Exploring the Influence of Patient-Professional Partnerships on the Self-Management of Chronic Back Pain: A Qualitative Study

Patients are encouraged to take an active role in self-managing their chronic back pain and functional problems. However, research suggests that patients do not self-manage, and they expect health professionals to fulfill a comprehensive role in managing pain. A partnership between patients and health professionals is called for, and self-management works best when they share knowledge and work together toward optimal goals. To explore how patients' partnerships with health professionals may influence their ability to self-manage pain by exploring patients' experiences. A grounded theory approach with in-depth, semistructured interviews was undertaken. Each interview was analyzed using constant comparative analysis. This study was nested within a larger study on patient-professional partnerships and the self-management of chronic back pain. Twenty-six patients with chronic back pain were recruited in a community-based pain management service in Northern England, United Kingdom. Three themes emerged: building partnerships with health professionals; being supported by health professionals to self-manage the pain; and experiencing a change in self-management. Five approaches that underpinned health professionals' self-management support were identified. Facilitators of and barriers to a good partnership were reported. This study suggests that a good patient-professional partnership has a positive effect on patients’ self-management ability. A theoretical model explaining how such partnership may influence self-management was developed. It is necessary for both patients and health professionals to be aware of their partnerships, which may enhance the effect of pain management services

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools.

BACKGROUND: There is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment. METHODS: We searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach. RESULTS: We retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a 'gold standard' significantly hinders the evaluation of tools' validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations. CONCLUSIONS: There are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence

Inverted regions induced by geometric constraints on a classical encounter-controlled binary reaction

The efficiency of an encounter-controlled two-channel reaction between two independently-mobile reactants on a lattice is characterized by the mean number \rt of steps to reaction. The two reactants are distinguished by their mass with the "light" walker performing a jump to a nearest-neighbor site in each time step, while the "heavy" walker hops only with a probability $p$; we associate $p$ with the "temperature" of the system. Lattices subject to periodic and to confining boundary conditions are considered. For periodic lattices, depending on the initial state, the reaction time either falls off monotonically with $p$ or displays a local minimum with respect to $p$; occurrence of the latter signals a regime where the efficiency of the reaction effectively decreases with increasing temperature. Such behavior disappears if the jump probability of the light walker falls below a characteristic threshold value. In lattices subject to confining boundary conditions, the behavior is more complex. Depending on the initial conditions, the reaction time as a function of $p$ may increase monotonically, decrease monotonically, display a single maximum or even a maximum and minimum. These inverted regions are a consequence of a strictly classical interplay between excluded volume effects implicit in the specification of the two reaction channels, and the system's dimensionality and spatial extent. Our results highlight situations where the description of an encounter-controlled reactive event cannot be described by a single, effective diffusion coefficient. We also distinguish between the inversion region identified here and the Marcus inverted region which arises in electron transfer reactions.Comment: revtex4 manuscript, approx. 45 pages, contains 18 figures and 18 tables, uses placeins.sty fil

Spin effects in intramolecular electron transfer in naproxen-N-methylpyrrolidine dyad

[EN] The intramolecular electron transfer in the naproxen-N-methylpyrrolidine dyad has been investigated by spin chemistry methods. The existence of CIDNP in a high magnetic field points to electron transfer as a possible mechanism of the quenching of the excited state of a dyad. However, the failure to detect magnetic field effects on triplet yield makes us conclude that this quenching mechanism is not the only one. The observation of CIDNP effects in the dyad in the media of low polarity and the short risetime of triplet state formation indicate a potential role of exciplex in the quenching of the excited state of the dyad.This work was supported by the Grants 08-03-00372 and 11-03-01104 of Russian Foundation of Basic Research, and the grant of Priority Programs of RAS, No. 5.1.5.Magin, I.; Polyakov, N.; Khramtsova, E.; Kruppa, A.; Tsentalovich, Y.; Leshina, T.; Miranda Alonso, MÁ.... (2011). Spin effects in intramolecular electron transfer in naproxen-N-methylpyrrolidine dyad. Chemical Physics Letters. 516(1-3):51-55. https://doi.org/10.1016/j.cplett.2011.09.057S51555161-

