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Ahlander, B.-M., Engvall, J., Maret, E. & Ericsson, E. (2018). Positive effect on patient experience of video-information given prior to cardiovascular magnetic resonance imaging, a clinical trial. Journal of Clinical Nursing, 27(5-6), 1250-1261
Open this publication in new window or tab >>Positive effect on patient experience of video-information given prior to cardiovascular magnetic resonance imaging, a clinical trial
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 5-6, p. 1250-1261Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To evaluate the effect of video information given before cardiovascular magnetic resonance imaging on patient anxiety and to compare patient experiences of cardiovascular magnetic resonance imaging versus myocardial perfusion scintigraphy. To evaluate whether additional information has an impact on motion artefacts.

Background: Cardiovascular magnetic resonance imaging and myocardial perfusion scintigraphy are technically advanced methods for the evaluation of heart diseases. Although cardiovascular magnetic resonance imaging is considered to be painless, patients may experience anxiety due to the closed environment.

Design: A prospective randomised intervention study, not registered.

Methods: The sample (n = 148) consisted of 97 patients referred for cardiovascular magnetic resonance imaging, randomised to receive either video information in addition to standard text-information (CMR-video/n = 49) or standard text-information alone (CMR-standard/n = 48). A third group undergoing myocardial perfusion scintigraphy (n = 51) was compared with the cardiovascular magnetic resonance imaging-standard group. Anxiety was evaluated before, immediately after the procedure and 1 week later. Five questionnaires were used: Cardiac Anxiety Questionnaire, State-Trait Anxiety Inventory, Hospital Anxiety and Depression scale, MRI Fear Survey Schedule and the MRI-Anxiety Questionnaire. Motion artefacts were evaluated by three observers, blinded to the information given. Data were collected between April 2015–April 2016. The study followed the CONSORT guidelines.

Result: The CMR-video group scored lower (better) than the cardiovascular magnetic resonance imaging-standard group in the factor Relaxation (p =.039) but not in the factor Anxiety. Anxiety levels were lower during scintigraphic examinations compared to the CMR-standard group (p <.001). No difference was found regarding motion artefacts between CMR-video and CMR-standard.

Conclusion: Patient ability to relax during cardiovascular magnetic resonance imaging increased by adding video information prior the exam, which is important in relation to perceived quality in nursing. No effect was seen on motion artefacts.

Relevance to clinical practice: Video information prior to examinations can be an easy and time effective method to help patients cooperate in imaging procedures.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
Keywords
cardiovascular magnetic resonance imaging; myocardial perfusion scintigraphy; nursing; patient experience; patient information; video information
National Category
Radiology, Nuclear Medicine and Medical Imaging Nursing
Research subject
Radiology; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-62679 (URN)10.1111/jocn.14172 (DOI)000428419400085 ()29149455 (PubMedID)2-s2.0-85042274450 (Scopus ID)
Note

Funding Agencies:

Futurum, County Council of Jönköping  

Division of Medical Diagnostics, Region Jönköping county Sweden

Available from: 2017-11-18 Created: 2017-11-18 Last updated: 2018-04-25Bibliographically approved
Nilsson, U., Ericsson, E., Eriksson, M., Idvall, E. & Bramhagen, A.-C. (2018). Psychometric evaluation of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery and postoperative behavior and recovery inchildren undergoing tonsil surgery. Journal of Perioperative Practice
Open this publication in new window or tab >>Psychometric evaluation of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery and postoperative behavior and recovery inchildren undergoing tonsil surgery
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2018 (English)In: Journal of Perioperative Practice, ISSN 1750-4589Article in journal (Refereed) Epub ahead of print
Abstract [en]

The study comprised a prospective, comparative cross-sectional survey in 143 (of 390) children undergoing tonsil surgery. Parents answered the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS), and children answered the questionnaire Postoperative Recovery in Children (PRiC). The PHBQ-AS had positive correlation with the PRiC and with general health. On day 10 after surgery, up to one-third of the children still reported physical symptoms (PRiC). No gender or age differences concerning the items of behavior (PHBQ-AS) were found. The quality of postoperative recovery (PRiC) in girls was lower, with higher levels of nausea, dizziness, coldness, and headache compared to the boys. Children <6 years of age reported higher levels of dizziness and lower sleep quality and lower general health.

