Improvements from a small-group multidisciplinary pain self-management intervention for women living with pelvic pain maintained at 12 months.

BACKGROUND: A small-group multidisciplinary pain self-management program for women living with pelvic pain, with or without endometriosis, was developed to address identified unmet treatment needs. Following completion, over 80% of participants demonstrated clinically significant improvement across a number of domains. There was no clinically significant deterioration on any measure and benefits continued at three months follow-up. AIMS: This study examines patient-reported outcomes at 12 months following program completion to ascertain maintenance of these improvements. MATERIALS AND METHODS: Self-report measures assessed quality of life across the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials domains prior to, at completion and 12 months following participation. RESULTS: At 12 months follow-up, improvement was seen in mean group scores for all baseline measures for 57% of participants who returned valid 12-month follow-up data, with clinically significant improvement seen for within-subject scores for 50% of these participants for pain severity and also for pain-related activity interference. Improvements were also reported in key predictors of long-term outcomes, pain self-efficacy and catastrophic worry, with 92% reporting improvement in each of these two constructs. There were 83% of respondents who reported feeling both improvement in overall sense of wellbeing and improvement in their physical ability compared to before the program. CONCLUSIONS: Results suggest that a six-week multidisciplinary small-group intervention increases participants' abilities to self-manage pain and improves quality of life with lasting clinically significant improvements.

Integration of a dental hygienist into the interprofessional long-term care team.

BACKGROUND: To address poor oral health of residents in long-term care homes (LTCH), this study explored the process of integrating an educational resource and a dental hygienist on the interprofessional care team. METHODS: This convergent mixed-methods study took place at a 472-bed LTCH in Toronto, Canada from February to August 2018. Nurses employed at the LTCH participated in the study. During the study period, a dental hygienist was integrated into an interprofessional LTCH team. Nurses completed an online eLearning module about using the Oral Health Assessment Tool (OHAT) when referring residents' oral health concerns to a. Pre/post knowledge quizzes, module feedback and satisfaction surveys were administered. A retrospective chart review examined OHAT use and compared nurse and dental hygienist oral health assessments. Two cycles of semi-structured interviews with five nurses explored experiences with the eLearning module, OHAT and integration of the dental hygienist into the team. RESULTS: Nurses scored well on the knowledge quizzes and reported comfort in using the OHAT to refer oral concerns to a dental hygienist; however, actual use was minimal. oral health issues were under-reported by nurses on the Resident Assessment Instrument-Minimum Data Set (RAI-MDS); the dental hygienist reported significantly more debris, teeth lost and carious teeth (all P < 0.0001). Qualitative analysis indicated that the nurses valued dental hygienist integration into the team. Using knowledge mobilisation practices, a new oral health referral tool was developed. CONCLUSIONS: This study highlights the feasibility and desirability of an oral health eLearning module, practical assessment tools and participation of a dental hygienist on the LTCH interprofessional care team.

Endometriosis and pelvic pain: Time to treat the symptoms not the assumptions?

The high incidence and burden of pelvic pain are increasingly recognised in both the healthcare sector and by the general public. Current approaches to management assume that the diagnosis and remediation of identified lesions will ease this burden. The evidence base and successes in other areas of medicine would suggest that this assumption requires reconsideration.

The impact of oral health education taken by personal support workers caring for a geriatric population in a long-term care facility: A mixed-methods study.

OBJECTIVE: To evaluate the impact of an online oral health education module on personal support workers' (PSW) knowledge and beliefs in their care for long-term care (LTC) residents in one Canadian LTC residence. BACKGROUND: LTC residents are dependent on PSWs for their oral health needs. However, PSWs receive minimal to no oral health education placing residents at risk for poor oral health. METHODS: A mixed-methods convergent design comprising a before-and-after questionnaire (N = 88), focus groups (N = 23) and interviews (N = 4) exploring module learning. Analysis of each data set was followed by their amalgamation and comparison. RESULTS: The online module had limited impact on the PSWs' knowledge and beliefs regarding resident oral health care. The quantitative results demonstrated knowledge improvements in two domains and changes in two belief domains. However, the qualitative results demonstrated new knowledge was not developed or sustained in practice. Themes that emerged include the following: lack of module recall, unmet learning needs and methods for oral care delivery, and timing of oral care in a busy clinical environment. CONCLUSION: Online oral health education alone has limited impact on PSWs' knowledge and beliefs. Research evaluating multifaceted education interventions including hands-on training with a dental expert is warranted.

Unmet treatment needs in patients with chronic pelvic pain in a New Zealand gynaecology service.

