Adequacy of Pain Management in HIV-Positive Patients

"Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence; severity; recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive; consenting HIVpositive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain; pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life. Results: Ninety-one per cent of participants reported pain with 83experiencing significant pain; in other words a ""worst pain"" rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients' daily functioning. Pain was documented on 71of the patients' medical charts that were reviewed; however; only 34were considered to be adequately managed for their pain. Conclusion: Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients' medical records; the management of pain was considered to be inadequate in a third of those experiencing pain."

Adequacy of Pain Management in HIV-Positive Patients

"Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence; severity; recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive; consenting HIV positive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain; pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life. Results: Ninety-one per cent of participants reported pain with 83 experiencing significant pain; in other words a ""worst pain"" rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients' daily functioning. Pain was documented on 71 of the patients' medical charts that were reviewed; however; only 34 were considered to be adequately managed for their pain.Conclusion: Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients' medical records; the management of pain was considered to be inadequate in a third of those experiencing pain."

Adequacy of Pain Management in HIV-Positive Patients

"Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence; severity; recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive; consenting HIV positive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain; pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life. Results: Ninety-one per cent of participants reported pain with 83 experiencing significant pain; in other words a ""worst pain"" rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients' daily functioning. Pain was documented on 71 of the patients' medical charts that were reviewed; however; only 34 were considered to be adequately managed for their pain. Conclusion: Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients' medical records; the management of pain was considered to be inadequate in a third of those experiencing pain."

The Social and Clinical Characteristics of Patients on Antiretroviral Therapy who are 'Lost to Follow-up' in KwaZulu-Natal; South Africa: a Prospective Study

A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms; quality of life; depression; herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-naive patients recruited from three (one urban; one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008. The aim of this study was to investigate predictors of loss to follow-up or all caused attrition from an ART programme within a cohort followed up for over 12 months. A total of 735 patients (217 men and 518 women) prior to initiating ART completed a baseline questionnaire and 6- and 12-months' follow-up. At 12-months follow-up 557 (75.9) individuals continued active ART; 177 (24.1) were all cause attrition; there were 82 deaths (13.8); 58 (7.9) transfers; 7 (1.0) refused participation; 8 (1.1) were not yet on ART and 22 (3.0) could not be traced. Death by 12-months of follow-up was associated with lower CD4 cell counts (risk ratio; RR=2.05; confidence intervals; CI=1.20 - 3.49) and higher depression levels (RR=1.05; CI=1.01 - 1.09) at baseline assessment. The high early mortality rates indicate that patients are enrolling into ART programmes with far too advanced immunodeficiency; median CD4 cell counts 119 (IQR=59 - 163). Causes of late access to the ART programme; such as delays in health care access (delayed health care seeking); health system delays; or inappropriate treatment criteria; need to be addressed. Differences in health status (lower CD4 cell counts and higher depression scores) should be taken into account when initiating patients on ART. Treating depression at ART initiation is recommended to improve treatment outcome

Limitations to practising holistically in the public sector in a rural sub-district in South Africa.

INTRODUCTION: The healthcare system in South Africa is based on the district health system through a primary healthcare approach. Although many vision and mission statements in the public healthcare sector in South Africa state that the service aspires to be holistic, it is at times unclear what exactly is meant by such an aspiration. The term 'holism' was coined in the 1920s and describes the phenomenon of the whole being greater than the sum of the parts. Over the past two decades the term has entered into many academic disciplines as well as popular culture. Also within public healthcare services, despite predominantly biomedical approaches, there is the aspiration to offer a more holistic service. As part of a larger research study, the limitations to working holistically in the public sector in a rural sub-district in South Africa were explored. METHODOLOGY: The study used a participatory action research design that allowed participants a large degree of influence over the direction of the study. The research group consisted of four primary healthcare nurses and one medical doctor, all working in the public sector in a rural sub-district. The research group took part in the process of design and data gathering phases, as well as analysing and making meaning of the data generated. After a thematic analysis of the transcribed meetings, interviews and field notes, the themes were shared with the participants, who arranged them into a graphic representation showing the interrelationships of the themes. RESULTS: From analysis of the data it was clear that there were significant limitations to practicing holistically in the public sector of the rural sub-district in which the study took place. The limitations were grouped into those arising from within the public healthcare system and those outside the healthcare system. Within the healthcare system, the main factors limiting holistic care were: limited resources; poor training in and knowledge of holistic care; poor supervision; distance from the community; the referral system, intersectoral work and bureaucracy. Outside the healthcare sector the following factors challenged the provision of holistic care: poverty; poor nutrition; HIV/AIDS; and the cultural context. All the limitations were found to contribute to the danger of burnout among healthcare workers who wanted to work holistically. The limitations were also found to have a negative impact on the healthcare worker-patient relationship, thereby further challenging holistic care. CONCLUSION: A number of aspects of the healthcare provision system that contributed to limiting the provision of holistic care could be changed quite readily, if there was a will to do so. Many of the issues seemed to plague the healthcare system generally, not only in relation to the provision of holistic care (such as supervision or a response to poverty). The close relationship between difficulty in providing a holistic healthcare service and burnout was an important finding that deserves further exploration.

Social support and health behaviour in women living with HIV in KwaZulu-Natal.