Place, publisher, year, edition, pages
Harrogate : Association for Perioperative Practice, 2018
Keywords
Behavior, Children, Pain, Postoperative recovery, Tonsil surgery
National Category
Medical and Health Sciences Pediatrics
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-67517 (URN)10.1177/1750458918782878 (DOI)29932361 (PubMedID)
Available from: 2018-06-27 Created: 2018-06-27 Last updated: 2018-09-14Bibliographically approved
Alm, F., Jaensson, M., Lundeberg, S. & Ericsson, E. (2017). Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery: A survey of the multidisciplinary team. International Journal of Pediatric Otorhinolaryngology, 101, 123-131
Open this publication in new window or tab >>Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery: A survey of the multidisciplinary team
2017 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 101, p. 123-131Article in journal (Refereed) Published
Abstract [en]

Background: Pain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping system have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013.

Objectives The objective of this study was to evaluate the professionals’ opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up.

Method: This descriptive cross-sectional study was based on data from an inter-professional questionnaire, which was validated by an expert group using a content validity index (S-CVI 0.93). The questionnaire was sent to all Swedish ear, nose and throat (ENT) departments (n=49) that the NTRS identified as performing tonsil surgery on children younger than 18 years of age. In each clinic, we asked for responses from staff in each of the following professions: ENT physicians, anesthesia physicians, registered nurse anesthetists, and registered nurses in the ENT departments.

Results: Respondents from 48 ENT departments participated, and 139/163 (85%) completed questionnaires were returned. The guidelines were reported as being clear, ensuring patient safety and providing optimal pharmacological treatment. Treatment was given according to the guidelines: Half of the departments gave pre- or intraoperative treatment with clonidine, betamethasone and high-dose paracetamol (acetaminophen). A multimodal pain approach (paracetamol and COX inhibitors) after hospital discharge was prescribed by all departments after tonsillectomy and, more extensively, after tonsillotomy. One-third of the departments prescribed paracetamol with a higher normal dose for the first three postoperative days. Half of the departments prescribed rescue analgesics, clonidine or opioids after tonsillectomy. None of the departments prescribed codeine or tramadol, drugs that are discouraged in the guidelines. The majority of the departments used the website tonsilloperation.se to provide information to the patients and their caregivers.

Conclusion: The respondents' opinions of and the ENT departments adherence to the Swedish national guidelines were considered to be good. The national implementation process in Sweden has impacted the manner in which ENT departments treat pain after tonsil surgery.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Children, Guidelines, Pain Management, Tonsillectomy, Tonsillotomy
National Category
Otorhinolaryngology Pediatrics
Research subject
Caring Sciences w. Medical Focus; Oto-Rhino-Laryngology; Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-59058 (URN)10.1016/j.ijporl.2017.07.040 (DOI)000413713100022 ()28964282 (PubMedID)2-s2.0-85026786151 (Scopus ID)
Projects
Effective postoperative pain management in children after tonsil surgery: barriers and possible solutions
Note

Funding agencies:

Research Committee at Region Örebro County

Örebro University Hospital Research Foundation OLL674631

Available from: 2017-08-07 Created: 2017-08-07 Last updated: 2017-12-05Bibliographically approved
Ericsson, E., Nilsson, U., Bramhagen, A.-C., Harden, S., Idvall, E. & Eriksson, M. (2017). Experiences of a new self-report instrument for post-operative recovery in children. In: : . Paper presented at XXXIII Congress of the Nordic Association of Otolaryngology, Gothenburg, Sweden, May 31 - June 3, 2017.
Open this publication in new window or tab >>Experiences of a new self-report instrument for post-operative recovery in children
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2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

The objective was to develop and test an instrument that provides children, also of a younger age, with a quality recovery self-report measure after tonsil surgery.

