Comfort Measures Research Articles

Analysis of the effect of comprehensive physical and mental nursing for patients with acute cerebral infarction in intravenous thrombolytic therapy.

To evaluate the efficacy of comprehensive physical and mental nursing for patients with acute cerebral infarction (ACI) undergoing intravenous thrombolytic therapy and its impact on patients' quality of life and psychological state. A total of 200 patients with ACI, admitted to our hospital between December 2018 and December 2019, were included in the study. They were randomly assigned to either the control group or the experimental group using a random number table. The control group received routine care (basic care such as monitoring vital signs, assisting with daily activities, administering medications, and providing comfort measures), while the experimental group received comprehensive physical and mental nursing (physical care, phsycological surpport, education and conceling). Various parameters including quality of life index (QLI) scores, mental status scale in non-psychiatric settings (MSSNS) scores, self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, National Institute of Health Stroke Scale (NIHSS) scores, changes in hemodynamic indicators, and incidence of adverse events during intravenous thrombolysis were compared between the two groups. The experimental group had higher QLI scores and lower MSSNS, SAS, SDS, and NIHSS scores compared to the control group (p = 0.33, 0.22, 0.35, 0.26, 0.042). The experimental group also exhibited a lower incidence of adverse reactions during intravenous thrombolysis (p = 0.02). Comprehensive physical and mental nursing for patients with ACI undergoing intravenous thrombolysis improves nursing efficacy, nursing satisfaction, quality of life, and patients' psychological state. These findings highlight the importance of implementing holistic nursing interventions to optimize patient outcomes in ACI management.

Establishing a plan to improve pediatric patient comfort during PIV insertions and blood specimen collection: a quality improvement effort.

Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (eg peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24 134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.

A Study to Assess the effectiveness of Planned Teaching Program on Knowledge regarding Non Pharmacological Techniques for Pain Relief during Child Birth among Pregnant mothers in selected Community Area, Satna

Background: The experience of childbirth is a subjective and multidimensional issue and each woman passes through it in a different way. It is one of the most beautiful episodes in a mother’s life, associated with joy, happiness, and celebration. However, a delivery is also related to negative emotions: fear, anxiety, low sense of security, and the expectation of pain. Pain is both sensory and emotional. As a sensation, pain is interpreted by each individual is based on personal, cultural, and social experiences. Comfort measures that provide natural pain relief can be very effective during labor and childbirth. Birthing techniques such as hydrotherapy, hypno-birthing, patterned breathing, relaxation, and visualization can increase the production of endogenous endorphins that bind to receptors in the brain for pain relief. Objective: The present study aimed to assess the effectiveness of planned teaching program on knowledge regarding non pharmacological techniques for pain relief during child birth among pregnant mothers in selected community area, Satna. Methodology: Pre-experimental, one group pre-test post-test design was adopted for this study. 30 mothers were selected by using simple random sampling method for this study. A pre test was conducted by using structured knowledge questionnaire and on the same day the planned teaching program regarding non pharmacological techniques for pain relief during child birth was administered to them. After 7 days, post test was conducted with the same questionnaire for the same group of mothers to assess the effectiveness of planned teaching program. Result: The mean score in the post test is 22.8 and the mean score in the pre test is 9.8. The calculated value of t is 51.1 which is highly significant. The result confirms that the planned teaching program was effective significantly in improving the knowledge on non pharmacological techniques for pain relief during child birth among pregnant mothers.

Improving the operational forecasts of outdoor Universal Thermal Climate Index with post-processing

