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Xiong Y, Wang D, Li S, Li X, Lin Y, Li J, Li Q. Adductor Canal Block Combined with General Analgesia for Patients with Recurrent Patellar Dislocation Undergoing "3-in-1" Procedure Surgery: A Prospective Randomized Controlled Trial. Orthop Surg 2023; 15:1636-1644. [PMID: 37194219 PMCID: PMC10235176 DOI: 10.1111/os.13706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/05/2023] [Accepted: 02/19/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE Patellar dislocation is a common injury in sports medicine. While surgical treatment is an important option, pain is severe after surgery. This study compared the analgesic effect and early rehabilitation quality between adductor canal block combined with general analgesia (ACB + GA) and single general analgesia (SGA) after recurrent patellar dislocation (RPD) for "3-in-1" procedure surgery. METHODS From July 2018 to January 2020, a prospective randomized controlled trial was conducted in analgesia management after RPD for "3-in-1" procedure surgery. The 40 patients in the experimental group received ACB (0.3% ropivacaine 30 mL) + GA, while the 38 patients in the control group received SGA. Patients in both groups received "3-in-1" procedure surgery, standardized anesthesia, and analgesia during hospitalization. The outcomes included the visual analog scale (VAS), quadriceps strength, Inpatient Satisfaction Questionnaire (IPSQ), Lysholm scores, and Kujala scores. Total rescue analgesic consumption and adverse events were also recorded. One-way analysis of variance (ANOVA) was used to compare continuous variables between groups and chi-square or Fisher's exact tests were used to compare count data. Nonparametric Kruskal-Wallis H tests evaluated ranked data. RESULTS No significant differences in resting VAS scores were observed at 8, 12, and 24 h postoperatively. However, the flexion and moving VAS scores of the ACB + GA group were significantly lower than those of the SGA group (p < 0.05). Meanwhile, the first triggering of rescue analgesics was advanced in the SGA group (p < 0.0001), and the dose of opioid analgesics was significantly higher (p < 0.0001). The quadriceps strength of the ACB + GA group was higher than that of the SGA group at 8 h postoperatively. The IPSQ of the ACB + GA group was significantly higher 24 h postoperatively. We observed no significant differences in Lysholm and Kujala scores between the two groups at 3 months after surgery. CONCLUSIONS Early analgesia management of ACB + GA showed excellent analgesia effectiveness and a positive hospitalization experience for RPD patients undergoing "3-in-1" procedure surgery. Moreover, this management was good for early rehabilitation.
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Affiliation(s)
- Yan Xiong
- Department of Orthopaedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduPeople's Republic of China
| | - Duan Wang
- Department of Orthopaedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduPeople's Republic of China
| | - Shu Li
- Department of Orthopaedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduPeople's Republic of China
| | - Xuejie Li
- Department of AnesthesiologyWest China Hospital of Sichuan UniversityChengduPeople's Republic of China
| | - Yanjun Lin
- Department of AnesthesiologyWest China Hospital of Sichuan UniversityChengduPeople's Republic of China
| | - Jian Li
- Department of Orthopaedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduPeople's Republic of China
| | - Qi Li
- Department of Orthopaedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduPeople's Republic of China
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A Comprehensive Assessment of The Eight Vital Signs. THE EUROBIOTECH JOURNAL 2022. [DOI: 10.2478/ebtj-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The term “vital sign” has been assigned to various phenomena with the presumptive intent to emphasize their importance in health care resulting in the emergence of eight vital signs with multiple designations and overlapping terms. This review developed a case definition for vital signs and identified and described the fifth through eighth vital signs. PubMed/Medline, Google and biographical databases were searched using the individual Medical Subject Headings (MeSH) terms, vital sign and fifth, vital sign and sixth, vital sign and seventh, and vital sign eighth. The search was limited to human clinical studies written in English literature from 1957 up until November 30, 2021. Excluded were articles containing the term vital sign if used alone without the qualifier fifth, sixth, seventh, or eighth or about temperature, blood pressure, pulse, and respiratory rate. One hundred ninety-six articles (122 for the fifth vital sign, 71 for the sixth vital sign, two for the seventh vital sign, and one for the eighth vital sign) constituted the final dataset. The vital signs consisted of 35 terms, classified into 17 categories compromising 186 unique papers for each primary authored article with redundant numbered vital signs for glucose, weight, body mass index, and medication compliance. Eleven terms have been named the fifth vital sign, 25 the sixth vital sign, three the seventh, and one as the eighth vital sign. There are four time-honored vital signs based on the case definition, and they represent an objective bedside measurement obtained noninvasively that is essential for life. Based on this case definition, pulse oximetry qualifies as the fifth while end-tidal CO2 and cardiac output as the sixth. Thus, these terms have been misappropriated 31 times. Although important to emphasize in patient care, the remainder are not vital signs and should not be construed in this manner.
