scholarly journals Management of Pain with Morphine in cancer patients in a Tertiary Care Centre of Nepal

2021 ◽  
Vol 23 (3) ◽  
pp. 210-215
Author(s):  
Rita Kumari Mahaseth ◽  
Rashmey Pun ◽  
Kriti Shrestha
Keyword(s):  
Cancer Pain ◽  
Cancer Patients ◽  
Health Care Professionals ◽  
Tertiary Care ◽  
Dose Titration ◽  
P Value ◽  
Visual Analogue Pain Scale ◽  
Policy Document ◽  
Visual Analogue Pain ◽  
Relieve Pain

Pain is one of the most afflicting symptoms reported by cancer patients, mainly those with metastatic disease. The prevalence of cancer has increased, with an estimated projection of 17 million new cases in 2020. This means that there will be an increase in individuals with pain caused by the disease and by treatment. Morphine has been used to relieve pain in cancer patients for centuries. WHO, created a global health policy document for management of cancer pain entitled “Cancer Pain Relive,1 in which morphine was central. In a retrospective study of 1229 patients with cancer pain, the author reported that the analgesic ladder was effective in 71%. Many patients do not get adequate pain relief. Rationale of this study was to assess cancer related pain by using visual analogue pain scale and to prescribe optimal dose of morphine through dose titration to relieve pain and to improve quality of life. An interventional hospital-based study was done in fifty-two different types of cancer patients from 1st Jan, 2020 to 31st Dec, 2020 at Department of Oncology, Nepal Medical college and Teaching Hospital (NMCTH), Kathmandu. Among them 31 were male and 21 were female with mean age 63.87 and 58.19 respectively and SD +/- 12.10 in male and 16.07 in female with p value 0.152 significant. These patients were assessed for severity of pain through visual pain analogue. Improvement in daily activities after administration of morphine according to ECOG performance scale was done. Constipation was the most common complication induced by morphine 38.5%, sedation 32.7% and nausea in 25%. By understanding the context and social meaning surrounding the use of morphine to treat cancer pain, health care professionals can begin to anticipate, acknowledge and address some of the barrier to its use, thereby enhancing the pain control.

scholarly journals Careful Breakthrough Cancer Pain Treatment through Rapid-Onset Transmucosal Fentanyl Improves the Quality of Life in Cancer Patients: Results from the BEST Multicenter Study

2020 ◽  
Vol 9 (4) ◽  
pp. 1003
Author(s):  
Arturo Cuomo ◽  
Marco Cascella ◽  
Cira Antonietta Forte ◽  
Sabrina Bimonte ◽  
Gennaro Esposito ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Rating Scale ◽  
Assessment System ◽  
P Value ◽  
Breakthrough Cancer Pain ◽  
Pain Clinics ◽  
Eortc Qlq

Objectives: To explore the effect of breakthrough cancer pain (BTcP) treatment on quality of sleep and other aspects of the health-related quality of life (HRQoL) in patients with cancer pain. Methods: In an observational, multicenter, cohort study, cancer patients from palliative care units, oncology departments, and pain clinics and affected by BTcP were included. Enrolled patients were assessed at the four visits: T0 (baseline), T7, T14, and T28. Stable chronic background pain (numeric rating scale, NRS ≤ 4) during the whole study period was mandatory. BTcP was treated through transmucosal fentanyl. Three questionnaires were used to measure the HRQoL: EORTC QLQ-C15-PAL, Pittsburgh Sleep Quality Index (PSQI), and the Edmonton Symptom Assessment System (ESAS). RESULTS: In 154 patients, the HRQoL showed a significant improvement for all physical and emotional characteristics in the EORTC QLQ-C15-PAL, except for nausea and vomiting (linear p-value = 0.1) and dyspnea (Linear p-value = 0.05). The ESAS and PSQI questionnaires confirmed these positive results (p < 0.0001 and p = 0.002, respectively). Conclusions: This prospective investigation by an Italian expert group, has confirmed that careful management of BTcP induces a paramount improvement on the HRQoL. Because in cancer patients there is a high prevalence of BTcP and this severe acute pain has deleterious consequences, this information can have an important clinical significance.

