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Background: Proper analgosedation is a cornerstone in the treatment of critically ill patients in Pediatric Intensive Care Units (PICUs). Medications, such as fentanyl, morphine, and midazolam, are essential to safe and respectful care. The use of these medications over time may lead to side effects such as iatrogenic withdrawal syndrome (IWS) in the tapering phase. The aim of the study was to test an algorithm for tapering analgosedation to reduce the prevalence of IWS in two Norwegian PICUs at Oslo University Hospital. Methods: A cohort of mechanically ventilated patients from newborn to 18 years with continuous infusions of opioids and benzodiazepines for 5 days or more were included consecutively from May 2016 to December 2021. A pre‐ and posttest design, with an intervention phase using an algorithm for tapering analgosedation after the pretest, was used. The ICU staffs were trained in using the algorithm after the pretest. The primary outcome was a reduction in IWS. The Withdrawal Assessment Tool‐1 (WAT‐1) was used to identify IWS. A WAT‐1 score ≥3 indicates IWS. Results: We included 80 children, 40 in the baseline group, and 40 in the intervention group. Age and diagnosis did not differ between the groups. The prevalence of IWS was 95% versus 52.5% in the baseline group versus the intervention group, and the peak WAT‐1 median was 5.0 (IQR 4–6.8) versus 3.0 (IQR 2.0–6.0) (p =.012). Based on SUM WAT‐1 ≥ 3, which describes the burden over time better, we demonstrated a reduction of IWS, from a median of 15.5 (IQR 8.25–39) to a median of 3 (IQR 0–20) (p = <.001). Conclusion: We suggest using an algorithm for tapering analgosedation in PICUs since the prevalence of IWS was significantly lower in the intervention group in our study. [ABSTRACT FROM AUTHOR]

Aim: One of the challenges of robotic‐assisted surgery is related to positioning of the patient on the operating table. Technological developments place increased demands on operating room nurses' competence to prevent positioning injuries and ensuring care quality. Therefore, the aim of the present study was to describe operating room nurses' experiences when positioning the patients for robotic‐assisted surgery. Design: A descriptive qualitative design. Methods: Seven operating room nurses with experience in robotic‐assisted surgery were included at a university hospital. Data were obtained through individual interviews and analysed using qualitative content analysis. The Consolidated Criteria for Reporting Qualitative research COREQ checklist was used. Results: We identified three categories, (a) patient positioning is challenging during robotic‐assisted surgery, (b) operating room nurses take responsibility for patient positioning during robotic‐assisted surgery, but teamwork is important and (c) operating room nurses aim to achieve safe patient positioning during robotic‐assisted surgery. [ABSTRACT FROM AUTHOR]

Background: Pain is a serious problem for intensive care unit (ICU) patients, but we are lacking data on pain at the hospital ward after ICU discharge. Aims and Objectives: To describe pain intensity, ‐interference with function and ‐location in patients up to 1 year after ICU discharge. To identify demographic and clinical variables and their association with worst pain intensity and pain interference. Design: A longitudinal descriptive secondary analysis of a randomized controlled trial on nurse‐led follow‐up consultations on post‐traumatic stress and sense of coherence after ICU discharge. Methods: Pain intensity, ‐interference, and ‐location were measured using Brief Pain Inventory at the hospital ward and 3, 6, and 12 months after ICU discharge. For associations, data were analysed using multivariate linear mixed models for repeated measures. Results: Of 523 included patients, 68% reported worst pain intensity score above 0 (no pain) at the ward. Estimated means for worst pain intensity and –interference (from 0 to 10) after ICU discharge were 5.5 [CI 4.6‐6.5] and 4.5 [CI 3.7‐5.3], and decreased to 3.8 [CI 2.8‐4.8] (P ≤.001) and 2.9 [CI 2.1‐3.7] after 12 months (P ≤.001). Most common pain locations were abdomen (43%), lower lumbar back (28%), and shoulder/forearm (22%). At 12 months, post‐traumatic stress (PTS) symptoms ≥25 (scale 10‐70), female gender, shorter ICU stay, and more traumatic ICU memories were significantly associated with higher worst pain intensity. PTS symptoms ≥25, female gender, more traumatic ICU memories, younger age, and not having an internal medical diagnosis were significantly associated with higher pain interference. Conclusions: Early after ICU discharge pain was present in 68% of patients. Thereafter, pain intensity and ‐interference declined, but pain intensity was still at a moderate level at 12 months. Health professionals should be aware of patients' pain and identify potentially vulnerable patients. Implication for Practice: Longitudinal assessment of factors associated with pain early after ICU discharge and the following year is a first step that could improve follow‐up focus and contribute to reduced development of chronic pain. [ABSTRACT FROM AUTHOR]

