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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Postal questionnaires were sent to general practitioner principals and hospital consultants in Ayrshire a year before and again 13 months after the opening of the Ayrshire Hospice. Seventy-three per cent of 342 doctors replied to the first survey and 62% replied to the second survey. There was initially a fairly strongly felt need for a hospice, with median Visual Analogue Score (VAS) of 16 ('definite need' = 0 and 'definitely no need' = 100). After the opening of the hospice doctors were much more enthusiastic (median VAS 5; p less than 0.0001). Doctors feeling no need for a hospice (VAS greater than 75) became fewer (9.6% before opening, 2% after). Doctors who would refer patients to a hospice, at first 82%, numbered 92% after opening. Seventy-one per cent of general practitioners and 60% of consultants had referred patients to the hospice within a year of opening. After opening, specialist advice with home care was considered the most useful aspect, in-patient beds useful, and day hospice least useful. Seventy-three per cent of referring doctors found the hospice a great help. In both surveys general practitioners and consultants felt the hospice should be run by a mixture of voluntary and NHS finance. Doctors appeared willing to learn about palliative care from hospice doctors, particularly after hospice opening. Doctors were initially rather dissatisfied with palliative care in existing hospitals, but became less so (particularly about pain control) after hospice opening. Surprisingly, in both surveys the attitudes of general practitioners and consultants were virtually identical.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:How do local doctors react to a hospice? 139 81

This is the report of a feasibility study of a randomised controlled trial of chiropractic and hospital outpatient management for low back pain of mechanical origin. Preparations for the study included an approach to the General Medical Council for guidance about the intended collaboration between medically qualified and heterodox practitioners, detailed communication with local general practitioners, and the provision of a Medical Research Council (MRC) grant to cover payments to the chiropractors for work carried out in the course of the study. A total of 238 patients were considered, 197 of whom had initially presented to Northwick Park Hospital and the remaining 41 to the chiropractic clinic in Harrow. Only 6% of the patients presenting to the hospital refused to enter. The single most frequent reason for ineligibility in the hospital patients was freedom from pain at the time of the first hospital visit (23%). A variety of medical contraindications accounted for the exclusion of a further 24% of hospital patients. Patients presenting to the chiropractic group tended to have had shorter current episodes of back pain but to have had more NHS treatment in the past than those presenting to hospital. The commonest reason for exclusion among those presenting to the chiropractic clinic was refusal to enter (34%). Only 5% of the chiropractic patients were ineligible for medical reasons. Overall, 16% of those presenting to hospital and 44% of those presenting to the chiropractors were eligible and willing to enter the randomised treatment phase of the study. Of the 50 patients who entered the treatment phase, all but seven completed treatment and the six weekly self-completed assessments of progress. Patients whose current episodes had lasted less than a month progressed significantly more rapidly than those with longer current episodes. It is likely that sufficient numbers of patients with low back pain are prepared to take part in a formal randomized controlled trial. The organization and working methods for such a trial appear to be feasible. A full scale multicentre trial should aim to include about 2000 patients.
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PMID:Comparison of chiropractic and hospital outpatient management of low back pain: a feasibility study. Report of a working group. 287 60

A 5-year trial of acupuncture therapy in the Finnish NHS is surveyed. In total 348 patients attending Halikko Health Centre in SW Finland were treated with needle-stimulation for a wide variety of chronic pain syndromes. The mean number of acupuncture sessions was 5 in the primary series and 41% of patients received more than one series. An analysis of results showed significant relief of pain (more than 40% reduction on the visual analogue scale) in myofascial syndromes affecting the head, neck, shoulder and arm. Osteoarthrosis of major joints, and backache, responded less favourably. In total 65% of those patients who had taken analgesics before acupuncture therapy, either stopped totally or reduced their dose considerably. Those with headache could significantly more often reduce their drug intake than those with arthritis or osteoarthrosis. More results and discussion will be published in part II later in this Journal.
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PMID:Long-term treatment of chronic pain with acupuncture. Part I. 288 34

A 5-year trial of acupuncture therapy in the Finnish NHS is surveyed. The material of 348 pain patients has been described in Part I. Acupuncture was less effective in the elderly, in patients with a psychiatric history, on high doses of analgesics, and in those with longstanding pain. Twenty six per cent of the patients were relieved of pain for more than two years. The response to treatment was not influenced by the patients social status or his expectations of benefit.
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PMID:Long-term treatment of chronic pain with acupuncture. Part II. 289 Feb 74

