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Background: Breakthrough pain is common in life-limiting conditions and at end-of-life. Despite over 30 years of study, there is little consensus regarding the definition and characteristics of breakthrough pain. Objective: This study aims to update and expand a 2010 systematic review by Haugen and colleagues to identify (1) all definitions of breakthrough pain and (2) all descriptions and classifications of breakthrough pain reported by patients, caregivers, clinicians, and experts. Design: This rapid systematic review followed the Cochrane Rapid Review Methods Group guidelines. A protocol is published on PROSPERO (CRD42019155583). Data sources: CINAHL, MEDLINE, PsycINFO, and the Web of Science were searched for breakthrough pain terms from the inception dates of each database to 26th August 2022. Results: We identified 65 studies that included data on breakthrough pain definitions, descriptions, or classifications from patients (n = 30), clinicians (n = 6), and experts (n = 29), but none with data from caregivers. Most experts proposed that breakthrough pain was a sudden, severe, brief pain occurring in patients with adequately controlled mild-moderate background pain. However, definitions varied and there was no consensus. Pain characteristics were broadly similar across studies though temporal factors varied widely. Experts classified breakthrough pain into nociceptive, neuropathic, visceral, somatic, or mixed types. Patients with breakthrough pain commonly experienced depression, anxiety, and interference with daily life. Conclusions: Despite ongoing efforts, there is still no consensus on the definition of breakthrough pain. A compromise is needed on breakthrough pain nomenclature to collect reliable incidence and prevalence data and to inform further refinement of the construct. [ABSTRACT FROM AUTHOR]

Infants, children and young people with life-limiting or life-threatening conditions often experience acute, transient pain episodes known as breakthrough pain. There is currently no established way to assess breakthrough pain in paediatric palliative care. Anecdotal evidence suggests that it is frequently underdiagnosed and undertreated, resulting in reduced quality of life. The development of a standardised paediatric breakthrough pain assessment, based on healthcare professionals' insights, could improve patient outcomes. This study aimed to explore how healthcare professionals define and assess breakthrough pain in paediatric palliative care and their attitudes towards a validated paediatric breakthrough pain assessment. This was a descriptive qualitative interview study. Semi-structured interviews were conducted with 29 healthcare professionals working in paediatric palliative care across the UK. An inductive thematic analysis was conducted on the data. Five themes were generated: 'the elusive nature of breakthrough pain', 'breakthrough pain assessment', 'positive attitudes towards', 'reservations towards' and 'features to include in' a paediatric breakthrough pain assessment. The definition and assessment of breakthrough pain is inconsistent in paediatric palliative care. There is a clear need for a validated assessment questionnaire to improve assessment, diagnosis and management of breakthrough pain followed by increased healthcare professional education on the concept. [ABSTRACT FROM AUTHOR]

Introduction: Digital delivery of pre‐operative total knee replacement (TKR) education and prehabilitation could improve patient outcomes pre‐ and post‐operatively. Rigorously developing digital interventions is vital to help ensure they achieve their intended outcomes whilst mitigating their potential drawbacks. Objective: To develop a pre‐operative TKR education and prehabilitation digital intervention, the 'Virtual Knee School' (VKS). Methods: The VKS was developed using an evidence‐, theory‐ and person‐based approach. This involved a mixed methods design with four phases. The first three focused on planning the VKS. The final phase involved creating a VKS prototype and iteratively refining it through concurrent think‐aloud interviews with nine patients who were awaiting/had undergone TKR. Meta‐inferences were generated by integrating findings from all the phases. ISRCTN registration of the overall project was obtained on 24 April 2020 (ISRCTN11759773). Results: Most participants found the VKS prototype acceptable overall and considered it a valuable resource. Conversely, a minority of participants felt the prototype's digital format or content did not meet their individual needs. Participants' feedback was used to refine the prototype's information architecture, design and content. Two meta‐inferences were generated and recommend: 1.Comprehensive pre‐operative TKR education and prehabilitation support should be rapidly accessible in digital and non‐digital formats.2.Pre‐operative TKR digital interventions should employ computer‐ and self‐tailoring to account for patients' individual needs and preferences. Conclusions: Integrating evidence, theory and stakeholders' perspectives enabled the development of a promising VKS digital intervention for patients awaiting TKR. The findings suggest future research evaluating the VKS is warranted and provide recommendations for optimising pre‐operative TKR care. Patient or Public Contribution: Patient and Public Involvement (PPI) was central throughout the project. For example, PPI representatives contributed to the project planning, were valued members of the Project Advisory Group, had key roles in developing the VKS prototype and helped disseminate the project findings. [ABSTRACT FROM AUTHOR]

Until recently the dominant critique of "student participation" projects was one based on the theoretical assumptions of critical theory in the form of critical pedagogy. Over the last decade, we have witnessed the emergence of a critical education discourse that theorises and critically analyses such projects using Foucault's notion of "governmentality". In this paper, I argue that while these governmentality studies challenge some of the key theoretical and taken for granted assumptions upon which such initiatives rest, they neglect to challenge the central assumption that such initiatives represent a historical break with traditional schooling practices. The importance of accounting for and critically analysing these projects within a historical framework will be argued through a discussion of Foucault's notion of genealogy as a particular conception and method of critique. It will also be demonstrated using an example, which shows an unacknowledged nineteenth century history of the current discourse and practice of student participation.

