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Hooten WM, Eberhart ND, Cao F, Gerberi DJ, Moman RN, Hirani S. Preoperative Epidural Steroid Injections and Postoperative Infections After Lumbar or Cervical Spine Surgery: A Systematic Review and Meta-Analysis. Mayo Clin Proc Innov Qual Outcomes 2023; 7:349-365. [PMID: 37655233 PMCID: PMC10466430 DOI: 10.1016/j.mayocpiqo.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Objective To determine the risk difference and 95% prediction intervals (PIs) for postoperative infections (POIs) associated with preoperative epidural steroid injections (ESIs) in adults undergoing lumbar or cervical spine surgery. Methods Comprehensive database searches were conducted from inception dates through December 2023. Inclusion criteria included all study designs involving adults receiving a preoperative ESI before lumbar or cervical decompression or fusion spine surgery. Risk of bias was assessed using a modified tool developed for uncontrolled studies. The summary estimates of risk difference and the corresponding PIs were reported. Results A total of 12 studies were included in the systematic review, of which 9 were included in the meta-analysis. Preoperative ESIs within 1 month of lumbar spine decompression or fusion surgery were associated with a 0.6% and 2.31% greater risk of a POI, respectively. In adults ≥65 years of age, ESIs within 1 or 1-3 months of lumbar spine decompression or fusion surgery were associated with a 1.3% and 0.6% greater risk of a POI, respectively. Preoperative ESIs within 3 months of cervical spine fusion were not associated with an increased risk of a POI. The bounds of all corresponding 95% PIs were nonsignificant. Conclusion The observations of this study provide summary estimates of risk difference and 95% PIs, which could be used to support shared decision-making about the use of ESIs before cervical or lumbar spine surgery.
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Affiliation(s)
- W. Michael Hooten
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Nathan D. Eberhart
- Department of Anesthesiology and Perioperative Medicine, Anesthesiology Systematic Review Group, Mayo Clinic, Rochester, MN
| | - Fei Cao
- Department of Psychiatry, Division of Pain Medicine, University of Missouri at Kansas City, Kansas City, MO
| | | | | | - Salman Hirani
- Comprehensive Pain Center, Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science Center, Portland, OR
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Joseph AE, Moman RN, Barman RA, Kleppel DJ, Eberhart ND, Gerberi DJ, Murad MH, Hooten WM. Effects of Slow Deep Breathing on Acute Clinical Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Evid Based Integr Med 2022; 27:2515690X221078006. [PMID: 35225720 PMCID: PMC8891889 DOI: 10.1177/2515690x221078006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Slow deep breathing (SDB) may help patients with acute pain. The primary aim of this systematic review and meta-analysis is to investigate the effects of SDB on acute pain. Secondary aims include investigating the effects of SDB on acute pain-related physical and emotional functioning. An a priori protocol was registered and a database search was conducted by a reference librarian. Randomized controlled trials (RCT) were eligible for inclusion and exclusion criteria included studies of SDB for non-pain indications and studies that applied SDB as a component of an encompassing intervention. The risk or bias was assessed using the Cochrane Collaboration's revised tool for assessing risk of bias in randomized trials. Meta-analysis was conducted using the random effects model. A total of 11 968 studies were screened and seven RCTs met inclusion criteria; five were judged to have low risk of bias. Meta-analysis of post-intervention pain scores demonstrated that SDB was associated with significantly lower pain scores compared with a control group, but with high levels of heterogeneity. Subgroup analyzes demonstrated that trials of burn pain were associated with a larger reduction in pain which partially explains the heterogeneity. Very low certainty evidence suggests that SDB may reduce acute pain intensity. Further research is needed to identify patients who are candidates for SDB and determine the best approach to deliver this therapy.
