Corticosteroids for the management of cancer-related pain in adults (Review)

Background: One of the most feared symptoms associated with cancer is pain. Opioids remain the mainstay of pain treatment but corticosteroids are often used concurrently as co- or adjuvant analgesics. Due to their anti-inflammatory mechanism of action, corticosteroids are said to provide effective analgesia for pain associated with inflammation and in the management of cancer-related complications such as brain metastasis and spinal cord compression. However, corticosteroids have a wide range of adverse effects that are dose and time dependent. Objectives: To evaluate the efficacy of corticosteroids in treating cancer-related pain in adults. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 4), MEDLINE (OVID) (1966 to 29 September 2014), EMBASE (OVID) (1970 to 29 September 2014), CINAHL (1982 to 29 September 2014), Science Citation Index (Web of Science) (1899 to 29 September 2014) and Conference Proceedings Citation Index - Science (Web of Science) (1990 to 29 September 2014). Selection criteria: Any randomised or prospective controlled trial that included patients over 18 years with cancer-related pain were eligible for the review. Corticosteroids were compared to placebo or usual treatment and/or supportive care. Data collection and analysis: All review authors independently assessed trial quality and extracted data. We used arithmetic means and standard deviations for each outcome to report the mean difference (MD) with 95% confidence interval (CI). Main results: Fifteen studies met the inclusion criteria, enrolling 1926 participants. The trial size varied from 20 to 598 patients. Most studies compared corticosteroids, particularly dexamethasone, to standard therapy. We included six studies with data at one week in the meta-analysis for pain intensity; no data were available at that time point for the remaining studies. Corticosteroid therapy resulted in less pain (measured on a scale of 0 to 10 with a lower score indicating less pain) compared to control at one week (MD 0.84 lower pain, 95% CI 1.38 to 0.30 lower; low quality evidence). Adverse events were poorly documented. Factors limiting statistical analysis included the lack of standardised measurements of pain and the use of different agents, dosages, comparisons and routes of drug delivery. Subgroup analysis according to type of cancer was not possible. The quality of this evidence was limited by the risk of bias of the studies and small sample size. The results were also compromised by attrition, with data missing for the enrolled patients. Authors' conclusions: The evidence for the efficacy of corticosteroids for pain control in cancer patients is weak. Significant pain relief was noted in some studies, albeit only for a short period of time. This could be important for patients with poor clinical status. Further trials, with increased numbers of participants, are needed to evaluate the safety and effectiveness of corticosteroids for the management cancer pain in adults, and to establish an ideal dose, duration of therapy and route of administration

شمل اور تاریخِ ادبِ اردو

Annamarie Schimmel was a renowned orientalist. Her main claim to fame is her life-long interest in Sufi tradition of Islam. She was well versed in many eastern languages including Pakistan’s national language-Urdu. She studied Urdu literature in depth. Her book “Classical Urdu Literature from the beginning to Iqbal” is a true example of her deep understanding and interest in Urdu. Despite shortcomings, this book is a valuable addition to Urdu by a foreigner. She elaborated Urdu’s classical poetry and proved her much appreciated literary acumen regarding 18th and 19th century Urdu literature. This book primarily is a portrayal of Urdu literature for Western readers.</p

رقصِ شرار- غالبؔ کی شاعری میں تمثالِ آتش

Annemarie Schimmel is a renowned Orientalist. The mystic tradition of Islam was her favorite area of interest. She loved mystic poetry very much. Besides Persian, she also took keen interest in Urdu poetry. She devoted herself for special study of Mirza Ghalib’s art and thought. She presented her finding in her famous book A Dance of Sparks-Imagery of Fire in Ghalib’s Poetry. She established in this book that the dance has special reference in different cultures. She also compared her loving Sufi personality of Mansoor Hallaj with Ghalib and gave an aesthetic touch to the motif of fire in dancing

