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Purpose: This thesis addresses feasibility issues of conducting a descriptive study of pain and health-related quality of life (HRQOL) in women after Cesarean section (c-section). Objectives: Feasibility issues surrounding population access, chart completeness for review, and preference for online data collection were investigated. Prevalence and prediction of postoperative pain and HRQOL at six-weeks was addressed to generate hypotheses for future study. Methods: A descriptive pilot design was used, collecting a convenience sample of 41 women recruited two hours prior to a planned c-section at Kingston General Hospital. Consenting women completed preoperative questionnaires via computerized tablet or paper and pen. Preoperative data included pain, HRQOL, anxiety, depression, somatization, HCU, and demographics. Six weeks postoperatively, women completed pain, HRQOL, and HCU questionnaires through the internet, postal mail, or telephone. A chart review was used to collect health and obstetrical history, and acute postoperative pain. Results: An average of two participants per week were recruited, with a participation rate of 83.7%. Online questionnaires were preferred by 34 women (83%) preoperatively, and 15 women (48.4%) postoperatively. Almost 40% of patient charts were incomplete, missing symptoms reported in the immediate postoperative period. Twenty-four percent of the sample was lost to follow-up. Mild postoperative pain was reported by seven women (23) within 24 hours of completing the questionnaire. Bodily pain and the physical component of HRQOL were worse both pre- and post-operatively than age- and sex-matched norms. Postoperative pain at six weeks was predicted by tubal ligation, pain expectancy, and severe postoperative acute pain. Postoperative HRQOL scores were correlated with preoperative HRQOL score, depression, somatization, and preoperative pain. HRQOL physical composite score, bodily pain scores, and trait anxiety were predictive of healthcare use. Conclusion: The planned c-section population is accessible for research purposes, however timing and mode of follow-up should be carefully considered due to the demands of newborn care. A larger study evaluating the prevalence of chronic pain after c-section is needed, in which the role of depression, anxiety, somatization, and pain expectancy in pain outcomes and the impact on healthcare use is investigated. / Thesis (Master, Nursing) -- Queen's University, 2007-10-01 13:12:33.096

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Background High incidence of post-operative trichiasis and other poor outcomes after surgery in most trachoma-endemic settings poses a major challenge to global elimination of trachoma. This systematic review aimed to assess the incidence of post-operative trichiasis and other poor outcomes of trichiasis surgery in Africa, based on findings of observational and interventional studies. Search methods We searched PubMed, Academic Search Premier, Africa-Wide Information, CINAHL and Health Source Nursing through EBSCOhost, Web of Science [all databases], and Cochrane Central Register of Controlled Trials for relevant studies on the subject. We also searched the reference lists of included studies to identify further potentially relevant studies. We included all observational and interventional studies that measured post-operative trichiasis as one of the primary outcomes. Only studies conducted in Africa were included in this review. Data collection and analysis Two reviewers independently screened the titles and abstracts, selected and assessed the articles for inclusion in this review. Any disagreements were resolved through discussion or by consulting a third reviewer. Where necessary, the corresponding authors of included studies were contacted to provide any missing data. Our primary outcome was post-operative trichiasis, which was defined as any eyelash touching the globe at different time points after surgery. Main results Thirty-five studies, including 12,943 participants, met the inclusion criteria. A number of the studies included in this review utilized the same data to measure the incidence of post-operative trichiasis and other poor outcomes over different follow-up periods. Overall, a review of the included studies revealed a pattern of high incidence of post-operative trichiasis and other poor outcomes ranging from 2.3 at 6 weeks to 65% at 7 years. This incidence varied by type of study design, surgical procedure and technique used as well as the follow up period among other factors.

Background: Managing pain is challenging, especially in neonates. Uncontrolled pain and opioid exposure are associated with short- and long-term adverse events. Adequately controlling pain while reducing opioid exposure is paramount in the neonatal population. This thesis presents three studies, all aiming to determine if IV acetaminophen is an appropriate adjunct to current opioid-based postoperative pain regimens. The population of interest is neonates admitted to the neonatal intensive care unit (NICU) treated with major abdominal and thoracic surgery. Chapter 1 provides the scientific framework underpinning this work and the rationale for performing the included studies. Chapter 2 presents the results of a systematic review and meta-analysis assessing the effect of IV acetaminophen on postoperative pain in pediatric patients. This chapter further expands on gaps and opportunities for future research. Chapter 3 reports the results of a national survey in which pediatric surgeons, anesthesiologists, and neonatologists reported their postoperative pain prescribing practices in the NICU and their perspectives on the use of IV acetaminophen. Chapter 4 describes the protocol for a pilot randomized controlled trial (RCT). This study will assess the feasibility of a multicenter RCT to evaluate the effectiveness of IV acetaminophen for postoperative pain in neonates recovering from major abdominal and thoracic surgery. Chapter 5 summarizes the results of the studies in context and details how the results of each study informed the others. It also discusses areas of future research. / Thesis / Master of Science (MSc) / All patients experience some amount pain after major surgery. Babies who are born too early (i.e., preterm) may experience more pain than babies those who are born close to their due date. Opioid drugs such as Fentanyl are commonly used to manage pain after surgery, but they have side effects, such as slowing down breathing and causing problems with gut function. Using non-opioid drugs (such as acetaminophen) and opioid drugs together may reduce the amount of opioids needed. This combination may also help with pain control. We want to know if using intravenous (IV) acetaminophen will reduce the rate of side effects, decrease the amount of opioids given, and still control pain well. To answer this question, we completed three studies. The first study reviewed all the published data on IV acetaminophen in children who need surgery. In the second study, we surveyed pediatric surgeons, anesthesiologists, and neonatologists to see how they manage pain after surgery and what they thought about IV acetaminophen. The last study is the plan for our pilot trial, where we will see if giving IV acetaminophen and opioids together is better than opioids alone.

