Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists

Purpose

Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self-perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management.

Methods

SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, knowledge, competence) while their agreement to attend educational courses was assessed using a 5-point Likert-type scale.

Results

Less than one in four participants declare to be dedicated to pain medicine activity with greater proportion among older (over 61 years) compared to younger ones (31–40 years). Regarding cancer and chronic noncancer pain a positive gradient of self-perceived competence has been observed in relation to seniority. In contrast, no gradient of self-perceived competence was reported about musculoskeletal and low back pain. Participants self-perceived competent in both opioid use and prevention of opioid-related adverse event while feeling less competent when managing drugs with abuse potential. The lowest competence has been observed in pediatric pain along with the lowest interest to attend educational courses. Participants were much and very much interested to education regarding cancer, noncancer, musculoskeletal, and low back pain, invasive analgesic procedures but less regarding items for which they declared less competence, such as use of pain scales, pain management in children, and use of drugs with abuse potential.

Conclusion

This work provides first evidence of a summative assessment of competency and related educational needs' profile of anesthesiologists/pain therapists thus paving the way for developing a nationwide educational program to improve chronic pain care in Italy.     

An integrated interpreting service normalizes access to care for culturally and linguistically diverse (CALD) patients with colorectal cancer

Aim

To compare access to the initial management and overall survival with colorectal cancer for limited English proficient (LEP) patients compared with patients from an English background.

Methods

All newly diagnosed patients from 2017 with colorectal cancer from a single health service with a highly multicultural catchment area and a well-developed and integrated translation and language support (TALS) department were recruited. Time from referral to: biopsy, date seen by a surgeon, oncologist, discussion at a multidisciplinary meeting (MDM), and day of commencement of the first treatment modality, and overall survival were analyzed.

Results

One hundred sixty-two patients were analyzed, including 57 LEP patients from 22 countries of birth. Interpreters were present at 687/782 appointments with LEP patients. There were no differences in demographics or cancer staging. There were no differences between English background and LEP patients with regard to times from referral to biopsy (1 vs. 0 days), specialist review (surgical: 4 vs. 6 days, oncological: 45 vs. 57 days), MDM discussion (23 vs. 15 days), or commencement of treatment (32 vs. 28.5 days). There were no differences in treatment for colorectal cancer, although a higher rate of stomas was noted in LEP patients. There was no difference in overall survival between groups.

Conclusion

Time to critical initial checkpoints and overall survival were similar in LEP and English background patients with colorectal cancer. An integrated TALS department may abrogate the language and cultural barriers that are known to disadvantage LEP patients and may contribute to normalizing care for the culturally and linguistically diverse community.     

Discussing the final size and shape of the reconstructed tissues in tissue engineering

Journal of Artificial Organs - Tissue engineering (TE) has made a revolution in repairing, replacing, or regenerating tissues or organs, but it has still a long way ahead. The mechanical properties...     

Durvalumab plus gemcitabine and cisplatin in advanced biliary tract cancer: An early exploratory analysis of real-world data

Background

The TOPAZ-1 phase III trial reported a survival benefit with the anti-programmed death cell ligand 1 (anti-PD-L1) durvalumab in combination with gemcitabine and cisplatin in patients with advanced biliary tract cancer. The present study investigated the efficacy and safety of this new standard treatment in a real-world setting.

Methods

The analysed population included patients with unresectable, locally advanced or metastatic adenocarcinoma of the biliary tract treated with durvalumab in combination with gemcitabine and cisplatin at 17 Italian centres. The primary endpoint of the study was progression-free survival (PFS), whereas secondary endpoints included overall survival (OS), overall response rate (ORR) and safety. Unadjusted and adjusted hazard ratios (HRs) by baseline characteristics were calculated using the Cox proportional hazards model.

Results

From February 2022 to November 2022, 145 patients were enrolled. After a median follow-up of 8.5 months (95% CI: 7.9–13.6), the median PFS was 8.9 months (95% CI: 7.4–11.7). Median OS was 12.9 months (95% CI: 10.9–12.9). The investigator-assessed confirmed ORR was 34.5%, and the disease control rate was 87.6%. Any grade adverse events (AEs) occurred in 137 patients (94.5%). Grades 3–4 AEs occurred in 51 patients (35.2%). The rate of immune-mediated AEs (imAEs) was 22.7%. Grades 3–4 imAEs occurred in 2.1% of the patients. In univariate analysis, non-viral aetiology, ECOG PS >0 and NLR ≥3 correlated with shorter PFS.

