EVALUATION OF THE QUALITY OF PAIN MANAGEMENT IN CANCER PATIENTS: STUDY OF 60 MOROCCAN PATIENTS AND LITERATURE REVIEW

Cancer is a chronic disease that affects patients quality of life, hence the need to evaluate the quality of care in its globality without forgetting cancer pain. This study aims to acknowledge the pain in cancer patients, evaluate it using international scales, and see to what extent this pain is managed in its totality. This is a prospective study to evaluate the quality of cancer pain management, 60 patients were included, 26 women and 34 men, with an average age of 52.2 years. The evaluation of pain concerned different cancer pathologies, according to the simple verbal scale and the visual analog scale, the majority of our patients (83.4%) had pain, 68.4% had moderate to severe pain, the use of level III analgesics occurred in 35% of patients. Among our sample 37% of cancer patients had negative pain management index scores, indicating inadequate analgesic treatment. This study shows that the management of cancer pain is still insufficient for reasons of organization and lack of information. This situation cannot be improved without the establishment of a global strategy for the management of cancer pain.

The Effect of an Alternative Definition of “Percent Highly Annoyed” on the Exposure–Response Relationship: Comparison of Noise Annoyance Responses Measured by ICBEN 5-Point Verbal and 11-Point Numerical Scales

Since the development of the 5-point verbal and 11-point numerical scales for measuring noise annoyance by the ICBEN Team 6, these scales have been widely used in socio-acoustic surveys worldwide, and annoyance responses have been easily compared internationally. However, both the top two categories of the 5–point verbal scale and the top three ones of the 11-point numerical scale are correspond to high annoyance, so it is difficult to precisely compare annoyance responses. Therefore, we calculated differences in day–evening–night-weighted sound pressure levels (Lden) by comparing values corresponding to 10% highly annoyed (HA) on Lden_%HA curves obtained from measurements in 40 datasets regarding surveys conducted in Japan and Vietnam. The results showed that the Lden value corresponding to 10% HA using the 5-point verbal scale was approximately 5 dB lower than that of the 11-point numerical scale. Thus, some correction is required to compare annoyance responses measured by the 5-point verbal and the 11-point numerical scales. The results of this study were also compared with those of a survey in Switzerland.

Psychometric Properties of WISC-IV Verbal Scales: A Study of Students in China Who Are Blind

Introduction: Numerous studies have investigated the use of Wechsler tests on individuals with visual impairments. However, few studies have examined the utilization of the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV) for such individuals. This study investigated the reliability and validity of the WISC-IV Verbal Scales’ (i.e., the Verbal Comprehension Index [VCI] and the Working Memory Index [WMI]) scores for children with blindness in China. Methods: One hundred children with blindness were assessed using the Chinese version of the WISC-IV Verbal and Nonverbal Cognitive Development Scales. Results: The results of this study generally support the internal consistency reliability and validity of WISC-IV Verbal Scale scores for Chinese children who are blind. The split-half reliability coefficients ranged from .79 to .97, while Cronbach’s alpha or KR-20 (KR-20 is a measure of internal consistency reliability for measures with dichotomous choices) reliability coefficients ranged from .83 to .97. In terms of construct validity through exploratory factor analysis, the subtests of the WISC-IV Verbal Scale were confirmed to belong to VCI or the WMI as intended by the original structure of the WISC-IV. The convergent validity showed that the VCI and WMI scores were moderately and positively correlated with the Nonverbal Cognitive Development Scale. Discussion: The WISC-IV VCI and WMI were found to be valuable instruments for assessing the cognitive abilities of students in China with blindness. Finally, the limitations and significance of the study were also discussed. Implications for practitioners: The WISC-IV Verbal Scales may be used to assess the cognitive abilities of the numerous students in China who are blind and may be used as one of many tests to provide reference information for educational placement, educational planning, employment, and project evaluation.