Methods: The development of Postoperative Recovery in Children (PRiC) was influenced by Quality of Recovery-24, for use in adults. It includes 23 items covering different aspects of recovery. PRiC was developed both as a traditional text-based instrument and as a version where each item is illustrated by a photo. It was distributed to 260 children undergoing tonsillotomy or total tonsillectomy in day-surgery, to be answered on post-operative days 1, 4 and 10.

Results: In the photo-version, 27% of the children marked the answers on the instrument themselves, compared to 19% in the text-version (n.s.). Parents of 64% of the children in the photo-group reported that their child participated in answering the questions to a very high degree, compared to 58% in the text-group (n.s.). Some parents described that their children were very proud to fill in the instrument and return them by mail. The questions were mainly described as easy to understand and respond to, especially when illustrated with a photo. Some parents highlighted pain issues and asked for specific questions about what pain medication was given at home. One parent asked for the possibility to respond to the instrument online.

Conclusion: PRiC can serve as a patient-reported outcome measure for children. PRiC can also provide parents with a tool for communicating with their child about post-operative recovery, especially when using the photo version.

National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-58199 (URN)
Conference
XXXIII Congress of the Nordic Association of Otolaryngology, Gothenburg, Sweden, May 31 - June 3, 2017
Projects
PRIC
Available from: 2017-06-22 Created: 2017-06-22 Last updated: 2017-10-18Bibliographically approved
Alm, F., Stalfors, J., Nerfeldt, P. & Ericsson, E. (2017). Patient reported outcome of pain after tonsil surgery: An analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-2016. In: : . Paper presented at Nordic Pediatric Pain Symposium 2017, Stockholm, Sweden, March 30-31, 2017.
Open this publication in new window or tab >>Patient reported outcome of pain after tonsil surgery: An analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-2016
2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Tonsil surgery is common surgical procedure in children and cause significant pain under postoperative recovery. The objective of this register study was to explore factors affecting pain after pediatric tonsil surgery, using patient-reported outcomes from questionnaires in the National Tonsil Surgery Registry in Sweden, 30 days after surgery. A total of 32,225 tonsil surgeries on children (aged 1-18 years) during January 2009- November 2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE±A) and 18,321 tonsillotomies with or without adenoidectomy (TT±A). In surgery cases of indication obstruction, the TT±A stopped taking painkillers and returned to normal eating habits sooner, and had less contact with health care services due to pain, compared to TE±A. After TE±A, the indication infection group had more days on analgesics and more contacts with health care services due to pain, compared to the indication obstruction group. TE±A with cold-dissection technique resulted in fewer days on painkillers compared to warm-technique, and reduced the number of contacts with health care services due to pain. Older children were affected by more days of morbidity than the younger ones, but there was no gender difference after adjustment for age, dissection technique and hemostasis technique. Implementation of national guidelines for pain treatment (2013) and patient information on the website tonsilloperation.se seems to have increased the days on analgesics after surgery. Pain after tonsil surgery depends on the surgical procedure and technique, as well as factors such as the patient’s age and surgical indication. More studies including pain interventions are needed to improve the care of tonsillectomy patients.

