What influences chronic pain management? A best–worst scaling experiment with final year medical students and general practitioners

Background: Chronic pain education is an essential determinant for optimal chronic pain management. Given that attitudes and preferences are involved in making treatment decisions, identifying which factors are most influential to final year medical students’ and general practitioners’ (GPs) chronic pain management choices is of importance. This study investigates Swedish and Australian students’ preferences with respect to a chronic pain condition, using a best–worst scaling (BWS) experiment, which is designed to rank alternatives. Methods: BWS, a stated-preference method grounded in random utility theory, was used to explore the importance of factors influencing chronic pain management. Results: All three cohorts considered the patients’ pain description and previous treatment experience as the most important factors in making treatment decisions, whereas their demographics and voices or facial expressions while describing their pain were considered least important. Factors such as social support, patient preferences and treatment adherence were, however, disregarded by all cohorts in favour of pain assessment factors such as pain ratings, description and history. Swedish medical students and GPs show very high correlation in their choices, although the GPs consider their professional experience as more important compared to the students. Conclusion: This study suggests that the relative importance of treatment factors is cemented early and thus underline the critical importance of improving pain curricula during undergraduate medical education

Differences in Swedish and Australian medical student attitudes and beliefs about chronic pain, its management, and the way it is taught

Background and aims: Medical students receive training in the management of chronic pain, but the training is often suboptimal. Considering that the basis for physician’s knowledge is their medical education, it is important to explore the attitudes and beliefs of medical students with respect both to chronic pain management and to their views on current pain education. Therefore, the aim of this study was to compare Swedish and Australian medical student’s attitudes and beliefs about patients with chronic pain, and their perceptions regarding their chronic pain management education. Methods: An online survey was conducted with final year Australian and Swedish medical students from two different universities between December 2016 and February 2017. Attitudes and beliefs towards chronic pain patients were measured using the Health Care Providers’ Pain and Impairment Scale (HC-PAIRS). A thematic analysis was conducted on open end questions regarding their views on their education and important skills for chronic pain management. Results: A total of 57 Swedish and 26 Australian medical students completed the HC-PAIRS scale. The Swedish medical students showed statistically significantly lower total mean HC-PAIRS scores compared to Australian medical students (46 and 51, respectively). Australian students had statistically significantly higher scores than the Swedish students for two of four factors: functional expectations and need for cure, whereas no significant differences were seen for the factors social expectations or for projected cognition. From the open end questions it was evident that final year medical students are knowledgeable about key chronic pain items described in clinical guidelines. However, both cohorts described their chronic pain training as poor and in need of improvement in several areas such as more focus on the biopsychosocial model, working in multidisciplinary teams, seeing chronic pain patients and pharmacological training. Conclusions: Attitudes and beliefs are formed during medical education, and our study exploring attitudes of medical students towards chronic pain and how it is taught have provided valuable information. Our survey provided detailed and cohesive suggestions for education improvement that also are in line with current clinical guidelines. This study indicates that the Swedish final year students have a more positive attitude towards chronic pain patients compared to their Australian counterparts. The majority of students in both cohorts perceived chronic pain management education in need of improvement. Implications: This study highlights several areas of interest that warrant further investigation, for example, the impact of a changed medical curriculum in alignment with these clinical guidelines requested by students in this survey, and correspondingly if their attitudes towards chronic pain patients can be improved through education. Further, we conclude that it would be valuable to align the implementation of the HC-PAIRS instrument in order to achieve comparable results between future studies

Institutional Ethnography (IE), Nursing Work and Hospital Reform: IE's Cautionary Analysis

