Needle procedures

2021 ◽  
pp. 192-200
Author(s):  
Anna Taddio
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Medical Care ◽  
Current Knowledge ◽  
Standard Of Care ◽  
Routine Clinical Practice ◽  
Evidence Based ◽  
Health Providers ◽  
Routine Medical Care ◽  
Potential Benefits

All children undergo needle procedures as part of routine medical care. Numerous interventions are available for relieving pain from needle procedures. These interventions can be divided into four domains (4 Ps of pain management): Procedural, pharmacological, psychological, and physical. Treating needle pain reduces pain and distress and improves satisfaction with medical care. Other potential benefits include a reduction in the development of needle fear and subsequent healthcare avoidance behavior. Adoption of the 4 Ps into routine clinical practice is feasible and should become a standard of care in the delivery of health care for children. There are various effective approaches for translating the research evidence into practice that target different stakeholders involved in children’s health care, including children, parents, health providers, and educators. This chapter is a narrative review of the current knowledge about epidemiology, pain experience, practices and attitudes, evidence-based interventions, and knowledge translation for pain management during common needle procedures.

Needle procedures

2013 ◽  
pp. 184-193 ◽  
Author(s):  
Anna Taddio
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Medical Care ◽  
Current Knowledge ◽  
Standard Of Care ◽  
Routine Clinical Practice ◽  
Evidence Based ◽  
Pain Experience ◽  
Routine Medical Care ◽  
Potential Benefits

All children undergo needle procedures as part of routine medical care. Numerous interventions are available for relieving pain from needle procedures. These interventions can be divided into four domains (4 Ps of pain management): procedural, pharmacological, psychological, and physical. Treating needle pain reduces pain and distress and improves satisfaction with medical care. Other potential benefits include a reduction in the development of needle fear and subsequent health care avoidance behaviour. Adoption of the 4Ps into routine clinical practice is feasible and should become a standard of care in the delivery of health care for children. This chapter is a narrative review of the current knowledge about: epidemiology, pain experience, practices and attitudes, and evidence-based interventions for pain management during common needle procedures.

The legal and ethical aspects of telemedicine. 4: Product liability and jurisdictional problems

1998 ◽  
Vol 4 (3) ◽  
pp. 132-139 ◽  
Author(s):  
Ben Stanberry
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Human Factor ◽  
Product Liability ◽  
Standard Of Care ◽  
Review Article ◽  
Medical Professionals ◽  
Communications Technology ◽  
Ethical Aspects ◽  
Cross Border

The use of telemedicine brings with it the risk that the human factor-the teleconsultant-will fail to reach the standard of care that the law requires of medical professionals. It also brings the risk that the telemedical equipment or system will fail at a crucial moment. Such risks, of course, are inherent in many aspects of medical care but in telemedicine, at the interface between communications technology and health care, one must consider not only who is liable for failure, but under which country's laws will that liability be determined. This final review article describes the challenges facing manufacturers and their customers in providing safe, properly endorsed telemedicine systems. The problem of which country's laws should apply to a cross-border teleconsultation is also reviewed.

scholarly journals Evidence-Based Medicine, Systematic Reviews, and Guidelines in Interventional Pain Management, Part I: Introduction and General Considerations

2008 ◽  
Vol 2;11 (3;2) ◽  
pp. 161-186
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Critical Appraisal ◽  
Evidence Based Practice ◽  
The United States ◽  
Evidence Based ◽  
Interventional Pain Management ◽  
Based Medicine

Evidence-based medicine, systematic reviews, and guidelines are part of modern interventional pain management. As in other specialties in the United States, evidence-based medicine appears to motivate the search for answers to numerous questions related to costs and quality of health care as well as access to care. Scientific, relevant evidence is essential in clinical care, policy-making, dispute resolution, and law. Consequently, evidence based practice brings together pertinent, trustworthy information by systematically acquiring, analyzing, and transferring research findings into clinical, management, and policy arenas. In the United States, researchers, clinicians, professional organizations, and government are looking for a sensible approach to health care with practical evidence-based medicine. All modes of evidence-based practice, either in the form of evidence-based medicine, systematic reviews, meta-analysis, or guidelines, evolve through a methodological, rational accumulation, analysis, and understanding of the evidentiary knowledge that can be applied in clinical settings. Historically, evidence-based medicine is traceable to the 1700s, even though it was not explicitly defined and advanced until the late 1970s and early 1980s. Evidence-based medicine was initially called “critical appraisal” to describe the application of basic rules of evidence as they evolve into application in daily practices. Evidence-based medicine is defined as a conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based practice is defined based on 4 basic and important contingencies, which include recognition of the patient’s problem and construction of a structured clinical question, thorough search of medical literature to retrieve the best available evidence to answer the question, critical appraisal of all available evidence, and integration of the evidence with all aspects and contexts of the clinical circumstances. Systematic reviews provide the application of scientific strategies that limit bias by the systematic assembly, critical appraisal, and synthesis of all relevant studies on a specific topic. While systematic reviews are close to meta-analysis, they are vastly different from narrative reviews and health technology assessments. Clinical practice guidelines are systematically developed statements that aim to help physicians and patients reach the best health care decisions. Appropriately developed guidelines incorporate validity, reliability, reproducibility, clinical applicability and flexibility, clarity, development through a multidisciplinary process, scheduled reviews, and documentation. Thus, evidence-based clinical practice guidelines represent statements developed to improve the quality of care, patient access, treatment outcomes, appropriateness of care, efficiency and effectiveness and achieve cost containment by improving the cost benefit ratio. Part 1 of this series in evidence-based medicine, systematic reviews, and guidelines in interventional pain management provides an introduction and general considerations of these 3 aspects in interventional pain management. Key words: Evidence-based medicine, systematic reviews, clinical guidelines, narrative reviews, health technology assessments, grading of evidence, recommendations, grading systems, strength of evidence.

