scholarly journals Analgesic prescribing habits and patterns of Canadian chief urology residents: A national survey

2020 ◽  
Vol 14 (6) ◽  
Author(s):  
Ali Dergham ◽  
Greg Hosier ◽  
Melanie Jaeger ◽  
J. Curtis Nickel ◽  
D. Robert Siemens ◽  
...  
Keyword(s):  
Pain Management ◽  
Response Rate ◽  
Formal Training ◽  
Knowledge Gaps ◽  
Opioid Prescribing ◽  
Review Course ◽  
Student’S T ◽  
The Impact ◽  
Student’S T Test

Introduction: Prior studies have identified significant knowledge gaps in acute and chronic pain management among graduating urology residents as of five years ago. Since then, there has been increasing awareness of the impact of excessive opioid prescribing on long-term narcotic use and development of adverse narcotic-related events. However, it is unclear whether the attitudes and experience of graduating urology residents have changed. We set out to evaluate the attitudes and experience of graduating urology residents in prescribing opioid/non-opioid analgesia for acute (AP), chronic non-cancer (CnC), and chronic cancer (CC) pain. Methods: Graduating urology residents were surveyed at a review course in 2018. The survey consisted of open-ended and close-ended five-point Likert scale questions. Descriptive statistics, Mann-Whitney U-test, and Student’s t-test were performed. Results: A total of 32 PGY5 urology residents completed our survey (92% response rate). The vast majority agreed that formal training in managing AP/CnC/CC to be valuable (91/78/81%). Most find their training in CnC/CC management to be inadequate and are unaware of any opioid prescribing guidelines; 66% never counsel patients on how to dispose of excess opioids. In general, 88% are comfortable prescribing opioids, whereas most are very uncomfortable prescribing cannabis or antidepressants (100%/78%). Residents reported the Acute Pain Service as the highest-rated resource for information, and dedicated textbooks the least. Conclusions: This survey demonstrated that experience in pain management remains variable among urology residents. Knowledge gaps remain, particularly in the management of chronic cancer/non-cancer pain.

scholarly journals Evaluation of an Educational Outreach Campaign (IMPACT) on Pain Management Delivered to General Practices in Walsall

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i48-i49
Author(s):  
S Visram ◽  
J Saini ◽  
R Mandvia
Keyword(s):  
Data Analysis ◽  
Pain Management ◽  
Cancer Pain ◽  
Educational Intervention ◽  
Opioid Analgesics ◽  
Educational Outreach ◽  
Opioid Prescribing ◽  
Prescribing Trends ◽  
The Impact

