Saudi Cultural Missions Theses & Dissertations
Permanent URI for this communityhttps://drepo.sdl.edu.sa/handle/20.500.14154/10
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Item Restricted Pain Management in Adult Intensive Care Unit in Saudi Arabia(University of Newcastle, 2024) Alotni, Majid Ali Saleh; Fernandez, Ritin; Guilhermino, MichelleThesis Abstract The prevalence of pain among patients in the intensive care unit (ICU) resulting from invasive procedures and medical interventions remains high. This issue is particularly complex for ICU patients unable to self-report their pain, leading to undetected and untreated pain and affecting quality of life. The specific aims were to: 1. Identify the barriers to nurse-led pain management in adult ICUs through an integrative review. 2. Implement the Critical Care Pain Observation Tool (CPOT) in Saudi Arabia to improve pain assessment in patients unable to self-report pain, with the goal of improving nurse practice and patient outcomes. 3. Develop and investigate the psychometric properties of an instrument designed to measure nurses’ readiness for implementing the CPOT, in ICUs in Saudi Arabia. Method An integrative review was conducted to identify the barriers to nurse-led pain management. Which were mapped to the COM-B model. This model suggested specific strategies to address the barriers. A stepped-wedge trial was conducted to assess the effect of the implementation of the CPOT on pain assessment. Finally, nurses’ readiness to implement was tested using the cross-sectional method with validity and psychometric analysis. Results The integrative review revealed several barriers to nurse-led pain management and informed the intervention. The intervention resulted in a significant increase in the number of pain assessments (Rate Ratio: 1.77, 95% confidence interval [CI]:1.45, 2.16, p < 0.001) and re-assessment (Rate Ratio: 13.99, 95% CI: 8.14, 24.02, p < 0.001) between the intervention and control groups. There was no significant effect on patient outcomes. The content validity of the mAFt. resulted in two factors: acceptability (10 items) and feasibility (five items). Conclusion Identifying barriers to nurse-led pain management in the ICU is crucial. Selecting the most effective interventions is essential to achieving optimal outcomes for both nurses and patients.19 0Item Restricted Postoperative pain assessment, and opioid utilisation after hospital discharge following colectomy(University of Nottingham, 2024-07-24) Baamer, Reham; Knaggs, Roger; Toh, Li Shean; Lobo, DileepBackground and aims Opioids have an established role in the management of postoperative pain; however, inappropriate opioid utilisation is evident, influenced by several factors including the overreliance on unidimensional pain assessment tools to guide opioid dosing. This thesis aims to advance the understanding of the management of postoperative pain, including pain assessment, opioid utilisation trends and persistent postoperative opioid use (PPOU) following colectomy. Methods Three interrelated studies were performed:1) a systematic review to assess the measurement properties of unidimensional and functional pain assessment tools in adult postoperative patients. Two pharmacoepidemiological studies were conducted using linked primary and secondary care data sources from England. 2): a retrospective cohort study to determine the prevalence and predictors of PPOU after colectomy. 3) A repeated cross-sectional analysis to describe the temporal trends in opioid prescriptions following discharge after colectomy. Results After a systematic search of four databases, 31 studies involving 12,498 participants were included. The quality of evidence for the measurement properties of all identified unidimensional pain assessment tools was suboptimal. Studies on functional assessment tools were scarce, with only one study including an ‘objective pain score’. However, it had suboptimal quality, with a very low quality of evidence. Amongst the 93,262 patients undergoing colectomy between 2010 and 2019, 15,081 (16.2%) were issued at least one opioid prescription within 90 days of discharge. From the whole cohort, 7540 (8.1%) developed PPOU. The odds of developing persistent opioid use were highest [OR 3.41 (95%CI 3.07–3.77)] for individuals who used long-acting opioid formulations in the 180 days before colectomy. Predictors of PPOU included previous opioid exposure; high deprivation index; multiple comorbidities; use of long-acting opioids; white race; and open surgery. Minimally invasive surgical approaches were associated with lower odds of PPOU. There was a downward trend in the proportion of opioid naïve patients who had post-discharge opioid prescriptions, from 11.4% in 2010 to 6.7% in 2019 (-41.3%, p < 0.001). However, the proportions prescribed opioids prior to surgery remained stable [57.5% in 2010 to 58.3% in 2019 (p = 0.637)]. Codeine represented 44.5% of all prescriptions and prescribing increased by 14.5%. Prescriptions for morphine and oxycodone rose significantly by 76.6% and 31.0% respectively, while tramadol prescribing dropped by 48.0%. Conclusion This thesis contributes to a deeper understanding of postoperative pain assessment and challenges the validity and reliability of unidimensional tools to quantify postoperative pain, and shows limited evidence for the use of functional pain assessment tools. There have been changes in the prescription of opioids following colectomy over the last decade and PPOU does occur after colectomy in England.27 0