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David H Goldstein

Publications and source records attributed to David H Goldstein.

14 recordsLinked to original sources
PubMed2006

Pain, health-related quality of life and health care utilization after inpatient surgery: a pilot study.

BACKGROUND: Little is known about pain-related outcomes in surgical inpatients after discharge from the hospital. An ongoing risk and outcomes monitoring system would provide valuable feedback to improve the quality of patient care. OBJECTIVES: The purpose of the present pilot study was to describe postoperative pain, medication use, health care utilization and health-related quality of life (HRQOL) immediately and four weeks after surgery; merge clinically captured data with Web-based follow-up data; and examine patients' willingness to complete Web-based health questionnaires. METHODS: One hundred two consecutive surgical inpatients were approached for participation. Perioperative data were abstracted from the acute pain management service clinical database and linked to follow-up data captured four weeks postoperatively. RESULTS: Follow-up questionnaires were completed by 88 participants. Clinical assessment data were successfully linked to Web-based follow-up data. Average pain intensity (3.7) four weeks following discharge fell just short of the acute pain management service active pain score of 3.9. At four weeks, all 88 participants reported significantly impaired HRQOL, 36 were still taking pain medications and 15 had visited an emergency room. Two-thirds of the participants had access to the Internet at home and approximately one-half were willing to complete on-line health questionnaires. DISCUSSION: The study indicates that it is feasible to link clinical and research data, and shows a significant burden of pain and reduced HRQOL in the weeks following discharge. This approach to converting clinically captured data into meaningful information about surgical outcomes is valuable in the development of an ongoing risk and outcomes monitoring system.

Adolescent↗
PubMed2005

A comparison of paper with electronic patient-completed questionnaires in a preoperative clinic.

UNLABELLED: In this unblinded randomized control trial we compared electronic self-administered Pre-Admission Adult Anesthetic Questionnaires (PAAQ) using touchscreen technology with pen and paper. Patients were recruited in the Pre-assessment Clinic if they had completed a PAAQ in the surgeon's office. Patients were randomized to study PAAQ using paper, hand-held computer (PDA), touchscreen desktop computer (kiosk), or tablet. Patients also completed a preference and satisfaction survey. The main outcome measures were percent agreement between the prestudy and study PAAQ and time to completion. Only six of the 366 patients approached refused to participate. The median time to completion of the PAAQ was shortest on the kiosk (2.3 min) and longest on the PDA (3.2 min) (chi2 = 14.5; P = 0.002). The mean agreement between the prestudy and the study PAAQ was approximately 94% across all study arms. The proportion of participants expressing comfort before and after completing the PAAQ increased from 10% to 97% on the computerized arms and from 60% to 64% on the paper arm. Touchscreen computer technology is an accurate, efficient platform for patient-administered PAAQ. Patients expressed comfort using the technology and preference for computerized versus paper for future questionnaires. IMPLICATIONS: Self-administered electronic health questionnaires using touchscreen computer technology are an accurate means of collecting patient information in the preoperative setting and can provide a valuable basis for an electronic perioperative patient record. Patients expressed comfort and satisfaction with this method of questionnaire completion.

Adolescent↗
PubMed2004

In Canada, anesthesiologists are less likely to respond to an electronic, compared to a paper questionnaire.

PURPOSE: A randomized unblinded controlled trial was used to assess the utility of electronic questionnaires in a survey of Canadian anesthesiologists. METHODS: Postal or electronic questionnaires were sent between November 2001 and March 2002 to 1,333 anesthesiologists registered with the Canadian Anesthesiologists' Society. The primary outcome measure was the difference in response rates between electronic and postal questionnaires. Secondary outcome measures included a comparison of demographic characteristics, cost, and knowledge and practice regarding prophylactic perioperative beta blockade. RESULTS: The overall response rate was 52%. E-mail participants were half as likely as postal participants to respond to the questionnaire (35% vs 69%, relative risk = 0.51, 95% confidence interval 0.45-0.58). Respondents who provided an e-mail address were younger and more likely to be affiliated with an academic institution. There were no significant differences in responses to knowledge and practice questions. The electronic arm was faster than the postal arm and the cost per reply was one-third the cost of the postal arm (2.50 dollars vs 8.02 dollars). CONCLUSIONS: Electronic surveys are a means of acquiring information from a large number of individuals in a rapid, efficient and cost-effective manner. This methodology may be particularly valid and useful in surveys of participants with similar backgrounds and internet access. However the lower response rates achieved as compared with postal surveys indicates a need to use vigilance when generalizing results to a broader population.

Academic Medical Centers↗
PubMed2004

Acute pain management services have progressed, albeit insufficiently in Canadian academic hospitals.

