Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: patient comfort (original) (raw)
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Develop a validated anesthesia quality assessment to evaluate patients postoperatively
Journal of Anesthesia & Critical Care: Open Access, 2020
Objective: The study is aimed to develop a well-validated anesthesia quality assessment to evaluate patients postoperatively. Materials and Methods: After securing Institutional Review Board approval, the study was registered via ClinicalTrials.gov (NCT 0307996). The Siriraj Anesthesia Quality Assessment Questionnaire was developed and validated under the conceptual/theoretical framework of Maslow's hierarchy of needs, Hospital Consumer Assessment of Healthcare Providers and System, Patient Satisfaction Questionnaire, Service Quality Questionnaire and Quality of Recover after Anesthesia. A total of 476 qualified responses with obtained consent were included in the study to verify the appropriateness of the tool. Results: The study involved 397 qualified patients (83.4%), aged 47.6±16.6, representing all anesthesia services. Significantly, a binary logistic regression revealed the predicted dependent variables as Process of Care (4.39±0.51) and Physical Support (4.35±0.66) in comparison with a sequence of Accessibility and Convenience (4.33±0.56), Communication and Information (4.00±0.70), Technical Quality (4.46±0.45) Psychological Support (4.57±0.65) and Loyalty (4.52±0.68) in anesthesia quality assessment. Conclusion: Process of Care and Physical Support appeared to be significantly valued features, whereas Communication and Information, Accessibility and Convenience, Technical Quality and Psychological Support were found to be weak points in anesthesia quality assessment.
2017
Background: Pain is a common phenomenon experienced by ventilated and critically ill adult patients. It is urgent to measure the pain among these patients since they are unable to report their pain verbally. Comfort Scale is one of the instruments used to measure pain in adult patients. The scale is used to measure pain among children patients with fairly high sensitivity and specificity. Purpose: This study aimed to examine the sensitivity and specificity of the Comfort Scale to measure pain in the ventilated critically ill adult patients in the ICU. Methods: This study employed a cross-sectional design with 66 ventilated adult patients in the ICUs of two hospitals in Semarang. The pain assessment was administered to the patients in 2 duplo periods by two observers comparing with the Comfort Scale and Critical Care Pain Observational Tool (CPOT) as a gold standard instrument during the pre and post positioning procedures. The data were analyzed using the receiver operating curve (ROC). Result: The results showed that in the pre-positioning procedure, the Comfort Scale had the sensitivity value of 69% and the specificity value of 81%. Meanwhile, in the postpositioning procedure, the values were decreasing (the sensitivity of 45%, the specificity of 67%). This indicated that the sensitivity value of the comfort scale decreased and could be interpreted that the ability of the instrument to detect pain remained low. Meanwhile, the decrease of the specificity value of the instrument between the pre and post administration was not far different, so it could be interpreted that the instrument can correctly identify the patient without pain. Conclusion: The Comfort Scale had a lower value of sensitivity and specificity in the post-positioning than that in the pre-positioning procedure. It is recommended that further studies should focus on the relationship between sedation and pain by using instruments of pain studies for adult patients (CPOT). Additionally, the hospital policy makers, that is Pain Task Force is expected to give education and training through workshops and seminars about the nurse skills in pain management on critical areas as part of the multidisciplinary team.
Correlation between observational scales of sedation and comfort and Bispectral Index scores (BIS)
Journal of pain and symptom management, 2017
When palliative care patients enter the phase of unconsciousness preceding death it is standard practice to initiate or continue a subcutaneous infusion of an opioid plus or minus a sedative. The doses are determined somewhat empirically and adjustments are based on clinical assessment and observational measures of sedation and comfort. Following reports that these observational measures could be misleading, this study assesses their validity by comparing them with an objective measure of sedation, the Bispectral Index score (BIS). To determine the validity of the Richmond Agitation and Sedation Scale (RASS) and the Patient Comfort Score (PCS) in assessing sedation and comfort in unconscious patients. Forty eligible and consenting patients were monitored from the onset of unconsciousness (unresponsiveness) until death. Measures of sedation (RASS) and comfort (PCS) were made by the attending nurse every 4 hours. Correlation coefficients examined the relationship between 4th hourly RA...
