Articles: pain-management.
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Proper coding and documentation for evaluation and management services continuously and progressively are becoming not only complicated, but also confusing. Although medical evaluation of patients has been a fact of life since the beginnings of medical history, medicine has been substantially influenced by federal regulations since the enactment of Medicare. Physicians' fear of being prosecuted is increasing. ⋯ While the history is the same for all types of visits except for the complexity for each level, four types of physical examination are available, either in a general multisystem examination or a single-system examination. However, the complexity of medical decision making is the essential factor in deciding to which level the evaluation and management belong. This review will discuss various aspects of evaluation and management guidelines in interventional practice and also guide the physician in performing these evaluations in an appropriate manner with proper documentation, thus avoiding the pitfalls of fraud and abuse.
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Epidural neuroplasty (lysis of epidural adhesions) is an interventional technique that has emerged over the last 10 years as part of a multidisciplinary approach to treating radiculopathy with low back pain when conservative management has failed. Neuroplasty was at one time performed as a single-catheter technique using the caudal approach. It now has many variations, including placement of the catheter tip in the anterior epidural space. This article will discuss the evolution and refinement of epidural neuroplasty at our institution.
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MCN Am J Matern Child Nurs · Jul 2000
ReviewHydrotherapy during labor. An example of developing a practice policy.
Warm water has been used for centuries to treat many painful ailments. In perinatal clinical practice, hydrotherapy is being used to increase relaxation and decrease pain during labor. This article summarizes clinical studies evaluating hydrotherapy during labor, describing the current evidence which supports hydrotherapy as an effective method for managing intrapartal pain. The article also describes the process by which an institution established an evidence-based practice policy for the use of hydrotherapy in labor.
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Clinical Trial Controlled Clinical Trial
A collaborative research utilization approach to evaluate the effects of pain management standards on patient outcomes.
The generation of research-based knowledge is incomplete unless it reaches clinicians at the point of care. Despite major advances in clinical research related to pain management, inadequate pain relief has become a significant quality issue in hospitalized patients, which has created an imperative for research-based pain management. Using a collaborative research utilization model, multidisciplinary academic scientists were paired with clinicians and undergraduate and graduate students to form a partnership that (1) examined the research base in pain management, (2) generated a research-based standard for pain management, and (3) evaluated the effect of that standard on four patient outcome variables in a 230-bed teaching hospital. ⋯ Interestingly, each of these improvements decreased after their discharge home. These results strongly suggest the need for better postdischarge preparation for pain management and for further development and testing of pain management standards in postdischarge settings. They also provide the basis for extending the model to address other situations in which there is a lag between the promising results of empirical research and their integration into practice.