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Xin J, Zhang Y, Li Q, Cheng X, Lin Y, Liu B, Zhou L. Adductor canal block is similar to femoral nerve block for the quality of rehabilitation after arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:2334-2342. [PMID: 31781802 DOI: 10.1007/s00167-019-05796-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Adductor canal block (ACB) provides postoperative pain relief as effectively as femoral nerve block (FNB) does, and it preserves the strength of the quadriceps femoris. However, its effect on rehabilitation after arthroscopic partial meniscectomy has not been reported. The purpose of this study was to determine the effect of pre-operative ACB and FNB on the quality of rehabilitation after arthroscopic partial meniscectomy. METHODS A total of 150 patients undergoing arthroscopic partial meniscectomy were randomly allocated to the FNB group (receiving 0.3% ropivacaine 30 ml at the thighroot-femoral nerve), the ACB group (receiving 0.3% ropivacaine 30 ml at mid-thigh adductor canal), or the control group. The primary outcome was the Hospital for Special Surgery (HSS) knee score on the 30th postoperative day. RESULTS The HSS knee score of the ACB group on the 30th day after the operation was significantly higher than those of the FNB and control groups (88.6 ± 5.3 vs. 85.3 ± 6.9 and 81.2 ± 5.9, respectively; P < 0.05). Both the ACB and FNB groups showed excellent rehabilitation, indicating similar rehabilitation quality for both treatments. CONCLUSION ACB is similar to FNB concerning the quality of rehabilitation and pain relief after arthroscopic partial meniscectomy, while ACB has little effect on the strength of the quadriceps femoris. LEVEL OF EVIDENCE I TRIAL REGISTRATAION: This trial was registered in the Chinese Clinical Trial Registry (ChiCTR-INC-16008346).
