Bariatric surgeons' views on pre-operative factors associated with improved health-related quality of life following surgery.

Bariatric surgery is an effective treatment for severe obesity, affording significant improvements in weight loss and health-related quality of life. However, bariatric surgeons' views on whether certain pre-operative factors predict improvements in post-operative health-related quality of life, and if so, which ones, are largely unknown. This cross-sectional survey study examined the views of 58 bariatric surgeons from Australia and New Zealand. A total of 18 factors were selected for exploration based on their mention in the literature. Participants rated the extent to which they thought these pre-operative factors would improve post-operative health-related quality of life. Responses showed that bariatric surgeons held diverse perspectives and revealed a lack of consensus regarding "predictive" factors. Generally, respondents agreed that better than average health literacy, higher socioeconomic status, good physical and psychological health, and positive social support were predictors of improved health-related quality of life following surgery. However, poor eating behaviours, smoking, and the use of alcohol or other substances were deemed negative predictors. Interestingly, aside from higher socioeconomic status, good psychological health, and positive social support, none of the aforementioned views aligned with existing literature. This study offers an initial insight into bariatric surgeons' views on the influence of different pre-operative factors on post-operative health-related quality of life. The array of views identified suggests that there may be an opportunity for medical education, but the findings warrant caution due to the sample size. Replication with a larger survey may be useful, especially as predicted health-related quality of life outcomes could guide decisions regarding surgical (non)progression.

Waiting in Pain II: An Updated Analysis of the Multidisciplinary Staffing Levels and Clinical Activity in Australian Specialist Persistent Pain Services.

This study provides an update on multidisciplinary staffing and clinical activity in Australian specialist persistent pain services. Of the 109 services identified, 57 responded, met inclusion criteria and completed a study-specific questionnaire detailing service characteristics, staff resources, and clinical activities. Where possible, data were compared between the 'Waiting in Pain' (WIP) investigations (WIP-I: Dec'08-Jan'10, WIP-II: Jul'16-Feb'18). WIP-II found more pain services (Level 1 centres, rural services) and more full-time equivalent (FTE) staffing (overall, psychiatry, psychology, occupational therapy) than WIP-I. Although Level 1 centres employed more FTE staff (overall, medical) than Level 2 clinics, staffing was comparable when considered relative to clinical activity and this was stable over time for most disciplines. Clinical activity in metropolitan and rural services also remained stable, as did rural service staffing (type, FTE), suggesting that newer clinics replicated existing models. WIP-II highlighted greater diversity in group structures than WIP-I and an associated mean .02FTE allied health staff/patient seen (WIP-I = .03 FTE). Staffing (amounts, types) did not change significantly over time when considered relative to clinical activity, supporting the conclusion that these are workable clinical structures. However, changes in group format (duration, staffing) suggest a shift towards lower-intensity programmes that require less allied health staffing to deliver. PERSPECTIVE: This article presents updated data regarding multidisciplinary staffing profiles, clinical activity, and group programme structures within Australian specialist persistent pain services and examines changes since the original investigation. As the only published staffing profile for multidisciplinary pain services, this project provides critical information to inform service (re)design and care delivery.

Improving management of needle distress during the journey to dialysis through psychological education and training-the INJECT study feasibility pilot protocol.

BACKGROUND: Needle-related distress is a common yet poorly recognised and managed problem among haemodialysis (HD) patients. The aim of this pilot study is to test the feasibility and acceptability of the INJECT Intervention-an innovative psychology-based intervention to empower patients to self-manage needle distress with the support of dialysis nurses. METHODS: This investigator-initiated, single-arm, non-randomised feasibility study will take place in a large dialysis service in Adelaide, Australia. Participants will include patients aged ≥ 18 years, commencing or already receiving maintenance HD, recruited through dialysis physicians and nursing staff as individuals believed to be at risk of needle distress. They will be screened for inclusion using the Dialysis Fear of Injection Questionnaire (DFIQ) and enrolled into the study if the score is ≥ 2. The multi-pronged intervention encompasses (i) psychologist review, (ii) patient self-management program and (iii) nursing education program. The primary aim is to evaluate feasibility and acceptability of the intervention from patient and dialysis nurse perspectives, including recruitment, retention, engagement with the intervention and completion. Secondary exploratory outcomes will assess suitability of various tools for measuring needle distress, evaluate acceptability of the nursing education program and measure cannulation-related trauma and vascular access outcomes. CONCLUSION: The results will inform the protocol for larger trials addressing needle distress in HD patients. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000229875, approved 4 April 2021, https://www.anzctr.org.au/ .

Sleep disturbances and sleep disorders in adults living with chronic pain: a meta-analysis.

