scholarly journals The Implications of Tobacco Smoking on Acute Postoperative Pain: A Prospective Observational Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Han-Liang Chiang ◽  
Yuan-Yi Chia ◽  
Huey-Shyan Lin ◽  
Chen-Hsiu Chen
Keyword(s):  
Postoperative Pain ◽  
Health Care Providers ◽  
Pain Perception ◽  
Clinical Importance ◽  
Smoking History ◽  
Major Surgery ◽  
Care Providers ◽  
Acute Postoperative Pain ◽  
Duration Of Surgery ◽  
Upper Abdomen

Background. The clinical importance of cigarette smoking on acute postoperative pain perception is not fully understood.Methods. To determine whether smokers who underwent major surgery need more postoperative opiate than do nonsmokers. We prospectively enrolled 407 male and 441 female participants who underwent in-hospital surgery. Current-smokers were compared with nonsmokers and past-smokers about opiate use during the first 72 h after surgery.Results. A greater proportion of males had more smoking history than females. The average age of male current-smokers is smaller than both nonsmokers and past-smokers. The surgical type (upper abdomen, lower abdomen, extremities, spine, and others) and duration of surgery have no differences between current-smokers, past-smokers, and nonsmokers. Statistically, the male current-smokers required more opiate analgesics during the first 72 h following surgery compared with the male nonsmokers and past-smokers; furthermore, the male current-smokers reported higher pain intensity when moving and at rest on day 1 after surgery.Conclusions. In this study, the male current-smokers required more morphine in the first 72 h after surgery than did the nonsmokers and past-smokers. Furthermore, smoking was more prevalent among the males than the females. Health care providers must be aware of the potential for increased narcotic requirements in male current-smokers.

scholarly journals Utilization of Non-Pharmacological Methods and the Perceived Barriers for Adult Postoperative Pain Management by the Nurses at Selected National Hospitals in Asmara, Eritrea

2020 ◽  
Author(s):  
Betiel Yihdego Kidanemariam ◽  
Traudl Elsholz ◽  
Laban L. Simel ◽  
Eyasu H. Tesfamariam ◽  
Yonatan Mehari Andemeskel
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Health Care Providers ◽  
Work Experience ◽  
Statistical Significance ◽  
Demographic Data ◽  
Postoperative Pain Management ◽  
Perceived Barriers ◽  
Care Providers ◽  
Cross Sectional

Abstract Background: Pharmacological methods are widely used for postoperative pain management however, poorly controlled pain continues to pose a significant challenge. Non pharmacological methods could contribute to the unresolved postoperative pain management in assisting nurses’ routine care and reducing the need for medication. This study aimed to assess nurses’ utilization of non-pharmacological methods in postoperative pain and the perceived barriers for their implementation at the National Hospitals.Methods: This was a descriptive cross sectional study conducted among 154 nurses working at the National Referral Hospitals and Sembel Private Hospital. A standardized five-point Likert-scale questionnaire which assesses nurses' utilization of selected non-pharmacological methods and the perceived barriers for the implementation was used to collect data. Descriptive statistics for the demographic data, independent samples t-test, one way ANOVA and factorial ANOVA were used to analyze the data. Statistical significance level was set at P < 0.05.Results: The study found out that emotional support (45.5%), helping with daily activities (67.5%) and creating a comfortable environment (61%) were mostly used while, cognitive-behavioral (5.9%) and physical methods (5.8%) were hardly used. The results also showed that, characteristics such as, age (p=0.013), level of education (p=0.012), work experience (p=0.001) and place of work (p=0.001), were significantly related to the use of non-pharmacological methods at bivariate level. However, hospitals were the only determinants of the non-pharmacological methods at multivariable level with a statistical significance of (p<0.001). On the perceived barriers; heavy work load (87.7%), shortage of time (84.4%), limited resources (82.5%), deficit in the guidelines for pain management (77.3%), patient’s uncooperative behavior (57.1%), language difference (64.4%), nurse’s lack of knowledge (50%) and experience (40.3%) were identified.Conclusion: The use of non-pharmacological methods in the studied hospitals varied greatly on the knowledge and experience of the nurses. Therefore, it is recommended that exposure and training for all health care providers at all level is a paramount importance in order to appreciate the benefits of non-pharmacological methods applicable to postoperative pain management. This could be achieved through on job training, seminars, scientific conferences and other brainstorming forums.

