Browsing by Author "Leiva, Ofelia"

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    Impact of a Curriculum Reform in Graduate Students Self-Reported Palliative Care Competencies
    (Elsevier Inc., 2025) Grez Artigues, Mónica Bernardita; Rodríguez Núñez, Alfredo; Maldonado Morgado, Armando José; Castro, Felipe; Orozco Soto, Nicolás Ignacio; Crispino Gastelumendi, Luciana; Villouta Cassinelli, María Francisca; Jaña Pozo, Carolina Andrea; Leiva, Ofelia; Pérez Cruz, Pedro
    Introduction. Expanding quality basic palliative care (PC) training for undergraduate health professionals is a key strategy to secure timely access to PC for the large population in need. However, evidence on the impact of changes in undergraduate medical curriculum in PC remains limited. This study aimed to assess the impact of expanded undergraduate PC training on students’ self-perceived competencies, knowledge, and training adequacy, comparing cohorts before and after a curricular reform. Methods. In this cross-sectional study, recently graduated medical students from two cohorts at the same university—one with limited exposure and the other with extended exposure to a PC curriculum—were invited to complete an electronic survey. The aim was to assess their perception of the PC training received during medical school, their self-assessed core competencies, and their knowledge in the field. Results. 157 (64%) out of 244 graduates answered the survey. Students exposed to the extended PC curriculum, more frequently reported that the theoretical and practical contents received were sufficient (P < 0.001), had higher scores in PC knowledge assessment and, reported having significantly more skills to deliver bad news (P = 0.01), to evaluate physical symptoms (P = 0.04), spiritual symptoms (P = 0.01), to explain what the PC consist of (P = 0.028) and to evaluate emotional symptoms (P = 0.003). Conclusions. Integrating and increasing exposure to PC training throughout the entire medical school curriculum enhances recently graduated medical students’ perception of the adequacy of their training, strengthens their self-perceived competencies, and improves their knowledge in PC. J Pain Symptom Manage 2025;000:1−10.
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    Is acetaminophen beneficial in patients with cancer pain who are on strong opioids? A randomized controlled trial
    (2023) Leiva, Ofelia; Letelier Saavedra, Luz María; Rojas Orellana, Luis; Viviani García, Paola; Castellano, Joel; González Candia, Antonio Felipe; Pérez Cruz, Pedro
    ContextPain is common among cancer patients. The evidence recommends using strong opioids in moderate to severe cancer pain. No conclusive evidence supports the effectiveness of adding acetaminophen to patients with cancer pain who are already using this regime.ObjectiveTo assess the analgesic efficacy of acetaminophen in hospitalized cancer patients with moderate to severe pain receiving strong opioids.MethodsIn this randomized blinded clinical trial, hospitalized cancer patients with moderate or severe acute pain managed with strong opioids were randomized to acetaminophen or placebo. The primary outcome was pain intensity difference between baseline and 48 hours using the Visual Numeric Rating Scales (VNRS). Secondary outcomes included change in morphine equivalent daily dose (MEDD), and patients’ perception of improved pain control.ResultsAmong 112 randomized patients, 56 patients received placebo, 56 acetaminophen. Mean (standard deviation (SD)) decrease in pain intensity (VNRS) at 48 hours were 2.7 (2.5) and 2.3 (2.3), respectively (95% Confidence Interval(CI) [-0.49;1.32];p=0.37). Mean (SD) change in MEDD was 13.9 (33.0) mg/day and 22.4 (57.7), respectively (95% CI [-9.24;26.1];p=0.35). The proportion of patients perceiving pain control improvement after 48 hours was 82% in the placebo and 80% in the acetaminophen arms (p=0.81).ConclusionAmong patients with cancer pain on strong opioid regime, acetaminophen may not improve pain control, or decrease total opioid use. These results add to the current evidence available suggesting not to use acetaminophen as an adjuvant for advanced cancer patients with moderate to severe cancer pain who are on strong opioids.
