scholarly journals Perceptions of Community-Dwelling Patients and Their Physicians on OxyContin® Discontinuation and the Impact on Chronic Pain Management

2017 ◽  
Vol 2017 ◽  
pp. 1-11
Author(s):  
Feng Chang ◽  
Sara Ibrahim
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Management Practices ◽  
Negative Impact ◽  
Community Dwelling ◽  
Drug Formulary ◽  
Physician Perceptions ◽  
Specialty Practice ◽  
Perceived Impact ◽  
The Impact

OxyContin, formerly one of the most commonly prescribed medications for chronic pain in Canada, was discontinued, delisted from the Ontario Drug Formulary, and replaced by a tamper-resistant formulation in 2012. The impact of discontinuing OxyContin on patients formerly prescribed it to treat chronic pain was unreported. Patients with chronic pain aged 45 years and over (n=13) were recruited from two primary care and one specialty practice sites and interviewed using a semistructured guide to capture their experiences with discontinuing OxyContin, the efficacy of alternate medications, and relationships with physicians. Additional interviews were conducted with their physicians (n=7) to obtain physician perceptions on discontinuation and to expand understanding of the patients’ experiences. Aspects of patients’ pain and medical care through the discontinuation process revealed emergent themes that both converge and diverge from that of treating physicians. Areas of divergence include the motive for discontinuation, which was condemned by most patients but supported by all physicians, and the perceived impact of discontinuance on pain control, with the majority of patients experiencing a negative impact and most physicians describing it as insignificant. Perceptions of patients and physicians coincided on the need to optimize pain management practices.

scholarly journals Is the perceived impact of disciplinary procedures on medical doctors’ professional practice associated with working in an open culture and feeling supported? A questionnaire among medical doctors in the Netherlands who have been disciplined

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e036922
Author(s):  
Berber S Laarman ◽  
Renée J R Bouwman ◽  
Anke J E de Veer ◽  
Roland D Friele
Keyword(s):  
Professional Practice ◽  
Negative Impact ◽  
Working Environment ◽  
Perceived Support ◽  
Medical Doctors ◽  
Safe Environment ◽  
Item Questionnaire ◽  
Disciplinary Procedures ◽  
Perceived Impact ◽  
The Impact

IntroductionDisciplinary procedures can have a negative impact on the professional functioning of medical doctors. In this questionnaire study, doctors’ experience with open culture and support during a disciplinary procedure is studied to determine whether open culture and support are associated with perceived changes in the professional practice of doctors.MethodsAll doctors who received a warning or a reprimand from the Dutch Medical Disciplinary Board between July 2012 and August 2016 were invited to fill in a 60-item questionnaire concerning open culture, perceived support during the disciplinary procedure and the impact of the procedure on professional functioning as reported by doctors themselves. The response rate was 43% (n=294).ResultsA majority of doctors perceive their work environment as a safe environment in which to talk about and report incidents (71.2% agreed). Respondents felt supported by a lawyer or legal representative and colleagues (92.8% and 89.2%, respectively). The disciplinary procedure had effects on professional practice. Legal support and support from a professional confidant and a professional association were associated with fewer perceived changes to professional practice.ConclusionOur study shows that doctors who had been disciplined perceive their working environment as open. Doctors felt supported by lawyers and/or legal representatives and colleagues. Legal support was associated with less of a perceived impact on doctors’ professional practice.

scholarly journals The impact of urban-based family medicine postgraduate rotations on rural preceptors/teachers

2021 ◽  
Author(s):  
Douglas Myhre ◽  
Jodie Ornstein ◽  
Molly Whalen-Browne ◽  
Rebecca Malhi
Keyword(s):  
Family Medicine ◽  
Negative Impact ◽  
Teaching Experience ◽  
Rural Environment ◽  
Free Text ◽  
Rural Physicians ◽  
Rural Residency ◽  
Perceived Impact ◽  
Rural Teaching ◽  
The Impact