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Affiliation(s)
- Juan Xin
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yabing Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qian Li
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xu Cheng
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - YanJun Lin
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Leng Zhou
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Li RJ, Loyo Li M, Leon E, Ng CWK, Shindo M, Manzione K, Andersen P, Clayburgh D, Wax M, Chan JYK. Comparison of Opioid Utilization Patterns After Major Head and Neck Procedures Between Hong Kong and the United States. JAMA Otolaryngol Head Neck Surg 2019; 144:1060-1065. [PMID: 30193293 DOI: 10.1001/jamaoto.2018.1787] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The current opioid abuse epidemic in the United States requires evaluation of prescribing practices within all medical specialties. This examination includes a review of postoperative pain management for patients undergoing major head and neck procedures. Objective To report differences in postoperative pain regimens between an international and domestic head and neck surgical program. Design, Setting, and Participants Pain management patterns after head and neck surgery in the programs at Chinese University of Hong Kong (CUHK) and Oregon Health and Science University (OHSU) were compared with a focus on opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen or paracetamol, and anxiolytics. Cases from July 1, 2013, through August 31, 2017, were reviewed. Standing medication orders the day before surgery (PRE1), postoperative day 6 (POD6), and postoperative day 14 (POD14) were compared between institutions. Exposures Head and neck surgery. Results A total of 253 cases from CUHK and 567 cases from OHSU were analyzed (mean [SD] age, 59.4 [14.3] and 60.1 [16.4] years, respectively). Patients from OHSU had a significantly higher frequency of opioid orders on PRE1 (15.3% vs 1.6%; odds ratio [OR], 11.3; 95% CI, 4.09-31.10), POD6 (86.8% vs 0.4%; OR, 1653.12; 95% CI, 228.51-11 959.01), and POD14 (71.4% vs 0.8%; OR, 313.75; 95% CI, 77.12-1276.52). There were no significant differences in acetaminophen or paracetamol, NSAID, or anxiolytic orders between institutions. Institution was the most significant indicator for the presence of opioid orders on POD6 (OR, 4271.10; 95% CI, 380.04-47 999.70) and POD14 (OR, 330.35; 95% CI, 79.67-1369.82). In addition to treating institution, multivariate analysis showed that PRE1 opioid orders indicated a significant increase in likelihood of opioid orders on POD6 (OR, 4.77; 95% CI, 1.23-18.57) but not POD14. POD6 anxiolytic orders remained a significant indicator of opioid orders for POD6 (95% CI, 1.49-113.10) and POD14 (95% CI, 1.17-5.03), respectively. Conclusions and Relevance A significantly lower frequency of postoperative opioid orders was observed from CUHK compared with OHSU across similar major head and neck procedures. This contrast encourages a careful examination of (1) cultural and patient expectations of pain control, (2) the metrics by which control is assessed, (3) industry and economic drivers of opioid use, and (4) alternatives to opioid pain regimens. A thoughtful shift in postoperative pain protocols that deemphasizes opioid use may be an opportunity to counter the epidemic of opioid abuse in the United States.
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Affiliation(s)
- Ryan J Li
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Myriam Loyo Li
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Enrique Leon
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Cherrie W K Ng
- Department of Otorhinolaryngology-Head and Neck Surgery, Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Maisie Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Katie Manzione
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Peter Andersen
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Daniel Clayburgh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Mark Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Jason Y K Chan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chinese University of Hong Kong, Kowloon, Hong Kong
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Validation of the Spanish Version of the Pain Assessment in Advanced Dementia Scale (PAINAD-Sp) in Hospitalized Patients with Neurologic Disorders and Oncologic Patients Unable to Self-Report Their Pain. Pain Manag Nurs 2018; 20:323-330. [PMID: 30425015 DOI: 10.1016/j.pmn.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/31/2018] [Accepted: 08/24/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pain has a significant impact on hospitalized patients and is a quality indicator for nursing care. The Pain Assessment in Advanced Dementia (PAINAD) scale measures pain in people with communication disorders and advanced dementia, but it has not been validated in any other population. AIMS The aim of this study was to validate the Spanish version (PAINAD-Sp) in hospitalized patients with neurologic disorders and in end-of-life cancer patients with difficulty self-reporting. DESIGN The study had two phases: (1) analysis of the content by a committee of experts and (2) a cross-sectional study. SETTINGS We collected phase 2 data from January 2017 to December 2017 in four hospitals in Barcelona: Hospital Germans Trias i Pujol, Institut Català d'Oncologia, Hospital Vall d'Hebron, and Hospital de Bellvitge. PARTICIPANTS/SUBJECTS We included all adults who had either a neurological disorder affecting language or an oncological disease with an end-of-life prognosis and difficulty self-reporting pain. We excluded patients with a diagnosis of dementia. METHODS The cross-sectional study included 325 patients who were simultaneously evaluated by two observers both at rest and in movement. We analyzed psychometric properties in terms of construct validity, reliability, and sensitivity to change. RESULTS We obtained Cronbach α > .70 in both situations and an inter-rater reliability of 0.80. Confirmatory factor analysis indicated that the model adjusted adequately to a unidimensional structure. In terms of sensitivity to change, the mean difference was greater in movement than at rest (difference in means was 1.15). CONCLUSIONS The PAINAD-Sp_Hosp scale had good psychometric qualities in terms of validity and reliability in neurology and oncology patients unable to self-report pain.
