Management ◽  
Smoking Status ◽  
Low Risk ◽  
The Self ◽  
Self Report ◽  
Drug Misuse ◽  
Aberrant Behavior ◽  
Cross Sectional ◽  
Risk Patients ◽  
Aberrant Behaviors

AbstractObjectiveTo analyze the validity of the Opioid Risk Tool (ORT) in a large. diverse population.DesignA cross-sectional descriptive study.SettingAcademic tertiary pain management center.SubjectsA total of 225 consecutive new patients, aged 18 years or older.MethodsData collection included demographics, ORT scores, aberrant behaviors, pain intensity scores, opioid type and dose, smoking status, employment, and marital status.ResultsIn this population, we were not able to replicate the findings of the initial ORT study. Self-report was no better than chance in predicting those who would have an opioid aberrant behavior. The ORT risk variables did not predict aberrant behaviors in either gender group. There was significant disparity in the scores between self-reported ORT and the ORT supplemented with medical record data (enhanced ORT). Using the enhanced ORT, high-risk patients were 2.5 times more likely to have an aberrant behavior than the low-risk group. The only risk variable associated with aberrant behavior was personal history of prescription drug misuse.ConclusionsThe self-report ORT was not a valid test for the prediction of future aberrant behaviors in this academic pain management population. The original risk categories (low, medium, high) were not supported in the either the self-reported version or the enhanced version; however, the enhanced data were able to differentiate between high- and low-risk patients. Unfortunately, without technological automation, the enhanced ORT suffers from practical limitations. The self-report ORT may not be a valid tool in current pain populations; however, modification into a binary (high/low) score system needs further study.

scholarly journals Prevalence of neuropathic pain in the foot and ankle patients

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0044
Author(s):  
Eliezer Sidon ◽  
Elizabeth McDonald ◽  
Annemarie Daecher ◽  
Rachel Shakked ◽  
David Pedowitz ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Management ◽  
Smoking Status ◽  
Current Level ◽  
Self Report ◽  
P Value ◽  
Foot And Ankle ◽  
Cross Sectional ◽  
Pain Mechanisms ◽  
Functional Scores

Category: Other Introduction/Purpose: The management of pain in patients with foot and ankle pain can be challenging. Cumulative data suggest that, in addition to nociceptive mechanisms, other neuropathic mechanisms can contribute to pain in a subset of people with osteoarthritis. Neuropathic mechanism include central sensitization or peripheral neuropathic hyper activated pain. Heterogeneous pain mechanisms may explain variable responses to recommended pain therapies. Accurate classification of pain phenotype using clinically feasible tools has potential to improve pain management. The PainDETECT score, a validated patient-report questionnaire was developed to identify neuropathic pain. A recent study found a prevalence of 23% of neuropathic pain following ORIF of Ankle fractures. The purpose of this study is to examine the prevalence of neuropathic pain (NP) in a variety of foot and ankle disorders. Methods: This is a cross-sectional study investigating the prevalence of NP in a population of patients undergoing foot and ankle surgery. The patient cohort will include 500 patients. Patients were prospectively reviewed, prior to their surgery, using a patient-self-report questionnaire (painDETECT). Patients’ demographics, diagnosis, comorbidities and functional scores were also prospectively collected. painDETECT score of less than 13 was considered as Nociceptive, score of more than 18 was considered as Neuropathic. Scores of 12 to 18 were considered as Unclear. ANOVA and Student’s t-tests were performed to compare the pain VAS scores, duration of pain prior to surgery, severity of the disease and the prevalence of NP, and among different foot and ankle procedures (bone versus tissue, elective versus trauma) and procedural regions (hindfoot/ankle, midfoot, forefoot). Results: A total of 116 patients were included in this preliminary study. 9 patients (7.7%) were diagnosed with neuropathic pain and 24 (20.6%) were Unclear according to their results in the painDETECT. There were 28 patients scheduled for surgery due to recent trauma, none of which had neuropathic pain. One patient with neuropathic pain was scheduled for excision of Morton’s neuroma and 2 patients for removal of foreign body or hardware. There was no significant correlation with age, BMI or smoking status nor with the patients’ functional scores. Patients with NP described their worst and current level of pain significantly higher than those with nociceptive pain. (9.4 Vs 7.4 for worst pain and 6.9 Vs 4.6 for current level in a scale from 0-10, p-value<0.05). Conclusion: A considerable number of the patients with foot and ankle problems requiring surgeries also has pain of a neuropathic mechanism. It is more common in chronic pain than in trauma. This should be evaluated pre-op and taken into attention when deciding on a surgical intervention or pain management.

