Recommendations for terminology and the identification of neuropathic pain in people with spine-related leg pain. Outcomes from the NeuPSIG working group.

ABSTRACT: Pain radiating from the spine into the leg is commonly referred to as "sciatica," "Sciatica" may include various conditions such as radicular pain or painful radiculopathy. It may be associated with significant consequences for the person living with the condition, imposing a reduced quality of life and substantial direct and indirect costs. The main challenges associated with a diagnosis of "sciatica" include those related to the inconsistent use of terminology for the diagnostic labels and the identification of neuropathic pain. These challenges hinder collective clinical and scientific understanding regarding these conditions. In this position paper, we describe the outcome of a working group commissioned by the Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain (IASP) which was tasked with the following objectives: (1) to revise the use of terminology for classifying spine-related leg pain and (2) to propose a way forward on the identification of neuropathic pain in the context of spine-related leg pain. The panel recommended discouraging the term "sciatica" for use in clinical practice and research without further specification of what it entails. The term "spine-related leg pain" is proposed as an umbrella term to include the case definitions of somatic referred pain and radicular pain with and without radiculopathy. The panel proposed an adaptation of the neuropathic pain grading system in the context of spine-related leg pain to facilitate the identification of neuropathic pain and initiation of specific management in this patient population.

Factors predicting the transition from acute to persistent pain in people with 'sciatica': the FORECAST longitudinal prognostic factor cohort study protocol.

INTRODUCTION: Sciatica is a common condition and is associated with higher levels of pain, disability, poorer quality of life, and increased use of health resources compared with low back pain alone. Although many patients recover, a third develop persistent sciatica symptoms. It remains unclear, why some patients develop persistent sciatica as none of the traditionally considered clinical parameters (eg, symptom severity, routine MRI) are consistent prognostic factors.The FORECAST study (factors predicting the transition from acute to persistent pain in people with 'sciatica') will take a different approach by exploring mechanism-based subgroups in patients with sciatica and investigate whether a mechanism-based approach can identify factors that predict pain persistence in patients with sciatica. METHODS AND ANALYSIS: We will perform a prospective longitudinal cohort study including 180 people with acute/subacute sciatica. N=168 healthy participants will provide normative data. A detailed set of variables will be assessed within 3 months after sciatica onset. This will include self-reported sensory and psychosocial profiles, quantitative sensory testing, blood inflammatory markers and advanced neuroimaging. We will determine outcome with the Sciatica Bothersomeness Index and a Numerical Pain Rating Scale for leg pain severity at 3 and 12 months.We will use principal component analysis followed by clustering methods to identify subgroups. Univariate associations and machine learning methods optimised for high dimensional small data sets will be used to identify the most powerful predictors and model selection/accuracy.The results will provide crucial information about the pathophysiological drivers of sciatica symptoms and may identify prognostic factors of pain persistence. ETHICS AND DISSEMINATION: The FORECAST study has received ethical approval (South Central Oxford C, 18/SC/0263). The dissemination strategy will be guided by our patient and public engagement activities and will include peer-reviewed publications, conference presentations, social media and podcasts. TRIAL REGISTRATION NUMBER: ISRCTN18170726; Pre-results.

Andexanet alfa versus four-factor prothrombin complex concentrate for the reversal of apixaban- or rivaroxaban-associated intracranial hemorrhages.

