scholarly journals Pain Management and Use of Opioids in Pediatric Oncology in India: A Qualitative Approach

2017 ◽  
Vol 3 (4) ◽  
pp. 331-337 ◽  
Author(s):  
Paola Angelini ◽  
Katherine M. Boydell ◽  
Vicky Breakey ◽  
Purna A. Kurkure ◽  
Marian A. Muckaden ◽  
...  
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Health Care Providers ◽  
Pediatric Oncology ◽  
Rural Areas ◽  
Dominant Role ◽  
Public Hospitals ◽  
Care Providers ◽  
Cultural Perceptions ◽  
Poor Access

Purpose Consumption of medical opium for pain relief in India is low, despite the country being one of the main world producers of the substance. We investigated obstacles to opioid use and physician perceptions about optimal pain management in pediatric oncology patients in India. Methods Semistructured interviews were conducted with oncologists who work in pediatric oncology settings. A mixed sampling strategy was used, including maximum variation and confirmation and disconfirmation of cases, as well as snowball sampling. Key informants were identified. Interviews were audio recorded, transcribed verbatim, and analyzed by thematic analysis methodology. Results Twenty-three interviews were performed across 20 Indian institutions. The main obstacles identified were lack of financial resources, inadequate education of health care providers on pain management, insufficient human resources (particularly lack of dedicated trained oncology nurses), poor access to opioids, and cultural perceptions about pain. Children from rural areas, treated in public hospitals, and from lower socioeconomic classes appear disadvantaged. A significant equality gap exists between public institutions and private institutions, which provide state-of-the-art treatment. Conclusion The study illuminates the complexity of pain management in pediatric oncology in India, where financial constraints, lack of education, and poor access to opioids play a dominant role, but lack of awareness and cultural perceptions about pain management among health care providers and parents emerged as important contributing factors. Urgent interventions are needed to optimize care in this vulnerable population.

scholarly journals Pain Management in Children with Cancer: National Surveys of Practices and Perceptions in Morocco

2020 ◽  
Vol 8 (B) ◽  
pp. 723-730
Author(s):  
Nisrine Khoubila ◽  
Mounia Bendari ◽  
Sara Benmiloud ◽  
Jamila ElHoudzi ◽  
Khadija Maani ◽  
...  
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Health Care Providers ◽  
Pediatric Oncology ◽  
Care Providers ◽  
Children With Cancer ◽  
Cross Sectional ◽  
Improvement Project ◽  
National Quality ◽  
Information And Communication

AIM: The aim of the study was to improve the quality of pain management in Moroccan pediatric oncology units, the Moroccan Society of Paediatric Haematology/Oncology initiated a national quality improvement project in 2014 with the support of the Lalla Salma Foundation for Prevention and Treatment of Cancer. METHODS: To assess the current situation of pain management in Moroccan pediatric oncology patients, two cross-sectional surveys were conducted, involving patient/parental proxies and health-care providers’. RESULTS: The first survey concerned 108 care providers from five institutions. The second survey covered 155 children with cancer from the five Moroccan pediatric oncology units. Among them, 145 reported suffering from pain, which patients/families attributed to the underlying cancer (n = 85), to procedures and treatment (n = 46), or to both the cancer and procedures/treatment (n = 19). Procedural pain was mainly related to lumbar puncture and bone marrow aspirate. The majority of patients/parents reported that pain negatively impacted their emotional, physical, and social functioning. The majority of parents requested further information and communication about pain management. CONCLUSION: Both health-care providers and families of children with cancer in Morocco report need for pain management improvement, including in institutional and educational practices. This current baseline data have informed the development of our ongoing project including continuing education, training, and practice policies development.

scholarly journals Plain Language Summary: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

2021 ◽  
Vol 164 (4) ◽  
pp. 704-711
Author(s):  
Samantha Anne ◽  
Sandra A. Finestone ◽  
Allison Paisley ◽  
Taskin M. Monjur
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Practice ◽  
Pain Management ◽  
Health Care Providers ◽  
Clinical Practice Guideline ◽  
Shared Decision ◽  
Care Providers ◽  
Plain Language ◽  
Opioid Prescribing

This plain language summary explains pain management and careful use of opioids after common otolaryngology operations. The summary applies to patients of any age who need treatment for pain within 30 days after having a common otolaryngologic operation (having to do with the ear, nose, or throat). It is based on the 2021 “Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations.” This guideline uses available research to best advise health care providers, and it includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to facilitate shared decision making between patients and their health care providers.