Background: The use of rural rotations within urban-based postgraduate programs is the predominant response of medical education to the health needs of underserved rural populations.  The broader impact on rural physicians who teach has not been reported. Methods: This study examined the personal, professional, and financial impact of a rural rotations for urban-based family medicine (UBFM) residents on Canadian rural teaching physicians. A survey was created and reviewed by community and academic rural physicians and a cohort of Canadian rural family physicians teaching UBFM residents was sampled. Survey data and free-text responses were assessed using quantitative and qualitative analyses.   Results: Participants with rural residency backgrounds perceived a negative impact of teaching UBFM (p = 0.02 personal and professional) and those in a primary rural environment (as defined below) perceived impact as positive (p < 0.001). Rural preceptors often held contrasting attitudes towards learners with negative judgements counter-balanced by positive thoughts. Duration in practice and of teaching experience did not have a significant impact on ratings. Conclusion: Being a rural preceptor of UBFM residents is rewarding but also stressful. The preceptor location of training and scope of practice appears to influence the impact of UBFM residents.

scholarly journals Phosphorus and Zinc Fertilization Improve Zinc Biofortification in Grains and Straw of Coarse vs. Fine Rice Genotypes

Agronomy ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 1155
Author(s):  
Amanullah ◽  
Inamullah ◽  
Mona S. Alwahibi ◽  
Mohamed Soliman Elshikh ◽  
Jawaher Alkahtani ◽  
...  
Keyword(s):  
Management Practices ◽  
Field Experiments ◽  
Negative Impact ◽  
Oryza Sativa L ◽  
Crop Productivity ◽  
Continuous Cropping ◽  
Rice Varieties ◽  
Rice Grains ◽  
Rice Genotypes ◽  
The Impact

Continuous cropping of rice (Oryza sativa L.) and wheat (Triticum aestivum L.) deplete soil fertility and reduce crop productivity as well as zinc (Zn) concentrations in rice grains and straw. Low Zn concentrations in rice grains have a negative impact on human health, while low Zn concertation in rice straw creates a nutritional problem for animals. The current high yielding rice varieties and hybrids remove large quantities of Zn from the soils, lowering the residual concentrations of soil Zn for the subsequent crop (e.g., wheat). Field experiments were conducted on farmers field in Malakand with the objective to evaluate the impact of various combinations of phosphorus (0, 40, 80, and 120 kg ha−1) and Zn levels (0, 5, 10, and 15 kg ha−1) on biofortification of Zn in grains and straw of rice genotypes [fine (Bamati-385) vs. coarse (Fakhre-e-Malakand and Pukhraj)]. The results revealed that Zn biofortification in rice genotypes increased with the integrated use of both nutrients (P + Zn) when applied at higher rates (80 and 120 kg P ha−1, and 10 and 15 kg Zn ha−1, respectively). The biofortification of Zn in both grains and straw was higher in the coarse than fine rice genotypes (Pukhraj > Fakhre-e-Malakand > Basmati-385). It was concluded from this study that the application of higher P and Zn levels increased Zn contents in rice parts (grains and straw) under the rice-wheat system. We also concluded from this study that Zn concentrations in rice grains and straw are influenced by plant genetic factors and Zn management practices.

scholarly journals Life in lockdown: a telephone survey to investigate the impact of COVID-19 lockdown measures on the lives of older people (≥75 years)

2020 ◽  
Author(s):  
Lesley Brown ◽  
Rahena Mossabir ◽  
Nicola Harrison ◽  
Caroline Brundle ◽  
Jane Smith ◽  
...  
Keyword(s):  
Older People ◽  
Telephone Survey ◽  
Negative Impact ◽  
Short Form ◽  
Health Anxiety ◽  
Good Health ◽  
Community Dwelling ◽  
Activity Levels ◽  
Cross Sectional ◽  
The Impact

