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Acute pain management in burn patients: appraisal and thematic analysis of four clinical guidelines.

https://arctichealth.org/en/permalink/ahliterature265210
Source
Burns. 2014 Dec;40(8):1463-9
Publication Type
Article
Date
Dec-2014
Author
Hejdi Gamst-Jensen
Pernille Nygaard Vedel
Viktoria Oline Lindberg-Larsen
Ingrid Egerod
Source
Burns. 2014 Dec;40(8):1463-9
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Acute Pain - etiology - psychology - therapy
Adaptation, Psychological
Adult
Analgesics - therapeutic use
Anti-Anxiety Agents - therapeutic use
Anxiety - drug therapy - psychology
Burn Units
Burns - complications - psychology - therapy
Child
Denmark
Evidence-Based Medicine
Humans
Hypnosis, Anesthetic
New Zealand
Pain Management - psychology - standards
Pain Measurement
Pain, Postoperative - psychology - therapy
Practice Guidelines as Topic - standards
Retrospective Studies
Sweden
United States
Abstract
Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units.
The study had a comparative retrospective design using combined methodology of instrument appraisal and thematic analysis. Three investigators appraised guidelines from burn units in Denmark (DK), Sweden (SE), New Zealand (NZ), and USA using the AGREE Instrument (Appraisal of Guidelines for Research & Evaluation), version II, and identified core themes in the guidelines.
The overall scores expressing quality in six domains of the AGREE instrument were variable at 22% (DK), 44% (SE), 100% (NZ), and 78% (USA). The guidelines from NZ and USA were highly recommended, the Swedish was recommended, whereas the Danish was not recommended. The identified core themes were: continuous pain, procedural pain, postoperative pain, pain assessment, anxiety, and non-pharmacological interventions.
The study demonstrated variability in quality, transparency, and core content in clinical guidelines on pain management in burn patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn patients in the clinic, to unify guideline construction, and to enable interdepartmental comparison of treatment and outcomes.
PubMed ID
25277698 View in PubMed
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Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery: A survey of the multidisciplinary team.

https://arctichealth.org/en/permalink/ahliterature286661
Source
Int J Pediatr Otorhinolaryngol. 2017 Oct;101:123-131
Publication Type
Article
Date
Oct-2017
Author
F. Alm
M. Jaensson
S. Lundeberg
E. Ericsson
Source
Int J Pediatr Otorhinolaryngol. 2017 Oct;101:123-131
Date
Oct-2017
Language
English
Publication Type
Article
Keywords
Analgesics - therapeutic use
Anesthesia
Child
Child, Preschool
Cross-Sectional Studies
Female
Follow-Up Studies
Guideline Adherence
Humans
Male
Pain Management - methods
Pain, Postoperative - drug therapy
Palatine Tonsil - surgery
Patient care team
Surveys and Questionnaires
Sweden
Tonsillectomy - adverse effects
Abstract
Pain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013.
The objective of this study was to evaluate the professionals' opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up.
This descriptive cross-sectional study was based on data from an inter-professional questionnaire, which was validated by an expert group using a content validity index (S-CVI 0.93). The questionnaire was sent to all Swedish ear, nose and throat (ENT) departments (n = 49) that the NTRS identified as performing tonsil surgery on children younger than 18 years of age. In each clinic, we asked for responses from staff in each of the following professions: ENT physicians, anesthesia physicians, registered nurse anesthetists, and registered nurses in the ENT departments.
Respondents from 48 ENT departments participated, and 139/163 (85%) completed questionnaires were returned. The guidelines were reported as being clear, ensuring patient safety and providing optimal pharmacological treatment. Treatment was given according to the guidelines: Half of the departments gave pre- or intraoperative treatment with clonidine, betamethasone and high-dose paracetamol (acetaminophen). A multimodal pain approach (paracetamol and COX-inhibitors) after hospital discharge was prescribed by all departments after tonsillectomy and, extensively, after tonsillotomy. One-third of the departments prescribed paracetamol with a higher normal dose for the first three postoperative days. Half of the departments prescribed rescue analgesics, clonidine or opioids after tonsillectomy. None of the departments prescribed codeine or tramadol, drugs that are discouraged in the guidelines. The majority of the departments used the website tonsilloperation.se to provide information to the patients and their caregivers.
The respondents' opinions of and the ENT departments adherence to the Swedish national guidelines were considered to be good. The national implementation process in Sweden has impacted the manner in which ENT departments treat pain after tonsil surgery.
PubMed ID
28964282 View in PubMed
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Adjunct High Frequency Transcutaneous Electric Stimulation (TENS) for Postoperative Pain Management during Weaning from Epidural Analgesia Following Colon Surgery: Results from a Controlled Pilot Study.