Inversion injuries of the ankle are a common cause of referral and presentation to accident units. They impose a load on radiographic services. A prospective trial was carried out to determine the accuracy of clinical examination. All patients were assessed clinically then examined radiographically, the clinical assessment missed 5% of the fractures. These, however, were all minor avulsion fractures or crush fractures and Tubigrip support was sufficient. Clinical examinations is, therefore, accurate and the need for most x-ray examination is questionable. X-ray examination should be reserved for patients with continuing pain or those who clinically have a fracture requiring immobilisation. This would produce a large saving in NHS resources.
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PMID:Inversion injuries of the ankle: clinical assessment and radiographic review. 678 89

Nurses working in private nursing homes may not have the same degree of access to support and education in palliative care as nurses in NHS 'care of the elderly' wards. A study was conducted comparing two groups of nurses working in these two environments in one health district. Twenty-four nurses underwent semistructured interviews focusing on pain management. Both groups showed equal enthusiasm for their work with elderly patients. However, those from the care of the elderly wards were able to offer many more treatment strategies to relieve pain than their colleagues from the private nursing homes. The study uncovered a sense of isolation and a lack of postbasic education opportunities for nurses outside the NHS. If this small local study reflects a national trend, then there are major implications for the educational activities of palliative care teams.
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PMID:Nurses in private nursing homes: a study of their knowledge and attitudes to pain management in palliative care. 758 81

From a clinical audit of the treatment given to 1005 patients suffering from ankle fractures, 507 patients of 626 taken randomly from 15 hospitals were contacted and asked to complete a questionnaire describing and evaluating their experiences. The design of the study aimed in a number of ways to reduce respondents' tendency towards a positive response in completing satisfaction scales. The very high response rate, commentaries and variations in opinions about specific service criteria indicate that the results have a high degree of validity. The generally high rates of satisfaction reported here reflect very well on existing NHS provision for a specific procedure, with the exception of certain hospitals' arrangements for waiting, and the provision of certain types of information. Against general indicators of satisfaction with the management of pain relief in hospitals, that in ankle fracture treatments appears to be exceptionally high. However, it would be valuable to discover why younger patients appear to be strikingly more critical than older patients across the entire range of issues. The inquiry aims to compare findings with studies of other orthopaedic services using a similar elementary methodology as a routine component of clinical audit.
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PMID:NHS provision for the treatment of ankle fractures: a patient satisfaction study. 831 26

Health care professionals have long recognised pressure sores as a problem (1, 2, 3). Attention has focused on the monetary cost and scale of the issue (4) in terms of pain caused and competition for finite resources (5). The Health of the Nation consultative document (6) estimated that 6.7 per cent of the adult hospital population are affected, costing the NHS at least 60 million pounds a year. Many consider these sores preventable, and believe the deployment of resources in the health service should focus on prevention instead of treatment (7).
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PMID:Keeping the pressure high on prevention. 843 81

The economic evaluation of alternative diagnostic and therapeutic interventions is not merely a help to the processes by which decision makers allocate scarce economic resources, it is an essential ingredient into those rationing processes. Clinicians and other decision makers who advocate the use of effectiveness data alone to determine who will be treated and who will be left in pain and discomfort may perpetuate the inefficient use of resources. Rationing, or resource allocation, in health care must be informed by knowledge of the costs and consequences (effects) or alternative interventions. To ignore the economic element in clinical choices, generates inefficiency, and therefore unethical practice. The great advantage of the economic approach to rationing is that it requires an explicit framework which identifies the costs and benefits of alternative actions in all domains of human action. The combination of explicitness and precision inherent in good economic evaluation can only help in the difficult task of producing further health benefits for patients from the limited resources of the NHS.
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PMID:Help or hindrance? The role of economics in rationing health care. 855 94

An audit was carried out in an NHS trust to identify the degree to which wound management products were being selected and used appropriately. Fifty patients with various types of wounds were involved; observers noted the condition of wounds at dressing changes and the procedures used, then studied each patient's hospital documentation (medical notes, nursing care plan and drug chart). Nursing staff were interviewed to ascertain the input of various disciplines in dressing choice. The 'correct' choice of dressing was made in only 48% of wounds, and correct choice and use were identified in just 20%, with wide variations between different products. A quarter of patients reported pain associated with their wounds, but none received analgesia before dressing changes. As a result of the audit, new guidelines on dressing choice and use have been produced, with others in preparation, and the hospital formulary has been amended.
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PMID:Assessing the use of dressings in practice. 895 15


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