آنیماری شمل : ایک عظیم مستشرقہ

Annemarie Schimmel is one of the great Orientalists of 20th century. She was a learned scholar and was fluent in many eastern and western languages. She travelled around the globe to conduct research and deliver lectures mainly on the Sufi tradition of Islam. She worked throughout her life to bridge intellectual gap between the East and the West. The paper covers the interests of this world renowned Orientalist chiefly concerned to her all her life.</p

The development and piloting of “ATTEND DR,” a clinical teaching tool to identify and prioritize potential causes of adverse drug reactions

Background The identification, management, and reporting of adverse drug reactions are integral to clinical practice and education; however, undergraduate teaching related to adverse drug reactions may be inadequate for practice. Existing methods of causality assessment have a number of limitations in relation to clinical teaching, for example, they do not deal well with the concurrent use of other medications. Objective To develop and pilot a teaching tool to guide students through the process of identifying and prioritizing potential causes of an adverse drug reaction. Setting University-based School of Pharmacy, Australia: an undergraduate Quality Use of Medicines course. Method A contrived acronym (mnemonic) was developed from causality assessments and discussions with practitioners. The acronym ATTEND DR (abnormality, taken, timeline, evidence, nothing else?, dose, dechallenge, and rechallenge) was piloted in workshops that focussed on adverse drug reactions and their management. Students’ responses to “What did you find most valuable about today's workshop?” and “How could we improve?” were analyzed. Results All attendees responded (65/65). Students indicated that the ATTEND DR acronym was easy to remember, and facilitated causality assessment in a clinical context, due to an easily followed, step-by-step, comprehensive process that was easy to remember. More practice case studies were requested. Conclusion The ATTEND DR acronym was designed to address limitations of the existing methods of causality assessment in relation to clinical teaching and preparation of students for future clinical roles. Students responded favorably to its introduction, commenting that it was easily remembered and provided a comprehensive, clinically orientated, step-by-step process

Educational Forum-Frontline defense against the next pandemic: Antivirals for avian flu

A pandemic of the human influenza virus has caused extensive morbidity and mortality around the world. The mechanisms involved in the emergence of new influenza viral strains and the epidemiological factors leading to pandemics are unpredictable. The spread of the virus and the challenges encountered in its management are discussed, along with a review on the antivirals against avian influenza. Till date, neuraminidase inhibitors remain the mainstay of management as they are well tolerated and less likely to promote the development of drug resistance, compared to the conventional adamantanes. Details on the clinical effects of antivirals on the infection, safety profile, status in clinical practice and drug resistance are covered in this paper. Future prospects and research to fight the pandemic are also addressed. An outbreak of this infection in various Asian countries emphasises the need for a collaborative approach from healthcare experts, governments and media, to control and curb the spread of infection worldwide

Provision of pharmaceutical care in patients with limited English proficiency: Preliminary findings

Objective: Overcoming language and cultural barriers is becoming ever challenging for pharmacists as the patient population grows more ethnically diverse. To evaluate the current practices used by the pharmacists for communicating with patients with limited English proficiency (LEP) and to assess pharmacists’ knowledge of, attitude toward, and satisfaction with accessing available services for supporting LEPs patients within their current practice settings. Methods: Semi-structured interviews were conducted with five pharmacists employed in pharmacies representing multiple practice settings Queensland, Australia. Thematic analysis was primarily informed by the general inductive approach. NVivo software (QSR International Pty Ltd.) was used to manage the data. Findings: Three interlinked themes emerged from the analysis of interview data: (1) Barriers to the provision of pharmaceutical care, (2) Strategies employed in dealing with LEP patients, and (3) Lack of knowledge about existing services. Pharmacists recognized their lack of skills in communicating with LEP patients to have potential negative consequences for the patient and discussed these in terms of uncertainty around eliciting patient information and the patient’s understanding of their instructions and or advice. Current strategies were inconsistent and challenging for LEP patient care. While the use of informal interpreters was common, a significant degree of uncertainty surrounded their actual competency in conveying the core message. Conclusion: The present study highlights a significant gap in the provision of pharmaceutical care in patients with LEP. Strategies are needed to facilitate quality use of medicines among this patient group