Search Results (35)

Background: Percutaneous epidural neuroplasty (PEN) and related adhesiolysis procedures are widely used for managing chronic spinal pain. Although generally safe, complications—ranging from minor to life-threatening—have been reported. This review aimed to estimate the incidence and characteristics of complications following PEN and to evaluate the medical rationale for post-procedural inpatient monitoring. Methods: We systematically searched PubMed, Embase, and the Cochrane Library for studies published from January 2000 to April 2025 reporting complications associated with PEN. We performed a random-effects meta-analysis on five eligible cohort studies to estimate the pooled complication rate and evaluated heterogeneity. Risk of bias was assessed using the Newcastle–Ottawa Scale. Results: Five cohort studies (n = 1740) were included in the meta-analysis, with a pooled complication rate of 9.0% (95% CI: 4.8–13.1%, I² = 97.5%). A total of 133 complications were identified from cohort studies and case reports. Mechanical and neurological complications were most common. Serious complications, including hematoma, meningitis, and cardiopulmonary arrest, were concentrated within the first 6 h post-procedure. Conclusions: This meta-analysis highlights a quantifiable risk of complications associated with PEN. Our findings support structured inpatient monitoring during the immediate post-procedural period to enhance safety and outcomes. Full article

Background/Objectives: Population aging and the rise in chronic diseases challenge healthcare systems to adopt person-centered approaches, especially in palliative care (PC), where symptom management remains limited. Physiotherapy plays a key role in alleviating discomfort but faces inconsistent integration in Portugal due to lack of recognition. Variations in intervention methods hinder uniform care delivery, limiting timely patient access to comfort-focused treatments and knowledge. This study aims to deepen the understanding of physiotherapy’s role in Portuguese PC to improve its integration into teams and enhance patient access to comfort care. Methods: This study used a descriptive qualitative approach with online focus groups (FG), guided by Krueger and Casey’s methodology and adhering to the COREQ checklist. A non-probabilistic convenience sample of physiotherapists working in palliative care across mainland Portugal and the islands was selected based on inclusion criteria. Three FGs were planned with up to ten participants each. However, due to availability and attendance issues, only 15 physiotherapists participated: 5 in FG1 (in-hospital PC units), 6 in FG2 (inpatient units), and 4 in FG3, the minimum appropriate number from community-based units. Results: Physiotherapy plays a crucial yet underrecognized role in PC, emphasizing the need for its full integration into care teams rather than reliance on late, on-call referrals. Techniques such as positioning, mobilization, pain and dyspnea relief, adapted exercises, massage, music therapy, and emotional support are employed. Conventional physiotherapy tools are used and personalized according to the patient’s context, duration, setting, dosage, and individual needs. Conclusions: Physiotherapy should be recognized as a fundamental part of PC, contributing not only to the prolongation of life but also to ensuring comfort and dignity for patients and their families. To achieve this, its role within multidisciplinary teams must be strengthened and supported by regulations that guarantee access and the formal integration of physiotherapists. However, a significant gap remains in patients’ regular access to comfort-focused interventions at the appropriate time, perhaps due to the considerable variation in physiotherapy practices depending on the patient and care setting, which presents a challenge for knowledge development both in Portugal and globally. Full article

Background: Opioid dependence is prevalent among patients undergoing lumbar spinal fusion and has been linked to poor postoperative outcomes. However, its specific impact on surgical complications and hospital resource utilization remains unclear. This study evaluates the association between opioid dependence and postoperative complications, length of stay (LOS), and hospital charges in lumbar fusion patients. Methods: A retrospective analysis was conducted using the National Inpatient Sample (NIS) database from 2016 to 2021. Adult patients (aged > 18 years) who underwent lumbar fusion surgery were identified and categorized based on opioid dependence using ICD-10 codes. Propensity score weighting (PSW) was employed to balance baseline characteristics. Primary outcomes included inpatient mortality, LOS, hospital charges, and postoperative complications. Statistical analyses were performed using survey-weighted generalized linear models. Results: Among 597,455 lumbar fusion patients, 7715 (1.3%) had documented opioid dependence. After PSW, opioid-dependent patients had significantly increased odds of blood loss anemia (OR 1.79, p < 0.001), respiratory complications (OR 2.17, p < 0.001), surgical site infections (OR 3.94, p = 0.001), and cardiac complications (OR 1.53, p = 0.002). They also had higher hospital charges (mean difference USD 17,739.2, p < 0.001) and prolonged LOS (mean difference 0.83 days, p < 0.001). Differences in urinary tract infections, acute renal failure, and stroke were not statistically significant after PSW. Conclusions: Opioid dependence is associated with increased postoperative complications, longer hospital stays, and higher healthcare costs in lumbar fusion patients. These findings highlight the need for improved perioperative pain management and opioid stewardship strategies to optimize surgical outcomes. Full article