Abstract Background In response to the coronavirus disease 2019 (COVID-19) pandemic, the UK government introduced social distancing measures and identified specific populations at high risk from the virus. People ≥70 were deemed ‘Clinically Vulnerable’. Distancing measures were introduced to reduce the risk of contracting COVID-19. However, these may have a negative impact on older people who are vulnerable to social isolation and may have challenges accessing services and provisions. Objectives To investigate the impact of COVID-19 lockdown measures on the lives of older people. Study design and setting Cross-sectional telephone survey. Participants Community-dwelling older people, 76–97 years. Outcomes Health anxiety; General health (RAND Short-form 36 Survey); Physical activity; Depression (PHQ-8); Anxiety (GAD-2); Loneliness; Access to services; Challenges, concerns and positive experiences. Data analysis Counts (%), means (SDs). Thematic analysis was used to identify themes from open questions. Results n = 142. 52% did not worry about their health; 76% rated their health as ‘good’, ‘very good’ or ‘excellent’; &lt;10% met the criteria indicative of depression (PHQ-8), or anxiety (GAD-2); 42% were less active than before lockdown; and 27% were lonely at least some of the time. Over half of participants identified positive aspects. Conclusions Most participants reported good health with low levels of health anxiety, anxiety and depression. Many were able to identify positive aspects to lockdown and may be better equipped to deal with lockdown than anticipated. Strategies may be required to ameliorate the negative impact of loneliness for a minority of older people, and help some resume previous activity levels and pursuits.

scholarly journals Interpreting the Meaning of Pain Severity Scores

2002 ◽  
Vol 7 (4) ◽  
pp. 192-198 ◽  
Author(s):  
Marilyn J Hodgins
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Health Care Professionals ◽  
Pain Measurement ◽  
Management Practices ◽  
Care Organization ◽  
Treatment Goals ◽  
Severity Scores ◽  
Measurement Tools ◽  
The Impact

Poor pain management practices are generally discussed in terms of barriers associated with the patient, clinician and/or health care organization. The impact of deficiencies in the tools that are used to measure pain are seldom addressed. Three factors are discussed that complicate the measurement of pain: the nature of pain, the lack of meaning associated with scores generated by pain scales, and treatment goals that lack specificity and are not linked to patients' pain scores. The major premise presented in the present article is that the utility of pain measurement is limited because health care professionals do not have a common understanding of the meaning of scores generated by pain measurement tools, especially within the acute care setting. To address this issue, approaches to establishing instrument validity need to be broadened to include the examination of the meaning and consequences of these measurements within a specific context. Substantive improvements in pain management are unlikely to occur until criteria are identified to link explicitly the scores generated by pain measurement tools to treatment goals.

scholarly journals Improvements in Pain Outcomes in a Canadian Pediatric Teaching Hospital Following Implementation of a Multifaceted, Knowledge Translation Initiative

2012 ◽  
Vol 17 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Lisa M Zhu ◽  
Jennifer Stinson ◽  
Lori Palozzi ◽  
Kevin Weingarten ◽  
Mary-Ellen Hogan ◽  
...  
Keyword(s):  
Pain Management ◽  
Knowledge Translation ◽  
Clinical Outcomes ◽  
Pain Assessment ◽  
Management Practices ◽  
Audit And Feedback ◽  
Opioid Administration ◽  
Pain Outcomes ◽  
Pain Prevalence ◽  
The Impact