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Arianpour K, Nguyen B, Yuhan B, Svider PF, Eloy JA, Folbe AJ. Opioid Prescription Among Sinus Surgeons. Am J Rhinol Allergy 2018; 32:323-329. [PMID: 29781284 DOI: 10.1177/1945892418773578] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Misuse and diversion of opioids have contributed to the U.S. opioid crisis, making an understanding of specialty-specific and procedure-specific trends essential. Objective The objective of this analysis was to evaluate nationwide trends in opioid prescribing patterns among sinus surgeons performing functional endoscopic sinus surgery and maxillary sinus balloon dilation, specifically examining factors associated with variations. Methods High-volume sinus surgeons were identified through the Centers for Medicare and Medicaid Services database and cross-referenced against prescriptions to Medicare Part D beneficiaries during 2013 through 2015. Number of opioid prescriptions, prescription lengths, and demographic information were obtained. Results This cohort of 570 surgeons wrote 21,042 opioid prescriptions (5.4 days per prescription) in 2015, with 80.3% and 54.7% writing >10 and >25 prescriptions, respectively. Surgeons writing a greater amount of prescriptions wrote lengthier courses throughout all 3 years ( P = .01, P = .002, P = .003). Female otolaryngologists wrote lengthier prescriptions (6.2 vs 5.3 days, P = .01). Early career otolaryngologists (≤10 years) offered fewer prescriptions compared to those who had greater experience (31.1 vs 39.3, P = .02). Moreover, 73.6% of fellowship-trained otolaryngologists offered >10 prescriptions versus 82.7% of nonfellowship-trained otolaryngologists ( P = .02). Practitioners in the South on average prescribed the greatest amount of opioids ( P < .05). Conclusion A majority of sinus surgeons prescribe ≥25 opioid prescriptions annually, with otolaryngologists who write a greater amount of prescriptions writing lengthier courses. As the mean opioid prescription length is 5.4 days, recent legislation limiting opioid prescriptions to 5 days may only have a modest impact for preventing the diversion of perioperative opioid prescriptions. These data suggest further standardized guidelines may be beneficial in elucidating the appropriate indications for the prescription of opioids among sinus surgeons.
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Affiliation(s)
- Khashayar Arianpour
- 1 Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,2 Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan
| | - Brandon Nguyen
- 1 Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,2 Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan
| | - Brian Yuhan
- 1 Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,2 Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan
| | - Peter F Svider
- 1 Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Jean Anderson Eloy
- 3 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,4 Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.,5 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,6 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Adam J Folbe
- 2 Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan.,7 Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
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Halifax E, Miaskowski C, Wallhagen M. Certified Nursing Assistants' Understanding of Nursing Home Residents' Pain. J Gerontol Nurs 2018; 44:29-36. [PMID: 29437185 DOI: 10.3928/00989134-20180131-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 12/19/2017] [Indexed: 01/12/2023]
Abstract
Pain is a significant problem for nursing home residents, yet its assessment is complex. Certified nursing assistants (CNAs) spend significant time with residents, but their role in understanding residents' pain is largely unexplored. The current qualitative grounded theory study analyzed interviews with 16 CNAs who described their experiences caring for residents in pain. Findings revealed how CNAs understood, recognized, interpreted, and responded to residents' pain. CNAs were found to differentiate between pain that they considered normal (everyday pain) and new pain judged significant enough to report to licensed nurses. CNAs exhibited a holistic understanding of pain, knowledge of strategies to identify and interpret pain, and actions to independently mitigate and report pain. Although additional confirmatory data are needed, the differentiation made between everyday and reportable pain may have important clinical implications suggesting that CNAs should always report to a licensed nurse when they perceive or suspect that residents have pain. [Journal of Gerontological Nursing, 44(4), 29-36.].