Postoperative Pain Management Among Dominican and American Health-Care Providers

2016 ◽  
Vol 98 (12) ◽  
pp. e50 ◽  
Author(s):  
Christopher A. Devine ◽  
Amy Yu ◽  
Rachel G. Kasdin ◽  
Laura M. Bogart ◽  
Aileen M. Davis ◽  
...  
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Postoperative Pain ◽  
Health Care Providers ◽  
Postoperative Pain Management ◽  
Care Providers ◽  
American Health Care

Factors influencing older adults to complete advance directives

2010 ◽  
Vol 8 (3) ◽  
pp. 267-275 ◽  
Author(s):  
Gloria J. Alano ◽  
Renee Pekmezaris ◽  
Julia Y. Tai ◽  
Mohammed J. Hussain ◽  
Jose Jeune ◽  
...  
Keyword(s):  
Older Adults ◽  
New York ◽  
Health Care Providers ◽  
Female Gender ◽  
Community Dwelling ◽  
Major Surgery ◽  
Care Providers ◽  
Media Campaigns ◽  
Tertiary Teaching ◽  
Relief Of Suffering

AbstractObjective:The purpose of this study was to determine the factors which influence advance directive (AD) completion among older adults.Method:Direct interviews of hospitalized and community-dwelling cognitively intact patients >65 years of age were conducted in three tertiary teaching settings in New York. Analysis of AD completion focused on its correlation with demographics, personal beliefs, knowledge, attitudes, and exposure to educational media initiatives. We identified five variables with loadings of at least 0.30 in absolute value, along with five demographic variables (significant in the univariate analyses) for multiple logistic regression. The backward elimination method was used to select the final set of jointly significant predictor variables.Results:Of the 200 subjects consenting to an interview, 125 subjects (63%) had completed ADs. In comparing groups with and without ADs, gender (p < 0.0002), age (p < 0.0161), race (p < 0.0001), education (p < 0.0039), and religion (p < 0.0104) were significantly associated with having an AD. Factors predicting AD completion are: thinking an AD will help in the relief of suffering at the end of life, (OR 76.3,p < 0.0001), being asked to complete ADs/ or receiving explanation about ADs (OR 55.2,p < 0.0001), having undergone major surgery (OR 6.3,p < 0.0017), female gender (OR 11.1,p < 0.0001) and increasing age (76–85vs.59–75: OR 3.4,p < 0.0543; <85vs. 59–75: OR 6.3,p < 0.0263).Significance of results:This study suggests that among older adults, the probability of completing ADs is related to personal requests by health care providers, educational level, and exposure to advance care planning media campaigns.

scholarly journals iCanCope PostOp: User-Centered Design of a Smartphone-Based App for Self-Management of Postoperative Pain in Children and Adolescents (Preprint)

2018 ◽  
Author(s):  
Kathryn A Birnie ◽  
Fiona Campbell ◽  
Cynthia Nguyen ◽  
Chitra Lalloo ◽  
Argerie Tsimicalis ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Children And Adolescents ◽  
Health Care Providers ◽  
Postoperative Pain Management ◽  
Self Management ◽  
User Centered Design ◽  
Care Providers ◽  
Pain Care ◽  
User Centered

