Cancer-related pain: a review of patient education to challenge a dominant biomedical view

Background: Cancer-related pain is a significant and growing problem for those living with and surviving cancer, requiring biopsychosocial (BPS) management independent to treatment of underlying disease. Best practice pain management has been established in the field of chronic non-cancer pain (CNCP), starting with education that is grounded in pain science. Consideration of this approach for cancer-related pain management is scarce, yet there is strong rationale for its use. The aim of this study was to explore the use of pain science in explaining cancer-related pain to patients through education, facilitating communication of a BPS phenomenon. Methods: An exploratory narrative review was used to unveil a practice in its inception and deepen understanding of the field, capturing all available literature defined by inclusion of target concepts of pain education. A descriptive synthesis of the findings was interpreted and critiqued in the discussion. Methodological quality was included to assess the impact on findings, not as criteria for exclusion. Results: Pain science education is poorly established in the cancer pain management literature. 8 studies met the inclusion criteria and were difficult to locate, akin to finding a needle in a haystack. Conclusive findings from a small evidence base of variable design and quality were limited, but positive individual outcomes provide rich detail for clinical application and a plausible basis for further research. Impending results promise a firmer foundation from which to raise awareness, encourage research and establish structure. Conclusions: To the author’s knowledge, this is the first review to explore the use of pain science in explaining cancer-related pain to patients through education. It provides a basis to illuminate this field and focus and develop the evidence-base for clinical practice. A biomedical model continues to dominate the management of cancer-related pain when an evidence-base exists for reconceptualising and communicating a BPS phenomenon through high quality education. The evidence base is in its inception, but the future potential is significant. Acknowledgements and Disclosures of Interest(s): The authors report no competing interests to declare, nor funding associated with this work

Clinical decision making in advanced practice

Introduction: The definition of advanced clinical practice explicitly includes complex decision-making, underpinned by master’s level education (HEE 2017). Decision making is a skill that combines clinical expertise, critical thinking, evidence-based knowledge, and ethical considerations to ensure high-quality, individualised, healthcare delivery. Aim: To ensure that decision making is guided by the best available evidence, advanced practitioners need to develop and refine their clinical judgment skills. A master’s level module was therefore specifically developed to equip trainee advanced practitioners with the knowledge, skills and confidence necessary to interrogate and understand the complex factors that underpin decision making in the context of health and social care. Details of the project: Although inherent in existing advanced practice modules, there was limited capacity to focus on empowered decision making in any depth. The ‘Advanced Clinical Decision Making’ module aims to incorporate critical thinking into trainee advanced practitioner’s clinical decision making processes while enhancing learning in existing modules. The module will provide students with the tools and frameworks to make informed and evidence-based decisions and support them to adopt a systematic and empowered approach to delivering patient care. Students study the following topic areas: The role of data and Information; Ethical, legal and professional accountability; A systematic approach to decision-making; Conceptual and theoretical frameworks; Decisions in action. Outcomes: The module assesses the student’s ability to interrogate a decision-making process and to develop their understanding of the decision, by considering how relevant concepts and theories have been applied. Impact: Effective decision making can positively impact clinical practice by enhancing patient safety, optimising resource utilisation, increasing patient and clinician satisfaction, and improving patient outcomes. It is a fundamental aspect of high-quality healthcare delivery and contributes to the overall efficacy of timely and holistic care

How to conduct a clinical consultation in advanced practice

This article on clinical consultation is the first in a series on assessment and interpretation for nurses and other non-medics working at or towards advanced practice level. It discusses ways to recognise and capitalise on the opportunity offered by clinical consultation, how to incorporate and adapt consultation models for practice and the importance of communication skills as a driver for better consultation

Cancer related pain: a review of patient education to challenge a dominant biomedical view

Background: Cancer related pain is a significant & growing problem for those living with & surviving cancer, requiring biopsychosocial (BPS) management independent to treatment of underlying disease. Best practice pain management has been established in the field of chronic non cancer pain (CNCP), starting with education that is grounded in pain science. Consideration of this approach for cancer related pain management is scarce, yet there is strong rationale for its use. The aim of this study was to explore the use of pain science in explaining cancer related pain to patients through education, facilitating communication of a BPS phenomenon. Methods: An exploratory narrative review was used to unveil a practice in its inception & deepen understanding of the field (Greenhalgh et al. 2018). All relevant literature was identified using 7 target concepts of pain education (search completed June ’21). A descriptive synthesis of findings was interpreted & critiqued. Methodological quality was included to assess the impact on findings, not as criteria for exclusion. Results: Pain science education is poorly established in the cancer pain management literature. 8 studies (4 RCTs, 2 pilot, 2 feasibility) met the inclusion criteria. Study sample sizes of 9-127, 238 unique participants, 112 received targeted pain education. Conclusive findings from a small evidence base of variable design & quality were limited, but positive individual outcomes provide rich detail for clinical application & a plausible basis for further research. Conclusions: To the author’s knowledge, this is the first review to explore the use of pain science in explaining cancer related pain to patients through education. It provides a basis to illuminate this field & focus & develop the evidence base for clinical practice. A biomedical model continues to dominate the management of cancer related pain when an evidence base exists for reconceptualising & communicating a BPS phenomenon through high quality education. The evidence base represents some progress, but is in its inception. The future potential could be significant. Acknowledgements and Disclosures of Interest(s): The authors report no competing interests to declare, nor funding associated with this work