The article explores the relationship between social support and health behaviour of rural and urban women who are living with HIV in South Africa. Our study was a descriptive survey of a group of pregnant and non-pregnant women living with HIV. The sample size was 262 women, 165 from urban area and 97 from rural area. Data were collected using 3 instruments, namely a demographic questionnaire, the health behaviour schedule and the Medical Outcomes Study (MOS) Social Support Survey. Significant findings indicate that in the urban area 71% of women had disclosed their HIV status to someone, while in the rural area 49% had done so. A total of 77% of the women indicated that they were sexually active--21% had 2 partners and 20% indicated that they had at least one episode of a sexually transmitted disease since finding out their HIV status. A total of 16% said that they currently received counselling, which was significantly more frequent in the rural sample (27%) than the urban (11%). The membership of support groups is at 12% among the participating women, and social support as well as membership of a support group was higher in the rural group than the urban group. Good social support showed an association with condom use, support group attendance and taking vitamins. However, receiving counselling as well as membership of a support group showed stronger association with positive health behaviour than social support on its own. The higher social support was not associated with increased disclosure.

Social Support and Health Behaviour in Women Living with HIV in KwaZulu-Natal

The article explores the relationship between social support and health behaviour of rural and urban women who are living with HIV in South Africa. Our study was a descriptive survey of a group of pregnant and non-pregnant women living with HIV. The sample size was 262 women; 165 from urban area and 97 from rural area. Data were collected using 3 instruments; namely a demographic questionnaire; the health behaviour schedule and the Medical Outcomes Study (MOS) Social Support Survey. Significant findings indicate that in the urban area 71 of women had disclosed their HIV status to someone; while in the rural area 49 had done so.A total of 77 of the women indicated that they were sexually active - 21 had 2 partners and 20 indicated that they had at least one episode of a sexually transmitted disease since finding out their HIV status. A total of 16 said that they currently received counselling; which was significantly more frequent in the rural sample (27) than the urban (11).The membership of support groups is at 12 among the participating women; and social support as well as membership of a support group was higher in the rural group than the urban group. Good social support showed an association with condom use; support group attendance and taking vitamins. However; receiving counselling as well as membership of a support group showed stronger association with positive health behaviour than social support on its own. The higher social support was not associated with increased disclosure

Complete haematological and cytogenetic response to interferon alpha-2a of a myeloproliferative disorder with eosinophilia associated with a unique t(4;7) aberration.

A female patient with eosinophilia and cardiac symptoms was found to have a unique chromosomal aberration [t(4;7)(q11;p13)] of bone-marrow precursors. The disorder was classified as a chronic myeloproliferative syndrome with eosinophilia. Due to a significant increase in the white blood cell and eosinophil count during initial treatment with prednisone and hydroxyurea, Interferon alpha-2a was administered at a dose of 3-5 x 10(6) I.U. s.c., five times per week, and induced a long-term complete haematological and cytogenetic response. The clinical features of this case are presented and discussed in the context of the current literature.

[Characterization of T lymphocyte defects in patients with Hodgkin's disease using enzyme chemical markers]. / Charakterisierung des T-Lymphozyten-Defektes bei Patienten mit Morbus Hodgkin mit Hilfe enzymzytochemischer Marker.

Patients suffering from lymphogranulomatosis were studied with respect to cellular immune deficiencies. For this purpose, mononuclear cells from venous blood were separated and subjected to analysis of lymphocyte markers. T-lymphocytes were enumerated by means of the sheep erythrocyte (SE) rosette test. T cell subpopulations were determined using enzyme cytochemical staining for dipeptidyl peptidase IV (DP IV) and unspecific acid alphanaphthylacetate esterase (ANAE). In 18 patients with M. Hodgkin a significant reduction in the T lymphocyte count in peripheral blood was found. This T cell defect is due to a selective decrease in the TM-subpopulation as identified by enzyme cytochemical markers DP IV and ANAE (focal reaction). From these results it is concluded that patients with lymphogranulomatosis have characteristic abnormalities in the immune system in the sense of a disturbed equilibrium of immune regulatory cells.

[Treatment of plasmacytoma with hyperviscosity syndrome]. / Die Behandlung des Plasmozytoms mit Hyperviskositätssyndrom.

It is reported on the treatment of three patients with a hyperviscosity syndrome in IgG-plasmocytoma. Before every polychemotherapy cycle a plasma exchange was carried out, when the total protein in the serum and the immunoglobulins were essentially increased and clinical symptoms of the hyperviscosity syndrome were existing. The results and the possible effects on the efficacy of the therapy with cytostatic agents are discussed. In the light of our experiences we can recommend the membrane plasma filtration treatment as symptomatic therapeutic measure in the hyperviscosity syndrome.

[Non-Hodgkin lymphoma (NHL) as a primary finding in the central nervous system]. / Das Non-Hodgkin-Lymphom (NHL) als Primärbefund im ZNS.

The clinical picture is dealt with on the basis of seven cases of primarily recognised non-Hodgkin's lymphomas in the CNS treated by us. Because of the frequently serious initial situation immediate surgical intervention can on the one hand improve or remove the paralysis and, on the other, it will lead to histological diagnosis. Elderly patients with a lower degree of malignity show a better prognosis.