BACKGROUND: Existing research recommends either andexanet alfa (AA) or four-factor prothrombin complex concentrate (4F-PCC) as an antidote for major bleeding events due to apixaban or rivaroxaban. Currently, there is limited published research that directly compares the risks and benefits of the two agents in patients with oral factor Xa inhibitor related traumatic and spontaneous intracerebral hemorrhages. Additional head-to-head data is needed to support favoring either AA or 4F-PCC when it comes to efficacy, safety, and cost. METHODS: A retrospective chart review was conducted to assess patients admitted to a multi-center healthcare system and a stand-alone teaching hospital in central Florida from June 2016 to December 2020. Patients included in the study were at least 18 years of age, taking apixaban or rivaroxaban prior to admission, had radiographical evidence of an intracranial hemorrhage, and received either AA or 4F-PCC as a reversal agent. The primary outcome analyzed was the level of excellent hemostasis achieved, based on a standardized rating system for effective hemostasis defined by the International Society of Thrombosis and Hemostasis (ISTH), after administration of AA or 4F-PCC. Secondary outcomes analyzed included changes in the initial hemorrhage volume as reported on computed tomography (CT) scan and at 12 to 24 h post treatment, rate of thromboembolic events, rate of inpatient mortality, and total cost of treatment after AA or 4F-PCC administration. RESULTS: A total of 109 patients were included in the study with 47 in the AA group (43.1%) and 62 in the 4F-PCC group (56.9%). There were no statistically significant differences between AA and 4F-PCC in terms of the primary and secondary outcomes with the exception of total cost of treatment. The level of excellent hemostasis achieved after reversal administration of AA was seen in 27 patients (71.1%) and 41 patients (70.7%) after 4F-PCC administration (p = 1, p adjusted = 0.654 after controlling for age, ICH score, regional mass effect, and midline shift). There was no statistically significant difference in the median percentage change in hemorrhagic volume from baseline to 12-24 h after reversal treatment (0 [-0.17--0.24] vs. 0 [-0.021-0.29], p = 0.439, adjusted p = 0.601) in the AA and 4F-PCC groups, respectively. The total incidence of thromboembolic events (4 [8.5%] vs. 6 [9.7%], p = 1, adjusted p = 0.973) and rate of inpatient mortality was similar between the two groups (16 [34.0%] vs. 13 [21.0%], p = 0.134, adjusted p = 0.283). A statistically significant difference was observed with the total cost of reversal treatment: $23,602 for treatment with AA and $6692 for treatment with 4F-PCC. CONCLUSIONS: No statistically significant differences were identified in primary or secondary outcomes between the two agents with the exception of total treatment cost. There is insufficient evidence based on this study to recommend AA over 4F-PCC for patients with intracranial hemorrhages associated with the use of apixaban or rivaroxaban.

A program using pharmacy technicians to collect medication histories in the emergency department.

PURPOSE: To evaluate the percentage, frequency, and types of medication history errors made by pharmacy technicians compared with nurses in the emergency department (ED) to determine if patient safety and care can be improved while reducing nurses' workloads. METHODS: Medication history errors were evaluated in a pre-post study comparing a historical control group (nurses) prior to the implementation of a pharmacy technician program in the ED to a prospective cohort group (pharmacy technicians). Two certified pharmacy technicians were trained by the post-graduate year one (PGY1) pharmacy practice resident to conduct medication history interviews in a systematic fashion, with outside resources (i.e., assisted living facility, pharmacy, physician's office, or family members) being consulted if any portion of the medication history was unclear or lacking information. The primary outcome compared the percentage of patients with accurate medication histories in each group. Secondary outcomes included differences between groups regarding total medication errors, types of errors, documentation of patient allergies and drug reactions, and documentation of last administration times for high-risk anticoagulant/antiplatelet medications. Accuracy was determined by reviewing each documented medication history for identifiable errors, including review of electronic generated prescriptions within the hospital system as well as physician notes or histories documented on the same day (for potential discrepancies). This review was performed by the pharmacy resident. The categories of errors included a drug omission, a drug commission, an incorrect or missing drug, an incorrect or missing dose, or an incorrect or missing frequency. Anonymous surveys were distributed to ED nurses to assess their feedback on the new medication reconciliation program using pharmacy technicians. RESULTS: A total of 300 medication histories from the ED were evaluated (150 in each group). Medication histories conducted by pharmacy technicians were accurate 88% of the time compared with 57% of those conducted by nurses (P < 0.0001). Nineteen errors (1.1%) were made by pharmacy technicians versus 117 (8.3%) by nurses (relative risk [RR], 7.5; P < 0.0001). The most common type of error was an incorrect or missing dose (10 versus 59, P < 0.001), followed by an incorrect or missing frequency (0 versus 30, P < 0.0001), and a drug commission (5 versus 23, P = 0.004). There were no differences between groups regarding the documentation of patient allergies. Documentation rates of high-risk anticoagulant and antiplatelet administration times were greater for pharmacy technicians than for nurses (76% versus 13%, P < 0.001). CONCLUSION: This study demonstrates that trained pharmacy technicians can assist prescribers and nurses by improving the accuracy of medication histories obtained in the ED.

Retired women and volunteering: the good, the bad, and the unrecognized.

In this article, we examine varied attitudes and practices toward volunteering in later life, as shared by a group of 40 retired women. We categorize women based on their engagement in retirement and label the categories according to societal expectations as follows: traditional volunteers as "good," nonvolunteers as "bad," and caregiving volunteers as "unrecognized." Using critical gerontology and a feminist framework, we juxtapose the lived experiences of retired women with a prevailing discourse on successful aging and civic engagement. We advocate for societal recognition of caregiving as a valuable form of volunteering, as well as the need to respect multiple ways in which older women experience and find meaning in later life.

