Self‐hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness

BackgroundAudit and feedback (A&F) enjoys widespread use, but often achieves only marginal improvements in care. Providing recipients of A&F with suggested actions to overcome barriers (action implementation toolbox) may increase effectiveness.ObjectiveTo assess the impact of adding an action implementation toolbox to an electronic A&F intervention targeting quality of pain management in intensive care units (ICUs).Trial designTwo-armed cluster-randomised controlled trial. Randomisation was computer generated, with allocation concealment by a researcher, unaffiliated with the study. Investigators were not blinded to the group assignment of an ICU.ParticipantsTwenty-one Dutch ICUs and patients eligible for pain measurement.InterventionsFeedback-only versus feedback with action implementation toolbox.OutcomeProportion of patient-shift observations where pain management was adequate; composed by two process (measuring pain at least once per patient in each shift; re-measuring unacceptable pain scores within 1 hour) and two outcome indicators (acceptable pain scores; unacceptable pain scores normalised within 1 hour).Results21 ICUs (feedback-only n=11; feedback-with-toolbox n=10) with a total of 253 530 patient-shift observations were analysed. We found absolute improvement on adequate pain management in the feedback-with-toolbox group (14.8%; 95% CI 14.0% to 15.5%) and the feedback-only group (4.8%; 95% CI 4.2% to 5.5%). Improvement was limited to the two process indicators. The feedback-with-toolbox group achieved larger effects than the feedback-only group both on the composite adequate pain management (p<0.05) and on measuring pain each shift (p<0.001). No important adverse effects have occurred.ConclusionFeedback with toolbox improved the number of shifts where patients received adequate pain management compared with feedback alone, but only in process and not outcome indicators.Trial registration numberNCT02922101.

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Different suturing techniques in thoracic incision: protocol for a feasibility randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2018-021645 ◽

2019 ◽

Vol 9 (1) ◽

pp. e021645

Author(s):

Zonghui Liu ◽

Xiangyu Liu ◽

Lin He ◽

Xueyuan Yu ◽

Lu Wang ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Costal Cartilage ◽

Clinical Effectiveness ◽

Suture Technique ◽

Skin Closure ◽

Mattress Suture ◽

Vertical Mattress ◽

Randomised Controlled

IntroductionBased on the principles of the ideal skin closure technique, we previously described a suture technique (wedge-shaped excision and modified buried vertical mattress suture (WE-MBVMS)) that could provide excellent outcomes for the most demanding surfaces. However, adequate clinical comparative evidence supporting improved outcomes is lacking. Thus, the purpose of this protocol is to establish the feasibility of conducting a fully randomised controlled trial (RCT) comparing the clinical effectiveness of WE-MBVMS with a buried intradermal suture (BIS) in closing thoracic incision.Methods and analysisThis study is a feasibility RCT of WE-MBVMS and BIS in patients undergoing surgery for costal cartilage harvesting. Seventy-eight participants are expected to participate in the study and will be randomised in a ratio of 1:1 to WE-MBVMS or BIS. Trial feasibility will be assessed by the number of participants assessed for eligibility, recruitment rates, reasons for ineligibility or non-participation, time for interventions, withdrawal and retention at all follow-up points (3, 6 and 12 months), follow-up rates and reasons for withdrawing from the trial. In addition, clinical data regarding the cosmetic results of scars will be collected to inform the sample size for a fully powered RCT.Ethics and disseminationThis study has been approved by The First Affiliated Hospital of Xi’an Jiaotong University Institutional Review Board (XJTU1AF2017LSK-120). The findings will be published in peer-reviewed journals.Trial registration numberChiCTR-INR-17013335; Pre-results.

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Effectiveness of a therapeutic patient education program in improving cancer pain management: EFFADOL, a stepped-wedge randomised controlled trial

BMC Cancer ◽

10.1186/s12885-019-5836-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Virginie Prevost ◽

◽

Natacha Heutte ◽

Alexandra Leconte ◽

Idlir Licaj ◽

...

Keyword(s):

Pain Management ◽

Randomised Controlled Trial ◽

Patient Education ◽

Cancer Pain ◽

Controlled Trial ◽

Stepped Wedge ◽

Cancer Pain Management ◽

Therapeutic Patient Education ◽

Patient Education Program ◽

Randomised Controlled

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Continuous Fentanyl Background Infusion Regimen Optimised by Patient-Controlled Analgesia for Acute Postoperative Pain Management: A Randomised Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm9010211 ◽

2020 ◽

Vol 9 (1) ◽

pp. 211 ◽

Cited By ~ 2

Author(s):

Jihoon Hwang ◽

Sang Kee Min ◽

Yun Jeong Chae ◽

Gang Mee Lim ◽

Han Bum Joe

Keyword(s):

Pain Management ◽

Side Effects ◽

Postoperative Pain ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Postoperative Pain Management ◽

Patient Controlled Analgesia ◽

Acute Postoperative Pain ◽

Background Infusion ◽

Randomised Controlled

Owing to a lack of studies investigating the effect of adjustments in fentanyl background infusion (BI) with patient-controlled analgesia (PCA) on postoperative analgesia, we evaluated three BI regimens with fentanyl PCA for acute postoperative pain management. This randomised controlled trial enrolled 105 patients, who were assigned to three parallel groups: constant rate BI of 2 mL/h (CRBI group); time-scheduled decremental BI of 6, 2 and 1 mL/h (TDBI group); and BI rates optimised to the demand of PCA (POBI group). The incidence of insufficient analgesia, visual analogue scale (VAS) pain score and side effects were evaluated. The incidence of insufficient analgesia in the post-anaesthesia care unit was lower in the TDBI and POBI groups than the CRBI group. Incidence of insufficient analgesia in the ward was lower in the POBI group than the CRBI group. Postoperative VAS scores were significantly lower in the TDBI and POBI groups for up to 4 h and 24 h, respectively, compared with the CRBI group. Side effects and infused fentanyl dose were highest in the CRBI group. Adjusting BI rate based on time or patient demands could improve postoperative analgesia and reduce side effects. Compared to a constant BI rate, PCA-optimised BI achieved higher patient satisfaction.

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