Severity and duration of pain after colonoscopy and gastroscopy: a cohort study.

AIMS AND OBJECTIVES: This study aimed to determine the prevalence, severity, location and duration of pain post-colonoscopy, and to explore possible associations between pain, demographic variables and diagnostic findings. The study also sought to provide information to guide decision-making on CO2 insufflation. BACKGROUND: Colonoscopy with sedation is a common day surgery procedure in Australia. Attendance for colonoscopy is influenced by patient expectations, particularly about pain. Research on post-colonoscopy pain has focussed on pain experienced immediately post-procedure, with few studies investigating pain beyond 24 hours. DESIGN: Follow-up study using patient-completed Pain Numerical Rating Scales. METHODS: Patients undergoing colonoscopy at a single hospital day surgery unit were invited to complete Pain Numerical Rating Scales (where 0 = no pain and 10 = worst possible pain) three times daily for three days post-colonoscopy. RESULTS: Among the 277 participants, 124 (45%) reported pain at any time during follow-up. Twenty-one (8%) participants experienced pain on each of the three days. Pain was most commonly experienced in the hypogastric and iliac regions. The severity of pain was low, with only 33 participants self-administering analgesics (paracetamol or nonsteroidal anti-inflammatory drugs) during follow-up. Participants who had both colonoscopy and gastroscopy were not more likely to report pain overall. However, they were more likely to report pain on days 2 and 3 and were also more likely to take analgesics. Pain was not associated with procedure duration, abdominal pressurisation, removal of polyps, diverticulitis, inflammatory bowel disease or the presence of benign or malignant lesions. CONCLUSIONS: This research indicates that fewer than half of the patients undergoing colonoscopy will experience post-procedure pain and that just over one in ten patients will require analgesics. Patients undergoing both gastroscopy and colonoscopy are more likely to experience pain for longer and require over-the-counter analgesics. The low prevalence of pain suggests that room air insufflation is an acceptable alternative to more expensive CO2 . RELEVANCE TO CLINICAL PRACTICE: The findings provide evidence for nurses and clinicians to advise patients about the likelihood of experiencing pain post-colonoscopy, and the characteristics of this pain. Nurses may reassure patients that pain is not more likely among patients diagnosed with colorectal disease or malignancy. Patients who have persistent pain for longer than 24 hours post-colonoscopy should be advised to seek medical care to investigate the cause of their pain.

The Cradle Coast personally controlled electronic health record evaluation research.

In 2010 the Federal Government announced funding over two years to create a Personally Controlled Electronic Health Record (PCEHR) for Australians. One of the wave 2 implementation sites is the Cradle Coast in Tasmania. A PCEHR Program Benefits and Evaluation Partner (BEP) has been appointed to undertake evaluation activities with the e-health lead implementation sites. In addition to this implementation a comprehensive research plan has been developed and commenced through the Rural Clinical School at the University of Tasmania. The overarching aim of the research agenda is to evaluate the outcomes of various elements of the 4C project as it evolves and is implemented, from multiple perspectives. The research agenda is important as it expands upon the NEHTA mandated evaluation and provides an holistic overview of the PCEHR implementation process and outcomes for clinicians, patients and family members. This paper will detail the planned evaluation and its progress to date.

Monitoring neuropeptides in vivo via microdialysis and mass spectrometry.

Neuropeptides are important signaling molecules that regulate many essential physiological processes. Microdialysis offers a way to sample neuropeptides in vivo. When combined with liquid chromatography-mass spectrometry detection, many known and unknown neuropeptides can be identified from a live organism. This chapter describes sample preparation techniques and general strategies for the mass spectral analysis of neuropeptides collected via microdialysis sampling. Methods for the in vitro microdialysis of a neuropeptide standard as well as the in vivo microdialysis sampling of neuropeptides from a live crab are described.

Combining microdialysis, NanoLC-MS, and MALDI-TOF/TOF to detect neuropeptides secreted in the crab, Cancer borealis.

Microdialysis is a useful technique for sampling neuropeptides in vivo, and decapod crustaceans are important model organisms for studying how these peptides regulate physiological processes. However, to date, no microdialysis procedure has been reported for sampling neuropeptides from crustaceans. Here we report the first application of microdialysis to sample neuropeptides from the hemolymph of the crab, Cancer borealis. Microdialysis probes were implanted into the pericardial region of live crabs, and the resulting dialysates were desalted, concentrated, and analyzed by LC-ESI-QTOF and MALDI-TOF/TOF mass spectrometry. Analysis of in vitro microdialysates of hemolymph revealed more neuropeptides and fewer protein fragments than hemolymph prepared by typical analysis methods. Mass spectra of in vivo dialysates displayed neuropeptides from 10 peptide families, including the RFamide, allatostatin, and orcokinin families. In addition, GAHKNYLRFa, SDRNFLRFa, and TNRNFLRFa were sequenced from hemolymph dialysates. The detection of these neuropeptides in the hemolymph suggests that they are functioning as hormones as well as neuromodulators. In vivo microdialysis offers the capability to further study these and other neuropeptides in crustacean hemolymph, complementing current tissue-based studies and extending our knowledge of hormonal regulation of physiological states.