1. Introduction and Overview. 2. Detecting Influential Observations and Outliers. 3. Detecting and Assessing Collinearity. 4. Applications and Remedies. 5. Research Issues and Directions for Extensions. Bibliography. