Abstract:
BACKGROUND:Previous national survey research has shown significant deficits in routine postoperative pain management in the UK. This study used an organizational change perspective to explore in detail the organizational challenges faced by three acute pain services in improving postoperative pain management. METHODS:Case studies were conducted comprising documentary review and semi-structured interviews (71) with anaesthetists, surgeons, nurses, other health professionals, and managers working in and around three broadly typical acute pain services. RESULTS:Although the precise details differed to some degree, the three acute pain services all faced the same broad range of inter-related challenges identified in the organizational change literature (i.e. structural, political, cultural, educational, emotional, and physical/technological challenges). The services were largely isolated from wider organizational objectives and activities and struggled to engage other health professionals in improving postoperative pain management against a background of limited resources, turbulent organizational change, and inter- and intra-professional politics. Despite considerable efforts they struggled to address these challenges effectively. CONCLUSIONS:The literature on organizational change and quality improvement in health care suggests that it is only by addressing the multiple challenges in a comprehensive way across all levels of the organization and health-care system that sustained improvements in patient care can be secured. This helps to explain why the hard work and commitment of acute pain services over the years have not always resulted in significant improvements in routine postoperative pain management for all surgical patients. Using this literature and adopting a whole-organization quality improvement approach tailored to local circumstances may produce a step-change in the quality of routine postoperative pain management.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Powell AE,Davies HT,Bannister J,Macrae WAdoi
10.1093/bja/aep066subject
Has Abstractpub_date
2009-06-01 00:00:00pages
824-31issue
6eissn
0007-0912issn
1471-6771pii
S0007-0912(17)34409-4journal_volume
102pub_type
杂志文章,多中心研究abstract:BACKGROUND:There have been few studies comparing the response to asphyxia and the effectiveness of typical cardiopulmonary resuscitation (CPR) using exogenous epinephrine administration and manual closed-chest compression between total intravenous anaesthesia (TIVA) and inhalational anaesthesia. METHODS:Twenty pigs we...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeg259
更新日期:2003-12-01 00:00:00
abstract::The effects of doxacurium chloride, a new long-acting non-depolarizing neuromuscular blocking drug, on cardiac performance were studied in 45 patients undergoing high-dose fentanyl-diazepam-oxygen anaesthesia for cardiac surgery. Data were collected at baseline (10 min after tracheal intubation), and at 2, 5 and 10 mi...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/63.6.675
更新日期:1989-12-01 00:00:00
abstract::The Walton-Brodie strain gauge arch is an instrument that quantitatively measures CF. Like many methods, the strain gauge arch is affected by loading conditions and heart rate. Nevertheless, this methodology, when properly used, has proved very useful in describing the direct action of anaesthetic drugs. Knowledge fro...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/60.suppl_1.78s
更新日期:1988-01-01 00:00:00
abstract::A recently installed anti-pollution system, initially designed to function in a passive mode, was evaluated, but found to be inconstant in its performance. A simple method of making the system active is described and evaluated. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/49.5.439
更新日期:1977-05-01 00:00:00
abstract::We studied 34 patients undergoing elective repair of an abdominal aortic aneurysm under combined general anaesthesia and epidural block to evaluate the acute effects of diaspirin crosslinked haemoglobin (DCLHb) 50, 100 and 200 mg kg-1 i.v. Haemodynamic variables were measured continuously using pulmonary and radial ar...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/83.5.702
更新日期:1999-11-01 00:00:00
abstract::A double-blind crossover volunteer trial has been carried out to determine if oral doxapram reduces the respiratory depression caused by morphine 0.12 mg kg-1 i.m. Doxapram was given to the subjects 90 min before the morphine and significantly reduced the displacement of the ventilatory response to carbon dioxide caus...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/62.2.159
更新日期:1989-02-01 00:00:00