PURPOSE: Acute pain management services (APMS) evolved in response to the desire for improved management of postoperative pain. The management of postoperative pain received formal support from international organizations over the past decade and by 1993 half of the Canadian university-affiliated teaching hospitals had implemented an APMS. The purpose of this survey was to describe APMSs in Canadian academic institutions, with specific emphasis on postoperative analgesics, new analgesic methods, training and research. METHODS: Between June 2000 and January 2001, 62 Canadian hospitals affiliated with the 16 Canadian university anesthesiology departments were sent a postal questionnaire. RESULTS: Fifty of the 62 respondents returned a completed questionnaire representing a response rate of 81%. Eighty percent of the hospitals surveyed had at least 200 beds, 90% (45) had implemented an APMS. Anesthesiology was primarily responsible in all 45 hospitals with an APMS. The results presented are based on the 45 centres with an APMS. CONCLUSION: Since the early 1990s the percent of Canadian academic hospitals with an APMS has increased from 53% to 92%. These figures are comparable to the United States. Greater collaboration from nursing and pharmacy, mandatory training for medical and nursing students and residents, and a standardized approach to continuous quality improvement remain necessary.

Acute Disease↗
PubMed2004

Recommendations for improved acute pain services: Canadian collaborative acute pain initiative.

The Canadian Collaborative Acute Pain Initiative, established in 2002, is a voluntary, multidisciplinary consortium of acute pain health professionals from across Canada whose goal is to improve acute pain management through discussion and consensus. The group met in January 2002 to define strategic areas related to the treatment of acute pain. The areas identified were: the definition of pain; the epidemiology of pain; the concept of an 'ideal' acute pain management service; education; therapeutic options; symptom management; and research and safety. In November 2002, a second meeting was held to develop objectives and recommendations for the management of acute pain based on the defined areas. The outcome of these discussions is summarized in this paper.

Canada↗
PubMed2003

Using a personal digital assistant enhances gathering of patient data on an acute pain management service: a pilot study.

PURPOSE: Handheld computer technology provides a unique opportunity for health care professionals to access real time or near real time patient information and evidence-based resources at the point-of-care. The purpose of this study was to assess one physician's experience using acute pain assessment software on a personal digital assistant (PDA) to assess patients on an acute pain management service (APMS). METHODS: Using a historical control and a "time and motion" study design, comparisons were made on acute pain assessment time and comprehensiveness when patient assessments are documented on a PDA vs the current paper-based method. RESULTS: The study physician (a PDA-user) reported feeling comfortable with the assessment software after five patient assessments. PDA assessments were more likely to contain documentation regarding pain and side effects (e.g., nausea, pruritus, hypotension) than the paper assessments. The median time of the "assessment only" component of the patient encounter was 53 sec longer using the PDA compared to paper (P < 0.00), however, the median "total encounter" (chart review, assessment, documentation) time was 74 sec shorter using the PDA vs paper (P < 0.00). DISCUSSION: The findings of this preliminary study suggest that the PDA is a reliable tool that meets the data management requirements within an APMS setting. This study found that patient assessments documented using acute pain software developed for use on a PDA were as efficient and content-rich as paper assessments. The PDA may even enhance the efficiency of the patient assessment process through the provision of more comprehensive digital data for research, clinical, and administrative needs.

Computers, Handheld↗
PubMed2003

The impact of sampling and measurement on the prevalence of self-reported pain in Canada.

BACKGROUND: Pain is an important public health problem in Canada. International estimates of general population pain prevalence range from 2% to 46%. OBJECTIVES: The purpose of this paper is to critically examine the potentially misleading use of overall prevalence estimates in the pain literature and to use two Canadian population-based surveys to assess the impact of sampling and measurement on prevalence. METHODS: Two of the secondary data sets used were the 1996/97 National Population and Health Survey (NPHS) and the Canadian Multicentre Osteoporosis Study (CaMos). This paper is based on the assessment of chronic pain in the NPHS, and the assessment of short term pain using the Medical Outcomes Trust's 36-item health survey and the Health Utilities Index, both collected by CaMos. Data are presented as frequencies and percentages overall and stratified by age and sex. CaMos prevalence estimates were age- and sex-standardized to the NPHS population. RESULTS: The overall prevalence of pain was 39% for one-week pain, 66% for four-week pain and 15% for chronic pain. Women were more likely to report pain than men and the prevalence of pain increased with age. CONCLUSIONS: This study yields useful information about the self-reported responses to a variety of questions assessing pain in the general population. Responses to the different questions likely represent different categories of pain, such as short term versus chronic pain, which in turn may have different epidemiological risk factors and profiles. Longitudinal studies of the epidemiology, predictors and natural history of chronic pain are urgently needed in the Canadian population.

Adult↗
PubMed2002

The relationship between movement-evoked versus spontaneous pain and peak expiratory flow after abdominal hysterectomy.