Background: Analgesics and sedatives are key elements to reduce physiological and psychological stress associated with treatment in paediatric intensive care. Prolonged drug use may induce tolerance and development of iatrogenic withdrawal syndrome (IWS) during the tapering phase. Our primary aim was to describe the prevalence of IWS among critically ill ventilated patients in two Norwegian paediatric intensive care units (PICUs), and secondary to investigate what motivated bedside nurses to administer additional drug doses. Methods: Mechanically ventilated patients (n = 40) from newborn to eighteen years of age, with continuous infusions of opioids and benzodiazepines for 5 days or more, were included consecutively from May 2016 to June 2018. By using Withdrawal Assessment Tool‐1 (WAT‐1) twice daily we recorded the prevalence of IWS. Additionally, we recorded signs and symptoms that led bedside nurses to administration extra bolus medication. Results: Peak WAT‐1 score indicated an IWS prevalence of 95% in this selected group. The first days of the tapering phase were most critical for IWS. The most frequent symptoms triggering administration of additional bolus doses were agitation/restlessness, and thiopental and propofol were the bolus drugs used most frequently. Conclusions: IWS affected 95% of the children having received infusions of opioids and benzodiazepines for 5 days or more in PICUs without a tapering protocol for these drugs. This calls for implementation and testing of such weaning protocols. [ABSTRACT FROM AUTHOR]

Background: Norwegian hospitals have operated within capacity during the COVID-19 pandemic. We present patient and management characteristics, and outcomes for the entire cohort of adult (>18 years) COVID-19 patients admitted to Norwegian intensive care units (ICU) from 10 March to 19 June 2020.Methods: Data were collected from The Norwegian intensive care and pandemic registry (NIPaR). Demographics, co-morbidities, management characteristics and outcomes are described. ICU length of stay (LOS) was analysed with linear regression, and associations between risk factors and mortality were quantified using Cox regression.Results: In total, 217 patients were included. The male to female ratio was 3:1 and the median age was 63 years. A majority (70%) had one or more co-morbidities, most frequently cardiovascular disease (39%), chronic lung disease (22%), diabetes mellitus (20%), and obesity (17%). Most patients were admitted for acute hypoxaemic respiratory failure (AHRF) (91%) and invasive mechanical ventilation (MV) was used in 86%, prone ventilation in 38% and 25% of patients received a tracheostomy. Vasoactive drugs were used in 79% and renal replacement therapy in 15%. Median ICU LOS and time of MV was 14.0 and 12.0 days. At end of follow-up 45 patients (21%) were dead. Age, co-morbidities and severity of illness at admission were predictive of death. Severity of AHRF and male gender were associated with LOS.Conclusions: In this national cohort of COVID-19 patients, mortality was low and attributable to known risk factors. Importantly, prolonged length-of-stay must be taken into account when planning for resource allocation for any next surge. [ABSTRACT FROM AUTHOR]

