Centre for medical and healthcare education

Trigeminal neuralgia (TN) is a rare form of neuropathic facial pain characterised by severe, paroxysmal pains in the face. Little is known about the decision process in treatment of TN, and management with anti-epileptic drugs or surgical procedures carries risks of side effects, recurrence and complications. One hundred fifty-six previously diagnosed TN patients completed an adapted timetrade-off utility measurement questionnaire to ascertain how they valued the potential outcomes from various surgical and medical treatments. The decision analysis revealed that microvascular decompression surgery (MVD) offered the best chance of improved quality of life or highest maximum expected utility (MEU). MVD (MEU = 16.08 out of a possible 20) was closely followed by balloon compression (MEU = 15.97), percutaneous glycerol rhizolysis (MEU = 15.61) and then radiofrequency thermocoagulation (MEU = 14.93). Medication offered the least optimal chance of improved quality of life (MEU = 14.61). The difference between the highest (MVD) and lowest scoring treatments (medication) was 7.3% (1.46/20). These results were sensitive to some utility values, meaning the preferred treatment is changed by the values patients assign to outcomes. As surgical techniques narrowly offer the highest chance of maximising patient quality of life, all patients with TN should consider surgery. However, surgery is not right for everyone, and patients should be informed about their full range of choices. Treatment decisions must take place after careful consideration of the values patients place on benefits and risks of treatment. Ó

Background: Paediatric Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is relatively common and disabling with a mean time out of school of more than one academic year. NICE guidelines recommend referral to specialist services immediately if severely affected, within 3 months if moderately affected and within 6 months if mildly affected. However, the median time-to-assessment by a specialist service in the UK is 18 months. This study used a mixed-methods approach to examine factors associated with time taken to access specialist services. Methods: Time-to-assessment was analysed as a continuous "survival-time" variable in Cox regression models using data from self-completed assessment forms for children attending a regional specialist CFS/ME service between January 2006 and December 2009. Semi-structured interviews about barriers experienced in accessing healthcare for their child were conducted with nine parents of children aged < 17 years (8 individual and one parent couple). Interviews were digitally recorded and analysed using "thematic analysis". Results: 405 children were assessed between 2006 and 2009 and information on school attendance was available on 388. Only 1/125 with severe CFS/ME and 49/263 (19%) with mild to moderate CFS/ME were seen within NICE recommended timeframe. Increased fatigue was associated with shorter time to assessment (HR = 1.15; 95% CI 1.03, 1.29 per unit increase in Chalder fatigue score; P = 0.01). Time-to-assessment was not associated with disability, mood, age or gender. Parents described difficulties accessing specialist services because of their own as well as their GP's and Paediatrician's lack of knowledge. They experienced negative attitudes and beliefs towards the child's condition when they consulted GPs, Paediatricians and Child Psychiatrists. Parents struggled to communicate an invisible illness that their child and not themselves were experiencing.

Mindfulness-based stress reduction (MBSR) has benefits for those with chronic pain. MBSR typically entails an intensive 8-week intervention. The effects of very brief mindfulness interventions are unknown. Among those with chronic pain, the immediate effects of a 10 min mindfulness-based body scan were compared with a control intervention. Fifty-five adult outpatients were randomly assigned to either: (1) mindfulness-based body scan (n = 27) or (2) a reading about natural history (control group, n = 28), provided via a 10 min audio-recording. Interventions were delivered twice across 24 h; once in the clinic and once in participants’ ‘normal’ environment. Immediately before and after listening to the recording, participants rated pain severity, pain related distress, perceived ability for daily activities, perceived likelihood of pain interfering with social relations, and mindfulness. In the clinic, there was a significant reduction in ratings for pain related distress and for pain interfering with social relations for the body scan group compared with the control group (p = 0.005; p = 0.036, respectively). In the normal environment none of the ratings were significantly different between the groups. These data suggest that, in a clinic setting, a brief body scan has immediate benefits for those experiencing chronic pain. These benefits need to be confirmed in the field.

The coming of globalization in the 21st century has brought to fore the urgent need of quality human resources in the economic system that exists on a very essential and complementary relationship between technology and people. Realizing such urgency,in view of the very fast advances in Information Technology, the private and public
colleges and universities continue to face the challenge of sustaining the educational program to produce quality and globally competitive graduates.

Labor Secretary Laguesma in a TV show (January 9, 2001) says, “Employmentshould be sustained despite the crisis.” This puts Technological Institutions, constantlyresponsive and effective entities of change, whose main responsibility is to maintain the
“Technician Education’s” timeliness and progressive mode of curricular program, in order to produce highly employable and competitive graduates with appropriate skills and work values; graduates that serve as strong manpower to close the gap between industry
and education, aid in solving the nation’s economic problem by sustaining the jobreadiness, job relevance, and competitive advantage of technician education graduates inthe “Age of Globalization” through curricular program that is adaptive to the changing need. As Santos (2000) puts it, there is, therefore a compelling need for education
leaders to face the challenge of “adaptive change” or be left behind by nations, which are trailing us today.

INTRODUCTION The coming of globalization in the 21 century has brought to fore the urgent need of quality human resources in the economic system that exists on a very essential and complementary relationship between technology and people. Realizing such urgency, in view of the very fast advances in Information Technology, the private and public colleges and universities continue to face the challenge of sustaining the educational program to produce quality and globally competitive graduates. Labor Secretary Laguesma in a TV show (January 9, 2001) says, “Employment should be sustained despite the crisis.” This puts Technological Institutions, constantly responsive and effective entities of change, whose main responsibility is to maintain the “Technician Education’s” timeliness and progressive mode of curricular program, in order to produce highly employable and competitive graduates with appropriate skills and work values; graduates that serve as strong manpower to close the gap betw...