Abstract Introduction Opioid class drugs are a commonly prescribed form of analgesic widely used in the treatment of acute, cancer and chronic non-cancer pain. Up to 90% of individuals presenting to pain centres receive opioids, with doctors in the UK prescribing more and stronger opioids (1). Concern is increasing that patients with chronic pain are inappropriately being moved up the WHO ‘analgesic ladder’, originally developed for cancer pain, without considering alternatives to medications, (2). UK guidelines on chronic non-cancer pain management recommend weak opioids as a second-line treatment, when the first-line non-steroidal anti-inflammatory drugs / paracetamol) ineffective, and for short-term use only. A UK educational outreach programme by the name IMPACT (Improving Medicines and Polypharmacy Appropriateness Clinical Tool) was conducted on pain management. This research evaluated the IMPACT campaign, analysing the educational impact on the prescribing of morphine, tramadol and other high-cost opioids, in the Walsall CCG. Methods Standardised training material was delivered to 50 practices between December 2018 and June 2019 by IMPACT pharmacists. The training included a presentation on pain control, including dissemination of local and national guidelines, management of neuropathic, low back pain and sciatica as well as advice for prescribers on prescribing opioids in long-term pain, with the evidence-base. Prescribing trends in primary care were also covered in the training, and clinicians were provided with resources to use in their practice. Data analysis included reviewing prescribing data and evaluating the educational intervention using feedback from participants gathered via anonymous questionnaires administered at the end of the training. Prescribing data analysis was conducted by Keele University’s Medicines Management team via the ePACT 2 system covering October 2018 to September 2019 (two months before and three months after the intervention) were presented onto graphs to form comparisons in prescribing trends of the Midland CCG compared to England. Results Questionnaires completed at the end of sessions showed high levels of satisfaction, with feedback indicating that participants found the session well presented, successful at highlighting key messages, and effective in using evidence-based practice. 88% of participants agreed the IMPACT campaign increased their understanding of the management and assessment of pain, and prescribing of opioids and other resources available to prescribers. The majority (85%) wished to see this form of education being repeated regularly in the future for other therapeutic areas. Analysis of the prescribing data demonstrated that the total volume of opioid analgesics decreased by 1.7% post-intervention in the Midlands CCG in response to the pharmacist-led educational intervention. As supported by literature, the use of educational strategies, including material dissemination and reminders as well as group educational outreach was effective in engaging clinicians, as demonstrated by the reduction in opioid prescribing and high GP satisfaction in this campaign. Conclusion The IMPACT campaign was effective at disseminating pain-specific guidelines for opioid prescribing to clinicians, leading to a decrease in overall prescribing of opioid analgesics. Educational outreach as an approach is practical and a valuable means to improve prescribing by continuing medical education. References 1. Els, C., Jackson, T., Kunyk, D., Lappi, V., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F. and Straube, S. (2017). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. This provided the statistic of percentage receiving opioids that present to pain centres. 2. Heit, H. (2010). Tackling the Difficult Problem of Prescription Opioid Misuse. Annals of Internal Medicine, 152(11), p.747. Issues with prescriptions and inappropriate moving up the WHO ladder.

scholarly journals Effect of Training About Child Neglect and Abuse to Teachers and Its Effect to Awareness

2021 ◽  
Author(s):  
İskender GÜN ◽  
Adeviye ÇOPUR ◽  
Elçin BALCI
Keyword(s):  
Child Neglect ◽  
Formal Training ◽  
Knowledge Level ◽  
Test Analysis ◽  
Survey Form ◽  
Abuse And Neglect ◽  
Level Of Knowledge ◽  
The Subject ◽  
Student’S T ◽  
Student’S T Test

Abstract Background: This study aimed to evaluate the effects of child neglect and abuse training on the knowledge and awareness of medical vocational schoolteachers in Turkey. Methods: This study was conducted with teachers from Kayseri, Turkey, between October 2016 and April 2017. Teachers who agreed to participate in the study received training on child neglect and abuse. Data were collected through a survey form and by the Scale for Identifying the Symptoms and Risks of Child Abuse and Neglect. Data were analyzed through the software SPSS V.20.0. For statistical analyses, student’s t test, analysis of variance and McNemar tests were performed, with p< 0.05 value being considered statistically significant. Results: Of the teachers, 63.7% were female and 80.5% were married. Teachers’ mean age was 40.5 ± 9.9 years. Of the teachers, 87.4% reported the training was adequate. Teachers’ level of knowledge on neglect and abuse and the percentage of those who reported that they would report it to the authorities when faced with such a case increased after the training. Women teachers’ scores for the neglect and abuse scale increased among those without children and who found the training adequate. Conclusions: Teachers’ knowledge level in the study group prior to the training was found higher. The subject of child neglect and abuse should be further discussed during teachers’ formal training.

scholarly journals THE OPIOID EPIDEMIC IN LONG-TERM CARE: A STAFF PERSPECTIVE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S709-S709
Author(s):  
Rachael Hemmert ◽  
Gabriella E Dull ◽  
Linda S Edelman
Keyword(s):  
Pain Management ◽  
Long Term Care ◽  
Adverse Drug Events ◽  
Well Being ◽  
Educational Needs ◽  
Opioid Use ◽  
Term Care ◽  
Opioid Prescription ◽  
The Impact

