scholarly journals Clinical benefits, referral practice and cost implications of an in-hospital pain service: results of a service evaluation in a London teaching hospital

2016 ◽  
Vol 11 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Maya Sussman ◽  
Elizabeth Goodier ◽  
Izabella Fabri ◽  
Jessica Borrowman ◽  
Sarah Thomas ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pain Management ◽  
Teaching Hospital ◽  
Rating Scale ◽  
Service Evaluation ◽  
Rank Test ◽  
Future Research ◽  
Binary Logistic Regression Analysis ◽  
Significant Difference ◽  
Referral Practice

Background: In-hospital pain services (IPS) are commonplace, but evidence of efficacy is inadequate, and patients’ pain management in any hospital ward remains problematic. This service evaluation aimed to measure the effect of a contemporary IPS, its appropriate use and cost-efficacy. Methods: Records of 249 adults reviewed by the IPS in an inner London Teaching Hospital over an 8-month period were analysed for demographic data, interventions, workload and change in pain intensity measured by numerical rating scale (NRS). Non-parametric tests were used to evaluate differences between initial and final NRS. Spearman’s rank correlation analysis was used to create a correlation matrix to evaluate associations between all identified independent variables with the change in NRS. All strongly correlated variables (ρ > 0.5) were subsequently included in a binary logistic regression analysis to identify predictors of pain resolution greater than 50% NRS and improvement rather than deterioration or no change in NRS. Finally, referral practice and cost of inappropriate referrals were estimated. Referrals were thought to be inappropriate when pain was not optimised by the referring team; they were identified using a set algorithm. Results: Initial median NRS and final median NRS were significantly different when a Wilcoxon signed-rank test was applied to the whole cohort; Z = –5.5 (p = 0.000). Subgroup analysis demonstrated no significant difference in the ‘mild’ pain group; z = –1.1 (p = 0.253). Regression analysis showed that for every unit increase in initial NRS, there was a 62% chance of general and a 33% chance of >50% improvement in final NRS. An estimated annual cost-saving potential of £1546 to £4558 was found in inappropriate referrals and patients experiencing no benefit from the service. Discussion: Results suggest that patients with moderate to severe pain benefit most from IPS input. Also pain management resources are often distributed inefficiently. Future research is required to develop algorithms for easy identification of potential treatment responders.

Evaluation of pain management in medical transfer of trauma patients by air

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 776-783
Author(s):  
Isabelle H. Miles ◽  
Russell D. MacDonald ◽  
Sean W. Moore ◽  
James Ducharme ◽  
Christian Vaillancourt
Keyword(s):  
Pain Management ◽  
Adverse Events ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Trauma Centre ◽  
Air Transport ◽  
Future Research ◽  
Trauma Patients ◽  
Numerical Rating ◽  
Standard Deviation Range

ABSTRACTObjectivesWith regionalized trauma care, medical transport times can be prolonged, requiring paramedics to manage patient care and symptoms. Our objective was to evaluate pain management during air transport of trauma patients.MethodsWe conducted a 12-month review of electronic paramedic records from a provincial critical care transport agency. Patients were included if they were ≥18 years old and underwent air transport to a trauma centre, and excluded if they were Glasgow Coma Scale score <14, intubated, or accompanied by a physician or nurse. Demographics, injury description, and transportation parameters were recorded. Outcomes included pain assessment via 11-point numerical rating scale, patterns of analgesia administration, and analgesia-related adverse events. Results were reported as mean ± standard deviation, [range], (percentage).ResultsWe included 372 patients: 47.0 years old; 262 males; 361 blunt injuries. Transport duration was 82.4 ± 46.3 minutes. In 232 (62.4%) patients who received analgesia, baseline numerical rating scale was 5.9 ± 2.5. Fentanyl was most commonly administered at 44.3 [25–60] mcg. Numerical rating scale after first analgesia dose decreased by 1.1 [-2–7]. Thereafter, 171 (73.7%) patients received 2.4 [1-18] additional doses. While 44 (23.4%) patients had no change in numerical rating scale after first analgesia dose, subsequent doses resulted in no change in numerical rating scale in over 65% of patients. There were 43 adverse events recorded, with nausea the most commonly reported (39.5%).ConclusionsInitial and subsequent dose(s) of analgesic had minimal effect on pain as assessed via numerical rating scale, likely due in part to inadequate dosing. Future research is required to determine and address the barriers to proper analgesia.

