Papers by Pati Dzotsenidze
European Journal of Cancer Supplements, 2009
Results: AWP provides a graphical user interface for the selection of analysis type and parameter... more Results: AWP provides a graphical user interface for the selection of analysis type and parameters , for performing the analysis and for displaying the results in text and in graphs. It also allows the user to save a statistical report in Microsoft Word and PDF format. At present, a functional Web portal has been established at one department. Conclusion: The Analytic Web Portal helps physicians and decision makers to assess the efficacy of standard cancer treatments. Data on the quality of standard treatment can be generated whenever needed. It facilitates a possibility to change standard treatment if data shows inferior survival compared to what would be expected. Survival data between different institutions can be compared due to the well defined interface of AWP to other databases. 3055 POSTER Does self regulation and autonomic regulation have an influence on survival in breast and colon carcinoma patients?-results of a prospective study
European Journal of Pain, 2009
There are no common guidelines for treating chronic noncancer pain (CNCP) in Russia. Purpose: To ... more There are no common guidelines for treating chronic noncancer pain (CNCP) in Russia. Purpose: To study the current approaches to CNCP treatment opioid analgesics’ usage in this condition. Methods: Interviews with doctors to find out their opinion on CNCP and their real practice in this field in out-patient clinics were held. Before the interview each doctor filled 5 clinic cards/CC on patients with CNCP. 375 doctors (150 general practitioners/GP, 150 neurologists/N and 75 rheumatologists/R) were interviewed, 1875 CC were filled. Results: The doctors’ interviews showed that for severe and very severe CNCP they prescribe in 98% of the cases nonsteroidal anti-inflammatory drugs/NSAID, in 87% central analgesics/CA, in 84% muscle relaxants/MR, in 68% antidepressants, in 51% glucocorticoids, in 20% opioid analgesics/OA. The main reason to avoid the prescription of OA in 58% is a complicated process of its prescription and control, in 40% (GP 42%, N 37%, R 40%), consider that OA could be prescribed for cancer patients, in 34% (31%, 35% and 37%) they fear of drug abuse, in 20% of cases (25%, 17%, 16%) administrative barriers. According to CC data less then 80% of patients received NSAID, about 3% muscle relaxants, CA and OA, less then 1% other medicines. Summary: Theoretical knowledge and preferences of doctors do not correspond to the real clinic practice of CNCP. The majority of Russian doctors are mostly not oriented to prescribe opioid analgesics in cases of severe and very severe noncancer pain.
The purpose of the study is to determine the importance of a multidisciplinary approach in pallia... more The purpose of the study is to determine the importance of a multidisciplinary approach in palliative care and to study the challenges in this regard in Georgia. The study showed a geographical imbalance in the field of palliative care, in particular, the state program of ambulatory palliative care is
EXPERIMENTAL & CLINICAL MEDICINE GEORGIA
Oxford Textbook of Public Health Palliative Care
This chapter discusses the essential roles of global and national palliative care advocacy in lay... more This chapter discusses the essential roles of global and national palliative care advocacy in laying the normative, legal, and technical groundwork for sustainable compassionate communities within national and subnational boundaries. It focuses on how evidence-based advocacy can promote the integration of palliative care into primary care to improve quality of life for patients and families in the low-, middle-, and upper middle-income countries that are the centre of the ‘pandemic of untreated [. . .] pain’. Part I discusses international law, advocacy, and palliative care praxis, Part II reviews advocacy issues for improved access to essential palliative care medicines, while Part III presents a case study of palliative care development in the Republic of Georgia, a former Soviet republic.