scholarly journals Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility

2016 ◽  
Vol 371 (1708) ◽  
pp. 20160013 ◽  
Author(s):  
Wolf Mehling
Keyword(s):  
Clinical Importance ◽  
The Self ◽  
Metacognitive Awareness ◽  
Self Report ◽  
Interoceptive Awareness ◽  
Cross Sectional ◽  
Error Awareness ◽  
Regulatory Aspects ◽  
Interoceptive Accuracy ◽  
Interoceptive Cues

Based on prior research, multiple discriminable dimensions of interoception have been defined: awareness, accuracy and sensibility. Some investigators defined interoceptive awareness as metacognitive awareness of interoceptive accuracy, assessed as correspondence between subjective confidence in and objective accuracy of one's heartbeat detection. However, metacognitive awareness has been understood quite differently: ‘a cognitive set in which negative thoughts/feelings are experienced as mental events, rather than as the self’ or as ‘error awareness’. Interoceptive sensibility , defined as self-reported interoception, distinguishes self-reported interoception from objective interoceptive accuracy , but does not differentiate between anxiety-driven and mindful attention styles towards interoceptive cues, a distinction of key clinical importance: one attention style is associated with somatization and anxiety disorders; the other has been viewed as healthy, adaptive, resilience-enhancing. The self-report Multidimensional Assessment of Interoceptive Awareness was developed to differentiate these attention styles. It has been translated into 16 languages and applied in cross-sectional and longitudinal studies. Findings from these applications suggest that differentiating interoceptive sensibility according to attention style and regulatory aspects (i) provides insights into the psychology of interoceptive awareness, (ii) differentiates between clinically maladaptive and beneficial interoceptive attention, and (iii) helps elucidate therapeutic approaches that claim to provide health benefits by training mindful styles of bodily awareness. This article is part of the themed issue ‘Interoception beyond homeostasis: affect, cognition and mental health’.

scholarly journals A cross-sectional study of the self-report of stress among emergency department patients

2009 ◽  
Vol 2 (3) ◽  
pp. 155
Author(s):  
TedD Nirenberg ◽  
Janette Baird ◽  
Magdalena Harrington ◽  
MichaelJ Mello ◽  
Robert Woolard ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
The Self ◽  
Self Report ◽  
Sectional Study ◽  
Cross Sectional ◽  
Emergency Department Patients

scholarly journals Comparison between objective measures of smoking and self-reported smoking status in patients with asthma or COPD: are our patients telling us the truth?

2015 ◽  
Vol 41 (2) ◽  
pp. 124-132 ◽  
Author(s):  
Rafael Stelmach ◽  
Frederico Leon Arrabal Fernandes ◽  
Regina Maria Carvalho-Pinto ◽  
Rodrigo Abensur Athanazio ◽  
Samia Zahi Rached ◽  
...  
Keyword(s):  
Smoking Status ◽  
Cross Sectional Study ◽  
The Self ◽  
Objective Measures ◽  
Cross Sectional ◽  
Current Smoking ◽  
Urinary Cotinine ◽  
Copd Patients ◽  
Asthma Patients ◽  
Cotinine Concentration

OBJECTIVE: Smoking prevalence is frequently estimated on the basis of self-reported smoking status. That can lead to an underestimation of smoking rates. The aim of this study was to evaluate the difference between self-reported smoking status and that determined through the use of objective measures of smoking at a pulmonary outpatient clinic. METHODS: This was a cross-sectional study involving 144 individuals: 51 asthma patients, 53 COPD patients, 20 current smokers, and 20 never-smokers. Smoking status was determined on the basis of self-reports obtained in interviews, as well as through tests of exhaled carbon monoxide (eCO) and urinary cotinine. RESULTS: All of the asthma patients and COPD patients declared they were not current smokers. In the COPD and asthma patients, the median urinary cotinine concentration was 167 ng/mL (range, 2-5,348 ng/mL) and 47 ng/mL (range, 5-2,735 ng/mL), respectively (p < 0.0001), whereas the median eCO level was 8 ppm (range, 0-31 ppm) and 5 ppm (range, 2-45 ppm), respectively (p < 0.05). In 40 (38%) of the patients with asthma or COPD (n = 104), there was disagreement between the self-reported smoking status and that determined on the basis of the urinary cotinine concentration, a concentration > 200 ng/mL being considered indicative of current smoking. In 48 (46%) of those 104 patients, the self-reported non-smoking status was refuted by an eCO level > 6 ppm, which is also considered indicative of current smoking. In 30 (29%) of the patients with asthma or COPD, the urinary cotinine concentration and the eCO level both belied the patient claims of not being current smokers. CONCLUSIONS: Our findings suggest that high proportions of smoking pulmonary patients with lung disease falsely declare themselves to be nonsmokers. The accurate classification of smoking status is pivotal to the treatment of lung diseases. Objective measures of smoking could be helpful in improving clinical management and counseling.

scholarly journals DALES - a prospective cross-sectional study of incidence of penicillin allergy labels, risk of true allergy and attitudes of patients and anaesthetists to de-labelling strategies

