Estudio observacional del control del dolor postoperatorio antes y después de la implementación de una guía del manejo del dolor postoperatorio / Observational study of post-operative pain control before and after the implementation of a clinical practice guideline for postoperative pain management

Antecedentes y objetivos: El dolor postoperatorio es frecuente en los hospitales. Se han desarrollado guías de práctica clínica para el control del dolor postoperatorio (GPCDP) y para mejorar su tratamiento. El objetivo fue evaluar la prevalencia e intensidad del dolor postoperatorio y las pautas analgésicas, antes y después de la implementación de una GPCDP. Material y método: Estudio observacional que incluyó 2estudios transversales realizados en 2períodos (anterior y posterior a la implementación de una GPCDP). Incluyó a pacientes adultos postoperados el primer día de ingreso en plantas de cirugía. Las variables demográficas, clínicas y farmacológicas se recogieron de las historias clínicas; la intensidad del dolor, mediante entrevista con los pacientes. Resultados: Se incluyó a 306 pacientes en el primer período y 317 en el segundo. No hubo diferencias respecto a las variables demográficas y clínicas de los pacientes en los 2períodos. La prevalencia del dolor fue del 92% (IC 95%: 87-95%) en el primer período y del 77% (IC 95%: 72-82%) en el segundo (p <0,05). El dolor más frecuente en las últimas 24 h fue moderado o intenso en el 53% (IC 95%: 48-59%) de los pacientes en el primer período y en el 33% (IC 95%: 28-38%) de los pacientes en el segundo (p <0,05). Conclusiones: Tras la implementación de la GPCDP se observó un descenso de la prevalencia e intensidad del dolor de los pacientes, pero sin llegar a ser óptimo. Son necesarias medidas continuadas de formación y evaluación del dolor para un tratamiento adecuado a lo largo del tiempo

Background and objectives: Postoperative pain is common in hospitals. Clinical practice guidelines for the control of postoperative pain (CPGPP) have been developed to improve its treatment. The objective of this study was to evaluate the prevalence and intensity of postoperative pain and analgesic norms, before and after the implementation of a CPGPP. Material and method: An observational study was carried out that included 2cross-sectional studies in 2separate periods, before and after implementation of the CPGPP. Adult patients postoperated on the first day of admission in the surgery plants were included. Demographic, clinical and pharmacological variables were collected from clinical histories. The intensity of the pain was collected through individual interviews with patients. Results: We included 306 patients in the first period and 317 in the second. There were no differences between patients' demographic and clinical variables and the 2periods. The prevalence of pain was 92% (IC 95%: 87%-95%) in the first period and 77% (IC 95%: 72%-82%) in the second (P <0.05). The most frequent pain in the last 24hours was moderate or intense in 53% (IC 95%: 48%-59%) of patients in the first period and in 33% (IC 95%: 28%-38%) of the patients in the second (P <0.05). Conclusions: After the implementation of the CPGPP, a decrease in the prevalence and intensity of pain in patients was observed, but without reaching an optimal level. Continued pain training and assessment measures are therefore necessary for proper pain treatment over time

Observational study of post-operative pain control before and after the implementation of a clinical practice guideline for postoperative pain management. / Estudio observacional del control del dolor postoperatorio antes y después de la implementación de una guía del manejo del dolor postoperatorio.

BACKGROUND AND OBJECTIVES: Postoperative pain is common in hospitals. Clinical practice guidelines for the control of postoperative pain (CPGPP) have been developed to improve its treatment. The objective of this study was to evaluate the prevalence and intensity of postoperative pain and analgesic norms, before and after the implementation of a CPGPP. MATERIAL AND METHOD: An observational study was carried out that included 2cross-sectional studies in 2separate periods, before and after implementation of the CPGPP. Adult patients postoperated on the first day of admission in the surgery plants were included. Demographic, clinical and pharmacological variables were collected from clinical histories. The intensity of the pain was collected through individual interviews with patients. RESULTS: We included 306 patients in the first period and 317 in the second. There were no differences between patients' demographic and clinical variables and the 2periods. The prevalence of pain was 92% (IC 95%: 87%-95%) in the first period and 77% (IC 95%: 72%-82%) in the second (P <0.05). The most frequent pain in the last 24hours was moderate or intense in 53% (IC 95%: 48%-59%) of patients in the first period and in 33% (IC 95%: 28%-38%) of the patients in the second (P <0.05). CONCLUSIONS: After the implementation of the CPGPP, a decrease in the prevalence and intensity of pain in patients was observed, but without reaching an optimal level. Continued pain training and assessment measures are therefore necessary for proper pain treatment over time.

[Systematic review of studies assessing the cost of adverse drug reactions]. / Revisión sistemática de los estudios de evaluación del coste de las reacciones adversas a medicamentos.

OBJECTIVE: Adverse drug reactions (ADRs) are an important healthcare problem. The objective of this study was to review published articles analyzing the cost of ADRs in any healthcare setting. METHOD: We conducted a search of articles published on the cost of ADRs in the bibliographic databases from 1970 to 2010. We identified 28 studies and selected 16 that included cases of ADR fitting the World Health Organization's definition of these events. The information on the characteristics of the study design, the types of costs analyzed and the reported results were reviewed. RESULTS: The design features and populations included in the studies were heterogeneous. Only two studies explicitly defined the perspective adopted. Only five studies compared cases of ADR with matched controls without ADRs. All studies analyzed direct healthcare costs, but none analyzed indirect or intangible costs. Fourteen publications analyzed the costs of length of hospital stay. The average (SD) percentage of ADRs was 3.04% (0.2) [median 2.4%, range 0.7% to 26.1%]. The median length of hospital stay in patients with ADRs was 8.8 days (range: 0.15 to 19.2 days). Accounting systems and monetary costs varied widely. CONCLUSION: Studies on the costs of ADRs are highly heterogeneous and have evaluated direct healthcare costs in hospitals. Their results indicate that ADRs generate substantial costs. More studies using appropriate methodology are needed on the costs of ADRs.

Gastroprotección y tratamiento con ácido acetilsalicílico a dosis bajas / Gastric protection and treatment with with low-dose aspirin

No disponible