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Biomedical subjects

Julie Bruce

Publications and source records attributed to Julie Bruce.

13 recordsLinked to original sources
PubMed2006

Quality of life and chronic pain four years after gastrointestinal surgery.

PURPOSE: Little is known about the prevalence of chronic postsurgical pain after gastrointestinal surgery. This study was designed to assess the prevalence of chronic pain and quality of life in a cohort of patients who underwent surgery for benign and malignant gastrointestinal disease. METHODS: A prospective cohort design was used to assess quality of life and morbidity at four years postoperatively in 435 patients who had upper, hepatopancreaticobiliary, small-bowel, and/or colorectal anastomotic surgery in 1999 at one regional center in Northeast Scotland. Chronic pain and quality of life were assessed by postal survey using the European Organization for Research and Treatment of Cancer Quality of Life-C30 questionnaire and McGill Pain Questionnaire. RESULTS: Of the 435 patients recruited in 1999, 135 (31 percent) had died by censor date in 2003. There was a 74 percent (n = 202) response rate from surviving patients eligible for follow-up. Prevalence of chronic pain at four years postoperatively was 18 percent (95 percent confidence interval, 13-23 percent). Pain was predominantly neuropathic in character; a subgroup reported moderate-to-severe pain. Risk factors for chronic postsurgical pain included female gender, younger age, and surgery for benign disease. Compared with those who were pain-free at follow-up, patients with chronic pain had poorer functioning, poorer global quality of life, and more severe symptoms, independent of age, gender, and cancer status. CONCLUSIONS: The prevalence of chronic pain after laparotomy for gastrointestinal malignancy and nonmalignant conditions at four years after surgery was 18 percent. These patients had significantly poorer quality of life scores independent of age, gender, and cancer status.

Abdominal Pain↗
PubMed2006

A United Kingdom survey of surgical technique and handling practice of inguinal canal structures during hernia surgery.

BACKGROUND: Recent trials have assessed the impact of elective nerve division on patient outcome after inguinal herniorrhaphy. The aim of this study was to establish UK surgical practice of handling of structures in the inguinal canal during herniorrhaphy. METHODS: A cross-sectional survey of all Fellows (n = 1113) of the Association of Surgeons of Great Britain and Ireland (ASGBI) was performed. The main outcomes were to determine method of inguinal hernia repair and routine practice for intra-operative handling of structures in the inguinal canal. RESULTS: A total of 852 (77%) questionnaires were returned, of which 784 (92%) surgeons performed inguinal herniorrhaphy. Approximately two-thirds (63%) of responding surgeons performed less than 50 procedures per annum and 37% conducted more than 50 procedures annually. Mesh was the preferred method used by 90% of surgeons; 6% used non-mesh, and 4% used other (laparoscopic) methods. Routine practice in relation to the inguinal structures varied by volume of hernia surgery; surgeons who conducted more than 50 procedures annually were more likely to visualize and preserve inguinal nerve structures. However, inconsistency in the answers suggested confusion over anatomy. CONCLUSION: This is the first UK survey to investigate method of hernia repair and usual handling practice of inguinal canal structures. There was wide acceptance of the use of mesh in inguinal hernia repair, with the majority of UK surgeons favoring an open approach. Surgeons performing high volumes of herniorrhaphy were more likely to preserve, rather than transect, inguinal nerve structures. This variation in practice may confound assessment of long-term neuralgia and other post-herniorrhaphy pain syndromes.

Cross-Sectional Studies↗
PubMed2006

Systematic reviews in midwifery.

This paper highlights the key steps to follow when conducting a systematic review (see Box 2). Healthcare practitioners may be limited by time and resources when conducting literature reviews, however, a systematic and transparent approach should be adopted wherever possible. Further detailed guidance on conducting systematic reviews is available from the NHS Centre for Reviews and Dissemination (NHS CRD, 2001) and the Cochrane Reviewers' Handbook (Alderson et al, 2003).

