Objectives: Pain after surgery has a major impact on acute and long-term recovery and quality of life, but its management is often insufficient. To enhance the quality of research and to allow for better comparability between studies, it is important to harmonize outcomes for assessing the efficacy and effectiveness of pain management interventions after surgery. As a first step in developing a core outcome set, this study aimed to systematically search for outcome domains assessed in research regarding acute pain management after sternotomy as an example of a typically painful surgical procedure.
Methods: A systematic literature review was performed using MEDLINE, Embase, and CENTRAL. Eligibility criteria consisted of randomized controlled trials and observational trials targeting pain management after sternotomy in adults in the acute postoperative setting (≤2 weeks). After duplicate removal and title and abstract screening by 2 independent reviewers, study characteristics and outcome domains were identified, which were extracted from full texts and summarized qualitatively.
Results: Of 1350 studies retrieved by database searching, 156 studies were included for full-text extraction. A total of 80 different outcome domains were identified: pain intensity, analgesic consumption, physiological function, and adverse events were the most frequent ones. Outcome domains were often not explicitly reported, and the combination of domains and assessment tools was heterogeneous. The choice of outcomes is commonly made within clinicians; patients' perspectives are not considered.
Conclusions: The wide variety of commonly applied outcome domains, the nonexplicit wording, and the heterogeneous combination of the domains indicating treatment benefit demonstrate the need for harmonization of outcomes assessing perioperative pain management after surgery.
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http://dx.doi.org/10.1016/j.jval.2021.01.016 | DOI Listing |
Rev Col Bras Cir
January 2025
- Universidade de São Paulo, Anestesiologia - São Paulo - SP - Brasil.
We discuss the arguments exposed in the Letter to the Editor "Reflections on the Inclusion of Direct-Care Physicians as Educators in Community Hospitals", exploring the teaching competencies necessary for community preceptors in the context of medical education, highlighting the growing responsibility of these professionals in the training of future physicians in health-deprived regions. From a narrative review, we analyze faculty development (FD) programs, emphasizing their importance in improving teaching skills, creating support networks, and providing personalized content for specific challenges. Among the competence domains identified are teaching skills, evaluation criteria, professionalism, communication, and leadership/management.
View Article and Find Full Text PDFJ Acquir Immune Defic Syndr
November 2024
Department of Health Policy & Management, University of North Carolina, Chapel Hill, NC, USA.
Background: Consistent evidence shows stigma impedes healthcare access in people living with HIV (PLWH) and men who have sex with men (MSM). We evaluated the impact of a stigma reduction training for providers whose design was informed by direct observation of their clinical behaviors obtained through visits by incognito standardized patient (SP).
Setting: We conducted this study in in sexually transmitted infection clinics in Guangzhou, China.
PLoS One
January 2025
Deptartment of Psychology, Faculty of Behavioural and Social Sciences, University of Amsterdam, Amsterdam, Netherlands.
Aging inevitably gives rise to many challenges and transitions that can greatly impact our (mental) well-being and quality of life if these are not controlled adequately. Hence, the key to successful aging may not be the absence of these stressors, but the ability to demonstrate resilience against them. The current study set out to explore how resilience and successful aging may intersect by investigating how various resilience capacity-promoting (protective) and resilience capacity-reducing (risk) factors relate to mental well-being and quality of life.
View Article and Find Full Text PDFJMIR Ment Health
December 2024
Innovation Horizons, Inc., 2819 27th Street, NW, Washington, DC, US.
Background: Access to accurate medical diagnosis has been hindered by socioeconomic disparities, limited availability of specialized medical professionals, and lack of patient education, among other factors. Inequities in access to high-quality healthcare services exacerbate these challenges, often leading to disparities in health outcomes. Missed or inaccurate diagnoses can lead to delayed or unnecessary treatments, risking worsening of the condition.
View Article and Find Full Text PDFJAMA Psychiatry
January 2025
Harvard Medical School, Boston, Massachusetts.
Importance: In the 2020 Bostock v Clayton County decision, the US Supreme Court extended employment nondiscrimination protection to sexual minority adults. The health impacts of this ruling and similar policies related to sexual orientation-based discrimination are not currently known.
Objective: To estimate changes in mental health following the Bostock decision among sexual minority adults in states that gained employment nondiscrimination protection (intervention states) compared with those in states with protections already in place (control states).
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