Evaluating Pain Management Practices for Cancer Patients among Health Professionals: A Global Survey.

Background: Cancer incidence in the world is predicted to increase in the next decade. While progress has been in diagnosis and treatment, much still remains to be done to improve cancer pain therapy, mainly in underserved communities in low-income countries. Objective: To determine knowledge, beliefs, and barriers regarding pain management in both high- and low-income countries (according to the WHO classification); and to learn about ways to improve the current state of affairs. Design: Descriptive survey. Setting/Subjects: Fifty-six countries worldwide; convenience sample of 1639 consisted of 36.8% physicians; 45.1% nurses, and 4.5% pharmacists employed in varied settings. Results: Improved pain management services are key elements. Top barriers include religion factors, lack of appropriate education and training at all levels, nonadherence to guidelines, patients' reluctance to report on pains, over regulation associated with prescribing and access to opioid analgesics, fear of addiction to opioids, and lack of discussions around prognosis and treatment planning. Conclusion: The majority of patients with cancer in low-income countries are undertreated for their pain. Promoting cancer pain accredited program of training and education on pain management for physicians and nurses is crucial, as well as advocating policymakers and the public at large.

Effect of a Video-Based Case Presentation Educational Intervention Anchored on the Theory of Planned Behavior on Adoption of Oral Health Behaviors Among Dental Patients: A Quasi-Experimental Study / Efecto de una intervención educativa de presentación de casos en video basada en la teoría del comportamiento planificado sobre la adopción de comportamientos de salud oral entre los pacientes dentales: un estudio cuasi-experimental

ABSTRACT: Objective: The integration of video technology in case-based presentations are useful approaches in teaching real-world problems that ultimately improves an individual's ability to reflect, analyze, and decide regarding any circumstance leading to change in behavior. Anchored on the Theory of Planned Behavior, this study aims to determine the effectiveness of an online case-based video patient education tool on the adoption of oral health behaviors by patients in the dental setting. Materials and Methods: The study was carried on 74 dental patients who were selected using simple sampling (37 patients each in Groups I and II). The two groups differed in presence (Group I-Control) or absence (Group II-Experimental) of prior exposure to professional oral care before Patient Educational Intervention through video-based case presentation was performed in the control and experimental groups. Data were collected using a questionnaire and analyzed by the Statistical Package for the Social Sciences version 18 software at 0.05 significance level. Results: A total of 37 participants per group in Groups I and II (N=74) responded to the pre-test phase and post-test phase. The pre-test mean scores of Groups I and II were 11.43 and 15.05, respectively. The post-test mean score of Groups I and II were 10.81 and 12.76, respectively. There is no statistical significance seen in the pre-test mean score and the post-test mean score of the patients who experienced professional oral health care (Group I) (p=0.113). However, there is a statistical significance in the mean pre-test score and the mean post-test score among patients who never experienced professional oral health care (Group II) (p=0.032). Conclusion: The study revealed that the video-based case presentations is an effective patient education strategy for dental patients who have never experienced professional oral health care manifested as a decline in the degree of dental neglect.

