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Why you should read this article: • To recognise the importance of undertaking comprehensive pain assessments for all patients who have undergone a surgical procedure • To be aware of various tools that could assist in assessing the type, nature and intensity of a patient’s pain • To support you with identifying when a patient may require appropriate pain management interventions. Rationale and key points: Acute post-operative pain is common among patients in secondary care settings, and the alleviation of this pain is a principal responsibility for all healthcare professionals, including nurses. To achieve this, it is essential to regularly undertake comprehensive pain assessments, using validated pain assessment tools, for all patients who have undergone a surgical procedure. Inadequate pain assessment may lead to ineffective or inappropriate pain management, which can adversely affect the patient’s recovery and increase their risk of developing chronic pain. •  Pain is a subjective experience and therefore requires individualised, comprehensive assessment and management interventions. •  The assessment process for patients with acute pain is fundamental to understanding the patient’s current status, informing differential diagnoses regarding the underlying cause of the pain, providing appropriate treatment and monitoring, and evaluating the effectiveness of treatment. •  Pain assessment should not be undertaken as a one-off care activity; it should be completed whenever a patient reports pain and repeated following pharmacological and/or non-pharmacological interventions. Reflective activity: ‘How to’ articles can help you to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: •  How this article might improve your practice when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain. •  How you could use this information to educate nursing students or colleagues on the appropriate actions to take when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain. [ABSTRACT FROM AUTHOR]

This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain -- United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1-49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1-3 months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient's circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. [ABSTRACT FROM AUTHOR]

Problem/Condition: Gastrointestinal illness is common worldwide and can be transmitted by an infected person or contaminated food, water, or environmental surfaces. Outbreaks of gastrointestinal illness commonly occur in crowded living accommodations or communities where persons are physically close. Pathogens that cause gastrointestinal illness outbreaks can spread quickly in closed and semienclosed environments, such as cruise ships. CDC's Vessel Sanitation Program (VSP) is responsible for conducting public health inspections and monitoring acute gastroenteritis (AGE) illness on cruise ships entering the United States after visiting a foreign port. Period Covered: 2006-2019. Description of System: VSP maintains the Maritime Illness Database and Reporting System (MIDRS) for monitoring cases of AGE illness among passengers and crew sailing on cruise ships carrying ≥13 passengers and within 15 days of arrival at U.S. ports from foreign ports of call. Cruise ships under VSP jurisdiction are required to submit a standardized report (24-hour report) of AGE case counts for passengers and crew 24-36 hours before arrival at the first U.S. port after traveling internationally. If the cumulative number of AGE cases increases after submission of the 24-hour report, an updated report must be submitted no less than 4 hours before the ship arrives at the U.S. port. A special report is submitted to MIDRS when vessels are within 15 days of arrival at a U.S. port and cumulative case counts reach 2% of the passenger or crew population during a voyage. VSP declares an outbreak when 3% or more of the passengers or crew on a voyage report AGE symptom to the ship's medical staff. Results: During 2006-2019, a total of 37,276 voyage reports from 252 cruise ships were submitted to MIDRS. Of the 252 cruise ships, 80.6% were extra large in size (60,001-120,000 gross registered tons [GRT]), 37.0% and 32.9% had voyages lasting 3-5 days and 8-10 days, respectively, and 53.2% were traveling to a port in the Southeast region of the United States at the time the final MIDRS report was submitted. During 2006-2019, VSP received 18,040 (48.4%) 24-hour routine reports, 18,606 (49.9%) 4-hour update reports, and 612 (1.6%) special reports (2% and 3% AGE reports). Incidence rates decreased from 32.5 cases per 100,000 travel days to 16.9 for passengers and from 13.5 to 5.2 for crew. Among passengers, AGE incidence rates increased with increasing ship size and voyage length. For crew members, rates were significantly higher on extra-large ships (19.8 per 100,000 travel-days) compared with small and large ships and on voyages lasting 6-7 days. Geographically, passenger incidence rates were highest among ships underway to ports in California, Alaska, Texas, New York, Florida, and Louisiana. Among passengers, AGE incidence rates were significantly higher on ships anchoring in California (32.1 per 100,000 travel-days [95% confidence interval (CI) = 31.7-32.4]); among crew, they were significantly higher in the South region of the United States (25.9 [CI = 25.1-26.7]). Interpretation: This report is the first detailed summary of surveillance data from MIDRS during 2006-2019. AGE incidence rates decreased during this time. Incidence rates among passengers were higher on mega and super-mega ships and voyages lasting >7 days. AGE incidence among crew was higher on extra-large ships and voyages lasting 6-7 days. Ship size and voyage length are associated with AGE incidence rates, and more targeted effort is needed to prevent disproportionate AGE incidence rates among passengers and crew sailing in high-risk situations. Public Health Actions: Maritime AGE surveillance provides important information about the epidemiology of gastrointestinal illness among cruise ship populations traveling in U.S. jurisdictions. AGE illness is highly contagious and can be transmitted quickly within vessels. State and local public health departments in the United States can use data in this report to better inform the traveling public about the risk for AGE and the importance of their role in minimizing the risk for illness while traveling onboard cruise ships. Key elements for reducing exposure to AGE illness, limiting the spread of illness, and preventing AGE outbreaks are proper hand hygiene practices and prompt isolation of symptomatic persons. Passengers can work in collaboration with cruise lines to promote onboard public health by frequently washing their hands, promptly reporting AGE illness symptoms, and isolating themselves from other persons immediately after illness onset. Access to and proper use of handwashing stations can reduce the risk for illness transmission aboard cruise ships. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To refresh your knowledge of the mode of action, side effects and risks of opioids • To enhance your awareness of the safety implications associated with the use of prescribed opioids • To understand the role of the nurse in caring for and supporting patients who are taking opioids Opioids are powerful analgesics that are derived from the opium poppy plant. They are recognised as central in the management of acute pain and cancer pain, but concerns about long-term use have resulted in recommendations that they should be used with caution in the management of chronic pain. Opioids have associated side effects and risks, but these may be exaggerated and some healthcare professionals can be unnecessarily cautious and withhold the use of opioids, even in cases where these medicines may be beneficial. It is important that nurses understand the pharmacology, side effects and risks of opioids, so they can ensure these medicines are administered safely. [ABSTRACT FROM AUTHOR]

