P-133 PROSPECTIVE INTERVENTIONAL STUDY OF THE ANALGESIC EFFICACY OF A CYCLOMESH™ PARIETAL REINFORCEMENT IMPLANT SOAKED IN ROPIVACAINE HYDROCHLORIDE 10MG/ML IN THE TREATMENT FOR UNCOMPLICATED INGUINAL HERNIA

Background

20–30% of patients operated for inguinal hernia will present early postoperative pain (EPP) which is, after the organizational causes, the first cause of conversion from ambulatory to traditional hospitalization. The objective of this study was to evaluate the interest of a parietal prosthesis (Cyclomesh ™) soaked with ropivacaine in the management of EPP.

Materials and Methods

This is a randomized, phase III, comparative superiority, double-blind, international multicentre study. From October 2019 to February 2022, 290 patients underwent surgery for inguinal hernia with placement of a ropivacaine or saline soaked parietal prosthesis. The primary endpoint was the H6 coughing pain assessment (EVA).

Results

The intention to treat population (ITTp) was composed of 150 patients in the ropivacaine group and 140 in the placebo group, for the per-protocol population (PPp) it was 125 and 115. The prosthesis type had no significant effect on H6 coughing pain, either for the ITTp (3.3 vs 3.2, p=0.12) or the PPp (3.3 vs 3.7, p=0.15). The ropivaciane soaked prosthesis resulted in a decrease in the overall pain at H2 (2.3 vs 3.2, p<0.0001), H4 (2.3 vs 3.1, p<0.0001) and H6 (2.3 vs 2.7, p=0.0039). Regarding painkillers consumption, postoperative complications and number of ambulatory conversions, there was no difference between the two groups.

Conclusion

The placement of a parietal prosthesis (Cyclomesh ™) soaked with ropivacaine did not reduce the H6 coughing pain but allowed a decrease in the overall pain over the first 6 hours after surgery and could simplify the management of patients.

The research gap in chronic paediatric pain: A systematic review of randomised controlled trials

BACKGROUND AND OBJECTIVE

Chronic pain is associated with significant functional and social impairment. The objective of this review was to assess the characteristics and quality of randomized controlled trials (RCTs) evaluating pain management interventions in children and adolescents with chronic pain.

METHODS

We performed a systematic search of PubMed, Embase and the Cochrane Library up to July 2017. We included RCTs that involved children and adolescents (3 months-18 years) and evaluated the use of pharmacological or non-pharmacological intervention(s) in the context of pain persisting or re-occurring for more than 3 months. Methodological quality was evaluated using the Cochrane Risk of Bias (ROB) Tool.

RESULTS

A total of 58 RCTs were identified and numbers steadily increased over time. The majority were conducted in single hospital institutions, with no information on study funding. Median sample size was 47.5 participants (Q1,Q3: 32, 70). Forty-five percent of RCTs included both adults and children and the median of the mean ages at inclusion was 12.9 years (Q1,Q3: 11, 15). Testing of non-pharmacological interventions was predominant and only 5 RCTs evaluated analgesics or co-analgesics. Abdominal pain, headache/migraine and musculoskeletal pain were the most common types of chronic pain among participants. Methodological quality was poor with 90% of RCTs presenting a high or unclear ROB.

CONCLUSIONS

Evaluation of analgesics targeting chronic pain relief in children and adolescents through RCTs is marginal. Infants and children with long-lasting painful conditions are insufficiently represented in RCTs. We discuss possible research constraints and challenges as well as methodologies to circumvent them.

SIGNIFICANCE

There is a substantial research gap regarding analgesic interventions for children and adolescents with chronic pain. Most clinical trials in the field focus on the evaluation of non-pharmacological interventions and are of low methodological quality. There is also a specific lack of trials involving infants and children and adolescents with long-lasting diseases.

A self-administered questionnaire to measure the painful symptoms of endometriosis: Results of a modified DELPHI survey of patients and physicians

PURPOSE

To develop a questionnaire based on patients' verbal descriptors, to measure the painful symptoms of endometriosis.

METHODS

We performed a two-round modified DELPHI procedure mixing endometriosis patients and physicians to select a set of statements to describe the painful symptoms of endometriosis. Each panelist rated each statement based on diagnosis validity and clarity. The clinicians were experts in endometriosis management selected from various geographic regions in France. Patients were women with surgically confirmed endometriosis who volunteered from a patient association and from the recruitment of the participating physicians. The first round questions were derived from words and phrases in narratives of pain by endometriosis patients.

RESULTS

Overall, 76 experts were invited, and of these 56 (74%), comprising 33 patients and 23 gynecologists, responded to the first round questionnaire, and 40 (71.4%) to the second round. Among the 48 statements assessed in the first-round questionnaire, 11 were selected after completion of the two round DELPHI procedure. After discussion and rewording of some items, a total of 21 questions were selected during a final face-to-face meeting. The content of the final questionnaire is organized according to four dimensions: (i) spontaneous pelvic pain and dysmenorrhea, (ii) dyspareunia, (iii) painful bowel symptoms, (iv) and other symptoms. We also provide an English (UK) version produced using several steps of translation and back-translation.

CONCLUSIONS

The questionnaire has content validity to measure the subjective experiences of patients with painful endometriosis and can provide a solid basis on which to develop an efficient patient-centered outcome to measure the painful symptoms in therapeutic or in diagnostic studies of endometriosis.

Methodology used in comparative studies assessing programmes of transition from paediatrics to adult care programmes: a systematic review

OBJECTIVE

To explore the methodologies employed in studies assessing transition of care interventions, with the aim of defining goals for the improvement of future studies.

DESIGN

Systematic review of comparative studies assessing transition to adult care interventions for young people with chronic conditions.

