The Impact of Patient Interactive Systems on the Management of Pain in an Inpatient Hospital Setting: A Systematic Review

Clinician Acceptance of Order Sets for Pain Management: A Survey in Two Urban Hospitals

BACKGROUND

 Order sets are a clinical decision support (CDS) tool in computerized provider order entry systems. Order set use has been associated with improved quality of care. Particularly related to opioids and pain management, order sets have been shown to standardize and reduce the prescription of opioids. However, clinician-level barriers often limit the uptake of this CDS modality.

OBJECTIVE

 To identify the barriers to order sets adoption, we surveyed clinicians on their training, knowledge, and perceptions related to order sets for pain management.

METHODS

 We distributed a cross-sectional survey between October 2020 and April 2021 to clinicians eligible to place orders at two campuses of a major academic medical center. Survey questions were adapted from the widely used framework of Unified Theory of Acceptance and Use of Technology. We hypothesize that performance expectancy (PE) and facilitating conditions (FC) are associated with order set use. Survey responses were analyzed using logistic regression.

RESULTS

 The intention to use order sets for pain management was associated with PE to existing order sets, social influence (SI) by leadership and peers, and FC for electronic health record (EHR) training and function integration. Intention to use did not significantly differ by gender or clinician role. Moderate differences were observed in the perception of the effort of, and FC for, order set use across gender and roles of clinicians, particularly emergency medicine and internal medicine departments.

CONCLUSION

 This study attempts to identify barriers to the adoption of order sets for pain management and suggests future directions in designing and implementing CDS systems that can improve order sets adoption by clinicians. Study findings imply the importance of order set effectiveness, peer influence, and EHR integration in determining the acceptability of the order sets.

Construction and Clinical Application Effect of General Surgery Patient-Oriented Nursing Information Platform Using Cloud Computing

The paper aims to build a nursing information platform (NIP) for general surgery (GS) patients and explore its clinical application effect based on cloud computing (CC) technology. Specifically, the present work first analyzes and expounds on the characteristics of GS patients, the CC concept, the three-tier service mode of CC, and the cloud data center (CDC). Secondly, based on the principle of the overall system design, the evaluation indexes of medical care end, patient end, family end, and management end are constructed using Visual Studio 2010. Thirdly, the expert evaluation and user evaluation methods are selected to analyze the clinical application effect of the proposed system. Finally, SPSS is used to analyze the effect of the proposed system. The results of the first and second rounds of the expert evaluation show that the authority coefficient of experts is greater than 0.7, which indicates that the degree of expert authority is good. The proposed CC-based GS patient-oriented NIP system is universal. The evaluation results of 20 users have shown 15 doctors and nurses, 14 patients, and 18 family members, who mostly still support applying the proposed CC-based GS patient-oriented NIP system and believe that the system brings convenience and improves work efficiency. In short, more incentives should be taken to build a NIP for GS patients.

Understanding cancer patients' use and perceptions of inpatient portal: A case study at a tertiary hospital in Saudi Arabia

BACKGROUND

Inpatient portals have been introduced into tertiary hospitals to meet patients' information and communication needs, to increase their awareness of health care, and to facilitate their transition after discharge. However, there is inadequate knowledge about hospitalised oncology patients' use and perceptions of these technologies.

OBJECTIVE

To explore cancer patients' use and perceptions of an inpatient portal in a tertiary hospital and to identify the main benefits and barriers for patients in using the portal.

METHOD

A qualitative case study was conducted in a tertiary hospital in Riyadh, Saudi Arabia. Only cancer patients were invited to participate. Twenty-two semi-structured interviews were conducted in the patient's room in a cancer care centre in January 2020. Interviews were audio-recorded, fully transcribed, and analysed using a thematic analysis method.

RESULTS

Most patients used the portal for the first time. The most used features were entertainment, watching fall prevention videos and viewing medication lists. Although the majority of patients were positive towards the portal, and considered it to be useful and easy to use, only a small number of them used the key clinical feature of the system such as pain assessment, health education, and discharge preparation. The patients would like to see further improvement in usability of the portal, appropriate user training, adding further information, and incorporating more services and features in the portal.

CONCLUSION

The introduction of the inpatient portal is successful in improving cancer patients' hospitalisation experience. It helped cancer patients to acquire knowledge about their own health, to actively engage in their care processes, and to request and acquire electronic services, in addition to providing entertainment. Future research on which factors inspire patients' use of the portal and how the influence is achieved is needed for the successful integration of the portal into the patients' hospital care process.

Complementary and Alternative Medicine for Postoperative Pain: A Systematic Review

BACKGROUND

The treatment of postoperative pain is an ongoing challenge for orthopaedic surgeons. Poorly controlled pain is associated with poorer patient outcomes, and the prescription of opioids may lead to prolonged, nonmedical use. Complementary and alternative medicine is widely adopted by the general public, and its use in chronic musculoskeletal pain conditions has been studied; however, its efficacy in a postoperative context has not yet been established.

METHODS

We conducted a systematic literature review of 10 databases to identify all relevant publications. We extracted variables related to pain measurement and postoperative opioid prescriptions.

RESULTS

We identified 8 relevant publications from an initial pool of 2,517 items. Of these, 5 were randomized studies and 3 were nonrandomized studies. All 8 studies addressed postoperative pain, with 5 showing significant decreases (p < 0.05) in postoperative pain. Also, 5 studies addressed postoperative opioid use, with 2 showing significant differences (p < 0.05) in opioid consumption. Substantial heterogeneity among the studies precluded meta-analysis. No articles were found to be free of potential bias.

CONCLUSIONS

Currently, there is insufficient evidence to determine the efficacy of complementary and alternative medicines for postoperative pain management or as an alternative to opioid use following orthopaedic surgery.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.