Manage My Pain

2019 ◽  
pp. 642-667
Author(s):  
Aliza Weinrib ◽  
Muhammad Abid Azam ◽  
Vered Valeria Latman ◽  
Tahir Janmohamed ◽  
Hance Clarke ◽  
...  
Keyword(s):  
Health Care ◽  
Pain Management ◽  
General Hospital ◽  
Health Care Providers ◽  
Virtual Community ◽  
User Engagement ◽  
Care Providers ◽  
Management Platform ◽  
Surgical Pain ◽  
Chronic Post Surgical Pain

This chapter describes the Manage My Pain digital pain management platform and its integration into the Transitional Pain Service at Toronto General Hospital. A collaboration between ManagingLife, the developer of Manage My Pain, and the Transitional Pain Service led to the creation of a patient-provider virtual community with the aim of managing complex pain after surgery so as to prevent the transition from acute post-surgical pain to chronic post-surgical pain. User engagement, motivation, and satisfaction are discussed with respect to the needs of (1) people living with pain and (2) health care providers. Challenges in implementation are described, along with new features developed for the digital platform as a result of the partnership between ManagingLife and the Transitional Pain Service.

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 Who are CHWs? An ethnographic study of the multiple identities of community health workers in three rural Districts in Tanzania

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mohamed Yunus Rafiq ◽  
Hannah Wheatley ◽  
Hildegalda P. Mushi ◽  
Colin Baynes
Keyword(s):  
Health Care ◽  
Family Planning ◽  
Health Services ◽  
Health Care Providers ◽  
Rural Areas ◽  
Health Workers ◽  
Multiple Roles ◽  
Care Providers ◽  
Professional Identities ◽  
Community Members

Abstract Background Numerous studies have examined the role of community health workers (CHWs) in improving the delivery of health services and accelerating progress towards national and international development goals. A limited but growing body of studies have also explored the interactions between CHWs’ personal, communal and professional identities and the implications of these for their profession. CHWs possess multiple, overlapping roles and identities, which makes them effective primary health care providers when properly supported with adequate resources, but it also limits their ability to implement interventions that only target certain members of their community, follow standard business working days and hours. In some situations, it even prevents them from performing certain duties when it comes to sensitive topics such as family planning. Methods To understand the multiple identities of CHWs, a mixture of qualitative and ethnographic methods was utilized, such as participant observation, open-ended and semi-structured interviews, and focus group discussions with CHWs, their supervisors, and their clients. The observation period began in October 2013 and ended in June 2014. This study was based on implementation research conducted by the Connect Project in Rufiji, Ulanga and Kilombero Districts in Tanzania and aimed to understand the role of CHWs in the provision of maternal and child health services in rural areas. Results To our knowledge, this was the first study that employed an ethnographic approach to examine the relationship between personal, communal and professional identities, and its implications for CHWs’ work in Tanzania. Our findings suggest that it is difficult to distinguish between personal and professional identities among CHWs in rural areas. Important aspects of CHW services such as personalization, access, and equity of health services were influenced by CHWs’ position as local agents. However, the study also found that their personal identity sometimes inhibited CHWs in speaking about issues related to family planning and sexual health. Being local, CHWs were viewed according to the social norms of the area that consider the gender and age of each worker, which tended to constrain their work in family planning and other areas. Furthermore, the communities welcomed and valued CHWs when they had curative medicines; however, when medical stocks were delayed, the community viewed the CHWs with suspicion and disinterest. Community members who received curative services from CHWs also tended to become more receptive to their preventative health care work. Conclusion Although CHWs’ multiple roles constrained certain aspects of their work in line with prevalent social norms, overall, the multiple roles they fulfilled had a positive effect by keeping CHWs embedded in their community and earned them trust from community members, which enhanced their ability to provide personalized, equitable and relevant services. However, CHWs needed a support system that included functional supply chains, supervision, and community support to help them retain their role as health care providers and enabled them to provide curative, preventative, and referral services.

scholarly journals Identifying and describing a model region to evaluate the impact of telemedicine

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Harst ◽  
S Oswald ◽  
P Timpel
Keyword(s):  
Health Care ◽  
Focus Group ◽  
Focus Groups ◽  
Health Care Providers ◽  
Rural Areas ◽  
Demographic Data ◽  
Care Providers ◽  
Age Related ◽  
Model Region ◽  
The Impact