RESUMEN: Objetivo: La integración de la tecnología de video en presentaciones basadas en casos son enfoques útiles para enseñar problemas del mundo real que, en última instancia, mejoran la capacidad de un individuo para reflexionar, analizar y decidir sobre cualquier circunstancia que conduzca a un cambio de comportamiento. Anclado en la Teoría del Comportamiento Planificado, este estudio tiene como objetivo determinar la efectividad de una herramienta de educación del paciente en video basada en casos en línea sobre la adopción de comportamientos de salud bucal por parte de los pacientes en el entorno dental. Materiales y métodos: El estudio se llevó a cabo en 74 pacientes dentales que fueron seleccionados mediante muestreo simple (37 pacientes cada uno en los Grupos I y II). Los dos grupos difirieron en presencia (Grupo I-Control) o ausencia (Grupo II-Experimental) de exposición previa a cuidados bucales profesionales antes de que se realizara la Intervención Educativa del Paciente a través de la presentación de casos en video en los grupos control y experimental. Los datos se recopilaron mediante un cuestionario y se analizaron con el software Statistical Package for the Social Sciences versión 18 a un nivel de significancia de 0.05. Resultados: Un total de 37 participantes por grupo en los Grupos I y II (N=74) respondieron a la fase previa a la prueba y a la fase posterior a la prueba. Las puntuaciones medias previas a la prueba de los Grupos I y II fueron 11,43 y 15,05, respectivamente. La puntuación media posterior a la prueba de los Grupos I y II fue 10,81 y 12,76, respectivamente. No se observa significancia estadística en la puntuación media previa a la prueba ni en la puntuación media posterior a la prueba de los pacientes que recibieron atención profesional de la salud bucal (Grupo I) (p=0,113). Sin embargo, existe una significancia estadística en la puntuación media previa a la prueba y la puntuación media posterior a la prueba entre los pacientes que nunca recibieron atención médica bucal profesional (Grupo II) (p=0,032). Conclusión: El estudio reveló que las presentaciones de casos en video son una estrategia eficaz de educación del paciente para los pacientes dentales que nunca han experimentado la atención de la salud bucal profesional que se manifiesta como una disminución en el grado de negligencia dental.

Development and validation of interprofessional learning assessment tool for health professionals in continuing professional development (CPD).

INTRODUCTION: Interprofessional learning (IPL) is increasingly recognized as a promising strategy in addressing the burgeoning challenges in healthcare. Its assessment remains to be perplexing and requires accurate measurements. Thus, this study intended to develop a valid and reliable reflective tool in assessing IPL as a Continuing Professional Development (CPD) outcome. METHODS: A one-group post-posttest pre-experimental design with tool development was employed to establish the validity and reliability of the "Inventory of Reflective Vignette-Interprofessional Learning" (IRV-IPL). This tool was developed from an extensive literature review and designed with three segments to assess interprofessional competencies before, after, and what if scenarios using vignettes. After it was validated by education experts (n = 5) and written consent forms were signed by the participants, the IRV-IPL was pilot tested among healthcare professionals (n = 10) for analysis and improvement. During the actual implementation, it was administered to healthcare professionals (n = 45) who participated in a university-provided CPD event. Collected data underwent validity and reliability testing. RESULTS: IRV-IPL generated excellent internal consistency (α = 0.98), and across all segments of collaboration (α = 0.96), coordination (α = 0.96), cooperation (α = 0.96), communication (α = 0.97), and commendation (α = 0.98). Items exhibited significantly positive large correlations (r > 0.35, p < 0.05) in all segments showing beneficial measures for postdictive validity in recalling prior interprofessional competencies, and predictive validity in estimating interprofessional learning as an outcome of CPD and alternative interventions. CONCLUSION: This study provided a piece of groundwork evidence on the use of IRV-IPL as a reflective assessment tool for interprofessional learning in CPD contexts. Further studies are essential to explore the educational utility of IRV framework in crafting relevant assessments and to establish construct validity of IRV-IPL using exploratory and confirmatory factor analyses.

Developing a valid and reliable assessment of knowledge translation (KT) for continuing professional development program of health professionals.

INTRODUCTION: Knowledge Translation (KT) is expected to be a critical learning outcome of a Continuing Professional Development (CPD) program. It continues to serve as an area of interest among educators and healthcare providers due to its importance to evidence-based practice. This study endeavored to develop a valid and reliable KT learning assessment tool in CPD. METHODS: The Inventory of Reflective Vignettes (IRV), an innovative approach of integrating research vignettes, was utilized in crafting the 20-item IRV-KT tool. This instrument includes knowledge creation and action as essential KT constructs. KT competency was assessed in three segments (i.e., before and after CPD event and if in a lecture) using a one-group post-posttest pre-experimental design. Health professionals who successfully completed a CPD program on a knowledge translation topic were asked to complete the IRV-KT during the pilot study (n = 10) and actual implementation (n = 45). Responses were subjected to Cronbach's reliability and criterion-validity testing. RESULTS: The initial test of the IRV-KT tool demonstrated a high internal reliability (α = 0.97) and most items yielded acceptable validity scores. During the actual implementation, a higher reliability score of 0.98 was generated with significant correlations between the before-after segments for both KT constructs of creation (r = 0.33, p < 0.05) and action (r = 0.49, p < 0.05). All items have significant positive validity coefficients (r > 0.35, p < 0.05) in all segments of the tool. DISCUSSION: The study produced a reflective assessment tool to validly and reliably assess KT learning in a CPD. IRV-KT is seen to guide the curriculum process of CPD programs to bridge learning and healthcare outcomes.

