scholarly journals Medical Evidence Influence on Inpatients and Nurses Pain Ratings Agreement

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Boaz Gedaliahu Samolsky Dekel ◽  
Alberto Gori ◽  
Alessio Vasarri ◽  
Maria Cristina Sorella ◽  
Gianfranco Di Nino ◽  
...  

Biased pain evaluation due to automated heuristics driven by symptom uncertainty may undermine pain treatment; medical evidence moderators are thought to play a role in such circumstances. We explored, in this cross-sectional survey, the effect of such moderators (e.g., nurse awareness of patients’ pain experience and treatment) on the agreement betweenn=862inpatients’ self-reported pain andn=115nurses’ pain ratings using a numerical rating scale. We assessed the mean of absolute difference, agreement (κ-statistics), and correlation (Spearman rank) of inpatients and nurses’ pain ratings and analyzed congruence categories’ (CCs: underestimation, congruence, and overestimation) proportions and dependence upon pain categories for each medical evidence moderator (χ2analysis). Pain ratings agreement and correlation were limited; the CCs proportions were further modulated by the studied moderators. Medical evidence promoted in nurses overestimation of low and underestimation of high inpatients’ self-reported pain. Knowledge of the negative influence of automated heuristics driven by symptoms uncertainty and medical-evidence moderators on pain evaluation may render pain assessment more accurate.

2021 ◽  
Vol 6 (1) ◽  
pp. 114-118
Author(s):  
Warren Fong ◽  
Yu Heng Kwan ◽  
Sungwon Yoon ◽  
Jie Kie Phang ◽  
Julian Thumboo ◽  
...  

Introduction: This study aimed to examine the perception of faculty on the relevance, feasibility and comprehensiveness of the Professionalism Mini Evaluation Exercise (P-MEX) in the assessment of medical professionalism in residency programmes in an Asian postgraduate training centre. Methods: Cross-sectional survey data was collected from faculty in 33 residency programmes. Items were deemed to be relevant to assessment of medical professionalism when at least 80% of the faculty gave a rating of ≥8 on a 0-10 numerical rating scale (0 representing not relevant, 10 representing very relevant). Feedback regarding the feasibility and comprehensiveness of the P-MEX assessment was also collected from the faculty through open-ended questions. Results: In total, 555 faculty from 33 residency programmes participated in the survey. Of the 21 items in the P-MEX, 17 items were deemed to be relevant. For the remaining four items ‘maintained appropriate appearance’, ‘extended his/herself to meet patient needs’, ‘solicited feedback’, and ‘advocated on behalf of a patient’, the percentage of faculty who gave a rating of ≥8 was 78%, 75%, 74%, and 69% respectively. Of the 333 respondents to the open-ended question on feasibility, 34% (n=113) felt that there were too many questions in the P-MEX. Faculty also reported that assessments about ‘collegiality’ and ‘communication with empathy’ were missing in the current P-MEX. Conclusion: The P-MEX is relevant and feasible for assessment of medical professionalism. There may be a need for greater emphasis on the assessment of collegiality and empathetic communication in the P-MEX.


2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
He-Yang You ◽  
Lei Wu ◽  
Hai-Ting Yang ◽  
Chen Yang ◽  
Xiao-Ling Ding

Background. Pain is frequent in Parkinson’s disease (PD) and Parkinson-plus syndrome. This study aimed to assess the prevalence, characteristics, therapy (especially the effect of dopaminergic therapy), and associated symptoms of pain in Parkinson's disease and multiple system atrophy (MSA) patients. Methods. Seventy-one PD patients, sixty-five MSA patients, and forty age-matched healthy controls were enrolled and evaluated by using the German pain questionnaire and visual analogue scale (VAS). In addition, the influence of pain in PD patients on anxiety, depression, and the quality of life was assessed with the Hospital Anxiety and Depression Scale (HADS) and Parkinson’s Disease Questionnaire (PDQ-39). Results. Compared to that of the healthy controls, the PD and MSA patients had a significantly higher presence of pain (P<0.01, P<0.01). PD patients had a higher presence of pain than MSA patients (P=0.007). No difference in VAS scores was observed between the PD and MSA patients (P=0.148). A total of 21 PD patients (42.85%) with pain and 13 MSA patients (43.33%) with pain received treatment. A total of 13 PD patients with pain and 6 MSA patients with pain had an improved pain intensity after using dopaminergic medication. The differences in the disease duration, Hoehn and Yahr stages, and scores on the Unified Parkinson’s Disease Rating Scale motor score, HAD-D, HAD-A, and PDQ-39 were significant between the PD patients with and without pain. Conclusion. PD and MSA patients are prone to pain with insufficient treatment. Pain interventions should be provided as soon as possible to improve the patient’s life.


