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

A pilot study assessed the feasibility of discharging NHS patients undergoing knee replacement within a day of surgery. Seven patients with medial compartment osteoarthritis were recruited after fulfilling strict exclusion criteria. Pre-operative assessment revealed that all patients had significant dysfunction and pain before operation. They had medial unicompartmental replacement through a short incision without dislocation of the patella. Each patient underwent an accelerated recovery program that included pain control, physiotherapy and self-assessment. Patients were mobilised immediately after operation. Follow-up assessment was performed at 1, 2 and 6 weeks after surgery. All patients, except one (who failed to go home because of an administrative error), returned home the day after surgery. The average pain score for the first 2 weeks after surgery was 2/10. At 6 weeks, knee flexion averaged 125 degrees and all patients were walking independently and painfree. The new protocol allows for early, safe discharge of patients undergoing unicompartmental knee replacement.
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PMID:Accelerated recovery for unicompartmental knee replacement--a feasibility study. 1212 81

There can be few who would argue with the notion that the nature of dental practice in the United Kingdom has changed dramatically over the last couple of decades. A variety of factors, including new clinical techniques, growing consumerism, a much greater awareness of health-related and well-being issues in the public at large, as well as a marked deregulation within the dental profession, the development of vocational training and recently mandatory lifelong learning, the growing number of females working in the profession, and an increasing reluctance of young dentists to finance dental practices have all combined to create an environment which has enabled and encouraged a move away from traditional forms of dental care delivery. Instead, there has been considerable growth in independently-funded practice and a commensurate growth in the number of practices operating under a corporate body umbrella of one form or another. Currently there are 27 corporate bodies registered with the General Dental Council (GDC) with the likelihood of more in the future given the proposed GDC review. This will no doubt take into consideration European law, under which the restriction within the Dentist's Act on the number of corporate bodies is likely to be untenable. Although they still have only a small share of the dental market--with 4% of all dentists in the UK in 1999--they have expanded rapidly from a small base. The data available at the time the paper was written indicate that the global total of fees earned from dentistry in the UK in the financial year 2001/2002 was almost 3 billion Pounds, of which 1.9 billion Pounds (64%) came from NHS fees and 1.1 billion Pounds (36%) from private fees. Of this 1.9 billion Pounds received in NHS fees in 2001/2002, 0.55 billion Pounds were paid by patients who were not exempt from charges, bringing the total amount actually paid out of patients' pockets for dental treatment to 1.65 billion Pounds. Compare these figures with 1996/1997 when NHS fees stood at 1.6 billion Pounds (71%) and private fees at 0.6 billion Pounds (29%) and it can be seen that while the size of the whole market has grown NHS fees have risen by around 18% while private sector fees have gone up by 64% during the same period. It cannot be said therefore that NHS dentistry has disappeared although it is clear that access to NHS dentistry has been and may still be difficult in some parts of the country. The Department of Health in England has responded by developing 'access centres' and in the recently published Options for Change sets out sweeping proposals to revitalise NHS dentistry and delegate decisions over funding to a local level. It is far from clear what the consequences of these changes will be. However, one possible scenario is that in many parts of the UK, although relief of pain, prevention and restoration of function will be funded by the NHS, other than in 'special circumstances' such as after trauma and inherited conditions 'cosmetic embellishment' will not be funded. In which case, ever increasing public interest in personal appearance may well lead to further growth in private dentistry. Against a background of change and uncertainty, this series of articles explores some of the issues facing dentists coming to terms with working in this brave new world. This first part examines an aspect of dental practice that is seldom discussed openly and yet is of such fundamental importance that it is the cornerstone of all successful practices and the main fault line in unsuccessful ones, namely the nature and strength of practice values.
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PMID:Current issues in dental practice management. Part 1. The importance of shared values. 1273 56

The aims of the study are to identify and prioritize research questions of importance to nurses in North Glasgow University Hospitals NHS Trust and to investigate and describe the existing evidence base for the highest priority questions identified. The consensus method known as the Delphi technique was used. Systematic searching of the literature for each question identified from the research priorities enabled the existing evidence base to be characterized. The following priorities were identified as the most important (in descending order of importance): Recruitment and Retention of Nursing Staff; Staff Stress & Morale; Training & Education of Nursing Staff; Infection Control; and Pain Management. The Delphi technique proved a useful method to determine and prioritize research areas in nursing.
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PMID:A Delphi study to determine nursing research priorities in the North Glasgow University Hospitals NHS Trust and the corresponding evidence base. 1275 36

The demographics and prevalence of symptoms in patients at first referral to the different components of palliative care services were identified by a retrospective case note study of 400 patients referred to three palliative care centres in London, UK: Michael Sobell House, Mount Vernon Hospital; The North London Hospice; St Bartholomew's and the Royal London Hospitals. One hundred consecutive referrals to each of the following service components were analysed: a hospice inpatient service; a community team; an NHS hospital support team and an outpatient service. A standardized proforma was used to collect the data. Ninety five per cent (380/400) of patients referred had a cancer diagnosis. The five most prevalent symptoms overall were pain (64%), anorexia (34%), constipation (32%), weakness (32%) and dyspnoea (31%), which is similar to other published reports. However, the commonest symptoms and their prevalence varied depending on the service component to which the patient was referred. Patients referred to hospice and community services had the highest symptom burden (mean number of symptoms per patient 7.21 and 7.13, respectively). This study suggests that different patient subgroups may have different needs in terms of symptoms, which will be relevant for the planning and rationalization of palliative care services.
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PMID:Symptoms in 400 patients referred to palliative care services: prevalence and patterns. 1498 15

