Experiences of people taking opioid medication for chronic non-malignant pain : a qualitative evidence synthesis using meta-ethnography

Objective To review qualitative studies on the experience of taking opioid medication for chronic non-malignant pain (CNMP) or coming off them. Design This is a qualitative evidence synthesis using a seven-step approach from the methods of meta-ethnography. Data sources and eligibility criteria We searched selected databases—Medline, Embase, AMED, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and Scopus (Science Citation Index and Social Science Citation Index)—for qualitative studies which provide patients’ views of taking opioid medication for CNMP or of coming off them (June 2017, updated September 2018). Data extraction and synthesis Papers were quality appraised using the Critical Appraisal Skills Programme tool, and the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation working group - Confidence in Evidence from Reviews of Qualitative research) guidelines were applied. We identified concepts and iteratively abstracted these concepts into a line of argument. Results We screened 2994 unique citations and checked 153 full texts, and 31 met our review criteria. We identified five themes: (1) reluctant users with little choice; (2) understanding opioids: the good and the bad; (3) a therapeutic alliance: not always on the same page; (4) stigma: feeling scared and secretive but needing support; and (5) the challenge of tapering or withdrawal. A new overarching theme of ‘constantly balancing’ emerged from the data. Conclusions People taking opioids were constantly balancing tensions, not always wanting to take opioids, and weighing the pros and cons of opioids but feeling they had no choice because of the pain. They frequently felt stigmatised, were not always ‘on the same page’ as their healthcare professional and felt changes in opioid use were often challenging

Arguing about intervention: a comparison of British and French rhetoric surrounding the 1882 and 1956 invasions of Egypt

This article compares the rhetorical justifications surrounding two landmark instances of Western imperialism. In 1882, the British occupied Egypt, ousting indigenous proto-nationalist forces that supposedly threatened British and other foreign interests. The consequences of this intervention were still being worked out in 1956 when, in the wake of the Cairo regime's nationalization of the Suez Canal, the British again invaded. France participated on this occasion, with serious but differing political consequences for both. We suggest that comparing how the British and French argued about these issues, and also examining how the rhetoric of the later crisis contrasted with the earlier one, offers useful insights into the two nations' respective imperial cultures. Specifically, we suggest that the latter-day imperialists Anthony Eden and Guy Mollet couched their actions in internationalist rhetoric reminiscent both of the Gladstone government's justifications for intervention in 1882 and of French official explanations for their takeover in Tunisia a year earlier. Each claimed their actions were taken both to uphold better standards of governance and to restore regional order, itself a highly loaded concept. The language of imperial domination was eschewed; but the ends of empire were served by the use of this rhetoric of ‘liberal order’

Knowledge and barriers to inclusion of ASC pupils in Scottish mainstream schools:A mixed methods approach

Inclusion of autistic pupils into mainstream schools is common practice and staff should have adequate knowledge on teaching and managing classroom behaviour. However, autism knowledge among teaching staff may be inconsistent. A mixed-methods design examined differences between school staff in autism knowledge, perceived barriers to inclusion and required support. 138 early years staff, school teachers and pupil support assistants took part. Knowledge and experience were assessed using Knowledge about Childhood Autism among Health Workers questionnaire (KCAHW; [Bakare, M. O., P. O. Ebigbo, A. O. Agomoh, and N. C. Menkiti. 2008. Knowledge about childhood autism among health workers (KCAHW) questionnaire: description, reliability and internal consistency. Clinical Practice and Epidemiology in Mental Health 4 (1): 17]). Qualitative measures addressed perceived barriers to inclusion and recommended supports. Significant differences in the knowledge of autism scores were shown. Similar themes were identified across all staff, with five themes reflecting barriers to inclusion (Knowledge, Support, Training, Management of ASC features and Parent involvement) and four themes relating to required support (Individualising educational experience, Changes to learning spaces, Opportunities to learn about ASC and Communication). Government inclusion policy should take a whole school approach and consider staffs’ actual and perceived barriers to inclusion of autistic children

Evidence that implementation intentions reduce drivers' use of mobile phones while driving