2018 ◽  
Vol 07 (04) ◽  
pp. 215-218 ◽  
Author(s):  
Vijay Kumar Chattu ◽  
Soosanna Kumary ◽  
Akshaya Srikanth Bhagavathula

Abstract Background: In Oman, a higher proportion of patients presented with breast cancer are relatively young age and with an advanced stage. This could be due to lack of awareness and knowledge about breast cancer among young women. Aim: To assess the breast cancer knowledge, awareness and factors associated with the practice of breast self-examination (BSE) among females in Buraimi, Oman. Methods: A cross-sectional survey was conducted among females attending the two days health exhibition event at a polyclinc, in Al-Buraimi, governorate. A pretested questionnaire to assess their knowledge, awareness and practices concerned to breast cancer was used. The collected data was categorized, analyzed using descriptive statistics and logistic regression model. All the statistical analysis was performed using SPSS 21.0 version. Results: Out of the total of one hundred and eighty nine (189) participants, 80% had information of breast cancer. Participants had better knowledge of symptoms but less knowledge about risk factors. When probed about BSE, only 43% performed it and only 21% of them do it monthly on regular basis. The main reasons for regular monthly BSE is mainly because of fear of breast cancer (9%), doctor's advice (6%) and awareness through media (5%). Conclusion: Our study participants showed insufficient knowledge in some areas related to sign and symptoms and risk factors of breast cancer and identified a negative influence of low knowledge on the practice of BSE. Thus, educational interventions need to be emphasized to provide comprehensive information of breast cancer.


2017 ◽  
Vol 6 (4) ◽  
pp. 268
Author(s):  
Famimah Famimah ◽  
Ani Margawati ◽  
Deny Yudi Fitranti

Background: Dysmenorrhea or menstrual pain was a gynecological complaint due to an imbalance of progesterone in the blood resulting in pain. A woman with dysmenorrhea should consume food rich in omega-3 fatty acids such as fish oil, fish (salmon, tuna, mackerel, herring), soybeans and fruits. Low fish consumption was related with severity of dysmenorrhea. In addition, physical activity and percent body fat were also associated with severity of dysmenorrhea.Objective : To determine the correlation between consumption of omega-3 fatty acids, physical activity and percent body fat to the classification of dysmenorrhea in adolescents.Methods : Cross sectional study of 90 adolescentsselected by purposive sampling. This research was conducted in SMA N 15 and SMA N 9 Semarang. Menstrual history was measured by direct interviews and level of dysmenorrhea was measured using Numerical Rating Scale Questionnaire. Omega-3 fatty acids were measured using Food Frequency Questionnaire (FFQ) and analyzed using a nutritional software program. Physical activity was measured using A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Percent body fat was measured using Bioelectrical Impedance Analysis (BIA). Data were analyzed by Independent T test/Mann Whitney. Result : There were significant correlation in omega-3 fatty acid (p= 0,015), and percent body fat (p= 0,026). While in physical activity there was no significant correlation (p= 0,394).Conclusion : Consumption of omega-3 fatty acids and percent body fat were associated with the classification of dysmenorrhea.