Creating retirement paths: examples from the lives of women.

Through in-depth interviews with 40 retired women diverse in age, marital status, ethnicity, income, and occupational background, we explored how women experience retirement. Following our analysis, we identified five retirement pathways: family-focused, service-focused, recreation-focused, employment-focused, and disenchanted retirements. These pathways represent dominant activities and interests at the time the women were interviewed and challenge the cultural portrayal of retirement as an unvarying life stage. The participants' narratives provide a glimpse into the pathways retired women create by revealing the complexity of later life and the changing nature of retirement.

Beyond health and wealth: predictors of women's retirement satisfaction.

Despite empirical support for the positive effects of health and wealth on retirement satisfaction, alternative variables also play a key role in helping to shape women's assessment of retirement. In the present study, we explore personal and psychosocial predictors of women's retirement satisfaction while controlling for financial security and health. Data from 330 retired women were analyzed using stepwise regression analysis. Results indicate the most significant predictors of women's retirement satisfaction are self-esteem, mastery, emotional support, and ethnicity. Financial security remained a significant predictor of satisfaction; whereas health did not. Suggestions are made to recognize the importance of women's psychological health in retirement, examine different types of social support in relation to stage of retirement, and incorporate diverse audiences in women's retirement research.

Exploring the relationship between employment history and retired women's social relationships.

This study explores the relationship between retired women's employment history and their social integration and social support networks in retirement. Employment history is defined by former occupation (professional, paraprofessional, nonprofessional) and job continuity (discontinuous and continuous). The sample consists of 330 retired women ranging in age from 50 to 83 years, with diverse occupational histories, who were retired an average of 3.5 years. Results indicate occupational status may influence women's social integration, part-time employment, caregiving tasks, and satisfaction with social support. Continuity of employment appears to only marginally influence social integration with no impact on social support or satisfaction with social support.

Exploring the relationship between marital status and women's retirement satisfaction.

Increased divorce rates, declining marriage rates, and a predisposition to widowhood in later life all contribute to the heterogeneous marital histories of women approaching retirement. Existing research on retirement, however, has not considered the diversity in marital status that exists among retired women. The purpose of the present study was to explore the influence of marital status (i.e., married, remarried, widowed, divorced/separated, never-married) on women's retirement satisfaction. Using a purposive sampling method, self-administered questionnaires were distributed to retired women. Participants (N = 331) were asked to report on their retirement satisfaction, psychological well-being, and perceived health. Results revealed retirement satisfaction and perceived health differed by marital status. Psychological well-being, however, did not differ significantly between marital groups. Future research exploring diversity in marital status among retired women is suggested.

Recruitment strategies for conducting research on women's retirement.

Currently, little information is available to inform new or returning researchers about designing and conducting research on the topic of women and retirement. Few published studies describe how to access non-probability samples of retired women, yet preliminary evidence suggests women possess distinctive characteristics that affect their retirement as well as complicate the recruitment process. In this article, certain challenges and benefits of conducting research with women in retirement are presented. Next, important issues to consider prior to sampling retired women are described. Finally, specific strategies for identifying and recruiting community-dwelling retired women are presented and discussed.

Implementing a university-community-retail partnership model to facilitate community education on universal design.

PURPOSE: A collaborative partnership model was used to develop and implement a state-wide community education program on universal design. DESIGN AND METHODS: University faculty, extension professionals, older adult service agencies, service learning students, and a community retail chain made up the original partnership. RESULTS: This collaboration resulted in a five-stage partnership model. The model was used to develop and disseminate a consumer education program to promote aging in place. The five stages include (a) identifying partner strengths and shared learning, (b) program development, (c) implementing the universal design program, (d) facilitating collaborative outreach, and (e) shifting toward sustainable outreach. IMPLICATIONS: A lack of knowledge exists among consumers, builders, and health care professionals regarding strategies for aging in place. Collaborations between educators, outreach professionals, students, and a retail partner resulted in increased interest and awareness about universal design changes that enable seniors to age in place.

Retirement for women: the impact of employment.

This study compares the retirement experiences of professional and nonprofessional women. The analysis is based on 48 interviews with women ranging in age from 63-83 years. Participants provided personal and occupational histories and described their retirement decisions, transitions, and lives in retirement. The women's retirement experiences differed in five areas: (1) attachment to work, (2) professional identity, (3) social contacts, (4) family roles/obligations, and (5) community involvement. Findings indicate investment in the work role does affect how women transition to retirement as well as how they structure their time in retirement.