scholarly journals Knowledge, attitude and practice regarding COVID-19 among doctors and nurses at a tertiary care maternity hospital in Nepal

2020 ◽  
Vol 7 (2) ◽  
pp. 23-31
Author(s):  
Shaheen Naaz Ansari ◽  
Imran Ansari ◽  
Meena Jha ◽  
Rakshya Upreti
Keyword(s):  
Health Care Professionals ◽  
Good Practice ◽  
Tertiary Care ◽  
P Value ◽  
Attitude Score ◽  
Attitude And Practice ◽  
Validated Questionnaire ◽  
Significant Difference ◽  
Knowledge Attitude And Practice ◽  
Doctors And Nurses

Introduction: Knowledge, attitude, and practice (KAP) survey provides a suitable format to evaluate existing programs and to identify effective strategies for behavior change in society. This study aimed to investigate and compare KAP concerning COVID-19 among Health Care Professionals (HCPs) at Paropakar Maternity and Women’s Hospital (PMWH). Method: This was a cross sectional descriptive study conducted in HCPs (doctors and nurses) of PMWH, Nepal, from May to June 2020. A pre-validated questionnaire was used to access the objectives where knowledge and attitude score was 10 each and practice score was 20. Collected data was entered in Microsoft excel spreadsheet and analyzed using IBM SPSS software and p-value < 0.05 was taken as statistically significant. Result: A total of 168 doctors and nurses responded to the survey, of which 112 (66.6%) were in 25-34 years of age group, 87.5% females, and 61.9% nurses. Mean score for knowledge, attitude and practice score was 5.8 (out of 10), 8.1 (out of 10) and 17.4 (out of 20) respectively. The score was significantly different among doctors and nurses in ‘knowledge’ (p=0.000) and ‘attitude’ categories (p = 0.006). There was no significant difference in ‘practice’ scores (p = 0.664). Conclusion: Doctors and nurses of PMWH have positive attitude and good practice towards COVID-19. This characteristic can prove handy in bringing about useful behavioural changes and promoting safe practices while managing maternity patients in this hospital.

scholarly journals Psychosocial Burden Among Informal Caregivers of Adult Cancer Patients Attending a Tertiary Care Cancer Center in Coastal South India

SAGE Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 215824401987628
Author(s):  
Bhaskaran Unnikrishnan ◽  
Priya Rathi ◽  
P. U. Prakash Saxena ◽  
Apoorva Aggarwal ◽  
Shashank Shekhar ◽  
...  
Keyword(s):  
Cancer Patients ◽  
South India ◽  
Tertiary Care ◽  
Cancer Center ◽  
P Value ◽  
Sociodemographic Characteristics ◽  
Psychosocial Burden ◽  
Chi Square ◽  
Chi Square Test

Cancer is the most dreaded and chronic disease with its treatment lasting almost lifelong with an uncertainty of cure. This not only adversely affects the quality of life among patients but also poses a psychosocial burden among family members, especially caregivers of the patient. This study was conducted with the objectives to assess the psychosocial burden on caregivers of cancer patients and to find out the association of various sociodemographic characteristics with the level of burden among caregivers. Caregivers of 205 cancer patients were interviewed. Information on sociodemographic characteristics of caregivers, cancer details of patients, and psychosocial burden among caregivers was collected using Zarit Burden Interview (ZBI) scale. Descriptive statistics were used to analyze the baseline data. Chi-square test was done to find out the association of burden with various sociodemographic and disease variables. A p-value of <0.05 was taken as statistically significant. The median (interquartile range) ZBI was 20 (10, 34). Fifty percent of the caregivers had no or minimal burden and only 2% had severe burden. Age of the caregiver was a significant determinant of their psychosocial burden.

scholarly journals Awareness About Ebola Virus Disease Among the Health Care Professionals in Karachi, Pakistan

2018 ◽  
Vol 55 (2) ◽  
pp. 102-107
Author(s):  
Kashif Ali ◽  
Syed Omair Adil ◽  
Subhana Akber ◽  
Shakir Khan ◽  
Nand Lal ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Ebola Virus ◽  
Virus Disease ◽  
Tertiary Care ◽  
Ebola Virus Disease ◽  
P Value ◽  
Care Hospital ◽  
Awareness Campaigns ◽  
Study Participants