abstract::In order to evaluate the use of the post-tetanic count (PTC) method during repetitive administration of vecuronium, we studied 20 patients allocated randomly to one of two groups: 10 patients received droperidol-fentanyl anaesthesia (control group); 10 other patients were given droperidol-fentanyl anaesthesia modified...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/65.4.487
更新日期:1990-10-01 00:00:00
abstract::The water soluble benzodiazepine midazolam was compared with diazepam, in doses of 0.07 mg kg-1 and 0.15 mg kg-1 respectively, administered i.v. to 100 patients undergoing gastroscopy. The degree of sedation, ease of endoscopy and recovery were comparable in the two groups. The effects of both drugs on arterial pressu...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/55.8.773
更新日期:1983-08-01 00:00:00
abstract::We studied 325 patients undergoing elective noncardiac surgery who had preoperative ambulatory ECG monitoring performed for a duration of 5130 h (range 8-24 h; mean 15.8 h). Sixty-four subjects (20%) had one or more episodes of ST segment depression consistent with myocardial ischaemia. Of all preoperative cardiovascu...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/73.5.574
更新日期:1994-11-01 00:00:00
abstract::We describe an anaesthesia simulator capable of simulating all possible situations during anaesthesia. The Leiden anaesthesia simulator (LAS) may be used with most commercially available anaesthesia equipment and monitors, which are connected to the simulated patient as they are to a patient. A commercially available ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/73.3.287
更新日期:1994-09-01 00:00:00
abstract::Many indices are used to quantify pulmonary oxygen transfer. Indices that use only measurements from arterial blood and inspired gas assume a constant C(a-v)O2. Though variations in C(a-v)O2 are recognized, indices such as PaO2/FIO2 remain popular and are often considered the best measure of pulmonary oxygen transfer ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/86.4.477
更新日期:2001-04-01 00:00:00
abstract::We have examined dimethylthiourea, a potent scavenger of free radicals, for its anaesthetic properties in mice and rats. In mice, dimethylthiourea abolished the righting reflex at intraperitoneal doses greater than 1.5 mg g-1 bodyweight; in rats, it decreased the MAC value for isoflurane in a dose-dependent fashion. D...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/70.4.456
更新日期:1993-04-01 00:00:00
abstract:BACKGROUND:We defined the nature of the pharmacological interaction after intrathecal co-administration of ginsenosides with clonidine, and clarified the contribution of the α-2 adrenoceptors on the effect of ginsenosides. METHODS:Pain was evoked by injection of a formalin solution (5%, 50 μl) into the hindpaw of male...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeq367
更新日期:2011-03-01 00:00:00
abstract::Thirty patients took part in a double-blind trial to compare morphine 10 mg i.m. with morphine 5 mg into the extradural space for pain relief following Caesarean section. With the extradural route the mean time to first analgesia was 7.95 h compared with 4.75 h for the i.m. route. The mean number of further doses of d...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/55.12.1201
更新日期:1983-12-01 00:00:00
abstract::Two techniques for endotracheal anaesthesia in dental outpatients have been compared: a spontaneous ventilation technique using nitrous oxide, oxygen and halothane, and a controlled ventilation technique using nitrous oxide and oxygen, with tubocurarine and fentanyl. The latter technique has several advantages: abolit...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/48.9.919
更新日期:1976-09-01 00:00:00
abstract::Purified serum cholinesterase 90 mg was administered to a patient with cholinesterase deficiency. The effect on the action of suxamethonium was studied. The half-life (44.7 h), time constant (64.5 h), rate constant (0.0155 h-1) and distribution volume (2740 ml) of the cholinesterase activity were determined. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/49.3.269
更新日期:1977-03-01 00:00:00
abstract::Robotic surgery pushes the frontiers of innovation in healthcare technology towards improved clinical outcomes. We discuss the evolution to five generations of robotic surgical platforms including stereotactic, endoscopic, bioinspired, microbots on the millimetre scale, and the future development of autonomous systems...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/aex383
更新日期:2017-12-01 00:00:00
