1,721,109 research outputs found
Status quo of pain-related patient-reported outcomes and perioperative pain management in 10,415 patients from 10 countries: Analysis of registry data
No full textBackground: Postoperative pain is common at the global level, despite considerable attempts for improvement, reflecting the complexity of offering effective pain relief. In this study, clinicians from Mexico, China, and eight European countries evaluated perioperative pain practices and patient-reported outcomes (PROs) in their hospitals as a basis for carrying out quality improvement (QI) projects in each country. Methods: PAIN OUT, an international perioperative pain registry, provided standardized methodology for assessing management and multi-dimensional PROs on the first postoperative day, in patients undergoing orthopaedic, general surgery, obstetric & gynaecology or urological procedures. Results: Between 2017 and 2019, data obtained from 10,415 adult patients in 105 wards, qualified for analysis. At the ward level: 50% (median) of patients reported worst pain intensities ≥7/10 NRS, 25% spent ≥50% of the time in severe pain and 20–34% reported severe ratings for pain-related functional and emotional interference. Demographic variables, country and surgical discipline explained a small proportion of the variation in the PROs, leaving about 88% unexplained. Most treatment processes varied considerably between wards. Ward effects accounted for about 7% and 32% of variation in PROs and treatment processes, respectively. Conclusions: This comprehensive evaluation demonstrates that many patients in this international cohort reported poor pain-related PROs on the first postoperative day. PROs and treatments varied greatly. Most of the variance of the PROs could not be explained. The findings served as a basis for devising and implementing QI programmes in participating hospitals. Significance: In preparation for quality improvement projects, we comprehensively evaluated pain-related patient-reported outcomes (PROs) and treatment practices of 10,415 adult patients spanning 10 countries. PROs were generally poor. Demographics, country and surgical discipline explained a small proportion of variation for the PROs, about 88% remained unexplained. Treatment practices varied considerably between wards. Ward effects accounted for about 7% and 32% of variation in PROs and treatment processes, respectively. Future studies will aim to identify treatments which are associated with improved outcomes
Right ventricular myocardial function in ARF patients: PEEP as a challenge for right heart - Reply
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Patient-requested neuraxial analgesia for labor: impact on rates of cesarean and instrumental vaginal delivery
No full textA systematic review, including a meta-analysis, on the timing
effects of neuraxial analgesia (NA) on cesarean and instrumental
vaginal deliveries in nulliparous women was conducted. Of
20 articles identified, 9 met the inclusion quality criteria (3,320
participants). Cesarean delivery (odds ratio, 1.00; 95% confidence
interval, 0.82–1.23) and instrumental vaginal delivery
(odds ratio, 1.00; 95% confidence interval, 0.83–1.21) rates were
similar in the early NA and control groups. Neonates of women
with early NA had a higher umbilical artery pH and received
less naloxone. In the early NA group, fewer women were not
compliant with assigned treatment and crossed over to the
control group. Women receiving early NA for pain relief are not
at increased risk of operative delivery, whereas those receiving
early parenteral opioid and late epidural analgesia present a
higher risk of instrumental vaginal delivery for nonreassuring
fetal status, worse indices of neonatal wellness, and a lower
quality of maternal analgesia
Transesophageal echocardiography for diagnosis of traumatic aortic injury: an appraisal of the evidence
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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