Pain assessment and management for people with dementia in the community.

People with dementia commonly experience pain, but it is often unrecognised, unrelieved and remains an underlying issue as the condition progresses. As a result, pain management for people with dementia is inadequate. Community nurses have a fundamental role in the assessment and management of pain and in supporting family carers. This article details the causes and effects of pain in people with dementia, explains the components of a holistic approach to individualised pain assessment, and describes various pharmacological and non-pharmacological interventions that can be used to manage pain in this population.

General dental practice and improved oral health: is there a win-win for both the professional establishment and government?

General dental practice in the United Kingdom has been in a state of unrest for over two decades, with practitioners having been confronted by two contract changes. The latest contract change of 2006 resulted in much disquiet, and services continue to be piloted in order to develop a contract that satisfies the needs of both government and the profession. Within this context, this paper explores the issues surrounding the present situation. To date, the profession has expanded service provision into the private market which has resulted in an exaggerated inverse care provision. This could be perceived as a move towards a retail philosophy and away from healthcare. In order to restore an equitable balance of care provision, the authors present possible solutions that could satisfy both parties.

Long term impact of powered toothbrush on oral health.

Data sources The Study of Health in Pomerania (SHIP).Data extraction and synthesis Data were taken from SHIP1 to SHIP3 over an 11 year period. Mixed-effects linear regression models were constructed between the exposure (manual versus powered toothbrush) and outcome variables (probing depths [PD], clinical attachment loss [CAL], caries status DMFS and DFS, tooth loss) adjusting for potential baseline covariates.Results Power toothbrush usage was found to be significantly associated with reduced mean PD and CAL progression scores, for example after 11 years the entire sample showed MTB users to have 0.41 mm PD mean progression while PTB users had 0.09 mm mean PD progression. This demonstrates PTB users having 0.32 mm less PD progression. Similar trends were shown for CAL mean scores.Conclusions There are benefits of power toothbrush usage and long term protective effects on oral health in terms of reduced probing depths, clinical attachments and number of teeth lost.

Role of the nurse in the assessment and management of post-operative pain.

While post-operative pain is a common and unavoidable consequence of surgery, evidence suggests that the levels of pain experienced by patients are unnecessarily high. In the past two decades, evidence has also indicated that nurses' knowledge of the assessment and effective management of pain is suboptimal. This article considers the elements required for an effective post-operative pain assessment, as well as examining the barriers that result in many patients' post-operative pain not being assessed. The article also provides an overview of the main pain management interventions available to nurses.

A Delphi study to identify healthcare users' priorities for cancer care in Greece.

User involvement is widely promoted within the European healthcare sector as an effective means of developing patient-centred health services. In addition, user involvement is recommended as an important aspect of developing effective cancer services. Despite the acknowledged benefits of user involvement, this concept has not been fully endorsed in Greece. Greek healthcare users may be increasingly involved in the decisions made for their health, but their involvement in cancer services planning remains very limited. The aim of this study was to identify healthcare users' key areas of cancer care and services that needed to be developed or improved in Greece and prioritise them through a consensus building study. A Delphi technique was used to collect data from a sample of 30 healthcare users in two rounds. The response rate for each round was over 80%. The main consensual issues prioritised by the healthcare users were the improvement of education for health professionals and the development of effective treatments. Other areas that were also rated highly included the organisation of cancer services, the need for more resources and improvements in the attitude of healthcare professionals. Healthcare users' priorities were focused on timely diagnosis and treatment by well-educated healthcare professionals, demonstrating a strong will for survival. Based on the findings from this study and the literature recommendations, it is expected that the re-organisation and fair distribution of the existing resources could improve the experience of healthcare users. In addition, the number of employed nurses should increase and improvements in healthcare professionals' education should be implemented in order to develop and improve cancer services. Public health education needs to be emphasised and prioritised especially in areas such as prevention and screening. The Greek government needs to address and encourage user involvement in planning healthcare services with the introduction of relevant legislation.

Healthcare providers' priorities for cancer care: A Delphi study in Greece.

Cancer is a major problem globally and effective cancer care services are needed to lessen its burden on the community. In Greece, oncology health services provision is not located efficiently, resulting in few patients receiving high-quality care. Furthermore, shortages of health professionals and underdeveloped services such as primary care, home care and palliative care have aggravated the problem. The absence of a national cancer registry means that the extent of cancer incidence cannot be evaluated effectively. Dissatisfaction with the Greek NHS is well established, despite the reforms proposed by consecutive Greek governments. It remains that limited research exists in the area of cancer services and cancer care. The aim of this study was to identify the key areas of cancer care and services that needed to be developed or improved in Greece and their prioritisation within the Greek healthcare system. A Delphi technique was used to collect data from a sample of 30 healthcare providers, in three rounds. The response rate for each round was over 77%. The priorities for healthcare providers were focused on staff shortages, working conditions, pain management, home care, day units and communication. Based on the priorities provided by the participants and supporting literature, it is suggested that a national cancer registry, the employment of nurses to develop primary care, home care, day care and palliative care services need to be established. Furthermore, education in communication skills and the redistribution of the bio-medical technology are needed in order to provide more effective cancer services in Greece. More research is needed to validate the actual level of cancer services provided in Greece.

Profiles of pain after day surgery: patients' experiences of three different operation types.

