Chronic noncancer pain management in primary care: family medicine physicians’ risk assessment of opioid misuse

Objective: The majority of patients with chronic noncancer pain (CNCP) are managed in the primary care settings. The primary care family physician (PCFP) generally has limited time, training, or access to resources to effectively evaluate and treat these patients, particularly when there is the added potential liability of prescribing opioids. The aim of this study is to make a favorable change in PCFPs’ knowledge, attitudes, and practices about opioid use in CNCP via education on assessment of the risk of opioid misuse. Materials and methods: The universe of this cross-sectional study comprised 36 family physicians working at Family Health Centers affiliated to Antalya Provincial Directorate of Health who volunteered to participate in the study. Initially, a survey on patients risk assessment was performed in both intervention and control groups; whereas the intervention group received education on assessment of the risk of opioid misuse, the control group did not. The survey was repeated after 6 months and the intervention group underwent a core examination. Data obtained were analyzed with Statistical Package for the Social Sciences 18.0 statistics program. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared. Results: About 61.1% of family physicians reported concern and hesitation in prescribing opioids due to known risks, such as overdose, addiction, dependence, or diversion, and agreed that family physicians should apply risk assessment before opioid use in CNCP. Only 16.6% of PCFP reported that risk assessment is not so necessary, whereas 22.2% of PCFP were undecided. Although 47.2% of the family physicians expressed a willingness to apply risk assessment before starting opioids, the rate of eagerness increased markedly to 77.7% after the education, but the rate of increase in practicing was not statistically significant. Conclusion: Knowledge and competency of the family physicians in managing CNCP were improved as was expected. Although the rate of eagerness about risk assessment of opioid misuse was increased, expected increase in the rate of using risk assessment was not achieved. Further studies are needed to identify the reasons of the difficulties on changing the attitudes and practices of primary care physicians about this subject.     

Short-term effects of a pay-for-performance programme for diabetes in a primary care setting: an observational study

Objective A pay-for-performance (P4P) programme for primary care was introduced in 2011 by a Swedish county (with 1.6 million inhabitants). Effects on register entry practice and comparability of data for patients with diabetes mellitus were assessed.Design and setting Observational study analysing short-term outcomes before and after introduction of a P4P programme in the study county as compared with a reference county.Subjects A total of 84 053 patients reported to the National Diabetes Register by 349 primary care units.Main outcome measures Completeness of data, level and target achievement of glycated haemoglobin (HbA1c), blood pressure (BP), and LDL cholesterol (LDL).Results In the study county, newly recruited patients who were entered during the incentive programme were less well controlled than existing patients in the register – they had higher HbA1c (54.9 [54.5–55.4] vs. 53.7 [53.6–53.9] mmol/mol), BP, and LDL. The percentage of patients with entry of BP, HbA1c, LDL, albuminuria, and smoking increased in the study county but not in the reference county (+26.3% vs –1.5%). In the study county, with an incentive for BP < 130/80 mmHg, BP data entry behaviour was altered with an increased preference for sub-target BP values and a decline in zero end-digit readings (38.3% vs. 33.7%, p < 0.001).Conclusion P4P led to increased register entry, increased completeness of data, and altered BP entry behaviour. Analysis of newly added patients and data shows that missing patients and data can cause performance to be overestimated. Potential effects on reporting quality should be considered when designing payment programmes.

Key points

• A pay-for-performance programme, with a focus on data entry, was introduced in a primary care region in Sweden.
• Register data entry in the National Diabetes Register increased and registration behaviour was altered, especially for blood pressure.
• Newly entered patients and data during the incentive programme were less well controlled.
• Missing data in a quality register can cause performance to be overestimated.

     

Academic advising and student support: Help-seeking behaviors among Saudi dental undergraduate students

Objective

The purpose of this study was to assess the use of and satisfaction with the academic-advising and student-support systems available to undergraduate students in the College of Dentistry at the University of Dammam. In addition, the study aimed to also identify factors that explained the help-seeking behavior of students which they used to solve academic issues.