Inadequate treatment practices for pain relief and adverse event management in cancer patients across 10 countries/regions in Asia: a call for greater efforts to improve standards for patient care.

AIM: To examine the treatment practices for cancer pain relief and adverse event management, and the factors related to patient outcomes in the participating countries/regions. METHODS: The study was a cross-sectional survey conducted between September and December 2013 in 10 countries/regions across Asia. Adult patients with a history of cancer pain at least 1 month before study entry completed the survey questionnaire. RESULTS: A total of 1190 patients were included. The mean Box Scale-11 (BS-11) pain score was 6.0 (SD 2.1), with 86.2% experiencing moderate-to-severe pain and 53.2% receiving opioids at time of the survey. The mean BS-11 scores were 5.3 (SD 2.1) in the "others" (single non-opioid medication or untreated) group, 6.3 (SD 2.0) in the ≥2 non-opioids group and 6.7 (SD 1.9) in the opioid group. The proportions of patients experiencing moderate-to-severe pain were 79.1%, 87.3% and 93.7%, respectively. About 70% of patients reported adverse events due to their pain medications, about half had received medications to manage these symptoms. Adverse events were negatively associated with activities of daily living (P < 0.0001). Pain and hindrance to activities of daily living were negatively associated with employment status (P = 0.003 and 0.021). Unemployment was significantly associated with poorer quality of life (P < 0.0001). CONCLUSION: This analysis demonstrates inadequate management of cancer pain and treatment-related adverse events in the participating cohort. Pain and inadequate management of adverse events were negatively associated with patients' overall well-being. More collaborative efforts should be taken to optimize pain treatment and increase awareness of adverse event management in physicians.

Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries.

In order to implement more effective policies for cancer pain management, a better understanding of current practices is needed. Physicians managing cancer pain and patients experiencing cancer pain were randomly surveyed across 10 Asian countries to assess attitudes and perceptions toward cancer pain management. A total of 463 physicians (77.3% oncologists) with a median experience of 13 years were included. Medical school training on opioid use was considered inadequate by 30.5% of physicians and 55.9% indicated ≤ 10 h of continuing medical education (CME). Of the 1190 patients included, 1026 reported moderate-to-severe pain (median duration, 12 months). Discordance was observed between physician and patient outcomes on pain assessment with 88.3% of physicians reporting pain quantification, while 49.5% of patients claimed that no scale was used. Inadequate assessment of pain was recognized as a barrier to therapy optimization by 49.7% of physicians. Additional barriers identified were patients' reluctance owing to fear of addiction (67.2%) and adverse events (65.0%), patients' reluctance to report pain (52.5%), excessive regulations (48.0%) and reluctance to prescribe opioids (42.8%). Opioid use was confirmed only in 53.2% (286/538) of patients remembering their medication. Pain affected the activities of daily living for 81.3% of patients. These findings highlight the need for better training and CME opportunities for cancer pain management in Asia. Collaborative efforts between physicians, patients, policy makers, and related parties may assist in overcoming the barriers identified. Addressing the opioid stigma and enhancing awareness is vital to improving current standards of patient care.