Confronting Medicine’s Dichotomies: Older Adults’ Use of Interpretative Repertoires in Negotiating the Paradoxes of Polypharmacy and Deprescribing

2019 ◽  
Vol 30 (3) ◽  
pp. 448-457 ◽  
Author(s):  
Alison Ross ◽  
James Gillett
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Medical Care ◽  
Health Care Providers ◽  
Qualitative Interviews ◽  
Care Providers ◽  
Routine Medical Care ◽  
Interpretative Repertoires

To address the risks associated with polypharmacy, health care providers are investigating the feasibility of deprescribing programs as part of routine medical care to reduce medication burden to older adults. As older adults are enrolled in these programs, they are confronted with two dominant and legitimate accounts of medications, labeled the medication paradox: medications keep you healthy but they might be making you sick. We investigated how the medication paradox operates in the lives of older adults. In-depth qualitative interviews were conducted and analyzed with older adults aged 70+ to identify the various paradoxes that seniors live through regarding their medications and the narratives that they engage to negotiate these contradictions. Older adults were found to have established interpretative repertoires to make sense of the incongruent narratives of the medication paradox. In this article, we demonstrate older adults’ efforts to carve out their unique place in the dichotomized institution of medicine.

scholarly journals American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature, a Compilation of Expert Opinion, and Next Steps

2020 ◽  
Vol 41 (6) ◽  
pp. 1129-1151
Author(s):  
Kathleen S Romanowski ◽  
Joshua Carson ◽  
Kate Pape ◽  
Eileen Bernal ◽  
Sam Sharar ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Control ◽  
English Language ◽  
Pain Treatment ◽  
Current Knowledge ◽  
Standard Of Care ◽  
Expert Consensus ◽  
Medline Search ◽  
Burn Care ◽  
Burn Patient

Abstract The ABA pain guidelines were developed 14 years ago and have not been revised despite evolution in the practice of burn care. A sub-committee of the American Burn Association’s Committee on the Organization and Delivery of Burn Care was created to revise the adult pain guidelines. A MEDLINE search of English-language publications from 1968 to 2018 was conducted using the keywords “burn pain,” “treatment,” and “assessment.” Selected references were also used from the greater pain literature. Studies were graded by two members of the committee using Oxford Centre for Evidence-based Medicine—Levels of Evidence. We then met as a group to determine expert consensus on a variety of topics related to treating pain in burn patients. Finally, we assessed gaps in the current knowledge and determined research questions that would aid in providing better recommendations for optimal pain management of the burn patient. The literature search produced 189 papers, 95 were found to be relevant to the assessment and treatment of burn pain. From the greater pain literature 151 references were included, totaling 246 papers being analyzed. Following this literature review, a meeting to establish expert consensus was held and 20 guidelines established in the areas of pain assessment, opioid medications, nonopioid medications, regional anesthesia, and nonpharmacologic treatments. There is increasing research on pain management modalities, but available studies are inadequate to create a true standard of care. We call for more burn specific research into modalities for burn pain control as well as research on multimodal pain control.

scholarly journals Development of an Electronic Database for Acute Pain Service Outcomes

2012 ◽  
Vol 17 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Brandy L Love ◽  
Louise A Jensen ◽  
Donald Schopflocher ◽  
Ban CH Tsui
Keyword(s):  
Health Care ◽  
Quality Assurance ◽  
Pain Management ◽  
Data Collection ◽  
Acute Pain ◽  
Acute Pain Service ◽  
Treatment Quality ◽  
Evidence Based ◽  
Electronic Database ◽  
Database Development

