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There is a large gap between contemporary evidence-based remedies for pain control and what is offered to Ukrainian patients with pain. Having thousands of people needlessly suffer from avoidable pain forces a consideration of 1) what prevents from their access to pain relief, 2) are their human rights being violated and 3) how can the situation be improved. In order to identify the obstacles to adequate pain management in Ukraine I collected evidence using two methods. First, I designed a questionnaire for the Ukrainian doctors, received approval from the University of Ottawa Ethics Board, distributed the questionnaire among potential responders and then organized the obtained results. Second, I did an extensive literature review to provide evidence from the patients. Then I analysed the provisions of Ukrainian domestic and international legislation as well as the available case law to find out if the human rights of Ukrainian patients and doctors are being violated by denial of adequate pain relief. According to my findings, the barriers to pain control in Ukraine are multidimensional and interdependent. They cause violations of human rights, which are not being effectively defended through the courts of Ukraine. These findings call for a more constructive approach to the development of the Ukrainian health law and policy, which I offer in this thesis.

The purpose of this project was to examine the effect of hypnosis as a treatment in the control of pain in a population of rheumatoid arthritic patients and further to examine any associated change in emotionality. Three groups of patients suffering from the pain of rheumatoid arthritis were selected. One group served as a control group. The other two groups served as a modified control group and as a treatment group, respectively. All three groups were pre, mid, and post-tested using the McGill Pah Questionnaire, the Minnesota Multiphasic Personality Inventory, the California Personality Inventory Well-Being scale items, and a check of their medication intake. The testing periods were before any treatment procedures were introduced, after a 6 week therapy involvement period for the modified control group and treatment group, and after another 6 week period with no further interaction of the patients with the therapists. The treatment group received hypnosis instruction for the treatment of pain, the modified control group received a ventilation or talk therapy, and the control group was not seen by any therapist. It was fond that self-hypnosis offers a viable and practical treatment technique to individuals in the control of their pain. individuals were not only able to reduce their perception of pain and its effect on their lives, but they were also able to be the ones in control of the process. Both the treatment group and the modified control group were able to achieve positive change in several emotional factors. The treatment group was able to achieve a more significant change and one that persisted after the therapy sessions were terminated. The members of the treatment group were thus able to increase their emotional functioning and decrease their dependency on medications. The treatment group was the only group able to decrease medication intake significantly thus gain indicating the importance of learning self-help procedure for controlling pain. It would seem from the results of this study that using self-hypnosis for pain control is useful and practical.

Background: The most common major surgical procedure performed worldwide is the caesarean section (CS). Effective pain management is a priority for women undergoing this procedure, to reduce the incidence of persistent pain, (a risk factor for postpartum depression), as well as optimize maternal-neonatal bonding and the successful establishment of breastfeeding. Multimodal analgesia is the gold standard for post-caesarean section analgesia. At present, no perioperative pain management protocols could be identified for the management of patients presenting for CS at regional hospitals in South Africa. This audit aimed to review the folders of patients who underwent CS, with reference to perioperative pain management guidelines for CS. Methods: A descriptive, retrospective, cross-sectional audit was conducted. Three hundred folders (10% of the annual number of caesarean procedures performed) from New Somerset Hospital, a regional hospital in Cape Town, South Africa were reviewed. Results: The women were a mean age of 30 years (SD 6.2). Median gravidity was 3 (IQR 2-3) and parity was 1 (IQR 1-2); 52% had previously undergone a CS. In 93.3%, spinal anaesthesia was employed for CS. Pain assessment was poor, with only 55 (18%) patients having their pain assessed on the day of the operation. Analgesia was prescribed in over 98% of the patients, however, medication was only administered as prescribed in 32.6%. Non-steroidal anti inflammatory drugs (NSAIDs) were prescribed in < 1.67% of cases. None of the patients received a patient-controlled analgesia (PCA), transversus abdominis plane (TAP) block, or wound infusion catheter as supplementary strategies. Conclusions: Pain management for post-CS patient at this hospital is lacking. There is the need for the implementation of a structured assessment tool to improve administration of analgesics in these patients. In addition, the reasons for the omission of NSAIDs from the analgesia regimen requires investigation. Hospitals require post-CS pain protocols to guide management especially in resource-limited settings.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-07-21T19:09:46Z No. of bitstreams: 1 CiceroAgostinho.pdf: 718364 bytes, checksum: 5b373c12916005349c74311789694b95 (MD5) / Made available in DSpace on 2017-07-21T19:09:46Z (GMT). No. of bitstreams: 1 CiceroAgostinho.pdf: 718364 bytes, checksum: 5b373c12916005349c74311789694b95 (MD5) Previous issue date: 2011-03-31 / The aim of this study was to evaluate the effect of two different concentrations (4 mg and 12 mg) of dexamethasone to control pain, swelling and trismus after third molar surgery inclusos. This clinical study was conducted with 16 adult patients of both sex, displaying mandibular third molar in the same position bilaterally, with an indication for surgical removal. Patients were treated with 4 mg or 12 mg of dexamethasone 1 hour before surgery on the first or second surgery. The choice of which side was operated first and which dose of dexamethasone would be taken first was performed randomly and double blind. The trismus was assessed by measuring the distance interincisal. Pain was assessed by the amount of tablets (paracetamol 750mg) taken after the surgery and the visual analogue pain scale (VAS). These data were obtained before surgery, 24 and 48 hours after surgery. Based on statistical analysis (Student's t test, Wilcoxon and Friedman), the results showed no differences in variables (swelling, pain and trismus) between the two doses of dexamethasone (4mg and 12mg). / O objetivo deste trabalho foi avaliar o efeito de duas concentrações diferentes (4mg e 12mg) de dexametasona no controle da dor, edema e trismo após a cirurgia de terceiros molares inferiores inclusos. Este estudo clínico foi realizado com 27 pacientes adultos, de ambos os sexos, que apresentavam terceiros molares inferiores inclusos na mesma posição bilateralmente, com indicação para remoção cirúrgica. Os pacientes foram medicados com 4mg ou 12mg de dexametasona uma hora antes do procedimento cirúrgico na primeira ou na segunda cirurgia. A escolha de qual lado foi operado primeiro e qual dose de dexametasona seria empregada inicialmente era realizada de forma randomizada e duplo-cega. O trismo foi avaliado pela medida da distância interincisal. A dor foi avaliada mediante a contagem da quantidade de comprimidos (paracetamol 750mg) ingerida após a cirurgia e da Escala Visual Analógica da dor (VAS). Esses dados foram obtidos antes da cirurgia, 24 horas e 48 horas depois do procedimento cirúrgico. Com base na análise estatística (teste t-student, Wilcoxon e Friedman), os resultados não mostraram diferença nas variáveis (edema, dor e trismo) entre as duas doses de dexametasona.

