WHAT'S KNOWN ON THIS SUBJECT:Research performed outside the United States suggests that children experience significant pain after tonsillectomy and adenoidectomy and are undermedicated by parents; however, that body of literature suffers from significant methodologic limitations. WHAT THIS STUDY ADDS:This study provides a description of children's pain after tonsillectomy and adenoidectomy in the United States, with a large sample size, validated outcome measures, and standardized anesthetic and surgical techniques.abstract OBJECTIVE: The purpose of this controlled study was to provide a description of children's postoperative pain, including pain intensity and analgesic consumption. METHODS:Participants included 261 children, 2 to 12 years of age, undergoing routine tonsillectomy and adenoidectomy surgery. Baseline and demographic data were collected before surgery, and a standardized approach to anesthesia and surgical procedures was used. Pain and analgesic consumption were recorded for 2 weeks at home. RESULTS:On the first day at home, although parents rated 86% of children as experiencing significant overall pain, 24% of children received 0 or just 1 medication dose throughout the entire day. On day 3 after surgery, although 67% of children were rated by parents as experiencing significant overall pain, 41% received 0 or 1 medication dose throughout the entire day. CONCLUSIONS:We conclude that a large proportion of children receive little analgesic medication after surgery and research efforts should be directed to the discrepancy between high ratings of postoperative pain provided by parents and the low dosing of analgesics they use for their children. Pediatrics 2009;124:e588-e595 AUTHORS:
Background The purpose of this investigation was to identify what perioperative information children want to be given by the medical staff. Methods As a first step we developed an instrument based on a qualitative study conducted with children in Great Britain, input from a focus group, and input from school children. On the day of surgery, 143 children aged 7-17 years old completed a 40-item assessment of desired surgical information and a measure of anxiety (STAIC). Parents completed a measure assessing their child’s temperament (EASI), and a measure of their own anxiety (STAI). Results Results indicated that the vast majority of children had a desire for comprehensive information about their surgery, including information about pain and anesthesia, as well as procedural information and information about potential complications. The most highly endorsed items by children involved information about pain. Children who were more anxious endorsed a stronger desire for pain information and lesser tendency to avoid information. Younger children wanted to know what the perioperative environment would look like more than adolescent children. Conclusions We conclude that the majority of children aged 7-17 years old who undergo surgery want to be given comprehensive perioperative information and healthcare providers should ensure adequate information regarding postoperative pain is provided.
Patients with osteoarthritis (OA) are faced with a barrage of treatment options, from recommendations from friends and social media to medications prescribed by the primary care physician. The purpose of this article is to critically review current approaches to generalized or monoarticular OA based on available evidence and to illustrate multidisciplinary and multimodal treatment strategies for the management of OA. Treatment options assessed for efficacy include patient education; oral and topical pharmacological agents; complementary and alternative medicine; surgery; manual medicine; acupuncture; interventional procedures (corticosteroid injection, viscosupplementation, and pulsed radiofrequency); bracing; assistive devices; physical therapy; and physical modalities. Multidisciplinary and multimodal treatment strategies combined with early detection and prevention strategies provide the best benefit to patients. This review also illustrates that traditional and alternative modalities of treatment can be both synergistic and beneficial. Physicians should be aware of the variety of tools available for the management of OA and the associated symptoms. Those healthcare providers who can best individualize treatment plans for specific patients and inspire their patients to embrace healthy lifestyle modifications will achieve the best results.
The purposes of this project were to propose an educational module to instruct pain medicine fellows in the appropriate performance of interventional pain management techniques and to verify procedural competency through objective evaluation methodology. Eight board-certified pain medicine physicians spanning two fellowship programs trained seven fellows using a standardized competency-based module. Assessment tools address the basic competencies outlined by the Accreditation Council for Graduate Medical Education (American Board of Anesthesiology Pain Medicine Content Outline). The seven fellows demonstrated proficiency in every segment of the evaluation module. Objective measures compared the fellows' performance on standardized procedure checklists administered 9 mos into training; fellows in the 2012-2013 academic year also received testing at the 3-mo mark. Support for the assessment module is demonstrated by appropriate performance of interventional procedures, with improvement noted from 3-mo to 9-mo testing, successful completion of chart-stimulated oral examinations, proper performance of relevant physical examination maneuvers, and completion of program-specific medical knowledge written tests. The fellows were evaluated via patient surveys and 360-degree global rating scales, maintained procedure logs, and completed two patient-care reports; these were reviewed by program directors to ensure adequate completion. The standardized educational module and evaluation methodology presented provide a potential framework for the definition of baseline competency in the clinical skill area of interventional pain management.
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