Abstract Opioid-based analgesic therapy is a common treatment for moderate to severe pain among long term care (LTC) residents. It has been estimated that 60% of LTC residents have an opioid prescription. Of these, 14% use opioids as part of a long term pain management strategy. LTC residents are particularly vulnerable to opioid misuse, exhibiting higher rates of adverse drug events. However, addressing pain, polypharmacological needs and resident well-being in the LTC setting is challenging. More research and education regarding opioid use in LTC is needed. The Utah Geriatric Education Consortium conducted interprofessional focus groups with LTC partners to 1) determine educational needs of staff regarding opioid use, and 2) gather qualitative data about the pain management experiences of staff when working with residents and families. Staff identified the following training needs: pain manifestation and assessment; certified nurse assistant education on opioid use; non-pharmacological options for pain management. Review of staff’s perception of the intersection of opioids, family and staff in a LTC setting revealed that 1) family is concerned about opioid use; 2) conversely, staff may not see opioid use as a problem; and 3) non-pharmacological options for pain management are often costly and unavailable to those in LTC. Identifying educational needs of LTC staff will help guide the development of educational materials and provide baseline data for future assessments of the impact of opioid education on long-term care patient outcomes.

scholarly journals ‘Blood in pee’ campaign: Increased demand on secondary care with no change in cancers diagnosed

2018 ◽  
Vol 12 (1) ◽  
pp. 15-19
Author(s):  
Kunjan Patel ◽  
Susan Jane Hall ◽  
Kamath Shraddha ◽  
Richard Stanford ◽  
Simon Williams ◽  
...  
Keyword(s):  
Cancer Awareness ◽  
Level Of Evidence ◽  
Awareness Campaigns ◽  
Economic Background ◽  
Kolmogorov Smirnov ◽  
The Mean ◽  
Student’S T ◽  
The Impact ◽  
Index Of Multiple Deprivation ◽  
Student’S T Test

Objective: As part of the national Be Clear on Cancer campaign, the ‘blood in pee’ campaign was launched in 2013. We aimed to evaluate the impact of the campaign on 2-week wait (2WW) referrals and the resulting diagnoses of malignancy at a single trust, and secondly, to evaluate the socio-economic background of patients referred. Patients and methods: Suspected cancer 2WW patients in the 3 months pre- and post-campaign were included. Demographics, investigations and diagnoses were recorded. A Kolmogorov–Smirnov test demonstrated a normal distribution. The data were treated as parametric and analysed with the unpaired Student’s t-test. Results: Referrals for visible haematuria significantly increased by 52% from 135 pre-campaign to 205 post-campaign ( p = 0.03). There was a fall in the proportion of patients diagnosed with malignancy from 20.27% pre-campaign to 15.36% post-campaign. The mean index of multiple deprivation score of referrals did not change: p = 0.43. Conclusion: This campaign has increased referrals without increasing the proportion of malignancies diagnosed, placing large demand on services without benefit or extra funding. Nor has the campaign effectively reached deprived socio-economic groups. There is little evidence as to the efficacy of untargeted cancer awareness campaigns and further work is needed to improve their pick-up of malignancies. Level of evidence: 2C

scholarly journals Pursuit of sexual function post-radical prostatectomy

2013 ◽  
Vol 7 (3-4) ◽  
pp. e183-9 ◽  
Author(s):  
Lisa G. Smyth ◽  
Ivor M. Cullen ◽  
David M. Quinlan
Keyword(s):  
Radical Prostatectomy ◽  
Sexual Function ◽  
Response Rate ◽  
Prostate Cancer Screening ◽  
Age Group ◽  
Small Problem ◽  
Younger Men ◽  
The Impact ◽  
Detailed Questionnaire

