Articles: pain-clinics.
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To analyse the cost-consequences of chronic neuropathic pain (NeP) outpatients care comparing management in general clinics (GC) versus specialised pain clinics (SPC) in neurology settings in Spain. ⋯ In neurology settings in Spain, the outpatient clinical management of chronic NeP in SPC was a dominant alternative compared with GC healthcare, since it has shown better patients healthcare outcomes with less severity and interference of pain on daily activities, while maintaining a similar level of costs. These results could help health decision makers when planning the use of health care resources.
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With reference to the article "Assessment of the efficiency of the clinical management of neuropathic pain in specialist clinics compared to general clinics in neurology health care units in Spain" by Matias-Guiu et al, a reflection is made on the methodological and operational difficulties of working with results in health, quality of life or costs in something so subjective as pain, and its impact on daily life. It then highlights the importance of the decision to establish a specialist clinic or other type specific care team for neuropathic pain, adding another level of care. Some points are given for the analysis of that decision.
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The purpose of this paper is to describe the measurement and characterization of the radiation exposure to the staff, patients, and the general public as a result of the operation of an interventional pain management (IPM) clinic, as well as the effectiveness of a peer-based fluoroscopy training program to keep doses as low as reasonably achievable (ALARA). During the last decade, pain management has evolved into an essential part of patient care. IPM, a subfield of pain management, uses fluoroscopic imaging in its procedures. ⋯ Ultimately, the goal is to maintain all doses (patient, physician, and the general public) using the ALARA principle. Using a Panasonic thermoluminescent dosimetry system, it was determined that a peer-based fluoroscopy training program effectively reduced the cumulative dose to clinic staff by approximately 50 percent. It was also determined that the standard building materials used in our facility provide enough shielding to keep doses to members of the general public below acceptable limits.
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Anesthesia and analgesia · Mar 2010
A national survey of American Pediatric Anesthesiologists: patient-controlled analgesia and other intravenous opioid therapies in pediatric acute pain management.
The influence of patient characteristics, institutional demographics, and published practice guidelines on the provision of IV opioid analgesia, particularly as delivered through a patient-controlled analgesia (PCA) delivery device, to pediatric patients is unknown. ⋯ Although IVPCA was available to pediatric patients at most institutions surveyed, prescribing practices and supervision of pediatric pain management were influenced by patient characteristics, institutional demographics, and published national guidelines. Recalled life-threatening events were reported in conjunction with all modes of opioid infusion therapy. Interventions that might diminish the incidence of adverse events but are not used to their fullest extent include improved education and implementation of systems designed to minimize human error involved in the prescribing of opioids. Providing a more accurate accounting of complications would require institutions to participate in a prospective data-collecting consortium designed to track both the incidence of therapy and associated complications.
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The health care industry in general and care of chronic pain in particular are described as recession-proof. However, a perfect storm with a confluence of many factors and events -none of which alone is particularly devastating - is brewing and may create a catastrophic force, even in a small specialty such as interventional pain management. Multiple challenges related to interventional pain management in the current decade will include individual and group physicians, office practices, ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPD). ⋯ There is focus on avoiding waste, abuse, fraud, and also cutting costs. Evidence-based medicine (EBM) and comparative effectiveness research (CER) have been introduced as cost-cutting and rationing measures, however, with biased approaches. This manuscript will analyze various issues related to interventional pain management with a critical analysis of physician payments, office facility payments, and ASC payments by various payor groups.