Background: One in five patients experience chronic pain 12 months following total knee arthroplasty (TKA). This longitudinal study used a person‐centred approach to identify subgroups of patients with distinct chronic pain profiles following TKA and identified preoperative characteristics associated with these profiles. Methods: On the day before surgery, 202 patients completed questionnaires that assessed pain, interference with functioning, fatigue, anxiety, depression and illness perceptions. Average and worst pain were assessed prior to surgery, on postoperative day 4, at 6 week and at 3 and 12 months following surgery. Using growth mixture modelling, two subgroups with distinct average and worst pain profiles were identified. Results: Patients in the "lower average" and "lower worst" pain classes had moderate preoperative pain scores that decreased over the remaining 9 months following TKA. Patients in the "higher average" and "higher worst" pain classes had relatively higher preoperative pain scores that increased during the first three months and then decreased slightly over the remaining 9 months. Patients in the higher pain classes had higher interference with function scores; used opioids prior to surgery more often, were more likely to receive a continuous nerve block and ketamine; had higher preoperative fatigue severity and interference scores; and had worse perceptions of illness than patients in the lower pain classes. Conclusions: These risk factors may be used to identify subgroups of patients at higher risk for more severe pain after TKA. Future studies should test whether modifying these risk factors can improve patients' outcomes after TKA. Significance statement: The present study provides a novel and original analysis of pain profiles following total knee arthroplasty that may contribute to our understanding of the transition from acute to chronic pain. Our results may be used to identify patients at higher risk for poorer outcomes based on preoperative risk factors. [ABSTRACT FROM AUTHOR]

Objective: To describe caregiver and patient characteristics that are associated with negative and positive reactions in family caregivers (FCs) of cancer outpatients. Methods: A total of 194 FCs completed the Caregiver Reaction Assessment (CRA) scale 6 months after start of new treatment in patients with breast, ovarian, colorectal, or head and neck cancer. Linear regression models were used to examine which caregiver characteristics (i.e. demographic, self‐efficacy and social support) and patient characteristics (i.e. clinical, symptoms) were associated with each of the CRA subscales (caregiver esteem, lack of family support, and impact on health, schedule and finances). Results: Less social support was significantly associated with poorer scores on all subscales (B −0.01/0.01). Also, poorer scores on one or more of the CRA subscales were reported by FCs who had lower self‐efficacy (B −0.02), a higher level of education (primary B 0.42, secondary B 0.22), more medical conditions (B 0.06), and were female (B 0.20), and by FCs of patients with colorectal (B 0.45) or head and neck cancer (B 0.27), and those who reported a higher symptom burden (B 0.28/0.49). Conclusion: Both caregiver and patient factors were associated with reactions in FCs of cancer outpatients. This information can be used by healthcare personnel to identify FCs who need additional support (e.g. counselling), and to increase focus on strengths and assets within the caregivers (e.g. support groups). [ABSTRACT FROM AUTHOR]

Background: Post‐traumatic stress (PTS) symptoms following intensive care unit (ICU) treatment can lead to post‐traumatic stress disorder and represent a severe health burden. In trauma patients, a strong sense of coherence (SOC) is associated with fewer PTS symptoms. However, this association has not been investigated in a general ICU sample. Aims and objectives: To examine the occurrence of PTS symptoms in general ICU patients early after ICU discharge and to assess possible associations between PTS symptoms and SOC, ICU memory, pain, and demographic and clinical characteristics. Design: This was a cross‐sectional study. Methods: Adult patients aged ≥18 years admitted for ≥24 hours to five ICUs between 2014 and 2016 were recruited. PTS symptoms and SOC were measured at the ward within the first week after discharge from the ICU using the Posttraumatic Stress Scale‐10 and Sense of Coherence Scale‐13. Multiple linear regression analysis was used to identify associations between PTS symptoms and SOC and the selected independent variables. Results: A total of 523 patients were included (17.8% trauma patients; median age 57 years [range 18‐94]; 53.3% male). The prevalence of clinically significant PTS symptoms was 32%. After adjustments for gender and age, lower SOC (P < 0.001), more ICU delusional memories (P < 0.001), greater pain interference (P < 0.001), not being a trauma patient (P = 0.02), and younger age (P = 0.03) were significantly associated with more PTS symptoms. Conclusions: One third of patients experienced clinically relevant PTS symptoms early after discharge from the ICU. In the present study, SOC, delusional memory, pain interference, younger age, and not being a trauma patient were factors associated with more PTS symptoms. Relevance to clinical practice: Early individual follow up after ICU discharge focusing on pain relief and delusional memory may reduce PTS symptoms, with a potential of improving rehabilitation. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in potential long-term outcomes following intensive care, but few researchers have studied the prevalence of multiple symptoms or the association between pain and other symptoms. Aims: To investigate the prevalence of anxiety, depression, fatigue, sleep disturbance and post-traumatic stress symptoms (PTSS) among intensive care survivors 3 months and 1 year after being discharged from an intensive care unit (ICU) and to determine whether pain is associated with higher prevalence of these symptoms 3 months and 1 year after ICU stay. Study design: Exploratory, longitudinal cohort of intensive care survivors from two mixed ICUs in a tertiary referral hospital in Norway. Methods: Intensive care survivors completed surveys at 3 months (n=118) and 1 year (n=89) after ICU discharge. Clinical Trials: NCT02279212. Results: Prevalence rates of intensive care survivors' symptoms were pain 58 (49·2%), anxiety/depression 24/118 (20·8%), fatigue 18/118(15·3%), PTSS 15 (12·8%) and sleep disturbance 58/118 (49·2%) at 3 months after ICU discharge (n=118). Prevalence rates at 1 year (n=89) changed only slightly to pain 34 (38·2%), anxiety/depression 17 (20·0%), fatigue 12 (13·8%), PTSS 13 (15·1%) and sleep disturbance 40/89 (46·5%). Associations were strong between pain and presence of sleep disturbance, anxiety/depression, PTSS and fatigue. Conclusions: Intensive care survivors have multiple symptoms and the prevalence rates of these symptoms remained almost unchanged from 3 months to 1 year after ICU discharge. The presence of pain was associated with high odds for the presence of sleep disturbance, anxiety/depression, PTSS and fatigue, compared to a no-pain group. ICU survivors may benefit from targeted interventions designed to alleviate the symptom burden. Relevance to clinical practice: Knowledge about ICU survivor's prevalence and risk for having multiple symptoms may help health care professionals to give better care, if needed, to the ICU survivors. [ABSTRACT FROM AUTHOR]