Materials and methods

Students enrolled in the five-year Bachelor of Dental Surgery (BDS) program in 2012–13 and 2013–14 first-year students were invited to respond to a self-administered questionnaire.

Results

The results showed that 66.2% of students had discussed academic issues with their advisor at least once, with a frequency ranging from zero to six times. Most students reported that their advisors were readily available, listened intently to their needs and questions, and helped them solve their problems. However, only 7.6% of students relied primarily on advisors for help with academic issues, whereas 51% depended first on colleagues and 13.8% did not seek help and relied on themselves. In total, 17.2% of students were very or somewhat satisfied with the academic advising system. Males had lower odds of discussing issues with their advisors, and the odds were higher with advisors who were more available (OR = 0.25 and 3.74, respectively). Alerting students to important dates in the academic calendar significantly increased the odds that a student would depend primarily on academic advisors for advice related to academic issues (OR = 6.53).

Conclusions

Few students were satisfied with the academic support system. We need to train advisors to help them develop their skills and knowledge and to enable them to provide the support needed by the students.     

免疫比浊法检测肌红蛋白的性能验证及临床应用评估

目的对免疫比浊法检测肌红蛋白(Mb)的检测性能进行评价,并对Mb的临床应用进行评估。方法检测150例健康人(健康对照组)血清Mb水平,建立参考值范围,评估免疫比浊法检测Mb的准确度、精密度、线性。对80例急性冠脉综合征(ACS)患者按心电图结果分组后,比较ACS组血清Mb浓度与健康对照组是否存在差异。对于存在差异的ACS患者,进一步收集疾病对照组,通过绘制ROC曲线,评价Mb与其他心肌标志物的诊断性能。结果健康人血清Mb参考范围为70.22mg/L(男)、52.22mg/L(女),差异有统计学意义(t=4.39,P0.05)。2个水平质控检测结果为100.31、295.50mg/L,均在厂商允许偏差范围内,批内、批间变异系数(CV)均在5%以内,0~800 mg/L范围内线性良好。ACS组、非ACS组、健康对照组的Mb水平分别为(285.28±314.63)、(76.24±40.77)、(44.96±12.62)mg/L,差异有统计学意义(P0.05)。Mb在ACS组中的ROC曲线下面积(AUC)为0.878。在ACS组中,Mb的诊断敏感度为80.0%,优于肌钙蛋白I(cTnI)的43.7%和肌酸激酶同工酶(CK-MB)的57.5%。结论免疫比浊法检测Mb的检测性能符合要求。     

Comparison of activities of daily living (ADLs) in two different one arm drive wheelchairs: a study of individuals/participants with hemiplegia

Aims: This pilot study measured activities of daily living performance in individuals/participants with hemiplegia propelling both a standard dual handrim Action 3 wheelchair and a standard Action 3 wheelchair with a Neater Uni-Wheelchair kit attachment. The kit consists of a steerable front. Research questions: Does the use of the NUW affect the performance quality of activities of daily living in individuals/participants with hemiplegia. Is there a difference in the motor and process skills during activities of daily living performance, and in the time taken to complete the activities. Methods: Four individuals/participants with hemiplegia were used in a cross over, repeated measures trial. Assessment of Motor and Process Skills of users undertaking making a bed and laying a table “Swedish style”, tasks were measured and time taken to complete each task were recorded. Results: Bed making completion time was quicker in the Neater Uni-wheelchair (p?p?Conclusion: Activities of daily living tasks in the Neater Uni-wheelchair were completed more efficiently with no loss in quality of motor and process skills performance. This suggests that the Neater Uni-wheelchair is a viable alternative to current one arm drive provision.

• Implications for Rehabilitation

• Inappropriate wheelchair provision can result in capacity limitation and poorer quality of ADL motor skill as well-lowered process performance skill.

• AMPS can help to explain motor and process skill differences in complex activities.