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https://www.readbyqxmd.com/read/28733043/perioperative-hypotension-and-discharge-outcomes-in-non-critically-injured-trauma-patients-a-single-centre-retrospective-cohort-study
#1
Nadav Sheffy, Itay Bentov, Brianna Mills, Bala G Nair, G Alec Rooke, Monica S Vavilala
BACKGROUND: There is a lack of information on the effect of age on perioperative care and outcomes after minor trauma in the elderly. We examined the association between perioperative hypotension and discharge outcome among non-critically injured adult patients. METHODS: We conducted a retrospective study of non-critically ill patients (ISS <9 or discharged within less than 24h) who received anaesthesia care for surgery and Recovery Room care at a level-1 trauma centre between 5/1/2012 and 11/30/2013...
June 24, 2017: Injury
https://www.readbyqxmd.com/read/28715535/improving-adherence-to-long-term-opioid-therapy-guidelines-to-reduce-opioid-misuse-in-primary-care-a-cluster-randomized-clinical-trial
#2
Jane M Liebschutz, Ziming Xuan, Christopher W Shanahan, Marc LaRochelle, Julia Keosaian, Donna Beers, George Guara, Kristen O'Connor, Daniel P Alford, Victoria Parker, Roger D Weiss, Jeffrey H Samet, Julie Crosson, Phoebe A Cushman, Karen E Lasser
Importance: Prescription opioid misuse is a national crisis. Few interventions have improved adherence to opioid-prescribing guidelines. Objective: To determine whether a multicomponent intervention, Transforming Opioid Prescribing in Primary Care (TOPCARE; http://mytopcare.org/), improves guideline adherence while decreasing opioid misuse risk. Design, Setting, and Participants: Cluster-randomized clinical trial among 53 primary care clinicians (PCCs) and their 985 patients receiving long-term opioid therapy for pain...
July 17, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28700116/an-integrative-literature-review-exploring-the-clinical-management-of-delirium-in-patients-with-advanced-cancer
#3
REVIEW
Hayley Lawley, Alistair Hewison
AIM: The aim of this paper is to present the findings of an integrative literature review of the evidence for the clinical management of delirium in patients with advanced cancer. BACKGROUND: Patients with advanced cancer frequently experience delirium which can be distressing for both patients and their families. Current guidelines recommend that underlying causes of the delirium be addressed and a course of antipsychotics considered. However the research into the effectiveness of treatments for delirium in people with advanced cancer is limited...
July 12, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28693334/impact-of-hospital-wide-comprehensive-pain-management-initiatives
#4
Paula E Lester, Janet Shehata, Melissa Fazzari, Shahidul Islam
This project aimed to improve pain management through clinician education, updated assessment tools, computer resources, and improved ordering and delivery systems. Clinicians were surveyed and results analyzed using Wilcoxon-Mann-Whitney testing and χ(2) testing. Prescribing patterns were evaluated by comparing proportions of prescription orders and dose intervals. Cochran-Armitage Trend Test was used for linear trends in proportion of prescription orders over time. Knowledge scores improved significantly for nurses ( P = ...
January 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/28688963/continuous-interscalene-brachial-plexus-blockade-is-associated-with-reduced-length-of-stay-after-shoulder-arthroplasty
#5
Peter N Chalmers, Dane Salazar, Mitchell E Fingerman, Jay D Keener, Aaron Chamberlain
BACKGROUND: Catheter-delivered continuous interscaleneanesthesia has demonstrated improved pain control in randomized clinical trials.The purpose of this study is to determine whether the introduction of continuous catheteranesthesia was associated with a change in length of stay (LOS), readmission, rates of discharge home without home health or nursing services, or opioid administration. We hypothesized that the introduction of continuous catheter anesthesia would be associated with a decrease in LOS, readmission, non-home discharge, and opioid administration...
July 5, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/28679460/serratia-marcescens-bacteremia-nosocomial-cluster-following-narcotic-diversion
#6
Leah M Schuppener, Aurora E Pop-Vicas, Erin G Brooks, Megan N Duster, Christopher J Crnich, Alana K Sterkel, Aaron P Webb, Nasia Safdar
OBJECTIVE To describe the investigation and control of a cluster of Serratia marcescens bacteremia in a 505-bed tertiary-care center. METHODS Cluster cases were defined as all patients with S. marcescens bacteremia between March 2 and April 7, 2014, who were found to have identical or related blood isolates determined by molecular typing with pulsed-field gel electrophoresis. Cases were compared using bivariate analysis with controls admitted at the same time and to the same service as the cases, in a 4:1 ratio...
