Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel.
chronic pain; COVID-19; COVID-19; epidural steroid injections; immune; management; opioid therapy; opioids; population; prevalence; prevention; quality-of-life; recommendations; risk; steroids; united-states
Chronic pain causes significant suffering, limitation of daily activities and reduced quality of life. Infection from COVID-19 is responsible for an ongoing pandemic that causes severe acute respiratory syndrome, leading to systemic complications and death. Led by the World Health Organization, healthcare systems across the world are engaged in limiting the spread of infection. As a result, all elective surgical procedures, outpatient procedures and patient visits, including pain management services, have been postponed or cancelled. This has affected the care of chronic pain patients. Most are elderly with multiple comorbidities, which puts them at risk of COVID-19 infection. Important considerations that need to be recognised during this pandemic for chronic pain patients include: ensuring continuity of care and pain medications, especially opioids; use of telemedicine; maintaining biopsychosocial management; use of anti-inflammatory drugs; use of steroids; and prioritising necessary procedural visits. There are no guidelines to inform physicians and healthcare providers engaged in caring for patients with pain during this period of crisis. We assembled an expert panel of pain physicians, psychologists and researchers from North America and Europe to formulate recommendations to guide practice. As the
Shanthanna H; Strand N H; Provenzano D A; Lobo C A; Eldabe S; Bhatia A; Wegener J; Curtis K; Cohen S P; Narouze S
Anaesthesia
2020
2020-04-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1111/anae.15076" target="_blank" rel="noreferrer noopener">10.1111/anae.15076</a>
Preventive Care In The Emergency Department, Part Ii: Clinical Preventive Services - An Emergency Medicine Evidence-based Review
Counseling; Emergency Medicine; emergency services; prevention; quality; recommendations; review; screening; trials
Introduction: Emergency departments (EDs) provide an opportunity to initiate preventive services for millions of Americans who have no other source for these services. Objectives: To identify primary and secondary preventive interventions appropriate for inclusion in routine emergency care and, secondarily, to recommend areas in which research into the efficacy and cost-effectiveness of interventions is needed. Methods: Systematic reviews were performed on 17 candidate preventive interventions with potential applicability in the ED. All but one was selected from those reviewed by the U.S. Preventive Services Task Force (USPSTF. Each two-person review team followed a template that provided a uniform approach to search strategy, selection criteria, methodology appraisal, and analysis of the results of primary studies bearing on ED cost-effectiveness. Assigned proctors provided methodological guidance to the review teams throughout the review process. A grading scheme was developed that took into account the evidence and recommendations of the USPSTF supporting primary efficacy of the intervention and the level of evidence supporting ED application identified by the Society for Academic Emergency Medicine Public Health and Education Task Force (PHTF) review teams. Results: Seventeen reviews were completed. The following interventions received an alpha rating, indicating that evidence is sufficient to support offering these services in the ED setting, assuming sufficient resources are available: alcohol screening and intervention, HN screening and referral tin high-risk, high-prevalence populations), hypertension screening and referral, adult pneumococcal immunizations (age greater than or equal to 65 years), referral of children without primary care physicians to a continuing source of care, and smoking cessation counseling. Interventions receiving a beta or gamma rating, indicating that existing research is not sufficient to recommend for or against instituting them routinely in the ED, include: identification and counseling of geriatric patients at risk of falls, Pap tests in women having a pelvic exam in the ED, counseling for smoke detector use, routine social service screening, depression screening, domestic violence screening, safe firearm storage counseling, motorcycle helmet use counseling, and youth violence counseling programs in the ED. Interventions not recommended for ED implementation (omega rating) include Pap test screening for women not having a routine pelvic exam, diabetes screening, and pediatric immunizations. Conclusions: A set of recommendations for prevention, screening, and counseling activities in the ED based on systematic reviews of selected interventions is presented. The applicability of these primary and secondary preventive services will vary with the different clinical environments and resources available in EDs. The PHTF recommendations should not be used as the basis of curtailing currently available services. This review makes clear the need for further research in this important area.
