ObjectiveTo systematically evaluate the measurement properties of observational pain assessment scales for pediatric patients after surgery. MethodsThe PubMed, Embase, CINAHL, PsycArticles, and SinoMed databases were electronically searched to collect studies related to the objects from inception to April 13, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. And the quality of measurement properties was rated using updated criteria for good measurement properties to determine recommendation levels. ResultsA total of 26 studies were finally included involving 12 observational pain assessment scales for pediatric patients after surgery. None reported measurement error or cross-cultural validity. The overall content validity of all 12 scales was evaluated by reviewers, with measurement properties rated as sufficient or inconsistent. For internal consistency, due to insufficient or uncertain content validity, the evidence quality was low. Eight scales calculated internal consistency, among which CHEOPS, CHIPPS, COMFORT, FLACC, and NCCPC-PV scales had sufficient measurement properties with evidence quality of low or above, receiving Grade A recommendations. ConclusionCompared with other scales, CHEOPS, CHIPPS, COMFORT, FLACC, and NCCPC-PV scales demonstrated good measurement property evaluation with acceptable evidence quality and can be recommended for use. Other scales still require further improvement in measurement property validation.
OBJECTIVE: To provide a better treatment method of lumbar stenosis and root pain resulting from simple hypertrophy of ligamentum flavum. METHODS: By studying the records of 143 lumbar pain cases, we found 5 cases caused by simple hypertrophy of ligamentum flavum. All the patients were old man with a long progressed history. There was little difference of clinical features between the disc herniation and hypertrophy of ligamentum flavum. All cases accepted resection of ligamentum flavum. RESULTS: All the symptoms were relieved postoperatively. The patients could walk. CONCLUSION: The degeneration of lumbar ligamentum flavum can cause lumbar stenosis and root pain. Resection of ligamentum flavum can relieve the symptom.
Objective To investigate the status quo of knowledge and attitude towards pain among medical staff in West China Hospital of Sichuan University. Methods The medical staff in Emergency Department of West China Hospital of Sichuan University were investigated by the Chinese version of Knowledge and Attitudes Survey Regarding Pain (2008) questionnaire, the contents of which related to pain assessment, pain related knowledge, analgesic related knowledge, and comprehensive application, etc. And the questionnaire scores were compared among medical workers with different background. Results A total of 156 questionnaires were sent out and 130 valid ones were taken back, with an effective recovery rate of 83.3%. There was no statistically significant difference in questionnaire scores among the medical workers with different education background or different professional titles (P>0.05). The questionnaire scores were significantly different among nurses with different seniority (F=3.785, P=0.035), and the mean score of the nurses with more than 10 years of seniority was the highest (22.78±7.11). The questionnaire scores were significantly different among nurses working in different areas (F=3.043, P=0.033), and the mean score of the nurses working in rescue room was the highest (24.53±7.84).The erroneous items were concentrated on item 5, 17, 19. In the answers to the open questions, 97.7% (127/130) thought that the existing pain knowledge could not satisfy the needs of clinical work; 100.0% (130/130) believed that it was necessary to study pain related knowledge; 80.0% (104/130) acquired pain related knowledge from clinical experience, 40.0% (52/130) from books, 15.4% (20/130) from the network; 90% ( 117/130) commonly used numeric rating scale to evaluate the patients’ pain degree, 20.0% (26/130) evaluated the patients’ pain degree through facial expressions. Conclusions The overall level of pain management knowledge and attitude in medical staff in Emergency Department is low. The continuing education on pain knowledge should be strengthened, the attitude towards pain treatment and the importance of pain management should be paid more attention, and the standardized training and supervision should be enhanced.
ObjectiveTo systematically review the efficacy and safety of extracorporeal shock wave therapy (ESWT) in the treatment of rotator cuff tendinopathy to provide evidence for clinical practice. MethodsDatabases including CENTRAL, MEDLINE, EMbase, CINAHL plus, PEDro, CNKI, CBM, WanFang Data, and VIP were searched to collect randomized controlled trials (RCTs) of ESWT in the treatment of rotator cuff tendinopathy from inception to January 11th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. ResultsA total of 12 RCTs from 11 articles were included, including 529 subjects (273 in the case group and 256 in the control group). Meta-analysis showed that no significant difference between ESWT and placebo in pain improvement (SMD=−1.08, 95% CI −2.45 to 0.29, P=0.12), superior pain improvement in ESWT group than electroacupuncture group (SMD=−7.15, 95%CI −8.50 to −5.80, P<0.000 01), and no significant difference in pain improvement between ESWT as adjuvant therapy and acupuncture alone (SMD=−4.32, 95%CI −11.93 to 3.29, P=0.27). Regarding the Constant–Murley score (CMS) for shoulder joint function, ESWT was associated with an improved CMS compared with placebo (SMD=1.31, 95%CI 0.08 to 2.53, P=0.04). There was no significant difference in the improvement in the CMS between ESWT and other treatments (SMD=0.13, 95%CI −2.07 to 2.53, P=0.91). There was no significant difference in the improvement in the CMS between ESWT as adjuvant therapy and acupuncture alone (SMD=1.68, 95%CI −0.69 to 4.05, P=0.16). ConclusionsESWT may improve shoulder joint function in patients with rotator cuff tendinopathy, and the alleviation of pain in patients with rotator cuff tendinopathy requires further investigation. Due to the limited quality and quantity of included studies, the above conclusions requires further investigation by more high-quality studies.