From mitigating complications during hospital stay to reducing the incidence of chronic pain, improving pain management positively impacts short- and long-term outcomes of treatment. Quality assurance has become the focus of many health care programs in an effort to confront the challenges presented by pain and its management. The analysis of treatment strategies and patient responses form the basis of a reflective, evidence-based practice, which can raise awareness of about the importance of adequate pain management. The capabilities of an electronic database can be exploited to organize large amounts of data, which can then be used to characterize symptoms and analyze treatment responses. However, the types of data to collect, the burden of data collection on workers, and costs must be considered before implementing an electronic database for research and/or everyday practice. This study tested the relevance and usability of an electronic database in an acute pain service by assessing several variables important to database development and evaluation.BACKGROUND: Quality assurance is increasingly important in the current health care climate. An electronic database can be used for tracking patient information and as a research tool to provide quality assurance for patient care.OBJECTIVE: An electronic database was developed for the Acute Pain Service, University of Alberta Hospital (Edmonton, Alberta) to record patient characteristics, identify at-risk populations, compare treatment efficacies and guide practice decisions.METHOD: Steps in the database development involved identifying the goals for use, relevant variables to include, and a plan for data collection, entry and analysis. Protocols were also created for data cleaning quality control. The database was evaluated with a pilot test using existing data to assess data collection burden, accuracy and functionality of the database.RESULTS: A literature review resulted in an evidence-based list of demographic, clinical and pain management outcome variables to include. Time to assess patients and collect the data was 20 min to 30 min per patient. Limitations were primarily software related, although initial data collection completion was only 65% and accuracy of data entry was 96%.CONCLUSIONS: The electronic database was found to be relevant and functional for the identified goals of data storage and research.

scholarly journals Knowledge Transfer in Surgery: Skills, Process and Evaluation

2007 ◽  
Vol 89 (8) ◽  
pp. 749-753 ◽  
Author(s):  
Martin Dawes ◽  
Marko Lens
Keyword(s):  
Health Care ◽  
Knowledge Transfer ◽  
Clinical Evidence ◽  
Essential Element ◽  
Routine Clinical Practice ◽  
Evidence Based ◽  
Literature Teaching ◽  
Based Medicine ◽  
Practice Skills

INTRODUCTION Knowledge transfer is an essential element in the management of surgical health care. In a routine clinical practice, surgeons need to make changes to the health care they provide as new clinical evidence emerges. MATERIALS AND METHODS The information was derived from the authors' experience and research in evidence-based practice, searching of the literature, teaching and organisation of various national and international workshops on evidence-based medicine. DISCUSSION This manuscript discusses principles of knowledge transfer in surgery including evaluation of recommended changes that can improve quality of health care in routine surgical practice. Skills, process and evaluation are carefully described. Continuous information delivery is required to enable surgeons to improve knowledge transfer and to keep up to date their knowledge.

scholarly journals Can Just-in-Time, Evidence-Based “Reminders” Improve Pain Management Among Home Health Care Nurses and Their Patients?

2005 ◽  
Vol 29 (5) ◽  
pp. 474-488 ◽  
Author(s):  
Margaret V. McDonald ◽  
Liliana E. Pezzin ◽  
Penny H. Feldman ◽  
Christopher M. Murtaugh ◽  
Timothy R. Peng
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Home Health Care ◽  
Home Health ◽  
Just In Time ◽  
Evidence Based

scholarly journals A Perfect Storm in Interventional Pain Management: Regulated, but Unbalanced

2010 ◽  
Vol 2;13 (1;2) ◽  
pp. 109-116
Author(s):  
Ramsin M. Benyamin
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Interventional Techniques ◽  
Research Bias ◽  
Interventional Pain Management ◽  
Based Medicine ◽  
The Impact ◽  
Perfect Storm

Interventional pain management now stands at the crossroads at what is described as “the perfect storm.” The confluence of several factors has led to devastating results for interventional pain management. This article seeks to provide a perspective to various issues producing conditions conducive to creating a “perfect storm” such as use and abuse of interventional pain management techniques, and in the same context, use and abuse of various non-interventional techniques. The rapid increase in opioid drug prescribing, costs to health care, large increases in death rates, and random and rampant drug testing, can also lead to increases in health care utilization. Other important aspects that are seldom discussed include medico-legal and ethical perspectives of individual and professional societal opinions and the interpretation of diagnostic accuracy of controlled diagnostic blocks. The aim of this article is to discuss the impact of several factors on interventional pain management and overuse, abuse, waste, and fraud; inappropriate application without evidence-based literature support (sometimes leading to selective use or non-use of randomized or observational studies for proving biased viewpoints — post priori rather than a priori), and issues related to multiple professional societies having their own agendas to push rather than promulgating the science of interventional pain management. This perspective is based on a review of articles published in this issue of Pain Physician, information in the public domain, and other relevant articles. Based on the results of this review, various issues of relevance to modern interventional pain management are discussed and the viewpoints of several experts debated. In conclusion, supporters of interventional pain management disagree on multiple aspects for various reasons while detractors claim that interventional pain management should not exist as a speciality. Issues to be addressed include appropriate use of evidence-based medicine (EBM), overuse, overutilization, and abuse. Key words: Interventional pain management, interventional techniques, physician payment reform, fraud, abuse, evidence-based medicine, health care costs, comparative effectiveness research, bias

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