An exploratory study on the neuromuscular junction activity of cestrum nocturnum extract in an in-vivo cat model

Muscle relaxants are an irreplaceable item within the modern surgical toolkit. Their almost universal use during surgical procedures of medium-to-long duration means that it is essential that all anesthesiologists must have a comprehensive knowledge of their history and the future prospects for their continued evolution. There are a number of naturally- occurring acetylcholinesterase and butrylcholinesterase inhibitors, including the solanaceous glycoalkaloids (SGAs), which are found in the plants of the family Solanaceae. In the Pharmacopiea of the Philippines indigenous plants, one such plants is Cestrum nocturnum (Dama de Noche). Objective: This experimental animal study was therefore undertaken to determine the neuromuscular effect of the intravenous administered Cestrun nocturnum in an anesthesixed cat. Methods: An N-of-1 A-B-A design in in vivo study was undertaken compairing the effect of the Cestrun Nocturnum ansd atracurium on the neuromuscular junction of an anesthesized cat. Results: Intravenously administered cestrum nocturnum produced an incomplete (40% TOF) but sustained depolarization of the neuromuscular junction that took an hour to fully recover. It also prolonged the onset of atracurium- induced paralysis and delayed its recovey in the pesence of neostigmine. Conclusion: In the light of these findings, we infer that cestrum nocturnum interact with atracurium and neostigmne possibly through pharmacokinetic and pharmacodynamic mechanisms. Further studies are recommended to elucidate these mechanisms.

Effect of ischemic preconditioning under hepatic inflow occlusion on the SGPT levels of domestic cats undergoing right hepatic lobectomy

OBJECTIVE: This controlled study was done to determine the protective effects of ischemic preconditioning (IP) on the liver of cats undergoing major liver resection.SPECIFIC OBJECTIVE: To determine the effect of IP on alanine transaminase (ALT or SGPT) in cat*that will undergo major liver resection.DESIGN: This study is a randomized controlled trial.SETTING: LIST Health Sciences Research Laboratory.PATIENTS/ PARTICIPANTS: This is an experimental study on the effects of ischemic preconditioning under hepatic inflow occlusion on the SGPT as a measure of morbidity in Felis catus (domestic cats) undergoing right hepatic lobectomy. Nine male cats, weighing 2.5-5kg, are equally allocated into any one of the following 3 study groups: Control group not subjected to ischemic preconditioning (C), Experimental group subjected to 1 1/2 minutes of ischemia followed by 1.5 minutes of reperfusion (El), Experimental group subjected to 5 minutes of ischemia followed by 5 minutes of reperfusion (E2).RESULTS: There was no significant difference in the mean weight of cats in the 3 groups (p = 1.00). Comparing the pre and post result between using paired t-test, there was no significant difference in the baseline values (p = 0.14). However, there was a significant difference in the post result between the three groups (p CONCLUSION: In the past few years, interesting new data on the presence of ischemic preconditioning in various organs as an endogenous means to protect itself from ischemiahas been available. This study investigated and suggests that ischemic preconditioning may provide protection to the liver undergoing hepatic lobectomy.

Development of a comprehensive self-administered pre-operative health assessment questionnaire: a risk stratification strategy

Introduction: Preanesthetic evaluation is a basic element of anesthesia care which aims to reduce the risks associated with anesthesia and increase quality of perioperative care. As part of the preanesthetic evaluation, questionnaires allow the anesthesiologist to quickly review a structured list and focus on pertinent findings thus ensuring a more focused evaluation. The objective of this study is to develop a self-administered preoperative assessment questionnaire in Filipinos that can be used for patients scheduled to undergo anesthesia and to determine if the questionnaire can help in risk stratification of these patients. Methods: Adult patients undergoing anesthesia were asked to fill up a 24-item questionnaire written in Filipino and English that emphasized the cardiovascular, respiratory, neurologic, endocrine, gastrointestinal, hematologic, and homeostatic status of the patient. Questions were answerable by "yes", "no", or "I don't know". A "yes" was counted as two points, "no" one point, "I don't know" as 0. Scores were then added for each patient. An anesthesia resident unaware of the results of the questionnaire validated the patient's responses by doing a routine preoperative evaluation. 'Results from the two were compared. Results: Eighty-four patients were included in the study. No significant difference was noted between the results of the questionnaire and the standard preoperative form. Tweny one patients were included in the high index group because their perioperative course was marked by previously defined adverse events while the remaining 63 were in the low index group because of an unremarkable perioperative course. Mean cumulative score of patients in the high index group was significantly higher than the low index group (30.48 vs. 27.42; p<0.05, Sig). A score of 29 or higher was also found to be associated with adverse events during the perioperative period. Conclusion: This self-administered form in Filipino was comparable to the standard evaluation done by a resident and was helpful in detecting potential problem areas for patients undergoing anesthesia and surgery. (Author)

Pharmacologic misadventures with herb-drug interactions

This article review and discuss the complimentary and alternative medicine (CAM), where it all began, practices and ideas self- defined by their users as preventing and treating illnesses or promoting health and well-being.

