ABSTRACT
Acute postoperative pain is a complex phenomenon that baffles the staff involved in both its prevention and treatment. Acute postoperative pain varies even among patients who underwent the same type of surgery, and it is now known to be caused by different factors, including genetic background. This review will focus on the most important genes correlated with inter-patient differences in both pain sensitivity and analgesic response. Pain therapy is often administered to patients who are also taking other types of medication; therefore, drug interactions must be considered. A genetic analysis of receptors, of drug transporters, and of metabolizing enzymes may be needed to establish the effective doses of each drug in the individual patient to prevent side effects and also to achieve pain relief in a shorter period of time, which may prevent acute pain from becoming chronic. The etiology of chronic pain has not been elucidated yet, but we know that genetic predisposition comes into play, together with other clinical factors. Clinical trials including genetic analysis could be extremely useful in optimizing the management of postoperative pain therapy.
Subject(s)
Pain, Postoperative/drug therapy , Pain, Postoperative/genetics , Pharmacogenetics , Acute Disease , Analgesics/pharmacokinetics , Analgesics/therapeutic use , Chronic Disease , Genetic Predisposition to Disease , Humans , Precision MedicineABSTRACT
The reviews of research, summarizing a great amount of studies in a manageable format, are invaluable tools for physicians, inundated with enormous amount of biomedical information. However, narrative reviews are often misleading because, mixing together opinions of authors and results of research, the relation between clinical recommendation and evidence is partial and based on a biased citation of primary studies. In contrast to narrative reviews, the systematic reviews assemble, critically appraise, and synthesize the results of primary studies addressing a specific topic. Additionally their authors use strategies for minimizing bias and random error. The science of systematic reviews is now supported by the Cochrane Collaboration, an international network established for "preparing, maintaining and disseminating systematic reviews of the effects of health care". The authors provide tools for searching, critically appraising and using in practice the systematic reviews, which use can help physicians to improve the transfer of research in clinical practice, a task obliged by limitation of financial resources to physicians of any health service.
Subject(s)
Evidence-Based Medicine , Bibliographies as Topic , Health Policy , Italy , Meta-Analysis as Topic , ResearchABSTRACT
This paper reports on the general features and findings of 11 studies conducted in Italy on appropriateness of hospital admission and days of stay using the Appropriateness Evaluation Protocol (AEP). Studies have been grouped for presentation in two categories. The first comprises six heterogeneous studies illustrating different ways of targeting the use of the AEP: two used it to assess appropriateness of admission in an emergency room setting, two measured appropriateness of days of stay in patients with AIDS and nosocomial infections and finally two others evaluated hospital days in a group of elderly patients and "before and after" the institution of a domiciliary nursing service, respectively. The second group comprises five more homogeneous utilization review studies aimed at assessing inappropriateness of admissions and days of stay in medical/surgical departments of large hospitals in northern Italy. Besides detecting a substantial amount of inappropriateness in admission (range = 25-38%) and days of stay (range = 28-49%) this latter group of studies suggests that delays in execution and reporting of laboratory investigations, unavailability of operating rooms and delays due to difficulties in transferring patients to long-term care facilities are the most common causes of inappropriate days of stay. Despite the differences in their objectives, design and methods of sampling, these studies indicate that an explicit, diagnosis-independent and standardized instrument such as the AEP can help to uncover a substantial amount of the potentially avoidable use of hospital resources in the Italian context.
