A survey of perceptions, attitudes, knowledge and practices of medical oncologists about cancer pain management in Spain.

PURPOSE: To monitor oncologists' perspective on cancer pain management. METHODS: An anonymized survey was conducted in two waves. First, over a convenience sample of oncologists known to be particularly concerned with the management of pain. Second, using a random sample of oncologists. RESULTS: In total, 73 and 82 oncologists participated in the first and second wave, respectively. Many oncologists reported to have good knowledge of analgesic drugs (95.9%), the mechanism of action of opioids (79.5%), and good skills to manage opioid-related bowel dysfunction (76.7%). Appropriate adjustment of background medication to manage breakthrough pain was reported by 95.5% of oncologists. Additionally, 87.7% (68.3% in the second wave, p = 0.035) of oncologists reported suitable opioid titration practices, and 90.4% reported to use co-adjuvant medications for neuropathic pain confidently. On the other hand, just 9.6% of oncologists participated in multidisciplinary pain management teams, and merely 30.3 and 27.1% reported to routinely collaborate with the Pain Clinics or involve other staff, respectively. Only 26.4% of the oncologists of the second wave gave priority to pain pathophysiology to decide therapies, and up to 75.6% reported difficulties in treating neuropathic pain. Significantly less oncologists of the second wave (82.9 vs. 94.5%, p = 0.001) used opioid rotation routinely. CONCLUSIONS: Unlike in previous surveys, medical oncologists reported in general good knowledge and few perceived limitations and barriers for pain management. However, multi-disciplinary management and collaboration with other specialists are still uncommon. Oncologists' commitment to optimize pain management seems important to improve and maintain good practices.

A bibliometric study of international scientific productivity in attention-deficit hyperactivity disorder covering the period 1980-2005.

OBJECTIVE: We have carried out a bibliometric analysis of scientific publications related to attention-deficit hyperactivity disorder (ADHD) and its pharmacological treatment over the period 1980-2005. METHOD: We selected (in EMBASE and MEDLINE databases) documents that contained in their title the descriptors attention deficit hyperactivity disorder, attention deficit disorder, ADHD and ADD. As bibliometric indicators of production and dispersion we applied Price's Law and Bradford's Law, respectively. We also calculated the national participation index (PI) and correlated it with overall PI in biomedical and health sciences, with PI in the discipline of Psychiatry and with the social-health indicators (per capita Gross Domestic Product, number of physicians and total per capita expenditure on health). RESULTS: We obtained 5,269 original documents (2,325 corresponded to pharmacological therapy). Our results indicate fulfilment of Price's Law, since scientific production on ADHD undergoes exponential growth (correlation coefficient r = 0.9859, vs. r = 0.9011 after linear adjustment). The most widely studied drugs are methylphenidate (1,251 documents). Division into Bradford zones yields a nucleus occupied exclusively by the Journal of the American Academy of Child and Adolescent Psychiatry (500 articles). A total of 866 different journals were employed. Twelve of the first 20 used journals have an Impact Factor > 2. The principal producer country is the United States (PI = 44.2). Only four countries, of the 20 major producers in health sciences, surpass their own PI in the field of Psychiatry (Brazil, China, Spain and the United States). The correlation between PI and total number of physicians for each country situates Canada, Australia, the United States and Israel in the top positions. CONCLUSION: Productivity on ADHD has undergone exponential growth in the period 1980-2005, without evidence a saturation point.