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Affiliation(s)
- Amira E Joseph
- Department of Anesthesiology and Perioperative Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - Rajat N Moman
- Washington University School of Medicine, Department of Anesthesiology, Division of Pain Medicine, St. Louis, MO, USA
| | - Ross A Barman
- Department of Anesthesiology and Perioperative Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - Donald J Kleppel
- Department of Anesthesiology and Perioperative Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - Nathan D Eberhart
- Department of Anesthesiology and Perioperative Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | | | - M Hassan Murad
- Department of Internal Medicine, Division of Preventive Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - W Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, 6915Mayo Clinic, Rochester, MN, USA
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Joseph A, Moman RN, Hunt T. Degenerative Cervical Myelopathy Presenting with Partial Brown Séquard Syndrome. Pain Med 2022; 23:213-217. [PMID: 33825895 DOI: 10.1093/pm/pnab132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amira Joseph
- Department of Anesthesiology and Perioperative Medicine
| | - Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine
| | - Terry Hunt
- Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA
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D'Souza RS, Peterson A, Barman R, Moman RN, Olatoye O. Radiation Use Trends During Spinal Cord Stimulator Placement Performed by Fellow Trainees. Pain Med 2021; 22:3100-3102. [PMID: 34255077 DOI: 10.1093/pm/pnab218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ashley Peterson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ross Barman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Oludare Olatoye
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Moman RN, Peterson AA, Maher DP, Eli I, Hagedorn JM, Bendel MA, Gerberi D, Murad MH, Hooten WM. Infectious Complications of Dorsal Root Ganglion Stimulation: A Systematic Review and Pooled Analysis of Incidence. Neuromodulation 2021; 25:956-964. [PMID: 34096135 DOI: 10.1111/ner.13473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/16/2021] [Accepted: 05/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Dorsal root ganglion stimulation (DRGS) is a newer form of neuromodulation that targets the dorsal root ganglion. DRGS has superior efficacy in complex regional pain syndrome compared to spinal cord stimulation (SCS) and may have efficacy in other forms of chronic pain. While decades of safety data are available for SCS, there is less available safety information for DRGS. The objectives of this systematic review and pooled analysis of incidence are to determine the overall incidence of DRGS infections, incidence at each stage (trial vs. implant vs. revision), infection characteristics, and outcomes. MATERIALS AND METHODS A comprehensive search of databases from January 1980 to January 2021 was conducted. RESULTS Ten studies met inclusion criteria. Eight studies reported patients with trial data (n = 291), ten studies reported patients with implant data (n = 250), and seven studies reported data with revisions (n = 26). The pooled incidence of trial infections was 1.03% (95% CI 0.35-2.99%), implant infections was 4.80% (95% CI 2.77-8.20%), revision infections was 3.85% (95% CI 0.20-21.59%), and overall infections was 2.82% (95% CI 1.62-4.54%). There was a statistically significant difference in infection rates between the trial, implant, and revision stages, X2 (2, N = 567) = 8.9839, p = 0.01. CONCLUSIONS This is the first systematic review and pooled analysis that followed PRISMA guidelines to report infectious complications of DRGS by stage (trial vs. implant vs. revision). DRGS trial appears to be low risk for infection but that risk is significantly increased with DRGS implant. Our findings highlight the need for further study of infectious complications, their risks, and optimal prophylaxis.
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Affiliation(s)
- Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ashley A Peterson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dermot P Maher
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins, Baltimore, MD, USA
| | - Ilhan Eli
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jonathan M Hagedorn
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Markus A Bendel
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - M Hassan Murad
- Division of Preventive Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - W Michael Hooten
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins, Baltimore, MD, USA
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6
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Boswell MR, Moman RN, Burtoft M, Gerdes H, Martinez J, Gerberi DJ, Wittwer E, Murad MH, Hooten WM. Lidocaine for postoperative pain after cardiac surgery: a systematic review. J Cardiothorac Surg 2021; 16:157. [PMID: 34059093 PMCID: PMC8166031 DOI: 10.1186/s13019-021-01549-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 05/24/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Lidocaine is one of the most widely used local anesthetics with well-known pharmacological properties. The purpose of this systematic review is to investigate the effects of lidocaine on postoperative pain scores and recovery after cardiac surgery. METHODS A comprehensive database search was conducted by a reference librarian for randomized clinical trials (RCT) from January 1, 1980 to September 1, 2019. Eligible study designs included randomized controlled trials of lidocaine for postoperative pain management in adults undergoing cardiac surgery. After removal of duplicates, 947 records were screened for eligibility and 3 RCTs met inclusion criteria. RESULTS Sources of bias were identified in 2 of 3 RCTs. Lidocaine was administered intravenously, topically, and intrapleurally. Key findings included [1] 2% lidocaine placed topically on chest tube prior to intraoperative insertion was associated with significantly lower pain scores and lower cumulative doses of fentanyl; and [2] 2% lidocaine administered intrapleurally was associated with significantly lower pain scores and significant improvements in pulmonary mechanics. Lidocaine infusions were not associated with significant changes in pain scores or measures of recovery. No significant associations were observed between lidocaine and overall mortality, hospital length of stay or ICU length of stay. No data were reported for postoperative nausea and vomiting or arrhythmias. CONCLUSIONS Due to the favorable risk profile of topical lidocaine and the need for further advancements in the postoperative care of adults after cardiac surgery, topically administered lidocaine could be considered for incorporation into established postoperative recovery protocols.