Pain is a complex and burdensome symptom frequently experienced by oncological patients. Despite increased attention from healthcare providers and novel approaches, pain remains undertreated and prevalent in this patient population. Programs of patient education about pain (pain education, PE) have been proposed as a potential method to enhance pain management. However, the effectiveness of such programs and their impact on pain relief have shown variable results across studies. In this narrative review, we analyzed existing systematic reviews and meta-analyses on PE in oncological patients. A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Library databases, following established guidelines. Studies meeting the selection criteria were selected and analyzed to evaluate the effectiveness of PE interventions. A total of nine publications, comprising six systematic reviews and three meta-analyses, were included. Across various clinical settings (inpatient and outpatient), the impact of pain education (PE) on pain intensity showed considerable variability: some reviews reported significant reductions, while others observed minimal or no effects. In contrast, PE consistently improved patients’ knowledge about pain and adherence to medication. However, the available evidence did not demonstrate significant improvements in quality of life. The observed heterogeneity in the results of pain relief outcomes could be attributed to the various types of pain analyzed and the diversity of clinical settings evaluated. Furthermore, differences in study designs, comprising the inclusion of non-randomized studies, contributed to the variability in findings. It remains unclear whether the effectiveness of PE is solely attributed to the educational content or if the attention provided to patients during the intervention partly explains the effect. Full article

Severe burns are among the most traumatic injuries, characterized by tissue damage, systemic inflammation, significant fluid shifts, and a high risk of complications such as infections, organ failure, anemia, malnutrition, and psychological trauma. This article reviews recent literature from the PubMed and Google Scholar databases to outline critical components of burn care, from initial resuscitation and stabilization through rehabilitation. Key topics include early airway management to prevent respiratory compromise, meticulous fluid resuscitation to maintain tissue perfusion while avoiding complications like fluid overload, and optimal pain management. It also discusses nutritional support tailored to the burn patient’s hypermetabolic state and surgical techniques like early debridement and skin grafting. Beyond physical recovery, the review emphasizes the importance of addressing the psychological impact of burn injuries, including depression, anxiety, and post-traumatic stress, which can significantly affect long-term outcomes. By integrating the expertise of a multidisciplinary team with a personalized approach and practical recommendations, this review aims to provide clinicians with a comprehensive framework for managing severe burns, from the initial emergency response to the challenges of inpatient care and, finally, rehabilitation. Full article

Objective: The aim of this meta-analysis was to investigate whether home-based physical therapy (HPT) is as safe and effective as the conventional inpatient/outpatient physical therapy (CPT) after total knee arthroplasty (TKA). Methods: Three databases (PubMed, Web of Science, and Cochrane) were systematically searched on 8 January 2024. Randomized controlled trials (RCTs) comparing HPT with CPT following TKA were included. The outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), 6 min walking test, range of motion (ROM), 36-Item Short Form Survey (SF-36), and visual analogue scale (VAS) for pain, and were analyzed at short-term (≤12 weeks) and mid/long-term follow-ups (>12 weeks). Results: Twenty RCTs (3706 patients) were included. Both groups experienced significant improvements, but no differences emerged when comparing all analyzed outcomes. WOMAC improvement was 36.2 points with HPT (p < 0.0001) vs. 39.2 with CPT (p < 0.0001); KOOS increased by 24.8 points with HPT (p < 0.0001) vs. 25.2 points with CPT (p < 0.0001); OKS improved by 16.1 points with HPT (p < 0.0001) vs. 16.3 points with CPT (p < 0.0001); ROM improved by 6.3° with HPT (p = n.s.) vs. 7.7° with CPT (p = 0.029); SF-36 improved by 3.3 points with HPT (p = n.s) vs. 7.4 points with CPT (p = n.s.); and VAS pain decreased by 2.5 points with HPT (p < 0.0001) vs. 3.0 points with CPT (p < 0.0001). Conclusions: HPT is a valid option for the post-operative rehabilitation of patients undergoing TKA, leading to results similar to CPT. This questions the need for a more complex and expensive management of these patients, considering the additional HPT benefits of healthcare cost reductions, early patient discharge, and less in-person physical therapy sessions, with equal patient final satisfaction. While this review offers a comprehensive representation of numerous studies, the research underlines significant heterogeneity in the reported data, thereby diminishing the overall robustness of the analysis, and future studies are needed to confirm the study results. Full article