UNLABELLED: The pathogenesis of postoperative lung dysfunction implies a role for movement-evoked pain (e.g., splinting/hypoventilation because of pain avoidance). However, interactions between evoked pain and respiratory physiology are poorly understood. Thus, we examined the relationship between evoked versus spontaneous pain and one index of pulmonary function. In 25 patients having undergone a hysterectomy, visual analog scale ratings (100 mm) for spontaneous pain (REST) and pain during sitting (SIT), forced expiration (BLOW), and coughing (COUGH) were measured together with peak expiratory flow (PEF) at eight time points during postoperative Days 1 and 2. Secondary outcome measures included oxygen saturation and oxygen requirements. Pain was significantly correlated with PEF for COUGH, SIT, BLOW, and REST at eight, seven, four, and two of the eight studied time points, respectively. Mean visual analog scale scores [SE] for COUGH (26.1 mm [1.7]) and SIT (21.5 mm [1.5]) were greater (P < 0.05) than REST (10.5 mm [0.8]), and COUGH was greater (P < 0.05) than BLOW (16.8 mm [1.3]). All pain measures diminished (P < 0.05), and PEF reductions improved (P < 0.05) across the study period. We hypothesize that the consistent negative correlation of COUGH-evoked pain with PEF is, in part, caused by avoidance of coughing, which ultimately limits deep inspiration, lung reexpansion, and clearance of secretions. IMPLICATIONS: Movement-evoked pain may be an important contributor to postoperative complications, but its mechanisms are poorly understood. This study provides the first evidence that postoperative evoked pain correlates with lung function and highlights the need for future research on mechanisms and implications of this phenomenon.

Adult↗
PubMedDate not supplied

A survey of directors of Canadian academic acute pain management services: the nursing team members role--a brief report.

PURPOSE: The purpose of this study was to identify Canadian academic centres with Acute Pain Management Service (APMS), and to describe the nature of nursing involvement on the APMS. METHODS: Departments of Anesthesiology in the 16 Canadian medical schools were contacted to obtain a list of affiliated hospitals and the person most responsible for acute pain. A questionnaire designed to gain insight into nursing involvement on APMS was sent out to the 62 hospitals between June 2000 and January 2001. RESULTS: Seventy-six percent of centres responded and of these 89% (n = 42) had an APMS. In 76% of APMS nursing was involved on the service. Sixty-two percent (n = 26) had a designated nursing team member on the APMS who contributed in the realms of patient care, staff and patient education, and administrative development. The APMS nurse performed patient rounds independently (62%) and with a physician (64%). Decision-making was primarily the responsibility of anesthesiology, however, the APMS nurse (38%) and the bedside nurse (23%) were involved in some centres. The highest educational attainment in the 26 hospitals with an APMS nurse was, diploma RN (27%), BScN (31%) and MSc (12%). The distribution of advance practice nursing was nurse practitioner (12%), clinical nurse specialist (27%), or both (8%). CONCLUSION: Nursing played an important role on the APMS, however, quality acute pain management can only be achieved with continuing efforts by anesthesiology, nursing and hospital administration to support the role of nurses as essential members of the acute pain team.

Academic Medical Centers↗
PubMedDate not supplied

Definitions of "respiratory depression" with intrathecal morphine postoperative analgesia: a review of the literature.

PURPOSE: To review the postoperative intrathecal morphine (ITM) analgesia literature for their definitions of "respiratory depression" (RD). SOURCE: Medline (1966 - June Week 5 2001) and reference lists were searched for original studies involving bolus-dose ITM for postoperative analgesia, which used "respiratory depression" or similar terms. PRINCIPLE FINDINGS: The search identified 209 studies. These were included if ITM use was appropriate (bolus dose, postoperative analgesia) and the term "respiratory depression" was used, which left 96 studies remaining. Forty-four (46%) did not define "RD" despite using this term. A further 24 (25%) defined RD with respiratory rate (RR) alone. Only 28 (29%) defined RD with more than RR alone. There was no statistically significant association between the presence of a definition for RD with study design, study size or publication period. Also, no significant association existed between rigorousness of RD definitions and the above factors. CONCLUSION: The term "respiratory depression" has no clear definition from a review of the literature on ITM use for postoperative analgesia. While defining RD with bradypnea is superior to having no definition, this is still inadequate. In future research, the consistent use of terms with specific meanings will facilitate understanding the true incidence of ITM's respiratory effects. If "respiratory depression" is used, then an explicit definition of its meaning should be provided. Future research must also address what is clinically significant respiratory impairment from intrathecal opioids, and how to optimally monitor for this. Further delineating their risks vs benefits will allow for more optimal dosing.

Analgesics, Opioid↗
PubMedDate not supplied

How do patients perceive electronic documentation at the bedside?

Electronic patient records provide an opportunity for real-time access to patient information at the bedside, which has the potential to improve healthcare quality because it would increase efficiency and facilitate best practice. Patients in this study reported that portable computers used at the bedside did not affect the clinician-patient relationship. Many patients thought that the technology was a valuable tool and that it could foster an efficient hospital atmosphere and promote reliable and accurate medical documentation.

Hospital Information Systems↗