Clinical Factors Associated with the Diagnosis of Granulomatosis with Polyangiitis

2017 ◽  
Vol 156 (3) ◽  
pp. 484-488 ◽  
Author(s):  
Erdem Eren ◽  
Toygar Kalkan ◽  
Seçil Arslanoğlu ◽  
Mustafa Özmen ◽  
Kazım Önal ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Nasal Mucosa ◽  
Odds Ratio ◽  
Granulomatosis With Polyangiitis ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Significant Difference ◽  
History Of

Objective To determine the predictive value of nasal endoscopic findings and symptoms in the diagnosis of granulomatosis with polyangiitis (GPA). Study Design A cross-sectional study. Setting A tertiary university hospital. Subjects and Methods A total of 116 adults were enrolled in the study: 19 patients with GPA, 29 patients with other rheumatic diseases, and 68 healthy volunteers. All patients were examined with a flexible endoscope, and nasal endoscopic images were recorded and evaluated blindly. The medical history of each patient was taken by a physician blinded to the patient’s diagnosis. Results Univariate analysis indicated a statistically significant difference in rhinorrhea ( P = .002), postnasal drip ( P = .015), epistaxis ( P < .001), and saddle nose ( P = .017). However, binary logistic regression analysis demonstrated that only history of epistaxis ( P = .012; odds ratio, 5.6) was statistically significant in predicting GPA. Univariate analysis showed a statistically significant difference in nasal secretion ( P = .028), nasal septal perforation ( P < .017), nasal crusting ( P < .001), nasal adhesion ( P < .001), nasal granuloma ( P = .017), and hemorrhagic fragile nasal mucosa ( P < .001). A binary logistic regression analysis demonstrated that only hemorrhagic fragile nasal mucosa ( P < .001; odds ratio, 52.9) was a statistically significant predictor of GPA. Conclusions Given the results of this study, we believe that hemorrhagic fragile nasal mucosa and history of recurrent epistaxis may put patients at risk for GPA and should be investigated accordingly.

Pengaruh Terapi Murottal Al-Qur’an terhadap Penurunan Intensitas Nyeri Persalinan Kala 1 Fase Aktif Dilatasi Maksimal

2021 ◽  
Vol 3 (1) ◽  
pp. 25-30
Author(s):  
Ayu Safitri ◽  
Artika Dewie ◽  
Niluh Nita Silvia
Keyword(s):  
Rating Scale ◽  
Active Phase ◽  
Numeric Rating Scale ◽  
Labor Pain ◽  
Rank Test ◽  
Phase Method ◽  
Signed Rank ◽  
Significant Difference ◽  
Before And After ◽  
Signed Rank Test

Introduction: Pharmacological and non-pharmacological techniques are methods used to reduce labor pain. Non-pharmacological techniques in the form of distraction by listening to the murottal Al-Qur'an can be an option. The purpose of this study was to determine the effect of murottal Al-Qur'an therapy on reducing the intensity of labor pain during the 1st active phase. Method: The type of research used in this study was Pre Experiment, one group pretest-posttest research design. The population in this study were mothers who gave birth at the first stage of Sriwati PMB with a sample of 15 people. The pain was measured using the Numeric Rating Scale (NRS). Statistical analysis used the Wilcoxon Signed Rank Test with a confidence level of 95% (α = 0.05). The result of the statistical test, the value of p=0.001, which means that there is a significant difference in labor pain in women who give birth before and after listening to the Murottal Al-Qur'an. It is suggested to do non-pharmacological techniques to listen to Murottal Al-Qur'an as one of the techniques to reduce the first stage labor pain at PMB Sriwati.

scholarly journals International Students in American Higher Education: A Quantitative Study Comparing Their Distribution from Both Synchronic and Diachronic Perspectives and the Implications on Policy Making

2018 ◽  
Vol 13 (7) ◽  
Author(s):  
Yuan Yao
Keyword(s):  
Higher Education ◽  
International Students ◽  
International Student ◽  
Geographic Location ◽  
Student Population ◽  
Rank Test ◽  
Future Research ◽  
American Higher Education ◽  
Significant Difference ◽  
Signed Rank Test

This study examined the distribution of international students in American higher education in each region of America. Non-parametric tests, Wilcoxon signed-rank test and Kruskal-Wallis test, were employed to explore the significant differences of international student population among the five American regions from both synchronic and diachronic perspectives. The results of the study show that 1) there is significant difference of international student population among the five American regions in 2016; 2) Northeastern, Southeastern, and Midwestern regions have significantly larger international student population in 2016 than that in 2015; however, Western and Southwestern regions do not have significantly larger international student population in 2016 than that in 2015; 3) climate and geographic location, and the population of immigrants are the reasons of the current distribution of international students; and 4) there are four potential strategies that can be applied to promote the internationalization of higher education and the enrollment of international students. Two future research directions were proposed at the end of the paper.

