Adequacy of cancer-related pain management and predictors of undertreatment at referral to a pain clinic

© 2017 Reis-Pina et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php)Background: Several guidelines have advocated the need for adequate cancer-related pain (CRP) management. The pain management index (PMI) has been proposed as an auditable measure of the appropriateness for analgesic therapy. Objectives: To determine the adequacy of CRP management based on the PMI status and its patient-related predictors at the point of referral to a pain clinic (PC). Methods: Consecutive patients referred to a PC had standardized initial assessments and status documentation on the Brief Pain Inventory (BPI) ratings; pain mechanism, using a neuropathic pain diagnostic questionnaire (the Douleur Neuropathique 4 tool); episodic pain; oral morphine equivalent daily dose; the Hospital Anxiety Depression Scale and the Emotion Thermometer scores; and cancer diagnosis, metastases, treatment, and pain duration. Predictors of “negative PMI status” [PMI(−)] were examined in logistic regression models. Variables with p<0.25 in an initial bivariable analysis were entered into a multivariable model. Results: Of 371 participants, 95 (25.6%) had PMI(−), suggesting undertreatment of CRP. Both female sex and higher scores on the BPI’s “interference with general activity” more strongly predicted PMI(−). Patients who received either radiotherapy or one or more adjuvant analgesics prior to the initial consultation at the PC, those who had neuropathic pain, those who had a greater need for emotional help, and those with higher BPI’s “relief ” scores were all less likely to be PMI(−). Conclusion: The potential burden of patient and family distress associated with suboptimal CRP management in one in four patients should generate major public health concern and prompt appropriate educational and health policy measures to address the deficit.info:eu-repo/semantics/publishedVersio

O tratamento da dor oncológica e a utilização idónea de opióides

Copyright © Ordem dos Médicos 2015Pain relief is vital to the treatment of cancer. Despite the widespread use and recognition of clinical recommendations for the management of cancer-related pain, avoidable suffering is still prevalent in patients with malignant disease. A gap exists between what is known about pain medical management and actual practices of patients, caregivers, healthcare professionals and institutions. Opioids are the pillar of the medical management of moderate to severe pain. The prescription of opioid analgesics - by a registered medical practitioner for absolute pain control - is a legitimate practice. In this article we look at patients' fears and physicians' general hesitations towards morphine and alike. We examine misconceptions that yield fallacies on the therapeutically use of opioids and, therefore, sustain inadequate pain management.O controlo da dor é fundamental no tratamento do cancro. Apesar da vasta utilização e do reconhecimento das normas de orientação clínica para o controlo da dor oncológica, o sofrimento evitável é ainda prevalente em doentes com cancro. Existe um hiato entre o co-nhecimento e a prática clínica no que concerne a uma adequada gestão da dor pelos doentes, cuidadores, profissionais e instituições de saúde. Os opióides representam o pilar do tratamento farmacológico da dor moderada a insuportável. A prescrição de analgésicos opióides - por um médico credenciado, para o controlo absoluto da dor, - é uma prática legítima. Neste artigo debruçamo-nos sobre as hesitações dos médicos e os receios dos doentes perante a morfina e similares. Examinamos os preconceitos que promovem o fracasso do uso terapêutico dos opióides e, consequentemente condicionam o controlo inadequado da dorinfo:eu-repo/semantics/publishedVersio

Settling on leaves or flowers: herbivore feeding site determines the outcome of indirect interactions between herbivores and pollinators

Herbivore attack can alter plant interactions with pollinators, ranging from reduced to enhanced pollinator visitation. The direction and strength of effects of herbivory on pollinator visitation could be contingent on the type of plant tissue or organ attacked by herbivores, but this has seldom been tested experimentally. We investigated the effect of variation in feeding site of herbivorous insects on the visitation by insect pollinators on flowering Brassica nigra plants. We placed herbivores on either leaves or flowers, and recorded the responses of two pollinator species when visiting flowers. Our results show that variation in herbivore feeding site has profound impact on the outcome of herbivore–pollinator interactions. Herbivores feeding on flowers had consistent positive effects on pollinator visitation, whereas herbivores feeding on leaves did not. Herbivores themselves preferred to feed on flowers, and mostly performed best on flowers. We conclude that herbivore feeding site choice can profoundly affect herbivore–pollinator interactions and feeding site thereby makes for an important herbivore trait that can determine the linkage between antagonistic and mutualistic networks.</p