Background Patients with head and neck cancer (HNC) experience diminished quality of life (QOL) during and after treatment. This study examined which characteristics were associated with QOL over time. Methods One hundred thirty-three patients with HNC from a study of 534 oncology patients rated physical and mental QOL using the Short Form-12 5 times from the initiation of radiotherapy (RT) through the following 6 months. Linear mixed model analyses examined changes over time and associated characteristics. Results The QOL deteriorated during RT and gradually improved after completion. Less social support was negatively associated with both physical and mental QOL. Older age, more comorbidities, more psychological symptoms, and concomitant chemotherapy (CTX) were negatively associated with physical QOL. Male sex, less physical symptoms, surgery before RT, and concomitant chemotherapy were positively associated with mental QOL. Conclusion Clinicians can use knowledge on time course and associated characteristics to identify and inform patients at higher risk for diminished QOL. [ABSTRACT FROM AUTHOR]

Background Adherence to guidelines for managing stable chronic obstructive pulmonary disease ( COPD) and its exacerbations is inadequate among healthcare workers and patients. An appropriate care model would meet patient needs, enhance their coping with COPD and improve their quality of life ( QOL). Aim This study aims to present the ' COPD-Home' as an integrated care model for patients with severe or very severe COPD. Model One principle of the COPD-Home model is that hospital treatment should lead to follow up in the patient's home. The model also includes education, improved coordination of levels of care, improved accessibility and a management plan. One of the main elements of the COPD-Home model is the clear role of the home-care nurse. Model development is based on earlier research and clinical experience. It comprises: (i) education provided through an education programme for patients and involved nurses, (ii) joint visits and telephone checks, (iii) a call centre for support and communication with a general practitioner and (iv) an individualised self-management plan including home monitoring and a plan for pharmacological and nonpharmacological interventions. Conclusion The COPD-Home model attempts to cultivate competences and behaviours of patients and community nurses that better accord with guidelines for interventions. The next step in its development will be to evaluate its ability to assist both healthcare workers and planners to improve the management of COPD, reduce exacerbations and improve QOL and coping among patients with COPD. [ABSTRACT FROM AUTHOR]