Hip and knee osteoarthritis (OA) affect a large and growing proportion of the population. Treatment options are typically conservative making self-management a priority. Using trained peers to support individuals with OA has potential to improve self-management. To explore the process of engaging and training volunteers to become peer mentors; and to qualitatively evaluate the feasibility, acceptability and value of being a peer mentor to support others' self-management of OA. A qualitative evaluation of a peer mentorship support intervention reporting the processes of recruitment and training; and semi-structured interviews conducted with nine active peer mentors. Transcribed interviews were coded and analysed using framework analysis. It was possible to recruit, train and retain volunteers with OA to become peer mentors. The peer mentors benefitted from their training and felt equipped to deliver the intervention. They enjoyed social elements of the mentorship intervention and gained satisfaction through delivering valued support to mentees. Peer mentors perceived the mentorship intervention to have a positive impact on self-management of OA for mentees. Training volunteers with OA to become peer mentors was feasible and acceptable. Peer mentors perceived their support benefitted others with OA. They positively rated their experience of providing mentorship support. This study demonstrates that it is possible to recruit, train and engage older volunteers to become peer mentors for people with osteoarthritis. Training should highlight the significance of employing key self-management techniques such as goal-setting. Peer mentors acknowledged that they benefitted from training and delivering the mentorship intervention, and this impacted positively on their own osteoarthritis self-management. Careful consideration of matching mentors and mentees appears to enhance the success of mentorship support. Recognising the impact of mentorship support on mentees' self-management is central to peer mentors' sustained engagement with the intervention. [ABSTRACT FROM AUTHOR]

Prompt diagnosis of rheumatoid arthritis (RA), the most common form of inflammatory arthritis, is crucial to optimise long-term patient outcomes through prevention of joint damage and disability. The international rheumatology community has adopted the term "pre-RA" to retrospectively describe a phase that an individual has progressed through once it is known that they have developed RA.[7] It is during this period that patients may present in primary care with non-specific musculoskeletal symptoms. 2021;7(3), e001768 11 Siddle HJ, Chapman LS, Mankia K. Perceptions and experiences of individuals at-risk of rheumatoid arthritis (RA) knowing about their risk of developing RA and being offered preventive treatment: systematic review and thematic synthesis of qualitative studies. [Extracted from the article]

Objective: To investigate half-marathon runners' frequency of use of recovery strategies, perceptions regarding the most beneficial recovery strategy, and reasons for using recovery strategies. Design: Cross-sectional survey. Participants: 186 participants of the 13.1 mile BUPA Great North Run 2013. Methods: A questionnaire was developed which required participants to indicate how frequently they used 12 different recovery strategies, identify which recovery strategy they believed to be most beneficial, and rank 6 reasons for using recovery strategies in order of importance. Data were analyzed using a Friedman nonparametric ANOVA and additional nonparametric tests. Results: All participants used recovery strategies. Stretching was the most commonly used recovery strategy (P < .001), whereas the use of nutritional supplements was the most commonly selected most beneficial recovery strategy. More than 50% of respondents indicated that they never used strategies such as kinesio tape (80%), hydrotherapy (78%), or ice baths (71%). A significant difference was observed between reasons for using recovery strategy (χ2 (5) = 292.29, P < .001). Reducing muscle tightness (rank 4.87) and reducing injury (rank 4.35) were the most frequently chosen most important reasons for using recovery strategies. Minor sex and age differences in the responses were identified. Conclusion: Recovery strategy usage appears to be widespread among half-marathon runners; however, disparities exist between the frequency of use and perceived effectiveness of different recovery strategies. Further research in this area is needed to facilitate the development of recovery strategy guidelines which are both evidence-based and practically relevant. [ABSTRACT FROM AUTHOR]

11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) activity is implicated as a moderator of the progression of multiple diseases and disorders in medicine and is actively subject to investigation as a therapeutic target. Here we summarize the mechanisms of the enzyme and detail the novel agents under investigation. Such agents modulate peripheral cortisol and cortisone levels in hypertension, type 2 diabetes, metabolic disorders, and Alzheimer's disease models, but there is mixed evidence for transduction into symptom management. There is inchoate evidence that 11β-HSD1 modulators may be useful pharmacotherapies for clinical improvement in psychiatry and neurology; however, more research is required. [ABSTRACT FROM AUTHOR]