Background: Total elbow arthroplasty (TEA) was initially introduced for end-stage rheumatoid arthritis but has since expanded to include osteoarthritis and complex distal humerus fractures, particularly in elderly patients. Over the past two decades, TEA utilization trends have fluctuated, with a recent decline attributed to advancements in disease-modifying antirheumatic drugs. Despite its benefits, TEA presents a high complication rate, necessitating further investigation into clinical outcomes, costs, and postoperative management. Methods: This retrospective cohort study analyzed TEA procedures from 2016 to 2019 using the National Inpatient Sample (NIS) database. Patients were identified via ICD-10 codes, with elective procedures included to ensure homogeneity. This study examined temporal trends, patient demographics, comorbidities, complication rates, length of stay (LOS), and hospitalization costs. Statistical analyses included chi-square tests, t-tests, and multivariate regression to assess associations between patient characteristics and outcomes. Results: A total of 4110 TEA procedures were analyzed, revealing a 16% decline in annual volume from 2016 to 2019 (p = 0.012). The cohort had a mean age of 65.99 years, with a predominance of female (75.3%) and White (72.6%) patients. The median LOS was two days, and median hospitalization costs were USD 78,473 (IQR: 56,935–115,671 USD). The most prevalent complications included mechanical loosening (12.5%), blood loss anemia (10.6%), cardiac complications (5.7%), and prosthetic-related pain (3.3%). Multivariate analysis identified hypertension, anemia, and respiratory disease as significant predictors of adverse outcomes. Conclusions: TEA utilization has declined, likely due to medical advancements in rheumatoid arthritis management. The procedure remains associated with substantial complication rates, particularly in trauma-related cases. Findings highlight the importance of patient optimization, surgical expertise, and postoperative monitoring to improve outcomes. Full article

For decades, art in its many forms has been used to improve patients’ quality of life and mental health. A growing amount of literature has shown the effectiveness of active visual art therapy (AVAT) on different patient outcomes and highlighted the need for international collaboration and harmonization of research methods. Evidence regarding AVAT inside the general hospital is still limited. This context poses unique challenges in terms of feasibility, heterogeneity, settings, and type of participants, together with significant ethical implications in terms of humanization of care. This narrative review aimed to report the available data on the effectiveness of visual art therapy in the general hospital and discuss them through the lens of the key bioethical principles of autonomy, beneficence, non-maleficence, and justice introduced by Childress and Beauchamp. Current evidence supports the effectiveness of AVAT on children and adult inpatients’ outcomes, particularly in the areas of pain control, anxiety, and depression, therefore supporting the individual’s autonomy and beneficence. With regard to justice and equity, AVAT proved to be a safe and cost-effective adjunct intervention to medical management inside the hospital. A more in-depth understanding of the ethical aspects implied in using AVAT in the general hospital may add a further contribution to the implementation of art interventions in patient-centered care. Full article

Objectives: To analyze the clinical characteristics, trends in hospitalization, and healthcare resource utilization of pediatric patients with fecal impaction. Methods: We utilized the Healthcare Cost and Utilization Project (HCUP) databases, including the National Inpatient Sample (NIS) and the Kids Inpatient Database (KID) datasets from 2011 to 2019, to include all hospitalizations of patients up to 18 years of age with a primary diagnosis of (1) fecal impaction or (2) a primary diagnosis of abdominal pain or constipation with a secondary diagnosis of fecal impaction. The study analyzed various comorbid factors and clinical characteristics of these patients. For healthcare resource utilization, we analyzed the length of hospital stays and total hospital charges, adjusted for inflation. Results: A total of 23,570 admissions due to fecal impactions in children between the years 2011 and 2019 were analyzed, contributing to 0.18% of the total pediatric admissions. Hospitalization rates nearly doubled from 2011 (0.15%) to 2019 (0.29%). The mean hospitalization charges also trended upwards from 15,234 USD in 2011 to 22,487 USD in 2019. The inflation-adjusted annual rate of increase in hospital charges during this period was 5.9% per year. Aggressive fecal disimpaction procedures (either manual or surgical) were performed in approximately 3% of these admissions. Multivariate regression showed that older children (13–18 years of age) were more likely to require aggressive disimpaction. Female children, those with Hispanic ethnicity, and those with obesity were less likely to be associated with the need for disimpaction. Conclusions: Hospitalizations for fecal impaction have increased significantly over the past decade, creating a substantial burden on healthcare resources. Our study highlights the importance of aggressive outpatient management strategies with close follow-up for fecal impactions, which will potentially minimize these hospitalizations. Full article