abstract::The analgesic effects of buprenorphine 2 microgram/kg--1 and 8 microgram. kg--1 were compared with those of pethidine 1 mg. kg--1 and pentazocine 0.6 mg.kg--1 in 172 patients recovering from surgery. The drugs were given by i.m. injection in the period immediately after operation and the quality of pain relief was ass...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/49.9.913
更新日期:1977-09-01 00:00:00
abstract:Background:Identification of statistically reliable outcomes for comparison among anaesthetists is challenging. Time-weighted intraoperative mean arterial pressure <65 mm Hg (AUC 65 ) is associated with increased odds for myocardial damage. We explored retrospectively whether such hypotension before incision was statis...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aex153
更新日期:2017-07-01 00:00:00
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journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/56.5.523
更新日期:1984-05-01 00:00:00
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journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aev552
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Positive end-expiratory pressure (PEEP) is widely used to improve oxygenation and prevent alveolar collapse in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS). Although PEEP improves arterial oxygenation predictably, high-PEEP strategies have demonstrated equivocal improv...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aew314
更新日期:2016-11-01 00:00:00
abstract::Interest in the use of psychosocial interventions to help older adults manage pain is growing. In this article, we review this approach. The first section reviews the conceptual background for psychosocial interventions with a special emphasis on the biopsychosocial model of pain. The second section highlights three p...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/aet129
更新日期:2013-07-01 00:00:00
abstract::We have compared the antagonism of neuromuscular block produced by pipecuronium with pancuronium in 80 anaesthetized surgical patients using mechanomyography and electromyography. Pancuronium 0.1 mg kg-1 or pipecuronium 0.07 mg kg-1 was given after induction of anaesthesia and neuromuscular block was adjusted to 75% t...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/74.4.410
更新日期:1995-04-01 00:00:00
abstract:BACKGROUND:Risks and costs of allogeneic blood transfusions mandate strategies to reduce blood loss in surgery. The objective of this study was to assess the efficacy of antifibrinolytic treatment in reducing perioperative blood loss during total knee replacement. METHODS:A double-blind, randomized and placebo-control...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/ael057
更新日期:2006-05-01 00:00:00
abstract::The ventilatory effects of single i.v. doses of morphine 0.1 mg kg-1, pethidine 0.67 mg kg-1 and methadone 0.1 mg kg-1 were compared after ophthalmic surgery in an open, randomized study in 30 children aged 3-8 yr. Ventilatory changes after each drug had distinctive profiles, with appreciable individual variation. Acu...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/70.4.414
更新日期:1993-04-01 00:00:00
abstract::Intravenous doses of 0.3 mg/kg dimethyl tubocurarine were required for consistent and adequate surgical relaxation in patients during nitrous oxide anaesthesia and produced virtually complete neuromuscular paralysis (96-100%) of the tetanic and twitch responses of the adductor pollicis muscle. The duration of action o...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/48.10.969
更新日期:1976-10-01 00:00:00
abstract:BACKGROUND:Data on contributors to between-individual variability in overall tramadol clearance and O-demethyl tramadol (M1) formation in preterm neonates and young infants are limited. METHODS:A population pharmacokinetic analysis of tramadol and M1 was undertaken using non-linear mixed effects model. Covariate analy...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aen019
更新日期:2008-04-01 00:00:00
abstract::We studied 60 patients undergoing operation on the kidney with combined general and epidural anaesthesia, in a double-blind, randomized, controlled study. Patients were allocated to receive a preoperative bolus dose of ketamine 10 mg i.v., followed by an i.v. infusion of ketamine 10 mg h-1 for 48 h after operation, or...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/81.5.707
更新日期:1998-11-01 00:00:00
abstract::In order to clarify the relative contribution of hepatic metabolism to the short term disposition of methohexitone, we have measured hepatic blood flow during induction of anaesthesia with a 1.5-mg kg-1 i.v. bolus dose of methohexitone. Median hepatic clearance was 1.01 litre min-1 and hepatic extraction 87%. As a con...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/69.5.478
更新日期:1992-11-01 00:00:00