ObjectiveTo explore the effect of rehabilitation training focusing on early exercise on the time of first getting out of bed after surgery, pain during early activities, postoperative infection rate and the length of hospital stay for renal transplant recipients.MethodsThe clinical data of patients undergoing allogeneic renal transplantation in West China Hospital of Sichuan University from June to August 2020 were analyzed retrospectively. According to the time of multidisciplinary postoperative management and the time of early rehabilitation intervention, the patients were divided into the conventional group (from June 2020 to the beginning of multidisciplinary postoperative management) and the rehabilitation group (after multidisciplinary postoperative management). The time to get out of bed for the first time after surgery, the Visual Analogue Score (VAS) during weight monitoring on the second day post operation, the number of days required to complete an independent walk of 100 meters, postoperative complications, the incidence of postoperative infection and the length of hospital stay were compared between the two groups.ResultsA total of 79 patients were included. There were 46 cases in the conventional group and 33 cases in the rehabilitation group. Among the included patients, 14 patients had postoperative infection, 1 patients in the conventional group developed thrombosis, no catheter shedding or bleeding after exercise occurred. The differences between the rehabilitation group and the conventional group in the time to get out of bed for the first time after surgery [(1.1±0.2) vs. (2.2±0.4) d; t=13.224, P<0.001], the VAS during weight monitoring on the day post operation (2.5±0.9 vs. 3.4±1.4; t=3.267, P<0.001), the number of days required to complete an independent walk of 100 meters [(2.2±0.4) vs. (4.0±0.8) d; t=11.312, P<0.001], and the incidence of postoperative infection (6.1% vs. 26.1%; χ2=5.285, P=0.022) were statistically significant. There was no significant difference in the length of stay between the rehabilitation group and the conventional group [(19.8±5.8) vs. (20.7±7.4) d; t=0.584, P=0.561].ConclusionEarly postoperative rehabilitation training reduces the time required for renal transplant recipients to get out of bed for the first time post operation and to walk 100 meters independently, reduce the pain response during early activities, and reduce the incidence of postoperative infection.
目的 调查胃肠道疾病患者围手术期的疼痛状况，为建立无痛病房，优化医疗和护理服务提供依据。 方法 对2011年12月5日－2012年1月14日胃肠外科所有的新住院患者共227例，采用《四川大学华西医院住院病人疼痛现状调查问卷》进行调查，并同期调查胃肠外科27名主管医师对疼痛药物了解状况。 结果 有明确行为能力的216例患者完成调查问卷，其中有195例（90.28%）接受手术治疗，全身麻醉患者193例（占手术患者98.97%），诊断为胃肠道肿瘤163例（占手术人数的83.59%），手术等级为三级146例（占手术人数的74.87%）。有168例（86.15%）患者术后镇痛，在术后镇痛过程中使用镇痛泵156例（92.86%），其中75例（48.08%）认为镇痛泵镇痛“基本有效”，30例（19.23%）认为“无效”。39例术后未使用镇痛泵，其中20例（51.28%）认为“未使用术后镇痛泵”最主要原因为“不了解镇痛泵”。受调查的主管医师了解的疼痛药物仅占罗列药物52种的（20 ± 5.36）种。 结论 疼痛现象在胃肠道疾病围手术期患者中属普遍现象，由于不断增强镇痛意识和镇痛需求与相关知识缺乏的矛盾存在，及较少的医疗护理干预，导致镇痛效果不佳，影响了疼痛管理长效机制的建立和无痛病房的建设。
Nevus flammeus is a skin disease caused by congenital skin capillary malformation. In recent years, photodynamic therapy (PDT) has been proved to be effective and safe for this disease, but significant pain in the treatment process is the biggest obstacle to the implementation of this therapy. This article reviews the current pain management strategies in PDT. The current pain management methods include topical anesthesia, cold air analgesia, nerve block and others. Topical anesthesia has weak analgesic effect and short duration in PDT. Cold air analgesia is simple and feasible, but there is potential risk of affecting the treatment effect. The analgesic effect of nerve block is accurate, but the application scenario is limited. For nevus flammeus patients who need PDT, individualized analgesia should be selected according to the patient’s age and treatment scenario.