Implementation intentions are IF-THEN plans that have the potential to reduce mobile phone use while driving and thus contribute towards the prevention of road traffic crashes. We tested whether an intervention, designed to promote the formation of implementation intentions, could reduce drivers’ use of mobile phones. A randomized controlled design was used. The participants (N = 136) were randomised to an implementation or a control condition. Self-report questionnaires were administered to all participants at both pre- and one-month post-intervention to measure the use of mobile phones while driving, goal intentions and the theoretically derived motivational pre-cursors of goal intentions (attitudes, subjective norm and perceived behavioural control). Immediately following the pre-intervention questionnaire, the participants in the implementation intention condition (n = 67) were given a volitional help sheet, which asked them to form implementation intentions by specifying target driving situations that tempted them the most to use a mobile phone and linking them with goal-directed responses that could be used to resist the temptation. The participants in the control condition (n = 69) were asked to specify target situations that tempted them the most to use a mobile phone while driving and to generally try to avoid using a mobile phone in those situations. One-month post-intervention, the participants in the implementation intention condition reported using a mobile phone less often while driving in their specified target driving situations than did the participants in the control condition. As expected, no differences were found between the conditions in the reported frequency of mobile phone use in unspecified driving situations, goal intentions or any motivational pre-cursor of goal intentions. The implementation intention intervention that was tested in this study is a potentially effective tool for reducing mobile phone use while driving in target driving situations where behaviour-change is most needed

Live imaging of wound angiogenesis reveals macrophage orchestrated vessel sprouting and regression

© 2018 The Authors. Published under the terms of the CC BY 4.0 license Wound angiogenesis is an integral part of tissue repair and is impaired in many pathologies of healing. Here, we investigate the cellular interactions between innate immune cells and endothelial cells at wounds that drive neoangiogenic sprouting in real time and invivo. Our studies in mouse and zebrafish wounds indicate that macrophages are drawn to wound blood vessels soon after injury and are intimately associated throughout the repair process and that macrophage ablation results in impaired neoangiogenesis.Macrophages also positively influence wound angiogenesis by driving resolution of anti-angiogenic wound neutrophils. Experimental manipulation of the wound environment to specifically alter macrophage activation state dramatically influences subsequent blood vessel sprouting, with premature dampening of tumour necrosis factor-α expression leading to impaired neoangiogenesis. Complementary human tissue culture studies indicate that inflammatory macrophages associate with endothelial cells and are sufficient to drive vessel sprouting via vascular endothelial growth factor signalling. Subsequently, macrophages also play a role in blood vessel regression during the resolution phase of wound repair, and their absence, or shifted activation state, impairs appropriate vessel clearance

Macrophage Reprogramming with Anti-miR223-Loaded Artificial Protocells Enhances In Vivo Cancer Therapeutic Potential

Several immune cell‐expressed miRNAs (miRs) are associated with altered prognostic outcome in cancer patients, suggesting that they may be potential targets for development of cancer therapies. Here, translucent zebrafish (Danio rerio) is utilized to demonstrate that genetic knockout or knockdown of one such miR, microRNA‐223 (miR223), globally or specifically in leukocytes, does indeed lead to reduced cancer progression. As a first step toward potential translation to a clinical therapy, a novel strategy is described for reprogramming neutrophils and macrophages utilizing miniature artificial protocells (PCs) to deliver anti‐miRs against the anti‐inflammatory miR223. Using genetic and live imaging approaches, it is shown that phagocytic uptake of anti‐miR223‐loaded PCs by leukocytes in zebrafish (and by human macrophages in vitro) effectively prolongs their pro‐inflammatory state by blocking the suppression of pro‐inflammatory cytokines, which, in turn, drives altered immune cell‐cancer cell interactions and ultimately leads to a reduced cancer burden by driving reduced proliferation and increased cell death of tumor cells. This PC cargo delivery strategy for reprogramming leukocytes toward beneficial phenotypes has implications also for treating other systemic or local immune‐mediated pathologies

Getting real about food prices

The 2008 price spike in world grain prices had serious impacts on food security and poverty but analysts have consistently described these real food prices as low in historical terms. The inconsistency between the severity of the food crisis and low real prices results from the use of advanced and global economy price indices to calculate real prices. This ignores the high share of food in poor people’s expenditures and indirect effects of income growth on expenditure patterns of rich and poor consumers. Poor consumers have not experienced the same falls in real food prices as those with growing incomes and are more vulnerable to price shocks. As high and fluctuating international grain prices appear to be a feature of the current world economy, food price and policy analysis must recognise this, and develop and use different price indices that take account of differences between consumer groups