Kyber terminates

The key generation of the lattice-based key-encapsulation mechanism CRYSTALS-Kyber (or short, just Kyber) involves a rejection-sampling routine to produce coefficients modulo $q=3329$ that look uniformly random. The input to this rejection sampling is output of the SHAKE-128 extendable output function (XOF). If this XOF is modelled as a random oracle with infinite output length, it is easy to see that Kyber terminates with probability 1; also, in this model, for any upper bound on the running time, the probability of termination is strictly smaller than 1. In this short note we show that an (unconditional) upper bound for the running time for Kyber exists. Computing a tight upper bound, however, is (likely to be) infeasible. We remark that the result has no real practical value, except that it may be useful for computer-assisted reasoning about Kyber using tools that require a simple proof of termination

New approaches for the study of faience using beads from Southern Portugal

A collection of 30 faience beads recovered from the Iron Age necropolis of Vinha das Caliças 4 (Beja, Portugal) was analyzed in order to identify their production technology and provide insights into their possible provenance. The multi-analytical approach employed, combining laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS), variable pressure scanning electron microscope coupled with energy dispersive X-ray spectrometry (VP-SEM-EDS) and micro-X-ray diffraction (µ-XRD), highlights the difficulties that arise from the analysis of weathered faience objects, and which are augmented by their intrinsic heterogeneous nature. VP-SEM-EDS analysis and LA-ICP-MS mapping revealed that the disk-shaped faience beads were manufactured using the cementation glazing method. Copper, most likely in the form of bronze scrapings, was used to impart a blue-green hue to these beads. Micro-XRD also revealed that the disk-shaped beads were manufactured using feldspathic sand. On the other hand, the cubic-shaped bead, identified as an Egyptian blue frit by VP-SEM-EDS and μ-XRD, owes its vivid blue color to the tubular crystals of this well-known synthetic pigment. Trace element analysis suggests that all beads were manufactured in the Levant region using coastal sands. Ultimately, this study highlighted the importance of the use of a combination of microstructural and geochemical criteria in the identification of faience production technology and provenance. The importance of the selection of the sampling strategy in LA-ICP-MS analysis of weathered faience objects was also emphasized.info:eu-repo/semantics/publishedVersio

New approaches for the study of faience using beads from Southern Portugal

A collection of 30 faience beads recovered from the Iron Age necropolis of Vinha das Caliças 4 (Beja, Portugal) was analyzed in order to identify their production technology and provide insights into their possible provenance. The multi-analytical approach employed, combining laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS), variable pressure scanning electron microscope coupled with energy dispersive X-ray spectrometry (VP-SEM-EDS) and micro-X-ray diffraction (µ-XRD), highlights the difficulties that arise from the analysis of weathered faience objects, and which are augmented by their intrinsic heterogeneous nature. VP-SEM-EDS analysis and LA-ICP-MS mapping revealed that the disk-shaped faience beads were manufactured using the cementation glazing method. Copper, most likely in the form of bronze scrapings, was used to impart a blue-green hue to these beads. Micro-XRD also revealed that the disk-shaped beads were manufactured using feldspathic sand. On the other hand, the cubic-shaped bead, identified as an Egyptian blue frit by VP-SEM-EDS and μ-XRD, owes its vivid blue color to the tubular crystals of this well-known synthetic pigment. Trace element analysis suggests that all beads were manufactured in the Levant region using coastal sands. Ultimately, this study highlighted the importance of the use of a combination of microstructural and geochemical criteria in the identification of faience production technology and provenance. The importance of the selection of the sampling strategy in LA-ICP-MS analysis of weathered faience objects was also emphasized