Interventions to reduce arterial puncture-related pain: A systematic review and meta-analysis.

BACKGROUND: Arterial puncture-related pain remains unaddressed across several clinical settings. Analgesic techniques are not routinely employed before arterial puncture despite the recommendation that local anesthesia be used, except in emergencies. A comprehensive review of interventions aimed at reducing arterial puncture-related pain and their potential effectiveness is lacking, and the benefit of some interventions is uncertain. OBJECTIVE: To describe interventions aimed at reducing arterial puncture-related pain and provide an estimate of their effectiveness. DESIGN: Systematic review and meta-analysis (PROSPERO no. CRD42020212299). DATA SOURCE(S): PubMed, CINAHL EBSCO, EMBASE, the Cochrane Database of Systematic Reviews, and Scopus were searched from their inception to 7 October 2020. No temporal or language limits were applied. METHODS: Published, quantitative studies on interventions aimed at reducing arterial puncture-related pain among adults were included. Screening, quality appraisal, and data extraction were undertaken independently by two reviewers. Random effects meta-analyses were performed to assess the association between interventions aimed at reducing arterial puncture-related pain and patients' perceived pain using difference in means (MD) with 95% confidence intervals (CIs). A funnel plot and Egger test were used to assess publication bias. RESULTS: The titles and abstracts of the 2446 identified articles were screened, and 43 and 31 studies were finally included in the systematic review and meta-analysis, respectively. Interventions to reduce arterial puncture-related pain included: topical anesthetics (n = 16), cryotherapy (n = 9), local anesthetic infiltration (n = 5), narrower needle gage (n = 5), ultrasound-guided procedure (n = 3), topical anesthetics combined with local anesthetic infiltration (n = 1), iontophoresis using anesthetics (n = 1), engineered blood gas syringe (n = 1), jet injector (n = 1), and local massage (n = 1). Topical anesthetics [MD -0.58, 95% CI -1.00, -0.15], cryotherapy [MD -1.13, 95% CI -1.72, -0.53], and local anesthetic infiltration [MD -1.13, 95% CI -1.72, -0.53] reduced arterial puncture-related pain. No benefit was found for narrower needle gage [MD -0.07, 95% CI -0.86, 0.71] or ultrasound-guided procedure [MD -1.74, 95% CI -3.51, 0.03]. No publication bias was detected. CONCLUSIONS: Local anesthetic infiltration provided the greatest pain reduction and should be considered standard practice. Cryotherapy may be a safe, convenient alternative to local anesthetic infiltration. Topical anesthetics had limited benefit, and their lengthy time of onset makes them unsuitable for critical or emergency situations, though they may represent an option when comorbid conditions make cooling impossible. Caution must be used when interpreting these results, given the high risk of bias in the methods of included studies and the heterogeneity across the studies.

From Measurement to Improvement in Ontario's Cancer System: Analyzing the Performance of 28 Provincial Indicators over 15 Years.

Over the past 15 years, Cancer Care Ontario has used a robust performance management approach to drive improvements in care. Each year, priority indicators and targets are selected or retained, and performance is reviewed quarterly with each of Ontario's Regional Cancer Programs. Improvement support and encouragement are provided, such as data analysis, program ranking, communities of practice, consultations, action plan requests and certificates. This article analyzes data on 28 indicators prioritized over these years and demonstrates that 25 have shown sustained improvement over time. The performance management approach, lessons learned and gaps in knowledge are described to inform future research and practice.

Evaluation of mobile apps for treatment of patients at risk of developing gestational diabetes.

This study evaluates mobile apps using a theory-based evaluation framework to discover their applicability for patients at risk of gestational diabetes. This study assessed how well the existing mobile apps on the market meet the information and tracking needs of patients with gestational diabetes and evaluated the feasibility of how to integrate these apps into patient care. A search was conducted in the Apple iTunes and Google Play store for mobile apps that contained keywords related to the following concepts of nutrition: diet, tracking, diabetes, and pregnancy. Evaluation criteria were developed to assess the mobile apps on five dimensions. Overall, the apps scored well on education and information functions and scored poorly on engagement functions. There are few apps that provide comprehensive evidence-based educational content, tracking tools, and integration with electronic health records. This study demonstrates the need to develop apps that have comprehensive content, tracking tools, and ability to bidirectionally share data.