A survey of current perianesthesia nursing practice for pain and comfort management
Journal of PeriAnesthesia Nursing, 2004
Widespread dissemination of information and high-profile press coverage about pain and comfort management has resulted in heightened awareness among health care professionals and the public of the need for improvements in the way pain and comfort are managed. Despite significant advances in treatment options for pain relief and comfort, studies show that both phenomena continue to be poorly managed and undertreated. Providing pain relief and comfort to patients are important fundamental components of good nursing care; however, no studies have been performed to evaluate these responsibilities in perianesthesia nursing practice. Therefore, a descriptive survey was undertaken to assess the current practices for pain and comfort management among perianesthesia nurses. A convenience sample of 220 perianesthesia nurses working in preoperative and postoperative settings in rural and urban hospitals, outpatient centers, and freestanding facilities completed a questionnaire survey. The survey asked 10 questions that addressed various aspects of pain and comfort care, including assessment in different settings, discharge criteria, and obstacles in the management of pain and comfort. Findings showed that perianesthesia nurses assessed pain at a frequency of 58% and comfort at a frequency of 56% on
Predictors of patient satisfaction with anaesthesia and surgery care
European Journal of Anaesthesiology, 2013
Context Previous research has shown that most patients are satisfied with their anaesthetic care. For those who are not the causes may be multifactorial including dissatisfaction with surgical outcomes. Objectives We aimed to identify whether quality of recovery after anaesthesia and surgery measured in multiple domains affects patient satisfaction. Design Sub-group analysis of previously published observational cohort study of quality of recovery after surgery (using the Postoperative Quality of Recovery Scale) was used to identify predictors of incomplete satisfaction 3 days after surgery. Setting Multicentre perioperative surgery. Patients Patients !6 years old, undergoing a variety of operation types and all receiving general anaesthesia. Observations Of 701 patients, 573 completed the satisfaction question on day 3. Satisfaction was rated by a single fivepoint rating question. Patients were divided into two groups: 477 (83%) were completely satisfied and 96 (17%) were not completely satisfied. Multivariable logistic regression analysis was performed on preoperative and patient characteristics and recovery in five domains as follows: physiological, nociceptive (pain and nausea), emotive (anxiety and depression), activities of daily living and cognition. Recovery was defined as return to baseline values or better for all questions within each domain. Results Incomplete satisfaction was predicted by persistent pain or nausea at day 3 [OR 8.2 (95% CI 2.5 to 27), P < 0.01] and incomplete satisfaction at day 1 [OR 28 (95% CI 10 to 77), P < 0.01]. Paradoxically, incomplete satisfaction was less likely to occur if pain or nausea was present 15 min after surgery [OR 0.34 (95% CI 0.11 to 0.99), P < 0.05] or at day 1 [OR 0.30 (95% CI 0.10 to 0.91), P ¼ 0.03]. Incomplete recovery in the other domains did not influence satisfaction. Conclusion Of the recovery domains measured using the Postoperative Quality of Recovery Scale, only nociception (pain or nausea) contributed to incomplete satisfaction. Eur J Anaesthesiol 2012; 29:000-000
Anesthesiology
Background Although there are thousands of published recommendations in anesthesiology clinical practice guidelines, the extent to which these are supported by high levels of evidence is not known. This study hypothesized that most recommendations in clinical practice guidelines are supported by a low level of evidence. Methods A registered (Prospero CRD42020202932) systematic review was conducted of anesthesia evidence-based recommendations from the major North American and European anesthesiology societies between January 2010 and September 2020 in PubMed and EMBASE. The level of evidence A, B, or C and the strength of recommendation (strong or weak) for each recommendation was mapped using the American College of Cardiology/American Heart Association classification system or the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The outcome of interest was the proportion of recommendations supported by levels of evidence A, B, and C. Changes in the...