Purpose: To investigate community-acquired pressure injuries (CAPIs) in older people by utilizing big data. Design: Retrospective data curation and analysis of inpatient data from two general medical centers between 1 January 2016 and 31 December 2018. Methods: Nursing assessments from 44,449 electronic medical records of patients admitted to internal medicine departments were retrieved, organized, coded by data engineers, and analyzed by data scientists. Potential explanatory patient characteristics tested were gender, age, admission indices, nursing assessments including CAPIs, CAPI type and location, vital signs, and the results of lab tests within the first 36 h of admission. Findings: Most CAPIs were located in the buttocks (56.9%), followed by the sacrum (11.8%), ankle (10.8%), trochanter (5.1%), and leg (3.9%). Tissue associated with CAPIs was described as necrotic, serotic, bloody, granolithic, epithelial, and infected. There were 31% of first-degree CAPIs, 41% second-degree, and 18% third-degree. Previously unacknowledged patient characteristics associated with CAPIs are as follows: age, oxygen use, intestinal function, the touch senses of heat and pain, albumin, RDW (red cell distribution width), and systolic blood pressure. Conclusions: The novel indicators for CAPIs underscore the importance of data-driven approaches in detecting and preventing CAPIs in community care. These markers can detect and prevent pressure ulcers in the community, particularly among the elderly. Relevance for Clinical Practice: Nursing management is called upon to integrate information about novel patient characteristics associated with CAPI into clinical practice. Assimilating the insights from this hospital nursing-led study into community nursing will enhance the safety and quality of care for the elderly. Full article

Background: Chronic pain is defined as any persistent or recurring pain lasting longer than 3 months that significantly affects a person’s quality of life. Millions worldwide are impacted by chronic pain, but its subjective nature makes it difficult to quantify and compare between individuals. Methods: This retrospective analysis aimed to examine the differences in pain perception and reporting between male and female patients, as well as how their pain was managed. Data from 1995 patients who met the inclusion criteria were selected from the Advocate Illinois Masonic Pain Clinic database. The types of pain assessed in this study included lower back pain, neck pain, and osteoarthritis. Results: The findings indicate that females suffer more from chronic pain conditions than males, where lower back pain had the highest prevalence in both sexes (63.7% reported). Baseline Numeric Rating Scale (NRS) scores at the first inpatient visit were statistically higher in females than males (7.95 ± 1.35 vs. 7.72 ± 1.46, p = 0.006). After 1 year of treatment, both sexes reported a clinical improvement in their symptoms. With regards to medication, females reported a higher use of medications such as muscle relaxants, benzodiazepines, and tricyclic antidepressants, while males reported a higher use of opioids (measured in MMEs). Conclusions: This study reveals a significant sex difference in the reporting of non-cancer-related chronic pain, with females reporting higher pain intensity than males. Full article

Background/Objectives: Falls and fractures are emerging as a near-pandemic and major global health concern, placing an enormous burden on ageing patients and public health economies. Despite the high risk of polypharmacy in the elderly patients, falls are usually attributed to age-related changes. For the “Individual Pharmacotherapy Management (IPM)” established at the University Hospital Halle, the IPM medication adjustments and their association with in-hospital fall prevention were analysed. Methods: On the basis of the most updated digital overall patient view via his inpatient electronic health record (EHR), IPM adapts each drug’s Summary of Product Characteristics to the patient’s condition. A retrospective pre-post intervention study in geriatric traumatology on ≥70 years old patients compared 200 patients before IPM implementation (CG) with 204 patients from the IPM intervention period (IG) for the entire medication list, organ, cardiovascular and vital functions and fall risk parameters. Results: Statistically similar baseline data allowed a comparison of the average 80-year-old patient with a mean of 11.1 ± 4.9 (CG) versus 10.4 ± 3.6 (IG) medications. The IPM adjusted for drug-drug interactions, drug-disease interactions, overdoses, anticholinergic burden, adverse drug reactions, esp. from opioids inducing increased intrasynaptic serotonin, psychotropic drugs, benzodiazepines, contraindications and missing prescriptions. IPM was associated with a significant reduction in in-hospital falls from 18 (9%) in CG to 3 (1.5%) in IG, a number needed to treat of 14, relative risk reduction 83%, OR 0.17 [95% CI 0.04; 0.76], p = 0.021 in multivariable regression analysis. Factors associated with falls were antipsychotics, digitoxin, corticosteroids, Würzburg pain drip (combination of tramadol, metamizole, metoclopramide), head injury, cognitive impairment and aspects of the Huhn Fall Risk Scale including urinary catheter. Conclusion: The results indicate medication risks constitute a major iatrogenic cause of falls in this population and support the use of EHR-based IPM in standard care for the prevention of falls in the elderly and for patient and drug safety. In terms of global efforts, IPM contributes to the running WHO and United Nations Decade of Healthy Ageing (2021–2030). Full article