Journal of pain and symptom management, Jan 29, 2018
Chronic pain management with opioids in incurable patients remains a challenge of modern medicine... more Chronic pain management with opioids in incurable patients remains a challenge of modern medicine regardless of the evidence-based effectiveness of opioids and recommendations of authorities such as the World Health Organization and International Narcotics Control Board. Many countries, including Georgia, maintain overly restrictive regulations that contribute to inadequate pain management. To identify barriers to pain management in Georgia caused by legislation, administrative issues, and physicians' lack of knowledge and understanding of legislative aspects governing opioid use, and their impact on opioid-prescribing practice. We conducted a survey among 550 primary health care physicians. In total, 302 physicians completed the questionnaire. Overall, 289 questionnaires were analyzed statistically with SPSS version 20 (Armonk, NY: IBM Corp.). We found that 38% of the physicians avoid prescribing opioids and only one-third of the physicians make an independent decision to treat...
Journal of Pain and Symptom Management
In the Republic of Georgia, the incidence and prevalence of cancer are increasing, signifying a g... more In the Republic of Georgia, the incidence and prevalence of cancer are increasing, signifying a growing need for palliative care and pain relief, including with controlled opioid medicines. As a signatory to the Single Convention, the Georgian government has a responsibility to ensure the adequate availability of controlled medicines for medical purposes; however, the consumption of morphine is very low, suggesting a high occurrence of unrelieved pain. In Georgia, palliative care development began in the 2000s including the adoption of a policy document in 2005, the creation of the National Palliative Care Coordinator in 2006, and important changes in Georgian legislation in 2007 and 2008, which served to lay a foundation for improving opioid availability. In 2008, a neurologist from the Sarajishvili Institute of Neurology and Neurosurgery in Tbilisi, and member of the Georgia National Association for Palliative Care, was selected to be an International Pain Policy Fellow to focus on improving opioid availability. Working with colleagues, government officials, and international experts, the Fellow contributed to several improvements to opioid availability, such as 1) positive changes to opioid prescribing legislation, 2) clarification of legislative terminology regarding dependence syndrome, 3) initiating the importation of both sustained-release and immediate-release oral morphine, and 4) improvements in the availability of sustained-release morphine. Despite these varied achievements, morphine consumption remains low in Georgia relative to the estimated amounts needed. The Fellow is continuing to study and understand the barriers that are impeding physician's prescription of opioids and patient's acceptance of them.
Background: Though the negative impact of chronic pain on incurable patients is well known, hardl... more Background: Though the negative impact of chronic pain on incurable patients is well known, hardly anything has changed regarding pain management in Georgia. Efforts to improve availability and accessibility of opioid analgesics (OAs), critical for severe pain relief, started a decade ago through refinement of the legislation, followed by importation of oral morphine formulations and the introduction of modern guidelines in chronic pain management. Despite these activities and significant progress, the desirable results were not achieved. The morphine consumption rates, the most objective indicator for adequate pain control, remain critically low. Aim: To highlight the impediments and discrepancies in Georgian legislation influencing pain management. Methods: We analyzed the legislation regulating the medical use of OAs to identify barriers to OA availability and accessibility. This analysis was guided by and compared to internationally recognized indicators, and then reviewed t...
European journal of pain (London, England)
Journal of Pain and Symptom Management
Georgia has established the foundational measures for a national palliative care programdpolicy, ... more Georgia has established the foundational measures for a national palliative care programdpolicy, education, drug availability, and implementation. Amendments to legislation needed to develop palliative care have been approved. Palliative care has been recognized as a subspecialty in oncology, critical care, internal medicine, and surgery. The National Plan for Palliative Care for 2011e2016 was approved. Opioids, especially oral morphine, are available on a limited basis for patients at home, but oral morphine is not available for patients in the hospital. Prescribing regulations have changed and all physicians are allowed to prescribe and the length of a prescription is now seven days rather than three days previously. Unfortunately, patients and families must still pick up their opioid medications at pharmacies in the police station. Opioids for cancer patients in inpatient units or at home are free. Palliative care education has been incorporated into both undergraduate and postgraduate medical and nursing education and a number of physicians have received specialist training abroad. Palliative Care Standards and Guidelines have been developed; and palliative care services, although insufficient to meet the need, are available for patients at home, as inpatients and a children's hospice opened in 2017.
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Papers by Pati Dzotsenidze