ABSTRACT
BACKGROUND: Pain is a major obstacle and one of the main reasons people seek medical attention and is a frequent stressor for many clients in the intensive care unit (ICU). However, clients should not be left complaining, especially when solutions are available; each patient has the right to assess and manage their pain in the best way possible. Therefore, the objective of this study was to analyze nurses' knowledge, attitudes, and practice (KAPs) regarding pain management in Palestinian ICU settings and to determine the possible obstacles that may hinder effective and competent pain management for critically ill clients. METHODS: This cross-sectional research was conducted online through social media. An approved questionnaire was used to assess KAPs and obstacles in pain treatment approaches for critically ill patients. Bloom's cutoff points for adequate practice, appropriate knowledge, and a positive attitude were applied. IBM SPSS Statistics for Windows, Version 21.0 was used for analyses. RESULTS: One hundred ninety-one nurses were approached, the majority of the participants in this investigation were males (n = 127, 66.5%), and the mean age of the study participant was 29 ± 7 (year). The overall knowledge score was 15, measured for median knowledge = 7 with an interquartile range (IQR) of 4-8, and higher scores indicate more knowledge about the management and control of pain. The total attitude score = 11, the median = 6, with an IQR of 5-7. The reluctance to prescribe opioids was 79.6%, the lack of proficiency in pain management knowledge was 78.5%, and rigorous controls over opioid use were 77.5%, which was the lion's share of commonly recognized hurdles. The overall practice score was 10, with a median of 5.0 with an IQR of 3.0 to 6.0, and nurses revealed that they would evaluate all the steps involved in pain management in each round they have. CONCLUSIONS: This research reveals a knowledge, attitude, and practice gap among the working nurses. Therefore, adequate and efficient plans must be aimed at ICU nurses to foster the level of knowledge and direct attitudes toward pain control through applicable interventional programs.
ABSTRACT
BACKGROUND: Vadadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, a class of compounds that stimulate endogenous erythropoietin production. METHODS: We conducted two randomized, open-label, noninferiority phase 3 trials to evaluate the safety and efficacy of vadadustat, as compared with darbepoetin alfa, in patients with anemia and incident or prevalent dialysis-dependent chronic kidney disease (DD-CKD). The primary safety end point, assessed in a time-to-event analysis, was the first occurrence of a major adverse cardiovascular event (MACE, a composite of death from any cause, a nonfatal myocardial infarction, or a nonfatal stroke), pooled across the trials (noninferiority margin, 1.25). A key secondary safety end point was the first occurrence of a MACE plus hospitalization for either heart failure or a thromboembolic event. The primary and key secondary efficacy end points were the mean change in hemoglobin from baseline to weeks 24 to 36 and from baseline to weeks 40 to 52, respectively, in each trial (noninferiority margin, -0.75 g per deciliter). RESULTS: A total of 3923 patients were randomly assigned in a 1:1 ratio to receive vadadustat or darbepoetin alfa: 369 in the incident DD-CKD trial and 3554 in the prevalent DD-CKD trial. In the pooled analysis, a first MACE occurred in 355 patients (18.2%) in the vadadustat group and in 377 patients (19.3%) in the darbepoetin alfa group (hazard ratio, 0.96; 95% confidence interval [CI], 0.83 to 1.11). The mean differences between the groups in the change in hemoglobin concentration were -0.31 g per deciliter (95% CI, -0.53 to -0.10) at weeks 24 to 36 and -0.07 g per deciliter (95% CI, -0.34 to 0.19) at weeks 40 to 52 in the incident DD-CKD trial and -0.17 g per deciliter (95% CI, -0.23 to -0.10) and -0.18 g per deciliter (95% CI, -0.25 to -0.12), respectively, in the prevalent DD-CKD trial. The incidence of serious adverse events in the vadadustat group was 49.7% in the incident DD-CKD trial and 55.0% in the prevalent DD-CKD trial, and the incidences in the darbepoetin alfa group were 56.5% and 58.3%, respectively. CONCLUSIONS: Among patients with anemia and CKD who were undergoing dialysis, vadadustat was noninferior to darbepoetin alfa with respect to cardiovascular safety and correction and maintenance of hemoglobin concentrations. (Funded by Akebia Therapeutics and Otsuka Pharmaceutical; INNO2VATE ClinicalTrials.gov numbers, NCT02865850 and NCT02892149.).
