Articles: pain-clinics.
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Spinal pain is an important public health problem affecting the population indiscriminately. The structures responsible for pain in the spine include the vertebrae, intervertebral discs, spinal cord, nerve roots, facet joints, ligaments, muscles, atlanto-occipital joints, atlanto-axial joints, and sacroiliac joints. Even though disc herniation, facet joints, strained muscles, and torn ligaments have been attributed to be the cause of most spinal pain, either in the neck and upper extremities, upper and mid back, or low back and lower extremities, disorders of the disc other than disc herniation have been implicated more frequently than any other disorders. ⋯ The three primary components of diagnostic disc injection are: provocation/analgesia, discometry, and nucleography. Despite the recent exponential growth of noninvasive spinal technology, diagnostic disc injection remains the sole direct method for definitively determining whether a disc is a physiological pain generator. It is clear that discography is a safe and powerful complement to the overall clinical context.
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Jt Comm J Qual Improv · Jul 2000
Multicenter StudyImplementing emergency department observation units within a multihospital network.
The proportion of emergency department (ED) chest pain patients who undergo an extended "rule out MI (myocardial infarction)" evaluation beyond the ED determines both the quality and cost of patient care. The higher an organization's rate of such evaluations, the lower the average miss rate for MI. Five of the 13 hospitals in the Voluntary Hospital Association Northeast multihospital network implemented ED observation units by June 1997 for outpatient rule out MI evaluations. ⋯ ED observation units represent a cost-effective restructuring of the diagnostic approach to patients with acute chest pain. In an improvement of quality of patient care, a larger proportion of ED chest pain patients receive an extended evaluation than is possible with hospital admission as the only ED disposition option.
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As hospitals across the country work to improve pain management in the face of ever-shrinking resources, one challenge that must be addressed is the delineation of specialized pain management services. Although pain management is an interdisciplinary process, nurses are in a unique position to provide leadership in both the organization and delivery of clinical services. This article describes the development and 2-year experience of a nurse-run inpatient pain management consultation service in an academic tertiary care hospital. The structure of the service, and nature and volume of consults is discussed along with recommendations for institutions considering this strategy.
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Anaesth Intensive Care · Jun 2000
The development of a performance indicator to objectively monitor the quality of care provided by an acute pain team.
Quality assurance procedures are essential in the maintenance of clinical standards in medicine. Conventional analysis techniques have difficulty in detecting gradual changes over time. Cumulative sum techniques monitor the frequency with which an event occurs and can detect changes in its frequency as soon as they become statistically significant. ⋯ It shows that periods of suboptimal performance can be readily identified. The prospective use of these techniques in clinical audit may allow the earlier identification and correction of technical or organisational problems. These should lead to improvements in patient care and satisfaction.
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Although much has been done to promote pain assessment and management, pain remains a major, yet largely preventable, public health problem in the United States. A strategy that has been proposed to assure optimal pain management is the development of formal means within institutions to evaluate pain management practices and foster improved outcomes. ⋯ A Pain Management Task Force was charged with the development of a comprehensive pain management program. Its efforts to date and plans for the future position this institution as ready for the Joint Commission for the Accreditation of Healthcare Organizations' pain assessment and management standards that were introduced in 2000.