National Category
Surgery Otorhinolaryngology Nursing
Research subject
Caring Sciences w. Medical Focus; Oto-Rhino-Laryngology; Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-58197 (URN)
Conference
Nordic Pediatric Pain Symposium 2017, Stockholm, Sweden, March 30-31, 2017
Available from: 2017-06-22 Created: 2017-06-22 Last updated: 2017-10-18Bibliographically approved
Alm, F., Stalfors, J., Nerfeldt, P. & Ericsson, E. (2017). Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016. European Archives of Oto-Rhino-Laryngology, 274(10), 3711-3722
Open this publication in new window or tab >>Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016
2017 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 274, no 10, p. 3711-3722Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to describe factors affecting pain after pediatric tonsil surgery, using patient reported pain-related outcome measures (pain-PROMs) from the National Tonsil Surgery Register in Sweden. In total, 32,225 tonsil surgeries on children (1 to\18 years) during 2009–2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE ± A), and 18,321 tonsillotomies with or without adenoidectomy (TT ± A). Adjustments were made for variables included in the register to compensate for contributable factors in the analysis. When compared to TE ± A for surgical indication obstruction, TT ± A resulted in lower pain-PROMs, shorter use of postoperative analgesics, earlier return to regular food intake, and lower risk for contact with health care services due to pain. Children who underwent TE ± A because of obstruction problems stopped taking painkillers and returned to normal eating habits sooner, compared to children who underwent TE ± A for infectious indications. In both indication groups, TE ± A performed with hot rather than cold technique (dissection and haemostasis) generally resulted in higher pain-PROMs. Older children reported more days on analgesics and a later return to regular food intake after TE ± A than younger ones. No clinically relevant difference between sexes was found. Between 2012 and 2016 (pre-and post-implementation of Swedish national guidelines for pain treatment), the mean duration of postoperative analgesic use had increased. In conclusion, TE ± A caused considerably higher ratings of pain-related outcome measures, compared to TT ± A. For TE ± A, cold surgical techniques (dissection and haemostasis) were superior to hot techniques in terms of pain-PROMs. Older children reported higher pain-PROMs after TE ± A than younger ones.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
Children, Pain, PROM, Tonsillitis, Tonsillar hypertrophy, Tonsillectomy, Tonsillotomy
National Category
Otorhinolaryngology Anesthesiology and Intensive Care Nursing
Research subject
Anaesthesiology; Oto-Rhino-Laryngology; Nursing Science
Identifiers
urn:nbn:se:oru:diva-59111 (URN)10.1007/s00405-017-4679-4 (DOI)000409888700021 ()28815308 (PubMedID)2-s2.0-85027510091 (Scopus ID)
Note

Funding Agency:

Swedish Association of Local Authorities and Regions

Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2018-08-01Bibliographically approved
Ericsson, E., Nilsson, U., Bramhagen, A.-C., Idvall, E. & Eriksson, M. (2017). Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy. In: : . Paper presented at XXXIII Congress of the Nordic Association of Otolaryngology, Gothenburg, Sweden, May 31 - June 3, 2017.
Open this publication in new window or tab >>Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy
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2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this aspect.

Methods: 238 children (4-12 years) with a history of obstructive problems and/or recurrent tonsillitis were included. 48% were operated with tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery. Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument, Postoperative Recovery in Children (PRiC), which includes 23 items covering different aspects of recovery after tonsil surgery.

Results: Daily life activities (sleeping, eating and playing), and physical (e.g., headache, stomach ache, throat ache, otalgia, dizziness, nausea, defecation, urination) and emotional aspects (sadness, frightening dreams) were affected during the recovery period.

The TE-girls showed higher scores than the boys in many factors. Children above 6 years of age reported higher values for the physical comfort variables while the younger group showed worse emotional states. Postoperative recovery improved from day 1 to 10 in all surgical groups. The TE-group had lower recovery compared to the TT-group (p < 0.01 – 0.001) in most items.

Conclusion: The goal of postoperative management is to minimise or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery after tonsil surgery, and thus, PRiC can serve as a PROM to obtain patient-centred data after tonsil surgery.

National Category
Nursing
Research subject
Caring Sciences w. Medical Focus; Caring sciences
Identifiers
urn:nbn:se:oru:diva-58201 (URN)
Conference
XXXIII Congress of the Nordic Association of Otolaryngology, Gothenburg, Sweden, May 31 - June 3, 2017
Note

 

Available from: 2017-06-22 Created: 2017-06-22 Last updated: 2017-10-18Bibliographically approved
Eriksson, M., Nilsson, U., Bramhagen, A.-C., Idvall, E. & Ericsson, E. (2017). Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy. International Journal of Pediatric Otorhinolaryngology, 96, 47-54
Open this publication in new window or tab >>Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy
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2017 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 96, p. 47-54Article in journal (Refereed) Published
Abstract [en]

Objectives: Tonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this respect.