Conclusion

The results reported in this first real-world analysis mostly confirmed the results achieved in the TOPAZ-1 trial in terms of PFS, ORR and safety.     

Protective and risk social dimensions of emergency remote teaching during COVID-19 pandemic: A multiple mediation study

The changes in teaching due to COVID-19-related restraints generated distress among teachers, putting their job-related efficacy and satisfaction at risk. This study deepens the community-related protective and risk factors in teachers' experience. An online questionnaire detecting social distancing burnout, job-related distress experience, efficacy and satisfaction, and Sense of Community (SoC) was administered to 307 Italian teachers. A multiple mediation model was tested with Structural Equation Modeling. Evidence showed that social distancing burnout could increase teachers' distress rates and, through them, impact their job-related efficacy and satisfaction; however, its effects on the latter depended on the kind of distress mediating. Conversely, SoC could support their job-related efficacy and satisfaction, yet no association with their distress rates emerged. The role of social distancing and Information and Communication Technologies (ICTs)-related distress as the main threats for teachers stems, along with the one of job distress and the community of belonging as assets on which teachers relied.     

What do we mean by long COVID? A scoping review of the cognitive sequelae of SARS-CoV-2 infection

Background and purpose

Many COVID-19 patients report persistent symptoms, including cognitive disturbances. We performed a scoping review on this topic, focusing primarily on cognitive manifestations.

Methods

Abstracts and full texts of studies published on PubMed (until May 2023) addressing cognitive involvement persisting after SARS-CoV-2 infection were reviewed, focusing on terms used to name the cognitive syndrome, reported symptoms, their onset time and duration, and testing batteries employed. Reported psychiatric symptoms, their assessment tools, and more general manifestations were also extracted.

Results

Among the 947 records identified, 180 studies were included. Only one third of them used a label to define the syndrome. A minority of studies included patients according to stringent temporal criteria of syndrome onset (34%), whereas more studies reported a minimum required symptom duration (77%). The most frequently reported cognitive symptoms were memory and attentional–executive disturbances, and among psychiatric complaints, the most frequent were anxiety symptoms, depression, and sleep disturbances. Most studies reported fatigue among general symptoms. Thirty-six studies employed cognitive measures: screening tests alone (n = 19), full neuropsychological batteries (n = 25), or both (n = 29); 30 studies performed psychiatric testing. Cognitive deficits were demonstrated in 39% of subjects, the most frequently affected domains being attention/executive functions (90%) and memory (67%).

Conclusions

Currently, no agreement exists on a label for post-COVID-19 cognitive syndrome. The time of symptom onset after acute infection and symptom duration are still discussed. Memory and attention–executive complaints and deficits, together with fatigue, anxiety, and depression symptoms, are consistently reported, but the objective evaluation of these symptoms is not standardized.     

Craniovascular variation in four late Holocene human samples from southern South America

Craniovascular traits in the endocranium (traces of middle meningeal vessels and dural venous sinuses, emissary foramina) provide evidence of vascular anatomy in osteological samples. We investigate the craniovascular variation in four South American samples and the effect of artificial cranial modifications (ACM). CT scans of human adult crania from four archeological samples from southern South America (including skulls with ACM) are used for the analyses. The craniovascular features in the four samples are described, skulls with and without ACM are compared, and additionally, South Americans are compared to a previously analyzed sample of Europeans. Of the four South American samples, the Southern Patagonian differs the most, showing the most distinct cranial dimensions, no ACM, and larger diameters of the emissary foramina. Unlike previous studies, we did not find any major differences in craniovascular features between modified and non-modified skulls, except that the skulls with ACM present somewhat smaller foramina. South Americans significantly differed from Europeans, especially in the anteroposterior dominance of the middle meningeal artery, in the pattern of sinus confluence, in the occurrence of enlarged occipito-marginal sinuses, and in foramina frequencies and diameters. Craniovascular morphology is not affected by the cranial size, even in skulls with ACM, indicating a minor or null influence of structural topological factors. Concerning the samples from distinct geographic and climatic environments, it must be evaluated whether the craniovascular morphogenesis might be partially influenced by specific functions possibly associated with thermoregulation, intracranial pressure, and the maintenance of intracranial homeostasis.