Chronic pain affects a significant percentage of the population and is defined as pain that lasts beyond the point of healing. People presenting to hospital with acute illness may have underlying chronic pain that can be exacerbated by their presenting condition, even if this chronic pain is not the reason for their admission. While people may tolerate their usual medicine regimen under normal circumstances, small changes in their physical health can rapidly cause issues with their medication such as increased side effects. This article considers how nurses can improve the safety of people experiencing pain who have been admitted to hospital, and outlines when changes in their health might have implications for their prescribed analgesics. [ABSTRACT FROM AUTHOR]

Red eye is a common ocular presentation in primary care, and there are several challenges that healthcare practitioners may encounter when caring for such patients. The main ocular conditions that can give rise to red eye are: primary acute angle closure glaucoma, acute iritis, dry eye, blepharitis and conjunctivitis. Red eye can be classified as sight-threatening or non-sight-threatening. Many patients presenting with painless red eye and normal vision usually recover well. However, when red eye is associated with pain, photophobia, watering and blurred vision, it is potentially sight-threatening and must be addressed urgently. Therefore, it is vital for healthcare practitioners to be able to undertake a careful assessment of the patient and make an accurate diagnosis early. This article provides an overview of the common causes of red eye encountered in general practice or an eye clinic. It discusses the nurse's role in the care and management of patients with red eye, with reference to patient assessment, the skills required to make an accurate diagnosis, treatment and health promotion. [ABSTRACT FROM AUTHOR]

Chronic pancreatitis is a complex inflammatory condition characterised by irreversible damage to the pancreas. This article explores the pathophysiology of this condition and its effects on pancreatic function. It outlines the causes and presenting features of chronic pancreatitis, as well as its effect on patients' quality of life and the changes to their lifestyle that are likely to be required. Chronic pancreatitis cannot be cured; therefore, treatment aims to control pain, manage problems associated with malabsorption, and assess and manage long-term complications that may develop, such as insulin dependence. [ABSTRACT FROM AUTHOR]