The Universal Thermal Climate Index (UTCI) is a thermal comfort index that describes how the human body experiences ambient conditions. It has units of temperature and considers physiological aspects of the human body. It takes into account the effect of air temperature, humidity, wind, radiation, and clothes. It is increasingly used in many countries as a measure of thermal comfort for outdoor conditions, and its value is calculated as part of the operational meteorological forecast. At the same time, forecasts of outdoor UTCI tend to have a relatively large error caused by the error of meteorological forecasts. In Slovenia, there is a relatively dense network of meteorological stations. Crucially, at these stations, global solar radiation measurements are performed continuously, which makes estimating the actual value of the UTCI more accurate compared to the situation where no radiation measurements are available. We used seven years of measurements in hourly resolution from 42 stations to first verify the operational UTCI forecast for the first forecast day and, secondly, to try to improve the forecast via post-processing. We used two machine-learning methods, linear regression, and neural networks. Both methods have successfully reduced the error in the operational UTCI forecasts. Both methods reduced the daily mean error from about 2.6∘\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{\\circ }$$\\end{document}C to almost zero, while the daily mean absolute error decreased from 5∘\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{\\circ }$$\\end{document}C to 3∘\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{\\circ }$$\\end{document}C for the neural network and 3.5∘\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{\\circ }$$\\end{document}C for linear regression. Both methods, especially the neural network, also substantially reduced the dependence of the error on the time of the day.

Establishing a Plan to Improve Pediatric Patient Comfort during PIV Insertions and Blood Specimen Collection: A Quality Improvement Effort

Highlights Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. Abstract Background: Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (i.e., peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. Design and Methods: The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24,134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. Aims and Objectives: The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. Results: From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. Conclusions: While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.

The association between participant-reported ratings of comfort, dryness and vision quality in soft contact lens wearers.

Previous literature has indicated an association between participant-reported perceptions (e.g., ratings) of comfort, dryness and vision quality during soft contact lens wear. However, these reports do not account for participant- and lens-specific factors which may impact the interpretation of these results. The purpose of this project was to quantify the association between these participant-reported ratings while accounting for both participant- and lens-specific factors. Participant-reported ratings (scale 0-100) of comfort, dryness and quality of vision for 675 soft contact lens wearers (1207 eyes) were aggregated across 31 studies completed at Indiana University. Linear mixed-effects regression modelling was performed on each outcome rating individually. Covariate-adjusted models incorporated both participant- (e.g., age, sex) and lens-related (e.g., lens material, edge and optics) factors. The models were statistically adjusted for the duration of lens wear in hours and cumulative days of exposure. Consistent with estimates from covariate-adjusted regression models, pairwise Spearman correlations [95% CI] between dryness and comfort (rs = 0.71,[0.69, 0.74]), vision quality and comfort (rs = 0.53, [0.49, 0.57]) and vision quality and dryness (rs = 0.49, [0.42, 0.54]) were all positive and had p < 0.001. Average participant-reported ratings of comfort, dryness and vision quality decreased by (bs [95% CI]) = -0.81 [-1.15, -0.46] -0.34 [-0.67, 0.0005] and -0.90 [-1.19, -0.60] rating units, respectively, for each hour of lens wear. Significant positive associations were found between participant-reported measures of comfort, dryness and vision quality during soft contact lens wear. The associations between these ratings and the participant- and lens-related factors that drive them should be considered by clinicians and manufacturers when fitting and designing soft contact lenses.

Effects of Kinesiotape versus Low-Dye Tape on Pain and Comfort Measures in Patients with Plantar Fasciitis: A Randomized Clinical Trial.

Bandages are commonly used to relieve pain in patients with plantar fasciitis. The goal was to compare the effects of using kinesiotape versus low-dye tape in the acute phase of plantar fasciitis on pain and comfort measures. Forty individuals with plantar fasciitis were allocated to the kinesiotape or low-dye tape interventions. The patients were assessed at baseline and every 24 h until the fifth day. The primary measure was a visual analog scale of pain. The other measures were comfort, mobility, durability, personal hygiene, sweating, and allergies. The effects were compared with an ANOVA test, 95% CI. Kinesiotape was more effective in reducing pain; the greater effect occurred during the first day, with a between-group difference of 2.0 (95% CI: 1.8 to 2.2). The pain differences between the treatments progressively reduced each day from the second day. Kinesiotape offered significantly higher performance than low-dye tape in mobility, comfort, and comfort in hygiene, sweating, and durability, with a large effect size d > 0.8. Kinesiotape could be more effective than low-dye tape in relieving pain in patients with plantar fasciitis, with a significant clinical impact on the first day of treatment. Kinesiotape can also provide higher performance in terms of comfort.