AIM: The aim of this paper is to examine the pain profile of three types of day surgery operation and undertake a comparative analysis of the intensity and duration of pain over a consecutive 4-day period. BACKGROUND: Although studies on pain after day surgery have figured prominently, evidence is limited as to what intensity and duration of pain should be regarded as unacceptable, and how it varies for different operation types. METHODS: A prospective postal survey (n = 785) was undertaken during a 12-month period in 1998/1999 involving three day surgery units in three different areas in England and Wales and based on three commonly performed operation types: hernia repair, varicose vein surgery and laparoscopic sterilization. A visual analogue scale was used to measure the intensity of pain experienced over a 4-day consecutive time period. Analysis of variance was used to explore statistically significant differences between levels of pain for the operation types. RESULTS: On the day of surgery and even on the third postoperative day, high levels of severe pain (>50 mm on a Visual Analogue Scale) were experienced. Pain levels differed across different operation types. On the day of surgery, more patients undergoing laparoscopic sterilization experienced severe pain. By the third postoperative day, more of those who had been operated on for hernia repair, followed by varicose vein surgery and laparoscopic sterilization, continued to experience severe pain. CONCLUSION: A large number of patients experienced severe levels of pain after day surgery. This could have resulted from a lack of knowledge about the assessment and management of pain, in which nurses play an important role. This study has highlighted that different pain trajectories are associated with different operation types, and this has important implications for the preoperative and postoperative preparation of day surgery patients as well as the role of nurses in the overall success of the day surgery process.

Impact of tele-advice on community nurses' knowledge of venous leg ulcer care.

AIM: This paper reports a study assessing the impact of the provision of expert tele-advice to community nurses in enhancing their knowledge of leg ulcer care. BACKGROUND: Community nurses have traditionally been responsible for the care of patients with leg ulcers. However, access to expert medical and nursing advice has been restricted to the local hospital environment. The introduction of e-health and telemedicine have created opportunities to provide online and immediate access to wound care expertise from centres of excellence to primary health care staff in managing patients' wounds in their own home. METHOD: A stratified randomized controlled trial was used to examine community nurses' knowledge before and after the provision of expert tele-advice. A knowledge measurement tool comprised of 40 multiple-choice questions was adopted, with correct responses identified by a panel of wound care experts. The questions covered the three themes of dressings, management and physiology, with different levels of difficulty categorized as easy, medium or difficult. The tool was administered before and after the intervention (12 weeks) to both the experimental and control groups. RESULTS: Statistically significant improvements were observed only for the experimental group in the areas of dressings and management, as well as in the medium level questions. No statistically significant improvement was seen for the easy questions, as there was little room for improvement because of preintervention high scores. For the difficult questions, it was thought that more time would be needed for a more positive outcome. CONCLUSIONS: The results suggest that tele-advice can be of great benefit to community nurses in enhancing their knowledge in the practice of leg ulcer care. This will have significant implications for more efficient use of human resources and cost effectiveness in wound care.

Postoperative pain assessment tools in day surgery: literature review.

BACKGROUND: Postoperative pain is an expected phenomenon. However, its passage beyond acceptable limits is a common and costly experience. This is particularly the case in day surgery, partly because of the increasing demand to reduce waiting lists for elective surgery, and partly because of lack of knowledge about patients' experiences of postoperative pain and relevant published research. The latter is mainly concerned with different interpretations of the phenomenon of pain that appear to have led to a variety of often inappropriate pain measurement tools. AIM: This paper critically reviews some of the available objective and subjective measures of pain and establishes the suitability of a Visual Analogue Scale (VAS) for measuring the intensity of pain after day surgery. METHOD: Nursing and health care papers published since 1983 were sought using the keywords: postoperative pain, day surgery, ambulatory surgery, rating scales, VAS, severity, assessment, tool, nursing, validity, sensitivity, reliability and their various combinations. The databases used were Medline, CINAHL, Nursing Collection, Embase, Healthstar, BMJ and several on-line Internet journals, specifically Ambulatory Surgery. The search included only papers published in the English language. FINDINGS: A range of interpretations of pain have led to the development of various measurement tools that address different components of pain. This inconsistency has led to ineffective pain management. Based on established criteria, the VAS was found to be methodologically sound, conceptually simple, easy to administer and unobtrusive to the respondent. On these grounds, the VAS seems to be most suitable for measuring intensity of pain after day surgery. CONCLUSIONS: Common guidelines on the definition and measurement of pain are needed. In day surgery, the availability of a unified and reliable measure of pain that can address its sensory component, such as the VAS, will provide more reliable information about the pain experience and, hence, improve its overall management.

Reported pain after day surgery: a critical literature review.

BACKGROUND: Despite technological advancements in anaesthesia and analgesia, reported pain levels after day surgery remains high. Whilst it is unrealistic to expect no pain, the level that constitutes 'acceptable' pain remains unclear because of inconsistencies in reporting. These inconsistencies have resulted from different interpretations of what pain is and the use of different measurement tools. AIM: The aim of this paper is to report a study investigating any disparity in reported levels of pain following day surgery, within different specialties and in relation to specific operative procedures. METHOD: Nursing and health care papers published since 1983 were sought using the keywords: postoperative pain, postoperative complications, pain after day surgery, day surgery, ambulatory surgery, nursing, operation types, operative procedures, surgical procedures, descriptors of pain, pain intensity, verbal descriptor scale, numerical rating scale, visual analogue scale, validity, reliability, design, sample size, data collection methods and their various combinations. Databases searched were Medline, CINAHL, Nursing Collection, Embase, Healthstar, BMJ and several on-line Internet journals, specifically Ambulatory Surgery. The search was restricted to publications in the English language. Findings. Twenty-four papers were identified. Inconsistencies in the reported intensity of pain are highlighted, in relation to different operative procedures and specialties. Data in the papers are based on different descriptors, measurement tools and data collection methods. In many cases, sample size, and validity and reliability can also be questioned. CONCLUSIONS: There is a disparity in reported levels of pain after day surgery. It is important that a unified day surgery pain measurement strategy is established, so that patients can be informed about the intensity of pain that they are likely to experience following specific procedures.