BACKGROUND Moderate to severe postoperative pain in children is common. Increased pediatric day surgeries have shifted postoperative pain management predominantly to the home setting. Mobile health technology has the potential to overcome barriers to pain care by improving access to self-management resources. However, pain apps generally lack scientific evidence and are highly underutilized due to lack of involvement of end users in their development. Thus, an evidence-based pain self-management smartphone app that incorporates the needs and perspective of children and adolescents (end users) has potential to improve postoperative pain management. OBJECTIVE This paper aimed to describe how the principles of user-centered design were applied to the development of iCanCope PostOp, a smartphone-based pain self-management app for children and adolescents after surgery. Specifically, it presents 2 completed phases of the user-centered design process (concept generation and ideation) for the iCanCope PostOp app. METHODS Phase 1 was a multisite needs assessment from the perspective of 19 children and adolescents who had undergone various day surgeries, 19 parents, and 32 multidisciplinary health care providers. Children, adolescents, and parents completed individual semistructured interviews, and health care providers participated in focus groups. Data were summarized using qualitative content analysis. Phase 2 developed a pain care algorithm for the app using Delphi surveys and a 2-day in-person design workshop with 11 multidisciplinary pediatric postoperative pain experts and 2 people with lived experience with postoperative pain. RESULTS Phase 1 identified self-management challenges to postoperative pain management and recovery; limited available resources and reliance on medications as a predominant postoperative pain management strategy; and shared responsibility of postoperative pain care by children and adolescents, parents, and health care providers. Key app functions of tracking pain, pain self-management strategies, and goal setting were identified as priorities. Phase 2 led to the successful and efficient generation of a complete preliminary pain care algorithm for the iCanCope PostOp app, including clinically relevant inputs for feasible assessment and reassessment of pain and function (rest or sleep, movement or play, and mood or worry), as well as a catalog of pain management advice to be pushed to end users (psychological, physical, pharmacological, and education). CONCLUSIONS The concept ideation and generation phases of the user-centered design approach were successfully completed for the iCanCope PostOp app. Next steps will include design finalization, app development (iOS or Android), evaluation through a randomized controlled trial, and subsequent implementation of the iCanCope PostOp app in clinical care.

Changes in health-related quality of life (HRQL) after bladder cancer (BC) diagnosis (DX): A longitudinal population-based study.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 317-317
Author(s):  
Chunkit Fung ◽  
Chintan Pandya ◽  
Elizabeth A. Guancial ◽  
Shri Noel ◽  
Katia Noyes ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Population Based ◽  
Analysis Of Covariance ◽  
Smoking History ◽  
Future Research ◽  
Care Providers ◽  
Comorbid Conditions ◽  
Population Based Study ◽  
Control Subjects ◽  
Muscle Invasive

317 Background: Few studies have examined longitudinal changes in HRQL among BC patients. To our knowledge, this is the largest prospective population-based study to quantify HRQL changes from before to after BC DX and to compare their HRQL with a non-cancer cohort. Methods: Our sample included 179 BC patients (≥ age 65) and 376,986 non-cancer subjects within the SEER-Medicare Health Outcomes Survey database (1998-2007). We assessed HRQL as measured by physical (PCS) and mental (MCS) component summary scores of the veterans RAND 12-item health survey. An analysis of covariance model was used to estimate changes in HRQL scores for patients after BC DX relative to control subjects with adjustment for baseline HRQL scores and covariates. Results: 84.4% (N=151) of BC patients had non-muscle invasive BC (NMIBC) and 15.6% (N=28) had muscle invasive BC (MIBC). 49.2% and 39.1% of BC patients had ≥2 comorbid conditions and ≥1 activities of daily living (ADL) deficit, respectively. Compared to the control subjects, more BC patients were men (67.0% vs 38.5%; P<0.01), current or former smokers (58.7% vs 37.3%; P<0.01), and had income ≥ $50,000(15.1% vs 8.8%; P=0.02). Other baseline demographic and socioeconomic characteristics were similar (P>0.05). After DX, BC patients reported a significant decline in PCS (1.9; 95% CI 0.1, 3.7) score compared to non-cancer controls whereas the decrease in MCS score (1.4; 95% CI -0.1, 3.0) was not statistically significant. For those with NMIBC, HRQL was not significantly different than that of the non-cancer cohort (P>0.05) after DX. However, the PCS and MCS scores of MIBC patients decreased by 5.3 (95% CI 0.9, 9.8) and 3.8 points (95% CI -0.1, 7.7) after DX, respectively. Older age at BC DX, lower educational and income levels, smoking history, and higher numbers of comorbid conditions and ADL deficits were significantly associated with inferior PCS and MCS scores after BC DX (P<0.01). Conclusions: Treatment-related side effects and/or symptoms due to BC adversely affect HRQL of BC patients, especially in those with MIBC, and should be consistently assessed by health care providers. Future research that examines interventions to improve HRQL is critical to improve BC care.