BACKGROUND: Chronic pelvic pain, which carries a high burden of disability and distress, is a common presentation to gynaecology clinics. While there is increasing acknowledgment of the complexity of chronic pelvic pain, and the benefits of providing management from a multidisciplinary team within a sociopsychobiomedical framework, the mainstay of management in gynaecology outpatient clinics remains within a single clinician biomedical-focused model. This model of care is only sufficient for women who present with minimal psychosocial complexity to their pain. AIMS: To estimate the proportion of women attending the gynaecology outpatient clinic at a public women's hospital in New Zealand referred with chronic pelvic pain who have needs unmet by the current biomedical model of care. Informed by international research, pain catastrophising was used as a psychosocial correlate of this complexity. METHODS: An audit was undertaken of 100 consecutive pre-appointment questionnaires of women, referred to a gynaecology outpatient clinic for review of pelvic pain of duration over six months, with no red flags in their referral history. RESULTS: An unexpectedly high level of catastrophic thoughts about pain was reported. Seventy-seven percent of the women scored in the high or severe range, with 55% endorsing clinically significant scores for helpless catastrophising. CONCLUSIONS: The Pain Catastrophising Scores in this cohort were found to be higher than those in similar groups in the published international literature and also than in patients referred to the local tertiary level pain management centre, further reinforcing the need for investment into appropriate services for women with chronic pelvic pain.

Emergency department attendances for persistent pelvic pain are not reduced following laparoscopic surgery for women with or without endometriosis.

AIM: To explore the change in emergency department (ED) attendances for persistent pelvic pain (PPP) following laparoscopic treatment of endometriosis. METHODS: A retrospective service evaluation was conducted on a convenience sample of 1 calendar year of elective gynaecological laparoscopies for PPP. Data were collected on ED visits for surgical complications, and for PPP in the 12 months prior to and following surgery. RESULTS: Of the 195 women undergoing laparoscopy, 30 had attended the ED owing to their PPP in the preceding year. Endometriosis was found and treated in 51% of the cohort and no cause for pain was found in the other 96 women. Eighteen women suffered postoperative complications. In the subsequent 12 months, 31 of the cohort attended the ED for PPP. Likelihood of unscheduled hospital visits for post-operative complications and for exacerbations of pain in the year prior to and following surgery was independent of the presence of endometriosis lesions. CONCLUSIONS: In a cohort of women living with PPP, laparoscopic surgery failed to reduce the need to attend the ED owing to their pain. Further investigation into interventions that can reduce the burden of pain on these women and the healthcare system is required.

Short review on adverse childhood experiences, pelvic pain and endometriosis.

The exposure to adverse childhood experiences has been associated with the subsequent development of several chronic health conditions, including pelvic pain. Endometriosis is a chronic disease characterized by the growth of endometrial-like tissue outside of the uterus, and is considered a common cause of chronic pelvic pain and infertility in reproductive-age women. However, the topic of pelvic pain and endometriosis is fraught with many challenges. This applies not just to clinical practice but also to research where many inconsistencies relating to pelvic pain and endometriosis definitions are encountered. A review was carried out for articles exploring the association of adverse childhood experiences and endometriosis. Studies addressing self-reported endometriosis suggested a relationship with childhood adversity, whilst papers relying on surgically diagnosed lesions of endometriosis irrespective of clinical presentation did not. This highlights the potential bias associated with the inconsistent use of the expression "endometriosis" in research.

The impact of implementing selected CBPR strategies to address disparities in urban Atlanta: a retrospective case study.

In 2005, the Institute of Public Health at Georgia State University (GSU) received a 3-year community-based participatory research (CBPR) grant from the National Center for Minority Health and Health Disparities entitled Accountable Communities: Healthy Together (ACHT). Because urban health disparities result from complex interactions among social, economic and environmental factors, ACHT used specific CBPR strategies to engage residents, and promote the participation of community organizations serving, a low-income community in urban Atlanta to: (i) identify priority health and social or environmental problems and (ii) undertake actions to mitigate those problems. Three years after funding ended, a retrospective case study, using semi-structured, taped interviews was carried out to determine what impacts, if any, specific CBPR strategies had on: (i) eliciting resident input into the identification of priority problems and (ii) prompting actions by community organizations to address those problems. Results suggest that the CBPR strategies used were associated with changes that were supported and sustained after grant funding ended. Insights were also gained on the longer term impacts of ACHT on community health workers. Implications for future CBPR efforts, for researchers and for funders, are discussed.

Repeated laparoscopies for pelvic pain: doing the same thing over and expecting a different outcome?

AIMS: To quantify the current practice of repeated laparoscopic procedures, informing the requirement for multidisciplinary meeting capacity. METHODS: A retrospective audit was undertaken of the elective gynaecological laparoscopies performed for pelvic pain within the Canterbury District Health Board in the 2019 calendar year. De-identified data were also obtained from private insurance providers for the same time-period. RESULTS: Of the women receiving a publicly funded laparoscopy, 34% had previously undergone at least one similar procedure (range 1-7). Although the data from the private sector have limitations, these also demonstrate a high number of repeated procedures - particularly for those residing in the Canterbury region. CONCLUSIONS: Despite being recognised as low-value, high-cost care, repeated laparoscopies are common management for women with pelvic pain, suggesting that further investment into multidisciplinary services is required.