The Contribution of Viral Genotype to Plasma Viral Set-Point in HIV Infection

Disease progression in HIV-infected individuals varies greatly, and while the environmental and host factors influencing this variation have been widely investigated, the viral contribution to variation in set-point viral load, a predictor of disease progression, is less clear. Previous studies, using transmission-pairs and analysis of phylogenetic signal in small numbers of individuals, have produced a wide range of viral genetic effect estimates. Here we present a novel application of a population-scale method based in quantitative genetics to estimate the viral genetic effect on set-point viral load in the UK subtype B HIV-1 epidemic, based on a very large data set. Analyzing the initial viral load and associated pol sequence, both taken before anti-retroviral therapy, of 8,483 patients, we estimate the proportion of variance in viral load explained by viral genetic effects to be 5.7% (CI 2.8-8.6%). We also estimated the change in viral load over time due to selection on the virus and environmental effects to be a decline of 0.05 log10 copies/mL/year, in contrast to recent studies which suggested a reported small increase in viral load over the last 20 years might be due to evolutionary changes in the virus. Our results suggest that in the UK epidemic, subtype B has a small but significant viral genetic effect on viral load. By allowing the analysis of large sample sizes, we expect our approach to be applicable to the estimation of the genetic contribution to traits in many organisms

Taking the lead : the leadership pillar in action

While leadership is a core pillar of advanced practice, it can be difficult for clinicians to identify in their own practice. In health and social care, the challenge is for practitioners to translate this pillar into practice and unlock their full potential as leaders. For leadership to flourish in advanced practice, it is essential to increase its recognition from the perspective of the individual and throughout an organisation. This article aims to challenge conventional notions of leadership by exploring the who, what and why in ‘taking the lead’, and offering a practical perspective for individual application. It recognises the unique challenges faced in health and social care settings, and emphasises the importance of candour and open dialogue as a means to embody leadership. Clinicians are encouraged to identify and cultivate their leadership skills through introspection and practical implementation. Advanced practice, synonymous with change, provides a network of emerging leaders capable of driving change through diverse and innovative approaches. Embracing the opportunities of advanced practice requires a movement to challenge traditional leadership paradigms, necessitating vision and compassion

Oropouche virus cases identified in Ecuador using an optimised qRT-PCR informed by metagenomic sequencing

Oropouche virus (OROV) is responsible for outbreaks of Oropouche fever in parts of South America. We recently identified and isolated OROV from a febrile Ecuadorian patient, however, a previously published qRT-PCR assay did not detect OROV in the patient sample. A primer mismatch to the Ecuadorian OROV lineage was identified from metagenomic sequencing data. We report the optimisation of an qRT-PCR assay for the Ecuadorian OROV lineage, which subsequently identified a further five cases in a cohort of 196 febrile patients. We isolated OROV via cell culture and developed an algorithmically-designed primer set for whole-genome amplification of the virus. Metagenomic sequencing of the patient samples provided OROV genome coverage ranging from 68-99%. The additional cases formed a single phylogenetic cluster together with the initial case. OROV should be considered as a differential diagnosis for Ecuadorian patients with febrile illness to avoid mis-diagnosis with other circulating pathogens

Investigating Antibody Interactions with a Polar Liquid Using Terahertz Pulsed Spectroscopy

In this article, we use terahertz spectroscopy to study the dielectric properties of the peroxidase-conjugated affinity purified goat anti-cat immunoglobulin G and the fluorescein-conjugated affinity purified goat anti-cat immunoglobulin G when they interact with polar liquids. The influence of protein concentration, as well as presence of glycerol as a cosolvent, is determined by estimation of the effective hydration shell radius of the protein in solution. The dielectric spectra in this study are measured over the frequency range 0.1–1.3 THz and it is found that the dielectric properties are dependent on the type of the charges in the hydrogen-bonded antibodies' networks. Our results indicate that the terahertz dielectric properties of polar liquids are strongly affected by the presence of the antibody and suggest that the dielectric spectrum is particularly powerful in the study of structural and conformational properties of proteins. Therefore, terahertz spectroscopy is a very sensitive approach to investigate structural features of biological systems