Patterns of volatile anesthetic utilization among anesthesiologists in a tertiary teaching hospital: the need for a pharmacoeconomic "Wake-up" policy for the "Sleep Agents"

The goal of cost-containment in anesthesia requires a global, multif actorial approach. Practice patterns need to be optimized by determined leadership, motivation and commitment of all concerned. It is clear from the current national debate on health care priorities that every health care worker, the anesthesiologist included, needs to examine not only the economic consequences of his daily practice decisions, but also his daily practice patterns of behavior in the operating room. When the patient grants his consent for anesthesia, he puts his complete trust on the anesthesiologist and then goes to sleep. He trusts that the anesthesiologist will give him the best anesthetic, and implicitly, that he [the anesthesiologist) would safeguard his interest and minimize cost. Objectives: 1) To determine the current patterns of volatile anesthetic utilization among the anesthesiologists in our institution; 2) To make a cost-minimization analysis of these practice patterns; and, 3) To collect baseline data prior to the development of pharmaceutical practice guidelines in anesthesiology for our institution. Materials and Methods: A cross-sectional survey was done using the anesthesia records of all patients admitted into the operating room at the Private Division of the University of Santo Tomas Hospital for the month of February 2000. The patients were stratified into those receiving general anesthesia and those receiving regional anesthesia. Only those surgical cases that required general inhalation anesthetic whether as primary or supplemental agent where included in the evaluation. The most commonly used volatile inhalation agents were determined. The cost of delivering inhalation anesthesia either as a single agent or in combination with a regional technique is determined by surveying the charges made for each individual case. Results: Total charges for anesthetic drugs used, including oxygen and local anesthetic agents amounted to Php 1,055,401.60. Charges for drugs alone amounted to Php 1,027,436.60, of which Php 42,738.00 comprise the cost of local anesthetics for regional techniques. All other drugs used amounted to PhP 984,698.60. The total cost for volatile inhalation agents alone comprised 47.9 percent of which sevoflurane accounted for the highest share of Php 378,425.45; isoflurane, Php 26,650.00; enflurane Php 14,908.00 and halothane Php 600.00. The neuromuscular blockers accounted for 16.5 percent; the sedative-hypnotics, diprivan (2.2 percent) and midazolam (2.5 percent); and the opiate agonist, fentanyl (1.9 percent) and partial agonist nalbuphine (3.3 percent) comprise a great part of the rest of the charges. Discussion: Pharmacoeconomics is an increasingly important consideration in the adoption of new drugs into practice. Not only must a new drug confer greater therapeutic benefit, but also that benefit must not be bought at too high a price. For injected drugs, determination of relative cost is straightforward. This is not true for inhaled anesthetics because cost is related to more than the amount of drug taken up; cost is also determined by waste of anesthetic consequent to delivery of anesthetic in excess of the amount taken up. It is not surprising therefore, that the charges for the volatile anesthetics are very much higher than the expected cost of consumption, practically accounting for 60-75 percent of charges for all anesthetic drugs combined. It behooves every anesthesiologist therefore to consider the cost of their pharmaceutical choices at all times and undertake cost minimization strategies for drugs used in anesthesia, especially the volatile anesthetics. (Author)

The need for a comprehensive obstetrical anesthesia evaluation and management center: A prescription for change in health policy

This paper focuses on the process measures of quality. As shown in later sections, consensus on appropriate processes for a selected anesthesia- related maternal health service, i.e., pre -anesthetic care is obtained and corresponding input requirements for these processes are identified.

Changing the pre-anesthetic evaluation process for obstetric patients: a utility analysis

The purpose of this paper is to present a utility analysis of the hierarchical framework of pre- anesthetic evaluation as part of antenatal care. A sensitivity analysis will likewise be done to test the robustness of the assumptions.