Chronic leg ulceration costs the NHS around pound 500 million per year (Moffatt and Dorman, 1995) so it is not surprising that the condition attracts attention from manufacturers of medical devices. However, the evidence available for many novel technologies is scant and a systematic approach to product evaluation is essential to avoid the adoption of ineffective and therefore costly measures. A low-frequency ultrasound device was presented in clinic as an aid to stimulate and accelerate healing in otherwise recalcitrant wounds. There followed a systematic evaluation of the product including a literature review of the mode of action, safety and efficacy, followed finally by a product evaluation with case studies used as outcome measures. In this case, the product proved to be a useful tool in the management of chronic wounds, not only for healing but also for pain, pigmentation and odour reduction. The importance of understanding fully a novel technology and how it fits with clinical practice cannot be underestimated.
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PMID:Low-frequency ultrasound to manage chronic venous leg ulcers. 1459 68

Continual epidural infusions are an accepted intervention for the management of postoperative pain (McQuay and Moore 1998). Benchmarking nationally through an unpublished audit of Pain Society members identified variation in the concentrations prescribed and delivery systems used. These differences were reflected in local practice. As a result of the local disparity in the management and provision of epidural infusions, the acute pain service at Southampton University Hospitals NHS Trust worked in conjunction with the pharmacy department to standardise the service provided to patients and staff. This process was complicated by the difficulty in obtaining anaesthetist consensus for a standard solution that was commercially available and funding for the dedicated delivery system.
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PMID:Using clinical governance to standardise an epidural service. 1464 93

This care study describes the application of an evidence-based approach to the care of an infant with a sacral haemangioma. It explores four key aspects of management: specific therapeutic modalities; local wound management; pain management; and management of infection. Clinical governance and evidence-based practice are now important elements of care delivery in the NHS (Department of Health (DoH), 1997). Current evidence relating to haemangiomas and wound management is critically appraised and applied to an individual patient within the primary care setting. The appropriateness of theories and models of nursing are considered in relation to holistic assessment. Recent evidence regarding the management of pain at dressing change (Moffatt et al, 2002) and its relevance to haemangiomas are highlighted. Reflective practice is an integral part of experiential learning and the development of practical knowledge (Ghaye, 2000). Reflective practice and critical analysis have facilitated the provision of high-quality care and allowed a deeper and clearer understanding of both practice and theory, and their relationship within clinical practice. It is concluded that reflective practice aids the delivery of high-quality care at a personal, professional and practice development level.
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PMID:Vascular birthmarks: a care study of an infant with haemangioma. 1499 65

In this systematic review, we identified and evaluated studies of the cost effectiveness of spinal cord stimulation (SCS) for the treatment of chronic pain. Published reports were identified from a systematic search of a number of general medical electronic databases (Medline, CINAHL, and EMBASE), and specialist economic databases (NHS Centre for Reviews and Dissemination Economic Evaluation Database, and Health Economics Evaluation Database). Reference lists of retrieved reports were also searched, and contact was made with experts in the field. Of the 99 abstracts identified, 14 studies were considered to meet the inclusion criteria of the review. We found that across a range of medical indications, the initial healthcare acquisition costs of SCS implantation are consistently offset by a reduction in post-implant healthcare resource demand and costs. Further research is required to formally examine the cost effectiveness of SCS.
J Pain Symptom Manage 2004 Apr
PMID:The cost effectiveness of spinal cord stimulation in the treatment of pain: a systematic review of the literature. 1505 Jun 65

The Cochrane Library of systematic reviews is published quarterly. Issue 2 for 2003 of the library was published in May 2003. That issue contains 2395 reviews of which 1669 are in full text. The issue contains 79 new reviews, seven of those are directly relevant to pain management and palliative care. Annotated bibliographies for those seven reviews are provided. Issue 3 for 2003, published in July 2003, contains 3058 reviews and protocols of which 1754 are fully published reviews. Issue 3 contains 85 new reviews, five are relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews. The Cochrane trials database now stands at over 375,000 records with an additional 4100 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE).
J Pain Palliat Care Pharmacother 2004
PMID:Evidence-based pain management and palliative care in The Cochrane Library. 1514 11

Patients are being increasingly involved in assessing the quality of care that they receive in the NHS. Our aim was to undertake a retrospective postal survey to evaluate their perception of the delivery of orthognathic surgery in the south west of the United Kingdom (UK) using a patient-centred measure. A total of 327 patients (53% response rate) participated. Although most participants (n = 249, 76%) reported that they were well-informed about what to expect during treatment, many reported that the symptoms of pain, swelling, or difficulty in eating that they experienced immediately post-operatively were worse than expected. A third also reported that it took them longer to recover from the operation than they had anticipated. Patients undergoing orthognathic surgery in the south west of the UK need more specific information about what to expect both immediately post-operatively and at home after discharge.
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PMID:Patients' experiences after undergoing orthognathic surgery at NHS hospitals in the south west of England. 1533 67


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