Abstract Background Telemedicine solutions providing patient-centered care over distance need to be integrated into the regional setting. The acceptance by both providers and patients hat to be continuously evaluated using methods of participatory implementation research. In controlled trials, often taking place in laboratory settings, these methods cannot be applied. In the following, research in progress is presented. Methods Based on socio-demographic data, epidemiology prevalence of age-related chronic diseases and data on the value of health care provision in Saxony, Germany a model region was chosen. Then, a focus group (n = 6) was conducted to differentiate the results and analyze the health networks of patients. For this, network maps putting the individual in the middle and his/her sources of information and support in case of illness in concentric circles around it, were used. The focus group was audiotaped, transcribed and analyzed by two researchers using MaxQDA. Results With a mean age of 47.8 years (n = 17,431), high prevalence of diabetes (>15.85 %) and hypertension (>39.1%) and an expected shortage of primary physicians in 2030, the town of Kamenz is a mirror image of the current health care challenges in rural areas of Saxony. Participants of the focus groups also stated problems in finding a primary physician or a dentist. Compensatory behavior, such as traveling large distances, relying on self-researched online diagnoses and immediately going to the emergency room for medical support was described. According to the network maps, primary sources of support in case of illness are partners and relatives, yet there is little connection between those and health care providers, as well as between different medical specialists. Conclusions The results will lead to potential use cases of telemedicine to be included into a standardized questionnaire for the assessment of telemedicine readiness in the model region. Key messages Telemedicine implementation in a rural area can be studied using a participatory approach. Focus groups and network maps are useful qualitative methods for participatory research and can inform the design of quantitative measurements.

Postoperative Pain Management Among Dominican and American Health-Care Providers

2016 ◽  
Vol 98 (12) ◽  
pp. e50 ◽  
Author(s):  
Christopher A. Devine ◽  
Amy Yu ◽  
Rachel G. Kasdin ◽  
Laura M. Bogart ◽  
Aileen M. Davis ◽  
...  
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Postoperative Pain ◽  
Health Care Providers ◽  
Postoperative Pain Management ◽  
Care Providers ◽  
American Health Care

Critical Challenges and Impediments Affecting Rural Physicians During a Public Health Emergency

2012 ◽  
Vol 6 (4) ◽  
pp. 342-348 ◽  
Author(s):  
Gavin J. Putzer ◽  
Mirka Koro-Ljungberg ◽  
R. Paul Duncan
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Rural Areas ◽  
Associated Factors ◽  
The United States ◽  
Public Health Emergency ◽  
Care Providers ◽  
Rural Physicians

ABSTRACTObjective: Disaster preparedness has become a health policy priority for the United States in the aftermath of the anthrax attacks, 9/11, and other calamities. It is important for rural health care professionals to be prepared for a bioterrorist attack or other public health emergency. We sought to determine the barriers impeding rural physicians from being prepared for a human-induced disaster such as a bioterrorist attack.Methods: This study employed a qualitative methodology using key informant interviews followed by grounded theory methods for data analysis. Semistructured interviews were conducted with 6 physicians in the state of Florida from federally designated rural areas.Results: The interview participants articulated primary barriers and the associated factors contributing to these barriers that may affect rural physician preparedness for human-induced emergencies. Rural physicians identified 3 primary barriers: accessibility to health care, communication between physicians and patients, and rural infrastructure and resources. Each of these barriers included associated factors and influences. For instance, according to our participants, access to care was affected by a lack of health insurance, a lack of finances for health services, and transportation difficulties.Conclusions: Existing rural organizational infrastructure and resources are insufficient to meet current health needs owing to a number of factors including the paucity of health care providers, particularly medical specialists, and the associated patient-level barriers. These barriers presumably would be exacerbated in the advent of a human-induced public health emergency. Thus, strategically implemented health policies are needed to mitigate the barriers identified in this study.(Disaster Med Public Health Preparedness. 2012;6:342–348)

Health Care Providers' Liability Exposure for Inappropriate Pain Management

1996 ◽  
Vol 24 (4) ◽  
pp. 360-364 ◽  
Author(s):  
Robyn S. Shapiro
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Cancer Patients ◽  
Health Care Providers ◽  
Nursing Home Residents ◽  
Hospitalized Patients ◽  
Care Providers ◽  
Experienced Pain ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Recent studies have exposed the startling inadequacy of health care providers knowledge about and practice of effective pain management. For example, in one study, it was reported that 79 percent of a random sample of 454 medical-surgical inpatients experienced pain during hospitalization, and that 58 percent of patients with pain considered the pain horrible or excruciating. In another study, 67 percent of 2,415 randomly selected hospitalized patients had pain during the twenty-four hours prior to being interviewed, and 50 percent reported pain at the time of the interview. In a study of seriously ill hospitalized patients reported in 1996, half of the patients complained of pain, and one-sixth reported that they experienced extremely severe pain at least half the time. According to one literature review, 75 percent of cancer patients have reported suffering pain, and one study estimates that 25 percent of cancer patients die with severe unrelieved pain. Chronic nonmalignant pain has been described as an extremely prevalent problem, and over two-thirds of nursing home residents experience serious pain.

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