BACKGROUND: A previous audit performed at a tertiary/quaternary pediatric hospital in Toronto, Ontario, demonstrated suboptimal assessment and treatment of children’s pain. Knowledge translation (KT) initiatives (education, reminders, audit and feedback) were implemented to address identified care gaps; however, the impact is unknown.OBJECTIVES: To determine the impact of KT initiatives on pain outcomes including process outcomes (eg, pain assessment and management practices) and clinical outcomes (eg, pain prevalence and intensity); and to benchmark additional pain practices, particularly opioid administration and painful procedures.METHODS: Medical records at The Hospital for Sick Children (Toronto, Ontario) were reviewed on a single day in September 2007. Pain assessment and management practices, and pain prevalence and intensity in the preceding 24 h were recorded on a standardized data collection form. Where possible, pain outcomes were compared with previous audit results.RESULTS: Records of 265 inpatients were audited. Sixty-three per cent of children underwent a documented pain assessment compared with 27% in an audit conducted previously (P<0.01). Eighty-three per cent of children with documented pain received at least one pain management intervention. Overall, 51% of children received pharmacological therapy, and 15% received either a psychological or physical pain-relieving intervention. Of those assessed, 44% experienced pain in the previous 24 h versus 66% in the previous audit (P<0.01). Fewer children experienced severe pain compared with the first audit (8.7% versus 26.1%; P<0.01). One-third of children received opioids; 19% of these had no recorded pain assessment. Among 131 children who underwent a painful procedure, 21% had a concurrent pain assessment. Painful procedures were accompanied by a pain-relieving intervention in 12.5% of cases.CONCLUSIONS: Following KT initiatives, significant improvements in pain processes (pain assessment documentation and pain management interventions) and clinical outcomes (pain prevalence, pain intensity) were observed. Further improvements are recommended, specifically with respect to procedural pain practices and opioid utilization patterns.

scholarly journals Sex Differences in Chronic Pain Management Practices for Patients Receiving Opioids from the Veterans Health Administration

Pain Medicine ◽  
2015 ◽  
Vol 16 (1) ◽  
pp. 112-118 ◽  
Author(s):  
Elizabeth M. Oliva ◽  
Amanda M. Midboe ◽  
Eleanor T. Lewis ◽  
Patricia T. Henderson ◽  
Aaron L. Dalton ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sex Differences ◽  
Pain Management ◽  
Management Practices ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Chronic Pain Management ◽  
Health Administration

scholarly journals Medical students’ perceptions and coping strategies during the first wave of the COVID-19 pandemic: studies, clinical implication, and professional identity

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wurth Sophie ◽  
Sader Julia ◽  
Cerutti Bernard ◽  
Broers Barbara ◽  
Bajwa M. Nadia ◽  
...  
Keyword(s):  
Medical Students ◽  
Professional Identity ◽  
Coping Strategies ◽  
Negative Impact ◽  
Positive Impact ◽  
Valuable Insight ◽  
Clinical Exposure ◽  
Perceived Impact ◽  
The University ◽  
The Impact

Abstract Background The unfolding of the COVID-19 pandemic during spring 2020 has disrupted medical education worldwide. The University of Geneva decided to shift on-site classwork to online learning; many exams were transformed from summative to formative evaluations and most clinical activities were suspended. We aimed to investigate the perceived impact of those adaptations by the students at the Faculty of Medicine. Methods We sent an online self-administered survey to medical students from years 2 to 6 of the University of Geneva, three months after the beginning of the pandemic. The survey explored students’ main activities during the first three months of the pandemic, the impact of the crisis on their personal life, on their training and on their professional identity, the level of stress they experienced and which coping strategies they developed. The survey consisted of open-ended and closed questions and was administered in French. Results A total of 58.8% of students responded (n = 467) and were homogeneously distributed across gender. At the time of the survey, two thirds of the participants were involved in COVID-19-related activities; 72.5% voluntarily participated, mainly fueled by a desire to help and feel useful. Many participants (58.8%) reported a feeling of isolation encountered since the start of the pandemic. Main coping strategies reported were physical activity and increased telecommunications with their loved ones. Most students described a negative impact of the imposed restrictions on their training, reporting decreased motivation and concentration in an unusual or distraction-prone study environment at home and missing interactions with peers and teachers. Students recruited to help at the hospital in the context of increasing staff needs reported a positive impact due to the enriched clinical exposure. Perceived stress levels were manageable across the surveyed population. If changed, the crisis had a largely positive impact on students’ professional identity; most highlighted the importance of the health care profession for society and confirmed their career choice. Conclusion Through this comprehensive picture, our study describes the perceived impact of the pandemic on University of Geneva medical students, their training and their professional identity three months after the start of the pandemic. These results allowed us to gain valuable insight that reinforced the relevance of assessing the evolution of the situation in the long run and the importance of developing institutional support tools for medical students throughout their studies.

