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1.
Br J Anaesth ; 123(6): 887-897, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31591019

RESUMO

BACKGROUND: An unintended consequence of medical technologies is loss of personal interactions and humanism between patients and their healthcare providers, leading to depersonalisation of medicine. As humanism is not integrated as part of formal postgraduate anaesthesiology education curricula, our goal was to design, introduce, and evaluate a comprehensive humanism curriculum into anaesthesiology training. METHODS: Subject-matter experts developed and delivered the humanism curriculum, which included interactive workshops, simulation sessions, formal feedback, and patient immersion experience. The effectiveness of the programme was evaluated using pre- and post-curriculum assessments in first-year postgraduate trainee doctors (residents). RESULTS: The anaesthesiology residents reported high satisfaction scores. Pre-/post-Jefferson Scale of Patient Perceptions of Physician Empathy showed an increase in empathy ratings with a median improvement of 12 points (range; P=0.013). After training, patients rated the residents as more empathetic (31 [4] vs 22 [5]; P<0.001; 95% confidence interval [CI]: 7-12) and professional (47 [3] vs 35 [8]; P<0.001; 95% CI: 9-16). Patient overall satisfaction with their anaesthesia provider improved after training (51 [6] vs 37 [10]; P<0.001; 95% CI: 10-18). Patients rated their anxiety lower in the post-training period compared with pretraining (1.8 [2.3] vs 3.6 [1.6]; P=0.001; 95% CI: 0.8-2.9). Patient-reported pain scores decreased after training (2.3 [2.5] vs 3.8 [2.1]; P=0.010; 95% CI: 0.4-2.8). CONCLUSIONS: Implementation of a humanism curriculum during postgraduate anaesthesiology training was well accepted, and can result in increased physician empathy and professionalism. This may improve patient pain, anxiety, and overall satisfaction with perioperative care.


Assuntos
Anestesiologia/educação , Competência Clínica/estatística & dados numéricos , Currículo , Humanismo , Internato e Residência , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesiologia/métodos , Atitude do Pessoal de Saúde , Empatia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudantes de Medicina/psicologia , Adulto Jovem
3.
Am J Phys Med Rehabil ; 97(12): 921-928, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30216212

RESUMO

The growth of physiatry in the United States is dependent on academic exposure at both the undergraduate and graduate medical education levels. Undergraduate medical education provides students with knowledge of physiatry, as well as proper understanding of human function, medical rehabilitation treatments, and of physiatrists as consultants. Graduate medical education contributes more directly to the total number of practicing physiatrists. This article presents disparities in medical student exposure to physiatry, physical medicine and rehabilitation residency positions, the number of practicing physiatrists, and physical medicine and rehabilitation-relevant patient care needs, by state. In the model, these disparities are highlighted to provide guidance and expose gaps/opportunities for targeted physiatric growth.


Assuntos
Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Educação de Graduação em Medicina/estatística & dados numéricos , Medicina Física e Reabilitação/educação , Escolha da Profissão , Humanos , Internato e Residência/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Medicina Física e Reabilitação/estatística & dados numéricos , Estados Unidos
4.
Am J Phys Med Rehabil ; 97(3): 216-221, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29473837

RESUMO

This national survey highlights graduate medical education funding sources for physical medicine and rehabilitation (PM&R) residency programs as well as perceived funding stability, alignment of the current funding and educational model, the need of further education in postacute care settings, and the practice of contemporary PM&R graduates as perceived by PM&R department/division chairs. Approximately half of the reported PM&R residency positions seem to be funded by Centers of Medicare and Medicaid Services; more than 40% of PM&R chairs believe that their residency program is undersized and nearly a quarter feel at risk for losing positions. A total of 30% of respondents report PM&R resident experiences in home health, 15% in long-term acute care, and 52.5% in a skilled nursing facility/subacute rehabilitation facility. In programs that do not offer these experiences, most chairs feel that this training should be included. In addition, study results suggest that most PM&R graduates work in an outpatient setting. Based on the results that chairs strongly feel the need for resident education in postacute care settings and that most graduates go on to practice in outpatient settings, there is a potential discordance for our current Centers of Medicare and Medicaid Services graduate medical education funding model being linked to the acute care setting.