This article outlines a plan for a change project to improve the quality of physical health care on mental health wards. The plan was designed to improve the monitoring and recording of respiratory rates on mental health wards, through the implementation of a training programme for staff. A root cause analysis was used to explore the reasons for the low incidence of respiratory rate measurement on mental health wards, and the results of this establish the basis of the proposed change project and its aims and objectives. The article describes how the project could be implemented using a change management model, as well as how its effects could be measured and evaluated. Potential barriers to the planned change project are discussed, including the human dimensions of change. The article suggests methods to overcome such barriers, discusses the value of leadership as an important factor, and examines the principles of clinical governance in the context of the planned change project. [ABSTRACT FROM AUTHOR]

The article offers several tips for ophthalmologists to treat acute dry eye. It offers information on dry-eye disease which is a chronic disease that requires chronic therapy and can be attributed to several factors including the environment. The differences between acute and chronic dry eye presentations are examined as well as various treatment options including corticosteroids. Also discussed are several studies on acute dry eye disease.

The article discusses a study which shows that patients treated with amniotic membrane transplantation (AMT) for Stevens-Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN) are at risk for developing severe eye and ocular surface disease. Topics covered include factors contributing to the development of chronic dry eye disease (DED) in patients with SJS/TEN, and a method for extending coverage of the involved tissues with AM.

Lumbar puncture has an important role in the diagnosis of acute central nervous system infections. The clinical contraindications to lumbar puncture must be considered before the procedure is carried out, and nurses need to have an understanding of how best to inform, support and reassure patients. [ABSTRACT FROM AUTHOR]

This article discusses data on waterborne disease outbreaks associated with drinking water in the U.S. from 2007 to 2008. The Waterborne Disease and Outbreak Surveillance System (WBDOSS) database provided data on outbreaks of diseases such as acute gastrointestinal illness (AGI) and acute respiratory illness (ARI). Other outbreaks recorded by the database include skin irritation and hepatitis.

Noroviruses are the most common cause of epidemic gastroenteritis, responsible for at least 50% of all gastroenteritis outbreaks worldwide, and a major cause of foodborne illness. In the United States, approximately 21 million illnesses attributable to norovirus are estimated to occur annually. Since 2001, when the most recent norovirus recommendations were published (CDC. "Norwalk-like viruses." Public health consequences and outbreak management. MMWR 2001;50[No. RR-9]), substantial advances have been made in norovirus epidemiology, immunology, diagnostic methods, and infection control. As molecular diagnostic techniques have improved in performance and become more widely available, detection and reporting of norovirus outbreaks have increased. Although the inability to culture human noroviruses in vitro has hampered progress, assessment of the performance of disinfectants has been facilitated by the discovery of new, cultivable surrogates for human noroviruses. In addition, the periodic emergence of epidemic strains (from genogroup II type 4, GII.4) and outbreaks in specific populations (e.g., the elderly in nursing homes) have been characterized. This report reviews these recent advances and provides guidelines for outbreak management and disease prevention. These recommendations are intended for use by public health professionals investigating outbreaks of acute gastroenteritis, including state and local health authorities, as well as academic and research institutions. [ABSTRACT FROM AUTHOR]

Faecal incontinence is common in acutely ill patients, and has many predisposing factors. It is important that nursing staff understand the process of normal defecation as well as the adverse effects faecal incontinence has on patients, relatives and carers. New techniques are emerging for the management of faecal incontinence and it is important that nurses are aware of these. [ABSTRACT FROM AUTHOR]

This article, the third in a five-part series, explores the difficulties that nurses experience when dealing with an offender who becomes acutely ill within the prison setting. The authors compare and apply the recommendations from the National Institute for Health and Clinical Excellence, the National Patient Safety Agency and the Department of Health to offender health care. The article also explores how education and simulation can be used to equip nurses to deal with any difficulties they experience. [ABSTRACT FROM AUTHOR]

This article aims to increase knowledge and understanding of aortic valve stenosis to support the treatment options available for older patients in the acute setting. The article discusses a relatively new procedure, transcatheter aortic valve implantation, which is appropriate for selected patients with aortic stenosis, and outlines the aftercare involved. [ABSTRACT FROM AUTHOR]

The article offers Great Britain Ophthalmology news brief as of March 6, 2020. Topics discussed include that National Health Service England has published guidance on standard operating procedures for primary care optical settings in relation to Covid-19; Safilo has started to replace its entire fleet of company cars with Toyota and Lexus hybrid vehicles as part of the eyewear company's sustainability commitment; and Shamir has partnered with Paris Miki, a Japanese optical retail chain.