Early detection of delirium – using the CAM score

2019 ◽  
Vol 2 (3) ◽  
pp. 50
Author(s):  
Lise Rekvad
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Research Team ◽  
Clinical Importance ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
University Hospital ◽  
Care Providers ◽  
Old Patients ◽  
Hospital Acquired

Background: Delirium is common in elderly patients and has been identified as an independent marker for increased mortality and hospital-acquired complications, yet it is poorly recognized by health care providers. The aim of this study was to investigate whether systematic use of the validated screening tool Confusion Assessment Method (CAM) would result in a higher recognizing of delirium in patients ≥ 65 years old admitted at Odense Emergency Department (FAM). Methods: All caregivers in the Emergency department (ED) at Odense University Hospital received 2 hours of education in delirium and how to use the CAM score. They were asked to systematically perform CAM score in all patients ≥ 65 years at arrival to the ED and at least every 8 hours.  During 2 periods of 5 days - one before the caregivers was educated (pre-CAM) and one 4 weeks after CAM scoring was started (during-CAM). A research team interviewed all ≥ 65 year old patients and their caregivers at the first and second day of admission. In relation to the interviews all patients underwent a cognitive assessment using the CAM by a trained investigator. These results were blinded to the clinical personal. After discharge patient files were screened with the aim to identify any delirium registered by the clinical personal. Results: Out of 276 screened patients 192 where included in the project. 100 patients and were included in the pre-CAM group and 92 patients in the during-CAM group. According to the registrations by the research team 24 of 100 (24% 95%CI 16%-34%) patients experience delirium in the pre-CAM group and 18 of 92 (20% 95%CI 12%-29%) in the during-CAM group. Increasing age and comorbidity was related to delirium.  Prevalence of the diagnoses delirium registered in the patient file increased from 1 of 24 (4% 95%CI  0%-21%) to 9 of 18 (50% 95%CI 26%-74%). Conclusion: One out of four elderly acute patients has deliria symptoms during the first 2 days at hospital. Systematic CAM scoring does not change the prevalence but increase the awareness significantly. The high prevalence underlines the clinical importance of the problem.

scholarly journals Utilization of non-pharmacological methods and the perceived barriers for adult postoperative pain management by the nurses at selected National Hospitals in Asmara, Eritrea

BMC Nursing ◽  
2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Betiel Yihdego Kidanemariam ◽  
Traudl Elsholz ◽  
Laban L. Simel ◽  
Eyasu H. Tesfamariam ◽  
Yonatan Mehari Andemeskel
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Health Care Providers ◽  
Work Experience ◽  
Statistical Significance ◽  
Demographic Data ◽  
Postoperative Pain Management ◽  
Perceived Barriers ◽  
Care Providers ◽  
Cross Sectional

Abstract Background Pharmacological methods are widely used for postoperative pain management however, poorly controlled pain continues to pose a significant challenge. Non pharmacological methods could contribute to the unresolved postoperative pain management in assisting nurses’ routine care and reducing the need for medication. This study aimed to assess nurses’ utilization of non-pharmacological methods in postoperative pain and the perceived barriers for their implementation at the National Hospitals. Methods This was a descriptive cross sectional study conducted among 154 nurses working at the National Referral Hospitals and Sembel Private Hospital. A standardized five-point Likert-scale questionnaire which assesses nurses’ utilization of selected non-pharmacological methods and the perceived barriers for the implementation was used to collect data. Descriptive statistics for the demographic data, independent samples t-test, one way ANOVA and factorial ANOVA were used to analyze the data. Statistical significance level was set at P < 0.05. Results The study found out that emotional support (45.5%), helping with daily activities (67.5%) and creating a comfortable environment (61%) were mostly used while, cognitive-behavioral (5.9%) and physical methods (5.8%) were hardly used. The results also showed that, characteristics such as, age (p = 0.013), level of education (p = 0.012), work experience (p = 0.001) and place of work (p = 0.001), were significantly related to the use of non-pharmacological methods at bivariate level. However, hospitals were the only determinants of the non-pharmacological methods at multivariable level with a statistical significance of (p < 0.001). On the perceived barriers; heavy work load (87.7%), shortage of time (84.4%), limited resources (82.5%), deficit in the guidelines for pain management (77.3%), patient’s uncooperative behavior (57.1%), language difference (64.4%), nurse’s lack of knowledge (50%) and experience (40.3%) were identified. Conclusion The use of non-pharmacological methods in the studied hospitals varied greatly due to knowledge and experience of the nurses. Therefore, it is recommended that exposure and training for all health care providers at all level is a paramount importance in order to appreciate the benefits of non-pharmacological methods applicable to postoperative pain management. This could be achieved through on job training, seminars, scientific conferences and other brainstorming forums.