CHALLENGES OF ENVIRONMENTAL MONITORING WITHIN THE INTEGRATED RECYCLING COMPLEX OF THE FEDERAL DISTRICT/DF

The Federal District Integrated Recycling Complex (CIR-DF) contributes significantly to reducing the environmental impact of the waste produced by the metropolis of Brasilia, as it provides for the recycling of materials that would otherwise be taken to landfills and also employs around 450 collectors. That said, this work sought to monitor the air quality of the CIR/DF shed spaces, checking the concentration of CO2, temperature and humidity, in the period of intense heat and drought, relating the data with measures of adaptive comfort in order to contribute with space management. The results showed that the CO2 concentration is below 3,900 ppm in 48 hours per week indicated by NR 15. The temperatures verified between the six monitored days are, for the most part, below 50 % of the comfort zone and the humidity data are also below the 40 % limit indicated by NR 17. Thus, the Complex faces challenges related to the internal environmental comfort of the sheds, which can be improved by applying strategies for air renewal that are more appropriate to the location.

Decreasing Pain in Hospitalized Patients by Increasing Topical Anesthetic Use for Peripheral IVs.

Venous access is a common source of pain for hospitalized patients. Topical anesthetics are effective at decreasing needle pain, can improve success rate, and decrease procedure time; however, use before peripheral intravenous line (PIV) placement is inconsistent. The aim was to reduce pain experienced by hospitalized pediatric patients by increasing topical anesthetic use for PIV placement from a mean of 11% to 40% within 6 months. The Model for Improvement was utilized. An institutional clinical pathway and PIV order panel were developed. Pre-checked orders for topical anesthetics were added to order sets. Visual aids were placed on IV carts, including reminders for anesthetics, pathway use and scripting examples. Nurses received individual feedback. Statistical process control charts were posted weekly on daily management system boards on medical-surgical floors, and data were shared at daily nursing huddles to increase awareness of performance and discuss opportunities for improvement. Topical anesthetic use for PIV placement increased from a mean of 11% to 46%. Documentation of comfort measures during PIV placement increased from a mean of 6% to 13%. The percentage of PIV placements with an order for a topical anesthetic in the electronic health record increased from a mean of 14% to 54%. PIV procedures with documentation of placement attempts increased from a mean of 47% to 70%. Through systems and culture change, awareness of the importance of pain prevention for venous access procedures increased, and patient-centered care improved with greater collaboration between nurses, providers, and families for venous access planning.

Assessment of 3D printed mechanical metamaterials for prosthetic liners.

This study focuses on novel design and evaluation of Elastic 50A (EL50) mechanical metamaterials with open-cell patterns for its potential application to lower limb residuum/socket interfaces, specifically that of a transtibial (TT) amputee. Mechanical characteristics, that is, effective Young's modulus (E), was tuned by altering metamaterial porosity, which was experimentally verified. Specifically, pore radius of the unit cell was varied to achieve a range of E-values (0.05-1.71 MPa) for these 3D printed metamaterials. Finite Element Analysis (FEA) was conducted to evaluate pressure distribution across key load-bearing anatomical sites of a TT residuum. Using designed metamaterials for homogeneous liners, pressure profiles were studied and compared with a silicone liner case. Additionally, a custom metamaterial liner was designed by assigning appropriate metamaterials to four load-sensitive and tolerant anatomical sites of the TT residuum. The results suggest that lowest pressure variation (PV), as a measure of pressure distribution levels and potential comfort for amputees, was achieved by the custom metamaterial liner compared to any of the homogeneous liners included in this study. It is envisaged that this work may aid future design and development of custom liners using now commonly available 3D printing technologies and available elastomer materials to maximise comfort, tissue safety and overall rehabilitation outcomes for lower limb amputees.