Während der letzten Jahrzehnte war das Krankenhauswesen in Kanada im Zuge der Durchsetzung einer neoliberalen Agenda erheblichen Restrukturierungsprozessen ausgesetzt, verbunden mit dem Ziel einer effektiveren Verwendung öffentlicher Mittel und einer zunehmenden Expansion des privaten Sektors im Gesundheitswesen. Hierbei kamen erhebliche öffentliche Mittel für Gesundheitsinformationsdienste und für Forschung zum Einsatz, um objektivierbares Wissen für die Reform des Gesundheitssystems zu generieren: die Hoffnung war, dass Gesundheitsorganisationen und deren Wirksamkeit deutlich verbessert werden würden. Die Forschungsarbeit, die Gegenstand dieses Beitrags ist, beschäftigt sich mit der professionellen Pflege in diesem restrukturierten Krankenhauswesen und insbesondere mit der Frage, inwieweit die Reformen sich in der Pflegepraxis niedergeschlagen haben. Dabei fokussiert unser Ansatz der institutionellen Ethnografie die soziale Organisation von Gesundheitsbezogenem Wissen aus der Perspektive derer, die in diese Reformprozesse involviert und ihnen unterworfen sind – nämlich aus der Perspektive des Pflegepersonals. Ein wesentlicher Befund betrifft einen neuen Modus der Entscheidungsaushandlung und -findung: Das Pflegepersonal bemüht sich aktiv um die Ein- und Unterordnung eigener professioneller Urteile in objektiviertes Wissen und vorgängig festgelegte, wissensbasierte Praktiken, sodass Entscheidungsprozesse eher externalisiert und an autoritativen Vorgaben orientiert verlaufen. In dem Beitrag wird der Einsatz der institutionellen Ethnografie an Beispielen aus dieser Forschung beschrieben und diskutiert. URN: urn:nbn:de:0114-fqs090287Los hospitales en Canadá han sido objeto de intensa reorganización en pocas décadas pasadas en tanto el sistema público de cuidado de la salud absorbe y se adapta a un programa de gobierno neoliberal que promueve el uso más "eficiente y eficaz" de los fondos públicos e incrementa la participación por parte de la sector privado. Una masiva infusión de dinero público para las tecnologías de información en salud y para la investigación de servicios en salud ha creado la capacidad para generar conocimiento objetivado y utilizarlo para reformar el sistema de atención de salud, tanto en su organización y, cada vez más, en su terapéutica, con la promesa de hacer que todo funcione mejor. La investigación que se reporta aquí es sobre la participación de profesionales de enfermería en su trabajo diario/nocturno en hospitales reestructurados y sobre cómo se reestructura la práctica de la enfermería en consecuencia. Nuestro enfoque de investigación, la etnografía institucional, se centra en la organización social de los conocimientos sobre la salud desde la perspectiva de quienes participan en ella y se subordinan a sus usos de gestión, en este caso, las enfermeras. Creemos que una nueva forma de gobernar se está desplegando. Las enfermeras desempeñan un papel activo en la subordinación de su propio juicio profesional al conocimiento objetivado y al conocimiento basado en las prácticas que externaliza la toma de decisiones y reposiciona el saber autorizado. Este artículo describe y discute la realización de una investigación etnográfica institucional (RANKIN & CAMPBELL 2006) e ilustra algunos de sus rasgos distintivos por medio de ejemplos en nuestra investigación. URN: urn:nbn:de:0114-fqs090287Hospitals in Canada have been subject to intensive reorganization in the past few decades as the public health care system absorbs and adapts to a neoliberal government agenda that promotes more "efficient and effective" use of public funds and increased involvement on the part of the private sector. A massive infusion of public money for health information technology and health services research has created the capacity to generate objectified knowledge and to use it to reform the health care system—both its organization and, increasingly, its therapeutics—with the promise of making it all work better. The research reported here is on the engagement of professional nurses in their everyday/night work in restructured hospitals and on how nursing practice is being reshaped in consequence. Our research approach, institutional ethnography, focuses on the social organization of health knowledge from the standpoint of those involved in and subordinated to its managerial uses, in this case, the nurses. We argue that a new form of ruling is being deployed. Nurses play an active part in the subordination of their own professional judgment to the objectified knowledge and knowledge-based practices that externalize decision making and reposition authoritative knowing. The paper describes and discusses the conduct of an institutional ethnographic inquiry (RANKIN & CAMPBELL, 2006) and illustrates some of its distinctive features using examples from our research. URN: urn:nbn:de:0114-fqs09028

Lesson plans to stimulate beginning creative writing in grades three, four, and five