2018 ◽  
Vol 7 (3.30) ◽  
pp. 449
Author(s):  
Nitce Isa Medina Machmudi Isa ◽  
Azlin Norhaini Mansor ◽  
Jamalul Lail Abdul Wahab ◽  
Bity Salwana Alias

Principals’ instructional leadership practices have proved to be an imperative predictor to teachers’ self-efficacy. Yet, educators are concerned about the ability to adapt to new instructional leaderships due to unspoken principal-teacher expectations. This paper discusses the extent of instructional leadership practices by two newly transferred principals at two different schools. The purpose of this quantitative study was to examine how their instructional leadership practices affected the self-efficacy of the teachers. Through the use of a cross-sectional survey, responses made by 64 teachers employed in one public school and one privately-run school, were compared. The Principal Instructional Management Rating Scale (PIMRS) Teacher Short Form and the Teachers’ Sense of Efficacy Scale (TSES) were used for data collection. The findings showed a high level of instructional leadership practices and self-efficacy in both schools. The test results indicated a strong and positive relationship between the principals’ perceived instructional leadership practices and the teachers’ self-efficacy. Some of the details even suggested that newly transferred principals enforce specific school goals as their main agenda. Nevertheless, the areas of significance identified by this study may help district school superintendents develop the right knowledge to support newly transferred principals in their instructional leadership, thus enhancing teachers’ self-efficacy at the school level.  


BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023997 ◽  
Author(s):  
Dong Roman Xu ◽  
Mengyao Hu ◽  
Wenjun He ◽  
Jing Liao ◽  
Yiyuan Cai ◽  
...  

IntroductionPrimary healthcare (PHC) serves as the cornerstone for the attainment of universal health coverage (UHC). Efforts to promote UHC should focus on the expansion of access and on healthcare quality. However, robust quality evidence has remained scarce in China. Common quality assessment methods such as chart abstraction, patient rating and clinical vignette use indirect information that may not represent real practice. This study will send standardised patients (SP or healthy person trained to consistently simulate the medical history, physical symptoms and emotional characteristics of a real patient) unannounced to PHC providers to collect quality information and represent real practice.Methods and analysis1981 SP–clinician visits will be made to a random sample of PHC providers across seven provinces in China. SP cases will be developed for 10 tracer conditions in PHC. Each case will include a standard script for the SP to use and a quality checklist that the SP will complete after the clinical visit to indicate diagnostic and treatment activities performed by the clinician. Patient-centredness will be assessed according to the Patient Perception of Patient-Centeredness Rating Scale by the SP. SP cases and the checklist will be developed through a standard protocol and assessed for content, face and criterion validity, and test–retest and inter-rater reliability before its full use. Various descriptive analyses will be performed for the survey results, such as a tabulation of quality scores across geographies and provider types.Ethics and disseminationThis study has been reviewed and approved by the Institutional Review Board of the School of Public Health of Sun Yat-sen University (#SYSU 2017-011). Results will be actively disseminated through print and social media, and SP tools will be made available for other researchers.


2020 ◽  
Vol 10 (4) ◽  
pp. 429-434 ◽  
Author(s):  
Marlise Poolman ◽  
Matthew Makin ◽  
Jess Briggs ◽  
Kate Scofield ◽  
Nick Campkin ◽  
...  

ObjectivesPercutaneous cervical cordotomy (PCC) is an interventional ablative procedure in the armamentarium for cancer pain treatment, but there is limited evidence to support its use. This study aimed to assess the effectiveness and safety of PCC.MethodsAnalysis was undertaken of the first national (UK) prospective data repository of adult patients with cancer undergoing PCC for pain treatment. The relationship between pain and other outcomes before and after PCC was examined using appropriate statistical methods.ResultsData on 159 patients’ PCCs (performed from 1 January 2012 to 6 June 2017 in three centres) were assessed: median (IQR) age was 66 (58–71) years, 47 (30%) were female. Mesothelioma was the most common primary malignancy (57%). The median (IQR) time from cancer diagnosis to PCC assessment was 13.3 (6.2–23.2) months; PCC to follow-up was 9 (8–25) days; and survival after PCC was 1.3 (0.6–2.8) months. The mean (SD) for ‘average pain’ using a numerical rating scale was 6 (2) before PCC and 2 (2) at follow-up, and for ‘worst pain’ 9 (1) and 3 (3), respectively. The median (IQR) reduction in strong opioid dose at follow-up was 50% (34–50). With the exception of ‘activity’, all health-related quality of life scores (5-level version of EuroQol-5 Dimension) either improved or were stable after PCC. Six patients (4%) had PCC-related adverse events.ConclusionsPCC is an effective treatment for cancer pain; however, findings in this study suggest PCC referrals tended to be late in patients’ disease trajectories. Further study into earlier treatment and seeking international consensus on PCC outcomes will further enhance opportunities to improve patient care.