Introduction: In the event of the implementation of prostate cancer screening, younger men will be diagnosed more frequently. Erectile dysfunction (ED) is a frequent long-term complication in men post-radical prostatectomy (RP). Since the introduction of RP, urologists have strived to improve postoperative sexual function. There is little literature, however, in the area of ED prescribing and sexual pursuit in men post-RP. We assessed the pursuit of sexual function in this group of patients.Methods: The study involved a detailed questionnaire sent to patients who have undergone radical retropublic prostatectomy (RRP) by one surgeon in one institution to ascertain the impact of ED on lifestyle and ED therapy prescription use.Results: There was a response rate of 59%; most patients who responded were in the 61 to 70 year age group at the time of the survey. About 25% of patients had intercourse more than once in the 4 weeks prior to the survey. A total 50% of patients had no problem or a very small problem with their sexual function. Overall 80% of patients were prescribed ED therapy, but less than 35% of them used it.Conclusion: Sexual frequency peaked in younger patients who were 3 years or more from surgery. Of note, 46% of men either declined the offer of ED therapy or got the prescription and never used it. Only 34% of men had used their ED prescription in the last 4 weeks. Urologists frequently find that patients behave differently postoperatively, with less interest in sexual activity. Interestingly, we found that 50% of our patients classified their sexual function, as at most a small problem.

scholarly journals Moderated Mediation Analysis of Leader Technology Orientation: A Study of Operations and Manufacturing Leaders of India

2020 ◽  
Vol 3 (1) ◽  
pp. 58-80
Author(s):  
Sumi Jha ◽  
Som Sekhar Bhattacharyya
Keyword(s):  
Supply Chain ◽  
Mediation Analysis ◽  
Response Rate ◽  
Moderated Mediation ◽  
Business Leaders ◽  
Years Of Experience ◽  
Technology Orientation ◽  
The Impact ◽  
The Relationship

This article aims to understand the impact of the relationship between operations leader employee orientation (LEO) and leader information orientation (LIO) on leader long-term orientation (LLTO). The relationship is mediated by leader inclusivity orientation (LINCO) and moderated by leader technology orientation (LTO). The data were collected from business leaders who had more than 15 years of experience in the domain of supply chain, operations, and manufacturing. The total number of questionnaires sent to respondents was 620. Authors received 446 filled responses, out of which 360 responses were usable. The response rate was 58 percent. Moderated mediation analysis was performed to analyze the data and to test the proposed hypothesis. The findings revealed that the relationship between LEO LIO has a significant effect on LLTO. The relationship was positively mediated by LINCO. Further, LTO was found to be significantly related to LEO–LINCO–LTO and LIO–LINCO–LTO in a way that the relationship is strong when LTO is high and weak when LTO is low.

162 IMPROVED EMBRYO SURVIVAL AND QUALITY WITH EMCARE II

2006 ◽  
Vol 18 (2) ◽  
pp. 189
Author(s):  
A. Harvey ◽  
M. Lane ◽  
J. Thompson
Keyword(s):  
Calf Serum ◽  
Cell Number ◽  
Tunel Staining ◽  
Embryo Survival ◽  
Improved Outcomes ◽  
Student’S T ◽  
The Impact ◽  
Student’S T Test

Collection of embryos exposes them to a number of stresses, including light, air, and changes in temperature. Improvement of holding media to reduce the impact of handling stresses on the embryo during in vivo collection and transfer is therefore beneficial to ensure maintenance of viability following transfer. The aim of this study was to compare the effect of holding IVP-derived blastocysts at 25°C in Emcare I (ECMI, Emcare, Dallas, TX, USA) with those held in Emcare II (ECMII), a proprietry formulation designed to reduce in vitro-induced stress. In vitro-produced bovine embryos were generated using standard protocols. Blastocysts were randomly allocated to either ECMI or ECMII (ICPBio, Aukland, New Zealand) on Day 7 and were held at 25°C for a period of 24 h, after which they were cultured in Cook Bovine Blast (Cook Australia, Brisbane, Australia) supplemented with 10% fetal calf serum for 48 h. At 24 and 48 h, embryos were scored for hatching, and a cohort removed for TUNEL staining at each time point. Differences were analyzed by Student's t-test. At both 24- and 48-h culture, hatching rates tended to be higher for embryos held in ECMII than in ECMI (Table 1). The level of apoptosis at 48 h was reduced in blastocysts held in ECMII (P = 0.06). Moreover, the total cell number of hatched blastocysts at 48 h was significantly increased (1.5-fold) in those held in ECMII (P = 0.01). Results suggest that the formulation of ECMII improves the ability of IVP bovine blastocysts to re-expand and hatch following an imposed stress (25°C for 24 h). Furthermore, ECMII improves overall embryo quality through a reduction in the percentage of cells undergoing apoptosis as well as through increased cell numbers, evident 48 h following cessation of the stress. We suggest that Emcare II reduces the impact of (or increases the embryo's tolerance to and recovery from) an imposed stress, which, although severe in the present study, may provide improved outcomes following embryo transfer in field situations. Table 1. Hatching and apoptosis of blastocysts held at 25°C for 24 h in Emcare I or Emcare II This work was supported with funding by ICPBio (NZ).