scholarly journals CHRONIC PAIN SELF-MANAGEMENT PRACTICES AND PREFERENCES AMONG URBAN AFRICAN AMERICAN OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S70-S70
Author(s):  
Mary R Janevic ◽  
Mary Janevic ◽  
Sheria Robinson-Lane ◽  
Susan Murphy ◽  
John Piette
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
African American ◽  
Pain Management ◽  
Focus Group ◽  
Management Practices ◽  
Pilot Trial ◽  
Self Management ◽  
Management Interventions ◽  
African American Older Adults

Abstract African American older adults experience disproportionate burden from disabling chronic pain. Pain self-management interventions for this group are most effective when they integrate culturally-relevant preferences into intervention design. In the STEPS pilot trial, we collected focus group (n=23) and survey (n=57) data from African Americans age 60+ years about pain-management practices. Participants were recruited from the community and reported pain for 3+ months, with intensity &gt;4 (0 to 10 scale). The most frequently-used pain-management strategies were exercise (75%) and prayer/Bible reading (74%). Also commonly used were healthy eating (61%), OTC medications (65%), and herbal supplements (51%). Focus group themes provided more nuanced information, including reasons for avoiding prescription pain medications, positive experiences with topical treatments, the value of movement, and the role of social support. Findings reveal strong engagement in pain self-care in this population. Interventions can build on existing practices by incorporating spirituality and appealing options for physical activity.

scholarly journals Learning optimal opioid prescribing and monitoring: a simulation study of medical residents

JAMIA Open ◽  
2018 ◽  
Vol 1 (2) ◽  
pp. 246-254 ◽  
Author(s):  
Thomas G Kannampallil ◽  
Robert McNutt ◽  
Suzanne Falck ◽  
William L Galanter ◽  
Dave Patterson ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Acute Pain ◽  
Management Practices ◽  
Longitudinal Design ◽  
Simulator Training ◽  
Appropriate Use ◽  
Long Acting ◽  
Prospective Longitudinal ◽  
The Impact

Abstract Objective Hospitalized patients often receive opioids. There is a lack of consensus regarding evidence-based guidelines or training programs for effective management of pain in the hospital. We investigated the viability of using an Internet-based opioid dosing simulator to teach residents appropriate use of opioids to treat and manage acute pain. Materials and methods We used a prospective, longitudinal design to evaluate the effects of simulator training. In face-to-face didactic sessions, we taught 120 (108 internal medicine and 12 family medicine) residents principles of pain management and how to use the simulator. Each trainee completed 10 training and, subsequently, 5 testing trials on the simulator. For each trial, we collected medications, doses, routes and times of administration, pain scores, and a summary score. We used mixed-effects regression models to assess the impact of simulation training on simulation performance scores, variability in pain score trajectories, appropriate use of short- and long-acting opioids, and use of naloxone. Results Trainees completed 1582 simulation trials (M = 13.2, SD = 6.8), with sustained improvements in their simulated pain management practices. Over time, trainees improved their overall simulated pain management scores (b = 0.05, P &lt; .01), generated lower pain score trajectories with less variability (b = −0.02, P &lt; .01), switched more rapidly from short-acting to long-acting agents (b = −0.50, P &lt; .01), and used naloxone less often (b = −0.10, P &lt; .01). Discussion and conclusions Trainees translated their understanding of didactically presented principles of pain management to their performance on simulated patient cases. Simulation-based training presents an opportunity for improving opioid-based inpatient acute pain management.

Sign in / Sign up

Export Citation Format

Share Document