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Affiliation(s)
- Michael R Boswell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - Melissa Burtoft
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - Harrison Gerdes
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - Jacob Martinez
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | | | - Erica Wittwer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - M Hassan Murad
- Division of Preventative Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - W Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA. .,Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
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7
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Moman RN, Olatoye OO, Pingree MJ. Temporary, Percutaneous Peripheral Nerve Stimulation for Refractory Occipital Neuralgia. Pain Med 2021; 23:415-420. [PMID: 33823015 DOI: 10.1093/pm/pnab128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rajat N Moman
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Oludare O Olatoye
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matthew J Pingree
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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8
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Moman RN, Hooten WM. Letter to the editor regarding a recent article: Meta-analysis comparing celecoxib with diclofenac sodium in patients with knee osteoarthritis. Pain Med 2021; 23:595-696. [PMID: 33724403 DOI: 10.1093/pm/pnab100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - W Michael Hooten
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
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9
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Moman RN, Michael Hooten W. Prescription for unguided mobile health applications. Br J Anaesth 2021; 126:e89-e92. [PMID: 33358047 PMCID: PMC8885105 DOI: 10.1016/j.bja.2020.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/04/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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10
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Moman RN, Moeschler SM, Pearson ACS, Hooten WM. Gender composition of speakers at two annual pain medicine meetings: a cross-sectional study. Reg Anesth Pain Med 2020; 45:920-921. [DOI: 10.1136/rapm-2020-101353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/04/2022]
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11
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Moman RN, Hooten WM. Comment on a manuscript by Paramasivan et al. entitled ‘Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials’. Eur J Pain 2020; 24:2037. [DOI: 10.1002/ejp.1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/15/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Rajat N. Moman
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester MN USA
| | - W. Michael Hooten
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester MN USA
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12
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Moman RN, Hooten WM. Letter to the editor for the article titled 'serotonin-norepinephrine reuptake inhibitors for the prevention of migraine and vestibular migraine: a systematic review and meta-analysis'. Reg Anesth Pain Med 2020; 46:289-290. [PMID: 32474418 DOI: 10.1136/rapm-2020-101624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Rajat N Moman
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - W Michael Hooten
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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13
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Hooten WM, Moman RN, Dvorkin J, Pollard EM, Wonderman R, Murad MH. Prevalence of smoking in adults with spinal cord stimulators: a systematic review and meta-analysis. Reg Anesth Pain Med 2020; 45:214-218. [PMID: 31996403 DOI: 10.1136/rapm-2019-100996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/13/2019] [Accepted: 12/04/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Smoking adversely impacts pain-related outcomes of spinal cord stimulation (SCS). However, the proportion of SCS patients at risk of worse outcomes is limited by an incomplete knowledge of smoking prevalence in this population. Thus, the primary aim of this systematic review is to determine the prevalence of smoking in adults with chronic pain treated with SCS. METHODS A comprehensive search of databases from 1 January 1980 to 3 January 2019 was conducted. Eligible study designs included (1) randomized trials; (2) prospective and retrospective cohort studies; and (3) cross-sectional studies. The risk of bias was assessed using a tool specifically developed for prevalence studies. A total of 1619 records were screened, 19 studies met inclusion criteria, and the total number of participants was 10 838. RESULTS Thirteen studies had low or moderate risk of bias, and six had a high risk of bias. All 19 studies reported smoking status and the pooled prevalence was 38% (95% CI 30% to 47%). The pooled prevalence in 6 studies of peripheral vascular diseases was 56% (95% CI 42% to 69%), the pooled prevalence of smoking in 11 studies of lumbar spine diagnoses was 28% (95% CI 20% to 36%) and the pooled prevalence in 2 studies of refractory angina was 44% (95% CI 31% to 58%). CONCLUSIONS The estimated prevalence of smoking in SCS patients is 2.5 times greater than the general population. Future research should focus on development, testing and deployment of tailored smoking cessation treatments for SCS patients.
