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      Project OPUS: Development and evaluation of an electronic platform for pain management education of medical undergraduates in resource-limited settings

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          Abstract

          Introduction

          Pain is a very frequent symptom that is reported by patients when they present to health professionals but remains undertreated or untreated, particularly in low-resource settings including Nigeria. Lack of training in pain management remains the most significant obstacle to pain treatment alongside an inadequate emphasis on pain education in undergraduate medical curricula, negatively impacting on subsequent care of patients. This study aimed to determine the effect of a 12-week structured e-Learning course on the knowledge of pain management among Nigerian undergraduate medical students.

          Methods

          Prospective, multisite, pre-post study conducted across five medical colleges in Nigeria. Structured modules covering aspects of pain management were delivered on an e-Learning platform. Pre- and post-test self-assessments were carried out in the 12-week duration of the study. User experience questionnaires and qualitative interviews were conducted via instant messaging to evaluate user experiences of the platform. User experience data was analysed using the UEQ Data Analysis Tool and Framework Analysis.

          Results

          A total of 216 of 659 eligible students completed all sections of the e-Learning course. Participant mean age was 23.52 years, with a slight female predominance (55.3%). Across all participants, an increase in median pre- and post-test scores occurred, from 40 to 60 (Z = 11.3, p<0.001, effect size = 1.3), suggestive of increased knowledge acquisition relating to pain management. Participants suggested e-Learning is a valuable approach to delivering pain education alongside identifying factors to address in future iterations.

          Conclusion

          e-Learning approaches to pain management education can enhance traditional learning methods and may increase students’ knowledge. Future iterations of e-Learning approaches will need to consider facilitating the download of data and content for the platform to increase user uptake and engagement. The platform was piloted as an optional adjunct to existing curricula. Future efforts to advocate and support integration of e-Learning for pain education should be two-fold; both to include pain education in the curricula of medical colleges across Nigeria and the use of e-Learning approaches to enhance teaching where feasible.

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          Most cited references40

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          Using the framework method for the analysis of qualitative data in multi-disciplinary health research

          Background The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
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            The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises

            The current International Association for the Study of Pain (IASP) definition of pain as "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" was recommended by the Subcommittee on Taxonomy and adopted by the IASP Council in 1979. This definition has become accepted widely by health care professionals and researchers in the pain field and adopted by several professional, governmental, and nongovernmental organizations, including the World Health Organization. In recent years, some in the field have reasoned that advances in our understanding of pain warrant a reevaluation of the definition and have proposed modifications. Therefore, in 2018, the IASP formed a 14-member, multinational Presidential Task Force comprising individuals with broad expertise in clinical and basic science related to pain, to evaluate the current definition and accompanying note and recommend whether they should be retained or changed. This review provides a synopsis of the critical concepts, the analysis of comments from the IASP membership and public, and the committee's final recommendations for revisions to the definition and notes, which were discussed over a 2-year period. The task force ultimately recommended that the definition of pain be revised to "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage," and that the accompanying notes be updated to a bulleted list that included the etymology. The revised definition and notes were unanimously accepted by the IASP Council early this year.
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              Causes and consequences of inadequate management of acute pain.

              Intense acute pain afflicts millions of patients each year. Despite the recently increased focus on the importance of pain control, management of acute pain has remained suboptimal.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: Writing – review & editing
                Role: Data curationRole: Project administrationRole: SoftwareRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                10 December 2020
                2020
                : 15
                : 12
                : e0243573
                Affiliations
                [1 ] Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
                [2 ] EPAC Research Team, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
                [3 ] Department of Radiation Medicine, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
                [4 ] African Palliative Care Association, Kampala, Uganda
                [5 ] Department of Mental Health, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
                [6 ] Oncology and Pathological Studies (OPS) Unit, Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos/ Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria
                [7 ] Department of Anaesthesia, College of Health Sciences, Bayero University/Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
                [8 ] Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
                [9 ] Department of Anaesthesia, College of Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
                [10 ] College of Medicine, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria
                [11 ] InStrat Global Health Solutions, Abuja, Nigeria
                [12 ] Department of Haematology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
                [13 ] Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
                Fondazione Ugo Bordoni, ITALY
                Author notes

                Competing Interests: Okey Okuzu is Founder and CEO, and Chinelo Oduche a Project Manager, for InStrat Global Health Solutions, the company providing the software on which the e-Learning platform was developed in collaboration with the research team. This commercial affiliation does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors declare no conflict of interest.

                Author information
                https://orcid.org/0000-0001-8138-3100
                https://orcid.org/0000-0002-0957-7389
                https://orcid.org/0000-0002-7399-0194
                Article
                PONE-D-20-19766
                10.1371/journal.pone.0243573
                7728241
                33301477
                e0f35e62-2047-461a-a6c2-5d9ceaa0dc36
                © 2020 Onyeka et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 26 June 2020
                : 23 November 2020
                Page count
                Figures: 5, Tables: 7, Pages: 20
                Funding
                Funded by: International Association for the Study of Pain
                Award Recipient :
                Funded by: African Palliative Care Association
                Award Recipient :
                Funded by: University Of Nigeria Nsukka (NG)
                Award Recipient :
                The e-Learning platform development was funded by the International Association for the Study of Pain (IASP) through the 2019 IASP Developing Countries Project: Initiative for Improving Pain Education Grant, a scientific grant awarded to T.C. Onyeka, M. Allsop, N. Iloanusi and E. Namisango. IASP funding supported the development of the e-Learning platform. Institutional support was provided by the College of Medicine, University of Nigeria (Enugu, Nigeria) and the African Palliative Care Association (Kampala, Uganda) to support staff costs to undertake research and evaluation activities. The funders provided support in the form of salaries for authors [TO, EN], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The commercial partner for this study, InStrat Global Health Solutions [OO, CO], did not provide funding to support this project. InStrat Global Health Solutions did not contribute to the study design, analysis or decision to publish. The platform developed by InStrat Global Health Solutions supported the collection of study data entered by study participants and the company provided technical input into the manuscript, supporting the description of the functionality of the eLearning platform. The specific roles of these authors are articulated in the ‘author contributions’ section.
                Categories
                Research Article
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Pain
                Medicine and Health Sciences
                Pain Management
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Psychology
                Learning
                Human Learning
                Biology and Life Sciences
                Psychology
                Cognitive Psychology
                Learning
                Human Learning
                Social Sciences
                Psychology
                Cognitive Psychology
                Learning
                Human Learning
                Biology and Life Sciences
                Neuroscience
                Learning and Memory
                Learning
                Human Learning
                People and Places
                Population Groupings
                Educational Status
                Undergraduates
                Social Sciences
                Sociology
                Education
                Medical Education
                Medicine and Health Sciences
                Medical Humanities
                Medical Education
                People and Places
                Geographical Locations
                Africa
                Nigeria
                Computer and Information Sciences
                Computer Networks
                Internet
                Medicine and Health Sciences
                Oncology
                Cancer Treatment
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

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