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Svider PF, Arianpour K, Guo E, Folbe E, Zuliani G, Lin H, Eloy JA, Folbe AJ. Opioid prescribing patterns among otolaryngologists: Crucial insights among the medicare population. Laryngoscope 2018; 128:1576-1581. [DOI: 10.1002/lary.27101] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 12/23/2017] [Accepted: 12/29/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Peter F. Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine; Detroit Michigan
| | | | - Eric Guo
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine; Detroit Michigan
| | - Elana Folbe
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine; Detroit Michigan
| | - Giancarlo Zuliani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine; Detroit Michigan
- Division of Facial Plastic and Reconstructive Surgery; Wayne State University School of Medicine; Detroit Michigan
- John Dingell Veterans Affairs Medical Center; Detroit Michigan
| | - Hosheng Lin
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine; Detroit Michigan
- John Dingell Veterans Affairs Medical Center; Detroit Michigan
- Barbara Ann Karmanos Cancer Institute; Detroit Michigan
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Department of Ophthalmology and Visual Science, Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Adam J. Folbe
- Department of Otolaryngology; William Beaumont Hospital; Royal Oak Michigan
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Koszalinski RS, Tappen RM, Viggiano D. Evaluation of Speak for Myself with Patients Who Are Voiceless. Rehabil Nurs 2014; 40:235-42. [PMID: 25424980 DOI: 10.1002/rnj.186] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 11/08/2022]
Abstract
PURPOSE To describe the creation and initial feasibility study of a new computer application to improve communication with people who cannot communicate by customary means during their hospitalization. DESIGN This was a mixed-methods, quasi-experimental design. METHODS This exploratory feasibility study obtained data about the experiences of 20 intensive care patients in three South Florida hospitals who were unable to speak due to mechanical obstruction. FINDINGS Study participants (20), who ranged in age from 45 to 91 years (M=67.4, SD=12.88) and between -1 to +1 (SD=-0.15) on the Richmond Agitation Sedation Scale, used Speak for Myself from 4 to 16 hours with a mean of 8.86 (SD=2.12). Ninety-five percent of the participants stated that Speak for Myself was helpful for communication. CONCLUSIONS Speak for Myself was helpful to patients who used it. This was a small study (n=20). It warrants further investigation. CLINICAL RELEVANCE Patients who are unable to communicate their needs through conventional methods still want to make their preferences and needs known. Speak for Myself is a new application that facilitates ensuring the patient's voice is heard.
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Affiliation(s)
- Rebecca S Koszalinski
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Ruth M Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - David Viggiano
- Department of Music Engineering, School of Music, University of Miami, Miami, FL, USA
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Abstract
The authors present the case of an elderly, nonverbal nursing home resident with dementia who developed fecal impaction, despite interventions such as enema. Subsequent stercoral perforation of the sigmoid colon resulted in peritonitis, sepsis, and death. The authors discuss colon perforation as a result of fecal impaction, as well as the difficulties of pain assessment and communication in patients with dementia.