Sickle cell disease (SCD) is the most common hemoglobinopathy in the world. Sickle cell vaso-occlusive episodes (VOEs) are very painful acute events and the most common complication as well as reason for hospitalization. SCD pain is best evaluated holistically with a pain functional assessment to aid in focusing pain management on reducing pain in addition to improving function. Patients with SCD have long endured structural racism and negative implicit bias surrounding the management of pain. Thus, it is important to approach the management of inpatient pain systematically with the use of multi-modal medications and nonpharmacologic treatments. Furthermore, equitable pain management care can be better achieved with standardized pain plans for an entire system and individualized pain plans for patients who fall outside the scope of the standardized pain plans. In this article, we discuss the best practices to manage SCD VOEs during an inpatient hospitalization. Full article

(1) Background: Acute pain in hospitalized children remains under-recognized and under-treated. Our objective is to benchmark pain assessment, documentation, treatment, and patient experience in children admitted to a US children’s hospital. (2) Methods: A cross-sectional, mixed-method survey of pain for children hospitalized ≥24 h. Charts were reviewed for modalities of pain assessment and treatment for all inpatients. If pain was documented, patients/caregivers were surveyed regarding their experience with pain and its management. (3) Results: Chart review: All 107 patients had ≥1 pain score documented. A total of 47 patients had a pain score ≥0, 35 (74.5%) of whom had ≥1 moderate-severe score. Seventy (65.4%) patients received ≥1 intervention for pain, including medications from ≥1 class (e.g., opioids) (n = 55, 51.4%) and/or integrative/non-pharmacologic intervention(s) (n = 39, 36.4%). There were assessment and documentation gaps. Patient survey: A total of 39 (83.0%) interviews were attempted; 25 (53.2%) were completed. The worst pain was mostly caused by acute illness (n = 13, 52%) and painful procedures (n = 10, 40%). Suggestions for improvement included increasing the use of integrative modalities and optimizing patient–clinician communication. (4) Conclusions: All patients admitted ≥24 h had ≥1 pain score documented; however, gaps in documentation were common. Multimodal treatment and integrative modalities were underutilized. Procedures were a frequent cause of under-treated pain, prompting an institution-wide quality improvement project. Full article

Background: Effective cancer pain management is essential for improving the quality of life of patients. However, the use of analgesics is often suboptimal due to various patient-related barriers. This study aims to explore the perceptions, knowledge, and attitudes toward analgesic use among cancer patients in Oman, which may influence their pain management strategies. Methods: In a cross-sectional study, we assessed 68 cancer patients undergoing pain management at an inpatient cancer clinic of a tertiary hospital in Oman from a pool of 154 eligible participants. The Barriers Questionnaire (BQ) and the Patient Pain Questionnaire (PPQ), both Arabic versions, were administered to evaluate the patients’ barriers to cancer pain management. The study period and the criteria for patient selection are specified. Results: With a participation rate of 44.2% and a female-to-male ratio of 2.28:1, the mean score on the BQ was 2.52 (SD 0.84), indicating a moderate level of perceived barriers. Patients’ scores suggested notable barriers, with older patients exhibiting reluctance toward analgesics for fear of masking symptoms and female patients expressing greater concerns about developing drug tolerance. Conclusion: The findings highlight significant attitudinal barriers to effective cancer pain management in Oman, notably a prevalent fear of medication tolerance. The study stresses on the need for targeted patient education and the correction of misconceptions. It also points to the influence of cultural and religious beliefs on patient responses, advocating for the implementation of culturally sensitive, evidence-based pain management guidelines, and the support of multidisciplinary palliative care teams. Full article