Background: Ebola virus disease is an acute and life-threatening illness, which, if untreated, is fatal. It was first discovered in 1976, which aware the world with sporadic outbreaks of Ebola in some parts of Africa. According to Centers for Disease Control and Prevention (CDC), the natural reservoir for Ebola virus remains unknown; however, it is yet to be affirmed that the natural habitat is animal-borne where bats are most likely to carry over this virus. Therefore, the aim of this study was to estimate awareness of health care professionals as they serve as the integral part of our health care system. Methods: A cross-sectional survey was conducted among 149 health care workers (HCWs) in Civil Hospital of Karachi from June 2015 to August 2015. The study participants were randomly selected individuals who were students of and/or were working in the university’s affiliated tertiary care hospital in Karachi, Pakistan. Results: Baseline characteristics of the study participants are shown in Table 1. Median age of the participants is 21 (range: 17-24) years. Female preponderance was found to be higher (104; 69.8%) as compared with the males (45; 30.2%). Discipline of majority of the study participants was medical technology (80; 53.7%), followed by nurses (38; 25.5%) and doctors (31; 20.8%). Majority of the study respondents were undergraduate medical students (60; 75%) as compared with medical technologist and the nurses (17; 24.6%) with a P value < .001 as shown in Figure 1. The mean for correct responses was 8.43 ± 4.08 (range: 3-17). Appropriate knowledge was observed in 84 (56.4%) responders and inappropriate knowledge was observed in 65 (43.6%) of the study respondents. Conclusion: Our study concludes that there is an unsatisfactory knowledge about Ebola virus disease among health care professionals. Moreover, public health authorities should signify the importance of prevention against Ebola virus disease not only among the health care professionals but also into the communities through mass media and awareness campaigns which can thus halt the panic and incidence of Ebola virus outbreaks in coming decades.

scholarly journals The Effect of Premedication with Curcumin on Post-Operative Pain in Single Visit Endodontic Treatment of Acute Pulpitis in Mandibular Molars: A Randomized Controlled Trial

2021 ◽  
Vol 1 (3) ◽  
pp. 1-8
Author(s):  
Ghada El Hilaly Mohamed Eid
Keyword(s):  
Repeated Measure ◽  
Rank Test ◽  
P Value ◽  
Visual Analogue Pain Scale ◽  
Visual Analogue Pain ◽  
Time Points ◽  
Single Visit ◽  
Mandibular Molars ◽  
Post Operative Pain ◽  
Irreversible Pulpitis

Objective: The purpose of this randomized double-blind clinical trial was to compare the effect of a single pretreatment dose of Curcumin and placebo on post-operative pain for patients diagnosed with symptomatic irreversible pulpitis in mandibular molars treated in single visit. Methods: Forty-four patients with severe to moderate pain randomly received either Curcumin (400mg +20 mg pepper) or placebo (420 mg Starch) one hour before starting root canal treatment (n = 22 per group). Participants rated their pain using visual analogue pain scale (VAS): preoperatively and at 5 time points: immediately post-operative, 8, 12, 24 and 48 hours postoperative. Patients also stated emergency analgesic intake. The need for supplemental anesthesia during treatment was recorded. Mann-Whitney U-test compared the two groups at each time point, while Repeated-Measure ANOVA and Wilcoxon Signed Rank test compared time points within each group. A p-value <0.05 was considered statistically significant. Results: Baseline characteristics of both groups showed non-significant differences (P > 05). Curcumin group at 8, 12 and 24 hours revealed statistically significantly less VAS values (44.2, 26.7, 19.1) than the placebo (58.5, 43.3, 30.3), respectively, (P > 05). All patients in Curcumin group did not need emergency analgesics. Curcumin group revealed statistically significantly lower percentages for the need of supplemental anesthesia (27.3%) compared to placebo (68.2%), (P < 05). Conclusion: Single preoperative oral dose of Curcumin proved to be an effective premedication that reduced post-operative pain as well as the need of supplemental anesthesia for patients diagnosed with symptomatic irreversible pulpitis of mandibular molars.