2021 ◽  
Vol 43 (5-6) ◽  
pp. 111-116
Author(s):  
Girijanandan Menon ◽  
Manjit George

Background: Effective control of immediate post operative abdominal pain following laparoscopic sterilization is challenging. The objective of the study was to estimate the incidence of immediate severe postoperative pain following laparoscopic sterilization under general anaesthesia by the proportion of patients with the pain assessed on a numerical rating scale. Methods: A cross sectional study was conducted with the approval of institutional review board and ethics committee. Fifty seven participants with written informed consent underwent the study over a period of six months. Pain was assessed by a trained recovery nurse and data was collected and analyzed. The main outcome measure was immediate severe post operative pain on numerical rating scale (NRS). Results: Among the 57 participants, 14 (24.6%) had immediate severe post operative pain with median score of five in the inter quartile range of 0 to 5.75 and 43 (75.4%) participants had no severe pain. Conclusion: The incidence of immediate severe postoperative abdominal pain after laparoscopic sterilization under general anaesthesia is high. Therefore, the management of pain following laparoscopic sterilization requires individually based multimodal analgesia.


2018 ◽  
Vol 14 (1) ◽  
pp. 270-283 ◽  
Author(s):  
Abdulqader Al Jarad ◽  
Ahmad Al Hadi ◽  
Ali Al Garatli ◽  
Aly Akram ◽  
Dakhil Alsaeidi ◽  
...  

Background:Major depressive disorder is a common condition with a high rate of recurrence, chronicity, and affecting economic burden, including disability in the workplace, which leads to negative consequences on both individuals and society.Objectives:This study aimed to estimate the impact of cognitive dysfunction, as declared by the patient, on performing daily tasks/activities among patients with major depression disorder (MDD).Methods:This investigation is based on multinational cross-sectional survey of 499 workers recruited from the Kingdom of Saudi Arabia (KSA) and United Arab Emirates (UAE). We assessed the severity of depression by Hamilton Depression Rating Scale (HDRS). Impact of Depression in the Workplace in Europe Audit (IDEA) survey and trial making test (TMT) parts A and B were used to assess the impact of cognitive dysfunction on performing daily tasks/activities in adult patients presented with MDD.Results:A total of 499 persons were included in this study, aged 18–66 years, current workers and managers. Of them, 17.8% were normal (remitted), 22.4% were mildly depressed, 23.4% were moderately depressed, 8.6% were severely depressed, and 27.7% were very severely depressed at the time of the study according to HDRS. Common symptoms attributable to depression were low mode or sadness (89.8%), followed by insomnia (75.2%) and crying (70.9%). Of them, low mode or sadness was the most common factor affecting the work performance (90.2%). About 66.3% of participants diagnosed with depression by a doctor/medical professional. Awareness of the disease was recognizable by patients’ managers in only 31.9% of the cases. Furthermore, 45.3% of cases had taken off work due to depression with mean duration of 38.7 (95% CI 37.7 to 39.7) days. The mean TMT parts A and B score were 69.2 (95% CI 66.3 to 72.2) and 126.6 (95% CI 121 to 132), respectively. Lastly, a significant positive correlation between the mean score for HDRS and TMT-A and B scores was observed.Conclusion:Depression affects work productivity and work environment with negative consequences to countries’ economy. Awareness of depression in the workplace in KSA and UAE is still suboptimal. The personal and societal burden of this issue cannot be neglected when we become aware of the proportion of affected people.


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