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Affiliation(s)
- W Michael Hooten
- Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Rajat N Moman
- Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Jodie Dvorkin
- Institute for Clinical Systems Improvement, Bloomington, Minnesota, USA
| | - E Morgan Pollard
- Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Robalee Wonderman
- Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - M Hassan Murad
- Preventive Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Moman RN, Hooten WM. The Major Barrier Facing Patients and Clinicians Who Are Interested in Utilization of Electronic and Mobile Health Technologies. Pain Medicine 2019; 21:e243-e246. [DOI: 10.1093/pm/pnz273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine
| | - W Michael Hooten
- Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA
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15
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Moman RN, Hanson AC, Schroeder DR, Warner MA. The importance of hospital length of stay in patients with acute brain injury: Reply. J Crit Care 2019; 58:128. [PMID: 31635953 DOI: 10.1016/j.jcrc.2019.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Andrew C Hanson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America
| | - Darrell R Schroeder
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America
| | - Matthew A Warner
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States of America.
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Moman RN, Dvorkin J, Pollard EM, Wanderman R, Murad MH, Warner DO, Hooten WM. A Systematic Review and Meta-analysis of Unguided Electronic and Mobile Health Technologies for Chronic Pain—Is It Time to Start Prescribing Electronic Health Applications? Pain Medicine 2019; 20:2238-2255. [DOI: 10.1093/pm/pnz164] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
Electronic (eHealth) and mobile (mHealth) technologies may be a useful adjunct to clinicians treating patients with chronic pain. The primary aim of this study was to investigate the effects of eHealth and mHealth interventions that do not require clinician contact or feedback on pain-related outcomes recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) guidelines in adults with chronic pain.
Methods
We searched four databases and included English language randomized controlled trials of ambulatory adults with chronic pain from January, 1 2000, to January 31, 2018, with interventions that are independent of clinician contact or feedback. In the meta-analysis, outcomes were assessed at short- (three months or less), intermediate- (four to six months), and long-term (seven or more months) follow-up.
Results
Seventeen randomized controlled trials (N = 2,496) were included in the meta-analysis. Both eHealth and mHealth interventions had a significant effect on pain intensity at short- and intermediate-term follow-up. Similarly, a significant but small effect was observed for depression at short- and intermediate-term follow-up and self-efficacy at short-term follow-up. Finally, a significant effect was observed for pain catastrophizing at short-term follow-up.
Conclusions
eHealth and mHealth interventions had significant effects on multiple short- and intermediate-term outcome measures recommended in the IMMPACT guidelines. Given widespread availability and low cost to patients, clinicians treating patients with chronic pain could consider using eHealth and mHealth interventions as part of a multidisciplinary pain treatment strategy.
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Affiliation(s)
- Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jodie Dvorkin
- Institute for Clinical Systems Improvement, Minneapolis, Minnesota
| | - E Morgan Pollard
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robalee Wanderman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Division of Preventive Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - W Michael Hooten
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Moman RN, Ostby SA, Akhoundi A, Kashyap R, Kashani K. Impact of individualized target mean arterial pressure for septic shock resuscitation on the incidence of acute kidney injury: a retrospective cohort study. Ann Intensive Care 2018; 8:124. [PMID: 30535664 PMCID: PMC6288098 DOI: 10.1186/s13613-018-0468-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/03/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To examine the relationship between delta mean arterial pressure (ΔMAP; MAP change between pre-admission minus post-resuscitation) and acute kidney injury (AKI) among patients with septic shock. In this retrospective, single-center cohort study of adult patients pre-admission MAP is defined as the median MAP recorded from 365 to 7 days before admission. Post-resuscitation MAP was median MAP during the 7th hour after initiating resuscitation. RESULTS In our cohort (N = 233; 55% male), the median (interquartile range [IQR]) age was 71 (58-81) years and the median (IQR) acute physiology, age, chronic health evaluation (APACHE) III score was 81 (66-97). Although those in the lowest ΔMAP quartile (-24.5 to 3.9 mmHg) had no demographic differences compared with the rest of the cohort, the odds ratio for AKI was 0.26 (95% CI 0.11-0.57) after adjustment for other known AKI risk factors. Among patients with a history of hypertension, the lowest quartile had an odds ratio for AKI of 0.12 (95% CI 0.04-0.37) after adjusting for risk factors for AKI in this cohort. CONCLUSIONS The incidence of AKI was lowest among those whose post-resuscitation MAP was closest to or higher than their pre-admission MAP. Further study regarding the effect of targeting the pre-admission MAP for post-resuscitation on the incidence of AKI is warranted.