Mental wellbeing in people with dementia following Cognitive Stimulation Therapy: Innovative practice

Dementia ◽  
2017 ◽  
Vol 19 (2) ◽  
pp. 496-504 ◽  
Author(s):  
Catherine Allward ◽  
Rosie Dunn ◽  
Gemma Forshaw ◽  
Chris Rewston ◽  
Nicola Wass
Keyword(s):  
Well Being ◽  
Service Evaluation ◽  
Cognitive Stimulation ◽  
Mental Wellbeing ◽  
Future Research ◽  
Cognitive Stimulation Therapy ◽  
People With Dementia ◽  
Significant Difference ◽  
Mental Well Being ◽  
General Wellbeing

The benefits of Cognitive Stimulation Therapy in supporting cognitive functioning for people with dementia are well recognised. It has been proposed that Cognitive Stimulation Therapy may offer additional benefits in terms of a person’s sense of general wellbeing. A service evaluation of 60 participants attending Cognitive Stimulation Therapy groups was conducted using the Short Warwick-Edinburgh Mental Well-Being Scale. Although this evaluation did not demonstrate a significant difference between pre- and post-treatment scores (t = −1.75, df = −59, p = −0.085), there was a trend in participants’ reported optimism about the future and confidence. Recommendations about future research in relation to mental wellbeing in dementia care are discussed.

Methylphenidate (MP) and nursing telephone intervention (NTI) for cancer-related fatigue (CRF) in advanced cancer patients: A double-blind randomized phase II trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9023-9023
Author(s):  
Eduardo Bruera ◽  
Sriram Yennurajalingam ◽  
Pedro Emilio Perez-Cruz ◽  
David Hui ◽  
Susan Frisbee-Hume ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Mixed Model ◽  
Rank Test ◽  
Telephone Intervention ◽  
Advanced Cancer Patients ◽  
Significant Difference ◽  
Edmonton Symptom Assessment Scale ◽  
Longitudinal Regression

9023 Background: CRF is the most common and distressing symptom in advanced cancer patients. Preliminary studies support MP and NTI for CRF (Bruera et al. JCO 2006). The primary objective of our study was to determine the effect of MP as compared to placebo (P). A secondary objective was to investigate the role of NTI as compared to control telephone intervention (CTI). Methods: Advanced cancer patients with fatigue ≥4/10 on the Edmonton Symptom Assessment Scale (ESAS), normal cognition, no evidence of major depression and hemoglobin ≥8 were eligible. Patients were randomized to 4 groups in a 2x2 factorial design (MP+NTI, P+NTI, MP+CTI and P+CTI). Primary endpoint was Functional Assessment of Chronic Illness-Fatigue (FACIT-F) subscale scores between day 15 and baseline. The dose and duration of methylphenidate was 5 mg every two hours, as needed, up to 20 mg/day. We tested the median difference in FACIT-F subscale scores between the groups using the Kruskal Wallis test and Wilcoxon signed rank test. Longitudinal regression analysis was conducted with a mixed model. Results: Total accrual was 197. Mean (SD) age was 58 (12), female 67% (N=148), white 72% (N=136), gastrointestinal cancers were the most common 22% (N=41). Baseline FACIT-F subscores were similar among the 4 groups. The median FACIT-F subscores showed significant improvement between Day 15 and baseline for all four groups except for P+CTI (Table): MP+NTI (4.5, P=0.004), P+NTI (8, P<0.001), MP+CTI (7, P<0.001), and P+CTI (5, P=0.06), with no statistically significant difference between MP and P (6 vs. 6, P=0.89). Longitudinal regression analysis showed a time effect (P<0.001) and group differences for NTI vs. CTI with FACIT-F (P=0.13) and ESAS (P=0.03). Grade 3 toxicities were similar between the MP and P arms (34/93 vs. 24/97, P=0.09). Conclusions: MP was not effective as compared to P for CRF in advanced cancer patients. NTI may be effective and should be further studied. [Table: see text]

scholarly journals Effectiveness of academic stress management programme on academic stress and academic performance among higher secondary students in selected schools of Udupi District

