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Acute Pain Management

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Keela Herr – 1st expert on this subject based on the ideXlab platform

  • Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults:
    Western Journal of Nursing Research, 2017
    Co-Authors: Clayton J. Shuman, Keela Herr, Marita G Titler

    Abstract:

    Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based Acute Pain Management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based Acute Pain Management practices and mean Pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean Pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based Acute Pain Management practices were sustained for 18 months following implementation….

  • Evidence-Based Practice Guideline : Acute Pain Management in Older Adults
    Journal of Gerontological Nursing, 2017
    Co-Authors: Randy Cornelius, Keela Herr, Debra B. Gordon, Kikikipa Kretzer, Howard K. Butcher

    Abstract:

    Abstract Acute Pain is a prevalent problem in a growing segment of the older adult population and is often ineffectively managed despite the accumulation of evidence to guide assessment and support interventions in managing Pain. Improvements in Acute Pain Management in older adults are needed to provide consistent and quality Pain assessment techniques and treatment therapies consistent with patient and/or family preferences. The current article briefly discusses ways to improve the Pain experience and outcomes for older patients and families. [Journal of Gerontological Nursing, 43(2), 18-27.].

  • effect of evidence based Acute Pain Management practices on inpatient costs
    Health Services Research, 2009
    Co-Authors: John M Brooks, Marita G Titler, Gail Ardery, Keela Herr

    Abstract:

    Objectives. To estimate hospital cost changes associated with a behavioral intervention designed to increase the use of evidence-based Acute Pain Management practices in an inpatient setting and to estimate the direct effect that changes in evidence-based Acute Pain Management practices have on inpatient cost. Data Sources/Study Setting. Data from a randomized ‘‘translating research into practice’’ (TRIP) behavioral intervention designed to increase the use of evidence-based Acute Pain Management practices for patients hospitalized with hip fractures. Study Design. Experimental design and observational ‘‘as-treated’’ and instrumental variable (IV) methods. Data Collection/Extraction Methods. Abstraction from medical records and Uniform Billing 1992 (UB92) discharge abstracts. Principal Findings. The TRIP intervention cost on average $17,714 to implement within a hospital but led to cost savings per inpatient stay of more than $1,500. The intervention increased the cost of nursing services, special operating rooms, and therapy services per inpatient stay, but these costs were more than offset by cost reductions within other cost categories. ‘‘As-treated’’ estimates of the effect of changes in evidencebased Acute Pain Management practices on inpatient cost appear significantly underestimated, whereas IV estimates are statistically significant and are distinct from, but consistent with, estimates associated with the intervention. Conclusions. A hospital treating more that 12 patients with Acute hip fractures can expect to lower overall cost by implementing the TRIP intervention. We also demonstrated the advantages of using IV methods over ‘‘as-treated’’ methods to assess the direct effect of practice changes on cost. In this study we estimate cost changes associated with implementing a ‘‘translating research into practice’’ (TRIP) behavioral intervention designed to increase the use of evidence-based Acute Pain Management practices for hospitalized older patients with hip fractures. This paper is a companion

Stephan A Schug – 2nd expert on this subject based on the ideXlab platform

  • Acute Pain Management scientific evidence fourth edition 2015
    The Medical Journal of Australia, 2016
    Co-Authors: Stephan A Schug, David Scott, Greta M Palmer, Richard Halliwell, Jane Trinca

    Abstract:

    n 1999, the first edition of Acute Pain Management: scientific evidence was written by a multidisciplinary This guideline summary describes the fourth edition of Acute Pain Management: scientific evidence, which was published by the Australian and New Zealand College of Anaesthetists (ANZCA) and its Faculty of Pain Medicine (FPMANZCA) in December 2015. The fourth edition summarises the best available evidence on Acute Pain Management, following methods established over the preceding three editions. It provides additional information by scoring the quality of and reporting further details on randomised controlled trials and meta-analyses. The information is condensed into key messages that provide:

  • Acute Pain Management in the opioid-tolerant patient
    Pain management, 2012
    Co-Authors: Stephan A Schug

    Abstract:

    SUMMARY Opioid use is increasing worldwide leading to an increasing number of opioid-tolerant patients requiring Acute Pain Management after surgery, trauma and Acute diseases. Provision of analgesia in opioid-tolerant patients is complex due to the pharmacological effects of long-term opioid exposure, but also due to pre-existing Pain states, comorbidities and psychosocial issues. Acute Pain Management in these patients is governed by the principles of provision of good analgesia, avoidance of withdrawal and organized discharge. Pain relief needs to be achieved by the use of multimodal analgesia, including regional anesthetic techniques and, if needed, opioids in increased doses. Withdrawal is best prevented by ongoing opioid substitution at previously established doses. Discharge planning requires multidisciplinary input and good communication with all healthcare providers involved.