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Chester JG, Rudolph JL. Vital signs in older patients: age-related changes. J Am Med Dir Assoc 2011; 12:337-43. [PMID: 21450180 PMCID: PMC3102151 DOI: 10.1016/j.jamda.2010.04.009] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 04/20/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
Abstract
Vital signs are objective measures of physiological function that are used to monitor acute and chronic disease and thus serve as a basic communication tool about patient status. The purpose of this analysis was to review age-related changes of traditional vital signs (blood pressure, pulse, respiratory rate, and temperature) with a focus on age-related molecular changes, organ system changes, systemic changes, and altered compensation to stressors. The review found that numerous physiological and pathological changes may occur with age and alter vital signs. These changes tend to reduce the ability of organ systems to adapt to physiological stressors, particularly in frail older patients. Because of the diversity of age-related physiological changes and comorbidities in an individual, single-point measurements of vital signs have less sensitivity in detecting disease processes. However, serial vital sign assessments may have increased sensitivity, especially when viewed in the context of individualized reference ranges. Vital sign change with age may be subtle because of reduced physiological ranges. However, change from an individual reference range may indicate important warning signs and thus may require additional evaluation to understand potential underlying pathological processes. As a result, individualized reference ranges may provide improved sensitivity in frail, older patients.
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Harmon JR, Higgins I, Summons P, Bellchambers H. Efficacy of the use of evidence-based algorithmic guidelines in the acute care setting for pain assessment and management in older people: a critical review of the literature. Int J Older People Nurs 2010; 7:127-40. [PMID: 21631883 DOI: 10.1111/j.1748-3743.2010.00261.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of the literature review was to identify all examples of primary research using an algorithmic approach for the implementation of a clinical practice guideline relating to pain assessment and/or management within acute care, with a specific focus on older people. DESIGN Critical literature review. DATA SOURCES Inclusion criteria were; English language publications within the past 13 years; peer reviewed; research conducted within a hospital; about adult inpatients. Exclusion criteria; research located outside of a hospital context; quality improvement studies; rehabilitation studies and literature reviews. REVIEW METHODS Critical appraisal of the literature by using a qualitative interpretation of a translational approach. The literature was thematically mapped according to the criteria of credibility, transferability, plausibility and applicability. RESULTS No clinical practice guideline was found that directly related to both assessment and management of pain using an algorithm in acute care for older people. Five studies were found to have relevance and were critically evaluated. CONCLUSION A critique of the literature shows that an algorithmic approach is feasible for translation into a clinical practice guideline for assessment and management of pain in older people within the acute care setting. IMPLICATIONS FOR PRACTICE Implementation of any algorithmic approach requires consideration of the environment, culture and availability of resources.
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Affiliation(s)
- Joanne R Harmon
- Division of Surgery, School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.
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Lin PC, Lin LC, Lotus Shyu YI, Hua MS. Chinese version of the Pain Assessment in Advanced Dementia Scale: initial psychometric evaluation. J Adv Nurs 2010; 66:2360-8. [DOI: 10.1111/j.1365-2648.2010.05405.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chang SO, Oh Y, Park EY, Kim GM, Kil SY. Concept analysis of nurses' identification of pain in demented patients in a nursing home: development of a hybrid model. Pain Manag Nurs 2010; 12:61-9. [PMID: 21620308 DOI: 10.1016/j.pmn.2010.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 05/16/2010] [Accepted: 05/26/2010] [Indexed: 11/26/2022]
Abstract
Pain is a subjective feeling, with no known biologic markers. Proof of its presence and measurement of intensity rely entirely on self-reporting by the patient. The hampered or abrogated ability of demented patients to report their pain is a major difficulty in pain assessment and management. The purpose of this study was to clarify and conceptualize pain identification in demented patients by nurses. The hybrid model of concept development was used in the development of a conceptual structure of pain in demented patients. Data were collected by literature review (theoretical phase) and among nurses caring for demented patients in three nursing homes in South Korea (fieldwork phase). The 13 nurses involved each reported >3 years' nursing home experience. In a hybrid model, pain identification in demented patients by nurses constituted an active daily process of integrating patient expressional cues during periods of pain and pain relief and involving three dimensions: identification schemes based on the stage and type of dementia, connecting assessments after each intervention, and cognitive efforts to establish the origin of pain. Identification of pain in demented patients by nurses is a complex process. More research is needed to formulate an assessment tool and pain management strategies for patients with dementia.