2015 ◽  
Vol 05 (04) ◽  
pp. 009-012
Author(s):  
Nikitha S. ◽  
Tessy Treesa Jose ◽  
Blessy Prabha Valsaraj
Keyword(s):  
Academic Performance ◽  
Stress Management ◽  
Secondary Students ◽  
Formative Evaluation ◽  
Rating Scale ◽  
Academic Stress ◽  
Management Programme ◽  
Rank Test ◽  
Significant Difference ◽  
Signed Rank Test

Abstract Problem statement: “A study to assess the effectiveness of academic stress management programme on academic stress and academic performance among higher secondary students in a selected school of Udupi district, Karnataka, India” Objective : To evaluate the effectiveness of academic stress management programme on academic stress and academic performance. Materials and Methods: Study was conducted among 96 subjects. Data were collected using Demographic Proforma and Academic stress Rating Scale. Academic performance was assessed by verifying existing school records of formative evaluation test conducted in the month of January and February 2013. Academic stress management programme was provided one hour per day for three consecutive days. Result: Data were analysed using t test and Wilcoxon signed rank test. Result showed a significant difference in pretest post test stress level and academic performance. Conclusion: The findings of the study indicated that academic stress management programme was effective in reducing academic stress but not in improving academic performance.

scholarly journals Ginger Tea on Dysmenorrhoea Among Nursing Students

2019 ◽  
Vol 09 (02) ◽  
pp. 64-75
Author(s):  
Sheetal Crasta ◽  
Philomena Fernandes ◽  
Shynee Paul
Keyword(s):  
Nursing Students ◽  
Quantitative Research ◽  
Rating Scale ◽  
Favorable Effect ◽  
Rank Test ◽  
Control Group ◽  
Research Approach ◽  
Menstrual Pain ◽  
Significant Difference ◽  
And Control

Abstract Background Dysmenorrhea is a common problem which can alter the daily routines of females. Primary dysmenorrhea affects 40 to 90% women. Dysmenorrhea sufferers account for 3 among 4 women as per evidences. Traditional remedies are chosen to get some relief because of their least side effects. These remedies have a favorable effect in reducing dysmenorrhea. Ginger is used since ancient times as various forms of alternative medicine. One of the traditional uses of ginger is for pain relief, including menstrual pain. The aim of this study was to identify the effectiveness of ginger tea in dysmenorrhea. Objectives The objectives of this study are (1) Assess the level of dysmenorrhea among nursing students. (2) Determine the effectiveness of ginger tea on dysmenorrhea among nursing students. (3) Find the association between level of dysmenorrhea before the administration of ginger tea and demographic variables. Methodology A quantitative research approach with quasi-experimental design was considered. The sample comprised of 50 students with moderate and severe menstrual pain as per numerical pain rating scale. The baseline data was collected. Ginger tea was prepared by the researcher and administered 120 mL to the subjects; on the first 2 days of menstruation in the morning and night after breakfast and dinner, respectively. Level of different aspects of pain was assessed before the administration as well as 2 hours after administration of ginger tea using Pain Quality Assessment Scale. Pre- and post-test were taken before as well as 2 hours after administering the drink. A total of four doses are given and ratings were measured eight times. Data was analyzed using descriptive and inferential statistics. Results The present study revealed that the median score of all seven characteristics of pain was higher in the preintervention when compared with postintervention. Mann-Whitney U test showed that there was a significant difference in level of pain between the experimental and control groups (p < 0.05). Wilcoxon signed-rank test showed that there was a significant difference in pain measurements before and after the administration of ginger tea (p < 0.05). These findings indicate that ginger tea was effective in reducing menstrual pain. Chi-square test and likelihood ratio were used to find the association between baseline dysmenorrhea with demographic and clinical variables. It was found that there is no significant association (p > 0.05). The responses given by the experimental and control group was mentioned separately. Ginger tea effects and experience were verbalized by the experimental group alone. This supported the statistical finding that ginger tea is effective in reducing dysmenorrhea. Conclusion Findings revealed that the administration of ginger tea can bring a sudden relief among the subjects with dysmenorrhea. The awareness about alternative therapies must be created among public.

scholarly journals Opioid free pain management in ambulatory hemorrhoidectomy reduces pain