Thesis (Ed.M.)--Boston Universit

Silicone microspheres and disposable separation technology for gaseous analytes

Part I of this dissertation describes the synthesis and characterization of solid, copolymeric, magnetic, fluorescent, core-shell, and hollow or foamed micron-sized silicone spheres prepared via ultrasonic spray pyrolysis (USP). Silicones are found in an amazing number of commercial products including cosmetics, sealants, adhesives, lubricants, medical devices, and even food. Despite the prevalence of bulk silicones in today’s society, the synthesis of silicone micromaterials has remained elusive. The same chemical and material characteristics that make silicones ideal for many commercial applications, namely hydrophobicity and low surface tension, cause the droplets in silicone-precursor emulsions to coalesce and aggregate upon curing. Conveniently, the aerosol created in USP, an industrially-scalable synthetic technique used to make relatively monodisperse sub-micron and micron-sized spheres, isolates silicone oligomers into individual droplets during curing. These USP prepared silicone microspheres range from ~500 nm to 2 µm in diameter and are prepared from commercial silicone kits and commercially available oligomers. Synthetic control over size, crosslinking density, composition, and swelling is shown. The solid USP PDMS microspheres are shown to be highly bioinert, are found to be taken into cell cytosol, and show impressive drug loading capacities (as high as 36% by weight). Functional silicone microspheres are obtained by simply adding the appropriate dopant (e.g., fluorescent dye, colloidal Fe3O4, polymeric or ionic salt core material) or changing the silicone oligomers of the precursor solution prior to nebulization. These results demonstrate the versatility and generalizability of this synthetic method and serve as a road-map for the fabrication of silicone microspheres with nearly any desired functionality. Part II of this dissertation describes our efforts in the development of a fully integrated, disposable, and portable gas chromatography column and detector. There is a pressing need for rapid, portable, and inexpensive technology for the on-site detection of gaseous analytes. Significant progress has been made towards this goal through the miniaturization of gas chromatographs (GC), the most widely used method for analyzing complex gas mixtures. Typical GC microcolumns are made through a multi-step fabrication process, which requires hazardous reagents, complex equipment, and problematic stationary phase coating procedures. This section of the thesis explores, as an alternative: a microcolumn made from a single microtextured polymer composite that acts as both the structural support and stationary phase. This work marks the first molded gas chromatography microcolumn capable of separating mixtures of VOCs in minutes with baseline resolution (N > 1800 plates m-1) and contributes significantly to understanding which factors (e.g., polymer permeability, phase-separated structure) must be considered in the design of such microcolumns. Finally, this work also describes advancements in realizing colorimetric sensor arrays as microdetectors for gas chromatography. Because GC miniaturization necessitates extremely short columns (often < 3 m in total length), micro-GC systems suffer from incomplete separations and frequently have analytes which coelute. Sensor arrays have been proposed as microdetectors for micro-GC analysis in an attempt to ameliorate this problem. Described here are initial studies on optimization of colorimetric sensor arrays for use with GC including the development of a solvatochromic array for sensing organic solvents, an analysis of the effects of secondary factors on sensor array kinetics, and a proof of concept study sensing amines as they elute from a microcolumn. These advances provide a basis for further development of colorimetric sensor array microdetectors for use with GC

Friends and Mates, When Do We Need Them? Investment Across Social Contexts

Friendships are extremely adaptive, but come at great cost. Examining real life friendship choices, may not accurately represent how individuals deal with the tradeoffs involved in having a wide social network, therefore the present studies used a series of budget allocation tasks. In these tasks, participants spent tokens on types of friends and/or mates in varying degrees of budgets. Varying the budgets determined which social relationships were viewed and necessities and which were viewed as luxuries. Furthermore, investment in social relationships may change given the context; therefore the present studies used different scenarios for each budget. Studies one and two examined friendships only and found that across scenarios close friends were treated as luxuries and necessities. Studies three and four examined friends and mates and found that across scenarios long-term mates were viewed as necessities and close friends were viewed as luxuries. These findings shed light on the adaptive tradeoffs involved in choosing which types of friends and mates to invest in given availability of energy and social context.Psycholog

Atrioventricular septal defects among infants in Europe: a population-based study of prevalence, associated anomalies, and survival

Abstract Objective To describe the epidemiology of chromosomal and non-chromosomal cases of atrioventricular septal defects in Europe. Methods Data were obtained from EUROCAT, a European network of population-based registries collecting data on congenital anomalies. Data from 13 registries for the period 2000-2008 were included. Results There was a total of 993 cases of atrioventricular septal defects, with a total prevalence of 5.3 per 10,000 births (95% confidence interval 4.1 to 6.5). Of the total cases, 250 were isolated cardiac lesions, 583 were chromosomal cases, 79 had multiple anomalies, 58 had heterotaxia sequence, and 23 had a monogenic syndrome. The total prevalence of chromosomal cases was 3.1 per 10,000 (95% confidence interval 1.9 to 4.3), with a large variation between registers. Of the 993 cases, 639 cases were live births, 45 were stillbirths, and 309 were terminations of pregnancy owing to foetal anomaly. Among the groups, additional associated cardiac anomalies were most frequent in heterotaxia cases (38%) and least frequent in chromosomal cases (8%). Coarctation of the aorta was the most common associated cardiac defect. The 1-week survival rate for live births was 94%. Conclusion Of all cases, three-quarters were associated with other anomalies, both chromosomal and non-chromosomal. For infants with atrioventricular septal defects and no chromosomal anomalies, cardiac defects were often more complex compared with infants with atrioventricular septal defects and a chromosomal anomaly. Clinical outcomes for atrioventricular septal defects varied between regions. The proportion of termination of pregnancy for foetal anomaly was higher for cases with multiple anomalies, chromosomal anomalies, and heterotaxia sequenc