https://arctichealth.org/en/permalink/ahliterature278492
Source
Pain Manag Nurs. 2015 Dec;16(6):944-50
Publication Type
Article
Date
Dec-2015
Author
Kristofer Bjerså
Pether Jildenstaal
Jan Jakobsson
Madelene Egardt
Monika Fagevik Olsén
Source
Pain Manag Nurs. 2015 Dec;16(6):944-50
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Analgesia, Epidural
Colon - surgery
Combined Modality Therapy - methods
Female
Humans
Male
Middle Aged
Pain Management - methods
Pain Measurement
Pain, Postoperative - prevention & control
Pilot Projects
Prone Position
Respiration
Sweden
Transcutaneous Electric Nerve Stimulation - methods
Treatment Outcome
Walking
Abstract
The potential benefit of nonpharmacological adjunctive therapy is not well-studied following major abdominal surgery. The aim of the present study was to investigate transcutaneous electrical nerve stimulation (TENS) as a complementary nonpharmacological analgesia intervention during weaning from epidural analgesia (EDA) after open lower abdominal surgery. Patients were randomized to TENS and sham TENS during weaning from EDA. The effects on pain at rest, following short walk, and after deep breath were assessed by visual analog scale (VAS) grading. Number of patients assessed was lower than calculated because of change in clinical routine. Pain scores overall were low. A trend of lower pain scores was observed in the active TENS group of patients; a statistical significance between the groups was found for the pain lying prone in bed (p 
PubMed ID
26541070 View in PubMed
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Advanced cancer patients' self-assessed physical and emotional problems on admission and discharge from hospital general wards--a questionnaire study.

https://arctichealth.org/en/permalink/ahliterature125804
Source
Eur J Cancer Care (Engl). 2012 Sep;21(5):667-76
Publication Type
Article
Date
Sep-2012
Author
L. Soelver
B. Oestergaard
S. Rydahl-Hansen
L. Wagner
Author Affiliation
Department of Surgery K, Bispebjerg Hospital, Bispebjeg Bakke 23, Copenhagen, Denmark. lsoe0012@bbh.regionh.dk
Source
Eur J Cancer Care (Engl). 2012 Sep;21(5):667-76
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Denmark
Diarrhea - etiology - therapy
Female
Hospitalization - statistics & numerical data
Hospitals, General - standards - statistics & numerical data
Humans
Male
Middle Aged
Neoplasms - complications - psychology - therapy
Pain - etiology
Pain Management - standards
Palliative Care - standards
Patient Discharge - statistics & numerical data
Prospective Studies
Questionnaires
Stress, Psychological - etiology - therapy
Terminally ill
Abstract
Most cancer patients receiving life-prolonging or palliative treatment are offered non-specialist palliative services. There is a lack of knowledge about their problem profile. The aim of this article is to describe the incidence of patient-reported physical and emotional problems on admission and discharge from general hospital wards and health staff's reported intervention. A prospective study was undertaken over 12 months, where advanced cancer patients completed a patient questionnaire, EORTC QLQ C15-PAL, on admission (n= 97) and discharge (n= 46). The incidences of the problems were dichotomised in intensity categories. The average number of 'clinically relevant problems' on admission was 5 (SD 2) and on discharge 4 (SD 2). A Wilcoxon signed rank test showed significant change in mean score for six out of nine problem areas, but the majority of the patients did not move to the lower intensity category. The highest concurrence was between patient-reported problems and reported intervention for physical function, pain, constipation and loss of appetite. Palliative cancer patients' self-reported problem profile on admission and discharge from hospital has not previously been described and the results indicate a need to focus on improvements to palliative services and for a special service for pain and constipation that could prevent some admissions.
PubMed ID
22452383 View in PubMed
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The Alberta Ambassador Program: delivering Health Technology Assessment results to rural practitioners.