Assuntos
Currículo , Administração Financeira , Internato e Residência/organização & administração , Medicina Física e Reabilitação/educação , Atitude do Pessoal de Saúde , Humanos , Inquéritos e Questionários
6.
Pain Med ; 17(4): 670-4, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26814285

RESUMO

OBJECTIVE: To assess whether a combination of lecture and model simulation improves resident competency and comfort level with needle driving for interventional pain medicine procedures. DESIGN: Prospective, observational study. METHOD: Trainees who rotated through the University of California, Irvine, outpatient pain medicine clinic were recruited for the study. Subjects were given a brief lecture and completed a survey with questions regarding their level of comfort with interventional pain medicine procedures. This was followed by a timed trial on a training simulator where the objective was to drive a needle to the target. After the trial, the subject was then given a 30-minute practice session with the simulation model. The subject was then asked to repeat the timed trial and complete a post-simulation survey. RESULTS: All measures of the level of comfort increased significantly after subjects underwent the simulation training. In addition, subjects were able to significantly decrease their entrance time (P= 0.002), total time (P= 0.033), and vertical (P≤ 0.001) and horizontal deviation (P≤ 0.001) from the final target point after the simulation training. CONCLUSIONS: Our study demonstrates that simulation training may improve both trainee comfort level and competency with needle driving. After a brief lecture and a 30-minute training session with the simulator, subjective comfort measures and competency measures (more subjects were able to reach the target, vertical and horizontal deviations from the target decreased) were significantly improved. This suggests that simulation may be a helpful tool in teaching needle driving skills.


Assuntos
Anestesiologia/educação , Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Corpo Clínico Hospitalar/educação , Manejo da Dor/métodos , Treinamento por Simulação/métodos , Adulto , Raquianestesia/métodos , Feminino , Humanos , Internato e Residência , Região Lombossacral , Masculino , Modelos Anatômicos , Agulhas , Estudos Prospectivos
7.
Pain Physician ; 16(5): E627-30, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24077212

RESUMO

Intrathecal drug delivery systems are becoming an increasingly common modality used by physicians to treat patients. Specifically, chronic spasticity secondary to multiple sclerosis (MS) may be treated with intrathecal baclofen (ITB) therapy when oral antispasmodics do not provide adequate relief. ITB therapy is effective, localizes drug delivery, and does not have the same degree of intolerable systemic effects often seen with oral and parenteral medications. As the use of intrathecal drug delivery systems has become more common, so has the incidence of adverse events. ITB administration requires the surgical implantation of indwelling catheters and a pump reservoir. Although this therapy is useful in treating spasticity, risks unique to intrathecal drug delivery systems include medication dosing errors, pump malfunction, infection, and catheter breakage or dislocation. To our knowledge intrathecal pump catheter migration into the spinal cord is a very rare complication with only 2 such complications reported. We present a case of an intrathecal baclofen pump catheter that was initially believed to have migrated into the spinal cord and the innovative use of cinefluoroscopy and digital subtraction used to identify catheter placement. Moreover, after confirmation of the catheter position within the spinal cord on magnetic resonance imaging (MRI) our team elected to perform a laminectomy, which demonstrated that the catheter was not in the spinal cord but was surrounded by arachnoid adhesions. We hope our efforts will provide the clinician insight into the common difficulties that arise and how best to troubleshoot them to serve this specific patient population and prevent potentially life-threatening complications.


Assuntos
Relaxantes Musculares Centrais/uso terapêutico , Espasticidade Muscular/cirurgia , Medula Espinal/patologia , Adulto , Baclofeno/administração & dosagem , Baclofeno/uso terapêutico , Cateterismo/efeitos adversos , Cateteres de Demora , Reações Falso-Positivas , Feminino , Humanos , Bombas de Infusão Implantáveis/efeitos adversos , Injeções Espinhais/métodos , Imagem por Ressonância Magnética/métodos , Esclerose Múltipla/tratamento farmacológico , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Medula Espinal/cirurgia
8.
Adv Mind Body Med ; 27(3): 7-13, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23784605