OBJECTIVES: Chronic pain, with or without an identified diagnosis or cause, is widespread and commonly associated with sleep disturbances. However, research has often used poor quality measures of sleep and focused on specific pain conditions, thereby limiting its reliability and applicability to the wider CP population. This study meta-analysed the findings from studies that used objective polysomnographic measures of sleep or examined diagnosed sleep disorders in people with CP. METHODS: Three databases were searched (PubMed, PsychINFO, Embase; inception to June 2017) for case-controlled polysomnography studies and studies that reported the prevalence of diagnosed sleep disorders in adults with CP. Hedge's g effect sizes and prevalence rates were calculated using the data from 37 studies. RESULTS: Polysomnographic measures of sleep onset latency and efficiency, time awake after sleep onset and awakenings were all significantly worse in those with CP when compared to healthy controls (large effects). Total sleep time, light sleep duration (NREM 1), number of stage-shifts, respiratory-related events and periodic limb-movements were also worse for those with CP, albeit to a lesser extent (small to medium effects). The pooled prevalence of sleep disorders in CP was 44%, with insomnia (72%), restless legs syndrome (32%) and obstructive sleep apnea (32%) being the most common diagnoses. CONCLUSIONS: Objective polysomnographic measures indicate that individuals with CP experience significant sleep disturbances, particularly with respect to sleep initiation and maintenance. Clinically diagnosed sleep disorders are also very prevalent. It is imperative that sleep disturbances and disorders be assessed and treated in conjunction with the CP.

Psychosocial aspects of spinal cord injury pain: a meta-analysis.

STUDY DESIGN: Meta-analysis. OBJECTIVES: Although the association between modifiable psychosocial factors and spinal cord injury (SCI) pain has been identified, the full range of psychological and social difficulties for those who experience acute and/or persistent pain remains unclear. This meta-analysis consolidates the available evidence, using the International Classification of Functioning, Disability and Health (ICF) as a reference framework. METHODS: Nineteen studies that examined persistent neuropathic, nociceptive or mixed pain subtypes in adults with a SCI (newly acquired and chronic; Nparticipants=2934) were identified from electronic database searches. Standardised mean differences between SCI pain and no-pain groups on self-reported psychosocial outcomes were calculated, along with 95% confidence intervals, fail-safe Ns and heterogeneity statistics. RESULTS: Twenty individual outcomes were grouped into nine ICF-related categories. Emotional functions were the most frequent (100%) psychosocial outcomes assessed, with pain contributing to heightened stress (d=-0.85), depression (d=-2.49) anxiety (d range=-0.85 to -1.45), poor self-efficacy (d=-0.77), lowered wellbeing (d range=-0.67 to -1.02) and decreased use of adaptive coping, such as illness acceptance (d=-0.85). Activity limitations and participation restriction were examined by seven studies (43%), although these findings were largely characterised by single studies. CONCLUSIONS: Multicomponent treatments that target mood disturbance and foster community connections are important in SCI pain management. However, to improve the comparability of future studies, SCI pain research must adopt definitions of pain consistent with the International Spinal Cord Injury Pain Classification along with validated outcomes that map onto the ICF framework.

Palliative care: an update on "terminal restlessness".

Terminal restlessness is a variant of delirium observed in some patients in their last days of life. Readily reversible causes of restlessness should be identified and treated. Benzodiazepines give effective palliation of this condition, and, unlike haloperidol and the phenothiazines, do not exacerbate the existing tendency to myoclonus and convulsions.

Terminal restlessness--its management and the role of midazolam.

OBJECTIVE: To describe the clinical picture of the syndrome of terminal restlessness in dying patients and the role and mode of administration of midazolam. SETTING: Hospice unit of a public hospital. DESIGN: Retrospective review of patient records and search of the literature for reports of the use of midazolam in palliative care from 1988 to 1990 and of the effects and side effects of drugs commonly used in the management of terminal restlessness. PATIENTS AND INTERVENTION: Eighty-six patients with terminal restlessness received midazolam to alleviate their symptoms. MAIN OUTCOME MEASURES: Improved relaxation in the patients, a reduction in family anxiety and reduced staff stress. RESULTS: Of the 86 patients with terminal restlessness, all but one obtained benefit. No apparent side effects or adverse reactions to the drug were observed. CONCLUSION: Midazolam given by the subcutaneous route can usually provide effective palliation of terminal restlessness when other measures are ineffective. The drug is also useful for providing short-term sedation for uncomfortable procedures and for managing catastrophic terminal events.

Counselling the elderly on nutrition in a community health care system.

A study was made of the effects of community nutrition services on 234 noninstitutional elderly aged 65 or older. Many of the problems were related to overweight and longstanding inappropriate food habits. The results indicated that counselling can stimulate an increased awareness of nutrition and improvement in the knowledge of nutrition and food selection. These elderly persons seemed to have a definite desire to achieve good health and were receptive to the nutritionist's recommendations. However, economic and physical limitations often influence their ability to adhere to the recommendations. In counselling the elderly, the nutritionist should be able to made a quick assessment of the elderly person's physical capabilities.