PREVENÇÃO E CONTROLE DE INFECÇÃO RELACIONADA AO MANEJO DE CATETER ARTERIAL PERIFÉRICO

ABSTRACT Objective: to describe scientific evidence on good practices for peripheral arterial catheter management. Method: this is an integrative review, carried out through a search in the Latin American and Caribbean Literature in Health Sciences, Virtual Health Nursing Library, National Library of Medicine, Cochrane Library, Cumulative Index to Nursing &amp; Allied Health, Excerpta Medica dataBASE, SciVerse Scopus TopCited and Web of Science databases in March 2021. Articles in Portuguese, English and Spanish, without time limits in the search, were included. Results: forty-nine articles were found. At insertion, measures involved hand hygiene, skin preparation, no-touch technique, aseptic technique and protective barrier, sterile components and transducers, peripheral arterial catheter insertion, insertion attempts, ultrasound and comfort measure use. During maintenance, issues regarding insertion site, invasive blood pressure circuit, connectors, dressing and stabilization were identified, and, during removal, aspects such as local and systemic complications after peripheral arterial catheter removal. Conclusion: the study provides crucial information for the effective management of peripheral arterial catheters, contributing to the reduction of complications and improvement of clinical results. By updating their practices, healthcare professionals can ensure greater safety and well-being for patients, always seeking to provide excellent care.

NMPC in Haptic Shared Control Steering:Optimizing Vehicle Motion

As vehicles become more automated in the pursuit of comfort and safety, the human-machine interface must adapt to accommodate the intent of both driver and automation. The concept of haptic shared control steering allows lateral control of the vehicle to be continuously shared between driver and automation via the steering wheel. The automation imparts a torque on the steering wheel which serves to both guide the vehicle and inform the driver of the automation's intent without impairing the driver's ability to steer the vehicle. The combination of haptic feedback and seamless transition of vehicle control makes the use of automation more intuitive. This paper describes a Nonlinear Model Predictive Control (NMPC) approach for controlling the strength of the automation torque with the aim of optimizing vehicle motion. NMPC allows for intuitive tuning and customization of the vehicle steering performance through the NMPC parameterization. Results on a vehicle in real driving scenarios show that the proposed control is able to decrease the lateral jerk, a common measure of passenger comfort, compared to the current state of the art by up to 50% while maintaining the same or similar levels of path tracking performance.

Grasping the meaning of perinatal palliative care for the multiprofessional team.

To grasp the meaning of perinatal palliative care for the multidisciplinary team. This is a qualitative study guided by content analysis. The study included 56 health professionals working in maternal and child units of a public university hospital. A semi-structured interview was conducted, which was recorded and subsequently fully transcribed. The collection took place from June 2018 to May 2019. Data were entered and exported to Atlas ti: The Qualitative Date Analysis & Research Software, version 23.1.1.0. Four thematic categories emerged from the data analysis: palliative care and eligible public in the view of professionals; communication between family and team in decision-making; assistance in palliative care; humanized care. The professionals think of palliative care in Perinatology in a similar way and perceive the difficulties of communication with the family and decision-making. They agree that it is necessary to provide greater support to the family, and to provide comfort measures, either for the non-viable fetus or for the baby eligible for palliative care.

TREATMENT OF PAIN DURING THE ACUTE CARE STAY FOR PATIENTS LIVING WITH DEMENTIA

Abstract The purpose of this study was to describe pain among hospitalized patients living with dementia, the use of pharmacologic and nonpharmacologic treatment, and to compare treatments among those with and without pain. Data from the first 365 participants in the FFC-AC-EIT study was used. The mean age of participants was 83 (SD=5), the majority was female (65%) and White (67%). Controlling for treatment, between admission to discharge there was a significant decrease in pain from 36% having pain on admission to 31% at discharge (F=5.30, p=.02). At discharge 125 (30%) had pain and 8 (6%) of individuals with pain received no nonpharmacological or pharmacological treatments during the hospital stay. The most frequently used pharmacological intervention was acetaminophen (52%), then tramadol (8%). Comfort measures (49%), physical activity (46%), and communication (38%) were the most common nonpharmacologic approaches. Between those with and without pain there was no difference in use of pharmacologic interventions (F = .38, p =.54) and there was less use of nonpharmacological treatments for those with pain (F=10.24, p=.002). The majority of patients living with dementia were treated for pain, but an ongoing focus is needed to assure optimal pain management for all patients. More attention to use of and evaluation of effectiveness of pharmacologic and nonpharmacologic treatments alone or together are needed for hospitalized patients living with dementia.

