Objective Determine the correlation between post-sympathetic block pain temperature change, and immediate and intermediate-term pain relief. Design Retrospective analysis Setting Academic setting Subjects 79 pts with CRPS who underwent sympathetic block. Methods Pre- and post-block temperatures in the affected extremity, and pain scores immediately (based on 6-hour pain diary) post-block and at the intermediate-term 4–8-week follow-up were recorded. Post-block pain reductions of 30–49% and ≥ 50% were designated as partially sympathetically-maintained pain (SMP) and SMP. A decrease in pain score ≥ 2-points lasting ≥ 4 weeks was considered a positive intermediate-term outcome for sympathetic block. Results A weak correlation was found between immediate-term pain relief and the extent of temperature rise for the cohort (R = 0.192, P = 0.043). Greater immediate-term pain reduction was reported among patients who experienced ≥ 7.5° C temperature increase (mean 4.1, 95% CI [3.33, 4.76]) compared to those who experienced < 2° C (2.3, 95% CI [1.36, 3.31]) and ≥ 2° C x < 7.5° C (2.9, 95% CI [1.8; 3.9]; P = 0.036). The correlations between temperature increase and intermediate-term pain score reduction at 4–8 weeks (R = 0.052, P = 0.329), and between immediate and intermediate-term pain relief (R = 0.139, P = 0.119) were not statistically significant. Conclusions A weak correlation was found for those who experienced greater temperature increases post-block to experience greater immediate pain relief. Higher temperature increase cutoffs than are typically used may be necessary to determine whether a patient with CRPS has SMP.
Background: Global surgical access is unequally distributed, with the greatest surgical burden in low-and middle-income countries, where surgical care is often supplemented by nongovernmental organizations. Quality data from organizations providing this care are rarely collected or reported. The Moore Pediatric Surgery Center in Guatemala City, Guatemala, is unique in that it offers a permanently staffed, freestanding pediatric surgical center. Visiting surgical teams supplement the local permanent staff by providing a broad range of pediatric subspecialty surgical and anesthesia care. Aim: The aim of this study was to collect and report the incidence of completed postoperative follow-up visits and outcome measures at this nonprofit, internationally supported surgery center. Methods: De-identified demographic and postoperative outcome data were collected from each routinely scheduled, one-week pediatric surgical mission trip and incorporated into an electronic data collection system. Emphasis was placed on identification of completed postoperative visits and associated perioperative complications. After 27 months of data collection, results were analyzed to identify and quantify trends in patient follow-ups and postoperative outcomes. Results: Over 27 months, 1639 pediatric surgical procedures were performed and included in data analysis. The percentage of completed postoperative day-1 followup visits was 99.1%, and seven complications were identified out of these 1624 cases (postoperative complication rate of 0.4%). The percentage of completed first postoperative visits after discharge was 93.3%, and 67 complications were identified out of these 1530 cases (postoperative complication rate of 4.4%). Conclusion: Our data show a high rate of postoperative follow-up visits completed and low perioperative complication rates similar to those of high-income countries.Our data suggest that The Moore Surgery Center model of care offers an alternative to the short-term visiting surgical model by incorporating the local system and allows for improved follow-up, outcomes analysis, and high quality of care.
ObjectiveTo quantify the representation of women trainees and faculty and to explore associations between them at Pain Medicine (PM) fellowship programs in the United States.SettingPM fellowship programs accredited by the Accreditation Council for Graduate Medical Education.MethodsAll PM programs approved for at least four fellows as of December 2017 were identified. Websites of these programs were reviewed to determine the number and gender of current fellows and faculty, and programs were contacted to verify the information.ResultsA total of 56 PM programs were eligible; of these, 48 PM programs (86%) provided information about the gender distribution of fellows. Women comprised ∼25% of PM fellows. PM programs with a female rather than male fellowship program director (PD) had 2.40 times increased odds of a female trainee. Proportion of female faculty and division chief gender were not significantly associated with trainee gender composition. The adjusted odds of a faculty member being female was 1.99 times greater for PM programs with a female vs male PD and 3.13 times greater for programs with a female vs male division chief.ConclusionsWomen are underrepresented throughout all levels of academic pain medicine. The presence of women in leadership roles is associated with higher proportions of female trainees and faculty, highlighting the need for more female role models in academic pain medicine.
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