2020 ◽  
Author(s):  
L Savic ◽  
C Thomas ◽  
D Fallaha ◽  
Michelle Wilson ◽  
PM Hopkins ◽  
...  
Keyword(s):  
Population Level ◽  
Cross Sectional Study ◽  
Low Risk ◽  
Penicillin Allergy ◽  
Risk Category ◽  
Sectional Study ◽  
Cross Sectional ◽  
Allergy Testing ◽  
Risk Patients ◽  
Provocation Testing

AbstractBackgroundDirect drug provocation testing (DPT) in patients with low-risk penicillin allergy labels would allow population-level ‘de-labelling’. We sought to determine the incidence and nature of penicillin allergy labels in a large UK surgical cohort and to define patient and anaesthetist attitudes towards penicillin allergy testing.MethodsA prospective cross-sectional study was performed in 213 UK hospitals. ‘Penicillin allergic’ patients were interviewed and risk-stratified. Knowledge and attitudes around penicillin allergy were defined in patients and anaesthetists, determining potential barriers to widespread testing.FindingsOf 21,281 patients 12% self-reported penicillin allergy and 67% of these were potentially suitable for direct DPT (stratified low or intermediate risk). Irrespective of risk category 62% wanted allergy testing. Of 4,978 anaesthetists 40% claimed to routinely administer penicillin when they judge the label to be low-risk; 64% would then tell the patient they had received penicillin. Only 47% of all anaesthetists would be happy to administer penicillin to a patient previously de-labelled by an allergy specialist using direct DPT; the commonest reason not to administer penicillin was perceived lack of support from their hospital. On the study days, 13% of low-risk patients requiring penicillin received it, and 6 patients with high-risk labels received it. There were no adverse events in any of this group. However, 1 patient who received an alternative antibiotic suffered suspected anaphylaxis to this.InterpretationThe majority of patients with a penicillin allergy label may be suitable for direct DPT and demand for testing is high among patients. Anaesthetists demonstrate inconsistent, potentially unsafe prescribing in patients labelled as penicillin allergic. More than half of anaesthetists are not reassured by a negative DPT undertaken by a specialist. Significant knowledge gaps may prevent widespread de-labelling being effectively implemented in surgical patients.FundingThe National Institute of Academic Anaesthesia.

scholarly journals Impact of COVID-19 restrictions on alcohol consumption behaviours

BJPsych Open ◽  
2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Emily O. C. Palmer ◽  
William Trender ◽  
Robin J. Tyacke ◽  
Adam Hampshire ◽  
Anne Lingford-Hughes
Keyword(s):  
Alcohol Consumption ◽  
Smoking Status ◽  
Psychiatric Morbidity ◽  
Group Analysis ◽  
Coefficient Matrix ◽  
Self Report ◽  
Depression And Anxiety ◽  
Cross Sectional ◽  
Drinking To Cope ◽  
Audit Score

Background We aimed to evaluate how coronavirus (COVID-19) restrictions had altered individual's drinking behaviours, including consumption, hangover experiences, and motivations to drink, and changing levels of depression and anxiety. Method We conducted an online cross-sectional self-report survey. Whole group analysis compared pre- versus post-COVID restrictions. A correlation coefficient matrix evaluated the associations between all outcome scores. Self-report data was compared with Alcohol Use Disorders Identification Test (AUDIT) scores from the 2014 Adult Psychiatric Morbidity Survey. Multiple linear modelling (MLM) was calculated to identify factors associated with increasing AUDIT scores and post-restriction AUDIT scores. Results In total, 346 individuals completed the survey, of which 336 reported drinking and were therefore analysed. After COVID-19 restrictions 23.2% of respondents reported an increased AUDIT score, and 60.1% a decreased score. AUDIT score change was positively correlated with change in depression (P < 0.01, r = 0.15), anxiety (P < 0.01, r = 0.15) and drinking to cope scores (P < 0.0001, r = 0.35). MLM revealed that higher AUDIT scores were associated with age, mental illness, lack of a garden, self-employed or furloughed individuals, a confirmed COVID-19 diagnosis and smoking status. Conclusions COVID-19 restrictions decreased alcohol consumption for the majority of individuals in this study. However, a small proportion increased their consumption; this related to drinking to cope and increased depression and anxiety.

scholarly journals Quality of life of adolescents with cerebral palsy: agreement between self-report and caregiver’s report*

2020 ◽  
Vol 28 ◽  
Author(s):  
Mariana Ceravolo Ferreira ◽  
Nathália Ribeiro Garcia ◽  
Cejane Oliveira Martins Prudente ◽  
Maysa Ferreira Martins Ribeiro
Keyword(s):  
Quality Of Life ◽  
Cerebral Palsy ◽  
Physical Health ◽  
Cross Sectional Study ◽  
The Self ◽  
Self Report ◽  
Cross Sectional ◽  
School Activities ◽  
Pedsql 4.0