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Cooper JW, Burfield AH. Assessment and management of chronic pain in the older adult. J Am Pharm Assoc (2003) 2010; 50:e89-99; quiz e100-1. [DOI: 10.1331/japha.2010.10028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Takai Y, Uchida Y. Frequency and type of chronic pain care approaches used for elderly residents in Japan and the factors influencing these approaches. Jpn J Nurs Sci 2010; 6:111-22. [PMID: 20021580 DOI: 10.1111/j.1742-7924.2009.00129.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To assess the frequency at which various chronic pain care (CPC) approaches were used while managing older residents of the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to assess the factors related to nurses and care workers that influence this care. METHODS A descriptive study design was used. The population comprised 31 nurses, 92 care workers, and 18 residents with chronic pain in eight HSFERC centers located in three provincial cities in Japan. A questionnaire was formulated by using the data collected by a literature review to assess the frequencies at which various CPC approaches were applied and the factors that might influence this care. RESULTS The most frequently preferred CPC approaches were gentle handling and support while providing daily care, listening attentively, and providing a recreational activity. The factors that affected the provision of CPC were the qualifications, years of experience of aged care, and experience of studying about chronic pain. The nurses tended to have a misconception regarding the manner in which the residents complained of pain and their pain sensitivity. Furthermore, organizational strategies for pain management were not reported by the nurses and care workers. CONCLUSIONS In order to provide effective and active CPC, ongoing education about pain and cooperation between nurses and care workers to manage residents' pain are highly recommended.
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Affiliation(s)
- Yukari Takai
- Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
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Sleeper RB. Geriatric primer - common geriatric syndromes and special problems. ACTA ACUST UNITED AC 2009; 24:447-62. [PMID: 19555155 DOI: 10.4140/tcp.n.2009.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Geriatric syndromes are common problems that affect older adults. They are often thought of as causes of morbidity in one or more functional domains, but they can simultaneously be a consequence of morbidity as well. This primer will cover 12 problems commonly considered to be geriatric syndromes and highlight the potential for outcomes in one area to affect those in another. The syndromes included are: losses in activities of daily living, cognitive dysfunction, delirium versus dementia, depression, dizziness, osteoporosis, falls, sensory loss, nutrition and weight loss, pain, substance abuse, urinary incontinence, and constipation. Each syndrome is briefly discussed, followed by strategies for assessment and intervention by the pharmacist in a community setting.
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Affiliation(s)
- Rebecca B Sleeper
- Texas Tech University Health Sciences Center School of Pharmacy, Department of Pharmacy Practice, Geriatrics Division, Lubbock, Texas, USA.
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Ferris M. Improving pain assessment and management for residents with dementia. THE CONSULTANT PHARMACIST : THE JOURNAL OF THE AMERICAN SOCIETY OF CONSULTANT PHARMACISTS 2009; 24:69-73. [PMID: 19275461 DOI: 10.4140/tcp.n.2009.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Pain is a phenomenon experienced by many older adults, with the majority reporting chronic or recurrent pain. Across the breadth of practice care settings, pain is poorly assessed and poorly managed for older patients and for those with dementia, and the pain management provided is typically even more deficient. Consultant pharmacists have the expertise to help other health care professionals do better in assessing and addressing pain in the older adult, especially those with cognitive impairment. The quality of life for elders can be greatly improved by sharing that expertise.
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Affiliation(s)
- Mara Ferris
- Association for Gerontologic Education, Exeter, NH 03833, USA.
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Wheeler MS. Pain assessment and management in the patient with mild to moderate cognitive impairment. ACTA ACUST UNITED AC 2006; 24:354-9; quiz 360-1. [PMID: 16849938 DOI: 10.1097/00004045-200606000-00003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The gold standard for pain screening and assessment is the patient report. Research shows that many patients with mild to moderate cognitive impairment retain the ability to report pain. All patients should be given the opportunity to self-report their pain using valid and reliable tools.
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