https://arctichealth.org/en/permalink/ahliterature169962
Source
BMC Med Educ. 2006;6:21
Publication Type
Article
Date
2006
Author
Saifudin Rashiq
Pamela Barton
Christa Harstall
Donald Schopflocher
Paul Taenzer
Author Affiliation
Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton AB, Canada. srashiq@ualberta.ca
Source
BMC Med Educ. 2006;6:21
Date
2006
Language
English
Publication Type
Article
Keywords
Alberta
Chronic Disease
Decision Making
Education, Medical, Continuing - methods
Evidence-Based Medicine - education
Humans
Pain Management
Physician's Practice Patterns
Program Development
Program Evaluation
Regional Medical Programs
Rural Health Services - standards
Teaching - methods
Teaching Materials
Technology Assessment, Biomedical
Abstract
The purpose of Health Technology Assessment (HTA) is to make the best possible summary of the evidence regarding specific health interventions in order to influence health care and policy decisions. The need for decision makers to find relevant HTA data when it is needed is a barrier to its usefulness. These barriers are highest in rural areas and amongst isolated practitioners.
A multidisciplinary team developed an interactive case-based instructional strategy on the topic of chronic non-cancer pain (CNCP) management using clinical evidence derived by HTA. The evidence for each of 18 CNCP interventions was distilled into single-sheet summaries. Clinicians and HTA specialists ('Ambassadors') conducted 11 two-hour interactive sessions on CNCP in eight of Alberta's nine health regions. Pre- and post-session evaluations were conducted.
The sessions were attended by 130 individuals representing 14 health and administrative disciplines. The ambassador model was well received. The use of content experts as ambassadors was highly rated. The educational strategy was judged to be effective. Awareness of the best evidence in CNCP management was increased. Although some participants reported practice changes as a result of the workshops, the program was not designed to measure changes in patient outcome.
The ambassador program was successful in increasing awareness of the best evidence in CNCP management, and positively influenced treatment decisions. Its teaching methods were felt to be unique and innovative by participants. Its methods could be applied to other clinical content areas in order to increase the uptake of the results of HTA.
Notes
Cites: J Contin Educ Health Prof. 2002 Fall;22(4):214-2112613056
Cites: J Health Soc Policy. 2002;15(3-4):23-3712705462
Cites: BMJ. 1998 Jul 25;317(7153):273-69677226
Cites: J Eval Clin Pract. 2003 Nov;9(4):385-9014758960
Cites: J Contin Educ Health Prof. 2004 Spring;24(2):68-7515279131
Cites: Lancet. 2003 Oct 11;362(9391):1225-3014568747
PubMed ID
16579855 View in PubMed
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'A lifebuoy' and 'a waste of time': patients' varying experiences of multidisciplinary pain centre treatment- a qualitative study.

https://arctichealth.org/en/permalink/ahliterature307475
Source
BMC Health Serv Res. 2019 Dec 30; 19(1):1015
Publication Type
Journal Article
Date
Dec-30-2019
Author
Torunn Hatlen Nøst
Aslak Steinsbekk
Author Affiliation
Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491, Trondheim, Norway. torunn.h.nost@ntnu.no.
Source
BMC Health Serv Res. 2019 Dec 30; 19(1):1015
Date
Dec-30-2019
Language
English
Publication Type
Journal Article
Keywords
Adult
Attitude to Health
Chronic Pain - therapy
Female
Humans
Male
Middle Aged
Norway
Pain Clinics
Pain Management - psychology
Qualitative Research
Tertiary Care Centers
Abstract
The recognition of chronic pain as a biopsychosocial phenomenon has led to the establishment of multidisciplinary pain treatment facilities, such as pain centres. Previous studies have focussed on inpatient, group-based or time-limited multidisciplinary pain programmes. The aim was to investigate variation in patients' experiences of attending individual outpatient multidisciplinary treatment at pain centres in Norway.
This was a qualitative study using semi-structured individual interviews with 19 informants. The informants were recruited among persons who after referral by their general practitioners 12?months prior had attended multidisciplinary pain treatment at a pain centre. The data were analysed thematically using systematic text condensation.
The informants had received different treatments at the pain centres. Some had undergone only one multidisciplinary assessment in which a physician, a psychologist and a physiotherapist had been present, whereas others had initially been to a multidisciplinary assessment and then continued treatment by one or more of the professionals at the centre. Their experiences ranged from the pain centre as being described as a lifebuoy by some informants who had attended treatment over time, to being described as a waste of time by others who had only attended one or two multidisciplinary sessions. Prominent experiences included being met with understanding and a perception of receiving the best possible treatment, but also included disappointment over not being offered any treatment and perceiving the multidisciplinary approach as unnecessary.
There were large variations in the informants' experiences in the pain centres. The findings indicate that the pain centres' multidisciplinary approach can represent a new approach to living with chronic pain but may also not provide anything new. Efforts should be devoted to ensuring that the pain centres' multidisciplinary treatment approach is aligned with their patients' actual needs.
PubMed ID
31888620 View in PubMed
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Ambulance nurse's experience to relieve pain in patients with addiction problems in Sweden.