Background: Hip and knee osteoarthritis (OA) are common musculoskeletal conditions. Treatment is usually conservative, making self‐management a priority. We developed and trialled an OA peer mentorship intervention to support self‐management in older people. Our objectives were to gain understanding of the perceived challenges of living with OA and explore how a peer mentorship intervention can support tackling these challenges; and to explore mentees' experiences of receiving the intervention to understand how this affected their OA self‐management. Methods: Qualitative semi‐structured interviews focussing on acceptability and feasibility of being in the study were conducted with mentees. Transcribed interviews were double coded and subject to framework analysis. To address the objectives of this paper, three main themes were subject to focused analysis: mentees' experiences of OA, experience of peer mentorship support and factors influencing self‐management. Results: Seventeen mentees participated in an interview following completion of the peer support intervention. Themes emerging from focused analysis were the following: tackling the challenges of living with OA pre‐ and post‐intervention; and the interplay of the peer mentorship intervention and self‐management. Key elements of the latter theme are enabling factors provided by peer mentorship, and mentees' readiness to self‐manage. Conclusion: To effectively support OA self‐management, peer mentorship interventions should include core educational components and focus on strategies that enhance key enablers of self‐management. Paying attention to the mentor–mentee relationship and timing of intervention engagement can maximise opportunities for older people to adjust and transition from supported to independent self‐management. [ABSTRACT FROM AUTHOR]

The article offers information on the Transitions of Care: Surgical Care Navigator Program course. According to the article, the course was implemented in January 2018 and aims to provide students in the health professions with first-hand experience in interprofessional communication during the transitions of care of medically complex surgical patients. Student perceptions after course participation in the spring of 2020 is also mentioned.

The relationship between risk and inequality has become a key area of research and theoretical debate in sociology and risk studies more broadly. My aim in this paper is to explore the role culture plays in the (re)production of inequalities of risk exposure. More specifically, I examine the ways cultural systems shape and animate judgements about acceptable standards of risk exposure for different groups within a society. The case study examines divergent policy judgements about acceptable risk exposure to road accident injury and death between a group of temporary visa workers and all other private passengers in Singapore. A key objective of the paper is to demonstrate the conceptual and empirical utility of Mary Douglas' cultural perspective for studying interconnections between risk and inequality. In particular, how taking up the problem of 'risk acceptability' is an effective way of approaching and studying the ways risk and inequality operate as mutually constitutive relations. In the discussion I show that what counts as risk and how acceptable or not risk is judged to be depends on the cultural system of classification used and the stratified social order it (re)produces. In the conclusion I consider the broader utility and significance of this critical approach for studying relations between risk and inequality through the problem of risk acceptability. A utility that may take on a particular significance in the present time of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Context: 11β-Hydroxysteroid dehydrogenase 1 (11βHSD1) reduces inert cortisone into active cortisol but also catalyzes reverse dehydrogenase activity. Drivers of cortisol/cortisone equilibrium are unclear. With obesity, 11βHSD1 transcripts are more abundant in adipose, but the consequences for oxidation vs reduction remain unknown.Objective: This work aimed to determine whether 11βHSD1 equilibrium in metabolic tissues is regulated by insulin and obesity.Methods: A 2-phase, randomized, crossover, single-blinded study in a clinical research facility was conducted of 10 lean and obese healthy men. 11β-Reductase and 11β-dehydrogenase activities were measured during infusion of 9,11,12,12-[2H]4-cortisol and 1,2-[2H]2-cortisone, respectively, on 2 occasions: once during saline infusion and once during a hyperinsulinemic-euglycemic clamp. Arterialized and venous samples were obtained across forearm skeletal muscle and abdominal subcutaneous adipose. Steroids were quantified by liquid chromatography-tandem mass spectrometry and adipose tissue transcripts by quantitative polymerase chain reaction.Results: Neither whole-body nor tissue-specific rates of production of cortisol or cortisone differed between lean and obese men, however insulin attenuated the diurnal decrease. Whole-body 11β-HSD1 reductase activity tended to be higher in obesity (~ 10%) and was further increased by insulin. Across adipose tissue, 11β-reductase activity was detected in obese individuals only and increased in the presence of insulin (18.99 ± 9.62 vs placebo 11.68 ± 3.63 pmol/100 g/minute; P < .05). Across skeletal muscle, 11β-dehydrogenase activity was reduced by insulin in lean men only (2.55 ± 0.90 vs 4.50 ± 1.42 pmol/100 g/minute, P < .05).Conclusions: Regeneration of cortisol is upregulated by insulin in adipose tissue but not skeletal muscle. In obesity, the equilibrium between 11β-reductase and 11β-dehydrogenase activities likely promotes cortisol accumulation in adipose, which may lead to adverse metabolic consequences. [ABSTRACT FROM AUTHOR]