July 6, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28668543/decreasing-opioid-utilization-in-rehabilitation-patients-using-a-clinical-nurse-specialist-pain-consultant-program
#7
Michael S Urton, Elaine Rohlik, Meagan Farrell, Wing Ng, Elizabeth K Woodard
OBJECTIVE: To investigate whether access to a clinical nurse specialist (CNS) with expertise in pain management will result in more rapid decline in opioid use across the rehabilitation hospitalization. DESIGN: Retrospective chart review of patients discharged during six months prior to and six months following introduction of the CNS role. SETTING: Not-for-profit 98-bed community inpatient rehabilitation hospital. PARTICIPANTS: Two population-based samples of adult, inpatient rehabilitation patients with daily opioid use ≥ 30 mg morphine equivalent dose (MED)/day on admission and length of stay ≥ 24 days...
June 28, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28632244/pain-management-in-the-middle-east-building-capacity-with-global-partners
#8
Jeannine M Brant, Susie Newton, Martha A Maurer
The Middle East (ME) is an economically diverse region that includes countries in Central Asia and Northern Africa. Regardless, cancer is a major health concern in the ME, and pain management is an essential component of cancer care across the disease trajectory. This column will provide background on opioid use for pain management in the ME and highlight the collaborative work of the Middle Eastern Cancer Consortium, Omani Cancer Association, and the Oncology Nursing Society to increase pain assessment and management capacity in the ME...
July 1, 2017: Oncology Nursing Forum
https://www.readbyqxmd.com/read/28614197/sedation-management-in-children-supported-on-extracorporeal-membrane-oxygenation-for-acute-respiratory-failure
#9
James B Schneider, Todd Sweberg, Lisa A Asaro, Aileen Kirby, David Wypij, Ravi R Thiagarajan, Martha A Q Curley
OBJECTIVES: To describe sedation management in children supported on extracorporeal membrane oxygenation for acute respiratory failure. DESIGN: Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (Randomized Evaluation of Sedation Titration for Respiratory Failure). SETTING: Twenty-one U.S. PICUs. PATIENTS: One thousand two hundred fifty-five children, 2 weeks to 17 years old, with moderate/severe pediatric acute respiratory distress syndrome...
June 13, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28585663/a-primer-on-heroin-and-fentanyl
#10
Julie Worley
Heroin and fentanyl use have reached epidemic proportions in the United States and are now blamed for the majority of drug-related overdose deaths. Both drugs are produced primarily in South America and Asia and enter the United States illegally. One result of smoking or injecting heroin or fentanyl is the development of a substance use disorder (SUD), which causes changes in brain chemistry and function. These changes result in negative behaviors and an inability to stop use. Yet, treatments are available and recovery is possible...
June 1, 2017: Journal of Psychosocial Nursing and Mental Health Services
https://www.readbyqxmd.com/read/28566361/effectiveness-of-%C3%AE-2agonists-for-sedation-in-paediatric-critical-care-study-protocol-for-a-retrospective-cohort-observational-study
#11
John C Hayden, Ian Dawkins, Cormac Breatnach, Finbarr P Leacy, June Foxton, Martina Healy, Gráinne Cousins, Paul J Gallagher, Dermot R Doherty
INTRODUCTION: Mechanically ventilated children in paediatric intensive care units are commonly administered analgesics and sedative agents to minimise pain and distress and facilitate cooperation with medical interventions. Opioids and benzodiazepines are the most common analgesic and sedative agents but have safety concerns. The α2 agonists clonidine and dexmedetomidine are alternative sedatives in use despite neither having robust evidence to support their use. Studies evaluating effectiveness of α2 agonists to date have not focused on sedation-based outcomes instead focusing on opioid-sparing properties and ventilation outcomes...
May 30, 2017: BMJ Open
https://www.readbyqxmd.com/read/28562813/opioid-analgesic-administration-in-patients-with-suspected-drug-use
#12
Maria Clara Giorio Dutra Kreling, Cibele Andrucioli de Mattos-Pimenta
Objective: To identify the prevalence of patients suspected of drug use according to the nursing professionals' judgement, and compare the behavior of these professionals in opioid administration when there is or there is no suspicion that patient is a drug user. Method: A cross-sectional study with 507 patients and 199 nursing professionals responsible for administering drugs to these patients. The Chi-Square test, Fisher's Exact and a significance level of 5% were used for the analyzes...
May 2017: Revista Brasileira de Enfermagem
https://www.readbyqxmd.com/read/28561914/opioid-use-disorder-in-pregnancy
#13
REVIEW
Van Roper, Kim J Cox
Opioid use disorder (OUD) in pregnancy has increased significantly in the past 10 years. Women with OUD may often be undertreated or untreated because of limited accessibility to treatment, particularly in rural areas. Because detoxification is not recommended during pregnancy due to the potential for adverse outcomes in the fetus and a high risk of relapse for the woman, more primary care providers need to be well versed in opioid-assisted therapy. In addition, recent changes in Food and Drug Administration regulations now allow nurse practitioners and physician assistants with specialized training to provide buprenorphine treatment for pregnant women with OUD in primary care settings...