https://arctichealth.org/en/permalink/ahliterature310226
Source
Int Emerg Nurs. 2019 09; 46:100779
Publication Type
Journal Article
Date
09-2019
Author
Katarina Bohm
Roger Lund
Jörgen Nordlander
Veronica Vicente
Author Affiliation
Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Sweden; The Emergency Department, Södersjukhuset in Stockholm, Sweden.
Source
Int Emerg Nurs. 2019 09; 46:100779
Date
09-2019
Language
English
Publication Type
Journal Article
Keywords
Adult
Ambulances
Emergency Medical Services - methods - standards - trends
Female
Humans
Male
Middle Aged
Nurses - psychology - statistics & numerical data
Pain Management - methods - psychology - standards
Qualitative Research
Substance-Related Disorders - drug therapy - psychology
Sweden
Abstract
Pain is a personal and subjective experience. Prehospital emergency nurses (PEN) should work on the basis that all people are equal and entitled to the same care regardless of gender, age, disability or social status. The objective of treatment in health care is that all the pain to be alleviated. People with addiction problems often seek emergency care and pain is a frequent symptom. Research shows that medical staff often under treats pain and treat patients with addiction differently.
To describe PENSs' experiences of relieving pain in patients with addiction problems, otherwise called Substance Abuse Syndrome.
The study is designed with a qualitative approach with semistructured interviews. Eight PENs were interviewed and the material was analyzed according to a manifest content analysis.
The study's main finding is that the PENs wanted to give all patients equal care but often experienced uncertainty in the care of addicts. Many of the perceived emotions created a doubt in what situations would be resolved. Lack of information and knowledge about addiction and their own feelings and values of addicts made it difficult to decide what was right or wrong treatment. The difficulty was further increased when the unclear guidelines and lack of support meant that the treatment still perceived to be different.
Pain management of patients with drug addiction can be characterized as a complex task that requires a high level of skill. PENs often encounter this population in their work. Several factors lead to their experiencing these care situations as difficult to manage. Treatment guidelines are perceived as unclear and giving weak support as to how patients with addiction and pain should be treated. To handle this, PEN sought support in their decision-making from colleagues in ambulance care and the Emergency Department. Their conclusion was that treatment would be different every time, and that patients with addiction and pain were all treated differently. Despite advances in treatment options, patients will continue to be under-treated. Unfortunately, it is not just better knowledge of pain physiology and pharmacology that is the solution. Knowledge about and attitudes to pain and addiction must be corrected before any behaviour can be changed. The results of this study will hopefully make knowledge more nuanced and raise awareness of shortcomings in order to optimize care and treatment in the prehospital environment.
PubMed ID
31345691 View in PubMed
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Ambulance personnel's experience of pain management for patients with a suspected hip fracture: A qualitative study.

https://arctichealth.org/en/permalink/ahliterature278758
Source
Int Emerg Nurs. 2015 Jul;23(3):244-9
Publication Type
Article
Date
Jul-2015
Author
D. Jakopovic
A-C Falk
V. Lindström
Source
Int Emerg Nurs. 2015 Jul;23(3):244-9
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Aged
Allied Health Personnel
Ambulances
Emergency Medical Services - organization & administration
Female
Hip Fractures
Humans
Interviews as Topic
Male
Pain Management - methods
Qualitative Research
Sweden
Abstract
Pain management is described to be insufficient for patients suffering from a hip fracture, and the management for this vulnerable group of patients may be challenging due to their medical history (multiple comorbidities) and polypharmacy. Previous research has mainly focused on fast tracks aiming to reduce time to surgery. But the research on how pain management is handled for these patients in the prehospital context has been sparse. Therefore, the purpose of this study was to describe the ambulance personnel's experience of managing the pain of patients with a suspected hip fracture. A descriptive and qualitative design with Critical Incident Technique was used for collecting data. Moreover, a qualitative content analysis was used for analysing the collected data. Twenty-two participants communicated their experiences and 51 incidents were analysed. The main finding in the study was that the ambulance personnel, by using their clinical knowledge and by empowering the patients to participate in their own care, managed to individualize the pain relief for patients with a suspected hip fracture through a variety of interventions.
PubMed ID
25676257 View in PubMed
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335 records – page 1 of 34.