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Affiliation(s)
- Rajat N Moman
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stuart A Ostby
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Obstetrics and Gynecology, University of Alabama Birmingham, Birmingham, AL, USA
| | - Abbasali Akhoundi
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rahul Kashyap
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Anesthesia Clinical Research Unit, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kianoush Kashani
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Moman RN, Kor DJ, Chandran A, Hanson AC, Schroeder DR, Rabinstein AA, Warner MA. Red blood cell transfusion in acute brain injury subtypes: An observational cohort study. J Crit Care 2018; 50:44-49. [PMID: 30471560 DOI: 10.1016/j.jcrc.2018.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/21/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Optimal red blood cell (RBC) transfusion thresholds in acute brain injury (ABI) are poorly defined. MATERIALS AND METHODS We conducted a retrospective cohort study of adult patients with ABI and moderate anemia (Hb 7-10 g/dL) in a neurological intensive care unit (ICU) at an academic medical center between 2008 and 2015. Transfused and non-transfused patients were matched based on age, ABI subtype, pre-transfusion hemoglobin, and ICU length of stay (LOS) at the time of RBC transfusion. Multivariable regression analyses were performed to assess the relationship between RBC transfusion and hospital LOS, hospital mortality, ICU LOS, ICU mortality, and 24 h change in sequential organ failure assessment (SOFA) scores. RESULTS 2638 patients met inclusion criteria, with 225 (8.5%) receiving RBC transfusion. Acute ischemic stroke was the most prevalent ABI diagnosis (43.3%) then intracranial hemorrhage (25.6%), subarachnoid hemorrhage (16.5%), and traumatic brain injury (TBI) (14.6%). In multivariable analyses, RBC transfusion was associated with longer hospital and ICU LOS, and higher SOFA scores. Each ABI subtype had similar results, except for TBI which showed no difference in hospital LOS. Mortality was not significantly different. CONCLUSIONS In moderately anemic patients with ABI, RBC transfusion was associated with longer hospital and ICU LOS. Prospective investigations are necessary to further assess these relationships.
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Affiliation(s)
- Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daryl J Kor
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arun Chandran
- Department of Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Andrew C Hanson
- Biostatistics, Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Darrell R Schroeder
- Biostatistics, Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Matthew A Warner
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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Moman RN, Loprinzi Brauer CE, Kelsey KM, Havyer RD, Lohse CM, Bellolio MF. PREDICTing Mortality in the Emergency Department: External Validation and Derivation of a Clinical Prediction Tool. Acad Emerg Med 2017; 24:822-831. [PMID: 28401622 DOI: 10.1111/acem.13197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND The Choosing Wisely campaign has called for better engagement of palliative and hospice care services for patients in the emergency department (ED). PREDICT is a clinical prediction tool that was derived in an Australian ED cohort. It assesses a patient's risk of mortality at 1 year to select those who would benefit from advanced care planning. Such goals-of-care discussion can improve patients' ability to communicate what they want out of their healthcare and, in cases of end of life, potentially reduce the number of futile interventions. Using a cutoff of 13 points, PREDICT had a reported 95.3% specificity and 53.9% sensitivity for 1-year mortality. We externally validated PREDICT and derived a simpler modified PREDICT tool to systematically identify high-risk patients eligible for goals-of-care discussions and palliative care consultation in the ED. METHODS This was an observational cohort study of a random sample of 927 patients aged 55+ seen in the ED in 2014. We identified advance healthcare directives (AHDs) on file. We summarized diagnostic accuracy of the clinical tool to predict 1-year mortality using sensitivity, specificity, and area under the curve (AUC). We refined PREDICT using multivariable modeling. We followed reporting guidelines including STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) for cohort studies and Standards for Reporting of Diagnostic Accuracy (STARD). RESULTS A total of 927 patients