Databases, Bibliographic↗
PubMed2003

Bioterrorism meets privacy: an analysis of the Model State Emergency Health Powers Act and the HIPAA privacy rule.

Ms. Bruce's paper analyzes the interplay between the Model State Emergency Health Powers Act and the HIPAA Privacy Rule. The article begins by examining specific relevant provisions of the Act and Rule. Next, it traces the history of public health law through the court system and then uses this foundation to discuss how the Model State Emergency Health Powers Act and the HIPAA Privacy Rule could co-exist, protecting Americans in the case of a bioterror attack, while being appropriately sensitive to the confidentiality of private health information.

Bioterrorism↗
PubMedDate not supplied

A review of chronic pain after inguinal herniorrhaphy.

BACKGROUND: Chronic pain was believed to be a recognized but infrequent complication after inguinal hernia repair. Evidence suggests that patients with chronic pain place a considerable burden on health services. However, few scientific data on chronic pain after this common elective operation are available. OBJECTIVES: To review the frequency of chronic pain and to discuss etiological theories and current treatment options for patients with chronic post herniorrhaphy pain. MATERIALS AND METHODS: All studies of postoperative pain after inguinal hernia repair with a minimum follow-up period of 3 months, published between 1987 and 2000, were critically reviewed. RESULTS AND DISCUSSION: The frequency of chronic pain after inguinal hernia repair was found to be as high as 54%, much more than previously reported. Quality of life of these patients is affected. Chronic pain is reported less often after laparoscopic and mesh repairs. Recurrent hernia repair, preoperative pain, day case surgery, delayed onset of symptoms, and high pain scores in the first week after surgery, however, were identified to be risk factors for the development of chronic pain. Definition of chronic pain was not explicit in the majority of the reviewed studies. Accurate evaluation of the frequency of chronic pain will require standardization of definition and methods of assessment. Prospective studies are required to define the role of risk factors identified in this review.

Chronic Disease↗
PubMedDate not supplied

Quantitative assessment of chronic postsurgical pain using the McGill Pain Questionnaire.

OBJECTIVES: The McGill Pain Questionnaire (MPQ) provides a quantitative profile of 3 major psychologic dimensions of pain: sensory-discriminative, motivational-affective, and cognitive-evaluative. Although the MPQ is frequently used as a pain measurement tool, no studies to date have compared the characteristics of chronic post-surgical pain after different surgical procedures using a quantitative scoring method. METHODS: Three separate questionnaire surveys were administered to patients who had undergone surgery at different time points between 1990 and 2000. Surgical procedures selected were mastectomy (n = 511 patients), inguinal hernia repair (n = 351 patients), and cardiac surgery via a central chest wound with or without saphenous vein harvesting (n = 1348 patients). A standard questionnaire format with the MPQ was used for each survey. The IASP definition of chronic pain, continuously or intermittently for longer than 3 months, was used with other criteria for pain location. The type of chronic pain was compared between the surgical populations using 3 different analytical methods: the Pain Rating Intensity score using scale values, (PRI-S); the Pain Rating Intensity using weighted rank values multiplied by scale value (PRI-R); and number of words chosen (NWC). RESULTS: The prevalence of chronic pain after mastectomy, inguinal herniorrhaphy, and median sternotomy with or without saphenectomy was 43%, 30%, and 39% respectively. Chronic pain most frequently reported was sensory-discriminative in quality with similar proportions across different surgical sites. Average PRI-S values after mastectomy, hernia repair, sternotomy (without postoperative anginal symptoms), and saphenectomy were 14.06, 13.00, 12.03, and 8.06 respectively. Analysis was conducted on cardiac patients who reported anginal symptoms with chronic post-surgical pain (PRI-S value 14.28). Patients with moderate and severe pain were more likely to choose more than 10 pain descriptors, regardless of the operative site (P < 0.05). DISCUSSION: The prevalence and characteristics of chronic pain was remarkably similar across different operative groups. This study is the first to quantitatively compare chronic post-surgical pain using similar methodologies in heterogeneous post-surgical populations.

Aged↗