[Identifying patients with risk for severe pain after ophthalmological surgery]. / Wie erkennt man Risikopatienten für starke Schmerzen nach Augeneingriffen?

Modern ophthalmology includes a wide range of surgical options and, accordingly, also requires appropriate pain management. There are established risk factors for severe postoperative pain that should be identified and considered in the perioperative management. The main risk factors and existing recommendations are presented in this article. Patients at risk should be identified before surgery. It is important that perioperative pain management is implemented in the treatment plan as part of an interdisciplinary cooperation to identify and address the risks as early as possible.

Effects of the Noise Reduction and Communication Management Headset System SLOS on Noise and Stress of Medical Laboratory Workers.

OBJECTIVE: To investigate the effects of the Silent Laboratory Optimization System (SLOS), a technical-noise reduction and communication-management system, on noise load and stress among medical-laboratory workers. METHODS: We conducted a quasiexperimental field study (20 days with SLOS as the experimental condition, and 20 days without SLOS as the control condition) in a within-subjects design. Survey data from 13 workers were collected before and after the shift. Also, a survey was conducted after the control and experimental conditions, respectively. Noise was measured in dBA and as a subjective assessment. Stress was operationalized via a stress composite score (STAI and Perkhofer Stress Scale), the Perceived Stress Scale (PSS), an exhaustion score (Leipziger StimmungsBogen in German [LSB]), and salivary cortisol values in µg/L. RESULTS: SLOS users perceived significantly less noise (V = 76.5; P =.003). Multilevel models revealed a stress reduction with the SLOS on the composite score, compared with a stress increase in the control condition (F[1, 506.99] = 6.00; P = .01). A lower PSS score (F[1,13] = 4.67; P = .05) and a lower exhaustion level (F[1, 508.72] = 9.057; P = .003) in the experimental condition were found, whereas no differences in cortisol (F[1,812.58.6] = 0.093; P = .76) were revealed. CONCLUSION: The workers showed reduced noise perception and stress across all criteria except cortisol when using SLOS.

Face validity of the ICD-10 criteria of substance abuse and dependence for patients prescribed cannabis-based medicines for chronic pain-A survey of pain medicine physicians in Canada, Germany and Israel.

BACKGROUND AND OBJECTIVE: A major concern with cannabis-based medicines (CbM) and medical cannabis (MC) is the risk of abuse and dependence. The face validity of the International Classification of Diseases (ICD-10) criteria for cannabis dependence in patients prescribed CbM for chronic pain has not been assessed. DATABASES AND DATA TREATMENT: Physicians from Canada, Germany and Israel were recruited via the mailing lists of national pain societies. To be eligible, physicians had to have prescribed CbM for chronic pain treatment in the past 12 months. Participants were asked to rate the appropriateness of items adapted from the substance use module of the Composite International Diagnostic Interview Version 3.0 to assess dependence in the context of chronic pain treatment with CbM and the appropriateness of two additional items. In case of disagreement, participants were asked to give reasons. Furthermore, they were asked to suggest potential additional criteria. RESULTS: On average 69.0% of 178 participating physicians indicated agreement with the appropriateness of the ICD-10 criteria, while 20.6% indicated disagreement. The highest disagreement rate was observed for the item on repeated use despite legal problems (35.4% disagreement or strong disagreement). Reasons for disagreement were summarized into six content categories using qualitative methods of analysis. Additional criteria suggested by participants were summarized into 10 content categories. CONCLUSIONS: A collaboration of psychiatrists and pain physicians is required to define criteria and develop instruments to capture abuse and dependence of CbM in chronic pain patients. SIGNIFICANCE: Sixty-nine per cent of 178 pain medicine physicians in Canada, Germany and Israel who participated in a survey on the appropriateness of the ICD-10 criteria for cannabis abuse and dependence for patients prescribed cannabis-derived products for chronic pain assessed the criteria as appropriate, whereas 20.6% deemed the criteria as not appropriate.

Assessing the unwanted: A systematic review of instruments used to assess negative effects of psychotherapy.

OBJECTIVE: While the efficacy of psychotherapy in the treatment of mental disorders is well examined, systematic research into negative effects of psychotherapy seems comparatively rare. Therefore, this review evaluates instruments for assessing negative effects of psychotherapy in order to create a consensus framework and make recommendations for their assessment. METHODS: The study selection procedure follows current best-practice guidelines for conducting systematic reviews, with 10 included studies in three databases (PsycINFO, PubMed, and Web of Science). The nine instruments identified were each critically reviewed concerning the theoretical orientation, including the assessed domains of negative effects, psychometric properties, and diagnostic characteristics. RESULTS: Seventeen domains of negative effects of psychotherapy were identified but inconsistently assessed by the nine instruments. Most instruments provide some initial data on their psychometric properties. Regarding diagnostic characteristics, different item-response formats are used but often with reference to "attribution to therapy." CONCLUSION: This review indicates that the existing instruments for assessing negative effects of psychotherapy cover a wide range of relevant domains without any consensus on the most important ones and their psychometric properties are usually unsatisfactory. A framework for consensus, building on the definition and conceptualization of negative effects, is synthesized, and recommendations for improving the assessment are derived.