acase@tulane.edu

Patients experience some degree of pain accompanying all surgical procedures. If this pain is not adequately treated, it will cause severe physiological and psychological damage. It will even affect patients' postoperative recovery. However, if preemptive analgesia is administered before noxious stimuli arise, rather than afterwards, it is significantly more effective. The purpose of this study is to recognize that reasonable effort and time should be spent to determine a patient's tolerance level towards pain before surgery. Then, the appropriate dosage of analgesia can be given immediately after surgery to alleviate pain. By administering effective pain relief, it will improve patient¡¦s satisfaction with medical services. Using classic experimental design (which consists of an experimental group and a control group), this study focuses on cases of patients who had hemorrhoid surgery in a certain hospital in southern Taiwan. The experimental group and the control group consist of a total of 75 valid samples. The experimental group received customizing analgesic postoperative care, while the control group received conventional analgesic postoperative care. Patient¡¦s satisfaction questionnaires were gathered from patients on the day they were discharged from the hospital. Instruments used in the experiment include VAS, PThM, and patient¡¦s satisfaction questionnaires.To examine the basic characteristics of the samples in both the experimental group and the control group, two statistical methods, Chi-square test and independent T test, were adopted. For patient¡¦s satisfaction questionnaires, Mann-Whitney-Wilcoxon test of nonparametric method was adopted to examine if obvious differences in satisfaction levels existed between the two groups. The result of the experiment shows the analgesic effect from customizing analgesic postoperative care is far better than conventional care. The patient¡¦s satisfaction toward the doctor's professional skill was higher as well. On the other hand, the patient¡¦s satisfaction level toward the whole medical process had no obvious improvement. This study proves that customizing analgesic postoperative care can effectively prevent postoperative pain from occurring. However, to raise patient¡¦s satisfaction towards the whole medical process, better professional medical skill is required as well as improved medical services.

Background: At the end of life, patients living in their own homes experience significantly more pain than those who die in either hospital or hospice care (Office for National Statistics, 2015). With an increasing prevalence of this, person-centred medicines optimisation is essential. Aim: To investigate the feasibility of community pharmacist medicines optimisation services for patients living with advanced cancer pain in community settings. Methods: Mixed methods were used, adopting a pragmatic stance and approach. Qualitative interviews, a systematic review and meta-analysis and a proof-of-concept study were undertaken. Results: Patients with advanced cancer pain need support with their medicines which could be provided by a pharmacist. Patients experienced a significant number of medicines related problems, even those already receiving specialist palliative care. Most problems were addressed by pharmacist advice with the remainder being referred for additional prescribing. Care for patients with cancer pain is currently not person-centred and the current medicines optimisation model is unsuitable for this patient group. An enhanced model of medicines optimisation is therefore presented for patients with advanced cancer and this model can be amended and adopted for other patient groups. Conclusions: An enhanced medicines optimisation model (MOCAP) has been created to inform person-centred medicines optimisation for patients with advanced cancer pain. Feasibility and acceptability were also confirmed and it can be adapted for further clinical use. This model contributes to the goals of the NHS agenda of choice and control of care as proposed in the NHS Long Term Plan (NHS, 2019b).

Emergence delirium (ED), also known as emergence agitation, is a postoperative condition characterized by aberrant cognitive and psychomotor behaviors following general anesthesia. The incidence of ED is 3 to 8 times higher in children 5 years of age or less. There is no standard of nursing practice for managing ED symptoms in the pediatric surgical population. The purpose of this quality improvement project was to address a gap in knowledge needed to inform clinical decision-making when managing ED in the postoperative setting. Using an educational presentation for post anesthesia care unit (PACU) nurses, this project introduced the use of non-pharmacological interventions to mitigate symptoms of ED in the pediatric population as inspired by The Green Star Initiative, an Army program at Fort Carson. The project aim was to describe the effectiveness of ED-specific interventions from the nursing perspective. Using tenets of the Iowa model, this quality improvement project included a needs assessment survey, PowerPoint presentation, parent education leaflet, ED cheat sheet, and a post-intervention survey. Applying the context, input, process, product model for evaluation, this project increased knowledge of ED-specific interventions used by nurses that demonstrates a change in clinical decision-making. PACU nurses rated the interventions 43% effective on pediatric patients. This project addressed the gap in practice by providing structured education on ED, inspiring the use of ED-specific interventions, and promoting readiness to care for the pediatric surgical population. Outcomes add to the nursing literature by introducing ED-specific interventions to manage pediatric ED in facilities nationwide. A social implication of this project is to improve the care of pediatric surgical patients.