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
F Haak ◽  
L Merlo ◽  
B Dursunoglu ◽  
M von Flüe ◽  
D Steinemann
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Urinary Retention ◽  
Rating Scale ◽  
Outpatient Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Early Discharge ◽  
Numeric Rating Scale ◽  
Significant Difference ◽  
The Impact

Abstract Objective Outpatient hemorrhoid surgery is a topic of growing importance with a need of modifications to pain management to enable early discharge. Opioid free anesthesia and analgesia (OFAA) has the goal to reduce postoperative pain as well as to improve discharge circumstances. The impact of OFAA on patients receiving ambulatory hemorrhoidectomy is investigated. Methods A retrospective cohort study on ambulatory hemorrhoidectomy between 2018 and 2020 was performed and patients that did and did not receive OFAA were compared. In the OFAA group patients received spinal anesthesia with Takipril and hyperbaric technique. Additionally Metamizole 500mg i.v. and Paracetamol 1g i.v. was used. In the non-OFAA group opioids were administered intravenously (fentanyl or remifentanyl) and sublingual (buprenorphin). Primary endpoint was pain measured according to a numeric rating scale (NRS) one hour postoperatively. Secondary endpoints were pain 24 hours postoperative, duration of hospital stay, urinary retention, postoperative nausea and vomiting (PONV), overall morbidity, and re-admission. Wilcoxon Rank-Sum test was performed to search for differences between the outcomes. Results 117 patients were included in the analysis. 41 percent of the patients were female. The mean age was 54±14 years. 40 patients did not receive opioids perioperatively (OFAA group) and 77 did (non-OFAA group). The non-OFAA group received a mean dose of 23.3±17.9 mg morphine equivalent. Median NRS score one hour postoperatively was 0 (interquartile range 0-1) for OFAA and 2 (0-4) for non-OFAA (p = 0.01). The median NRS score 24 hours postoperatively was 1 (0-2) for OFAA and 1 (0-3) for non-OFAA (p = 0.40). There were 3 patients (7.5%) with urinary retention in OFAA and 5 patients (6.5%) in non-OFAA(p = 0.84).No patient had PONV in OFAA and 5 (6.5%) in non-OFAA (p = 0.10). The overall morbidity was 5 (12.5%) in OFAA and 16 (20.8%) in non-OFAA (p = 0.27). There were two readmissions (5%) in OFAA and 6 (7.8%) in non-OFAA (p = 0.58). Conclusion There is a significant difference in pain one hour postoperatively between OFAA and non-OFAA with a clear benefit of not administering opioids. Opioids may trigger pelvic floor spasms and disimprove postoperative pain. In the context of outpatient surgery, we recommend an opioid free operation to reduce postoperative pain and improve discharge prerequisites.

scholarly journals Pain Level of Postoperative Orthopedic Patients at Dr. Soetomo General Hospital

2019 ◽  
Vol 1 (1) ◽  
pp. 19
Author(s):  
David Wicaksono ◽  
Lilik Herawati ◽  
Herdy Sulistyono
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Rating Scale ◽  
Postoperative Pain Management ◽  
Medical Personnel ◽  
Numeric Rating Scale ◽  
Individual Factors ◽  
Pain Level ◽  
Post Surgery ◽  
Significant Difference

Introduction: Postoperative pain is the most undesirable consequence of the surgery. If it is not managed properly, it can lead to a long healing. However, assessment and treatment of postoperative pain in surgical wards still have not received attention. Differences in patient’s pain level after surgery and after being transferred to the surgical ward is very important in monitoring the effectiveness postoperative pain management. Objective: This study was conducted to determine the overview of pain level experienced by patients following orthopedic surgery and to know the individual factors that can affect the patient's pain level. Method and Material: This research was observational analytic with 43 orthopedic postoperative patients as a sample. The Patients’ pain level were measured by the Numeric Rating Scale (NRS) at one hour after surgery and 24 hours after surgery. Result and Discussion: The Pain level one hour after surgery varied between pain level 0 as much as 53% to pain level 8 as much as 4.7%. The results of measurements of pain 24 hours after surgery only 23.3% of the patients who did not complain of pain, and there was a patient who experienced pain level 10. The results of the statistical calculation, the difference between the level of pain one hour and 24 hours post-surgery obtained value of p=0.037 (p<0.05). Conclusion: There was a significant difference between the pain level at one hour and 24 hours post-surgery. It might be due to the process of peripheral and central sensitization in patients with delayed pain management. It also may be influenced by individual factors as well as medical personnel.

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