  • New formulations of fentanyl for Acute Pain Management
    Drugs of Today, 2012
    Co-Authors: Michael J. Paech, M. Bloor, Stephan A Schug

    Abstract:

    Intravenous fentanyl citrate has stood the test of time as a valuable formulation for Pain Management. The desirable physicochemical properties of fentanyl have allowed the development of several alternative formulations for delivery using less invasive routes, for example, transmucosal (intranasal, oral buccal and oral sublingual) and transdermal. These new formulations have been applied to clinical settings in which rapid onset of analgesia is desired, using convenient but noninvasive methods. Recent commercialization of various formulations has been driven largely by the needs of cancer patients, for whom severe but self-limiting “breakthrough” Pain is less suitably treated by parenteral or oral routes of opioid administration. However, these formulations are also used for Acute analgesia in prehospital and in-hospital emergency department care, and for pediatric Acute Pain Management. Finally, they are increasingly used by patients with chronic Pain of nonmalignant origin, although there is considerable debate about their merit in this group. We searched the databases MEDLINE, PubMed, EMBASE, CINAHL and Cochrane up to October 2011, using search terms “fentanyl AND nasal; intranasal; transmucosal; buccal; sublingual; oral; inhaled; inhalation; transdermal”. The characteristics of several formulations of fentanyl are reviewed, detailing their pharmacokinetics, pharmacodynamics and clinical experience with their use for Acute Pain Management.

Marita G Titler – 3rd expert on this subject based on the ideXlab platform

  • Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults:
    Western Journal of Nursing Research, 2017
    Co-Authors: Clayton J. Shuman, Keela Herr, Marita G Titler

    Abstract:

    Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based Acute Pain Management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based Acute Pain Management practices and mean Pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean Pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based Acute Pain Management practices were sustained for 18 months following implementation….

  • effect of evidence based Acute Pain Management practices on inpatient costs
    Health Services Research, 2009
    Co-Authors: John M Brooks, Marita G Titler, Gail Ardery, Keela Herr

    Abstract:

    Objectives. To estimate hospital cost changes associated with a behavioral intervention designed to increase the use of evidence-based Acute Pain Management practices in an inpatient setting and to estimate the direct effect that changes in evidence-based Acute Pain Management practices have on inpatient cost. Data Sources/Study Setting. Data from a randomized ‘‘translating research into practice’’ (TRIP) behavioral intervention designed to increase the use of evidence-based Acute Pain Management practices for patients hospitalized with hip fractures. Study Design. Experimental design and observational ‘‘as-treated’’ and instrumental variable (IV) methods. Data Collection/Extraction Methods. Abstraction from medical records and Uniform Billing 1992 (UB92) discharge abstracts. Principal Findings. The TRIP intervention cost on average $17,714 to implement within a hospital but led to cost savings per inpatient stay of more than $1,500. The intervention increased the cost of nursing services, special operating rooms, and therapy services per inpatient stay, but these costs were more than offset by cost reductions within other cost categories. ‘‘As-treated’’ estimates of the effect of changes in evidencebased Acute Pain Management practices on inpatient cost appear significantly underestimated, whereas IV estimates are statistically significant and are distinct from, but consistent with, estimates associated with the intervention. Conclusions. A hospital treating more that 12 patients with Acute hip fractures can expect to lower overall cost by implementing the TRIP intervention. We also demonstrated the advantages of using IV methods over ‘‘as-treated’’ methods to assess the direct effect of practice changes on cost. In this study we estimate cost changes associated with implementing a ‘‘translating research into practice’’ (TRIP) behavioral intervention designed to increase the use of evidence-based Acute Pain Management practices for hospitalized older patients with hip fractures. This paper is a companion

  • Summative index: Acute Pain Management in older adults
    Applied Nursing Research, 2009
    Co-Authors: Marita G Titler, John M Brooks, Keela Herr, Margo Schilling, J. Lawrence Marsh

    Abstract:

    Abstract One of the challenges in measuring adoption of complex evidence-based practices (EBPs) such as Acute Pain Management is determining what constitutes adherence to an EBP guideline. Traditionally, individual process indicators extrapolated from an EBP guideline are selected as dependent measures of guideline adoption. When using multiple indicators, the challenge is determining the number of indicators that must be met to define adherence to the EBP guideline. The primary goal of the study reported herein was to develop and test a summative index (SI) of guideline adherence for Acute Pain Management of hospitalized older adults. Steps in formulating the initial index are described as well as refinement of this metric. Techniques used included factor analysis, discriminate validity, and split-half reliability. The resulting SI is composed of 18 indicators each scored as 0 (not present) or 1 (present), with a total SI score of 0 to 18.