RESUMO

CONTEXT: Chronic pain affects millions of Americans. Treating chronic pain can be difficult because it is a complex condition influenced by genetic makeup and physiological and psychological factors. The experience of major life events has also been found to affect the psychosocial functioning, health, and health behaviors of patients. Whereas the impact of major life events on the use of traditional medical practices has been explored, only one study to date has examined the relationship between major life events and use of complementary and alternative medicine (CAM). OBJECTIVE: This study examined the impact of major life events on the use of CAM among patients with chronic pain syndromes. DESIGN: Participants were consecutive patients seeking treatment at a pain clinic. SETTING: The study occurred at a tertiary center for pain management in Southern California. PARTICIPANTS: Participants were adult patients experiencing chronic pain for at least 6 mo, seeking treatment at a pain center. OUTCOME MEASURES: Participants completed a measure assessing their use of CAM modalities as well as their receptiveness to using previously unused CAM modalities, and they provided demographic information, including the occurrence of major life events, such as a job loss. RESULTS: A total of 199 adults with chronic pain participated in the study. The majority (91.6%) of chronic pain patients in the study reported using at least one form of CAM, with an average of at least five different forms of CAM. Individuals reported receptiveness to CAM modalities that they had not previously used (P < .05). Rates of CAM use were greater among those that had experienced a major life event in the prior 6 mo (P < .05). The most common major life events for this group included a compromised medical status, death of a loved one, financial hardship, a major geographical move, and altered family relationships. CONCLUSIONS: The study found that individuals with chronic pain frequently use CAM therapies, especially those who had recently experienced a major life event. Major life events may motivate patients with chronic pain to seek out different forms of CAM as a way to manage their pain.


Assuntos
Dor Crônica/psicologia , Dor Crônica/terapia , Terapias Complementares , Acontecimentos que Mudam a Vida , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
9.
Pain Manag ; 3(4): 295-301, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24654815

RESUMO

SUMMARY Medical progress is measured by advances in science and technology. The pace of discovery will surely accelerate. We are increasingly challenged not only to assimilate new information, but also to reconcile our learning with our art. We present the common clinical problem of managing pain in osteoarthritis as a paradigm for this dilemma in contemporary patient care. We do not yet have the understanding and interventions to do this optimally for all with osteoarthritis, leaving us with uncertainties as we struggle to care for these patients. In a world of growing complexity and sophistication we must not overlook the person who is our patient. It is easy to be seduced by electronic and informational advances, to be entranced by machinery, and to forget the unique individuality and needs of each patient. Osler taught that "the practice of medicine is an art, based on science". This doesn't change.

10.
Methods Mol Biol ; 851: 275-84, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22351099

RESUMO

The spinal nerve ligation model of neuropathic pain in rats, as originally described by Kim and Chung (Pain 50:355-363, 1992), provides an excellent venue to study the antinociception and modulation effects of pulsed radiofrequency (PRF) current in pain processing. We describe the procedure of application of PRF current near the exposed L5 dorsal root ganglion (DRG) in rats with L5 spinal nerve ligation injury-induced behavioral hypersensitivity. This method employs the direct visualization of the L5 DRG, allowing for confirmation of the location of the PRF probe adjacent to the DRG.


Assuntos
Gânglios Espinais/efeitos da radiação , Neuralgia/etiologia , Traumatismos dos Nervos Periféricos/complicações , Animais , Modelos Animais de Doenças , Gânglios Espinais/patologia , Gânglios Espinais/fisiopatologia , Neuralgia/patologia , Medição da Dor , Traumatismos dos Nervos Periféricos/patologia , Ondas de Rádio , Ratos , Ratos Sprague-Dawley
11.
Pain Med ; 12(9): 1361-75, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21914121

RESUMO

The practice of contemporary pain medicine is laced with a number of significant ethical challenges. Considerable difficulties include the overutilization of interventional procedures, the application of under-evidenced treatment modalities, and potentially superfluous opioid prescribing. As with many other fields in medicine, including orthopedic surgery, relationships with industry are both common and pervasive, and influence our medical practice through education, publications, and research. This article highlights these ethical challenges and broaches several physician-driven solutions: The Association for Medical Ethics, the Physicians Payment Sunshine inspired by it, and other non-legislative reforms are discussed.


Assuntos
Analgesia/ética , Dor Intratável/terapia , Padrões de Prática Médica/ética , Mecanismo de Reembolso/ética , Sociedades Médicas/ética , Analgesia/normas , California/epidemiologia , Humanos , Dor Intratável/epidemiologia , Padrões de Prática Médica/legislação & jurisprudência , Padrões de Prática Médica/tendências , Mecanismo de Reembolso/legislação & jurisprudência , Mecanismo de Reembolso/tendências , Sociedades Médicas/legislação & jurisprudência , Sociedades Médicas/normas
12.
Anesth Analg ; 113(3): 610-6, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21596869