Irvin C B; Wyer P C; Gerson L W; Soc Acad Emergency Med Public Hlth
Academic Emergency Medicine
2000
2000-09
Journal Article or Conference Abstract Publication
n/a
Identification And Ablation Of Dormant Conduction In Atrial Fibrillation Using Adenosine
Ablation; Adenosine; antiarrhythmic-drug therapy; Arrhythmias; Atrial fibrillation; catheter ablation; Electrophysiology; end-points; expert consensus; follow-up; General & Internal Medicine; patient-management; procedural techniques; pulmonary vein isolation; recommendations; statement; surgical ablation
Luni F K; Khan A R; Singh H; Riaz H; Malik S A; Khawaja O; Farid T; Cummings J; Taleb M
American Journal of the Medical Sciences
2018
2018-01
Journal Article or Conference Abstract Publication
n/a
Biochemical Disease-free Survival Rates Following Definitive Low-dose-rate Prostate Brachytherapy With Dose Escalation To Biologic Target Volumes Identified With Spect/ct Capromab Pendetide
adenocarcinoma; brachytherapy; BTV; cancer; conformal radiation-therapy; dosimetry; external-beam radiation; failure definition; hormonal-therapy; Nuclear Medicine & Medical Imaging; Oncology; ProstaScint; prostascint(r); prostate; Radiology; radiotherapy; recommendations; SPECT/CT; survival
Ellis R J; Zhou H; Kim E Y; Fu P F; Kaminsky D A; Sodee B; Colussi V; Vance W Z; Spirnak J P; Kim C; Resnick M I
Brachytherapy
2007
2007-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.brachy.2006.11.002" target="_blank" rel="noreferrer noopener">10.1016/j.brachy.2006.11.002</a>
Single Photon Emission Computerized Tomography With Capromab Pendetide Plus Computerized Tomography Image Set Co-registration Independently Predicts Biochemical Failure
capromab pendetide; emission-computed; localized prostate-cancer; prostatic neoplasms; radiation-therapy; radiotherapy; recommendations; single-photon; tomography; Urology & Nephrology
Ellis R J; Zhou E H; Fu P; Kaminsky D A; Sodee D B; Faulhaber P F; Bodner D; Resnick M I
Journal of Urology
2008
2008-05
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.juro.2008.01.025" target="_blank" rel="noreferrer noopener">10.1016/j.juro.2008.01.025</a>
Executive Summary: IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults
Infectious Diseases; Microbiology; Immunology; quality; grade; consensus; recommendations
Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.
Chow A W; Benninger M S; Brook I; Brozek J L; Goldstein E J C; Hicks L A; Pankey G A; Seleznick M; Volturo G; Wald E R; File T M
Clinical Infectious Diseases
2012
2012-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1093/cid/cir1043" target="_blank" rel="noreferrer noopener">10.1093/cid/cir1043</a>
Consensus on Elastography of the Liver Response
guidelines; Radiology; stiffness; transient elastography; Nuclear Medicine & Medical Imaging; fibrosis; recommendations; clinical-use; noninvasive assessment; arfi
Barr R G; Ferraioli G; Levine D
Radiology
2016
2016-01
Journal Article or Conference Abstract Publication
n/a
The Role of Sonoelastography in Breast Lesions
liver; experience; strain elastography; guidelines; Radiology; elasticity; Nuclear Medicine & Medical Imaging; masses; recommendations; shear-wave elastography; clinical-use; ultrasound elastography; wfumb
There is a large body of published material that supports the use of elastography, both strain and shear wave, for characterization of breast lesions. To a lesser extent, elastography can be used in the detection of breast abnormalities. This article reviews the principles of elastography regarding breast imaging, reviews the techniques to perform both strain and shear wave elastography, and reviews the literature and discusses how elastography can be used to improve the characterization of breast lesions to allow for decrease in the number of short-term follow-up examinations and benign biopsies. (C) 2018 Elsevier Inc. All rights reserved.
