Nurse-led care of patients with AF is superior to usual care provided by a cardiologist in terms of cardiovascular hospitalizations and cardiovascular mortality. Trial registration information: Clinicaltrials.gov identifier number: NCT00391872.
A water test combined with pulse oximetry using coughing, choking and voice alteration as endpoints is currently the best method to screen patients with neurological disorders for dysphagia. Further research is needed to establish the most effective standardized administration procedure for such a water test, and to assess the value of pulse oximetry, in addition to a trial swallow to detect silent aspiration.
The effectiveness of a Pain Education Program in cancer patients with chronic pain offered by nurses was investigated in a randomized controlled clinical trial. A multi-method approach was used in which verbal instruction, written material, an audio cassette tape, and the use of a pain diary were combined to inform and instruct patients about pain and pain management. The Pain Education Program was tailored to the needs of the individual patient and consisted of three elements: (1) educating patients about the basic principles regarding pain and pain management; (2) instructing patients how to report their pain in a pain diary; and (3) instructing patients how to communicate about pain and how to contact health care providers. Following pretesting in 313 patients, patients who needed district nursing and who did not need district nursing at home were randomly assigned to a control or intervention group. Intervention group patients received the Pain Education Program in the hospital, and 3 and 7 days postdischarge by telephone; this was done by nurses who were specially trained as pain counselors. Follow-up assessments were at 2, 4 and 8 weeks postdischarge. Results of the pretest showed that many patients lacked knowledge about pain and pain management. The majority of pain topics had to be discussed. The Pain Education Program proved to be feasible: 75.0% of the patients had read the entire pain brochure, 55.7% had listened to the audio cassette, and 85.6% of pain scores were completed in the pain diary. Results showed a significant increase in pain knowledge in patients who received the Pain Education Program and a significant decrease in pain intensity. However, pain relief was mainly found in the intervention group patients without district nursing. It can be concluded that the tailored Pain Education Program is effective for cancer patients in chronic pain. The use of the Pain Education Program by nurses should be seriously considered on oncology units.
Systematic assessment of pain is the basis for adequate pain treatment. In the home situation, however, it is difficult to assess patients' pain intensity. A group of 159 cancer patients who had been admitted to a cancer hospital with pain caused by cancer, cancer therapy, or illness that persisted for at least 1 month received a pain diary. These patients were asked to register their pain intensity at home. Patients were instructed by a nurse to record their Present Pain Intensity on a scale from 0-10 once every morning and every evening for a period of 2 months. In this study, the use of a pain diary in cancer pain patients at home was evaluated. To determine the effects of the pain diary, patients were interviewed at baseline, at 2, 4, and 8 weeks postdischarge. Pain intensity scores were obtained both by patient interviews and from the pain diary. Results show that the use of a pain diary is an appropriate way to assess patients' pain intensity at home. Patients' compliance was high (86%), even in seriously ill patients. When comparing pain scores obtained by patient interview with scores obtained by pain diary, results showed that Present Pain Intensity scores, rather than Average Pain Intensity scores, should be used in both the clinical and the home setting because patients' recall accuracy depends, in part, on the stability of the pain. Because the pain intensity scores fluctuate greatly during the day and over a period of time, the use of a pain diary is useful in the home setting. In 60% of the patients, completing the pain scores helped them to cope with the pain.
Complex Regional Pain Syndrome type 1 (CRPS1) is a complication after trauma or surgery. Its pathophysiology is still a matter of debate, and psychological factors have been suggested to play a role, although their influence is unclear. The aim of this study was to investigate the evidence for the influence of psychological factors on the onset and maintenance of CRPS1 in adults. In a systematic review, articles were selected using Cochrane, Pubmed/Medline, Psychinfo, and Cinahl since 1980. Only original articles and empirical studies were included. Based on these selection criteria, 31 articles were identified. Studies were evaluated and weighted using a quality assessment instrument. The few prospective studies do not report a relationship between CRPS1 and depression, anxiety, neuroticism, or anger. The results of the retrospective/cross-sectional studies yield contradictory results regarding psychological problems in patients with CRPS1. A majority show no association, and studies with a higher methodological quality lean to a conclusion of no relationship between psychological factors and CRPS1. The majority of included studies (N=24; 77%) had only a poor to moderate methodological quality. Although many patients with CRPS1 are stigmatized as being psychologically different, this literature review identified no relationship between CRPS1 and several psychological factors. Only life events seemed to be associated with CRPS1: patients who experienced more life events appeared to have a greater chance of developing CRPS1. More studies with greater methodological quality and more participants should be performed on the association between psychological factors and the development and course of CRPS1.
As different methods of evaluating reliability and validity were used, and different aims (e.g., type of pain) were pursued, the available scales cannot be compared easily. Nevertheless, a few are promising, given preliminary results. These should be examined further on psychometric properties and usefulness in different populations because optimal pain assessment is necessary for efficient and effective pain treatment.
Based on these results it can be concluded that it is possible to implement the PMP in daily clinical practice. Moreover, the beneficial effects of our programme on nurses' knowledge and attitudes have been demonstrated. Therefore, participating hospitals were advised to continue and extend the programme and other hospitals are encouraged to implement it.
The pain prevalence rate in Dutch residential homes is similar to rates found in other Anglo-Saxon countries. Furthermore, they are also comparable to rates reported from European nursing homes. Pain treatment is insufficient and although pain interferes with daily activities and mood, elderly tend to accept pain as an unavoidable part of aging.
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