在大手术后的阿片类药物降解策略中解码行为改变技术:对减少术后阿片类药物使用的干预措施的系统性审查
Neetu Bansal1, Christopher J Armitage2,3, Rhiannon E Hawkes3
1Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health,Manchester Academic Health Science Centre, Oxford Road, University of Manchester, Manchester, UK neetu.bansal@manchester.ac.uk.
BMJ quality & safety
|July 29, 2024
概括
这项研究确定了对术后成年人有效的阿片类药物减少干预措施的关键行为改变技术 (BCT). 针对医疗保健专业人员的干预,使用行为指令和目标设定等技术,显示出最大的影响.
科学领域:
- 医学研究 医学研究
- 临床干预措施 临床干预
- 公共卫生 公共卫生
背景情况:
- 大型手术后使用阿片类药物是一个重大挑战.
- 减少阿片类药物的有效策略对于患者的康复和安全至关重要.
- 行为改变技术 (BCT) 越来越多地被认为是对改变健康行为的作用.
研究的目的:
- 系统地审查旨在减少成年人大手术后阿片类药物消费的干预措施.
- 识别和分析在这些干预中使用的行为改变技术 (BCT).
- 探索特定的BCT与阿片类药物减少策略的有效性之间的关联.
主要方法:
- 在多个数据库 (MEDLINE,Embase,CINAHL Plus,PsycINFO,Cochrane Library) 进行了全面的文献搜索,截至2023年10月.
- 包括专注于接受重大手术的成年患者和针对阿片类药物减少的干预措施的研究.
- 使用Cochrane RoB 2和ROBINS-I工具评估偏差风险;计算了科恩的d效应大小和BCT (使用验证的分类学).
主要成果:
- 包括22项研究 (7项RCT,15项队列研究),表现出各种偏差风险.
- 干预措施包括教育,指导方针,多方面的,和药剂师主导的方法,具有不同的效果大小 (10小-中等,12大).
- 确定了23种独特的BCT;具有大效果的大小的干预措施主要针对医疗保健专业人员,并使用诸如行为指令,目标设定和社会支持等技术.
结论:
- 了解在有效干预中占主导地位的BCT为未来的阿片类药物逐渐减少策略提供了洞察力.
- 需要进一步的研究来验证BCT与干预有效性之间的关联,同时考虑其他影响因素.
相关概念视频
Analgesia and Pain Management
557
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
557
Opioid Analgesics: Synthetic and Semisynthetic Opioids
260
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
260
Operant Conditioning Intervention
55
Operant conditioning serves as a foundational principle in therapeutic interventions aimed at modifying maladaptive behaviors. Central to this approach is the notion that behaviors, both adaptive and maladaptive, are learned through reinforcement. By analyzing the environmental factors that reinforce problematic behaviors, clinicians can design interventions to weaken these reinforcements and replace maladaptive behaviors with healthier alternatives.
In operant conditioning, behaviors that are...
In operant conditioning, behaviors that are...
55
Appendicitis-II: Diagnostic Studies and Management
73
Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
73
Chronic Pancreatitis II: Collaborative Care
79
The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
Assessment:
79
Opioid Analgesics: Morphine and Other Natural Cogeners
210
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
210