ANAESTHESIA, PAIN & INTENSIVE CARE CONTENTS MARCH 2018 ISSUE
Technology and the future of anesthesiology 01 Amer Majeed How could fundamental disagreements 05 about the correct anatomy of the pediatric larynx develop during the last 15 years? Josef Holzki ORIGINAL ARTICLES A combination of intrarectal lignocaine 08 cream plus periprostatic nerve block improves pain control in transrectal ultrasound guided prostate biopsy: A prospective evaluation Ekrem Akdeniz, Sevda Akdeniz Evaluation of clinical effectiveness of three 16 different sedation protocols (intravenous propofol vs. ketamine vs. ketofol) in anxious children Gözde Yalçın, Nurhan Öztaş,Gülay Kip Effect of low dose intrathecal clonidine as an 26 adjuvant to hyperbaric bupivacaine on postoperative analgesia in patients undergoing elective infra umbilical surgeries Prachi Surve, Neeta Dsouza, Rajendra Patil, Dheeraj Narayan Agrawal, Anshumali Study to evaluate transversus abdominis 32 plane (TAP) block with ropivacaine in appendectomy patients by total requirement of diclofenac as a postoperative analgesia drug Intravenous regional anesthesia: comparing 48 efficacy of magnesium sulphate and clonidine as an adjuvant to lignocaine for intraoperative and postoperative analgesia. Deepak Solanki, Meena Singh Effectiveness of audio visual distraction using 55 virtual reality eyeglasses versus tablet device in child behavioral management during inferior alveolar nerve block A prospective randomized controlled trial 62 comparing the effects of dexmedetomidine and fentanyl on attenuation of pressor response during laryngoscopy and intubation Baikady Vasudevarao Sunil, Neeta Santha Comparison of postoperative pain relief 67 following use of spinal anesthesia versus general anesthesia for patients undergoing laparoscopic cholecystectomy Amna Sharaf, Ahmed Mujadid Burki, Saira Mahboob, Razia Bano Awareness, knowledge and attitude about 73 labor analgesia among providers and parturients; a survey based study Effectiveness of algorithm based teaching 81 on recognition and management of periarrest bradyarrhythmias among interns -a randomized control study Kusha Nag, Rani P. VR. Hemanth Kumar, Anand Monickam, Dewan Roshan Singh, T. Sivashanmugam Ultrasound guided 4 in 1 block -a newer, 87 single injection technique for complete postoperative analgesia for knee and below knee surgeries A comparison between intrathecal isobaric 94 levobupivacaine 0.5% and isobaric ropivacaine 0.5% in lower limb surgeries: a prospective, randomized, double blind study Kajal A. Bhatt, Ila A. Prajapati REVIEW ARTICLE Common low back pain, is it really a mystery? 125 Kjetil Larsen EDUCATION Fundamentals of clinical research 131 2: Designing a research study
Gastrointestinal Endoscopy, 2015
Background-Over 20 million invasive procedures are performed annually in the United States. The vast majority are performed with moderate sedation or deep sedation yet there is limited understanding of drivers of sedation quality and patient satisfaction. Currently, the major gap in quality assurance for invasive procedures is the lack of procedural sedation quality measures. Objective-To develop and validate a robust, patient-centered measure of procedural sedation quality, the PROcedural Sedation Assessment Survey (PROSAS). Design-Through a series of interviews with patients, proceduralists, nurses and anesthesiologists, and an interactive patient focus group, major domains influencing procedural sedation quality were used to create a multipart survey. The pilot survey was administered and revised in sequential cohorts of adults receiving moderate sedation for GI endoscopy. After revision, the PROSAS was administered to a validation cohort. Setting-GI endoscopy unit.