scholarly journals Careful Breakthrough Cancer Pain Treatment through Rapid-Onset Transmucosal Fentanyl Improves the Quality of Life in Cancer Patients: Results from the BEST Multicenter Study

2020 ◽  
Author(s):  
Arturo Cuomo ◽  
Marco Cascella ◽  
Cira Antonietta Forte ◽  
Sabrina Bimonte ◽  
Gennaro Esposito ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Pain Treatment ◽  
Assessment System ◽  
P Value ◽  
Breakthrough Cancer Pain ◽  
Pain Clinics ◽  
Eortc Qlq

Objectives: To explore the effect of breakthrough cancer pain (BTcP) treatment on quality of sleep and other aspects of the health-related quality of life (HRQoL) in patients with cancer pain. Methods: In an observational, multicenter, cohort study, cancer patients from palliative care units, oncology departments, and pain clinics and affected by BTcP were included. Enrolled patients were assessed at the four visits: T0 (baseline), T7, T14, and T28. Well-controlled chronic background pain during the whole study period was mandatory. BTcP was treated through transmucosal fentanyl. Three questionnaires were used to measure the HRQoL: EORTC QLQ-C15-PAL, Pittsburgh Sleep Quality Index (PSQI), and the Edmonton Symptom Assessment System (ESAS). Results: In 154 patients, the HRQoL showed a significant improvement for all physical and emotional characteristics in the EORTC QLQ-C15-PAL, except for nausea and vomiting (Linear p-value = 0.1) and dyspnoea (Linear p-value =0.05). The ESAS and PSQI questionnaires confirmed these positive results (p&lt;0.0001 and p=0.002, respectively). Conclusions: This prospective investigation by an Italian expert group, has confirmed that careful management of BTcP induces a paramount improvement on the HRQoL. Because in cancer patients there is a high prevalence of BTcP and this severe acute pain has deleterious consequences, this information can have an important clinical significance

Interpretation of Electrocardiogram and Emergency Management of Myocardial Infarction: A Survey among Doctors

2020 ◽  
Author(s):  
Farah Ahmad
Keyword(s):  
Myocardial Infarction ◽  
General Practitioners ◽  
Health Care Professionals ◽  
Tertiary Care ◽  
Ethical Review ◽  
P Value ◽  
Acute Management ◽  
Inverse Results ◽  
Ecg Interpretation ◽  
Emergency Doctors

Background: A virtuous understanding of Electrocardiogram is an indispensable ability and essential skill required in doctors. This study assessed the understanding of the electrocardiogram and acute management of myocardial infarction among emergency doctors, general practitioners, medical officers, house officers and postgraduate students. Methods: A cross sectional survey was conducted for 7 months on n=312 doctors working in tertiary care public and private hospitals and as General practitioners in Karachi, Pakistan. Convenience sampling technique was used. Participants were asked to interpret a 12 lead electrocardiogram attached to questionnaire and write down their findings and diagnoses. They were then asked about its acute management. ANOVA and Chi square was applied for making inferences from the acquired data. p value of less than 0.05 was taken as significant. Approval was taken from the Ethical Review board. Results: Knowledge was assessed on basis of designation, 84.6% of the emergency doctors correctly interpreted the ECG while 75.4% of general physicians read it correctly. House officers and medical officers had the lowest scores in ECG interpretation. Years of experience demonstrated inverse results with >5 years experience at the lowest scores for interpretation of ECG and MI management. Interpretation scores of ECG were significantly high (p value 0.03) in participants who attended workshops compared to those who didn’t. Conclusion: Emergency doctors had better scores when it comes to ECG interpretation and management of MI. Frequent workshops and cardiology rotations should be mandatory for health care professionals to improve essential skill and knowledge of acute management of myocardial infarction.

scholarly journals Study on Psycho-social Problems among COVID-19 Patients in Tirunelveli District, Tamil Nadu, India

2021 ◽  
Vol 53 (03) ◽  
pp. 173-180
Author(s):  
Praveena Daya A ◽  
Keyword(s):  
Health Care Professionals ◽  
Tamil Nadu ◽  
Social Problems ◽  
Social Issues ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Mental Illnesses ◽  
Categorical Variables ◽  
P Value ◽  
Care Institute