Hormones as indicator of relapse-free period in breast cancer (BC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12550-e12550
Author(s):  
Natalia Yu. Samaneva ◽  
Elena M. Frantsiyants ◽  
Liubov Yu Vladimirova ◽  
Anna E. Storozhakova ◽  
Elena A. Sheiko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Pituitary Hormones ◽  
Blood Levels ◽  
Test Results ◽  
Luminal A ◽  
Luminal B ◽  
Before And After ◽  
Student’S T ◽  
Student’S T Test

e12550 Background: BC is still one of the main causes of death in women due to the tumor recurrence and/or resistance to anticancer therapy. The criteria to assess the effectiveness of BC treatment are important. The purpose of the study was to analyze blood levels of steroid and pituitary hormones in BC patients after two chemotherapy cycles. Methods: The study included 42 patients with various biological BC subtypes: luminal A, luminal B and triple-negative BC (TNBC). Levels of estradiol, testosterone, progesterone, prolactin, LH, FSH and cortisol were measured by RIA in the blood of all patients before and after two neoadjuvant chemotherapy cycles. Significance of differences was evaluated by the Student’s t-test. Results: Levels of many hormones were high before the treatment in patients with all BC subtypes. After two chemotherapy cycles, unidirectional changes in the values were found in patients with subsequent remission for more than three years. Levels of estradiol decreased in luminal A BC by 1.7 times (p˂0.05), in luminal B BC – by 11.6 times (p˂0.05), cortisol decreased by 2.4 and 1.7 times (p˂0.05) respectively, and prolactin – on average by three times (p˂0.05). LH levels increased in luminal A and luminal B BC by 1.65 times (p˂0.05). In patients with TNBC, levels of estradiol decreased by 1.8 times, and cortisol – by two times (p˂0.05). Patients with subsequent remission regardless of BC subtypes had unchanged levels of testosterone, progesterone and FSH. Patients with luminal B and TNBC subtypes with progression in 6-12 months did not show significant changes in prolactin and cortisol levels after two chemotherapy cycles, compared with the values before treatment. Conclusions: A decrease in blood levels of prolactin and cortisol after two chemotherapy cycles is an indicator of a long-term remission in patients with breast cancer.

Impact of the VA opioid safety initiative on pain management for cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 102-102
Author(s):  
Mallika Marar ◽  
Vinit Nalawade ◽  
Neil Panjwani ◽  
Paul Riviere ◽  
Timothy Furnish ◽  
...  
Keyword(s):  
Pain Management ◽  
Cancer Patients ◽  
Opioid Abuse ◽  
Prescribing Patterns ◽  
Health Administration ◽  
Opioid Use ◽  
Opioid Prescribing ◽  
Ed Visits ◽  
The Impact ◽  
Safety Initiative