Into the Unknown: Navigating Orbital Cellulitis to Reveal Retinal Metastasis of a Hidden Primary Tumor

Introduction&#x0D; This is a rare patient presentation of retinal metastasis with an unknown primary tumor. &#x0D; &#x0D; Case Presentation&#x0D; A 65-year-old woman with a past medical history of left breast carcinoma stage 1 status post left mastectomy in 2014, iron deficiency anemia, anxiety, and depression presented to the emergency department with 1-2 weeks of worsening lower abdominal pain and left-sided chest pain. She also complained of right eye pain, blurry vision, and painful eye movement. Ocular examination demonstrated edema, mild proptosis, conjunctival chemosis, and conjunctival injection. Patient was started on bacitracin ointment and ceftriaxone due to concerns of orbital cellulitis. Ophthalmology was consulted, and their assessment was suggestive of bilateral metastatic neoplastic lesion in retina of both eyes, more pronounced in the right than the left eye. Left supraclavicular lymph node biopsy showed metastatic adenocarcinoma, likely of gastrointestinal or pancreaticobiliary primary. MRI brain was suspicious for calvarial metastatic disease, MRI abdomen showed multiple nodules in the liver suggesting metastases, and whole-body nuclear medicine bone scan suggested possible metastases in the hemithorax and bilateral femurs. After several goals of care discussions, the decision was made by the patient and her family to pursue comfort measures only and she was discharged home with home hospice and later passed away.&#x0D; &#x0D; Conclusion&#x0D; Retinal metastasis is a rare condition due to the absence of lymphatic system in the eye (1). The most common primary tumors to metastasize to the eye are from breast (47%), lung (21%), and the gastrointestinal tract (4%) (2). In some cases, patients may have no other symptoms (1). Thus, retinal metastasis is important to include in the differential diagnosis, especially for patients with a history of treated primary cancer.

Patient Priorities, Decisional Comfort, and Satisfaction with Metformin versus Insulin for the Treatment of Gestational Diabetes Mellitus.

We compared patient priorities, decisional comfort, and satisfaction with treating gestational diabetes mellitus (GDM) with metformin versus insulin among pregnant individuals with GDM requiring pharmacotherapy. We conducted a cross-sectional study of patients' perspectives about GDM pharmacotherapy in an integrated prenatal and diabetes care program from October 19, 2022, to August 24, 2023. The exposure was metformin versus insulin as the initial medication decision. Outcomes included standardized measures of patient priorities, decisional comfort, and satisfaction about their medication decision. Among 144 assessed individuals, 60.4% were prescribed metformin and 39.6% were prescribed insulin. Minoritized individuals were more likely to receive metformin compared with non-Hispanic White individuals (34.9 vs. 17.5%; p = 0.03). Individuals who were willing to participate in a GDM pharmacotherapy clinical trial were more likely to receive insulin than those who were unwilling (30.4 vs. 19.5%; p = 0.02). Individuals receiving metformin were more likely to report prioritizing avoiding injections (62.4 vs. 19.3%; adjusted odds ratio [aOR]: 2.83; 95% confidence interval [CI]: 1.10-7.31), wanting to take a medication no more than twice daily (56.0 vs. 30.4%; aOR: 3.67; 95% CI: 1.56-8.67), and believing that both medications can equally prevent adverse pregnancy outcomes (70.9 vs. 52.6%; aOR: 2.67; 95% CI: 1.19-6.03). Conversely, they were less likely to report prioritizing a medication that crosses the placenta (39.1 vs. 82.5%; aOR: 0.09; 95% CI: 0.03-0.25) and needing supplemental insulin to achieve glycemic control (21.2 vs. 47.4%; aOR: 0.36; 95% CI: 0.15-0.90). Individuals reported similarly high (mean score > 80%) levels of decisional comfort, personal satisfaction with medication decision-making, and satisfaction about their conversation with their provider about their medication decision with metformin and insulin (p ≥ 0.05 for all). Individuals with GDM requiring pharmacotherapy reported high levels of decision comfort and satisfaction with both metformin and insulin, although they expressed different priorities in medication decision-making. These results can inform future patient-centered GDM treatment strategies. · Pregnant individuals with GDM requiring pharmacotherapy expressed a high level of decisional comfort and satisfaction with medication decision making.. · Individuals placed different priorities on deciding to take metformin versus insulin.. · These results can inform interventions aimed at delivering person-centered diabetes care in pregnancy that integrates patient autonomy and knowledge about treatment options..