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    Opioid prescribing for cancer pain in Latin America: systematic review
    (2024) Leiva, Ofelia; Chukwusa, Emeka; Nkhoma, Kennedy; Dittborn, Mariana; Turrillas, Pamela; Pastrana, Tania
    Objective To explore opioid prescribing patterns for cancer pain in Latin America (LA).Methods A systematic review was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Relevant databases, including MEDLINE, EMBASE, PubMed, LILACS and Scielo, were searched from inception to June 2023. Empirical studies of opioid prescription patterns in adult palliative care patients with cancer pain were included. Methodological quality was assessed using the Effective Public Health Practice Project tool. Data were analysed using narrative synthesis. Descriptive statistical analyses were conducted using SPSS V.28 (IBM). Categorical variables were summarised using frequencies and percentages and continuous variables as means or medians.Results Seventeen studies from six countries were included. Ten were observational, while seven were experimental, including five randomised controlled trials (RCT) and two non-RCT. Most were low or moderate methodological quality. Out of 7809 patients, morphine (54%) and tramadol (18%) were the most prescribed opioids. The median of morphine equivalent daily dose was 26 mg (IQR 26-41).Conclusion Latin America shows lower opioid consumption rates compared with high-income countries for control pain management (CPM). More rigorous research on CPM in LA is needed. Additionally, a comprehensive review of opioid prescription patterns, including non-cancer diagnoses, is necessary.
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    Paracetamol como coadyuvante a opioides fuertes en dolor oncológico moderado a intenso: ¿es realmente efectivo?
    (Sociedad Medica de Santiago, 2021) Leiva, Ofelia; Pérez Cruz, Pedro
    Cancer related pain is one of the most frequent and relevant symptoms in patients with malignant tumors, causing a huge impact in their quality of life. According to the Chilean Public Health System Technical Report of the Cancer Pain Control and Palliative Care Program 2013-2014, 90% of cancer patients admitted to the Program experienced pain, being moderate or intense in 34%. International and local standards recommend the use of strong opioids (morphine, methadone, or fentanyl) associated with adjuvants such as paracetamol as an initial strategy for pain management. This recommendation assumes that the use of combined analgesics could allow the use of lower opioid doses to obtain similar analgesic effect, decreasing the occurrence of opioid side effects. However, this technical report also describes that there is uncertainty about the impact of paracetamol as an adjuvant in patients with cancer pain who are already receiving strong opioids. This review aims to describe the current state of the art regarding the role of paracetamol as a coadjuvant in cancer pain patients.
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    Randomized double-blind controlled trial to assess the efcacy of intravenous acetaminophen associated with strong opioids in the treatment of acute pain in adult cancer patients: study protocol
    (2022) Leiva, Ofelia; Castellano, Joel; Letelier Saavedra, Luz María; Rojas Orellana, Luis; Viviani García, Paola; González Candia, Antonio Felipe; Pérez Cruz, Pedro
    Background: Cancer pain is one of the most frequent and relevant symptoms in cancer patients and impacts on patient’s quality of life. International and local standards recommend as an initial strategy the use of an analgesic scheme composed of strong opioids associated with adjuvants such as acetaminophen, based upon the assumption that combining drugs could have a better analgesic effect, could allow lowering opioid dosing, and could prevent the occurrence of adverse effects of opioids. However, there is uncertainty about the impact of acetaminophen as an adjuvant in patients who use strong opioids for moderate to severe pain management in cancer patients. The aim of this study is to assess the efficacy and safety of intravenous acetaminophen associated with strong opioids in hospitalized adult cancer patients who have moderate to severe cancer-related pain. Methods: We will perform a randomized double-blinded controlled study comparing intravenous acetaminophen 1 g 4 times a day versus placebo for 48 h as an adjuvant to strong opioids. We will assess pain intensity as a primary outcome, using the verbal numerical rating scale (VNRS, I0 to 10 scale with higher scores meaning higher pain intensity), and we will compare the mean difference in pain intensity between baseline and 48 h among the placebo and intervention groups. We estimate that a decrease of 1 point in the VNRS would be clinically significant. Assuming a standard deviation in pain intensity of 1.7 points, an alpha of 0.025, and a power of 0.8, we estimate a sample size of 112 patients, with 56 patients in each arm. Secondary outcomes include the difference in total opioid use between baseline and at 48 h among the groups, and adverse effects such as drowsiness, constipation, nausea, and vomiting would be evaluated. Discussion: The randomized, double-blind, placebo-controlled design is the best strategy to assess the efficacy of acetaminophen as an adjuvant in adult cancer patients with moderate to severe pain who are receiving strong opioids. We expect to contribute to national and international guidelines with these results.