Objective: to assess the quality of life (QOL) of adolescents with cerebral palsy (CP) by self-report and by the caregiver’s report, and to analyze the agreement between these reports. Method: cross-sectional study conducted with 101 adolescents with CP and 101 caregivers. Both answered the Pediatric Quality of Life Inventory (PedsQL), module 4.0 - Generic (PedsQL 4.0) and module 3.0 - PC (PedsQL 3.0). Agreement between reports was analyzed using the Mann-Whitney test and the intra-class correlation coefficient (ICC) (p<0.05). Results: the lowest scores were in physical health, school activities and fatigue in the self-report. The lowest scores were in physical health and daily activities, in the caregivers’ report. Perceptions among adolescents and caregivers differed in physical health, movement and equilibrium, daily and school activities, with a lower score for caregivers in all of them. The agreement between the self-report and the caregivers’ report was poor (ICC<0.44) and in both instruments, the caregivers’ report was less optimistic. Conclusion: physical health is the most impaired domain of the QOL of adolescents with CP, both in the self-report and in the caregivers’ report. However, there is poor agreement between these reports, emphasizing that the use of the caregivers’ report should be cautious.

scholarly journals Pain in Nursing Homes Residents With and Without Cognitive Impairment. Results From Five Consecutive Multicenter Cross-sectional Surveys Carried Out Between 2014 and 2018 in Germany

2020 ◽  
Author(s):  
Rainer Centmayer ◽  
Manfred Leiske ◽  
Nils Axel Lahmann
Keyword(s):  
Cognitive Impairment ◽  
Pain Management ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Self Report ◽  
Cross Sectional ◽  
Intensive Training ◽  
Prevalence Of Pain ◽  
Significant Deficit

Abstract Background: There is evidence that knowledge about the prevalence of pain and quality of pain management particularly in nursing home residents (NHR) with severe cognitive impairment (CI) is poor.Methods: The multicenter cross-sectional surveys explored the prevalence of pain of NHR with or without CI from nursing homes in Germany. Actual pain intensity in rest and stress were documented. NHR were asked about their daily restrictions due to pain. Data about the pain management were collected and analyzed.Results: A total of 3437 residents were interviewed with respect to feeling pain, including one third each with mild and severe CI. The prevalence of actual pain was 31,8%. Women reported pain more often. Prevalence of NHR without CI or with self-report on pain was significantly higher than NHR with severe CI or with external report on pain. About 20% of all NHR were dependent on external pain-recording. Nearly 10% of all NHR with pain confirmed pain in stress above 5 on a scale of 0 - 10. 85% of all NHR with pain reported that they had pain for longer than 3 months. Residents with severe CI are 0.55 times less likely to take painkillers than NHR without CI.Conclusion: The study points out a significant deficit in pain management in German NHR with severe CI. Intensive training in pain management for employees in nursing homes is recommended.

scholarly journals Mental health of Brazilian physicians during the COVID-19 pandemic

2020 ◽  
Vol 9 (10) ◽  
pp. e5129108758
Author(s):  
Déborah Pimentel ◽  
Daniel Lima Figueiredo ◽  
Roberta Machado Pimentel Rebello de Mattos ◽  
Ikaro Daniel de Carvalho Barreto
Keyword(s):  
Mental Health ◽  
Drug Use ◽  
Mental Disorders ◽  
Quantitative Study ◽  
Public Service ◽  
The Self ◽  
Self Report ◽  
Daily Activities ◽  
Cross Sectional ◽  
Impaired Sleep

Aim: To identify the profile of Brazilian doctors and the prevalence of mental suffering during the COVID-19 pandemic. Methods: This is a cross-sectional, exploratory quantitative study, performed between April and May 2020, using a sociodemographic questionnaire and a specific tool for tracking non-psychotic mental disorders: the Self Report Questionnaire. Results: Participant profile: women (68.1%), between 31 and 40 years old (39.9%), married or with partners (59.9%), without children (53.3%), with up to five years of graduation (30.9%), and working in public service (40.7%). The doctors (49.79%) show strong signs of mental suffering, with impaired sleep, headache, and psychotropic drug use. Many of them feel easily tired and have difficulty in satisfactorily carrying out daily activities. Many are tense, nervous or worried (77.4%); feel sad and are crying more than usual. Among them, 34.8% are losing interest in things, 14.6% feel they are useless, and 4.3% have suicidal thoughts. Conclusions: Almost half of the Brazilian doctors (49.79%) show strong signs of mental suffering, with a level of tension, nervousness and worry that affects more than half of the professionals. Ongoing programs for the prevention of mental disorders and suicide during and after the COVID-19 pandemic are required.

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