RESUMO

BACKGROUND: Application of pulsed radiofrequency (PRF) currents to the dorsal root ganglia (DRG) has been reported to produce relief from certain pain states without causing thermal ablation. In this study, we examined the direct correlation between PRF application to DRG associated with spinal nerve injury and reversal of injury-induced behavioral hypersensitivity in a rat neuropathic pain model. METHODS: Neuropathic lesioning was performed via left L5 spinal nerve ligation on male adult Sprague-Dawley rats. Once the injured rats had developed tactile allodynia, one group was then assigned to PRF treatment of the L5 DRG and another group was assigned to the sham treatment to the DRG. Behavioral testing was performed on both the control and treated paws using the von Frey filament test before the surgery and at indicated days. The resulting data were analyzed using a linear mixed model to assess the overall difference between the treatment groups and the overall difference among the study days. Cohen's d statistic was computed from paired difference-from-baseline scores for each of the 14 study days after treatment and these measures of effect size were then used to descriptively compare the recovery patterns over time for each study group. RESULTS: Spinal nerve injury resulted in the development of behavioral hypersensitivity to von Frey filament stimulation (allodynia) in the hindpaw of the left (injury) side. Mixed linear modeling showed a significant difference between the treatment groups (P = 0.0079) and a significant change of paw withdrawal threshold means over time (P = 0.0006) for all 12 animals. Evaluation of Cohen's d (effect size) revealed that the PRF-treated animals exhibited better recovery and recorded larger effect sizes than the sham-treated animals on 10 of the 14 post-PRF treatment days and exhibited moderate-to-strong effects posttreatment at days 8 to 10 and at and beyond day 32. CONCLUSIONS: Findings from this study support that PRF of the DRG causes reversal of nerve injury (spinal nerve ligation)-induced tactile allodynia in rats. This allodynia reversal indicates that nonablative PRF acting via modulation of the DRG can speed recovery in nerve injury-induced pain.


Assuntos
Terapia por Estimulação Elétrica , Gânglios Espinais/fisiopatologia , Hiperalgesia/terapia , Neuralgia/terapia , Nervos Espinhais/fisiopatologia , Análise de Variância , Animais , Comportamento Animal , Modelos Animais de Doenças , Hiperalgesia/etiologia , Hiperalgesia/fisiopatologia , Hiperalgesia/psicologia , Ligadura , Modelos Lineares , Masculino , Neuralgia/etiologia , Neuralgia/fisiopatologia , Neuralgia/psicologia , Medição da Dor , Limiar da Dor , Ratos , Ratos Sprague-Dawley , Nervos Espinhais/cirurgia , Fatores de Tempo
13.
Pediatrics ; 125(6): e1372-8, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20498177

RESUMO

OBJECTIVES: Previous studies suggested that parents frequently do not adequately treat postoperative pain that is experienced at home. Reasons for these parental practices have not been extensively studied. Aims of this study were to examine parental postoperative pain assessment and management practices at home as well potential attitudinal barriers to such pain practices. METHODS: This was a longitudinal study involving 132 parents of children who were aged 2 to 12 years and undergoing elective outpatient surgery. Parental attitudes about pain assessment and management were assessed preoperatively, and children's pain severity and analgesic administration were assessed postoperatively for the first 48 hours after discharge. RESULTS: Although postoperative parental ratings indicated significant pain, parents provided a median of only 1 dose of analgesics (range: 0-3) during the first 48 hours after surgery. In the attitudinal survey, parents' responses have indicated significant barriers. For example, 52% of parents indicated that analgesics are addictive, and 73% reported worries concerning adverse effects. Also, 37% of parents thought that "the less often children receive analgesics, the better they work." Regression analysis demonstrated that, overall, more preoperative attitudinal barriers to pain management were significantly associated with provision of fewer doses of analgesics by parents (P < .05). CONCLUSIONS: Parents detected pain in their children yet provided few doses of analgesics. Parents may benefit from interventions that provide them with information that addresses individual barriers regarding assessing and treating pain.


Assuntos
Analgésicos/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Dor Pós-Operatória/prevenção & controle , Adulto , Atitude Frente a Saúde , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pais/psicologia
14.
Anesth Analg ; 110(1): 208-10, 2010 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-19861358

RESUMO

BACKGROUND: Data on the effect of Hemisync sounds on perioperative analgesic requirements are scant. METHODS: We randomized surgical outpatients into a treatment group that received Hemisync sounds (n = 20), a music group that received music (n = 20), and a control group that had a blank cassette tape (n = 20). All subjects underwent a controlled standardized propofol-nitrous-vecuronium and fentanyl general anesthesia. RESULTS: The treatment group had significantly reduced intraoperative fentanyl consumption (P < 0.05). Postoperatively, pain visual analog scale scores were significantly lower in the Hemisync group at 1 h (P = 0.02) and 24 h (P = 0.005). Subjects in the Hemisync group were also discharged earlier (P = 0.048). CONCLUSION: The use of Hemisync sounds before and during general anesthesia reduces intraoperative analgesic requirements, postoperative pain scores, and discharge time.