DATA SOURCES

MEDLINE, EMBASE, ClinicalTrial.gov.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

2 reviewers screened comparative studies with experimental and quasi-experimental designs, published or registered before July 2015. Eligible studies evaluate transition interventions at least in part after transfer to adult care of young people with chronic conditions with at least one outcome assessed quantitatively.

RESULTS

39 studies were reviewed, 26/39 (67%) published their final results and 13/39 (33%) were in progress. In 9 studies (9/39, 23%) comparisons were made between preintervention and postintervention in a single group. Randomised control groups were used in 9/39 (23%) studies. 2 (2/39, 5%) reported blinding strategies. Use of validated questionnaires was reported in 28% (11/39) of studies. In terms of reporting in published studies 15/26 (58%) did not report age at transfer, and 6/26 (23%) did not report the time of collection of each outcome.

CONCLUSIONS

Few evaluative studies exist and their level of methodological quality is variable. The complexity of interventions, multiplicity of outcomes, difficulty of blinding and the small groups of patients have consequences on concluding on the effectiveness of interventions. The evaluation of the transition interventions requires an appropriate and common methodology which will provide access to a better level of evidence. We identified areas for improvement in terms of randomisation, recruitment and external validity, blinding, measurement validity, standardised assessment and reporting. Improvements will increase our capacity to determine effective interventions for transition care.

[Consensus validation of a tool to identify inappropriate prescribing in pediatrics (POPI)]

OBJECTIVE

Medication errors including inappropriate prescriptions and drug omissions are one of the causes of adverse drug events in children. Our aim was to develop a preliminary screening tool to detect omissions and inappropriate prescriptions in pediatrics based on French and international guidelines.

MATERIEL AND METHODS

Disease classification was based on the prevalence rate of pathology and hospital statistics. The criteria were obtained by reviewing many French and international references. The Delphi consensus technique was used to establish the content validity of POPI. The level of agreement and the proposals of healthcare professionals was noted on a nine-point Likert scale.

RESULTS

The criteria were categorized according to the main physiological systems (gastroenterology, respiratory infections, pain, neurology, dermatology, and miscellaneous). They were distributed to 16 French pediatric panelists (eight pharmacists, eight pediatricians who were hospital-based [50%] or working in the community [50%]). After two rounds of the Delphi process, 101 of 108 criteria were chosen with strong consensus (76 inappropriate prescriptions and 25 omissions).

CONCLUSIONS

POPI is the first screening tool to detect inappropriate prescriptions and omissions in pediatrics. It is now necessary to conduct a prospective study to determine inter-rater reliability and the tool's detection capacity.

Development of a consensus-base list of criteria for prescribing medication in a pediatric population

BACKGROUND

Although many people are involved in the optimal use of a medication within this process, the use of medications carries risks of adverse events, which are greater in the pediatric population because of many factors.

OBJECTIVE

In this context, our aim was to develop a consensus-based list of criteria for the safety of the pediatric medication-use process or circuit (referred to from now on as the CIRCUS tool: CIRcuit-of-Child-drug-USe).

SETTING

Multicenter with a trio of experts from eight university hospitals.

METHODS

A literature search (1998-2013) was conducted in order to identify the different safety practice domains for the pediatric medication use process. Twenty-six safety practice domains were identified and 48 compliance criteria were formulated. In order to reach a consensus on the most relevant compliance criteria for safety practices, an international 24 French-speaking multidisciplinary panelists (8 doctors, 8 pharmacists and 8 nurses) selected to represent a broad range of experience levels and specialties took part in a two round Delphi survey which was conducted between March and July 2013. Each panelist was asked to rate each proposed criterion on a 1-9 Likert scale in order to show their level of agreement (i.e. 1 reflects strong disagreement and 9 reflects strong agreement).

MAIN OUTCOME MEASURE

Development of a consensus-base list for safety practices in pediatrics.

RESULTS

Twenty-two of the 24 professionals invited to take part in this survey (92% participation rate) completed the two Delphi rounds. At the end of the two Delphi rounds, a total of 38/48 (79%) safety practice compliance criteria achieved consensus by the panelists. The criteria were grouped into 23 domains.

CONCLUSION

This study presents the development of a self-assessment tool for safety practices in the pediatric drug-use process using a Delphi method. This tool may be used in order to record and compare the prevalence of best safety practices in the pediatric drug-use process.

Monitoring healthcare quality in an obstetrics and gynaecology department using a CUSUM chart

OBJECTIVE

To use cumulative sum (CUSUM) charts for the early detection of variations in quality of care in a maternity department.

DESIGN

Retrospective analysis of prospectively collected data.

SETTING

Maternity department of a teaching hospital in Paris (France).

POPULATION

Data from 20 519 women and 21 448 infants were collected between January 2000 and December 2007.

METHODS

CUSUM charts were used to monitor the rate of 19 pre-selected quality indicators over 3 years (2005-2007), against standards developed by department obstetrician gynaecologists. Periods with adverse event rates that did not meet the standards were identified.

MAIN OUTCOME MEASURES

Quality indicator rates.

RESULTS

Indicators fell into three groups based on the number of periods with unacceptable rates: less than one per year [e.g. the rate of intensive care unit (ICU) admission of mothers and rate of third- or fourth-degree perineal tears]; one every 2-12 months on average (e.g. blood transfusion and sulprostone use in the overall population of women); and at least one per month (insufficient availability of epidural analgesia).

CONCLUSION

CUSUM charts for a broad range of quality indicators can be used to monitor the quality of care in an obstetrics department. A prospective study investigating the ability of CUSUM-based monitoring to improve maternal and neonatal outcomes would be of interest.