Postoperative Pain Profile After Major Cervicofacial Cancer Surgery

Background: Despite its anticipation, postoperative pain may be still poorly managed in some cases, such as in patients undergoing major cervicofacial cancer surgery. Indeed, the postoperative pain associated with these surgeries is complex and multifactorial. Objective: To assess the profile of postoperative pain scores and opioid requirements in a cohort of consecutive patients undergoing major cancer cervicofacial surgery with or without reconstruction. Methods: A cohort of 42 consecutive patients was studied. The following parameters were recorded: patients characteristics, type of surgery, preoperative medication preoperative pain scores, and postoperative pain score (5-point numerical verbal scale) upon arrival at the postanesthesia care unit (PACU) and at Day 1 to Day 7 (11-point visual numeric scale), the presence or absence of neuropathic and/or chronic pain one year later (determined by a phone interview), and morphine consumption. Results: All patients had a pain score of less than 3 in the PACU. From postoperative day 1 to day 7, pain scores were extremely variable and stayed high or even increased up to 7 in many patients. At the one-year phone interview, some patients had neuropathic and chronic pain.Discussion: Postoperative pain profiles in major cervicofacial cancer are complex, with high interindividual variability and with cases with neuropathic patterns and high pain scores that can last up to 7 days postoperatively.

Compensation capacities of brain in unilateral and bilateral auditory system damage in children

Neuroplasticity is a basic feature of neuronal system which provides function rebuilt or developmental dysfunction repair. Hearing impairment can have an impact on intelligence levels, organization and structure of cognitive processes. Cognitive capacities profiles of deaf people present neuropsychological results of functional reorganization of brain. 208 children were accepted for this study. Experimental group consisted of 126 children suffering from sensorineural hearing insufficiency. 26 children were diagnosed with right-sided hearing loss, 34 children were diagnosed with left-sided hearing loss and 66 children were diagnosed with bilateral hearing loss. Control group consisted of 82 normally hearing children, confirmed in audiometric assessment. In order to establish levels of cognitive abilities and intelligence in patients enrolled for the study polish adaptation of Wechsler Intelligence Scale for Children (WISC-R) was administered. Children with bilateral hearing loss obtained worse results in verbal scale compared to well hearing controls. Verbal intelligence in control group was statistically higher than in right-sided auditory dysfunction group. Control group average result in nonverbal scale was statistically significantly higher compared to left-sided hearing loss patients. Children with right-sided auditory dysfunction obtained higher results in nonverbal scale compared to children with left-sided auditory dysfunction. Left-sided hearing impairment group had higher scores in almost all subtests of verbal scale than right-sided hearing impairment group. Left-sided auditory disability enhances linguistic capacity, which indicates compensation abilities of left hemisphere responsible for verbal processes. Right-sided auditory disability enhances analytic processes, visual synthesis and image reasoning, which indicates compensation abilities of right hemisphere responsible for nonverbal processes.

The Effect of Ginger-chamomile Sachet with Honey on Primary Dysmenorrhea and Associated Symptoms: A Randomized, Double-Blind, Controlled Trial

Background: Dysmenorrhea is one of the most frequent pelvic pains among young women, impairing their quality of life. Objective: This research aims to investigate the effect of ginger-chamomile herbs with honey in reducing dysmenorrhea pain, associated symptoms, and the extent of bleeding. Methods: In this randomized clinical trial (IRCT No.: 2016100825031N5), 200 female students with primary dysmenorrhea, from Arak universities, were included and randomly divided into two groups. All the students were evaluated for one cycle without intervention, then group (A) received mefenamic acid (250 mg) and group (B) received ginger (1000 mg), chamomile (5000 mg), and one teaspoonful of honey for two days before and for the first three days of menstruation, three times a day, in two consecutive cycles. Pain severity, associated symptoms of dysmenorrhea, and bleeding were assessed using a visual analogue scale, Andersch-Milsom Verbal Scale, and Higham chart. Data were analyzed by descriptive and inferential statistical tests through SPSS21. Results: The pain intensity in group B diminished significantly after the intervention in comparison to group A (p <0.05). The mean severity of dysmenorrhea accompanying symptoms decreased significantly in group B compared to group A (P=0.009). However, the mean quantity of bleeding significantly decreased in group A (P = 0.004), with no increase in the extent of bleeding in group B. Conclusion: The present study indicated that the combination of the ginger-chamomile sachet with honey has the same effect as nonsteroidal anti-inflammatory drugs for pain mitigation, and the associated symptoms reduced better than mefenamic acid.

