The stigmatisation of people with chronic back pain

This study responded to the need for better theoretical understanding of experiences that shape the beliefs, attitudes and needs of chronic back patients attending pain clinics. The aim was explore and conceptualise the experiences of people of working age who seek help from pain clinics for chronic back pain. Methods. This was a qualitative study, based on an interpretative phenomenological approach (IPA). During in-depth interviews in their homes, participants were invited to 'tell their story' from the time their pain began. Participants were twelve male and six female patients, aged between 28 and 62 years, diagnosed as having chronic benign back pain. All had recently attended one of two pain clinics as new referrals. The interview transcripts were analysed thematically. Findings. Stigmatisation emerged as a key theme from the narrative accounts of participants. The findings expose subtle as well as overt stigmatising responses by family, friends, health professionals and the general public which appeared to have a profound effect on the perceptions, self esteem and behaviours of those interviewed. Conclusions. The findings suggest that patients with chronic back pain feel stigmatised by the time they attend pain clinics and this may affect their attitudes and behaviours towards those offering professional help. Theories of chronic pain need to accommodate these responses, while pain management programmes need to address the realities and practicalities of dealing with stigma in everyday life

Once-a-week or every-other-day urethra-sparing prostate cancer stereotactic body radiotherapy, a randomized phase II trial: 18 months follow-up results

Background To present the 18 months results from a prospective multicenter phase II randomized trial of short vs protracted urethra-sparing stereotactic body radiotherapy (SBRT) for localized prostate cancer (PCa).Methods Between 2012 and 2015, a total of 170 PCa patients were randomized to 36.25 Gy in 5 fractions (6.5 Gy x 5 to the urethra) delivered either every other day (EOD, arm A, n = 84) or once a week (QW, arm B, n = 86). Genitourinary (GU) and gastrointestinal (GI) toxicity (CTCAE v4.0 scale), IPSS, and QoL scores were assessed at baseline, at the 5th fraction (5fx), 12th weeks (12W), and every 6 months after SBRT. The primary endpoint was biochemical control at 18 months and grade >= 3 toxicity (including grade >= 2 for urinary obstruction/retention) during the first 3 months.Results Among the 165 patients analyzed, the toxicity stopping rule was never activated during the acute phase. Maximum acute grade 2 GU toxicity rates at 5fx were 17% and 19% for arms A and B, respectively, with only 2 cases of grade 2 GI toxicity at 5fx in arm A. At month 18, grade >= 2 GU and GI toxicity decreased below 5% and 2% for both arms. No changes in EORTC QLQ-PR25 scores for GU, GI, and sexual domains were observed in both arms between baseline and month 18. Four biochemical failures were observed, 2 in each arm, rejecting the null hypothesis of an unfavorable response rate = 95% rate.Conclusions At 18 months, urethra-sparing SBRT showed a low toxicity profile, with minimal impact on QoL and favorable biochemical control rates, regardless of overall treatment time (EOD vs QW)

An investigation of incorporating online courses in public high school curricula

This study investigated the incorporation of online courses in public high school curricula. The researcher examined the barriers and possible solutions to using online classes at the high schools level. Solicitations for the electronic survey were emailed to high school principals in Iowa, Missouri, and Nebraska. Two hundred seventy-one principals from Iowa, Missouri, and Nebraska rated survey items in the categories of funding, faculty and administration, technology, and implementation. Respondents were evenly distributed among the three states. The majority of respondents were from small, rural schools (86%). Data analyses included reporting descriptive statistics and investigating group differences based on the school’s community type, size, and state. Analyses also compared differences between schools currently using online classes and those that were not. Funding barriers were rated as the most severe type of barriers, while barriers related to technology were the least reported barriers. Faculty beliefs about the quality of online learning and concerns about student motivation were also commonly reported barriers. The solutions rated as being potentially the most helpful were in the categories of funding and faculty/administration solutions. Items such as increased funding for staff, decreased tuition for online classes, and the need for faculty training were rated as the most helpful solutions. Some significant group differences were found. The need for technology solutions were more commonly identified by more Missouri principals when compared with other states. Solutions related to implementation were rated as significantly more helpful by large-sized districts when compared to ratings from the small-sized districts. Ratings of solutions from rural school principals differed from those from suburban and urban schools. There were also significant differences in ratings for all barrier and solution categories for those schools that were not currently incorporating online classes in their curricula. Those principals who reported no current use of online classes rated all barrier categories as more severe and rated the potential solutions in all categories as being more helpful in overcoming the barriers they experience

Paracetamol en coumarineanticoagulantia: niet altijd een onschuldige combinatie

Orale anticoagulantia worden zeer veel toegediend. De patiënt en de arts zouden goed op de hoogte moeten zijn van de talloze wisselwerkingen met andere geneesmiddelen. We beschrijven hier een geval van spontane buikwandbloeding wegens protrombineontregeling door inname van paracetamol bij een patiënte die al lang behandeld werd met coumarinen. De literatuur over deze niet goed gekende potentiële interactie wordt samengevat. Op basis van de beperkte literatuurgegevens Proberen we een advies voor de praktijk te formuleren.status: publishe