Background: Phase of Illness is used to describe the stages of a patient's illness in the palliative care setting. Categorization is based on individual needs, family circumstances, and the adequacy of a care plan. Substantial (κ =.67) and moderate (κ =.52) inter-rater reliability is demonstrated when categorizing adults; however, there is a lack of similar studies in pediatrics. Objective: To test the inter-rater reliability of health-care professionals when assigning pediatric palliative care patients to a Phase of Illness. Furthermore, to obtain user views on phase definitions, ease of assignment, feasibility and acceptability of use. Method: A prospective cohort study in which up to 9 health-care professionals' independently allocated 80 pediatric patients to a Phase of Illness and reported on their experiences. This study took place between June and November 2017. Results: Professionals achieved a moderate level of agreement (κ = 0.50). Kappa values per phase were as follows: stable = 0.63 (substantial), unstable = 0.26 (fair), deteriorating = 0.45 (moderate), and dying = 0.43 (moderate). For the majority of allocations, professionals report that the phase definitions described patients very well (76.1%), and they found it easy to assign patients (73.5%). However, the unstable phase caused the most uncertainty. Conclusion: The results of this study suggest Phase of Illness is a moderately reliable, acceptable, and feasible tool for use in pediatric palliative care. Current results are similar to those found in some adult studies. However, in a quarter of cases, users report some uncertainty in the application of the tool, and further study is warranted to explore whether suggested refinements improve its psychometric properties. [ABSTRACT FROM AUTHOR]

Introduction Breakthrough pain is common in children and adults with cancer and other conditions, including those approaching end-of- life, although it is often poorly managed, possibly partly due to a lack of validated assessment tools. This review aims to (1) identify all available instruments measuring breakthrough pain in infants, children, adolescents or adults and (2) critically appraise, compare and summarise the quality of the psychometric properties of the identified instruments using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. Methods and analysis Two searches will be carried out between October 2019 and January 2020, one for each aim of the review. The Cochrane Library, International Prospective Register of Systematic Reviews, Embase, Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), PsycINFO, Web of Science Core Collection, Google Scholar, the ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey databases will be searched from database inception until the date the search is conducted. Reference lists of eligible articles will be screened and authors in the field contacted. For search 1, articles will be screened by two reviewers by abstract, and full-text where necessary, to identify if a breakthrough pain assessment was used. Search 2 will then be conducted to identify studies evaluating measurement properties of these assessments. Two reviewers will screen articles from search 2 by title and abstract. All potentially relevant studies will be screened by full text by both reviewers. For search 2, data will be extracted in parallel with the quality assessment process, as recommended by COSMIN. Two reviewers will assess methodological quality using the COSMIN Risk of Bias checklist and the COSMIN updated criteria for good measurement properties. Findings will be summarised and, if possible, data will be pooled using meta-analysis. The quality of the evidence will be graded and summarised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines. Ethics and dissemination Results of this review will be submitted for publication in a peer review journal and presented at conferences. [ABSTRACT FROM AUTHOR]

This study investigated the effect of using a cycling workstation on mouse dexterity, including if and how this changed with practice. Thirty-four healthy adults were allocated to a sitting group (n = 17) or cycling group (n = 17). All participants completed standardised computer tasks on 6 occasions: baseline and final—all participants were seated; practice 1 to 4—sitting group participants were seated, cycling group participants pedalled on an under desk cycle. Three computer tasks were employed: (1) Tracking (continuous task)—participants used the mouse pointer to track a dot in a figure of 8 pattern at 3 different speeds without a guide then with a guide (2) Aiming (discrete task)—participants moved the mouse pointer to a dot which repeatedly disappeared then reappeared again in different locations, creating the outline of a pentagram (3) Steering (continuous task)—participants steered the mouse pointer around two different pathways. Accuracy was measured during the Tracking and Steering tasks as the root mean square error and penalised path accuracy respectively. Speed was measured during the Aiming task as the movement time. Data was analysed using frequentist and Bayes Factor analyses. During the continuous tasks (Tracking and Steering), accuracy was impaired among participants using the cycling workstation, both compared to their accuracy when seated and to the accuracy of participants in the sitting group. In contrast, no deficits in speed were noted among participants using the cycling work station during the discrete task (Aiming). No learning effects were observed among either group for any tasks. These findings suggest using a cycling workstation may impair the accuracy but not speed of mouse use, regardless of task practice. Overall this supports the implementation of cycling workstations in typical office settings, but suggests cycling workstations may impair productivity among workers performing high precision mouse tasks. [ABSTRACT FROM AUTHOR]