Indiana University-Purdue University Indianapolis (IUPUI) / Purpose: The purpose of this study is to investigate what post-operative analgesic agents if any, are provided by clinicians for their pediatric dental patients. The study will also evaluate the clinician's philosophy toward pain management in the child patient and look for trends in these philosophies, as well as trends in where they currently practice with regards to pain management and specific analgesic agents. Methods: An on-line survey (appendix A) was sent to gather data from board certified pediatric dentists. The American Board of Pediatric Dentistry (ABPD) website was used to obtain an e-mail directory of addresses of all registered ABPD members. This e-mail provided them with a link to an online survey site where they could access the survey. The online survey site used was surveymonkey.com. The survey was available on-line for 3 months. Mantel-Haenszel and chi-square tests were used to check the relationships of hours of patient care, years of experience, and region of the country with other items in the survey. Results: Responses were received from 210 (27%). The region distribution of the responders was compared to the region distribution of all pediatric dentists. The distributions were found to be similar (p=0.81 using a one-sample chi-square test). Conclusions: Ibuprofen and acetaminophen are recommended most frequently for over the counter (OTC) post-operative pain control by board certified pediatric dentists. Acetaminophen with codeine is prescribed most frequently for post-operative pain control by board certified pediatric dentists. The majority of board certified pediatric dentists adhere to the same philosophies with regard to post-operative pain management as taught in their respective post graduate programs.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Pain management is a vital component of post-operative nursing care. Orthopaedic patients in particular experience severe pain following surgical intervention. Since effective pain management is crucial in the post-operative recovery of orthopaedic patients, it was essential to explore the knowledge and clinical practice of nurses in orthopaedic wards. The aim of the study was to establish nurses’ knowledge and clinical practice for adult postoperative pain management of orthopaedic patients. A non-experimental, descriptive self-administered survey using a quantitative approach was applied. The total population of N=97 registered professional and enrolled nurses working in dedicated orthopaedic wards in two central hospitals in the Cape Town Metropole district, South Africa were invited to participate in the study. A structured questionnaire was used to collect the data. Reliability and validity was assured by means of a pilot study and consultation with nursing experts and a statistician. Ethical approval was obtained from the Health Research Ethics Committee of the University of Stellenbosch. Permission for access to the hospitals was obtained from the hospital and nursing managers. Informed written consent was obtained from the participants. The data was analysed by the statistician and presented in frequencies, tables and histograms. The variables were compared using either the Pearson chi-square test for differences in nursing category or the Mann-Whitney U-test for differences in years of experience. The analysis of the results illustrated knowledge deficits, inconsistent clinical practices and limited training in post-operative pain management. The recommendations include training courses, revision of the patient’s observation chart and formulation of policies and guidelines for pain management. Appropriate knowledge and clinical skills of nurses are critical to ensure optimal pain management for post-operative orthopaedic patients. / AFRIKAANSE OPSOMMING: Die bestuur van pyn is ’n essensiële component van post-operatiewe verpleegsorg. Ortopediese pasiënte ervaar spesifiek fel pyn na afloop van ’n chirugiese intervensie. Aangesien effektiewe pynbestuur belangrik in die post-operatiewe herstel van ortopediese pasiënte speel, was dit nodig om die kennis en kliniese praktyke van verpleegpersoneel in ortopediese sale te verken. Die doel van die studie was om verpleegpersoneel se kennis en kliniese ervaring van volwasse post-operatiewe pynbestuur van ortopediese pasiënte vas te stel. ’n Nie-eksperimentele, deskriptiewe, self-toegediende opname is toegepas wat gebruik maak van ’n kwantitatiewe benadering. Die totale populasie van 97 geregistreerde professionele en ingeskrewe verpleegkundiges wat in toegewyde ortopediese sale van twee sentrale hospitale in die Kaapstad Metropol distrik, Suid Afrika werk, is genooi om aan die studie deel te neem. ’n Gestruktureerde vraelys is gebruik om data in te samel. Betroubaarheid en geldigheid is verseker deur middel van ’n voortoets en konsultasie met verpleegkundige kenners en ’n statistikus. Etiese goedkeuring is verkry van die Gesondheidsnavorsing Etiese Komitee van die Universiteit Stellenbosch. Toestemming om toegang tot die hospitale te kry is verkry van die hospitaal en verpleegbestuurders. Ingeligte, geskrewe toestemming is van die deelnemers verkry. Die data is geanaliseer deur die statistikus en is aangebied in frekwensietabelle en histogramme. Die veranderlikes is vergelyk deur of die Pearson chi-vierkant toets te doen vir verskille in verpleegkategorieë, of die Mann-Whitney U-toets vir verskille in jare ervaring. Die analise van die resultate het kennistekorte, teenstrydige kliniese praktyke en beperkte opleiding in post-operatiewe pynbestuur uitgewys. Die aanbevelings sluit opleidingskursusse, hersiening van pasiënte se waarnemingsgrafiek en die formulering van beleid en riglyne vir pynbestuur in. Toepaslike kennis en kliniese vaardighede van verpleegpersoneel is krities om optimale pynbestuur vir post-operatiewe ortopediese pasiënte te verseker.