Methods: In total, 238 children (4–12 years old) with a history of obstructive problems and/or recurrent tonsillitis, and undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery.

Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children. This includes 23 items covering different aspects of recovery after tonsil surgery. A higher score indicates worse status in the respective items.

Results: Daily life activities (sleeping, eating and playing), physical symptoms (e.g., headache, stomach ache, sore throat, otalgia, dizziness, nausea, defecation, urination), and emotional aspects (sadness, frightening dreams) were affected during the recovery period.

The TE-girls showed higher scores than the boys regarding stomach ache, defecation and dizziness.

Children above 6 years of age reported higher values for the physical comfort variables, while the younger group showed worse emotional states.

Postoperative recovery improved from day 1–10 in all surgical groups. The TE-group showed lower recovery compared to the TT-group (p < 0.01–0.001) in most items.

Conclusion: The goal of postoperative management is to minimize or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery, and thus, PRiC seems to be able to serve as a PROM to obtain patient-centered data after tonsil surgery. The recovery process after TT causes less postoperative morbidity and a quicker return to normal activity compared to TE.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Patient-reported outcome measures, postoperative recovery, Pain, Tonsillectomy tonsillotomy
National Category
Nursing Otorhinolaryngology Pediatrics
Research subject
Oto-Rhino-Laryngology; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-56233 (URN)10.1016/j.ijporl.2017.02.029 (DOI)000403737800010 ()28390613 (PubMedID)2-s2.0-85014815423 (Scopus ID)
Note

Funding agencies:

Research Committee at Region Örebro County  

Örebro University Hospital Research Foundation  

Research Council of South East Sweden [FORSS]  

Sloane University Care 

Available from: 2017-03-10 Created: 2017-03-10 Last updated: 2017-09-18Bibliographically approved
Hallenståhl, N., Sunnergren, O., Ericsson, E., Hemlin, C., Hessén-Söderman, A.-C., Nerfeldt, P., . . . Stalfors, J. (2017). Tonsil surgery in Sweden 2013–2015: Indications, surgical methods and patientreported outcomes from the National Tonsil Surgery Register. Acta Oto-Laryngologica, 137(10), 1096-1103
Open this publication in new window or tab >>Tonsil surgery in Sweden 2013–2015: Indications, surgical methods and patientreported outcomes from the National Tonsil Surgery Register
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2017 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 137, no 10, p. 1096-1103Article in journal (Refereed) Published
Abstract [en]

Aim: To describes how tonsil surgery was performed in Sweden from 2013 to 2015 with data from the National Tonsil Surgery Registry in Sweden (NTSRS).

Method: The registry collects data from both professionals and patients through questionnaires. A total of 33,870 tonsil surgeries were analysed, comprising approximately 80% of all tonsil surgeries in Sweden from 2013 to 2015.

Results: The two most common procedures were tonsillectomy (41%) and tonsillotomy with adenoidectomy (38%). Tonsillectomy was most commonly performed to treat frequent tonsillitis, while the main indication for tonsil surgery with combined adenoidectomy and for tonsillotomy alone was upper airway obstruction. The most commonly used techniques were cold steel (70%) for tonsillectomy/adenotonsillectomy and radiofrequency (79%) for tonsillotomy/adenotonsillotomy. Ninety-five percent of patients reported symptom relief after 180 d. Day surgery was utilised in 70% of the surgeries. The rate of readmission due to post-tonsillectomy haemorrhage was 5.1%. Male patients more often underwent tonsil surgery at preschool ages due to upper airway obstruction; in comparison, female patients to a larger extent underwent surgery in their early teens because of previous infections.