Comparison of the effect of Chamomile and Mefenamic Acid on primary dysmenorrhea, associated symptoms and menstrual bleeding – A randomized clinical trial study

Background Dysmenorrhea is one of the most common pelvic pains in women, impairing their quality of life.This study investigated the effects of chamomile sachet and mefenamic acid on primary dysmenorrhea, associated symptoms and bleeding. Methods In this randomized clinical trial, 200 female students with primary dysmenorrhea from Arak universities were randomly assigned to two groups. The group (A) received mefenamic acid (250 mg) and group (B) received chamomile (5000 mg) plus one teaspoonful of honey )as a flavoring( for two days before up to the first three days of menstruation, three times a day in two consecutive cycles. Pain severity, associated symptoms and bleeding were assessed using visual analog scale, Andersch-Milsom Verbal Scale and Higham chart, respectively. Data were analyzed by descriptive and inferential statistical tests by SPSS 21. Results Severe pain during two months after intervention was in 6 (6.3%) of group (B) and 6 (6.3%) in group (A) (p = 0.351, p = 0.332). Mean severity of associated symptoms two months after the treatment was( 4.93 ± 3.54) in group (B) and (5.62 ± 3.54 ) in group (A), indicating further reduction in group (B) but not significant (p = 0.278). Mean of bleeding was (88.71 ± 66.4 vs. 70.54 ± 53. 34) in group (B) and (A) respectively, in two months later. therefore decrease in the two groups but was not significant between groups(p = 0.567). Conclusions It seems chamomile sachet can reduce the severity of pain and bleeding similar to mefenamic acid and even further mitigate the symptoms associated with dysmenorrhea. Trial registration: This study was performed with the proposal approval code of 2611, ethics code of (ARAKMU.REC.1395.164) at Arak University of medical sciences and code of IRCT 2016100825031N5 on 2016.11.08.

Effect of treatment on cognitive and attention problems in children with narcolepsy type 1

Study Objectives To ascertain the presence of cognitive and attention problems in treatment naïve children with narcolepsy type 1 (NT1) and to explore whether children recently diagnosed with NT1 improve with respect to cognition and attention problems 1 year after regular treatment for NT1. Methods A total of 15 treatment naïve children (7–15 years) with recently diagnosed NT1 were recruited from three sleep medicine centers in the Netherlands. The control group consisted of 15 healthy children, being frequency matched on age and gender. Both groups were investigated at baseline to examine intelligence profile (Wechsler Intelligence Scale for Children [WISC] III), attention problems, and processing speed (Bourdon Vos and sustained attention to respond task [SART]). These tests were repeated in children with NT1 1 year after regular (behavioral and medication) treatment for NT1. Results Children with NT1 scored significantly lower on the verbal scale and processing speed subscale of the WISC III, showed more fluctuations in reaction time of the Bourdon Vos and made more mistakes during the SART than the healthy control group at baseline. Children with NT1 significantly improved on total IQ score, and on the WISC indices processing speed, and perceptual organization 1 year after treatment. At follow-up, test scores of treated children were largely comparable to those of the control group at baseline. Conclusions Children with NT1 show improvement in several cognitive domains 1 year after start of treatment. Our findings stress the need for early detection and treatment of narcolepsy in childhood.

Results of the Insertion of Hysteroscopic Sterilization Devices in a Brazilian Public Hospital

Objective To evaluate the insertion of the hysteroscopic intratubal sterilization device for female sterilization concerning the technique and the feasibility. Methods Retrospective study with data collection of medical records of 904 patients who underwent device insertion between January and September 2016 in a public hospital in Rio de Janeiro (Brazil) with data analysis and descriptive statistics. Results In 85.8% of the cases, the uterine cavity was normal, and the most commonly-described findings upon hysteroscopy were synechiae (9.5%). The procedure lasted an average of 3.56 minutes (range: 1 to 10 minutes), and the pain was considered inexistent or mild in 58,6% of the cases, mild or moderate in 32,8%, and severe or agonizing in less than 1% (0.8%) of the cases, based on a verbal scale ranging from 0 to 10. The rate of successful insertions was of 85.0%, and successful tubal placement was achieved in 99.5% of the cases. There were no severe complications related to the procedure, but transient vasovagal reactions occurred in 5 women (0.6%). Conclusion Female sterilization performed by hysteroscopy is a safe, feasible, fast, and well-tolerated procedure. The rates of successful insertions and tubal placements were high. There were few and mild adverse effects during the procedure, and there were no severe complications on the short term.