We appreciate Riddle et al's (Riddle and Dumenci 2021) interest in our article on pain profiles after total knee arthroplasty (TKA)(Lindberg et al., 2020) and the opportunity to discuss this important clinical problem of common concern. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2012; 26; 545-552 Attitudes, beliefs and self-reported competence about postoperative pain among physicians and nurses working on surgical wards Aims: To investigate attitudes, beliefs and self-reported competence with regard to pain management in nurses and physicians on surgical wards. Interprofessional differences between physicians and nurses were also examined. Methods: A total of 795 physicians and nurses from different surgical departments in Norway were invited to complete a questionnaire measuring attitudes, beliefs and self-reported competence about postoperative pain. Findings: In total, 128 physicians and 407 nurses completed the questionnaire (response rate 68%). Of these, 77% of physicians and 57% of nurses reported more than 4 years' work experience with postoperative pain. Most of the physicians (95%) and nurses (86%) reported that patients 'often' or 'very often' achieved satisfactory pain relief. Overall, 69% of the sample evaluated themselves as being highly competent or competent in treating nociceptive pain, while only 16% reported they were highly competent or competent in treating neuropathic pain. There were no statistically significant differences between the professions regarding their self-reported competence in pain management, and nurses and physicians only differed on three out of 18 conditions regarding their appraisal of conditions related to postoperative pain management after controlling for years of experience. Only 20% of respondents were satisfied with the annual updates for staff about pain relief for patients with postoperative pain. Conclusions: Even though the majority of physicians and nurses described themselves as competent in management of nociceptive pain, and thought that patients often or very often achieved satisfactory pain relief, the respondents reported dissatisfaction with the annual updates in pain management and poor competence in treatment of neuropathic pain. [ABSTRACT FROM AUTHOR]

The Barriers Questionnaire II (BQ-II) was developed to assess barriers to effective pain management. The purpose of this study was to evaluate the psychometric properties of the BQ-II in a sample of Norwegian cancer patients. The BQ-II was translated into Norwegian and pilot tested with eight oncology outpatients. Then, a convenience sample of 321 cancer patients from two different sites was recruited to maximize the number of questionnaires available for the psychometric analyses. Patients were included if they: were >18 years of age; had a diagnosis of cancer; and self-reported pain and/or use of analgesics. Construct validity of the Norwegian version of the BQ II (NBQ-II) was evaluated using an exploratory factor analysis. A seven-factor solution was found that was more consistent with the original version of the BQ. Construct validity of the NBQ-II was demonstrated through positive correlations between most of the subscale and total scores on the NBQ-II and pain intensity and pain interference scores. Finally, Cronbach’s α coefficients of ≥0.7 for six of the seven subscales and 0.89 for the total scale demonstrated acceptable levels of internal consistency. In conclusion, the NBQ-II demonstrated adequate psychometric properties. However, further revision and testing of the questionnaire should be performed to confirm the factor structure that was identified in this study. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To determine the self-reported prevalence rates for cancer, non-cancer, and both cancer and non-cancer pain and to determine if there were differences in demographic, clinical, and pain characteristics among the three pain groups. Methods: Patients were screened in outpatient oncology clinics for the presence of pain and/or analgesic use. Patients who reported pain completed the study questionnaires. Results: A total of 1790 patients were available for screening in the outpatient clinics and 1549 (86.5%) completed the screening questionnaire. Out of them, 332 (21.4%) reported pain or used analgesics. Of the 217 patients who completed the study questionnaires, 53% had only cancer pain (pain due to cancer and/or treatment), 25.3% had non-cancer pain, and 21.7% had both cancer and non-cancer pain. No differences were found, among the three pain groups, in pain intensity or pain duration. However patients in the cancer and non-cancer pain group had higher pain interference scores, higher severity scores for various pain descriptors, and a higher number of pain locations. Conclusions: These findings suggest that outpatients with a combination of cancer and non-cancer pain may be at greater risk for under-treatment of pain. Oncology clinicians and primary care providers need to perform a comprehensive pain assessment of all oncology patients in order to be able to formulate an effective pain management plan. [Copyright &y& Elsevier]