Background: COVID-19 crisis leads to significant changes in routine life, loss of employment, financial crisis, living in isolation, and death of loved ones etc. that can create worry and stress among the people infected with COVID-19. The aim of the study is to estimate the burden of psycho-social problems among COVID-19 patients admitted in a tertiary care institute. A hospital-based cross-sectional study carried out among stable 450 RT-PCR confirmed COVID-19 patients admitted in the COVID ward of Tertiary Care Institute, Tirunelveli, Tamil Nadu, India between August and September 2020. Materials and Methods: Participants with self-reported pre-existing mental illnesses were excluded. Psycho-social issues of the participants were studied through telephonic conversation using a predesigned questionnaire including DASS 21 scale. Chi-square test was used to test the association between categorical variables. Variables significant in univariate analysis were included for multivariate analysis. P-value < 0.05 was considered to be statistically significant. Results: Based on DASS21 Scoring, 89 (20%) had depression, 190 (42%) were anxious and 53 (12%) were under stress. Patients aged more than 60 years, literate, with risk factors like diabetes mellitus and hypertension were more likely to have one or more psychological conditions. Conclusion: There is an increased prevalence of psychological morbidities among COVID-19 patients. It warrants the need for a combined action from health care professionals in the early identification of these psychological issues to prevent long term mental health issues among survivors.

The Risk of Venous Thromboembolism (VTE) among Cancer Patients by Tumor Site: A Population-Based Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2596-2596 ◽  
Author(s):  
John A. Heit ◽  
Tanya M. Petterson ◽  
Randolph S. Marks ◽  
Kent R. Bailey ◽  
L. Joseph Melton
Keyword(s):  
Cancer Patients ◽  
Tertiary Care ◽  
Population Based ◽  
Baseline Risk ◽  
P Value ◽  
Tumor Site ◽  
Olmsted County ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Active Cancer

Abstract Active cancer is an independent VTE risk factor (overall 6- to 9-fold increased risk) and accounts for almost 20% of all VTE in the community, but which cancer patients are at risk for VTE is largely unknown. Reportedly, VTE risk varies by tumor site, and cancer of the ovary, pancreas, colon, stomach, lung, prostate, and kidney convey particularly high VTE risk. Objective: To estimate VTE risk by tumor site. Methods: We enumerated observed cancers by tumor site for Olmsted County, MN active cancer patients with incident VTE over the seven-year period, 1991–1997 (n=152). We used 1991–1997 State Surveillance, Epidemiology, and End Results (SEER) data for Iowa to estimate the expected age-specific prevalence of cancer by tumor site in Olmsted County. VTE risk ratios (RR) for each tumor site were estimated by dividing the observed number of cancers by the expected number (calculated as the product of the SEER prevalence and the number of incident VTE cases in the age stratum). Results: For our population of 1991–1997 VTE cases, all tumor sites had RR > 5.0 (range 5.2 to 37.3, all p-values<0.05). Compared to published overall VTE odds ratios of 6–9 for active cancer compared to no cancer, the RR for some tumor sites were particularly increased. A Chi-squared test of heterogeneity of the RR across sites was highly significant (p-value<0.001). Three rare cancer sites - pancreatic cancer, lymphoma, and brain cancer - had unusually high RR (all RR>25). The high number of VTE cases with lymphoma was not due to catheter-related arm vein thrombosis. Liver, leukemia, other gastrointestinal (esophagus, small intestine, gallbladder, other biliary) and other gynecologic (primarily cervical) cancers had over twice the baseline risk (i.e., RR>17.0). On the other hand, the RR for many common cancers (breast, colorectal, ovary, lung, prostate) were essentially the same as the overall baseline risk (all had 9.5<RR<12.0). Conclusions: In contrast to previous reports, pancreas, lymphoma, brain, liver, leukemia, other gastrointestinal, and other gynecologic cancers have the highest VTE risk. Prior estimates of VTE risk by tumor site may have been biased by studies of prevalent cancers among patients hospitalized in tertiary care centers.

Sign in / Sign up

Export Citation Format

Share Document