The solid-state photo-CIDNP effect

The solid-state photo-CIDNP effect is the occurrence of a non-Boltzmann nuclear spin polarization in rigid samples upon illumination. For solid-state NMR, which can detect this enhanced nuclear polarization as a strong modification of signal intensity, the effect allows for new classes of experiments. Currently, the photo- and spin-chemical machinery of various RCs is studied by photo-CIDNP MAS NMR in detail. Until now, the effect has only been observed at high magnetic fields with 13C and 15N MAS NMR and in natural photosynthetic RC preparations in which blocking of the acceptor leads to cyclic electron transfer. In terms of irreversible thermodynamics, the high-order spin structure of the initial radical pair can be considered as a transient order phenomenon emerging under non-equilibrium conditions and as a first manifestation of order in the photosynthetic process. The solid-state photo-CIDNP effect appears to be an intrinsic property of natural RCs. The conditions of its occurrence seem to be conserved in evolution. The effect may be based on the same fundamental principles as the highly optimized electron transfer. Hence, the effect may allow for guiding artificial photosynthesis

Quantum physics meets biology

Quantum physics and biology have long been regarded as unrelated disciplines, describing nature at the inanimate microlevel on the one hand and living species on the other hand. Over the last decades the life sciences have succeeded in providing ever more and refined explanations of macroscopic phenomena that were based on an improved understanding of molecular structures and mechanisms. Simultaneously, quantum physics, originally rooted in a world view of quantum coherences, entanglement and other non-classical effects, has been heading towards systems of increasing complexity. The present perspective article shall serve as a pedestrian guide to the growing interconnections between the two fields. We recapitulate the generic and sometimes unintuitive characteristics of quantum physics and point to a number of applications in the life sciences. We discuss our criteria for a future quantum biology, its current status, recent experimental progress and also the restrictions that nature imposes on bold extrapolations of quantum theory to macroscopic phenomena.Comment: 26 pages, 4 figures, Perspective article for the HFSP Journa

Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study

This is the final version. Available from NIHR Journals Library via the DOI in this record.Background Pain and dementia are common in older people, and impaired cognitive abilities make it difficult for them to communicate their pain. Pain, if poorly managed, impairs health and well-being. Accurate pain assessment in this vulnerable group is challenging for hospital staff, but essential for appropriate management. Robust methods for identifying, assessing and managing pain are needed. Aims and objectives Two studies were undertaken to inform the development of a decision support tool to aid hospital staff in the recognition, assessment and management of pain. The first was a meta-review of systematic reviews of observational pain assessment instruments with three objectives: (1) to identify the tools available to assess pain in adults with dementia; (2) to identify in which settings they were used and with what patient populations; and (3) to assess their reliability, validity and clinical utility. The second was a multisite observational study in hospitals with four objectives: (1) to identify information currently used by clinicians when detecting and managing pain in patients with dementia; (2) to explore existing processes for detecting and managing pain in these patients; (3) to identify the role (actual/potential) of carers in this process; and (4) to explore the organisational context in which health professionals operate. Findings also informed development of health economics data collection forms to evaluate the implementation of a new decision support intervention in hospitals. Methods For the meta-review of systematic reviews, 12 databases were searched. Reviews of observational pain assessment instruments that provided psychometric data were included. Papers were quality assessed and data combined using narrative synthesis. The observational study used an ethnographic approach in 11 wards in four UK hospitals. This included non-participant observation of 31 patients, audits of patient records, semistructured interviews with 52 staff and four carers, informal conversations with staff and carers and analysis of ward documents and policies. Thematic analysis of the data was undertaken by the project team. Results Data from eight systematic reviews including 28 tools were included in the meta-review. Most tools showed moderate to good reliability, but information about validity, feasibility and clinical utility was scarce. The observational study showed complex ward cultures and routines, with variations in time spent with patients, communication patterns and management practices. Carer involvement was rare. No pain decision support tools were observed in practice. Information about pain was elicited in different ways, at different times, by different health-care staff and recorded in separate documents. Individual staff made sense of patients’ pain by creating their own ‘overall picture’ from available information. Limitations Grey literature and non-English-language papers were excluded from the meta-review. Sample sizes in the observational study were smaller than planned owing to poor documentation of patients’ dementia diagnoses, gatekeeping by staff and difficulties in gaining consent/assent. Many patients had no or geographically distant carers, or a spouse who was too unwell and/or reluctant to participate. Conclusions No single observational pain scale was clearly superior to any other. The traditional linear concept of pain being assessed, treated and reassessed by single individuals did not ‘fit’ with clinical reality. A new approach enabling effective communication among patients, carers and staff, centralised recording of pain-related information, and an extended range of pain management interventions is proposed [Pain And Dementia Decision Support (PADDS)]. This was not tested with users, but a follow-on study aims to codesign PADDS with carers and clinicians, then introduce education on staff/patient/carer communications and use of PADDS within a structured implementation plan. PADDS will need to be tested in differing ward contexts.National Institute for Health Research Health Services and Delivery Research programm