The article discusses a strategy adopted for the management of acute conjunctivitis that is beneficial for patients and doctors and easy for technicians to follow. It notes that the patients are given accurate diagnosis allowing doctors to better discuss treatment options and determine whether the patient has bacterial or allergic conjunctivitis. It cites the importance for technician to take a careful history from the patient to help in determining the treatment.

The author discusses how a continuing professional development (CPD) article has improved her understanding of the assessment and management of chronic pancreatitis (CP). Topics mentioned include the nature of the CPD activity, the lessons she learned from it, how she improved her practice, and the article's relevance to The Code theme of prioritising people.

An interview with Tina Price, staff nurse at Sandwell General Hospital in England, is presented. Price discusses the nature of the continuing professional development (CPD) activity, practice-related feedback and experience in the practice. She also talks about mentoring nursing students and the relevance of the practice to the code for nurses and midwives.

The article discusses 2018 studies evaluating a fixed combination of povidone-iodine 0.6%/dexamethasone 0.1% (SHP640, Shire) in phase III clinical trials as treatment for adenoviral and bacterial acute conjunctivitis in 2018. It states that it aims to mitigate misdiagnosis and address unnecessary anti-biotic use. Also noted are the studies' additional evaluations on pathogen eradication, time to clinical resolution, and rescue medication use.

The article discusses the association of ipsilateral carotid artery stenosis with nonarteritic central retinal artery occlusion (CRAO). Tpics covered include the importance of carotid ultrasonography to accurately detect ipsilateral carotid artery stenosis. Also is the risk of patients with the stenosis for having cardiovascular diseases.

The article reports on the efforts of ophthalmologists to reduce the rate of condition and the risk factors linked to endophthalmitis. Topics discussed include the occurrence of gram positive acute endophthalmitis within the first few days of cataract surgery and variations in the rate of condition according to the findings of European and U.S. research. The use of topical antibiotics and risks derived from corneal versus scleral incisions are also mentioned.

The article cites a Canadian study that was published in the "American Journal of Transplantation" which found the attractiveness of live donor liver transplantation as an option for patients with acute liver failure.

The article examines the effectiveness of beta-blocker eye drops for the treatment of pain resulting from migraine. Topics covered include the mechanism of action of the drops, rapid absorption of the drops into the blood vessels and the result of studies in 38-year-old and 57-year-old women indicating that beta-blockers can be an inexpensive way to eliminate pain in patients with acute migraine.

The article presents decentralised agency European Medicines Agency-requested research showing the high paracetamol-induced liver failure rate in Great Britain and Ireland in 2015.

The article discusses some medical errors associated with the use of the Diastat Acudial delivery system for the treatment of acute seizure in children. Topics cited include the failure of pharmacists to properly dial and lock the device after dispensing, incidence of respiratory depression which requires emergency intervention, and tips on how to avoid errors.

The article discusses research in the article "Secretory Leukocyte Protease Inhibitor (SLPI): A Pivotal Mediator of Anti-Inflammatory Responses in Acetaminophen Induced Acute Liver Failure" by C. Antoniades et al., in the journal "Hepatology", which found that blocking the activity of the SLPI protein improves acute liver failure prospects.

The article discusses management and treatment of acute conjunctivitis. It discusses red eye protocol that is built around the point-of-care diagnostic device AdenoPlus by pharmaceutical company Nicox. He states that the patient has to refrain from work unless he is cured of acute adenoviral conjunctivitis to prevent epidemic spread. He highlights that implementing evidence-based approach to acute conjunctivitis is effective.

The author reports that low-level laser therapy have been found to improve acute neck pain and chronic neck pain in patients for up to 22 weeks following treatment. Research was performed by an international group of researchers who conducted a systematic review and meta-analysis of randomized placebo and controlled trials.

Stroke units have a serious shortage of specialist nurses and need to boost their quotas three-fold, the Royal College of Physicians (RCP) has found. [ABSTRACT FROM AUTHOR]