were included: 55.0% were male, 63 (7.0%) were nursing home residents, 389 (42.0%) patients had an AHD in their medical record at the time of ED visit, and 245 (26.4%) were deceased at 1 year. Of the 780 patients with PREDICT scores < 13, a total of 164 (21.0%; 95% confidence interval [CI] = 18.3-24.1) were deceased at 1 year, and of the 147 patients with PREDICT scores ≥ 13, a total of 81 (55.1%; 95% CI = 46.7-63.2) were deceased at 1 year. The AUC of the PREDICT score was 0.717 (95% CI = 0.680-0.754), sensitivity was 33.1% (95% CI = 27.3-39.4), and specificity was 90.3% (95% CI = 87.8-92.4) to predict 1-year mortality. The modified PREDICT tool resulted in an AUC of 0.709 (95% CI = 0.671-0.747). We decided to select this model as the preferred model, as the variable of intensive care unit (ICU) admission with multiorgan failure can be difficult to assess in the ED and may delay advanced care planning. Reweighting the score did not improve fit or the AUC, so points assigned to each variable were not adjusted. CONCLUSION PREDICT is an easy tool to administer to be able to identify patients who are at high risk of 1-year mortality and who could benefit from AHDs, goals-of-care discussion, and when appropriate in the context of an end-of-life setting, palliative medicine consultation. External validation of PREDICT was successful in our population. We simplified PREDICT and derived a new tool, the modified PREDICT minus ICU tool, without significantly altering the sensitivity, specificity, and AUC for death at 1 year. The next steps include external validation of the newly derived rule and prospective implementation.
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Affiliation(s)
- Rajat N. Moman
- Department of Emergency Medicine; Rochester MN
- Mayo Clinic, and the Mayo Clinic School of Medicine; Rochester MN
| | | | - Katherine M. Kelsey
- Department of Emergency Medicine; Rochester MN
- Mayo Clinic, and the Mayo Clinic School of Medicine; Rochester MN
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Pearson AC, Moman RN, Moeschler SM, Eldrige JS, Hooten WM. Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey. J Pain Res 2017; 10:1395-1400. [PMID: 28652805 PMCID: PMC5476583 DOI: 10.2147/jpr.s136478] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Many providers report lack of confidence in managing patients with chronic pain. Thus, the primary aim of this study was to investigate the associations of provider confidence in managing chronic pain with their practice behaviors and demographics. Materials and methods The primary outcome measure was the results of the Opioid Therapy Provider Survey, which was administered to clinicians attending a pain-focused continuing medical education conference. Nonparametric correlations were assessed using Spearman’s rho. Results Of the respondents, 55.0% were women, 92.8% were white, and 56.5% were physicians. Primary care providers accounted for 56.5% of the total respondents. The majority of respondents (60.8%) did not feel confident managing patients with chronic pain. Provider confidence in managing chronic pain was positively correlated with 1) following an opioid therapy protocol (P=0.001), 2) the perceived ability to identify patients at risk for opioid misuse (P=0.006), and 3) using a consistent practice-based approach to improve their comfort level with prescribing opioids (P<0.001). Provider confidence was negatively correlated with the perception that treating pain patients was a “problem in my practice” (P=0.005). Conclusion In this study, the majority of providers did not feel confident managing chronic pain. However, provider confidence was associated with a protocolized and consistent practice-based approach toward managing opioids and the perceived ability to identify patients at risk for opioid misuse. Future studies should investigate whether provider confidence is associated with measurable competence in managing chronic pain and explore approaches to enhance appropriate levels of confidence in caring for patients with chronic pain.
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Affiliation(s)
- Amy Cs Pearson
- Department of Anesthesiology & Perioperative Medicine, Mayo School of Graduate Medical Education, Mayo Clinic
| | | | - Susan M Moeschler
- Department of Anesthesiology & Perioperative Medicine, Mayo College of Medicine, Rochester, MN, USA
| | - Jason S Eldrige
- Department of Anesthesiology & Perioperative Medicine, Mayo College of Medicine, Rochester, MN, USA
| | - W Michael Hooten
- Department of Anesthesiology & Perioperative Medicine, Mayo College of Medicine, Rochester, MN, USA
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