Parental correlates of unintentional burn injuries in infancy and early childhood.

The main purpose of this paper is to review parental factors associated with unintentional burns in early childhood. The problem and characteristics of early childhood burns are discussed. Child injury prevention strategies and models are presented. Parental correlates of pediatric injuries in general and specific to burns are reviewed. In conclusion, the authors recommend greater examination of parental variables potentially amenable to treatment, such as psychological functioning, and improved methodology including the use of prospective analyses, multiple methods and informants, and comparison groups. These efforts should enable greater understanding of parental factors related and causal to early childhood burns and, in turn, guide prevention initiatives.

Unintended pregnancy and therapeutic abortion in the postpartum period. Is an opportunity to intervene being missed?

AIMS: To explore the reasons why women have an abortion soon after delivering an infant and what could reduce unintended pregnancy and abortion in this group of women. METHODS: Data were collected from anonymous self-complete questionnaires from women who presented to a first trimester Termination of Pregnancy service and who had delivered a live-born infant within the preceding 6 months; and also from the healthcare professionals who are responsible for maternity care to identify the reasons behind the unintended pregnancies, and around Lead Maternity Caregivers' (LMCs') usual practice of postnatal contraceptive provisions, and any barriers to its provision. RESULTS: 22 women were recruited into the study and completed the questionnaire. The majority of women (19) reported that they had discussed contraception with the LMC. However only 4 women were given a prescription for the pill and 2 women were given a prescription for condoms (which was not filled). Almost all women had previously accessed contraception from another provider. 59 LMCs responded. All LMCs reported that they discuss contraception with women, However the majority reported that they discuss contraception with all women at discharge (50) and/or postnatally (49). Only 23 LMCs reported discussing contraception antenatally or at booking. CONCLUSIONS: Opportunities to intervene are being missed. These include: discussing contraception with all women at booking and/or antenatally; for LMCs to offer prescriptions for contraception to all women and to encourage them to access the supplies, for LMCs to be trained so they feel confident to advise and supply all contraceptive options. Improvements for women could also be made by providing postnatal women with free consultations to her choice of provider, during pregnancy to organise postnatal contraception.

Providing dust mite-proof covers improves adherence to dust mite control measures in children with mite allergy and asthma.

INTRODUCTION: The most critical dust mite avoidance technique for asthmatic children with mite allergy is the use of dust mite-proof bedding covers. Adherence to allergen control measures is poor due to cost. The purpose of this study was to determine whether giving families mite-proof bedding encasings at the time of the diagnosis with mite allergy would improve adherence at a home visit 2 months later. METHODS: Parents of children (mean age 7.7 years) with asthma and positive skin tests for dust mite were assigned either to an intervention group, which received dust mite covers upon enrollment or a comparison group, which did not. Both groups were instructed in dust mite control measures by a medical provider and told to invest in the covers as part of standard care. Two months after enrollment, parent report and observational measures from each family were obtained during a home visit. RESULTS: The group provided allergen encasings was found to be significantly more likely to have used the casings at the home visit, t(22) = 2.77, P < 0.05. There were no differences between groups in adherence to other mite control strategies. Parenting stress was significantly related to poorer mite control compliance. The most common reason reported for nonadherence to control measures was cost. CONCLUSIONS: Providing mite bedding encasings at the time of diagnosis significantly increases compliance at a 2-month home visit. Medicaid and insurance companies should be encouraged to pay for casings as a cost effective measure to improve asthma care in children with mite allergy.

Living with a chronic illness: a measure of social functioning for children and adolescents.

OBJECTIVE: To describe the development and initial psychometric evaluation of a measure of social functioning in children and adolescents with chronic medical conditions, Living with a Chronic Illness (LCI), designed to distinguish social difficulties related to the illness from those social difficulties associated with other factors (e.g., limited income). METHODS: Parents (n = 108) and youths (n = 115) completed the LCI, along with other psychological measures (e.g., Youth Self-Report). Teachers completed the Teacher Report Form and provided grade and absence data. Health care utilization data were obtained from medical charts. RESULTS: Statistical analyses supported the internal consistency and initial validity of LCI scores. Correlational results strongly point to the distinction made between illness-related and non-illness-related social difficulties and suggest that the LCI has some relation to existing measures (e.g., Child Behavior Checklist), while still providing a unique perspective on children's social functioning. Univariate and regression analyses revealed significant relations between LCI scores and health care utilization. CONCLUSIONS: These findings support the initial psychometric properties and clinical utility of the LCI scores. We discuss strengths and limitations of this study, as well as potential clinical applications for the LCI questionnaire.