Assuntos
Estimulação Acústica , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Dor/tratamento farmacológico , Assistência Perioperatória , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestesia Geral , Sincronização Cortical , Método Duplo-Cego , Determinação de Ponto Final , Feminino , Fentanila/administração & dosagem , Fentanila/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Dor/prevenção & controle , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Adulto Jovem
15.
Neurotherapeutics ; 6(4): 679-92, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19789072

RESUMO

Voltage-gated calcium channels (VGCC) play obligatory roles in diverse physiological functions. Pathological conditions leading to changes in their biophysical properties and expression levels may cause malfunctions of VGCC-mediated activities, resulting in disease states. It is believed that changes in VGCC properties under pain-inducing conditions may play a causal role in the development of chronic pain, including nerve injury-induced pain or neuropathic pain. For the past several decades, preclinical and clinical research in developing VGCC blockers or modulators for chronic pain management has been fruitful, leading to some U.S. Food and Drug Administration-approved drugs currently available for chronic pain management. However, their efficacy in pain relief is limited in some patients, and their long-term use is limited by their side-effect profiles. Certainly, there is room for improvement in developing more subtype-specific VGCC blockers or modulators for chronic pain conditions. In this review, we summarized the most recent preclinical and clinical studies related to chronic pain medications acting on the VGCC. We also included clinical trials aiming to expand the application of approved VGCC drugs to different pain states derived from various pathological conditions, as well as drug combination therapies trying to improve the efficacies and side-effect profiles of current pain medications.


Assuntos
Canais de Cálcio/metabolismo , Moduladores de Transporte de Membrana/uso terapêutico , Neuralgia/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Animais , Humanos , Neuralgia/metabolismo , Doenças do Sistema Nervoso Periférico/metabolismo
16.
Anesth Analg ; 108(6): 1777-82, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19448201

RESUMO

BACKGROUND: In this investigation, we sought to assess the ability of pediatric attending anesthesiologists, resident anesthesiologists, and mothers to predict anxiety during induction of anesthesia in 2 to 16-yr-old children (n = 125). METHODS: Anesthesiologists and mothers provided predictions using a visual analog scale and children's anxiety was assessed using a valid behavior observation tool the Modified Yale Preoperative Anxiety Scale. All mothers were present during anesthetic induction and no child received sedative premedication. Correlational analyses were conducted. RESULTS: A total of 125 children aged 2-16 yr, their mothers, and their attending pediatric anesthesiologists and resident anesthesiologists were studied. Correlational analyses revealed significant associations between attending predictions and child anxiety at induction (r(s) = 0.38, P < 0.001). Resident anesthesiologist and mother predictions were not significantly related to children's anxiety during induction (r(s) = 0.01 and 0.001, respectively). In terms of accuracy of prediction, 47.2% of predictions made by attending anesthesiologists were within one standard deviation of the observed anxiety exhibited by the child, and 70.4% of predictions were within two standard deviations. CONCLUSIONS: We conclude that attending anesthesiologists who practice in pediatric settings are better than mothers in predicting the anxiety of children during induction of anesthesia. Although this finding has significant clinical implications, it is unclear if it can be extended to attending anesthesiologists whose practice is not mostly pediatric anesthesia.


Assuntos
Ansiedade/diagnóstico , Ansiedade/psicologia , Cuidados Pré-Operatórios/psicologia , Adolescente , Anestesia/psicologia , Ansiedade/etiologia , Criança , Pré-Escolar , Emoções , Feminino , Pessoal de Saúde , Humanos , Comportamento Impulsivo/psicologia , Masculino , Mães , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica , Comportamento Social , Temperamento , Resultado do Tratamento
17.
Clin Geriatr Med ; 22(2): 331-54; ix, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16627082

RESUMO

The use of the physical modalities in the treatment of musculoskeletal conditions has a long and rich history. This article explores the various physical modalities and their indications, precautions, and contraindications, especially in their applied use in pain management. It also highlights the role of the physical modalities as agents for the management of pain in the geriatric population.


Assuntos
Pessoas com Deficiência/reabilitação , Guias como Assunto , Dor/reabilitação , Modalidades de Fisioterapia , Idoso , Idoso de 80 Anos ou mais , Analgésicos/uso terapêutico , Avaliação da Deficiência , Feminino , Temperatura Alta/uso terapêutico , Humanos , Hidroterapia/métodos , Masculino , Medição da Dor , Prognóstico , Medição de Risco , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento , Terapia por Ultrassom/métodos
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