Brit J Hosp Med
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Review Meta Analysis
Can perioperative psychological interventions reduce chronic pain after surgery?
Chronic post-surgical pain is a relatively common adverse effect following surgery. Several prognostic factors for chronic post-surgical pain have been identified, including psychological states and traits. Psychological factors are modifiable, and perioperative psychological interventions may reduce the incidence of chronic post-surgical pain. ⋯ In addition, demonstration of cost-effectiveness may be a prerequisite for wider adoption of perioperative psychological interventions in regular healthcare. Offering psychological interventions selectively to patients at risk of chronic post-surgical pain could be a means to increase cost-effectiveness. Stepped-care approaches should also be considered, where the intensity of psychological support is adapted to the needs of the patient.
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Fractures of the humeral shaft represent roughly 5% of all fractures. They occur in an approximate bimodal distribution, typically affecting young adults following trauma and older females after low energy falls in the presence of osteoporosis. ⋯ While most humeral shaft fractures are conservatively managed, operative management is indicated in certain circumstances. This article provides an overview of these fractures, including their initial management approach and definitive treatment.