102 Background: Limited research exists on how risk reduction policies in response to the opioid epidemic have impacted pain management among cancer patients. This study investigated the impact of the Veteran’s Health Administration (VHA) Opioid Safety Initiative (OSI) on opioid prescribing patterns and opioid-related toxicity among patients undergoing definitive cancer treatment. Methods: This retrospective cohort study included 42,064 opioid-naïve patients receiving definitive local therapy for prostate, lung, breast, and colorectal cancer at the VHA from 2011-2016. Interrupted time series analysis with segmented regression was used to evaluate the impact of the OSI, which launched October 2013. The primary outcome was the incidence of new opioid prescriptions with diagnosis or treatment. Secondary outcomes included rates of high daily dose opioid (≥ 100 morphine milligram equivalent) and concomitant benzodiazepine prescriptions. Additional long-term outcomes included persistent opioid use, opioid abuse diagnoses, pain-related ED visits, and opioid-related admissions. Results: Prior to OSI implementation, the incidence of opioid prescriptions among new cancer patients increased from 26.7% (95% CI 25.0 – 28.4) in the first quarter (Q1) of 2011 to 50.6% (95% CI 48.3 – 53.0) in Q3 2013. There was a monthly increase in opioid prescription rate pre-OSI followed by a monthly decrease post-OSI (Table). High-dose opioid prescriptions were rare, and the monthly rate was stable before and after the OSI. Monthly incidence of concomitant benzodiazepine prescriptions was stable pre-OSI and decreased post-OSI. Persistent opioid use increased pre-OSI and decreased post-OSI. Pain-related ED visits had an incidence of 0.8% (95% CI 0.4 – 1.0) in Q1 2011, 0.3% (95% CI 0.1 – 0.6) in Q3 2013, and 1.8% (95% CI 0.9 – 2.7) in Q4 2016, with an increasing monthly rate after the OSI. At three years, the cumulative incidence of opioid abuse was 1.2% for both the pre- and post-OSI groups but opioid-related admissions were greater in the pre-OSI cohort than the post-OSI cohort (0.9% vs. 0.5%, p < 0.001). Conclusions: The OSI was associated with a decrease in new, persistent, and certain high-risk opioid prescribing as well as an increase in pain-related ED visits. Further research on patient-centered outcomes is required to optimize opioid prescribing policies for patients with cancer.[Table: see text]

Postoperative surgical trainee opioid prescribing practices (POST-OPP): A national survey

2019 ◽  
Vol 15 (4) ◽  
pp. 307-322 ◽  
Author(s):  
David J. Hall, MD ◽  
Juan C. Mira, MD ◽  
Melissa R. Hoffman, MD, ND ◽  
Hari B. Keshava, MD, MS ◽  
Kevin R. Olsen, MD ◽  
...  
Keyword(s):  
Pain Management ◽  
Medical School ◽  
General Surgery ◽  
Online Survey ◽  
Management Training ◽  
Prescribing Practices ◽  
Surgical Trainee ◽  
Opioid Prescribing ◽  
Surgical Trainees ◽  
The Impact

Background: Increasing opioid-related deaths have heightened focus on combating the opioid epidemic. The impact of surgical trainees on opioid-related deaths is unclear, and there is little data examining the association between trainee pain management education and opioid prescribing practices.Methods: An anonymous, online survey was distributed to members of the Resident and Associate Society of the American College of Surgeons. The survey covered five themes: education and knowledge, prescribing practices, clinical case scenarios, policy, and beliefs and attitudes. Linear mixed models were used to evaluate the influence of respondent characteristics on reported morphine milligram equivalents (MME) prescribed for common general surgery clinical scenarios.Results: Of 427 respondents, 54 percent indicated receiving training in postoperative pain management during medical school and 66 percent during residency. Only 35 percent agreed that they had received adequate training in prescribing opioids. There was a significant association between undergoing formal pain management training in medical school and prescribing fewer MME for common outpatient general surgery scenarios (94 ± 15.2 vs 108 ± 15.0; p = 0.003). Similarly, formal pain management training in residency was associated with prescribing fewer MME in the survey scenarios (92.6 ± 15.2 vs 109 ± 15.2; p = 0.002).Conclusion: In this survey, nearly two-thirds of surgical residents felt that they were inadequately trained in opioid prescribing. Our findings additionally suggest that improving education may result in increased resident comfort with managing surgical pain, potentially leading to more responsible opioid prescribing. Further work will facilitate residency programs’ development of educational curricula for opioid prescribing best practices.

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