Aim. In a sample of patients who underwent instrumented spinal fusions for chronic low back pain (CLBP), the purposes of this study were: to determine the amount of pain patients experienced and to determine the impact of length of time since surgery, use of pain medication and their outlook on the future on these pain intensity scores. Background. An increasing number of people report CLBP and one of the treatments is instrumented fusion. Method. The study used a cross-sectional design. Visual analogue scales were used to measure pain intensity in different locations and a single item measured patients’ view of the future. Data were collected in November 2001. Results. The sample consisted of 101 patients (71% women) aged 26–59 years treated with instrumented fusion 1–8 years ago. As many as 87% reported pain 1–8 years after the surgery. Most patients reported pain of low-to-moderate intensity in the neck and shoulders, back and hips, feet and legs and in total pain. As many as 45% of the patients did not take pain medication and patients using more analgesics reported more pain than those using fewer analgesics ( p < 0·05). Patients with a more positive outlook on the future reported significantly less pain in all of the locations that were evaluated ( p < 0·01). Conclusion. A high percentage of patients with CLBP continue to experience pain 1–8 years after spinal fusion. A positive outlook towards the future seems to be associated with less pain in these patients. Relevance to clinical practice. Patients who continue to experience pain and have a more negative outlook on the future may benefit from psychoeducational interventions that teach them how to better cope with their pain. [ABSTRACT FROM AUTHOR]

stabell a, eide h, solheim ga, solberg kn & rustøen t (2004) Journal of Clinical Nursing 13, 677–686 Nursing home residents’ dependence and independence Entering an institution constitutes one of the most difficult developmental challenges for older people, and may lead to increased dependency because of reinforcing environmental events such as the interaction pattern of the staff. The aim of this paper was to describe the pattern of social interaction between nursing home residents and the nursing staff during mealtimes. Six residents of a nursing home in a suburb of Oslo were observed. Data were collected during 120 systematic observations. Different types of behaviour relating to the residents’ level of independence when interacting with the staff were examined using a structured observational scheme developed by Baltes. Data showed that the residents’ maintenance of independent self-care was the most predominant behaviour. Residents were rarely socially active. The behaviour of one resident varied among meals. Observations of independent self-care maintenance during interactions between the residents and the staff were sometimes consistent and sometimes inconsistent. The response of the nursing staff to the residents’ social engagement was variable. Generally, however, they did not respond at all and seldom displayed engagement-supportive behaviour. The results represent a challenge to the nursing staff to increase social interaction during mealtimes, and also to examine their inconsistent behaviour towards the residents. Mealtime appears to be a good opportunity to foster the independence of the residents as well as to enhance social activity in the form of informal conversation. Greater consistency of staff behaviour is required, based on ethical values such as consideration of the residents’ self-esteem and autonomy, thereby stimulating independent self-care at mealtimes. Inconsistent behaviour, often based on values that are not clarified, may, on the contrary, lead to increased dependence of the residents. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe what domains in quality of life were considered most or least important by patients with newly diagnosed cancer and in what way the domains of importance changed during a 9-month period. We also analysed the impact of selected demographic variables on the important domains. The Ferrans' and Powers' Quality of Life Index was used to measure quality of life. As this index consists of one section measuring the importance of various domains of life, information about changing standards was available. The study sample consisted of 131 adult patients recently diagnosed with different cancers. The whole sample filled in the questionnaire once, while part of the sample (n = 41) filled it in four times during a 9-month period. Items related to family matters were rated as most important, while faith in God was reported to be of least importance. The patients fluctuated somewhat in terms of what was most important to them during the study period. Overall, the most unstable items tended to be less important over time. In addition, results showed significant differences in the importance of quality of life domains according to gender, age, educational level and cohabitation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the validity and reliability of the Norwegian version of the Ferrans and Powers Quality of Life Index in a sample of 131 men and women with newly diagnosed cancer. The Quality of Life Index was translated into Norwegian using a standardized international approach, including back-translation. The findings showed high internal consistency reliability for the global score (alpha = 0.93 (test)) as well as for the following domains: health and functioning (alpha = 0.88), socio-economic (alpha = 0.82), psychological/spiritual (alpha = 0.82) and family (alpha = 0.79). The test–retest reliability after 3–4 weeks was 0.78 for the global score. A factor analysis partially confirmed the different subscales. In conclusion, the Quality of Life Index was found to be reliable and had sufficient validity to be used for measuring quality of life in Norwegian cancer patients. [ABSTRACT FROM AUTHOR]