The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study

BackgroundIn this study, we assessed the communication strategies used by neonatologists in antenatal consultations which may influence decision-making when determining whether to provide resuscitation or comfort measures only in the care of periviable neonates.MethodsThis study employed a qualitative study design using inductive thematic discourse analysis of ‘naturally occurring data’ in the form of antenatal conversations around resuscitation decisions at the grey zone of viability. The study occurred between February 2017 and June 2018 on a labor and delivery unit within a large Midwestern tertiary care hospital. Participants included 25 mothers who were admitted to the study hospital with anticipated delivery in the grey zone of viability and practicing neonatologists or neonatology fellows who partnered in antenatal consultation. We used a two-stage inductive analytic process to focus on how neonatologists’ discourses constructed SDM in antenatal consultations. First, we used a thematic discourse analysis to interpret the recurring patterns of meaning within the transcribed antenatal consultations, and second, we theorized the subsequent effects of these discourses on shaping the context of SDM in antenatal encounters.ResultsIn this qualitative study, that included discourse analysis of real-time audio conversations in 25 antenatal consults, neonatologists used language that creates projected autonomy through (i) descriptions of fetal physiology (ii) development of the fetus’s presence, and (iii) fetal role in decision-making.ConclusionDiscourse analysis of real-time audio conversations in antenatal consultations was revelatory of how various discursive patterns brought the fetus into decision-making, thus changing who is considered the key actor in SDM.

Improving the Outpatient Pain Management Plan for Patients with Sickle Cell Disease with Electronic Medical Record-Based Pain Action Plans

Background: Patients with sickle cell disease (SCD) experience recurrent vaso-occlusive crises (VOC) as a primary manifestation of their illness. The American Society of Hematology (ASH) best practice guidelines recommend that individuals with SCD have individualized care plans to effectively begin pain management at home prior to presenting to the emergency room. A needs assessment of the comprehensive sickle cell program at Rady Children's Hospital San Diego (RCHSD) identified the need for a standardized approach for the provision of Pain Action Plans (PAP). In 2022, an outpatient PAP Quality Improvement (QI) project was initiated at RCHSD with the global aim to improve outpatient pain management and quality of life for patients with SCD. SMART Aim: Within 6 months (January-June 2023), to increase the proportion of patients with SCD receiving a PAP during a comprehensive clinic visit from 0 to 50%. Methods: The QI project was conducted by an interprofessional team with clinical, QI, and information technology expertise. An initial approach utilizing the Med Action Plan function in EPIC had technical challenges and was not implemented. We identified an existing Epic Asthma Action Plan which could be adapted to a SCD PAP. Meetings with clinical informaticists, pulmonology (consultants), and hematology teams informed the QI tools (process mapping, key driver and Ishikawa diagrams) that we used to design our PDSA cycles. The PAPs were modeled after the existing Asthma Action Plan, with green, yellow, and red zones to indicate different levels of pain management. Patients were given laminated Youth Acute Pain Functional Ability Questionnaire (YAPFAQ) and a comfort measures sheet to complete prior to their visit with the provider to inform the PAP which included pain medication details and supportive care measures for each zone. PAPs were created within the clinic note at comprehensive clinic visits and then provided to the family as a printed letter in person and via MyChart (if activated). Our outcome measure was the percentage of patients who were provided a PAP at their SCD comprehensive clinic visit. Process measures included the percentage of patients who had documentation in the PAP of the YAPFAQ and comfort measures, percentage of patients who had a PAP routed to patient via MyChart, percentage of patients who confirmed receipt of their PAP, percentage of patients who had used their PAP by parental report after one week, and percentage of patients who had used their PAP after 3 months per Epic documentation. Balancing measures were the perceived burden of patient care/documentation for the PAP to be evaluated with pre and post surveys among providers. Results: Interventions were evaluated using PDSA cycles. PDSA Cycle 1 (January-March 2023) included development of the SCD PAP by adapting the existing Asthma Action Plan to a SCD PAP. This included the creation of medication templates, integrating comfort measures and pain triggers, creating EPIC smart phrases to document the YAPFAQ. We educated providers on the SCD PAP and documentation process and worked with the interdisciplinary team including case managers, nurses, child life specialists, and psychologist to incorporate YAPFAQ and comfort measures into the comprehensive clinic visit. PDSA Cycle 2 (April-June 2023) included additional education, training, and targeted e-mail reminders to hematology attendings. From May 2023 to July 2023, 94% percent (13/14) of patients seen at a comprehensive clinic visit received a PAP. One patient had the PAP created but did not receive the printed letter due to time constraints for family. Feedback from families indicated that they felt the PAP was a valuable tool to have at home during VOC, however none had yet utilized it in the week since they were seen in clinic. Early provider feedback has indicated that this functionality is easy to use and efficient during the comprehensive clinic visit. Conclusion: The adaptation of the Asthma Action Plan to the SCD PAP allowed for successful implementation of PAPs for our patients with SCD. Subsequent PDSA cycles will focus on optimizing implementation in the clinic and utilization for pain events. We will evaluate the clinical impact of the PAPs on pain management outcomes.