Different Perceptions Exist Between Health Care Providers and the General Population Regarding the Importance of Findings on Additional Imaging for Trauma Consults

2020 ◽  
Vol 86 (7) ◽  
pp. 830-836
Author(s):  
Andrew L. Plaster ◽  
Emily R. Faulks ◽  
Jacob N. Gillen ◽  
Allison N. Tegge ◽  
Miguel A. Matos ◽  
...  
Keyword(s):  
Health Care ◽  
General Population ◽  
Health Care Providers ◽  
Clinical Importance ◽  
Rib Fractures ◽  
Trauma Patients ◽  
Care Providers ◽  
Linear Modeling ◽  
Public Data ◽  
Additional Imaging

Background Approximately one-third of additional imaging for trauma consults results in the discovery of new injuries. No studies have addressed the perception of these findings in non-health care providers. Our hypothesis was that significant differences in perception of the importance of injuries would exist between health care providers (HCPs) and the general population. Methods Six standardized scenarios were developed detailing common new injury findings on additional imaging in trauma consults. Demographics as well as information regarding the significance of findings, potential for change in care, and the importance of patient notification were collected. Surveys were electronically distributed to HCPs in our system and the public. Data analysis was performed with generalized linear modeling. Results A total of 339 public and 129 HCP surveys were returned. HCPs included attending staff, residents, and advanced care providers from a variety of specialties. Significant differences in perception were found in traumatic brain injury, spine fractures, and rib fractures, with HCPs rating most findings as less clinically important than the general population, while rating patient notification as more important. Perceived importance decreased with increased age in the general population. Increasing HCP age or length in practice did not significantly affect perception of clinical importance, except for rib fractures. Discussion Differences in perception exist regarding the significance of additional injuries between HCPs and the general population. Perceptions of the general population also change with age. Decisions to pursue additional imaging in trauma patients should include consideration of these differences in perception to help support quality patient-centered care.

scholarly journals Postoperative Self-Report of Pain in Children: Interscale Agreement, Response to Analgesic, and Preference for a Faces Scale and a Visual Analogue Scale

2010 ◽  
Vol 15 (3) ◽  
pp. 163-168 ◽  
Author(s):  
Clément de Tovar ◽  
Carl L von Baeyer ◽  
Chantal Wood ◽  
Jean-Pierre Alibeu ◽  
Malik Houfani ◽  
...  
Keyword(s):  
Health Care ◽  
Postoperative Pain ◽  
Health Care Providers ◽  
Analogue Scale ◽  
Age Groups ◽  
Postoperative Recovery ◽  
Self Report ◽  
Care Providers ◽  
Validation Data ◽  
Global Satisfaction

OBJECTIVE: To augment available validation data for the Faces Pain Scale – Revised (FPS-R) and to assess interscale agreement and preference in comparison with the Coloured Analogue Scale (CAS) in pediatric acute pain.METHOD: The present prospective, multicentre study included 131 inpatients five to 15 years of age (mean age 8.8 years; 56% male) seen in postoperative recovery. They provided CAS and FPS-R pain scores before and after administration of analgesic medication. Nurses and physicians used the same tools as observational scales. Children and health care providers indicated which scale they preferred.RESULTS: FPS-R scores for the intensity of postoperative pain correlated highly with the corresponding CAS scores in all age groups (0.66 ≤ r ≤ 0.88). There were no significant mean differences in any age group between the scales. Scores on the two scales differed by 2/10 or less in 81% to 91% of children, depending on age. Both scales demonstrated expected changes in postoperative pain following administration of an analgesic. Scores at the upper end point were given by approximately 20% of children five to six years of age on both scales, compared with 2% to 9% in the older age groups. Health care providers’ observational ratings were significantly lower than self-ratings. The FPS-R was preferred over the CAS by most children in all age groups and both sexes. Global satisfaction of the health care providers was similar for both tools.DISCUSSION: These results support the use of the FPS-R for most children five years of age or older in the postoperative period. Further research is needed to identify young children, particularly those younger than seven years of age, who have difficulty with self-report tools, and to establish methods for training them in the reliable use of these measures.

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