Conclusions: The NTSRS provides an opportunity to survey tonsil surgery in Sweden and to launch and follow up improvement programmes as desired.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2017
Keywords
Tonsil surgery, tonsillotomy, tonsillectomy, national registry, outcome, complications
National Category
Otorhinolaryngology
Research subject
Caring Sciences w. Medical Focus; Surgery
Identifiers
urn:nbn:se:oru:diva-58193 (URN)10.1080/00016489.2017.1327122 (DOI)000407072000014 ()28598766 (PubMedID)2-s2.0-85020679400 (Scopus ID)
Available from: 2017-06-22 Created: 2017-06-22 Last updated: 2018-07-31Bibliographically approved
Alm, F., Jaensson, M., Lundeberg, S., Hemlin, C., Hessén-Söderman, A.-C., Nerfeldt, P., . . . Ericsson, E. (2016). Adherence to Swedish Guidelines for Pain Treatment in Tonsil Surgery in Pediatric Patients. In: : . Paper presented at 13th Congress of the European Society of Pediatric Otorhinolaryngology (ESPO 2016), Lisbon, Portugal, June 18-21, 2016.
Open this publication in new window or tab >>Adherence to Swedish Guidelines for Pain Treatment in Tonsil Surgery in Pediatric Patients
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2016 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Objective: As shown by data from the National Tonsil Surgery Register in Sweden, tonsil surgery often causes severe pain that lasts for many days. The register data demonstrate the necessity for better evidence-based pain treatment guidelines for tonsil surgery. The guidelines, introduced in 2013, consist of both pharmacological and non-pharmacological recommendations. In the guidelines, a multimodal analgesic approach and combination of analgesics are recommended to provide effective pain treatment with limited side effects. Two national multi-professional education days on pain, pharmacology and the guidelines were offered. Web-based information about pharmacological treatment (www.tonsililloperation.se) was designed for patients and next-of-kin. The current aims were to describe adherence to the Swedish guidelines for pain treatment in tonsil surgery in pediatric patients < 18 years

Method: An inter-professional questionnaire was developed, including questions linked to the relevant guidelines. The questions came from a national mapping before the guidelines were designed. The items were discussed by an expert group, and content validity was evaluated using the content validity index.ENT-and anesthesia physicians and nurses from all 50 ENT clinics in Sweden were enrolled.

Results: Most clinics had received the guidelines, but there was a discrepancy between the professions. More than half had perused the literature review performed before the guidelines were designed, and attended themulti-professional education day. Pre- and perioperative treatment usually included paracetamol, clonidine and betamethasone. A multimodal pain approach after discharge from hospital (tonsillectomy and tonsillotomy) was used, combining paracetamol with cox-inhibitors. Most clinics used paracetamol, with a higher dose for the first 3 days (healthy children and acceptable nutrition), and a reduced dose from day 4.In case of inadequate analgesia after tonsillectomy, oral clonidine or opioids were used. Several clinics followed the recommendation to use clonidine as first choice and secondly an opioid. No respondents prescribed codeine compared to 80% at the mapping before the guidelines were designed. The guidelines were experienced as clear, safe and sufficient. The web-based information was used by most of the clinics to improve quality of care and provide facilitating tools for patients, relatives and caregivers.

Conclusion: Swedish guidelines for tonsil surgery provide practical evidence-based pain treatment recommendations. To achieve a change, multi-professional education is necessary. This needs to be repeated for a wider spread.

Future research should include evaluation through pain diaries and questionnaires to next-of-kin and children. There should be matching of data from the quality registers at each clinic, with pain variables such as unplanned health care contacts due to pain, number of days with analgesics, and return to normal diet

Keywords
Tonsilsurgery, pain
National Category
Nursing Otorhinolaryngology
Research subject
Caring Sciences w. Medical Focus; Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:oru:diva-52856 (URN)
Conference
13th Congress of the European Society of Pediatric Otorhinolaryngology (ESPO 2016), Lisbon, Portugal, June 18-21, 2016
Available from: 2016-10-06 Created: 2016-10-06 Last updated: 2018-07-17Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8549-9039

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