Structured pain management reduces patient discomfort after catheter ablation and rhythm device surgery

An intervention study of a combined intervention of positioning and hand massage in patients undergoing radiofrequency catheter ablation

AIM

To identify the effectiveness of a combined intervention of 25° upper body elevation and hand massage in patients undergoing radiofrequency catheter ablation.

DESIGN

A quasi-experimental study using a non-equivalent control group pre-test-post-test design.

METHODS

A total of 46 participants were assigned to an intervention group (N = 21) and a control group (N = 25). To test the effectiveness of the combined intervention, the major variables were low back pain and discomfort, including physical, psychological and environmental factors.

RESULTS

The control group had low back pain, and the physical, psychological and environmental discomfort scores increased over time, whereas the experimental group showed low back pain, and the physical, psychological and environmental discomfort scores were statistically significantly decreased. The combined intervention can be applied in clinical practice not only in patients who have undergone radiofrequency catheter ablation but also in those who require an immobile position due to puncture of a femoral blood vessel.

Pain Management Program in Cardiology: A Template for Application of Normalization Process Theory and Social Marketing to Implement a Change in Practice Quality Improvement

Quality improvement plays a major role in healthcare, and numerous approaches have been developed to implement changes. However, the reasons for success or failure of the methods applied often remains obscure. Normalization process theory, recently developed in sociology, provides a flexible framework upon which to construct quality improvement. We sought to determine if examination of a successful quality improvement project, using normalization process theory and social marketing, provided insight into implementation. We performed a retrospective analysis of the steps taken to implement a pain management program in an electrophysiology clinic. We mapped these steps, and the corresponding social marketing tools used, to elements of normalization process theory. The combination of mapping implementation steps and marketing approaches to the theory provided insight into the quality-improvement process. Specifically, examination of the steps in the context of normalization process theory highlighted barriers to implementation at individual, group, and organizational levels. Importantly, the mapping also highlighted how facilitators were able to overcome the barriers with marketing techniques. Furthermore, integration with social marketing revealed how promotion of tangibility of benefits aided communication and how process co-creation between stakeholders enhanced value. Our implementation of a pain-management program was successful in a challenging environment composed of several stakeholder groups with entrenched initial positions. Therefore, we propose that the behavior change elements of normalization process theory combined with social marketing provide a flexible framework to initiate quality improvement.

[Pain management in departments of internal medicine : Results of a national survey on structures and processes of care]

Hintergrund und Ziel der Arbeit

Seit Jahren werden Defizite der Qualität der Schmerztherapie im Krankenhaus beschrieben. Ziel der vorliegenden Untersuchung war es, Strukturen und Prozesse des Schmerzmanagements in internistischen Abteilungen darzustellen.

Material und Methoden

Die Datenerfassung erfolgte mittels eines standardisierten Telefoninterviews (nichtuniversitäre Abteilungen); bei universitären Abteilungen separat mittels eines Onlinefragebogens (SurveyMonkey®).

Ergebnisse

Daten von 139 nichtuniversitären Abteilungen (Rücklauf: 21 %) und 33 universitären Abteilungen (davon 21 vollständig beantwortete Fragebögen, Rücklauf 17 % bzw. 11 %) wurden erhoben. 441 von 619 kontaktierten nichtuniversitären Abteilungen lehnten die Teilnahme ausdrücklich ab, am häufigsten mit der Begründung, es bestünde kein Interesse am Thema Schmerzmanagement. In den 172 teilnehmenden Einrichtungen wurde Schmerz als eigenständiger Parameter in 89 % der nichtuniversitären Abteilungen (96 % universitär) regelmäßig während der Visite erfasst; schriftliche Behandlungsstandards zur Schmerztherapie lagen in 57 % der nichtuniversitären Abteilungen vor (54 % universitär). In 76 % der nichtuniversitären Krankenhäuser (100 % universitär) stand auch für die internistischen Patienten ein Akutschmerzdienst zur Mitbehandlung zur Verfügung, schriftliche Vereinbarungen zur Zusammenarbeit lagen bei 35 % vor (18 % universitär).

Diskussion

Die berichtete Umsetzung des Schmerzmanagements war in den teilnehmenden Abteilungen gut. Gleichwohl sind die Ergebnisse bei niedriger Teilnahme und häufiger Ablehnung mit der Begründung einer fehlenden Relevanz nur eingeschränkt aussagekräftig. Die erfassten Daten reflektieren daher vermutlich eine erhebliche positive Selektion und sind nicht als repräsentativ für das Schmerzmanagement in der inneren Medizin zu werten.

Pain During "Noncomplex" Electrophysiological Studies and Cardiac Rhythm Device Surgery

BACKGROUND

There are only limited data about peri-interventional pain during cardiac electrophysiological procedures without analgosedation. In this study, peri-interventional pain and recollection of it after the intervention were evaluated.

METHODS

A total of 101 patients (43 electrophysiological/ablation procedures and 58 device surgeries) reported pain on a numerical rating scale (NRS; 0-10) before (pre), during (peri), and after (post) the intervention. Maximum pain (maxNRS) and the average of pain (meanNRS) were used for statistical analysis. Peri-interventional pain was compared with postinterventional data of the recollection of peri-interventional pain (peri-post). Patients were allocated into 2 groups (with 51 and 50 patients, respectively) to evaluate the mode of patient-staff interaction on pain recollection. Depressive, anxiety, and somatic symptom scales (Patient Health Questionnaire-15, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-15) were used to analyze their influence on pain recollection.

RESULTS

In total, 49.6% of patients (n = 50) complained of moderate to severe pain (maxNRS) at least once during the procedure. The comparison between peri and peri-post data revealed the following (median (range)-maxNRS, peri: 3 (0-10) versus peri-post: 4 (0-9) (ns), and meanNRS, peri: 1.4 (0-7) versus peri-post: 2.0 (0-6) (ns). The mode of patient-staff interaction had no influence on pain. No effect was found for psychosocial factor concerning pain and the recollection of pain. The results of the linear regression showed no influence of low-dose midazolam on recollection of pain.

CONCLUSION

Half of the patients reported moderate to severe pain at least once during cardiac electrophysiological procedures without analgosedation. However, on average, patients reported only low pain levels. Postinterventional derived data on discomfort reflect the peri-interventional situation.