May 2017: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/28556573/initiating-intrapartum-nitrous-oxide-in-an-academic-hospital-considerations-and-challenges
#14
Laura Migliaccio, Robyn Lawton, Lawrence Leeman, Amanda Holbrook
A 50%-50% mixture of nitrous oxide and oxygen has long been used for managing pain during labor in many countries, but only recently has this intrapartum analgesic technique become popular in the United States. Nitrous oxide is considered minimal sedation and a safe pain management alternative. Many facilities are now interested in providing laboring women this analgesic option. The process of establishing use of nitrous oxide in a large institution can be complicated and may seem daunting. This brief report describes the challenges that occurred during the process of initiating nitrous oxide for pain management during childbirth at an academic medical center and discusses various committee roles...
May 2017: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/28551445/decreasing-postoperative-narcotics-in-reconstructive-pelvic-surgery-a%C3%A2-randomized-controlled-trial
#15
Krista M L Reagan, David M O'Sullivan, Richard Gannon, Adam C Steinberg
BACKGROUND: Postoperative pain control is crucial to any successful recovery plan. Many currently used medication regimens are narcotic-focused. OBJECTIVE: The objective of our study was to evaluate the efficacy of a multimodal pain regimen after pelvic reconstructive surgery. STUDY DESIGN: The primary outcome measure was narcotic use. Secondary outcomes included pain, nausea, and constipation. Patients were randomized to either usual care postoperative treatment or multimodal pain regimen...
May 25, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28537773/a-new-generation-of-comfort-care-order-sets-aligning-protocols-with-current-principles
#16
Melissa A Bender, Caroline Hurd, Nicole Solvang, Kathy Colagrossi, Diane Matsuwaka, J Randall Curtis
BACKGROUND: There are few published comfort care order sets for end-of-life symptom management, contributing to variability in treatment of common symptoms. At our academic medical centers, we have observed that rapid titration of opioid infusions using our original comfort care order set's titration algorithm causes increased discomfort from opioid toxicity. OBJECTIVE: The aim of this study was to describe the process and outcomes of a multiyear revision of a standardized comfort care order set for clinicians to treat end-of-life symptoms in hospitalized patients...
May 24, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28527640/influences-on-patient-satisfaction-among-patients-who-use-emergency-departments-frequently-for-pain-related-complaints
#17
Patricia Newcomb, Marian Wilson, Ralph Baine, Terence McCarthy, Nicholas Penny, Caroline Nixon, Justin Orren
INTRODUCTION: The primary purpose of this study was to assess relationships between opioid prescribing practices, patient and ED attributes, and patient satisfaction ratings of nursing and physician care among patients with high utilization of the emergency department for pain relief. METHODS: A retrospective cohort study was conducted to examine 305 individual patient satisfaction surveys from users with high ED utilization for pain complaints. Responses were compared with an age-matched control group (n = 305) of nonfrequent ED users...
May 17, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28527544/a-prospective-study-of-nausea-and-vomiting-after-breast-cancer-surgery
#18
Susan W Wesmiller, Catherine M Bender, Yvette P Conley, Dana H Bovbjerg, Gretchen Ahrendt, Marguerite Bonaventura, Susan M Sereika
PURPOSE: Postoperative nausea and vomiting (PONV) and post-discharge nausea and vomiting (PDNV) continue to be common and disturbing complications experienced after surgery, particularly in women and especially in women undergoing breast cancer surgery. The purpose of this study was to assess the incidence and risk factors associated with PONV and PDNV from preoperative to 48 hours postoperatively in 97 women scheduled for breast cancer surgery. DESIGN: Prospective, comparative design...
June 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/28524907/breakthrough-cancer-pain-a-systematic-review-of-pharmacologic-management%C3%A2
#19
Jeannine M Brant, Barbara B Rodgers, Eva Gallagher, Thiruppavai Sundaramurthi
BACKGROUND: Breakthrough cancer pain (BtCP), defined as a transient exacerbation of pain that occurs in conjunction with well-controlled background pain, is a common and burdensome problem in patients with cancer.
. OBJECTIVES: The aim of this systematic review is to identify evidence-based pharmacologic modalities for adequate management of BtCP. 
. METHODS: PubMed and CINAHL® databases were searched to identify literature regarding pharmacologic strategies for BtCP published from January 2006 to June 2016...
June 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/28524906/chronic-and-refractory-pain-a-systematic-review-of-pharmacologic-management-in-oncology%C3%A2
#20
Jeannine M Brant, Lisa Keller, Karen McLeod, Chao Yeh, Linda H Eaton
BACKGROUND: Chronic and refractory cancer pain are significant issues and can increase patient suffering and compromise quality of life. A variety of evidence-based pharmacologic strategies can be used routinely to control cancer pain. 
. OBJECTIVES: The purpose of this study is to conduct a systematic review of the pharmacologic evidence in the management of chronic and refractory cancer pain. 
. METHODS: The Oncology Nursing Society's Putting Evidence Into Practice pain team conducted a search of 184 systematic reviews, meta-analyses, research studies, and guidelines and classified the evidence into weight-of-evidence categories...
June 1, 2017: Clinical Journal of Oncology Nursing
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