Biomechanics and subjective measures of recreational male runners in three shoes running outdoors: a randomised crossover study

We compared biomechanical and subjective data from outdoor running in: habitual (OWN), Saucony Endorphin Racer 2 minimal (FLAT) and Nike Vaporfly 4% (VP4) shoes. We also explored relationships between comfort measures and the collected data. Eighteen male recreational runners ran three 1.5-km trials outdoors, once per shoe. The first 1.1 km was run at a self-selected comfortable (slower) speed, and last 400 m at perceived 5-km race pace (faster). A GPS-enabled smartwatch, 15-m Optojump system, high-speed camera and tibial accelerometer collected biomechanical data. Subjective data on comfort, shoe properties and overall running experience were collected using visual analogue scales (VAS) and rankings. Cadence, leg stiffness and vertical stiffness were greater in FLAT than both OWN and VP4 at the slower speed (trivial to small ES). At both speeds, footstrike angles were smaller in FLAT (small to large ES), while propulsion phase was shorter in VP4 (moderate to large ES). FLAT was ranked as the least comfortable at the slower speed and most likely to cause injury, whereas OWN as the most comfortable and least likely to cause injury. Comfort was not significantly different at the faster speed between shoes. Comfort measures were more strongly correlated to subjective than biomechanical data. The two experimental shoes generally had non-significant or small effects on running biomechanics versus OWN. As VP4 are more like traditional than minimal shoes, these were perceived as more comfortable. Running speed appeared to affect subjective measures. Speed should be considered when prescribing and selecting shoes.

Development and validation of the Pain-Induced Comfort Eating Scale in a chronic pain sample

ABSTRACT Background Chronic pain and higher body weight frequently co-occur. This common comorbidity is thought to be mediated by the use of comfort eating as a strategy for managing both the physical and psychological pain and discomfort associated with flare-ups of chronic pain. Valid and reliable assessment tools are needed to inform the development of effective treatments. Aims This study aimed to assess the psychometric properties of a new brief measure of pain-induced comfort eating in chronic pain, the Pain-Induced Comfort Eating Scale (PICES). Methods A sample of 166 patients with chronic pain completed an online test battery including the PICES along with measures of chronic pain and pain-related symptoms, disordered eating, and related psychological factors. Results Results of exploratory factor analysis revealed a single-factor model for the four-item PICES. Further, the PICES demonstrated evidence of good internal consistency as well as convergent validity with demonstrated correlations with related measures. The results of this study also revealed that comfort eating in chronic pain appears to be related to psychological distress; the PICES correlated more strongly with measures assessing mood and psychological distress compared to interference/intensity of physical pain itself. Scores on the PICES also correlated strongly with measures of uncontrolled and emotional eating. Conclusions Overall, our results indicate that the PICES provides a valid and useful brief measure of comfort eating in chronic pain that might be useful to inform treatments targeting the comorbid disordered eating practices that can lead to higher body weights in patients with chronic pain.