Barr R G
Seminars in Ultrasound Ct and Mri
2018
2018-02
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1053/j.sult.2017.05.010" target="_blank" rel="noreferrer noopener">10.1053/j.sult.2017.05.010</a>
An initial study of complete 2D shear wave dispersion images using a reverberant shear wave field
benign; clinical-use; deep; Diagnosis; elastography; Engineering; Nuclear Medicine & Medical Imaging; Radiology; recommendations; reverberant shear wave field; shear dispersion; shear elastography; soft; tissue; tissue viscoelasticity; viscoelasticity; wfumb guidelines
Within the field of elastography, a relatively new approach analyzes the limiting case of shear waves established as a reverberant field. In this framework, it is assumed that a distribution of shear waves exists, oriented across all directions in 3D and continuous in time. The simultaneous multi-frequency application of reverberant shear wave fields can be accomplished by applying an array of external sources that can be excited by multiple frequencies within a bandwidth, for example 50, 100, 150, ..., 500 Hz, all contributing to the shear wave field produced in the liver or other target organ. This enables the analysis of the dispersion of shear wave speed as it increases with frequency, indicating the viscoelastic and lossy nature of the tissue under study. Furthermore, dispersion images can be created and displayed alongside the shear wave speed images. We report preliminary studies on breast and liver tissues using the multi-frequency reverberant shear wave technique, employing frequencies up to 700 Hz in breast tissue, and robust reverberant patterns of shear waves across the entire liver and kidney in obese patients. Dispersion images are shown to have contrast between tissue types and with quantitative values that align with previous studies.
Ormachea J; Parker K J; Barr R G
Physics in Medicine and Biology
2019
2019-07
<a href="http://doi.org/10.1088/1361-6560/ab2778" target="_blank" rel="noreferrer noopener">10.1088/1361-6560/ab2778</a>
A Clinical Study Comparing the Diagnostic Performance of Assist Strain Ratio Against Manual Strain Ratio in Ultrasound Breast Elastography
breast cancer; elastography; cancer; guidelines; Radiology; elasticity; strain; Nuclear Medicine & Medical Imaging; us; recommendations; society; strain ratio; fat-to-lesion ratio; FLR
Objective Strain ratio (SR) is a semiquantitative parameter in differentiating benign from malignant tumors in breast ultrasound elastography. Currently, SR is computed manually and, thus, user dependent. The objective of this study was to evaluate the performance of a new tool assist strain ratio (ASR) and determine how it performs compared with an expert sonologist. Methods Ninety-one patients scheduled for breast biopsy were included in this institutional review board-approved/Health Insurance Portability and Accountability Act-compliant study. For manual strain ratio (MSR), fat and lesion were manually outlined, whereas for ASR, the clinician indicated the lesion center and the fat-to-lesion ratio is computed automatically. Three measurements were obtained for each lesion. The same raw data were used to calculate the MSR and ASR. Results The SR thresholds to differentiate benign from malignant tumors were determined using the Youden index. For MSR, the cutoff was 2.7, and for ASR was 2.8. The MSR showed a sensitivity of 88%, specificity of 64%, accuracy of 77%, positive predictive value of 72%, and negative predictive value of 92.1%. Corresponding ASR showed a sensitivity of 86%, specificity of 76%, accuracy of 81%, positive predictive value of 79%, and negative predictive value of 84%. The areas under the curve for the MSR and ASR were 0.83 and 0.85, respectively. The average coefficients of variation for the MSR and ASR measurements were 43% and 30%, respectively. Conclusion Assist strain ratio demonstrated similar diagnostic performance compared with MSR. In addition, the coefficient of variation of ASR is lower, implying lower intraoperator dependency. Thus, ASR may aid less-experienced scanners in obtaining improved results.
Barr R G; Managuli R A
Ultrasound Quarterly
2019
2019-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/ruq.0000000000000398" target="_blank" rel="noreferrer noopener">10.1097/ruq.0000000000000398</a>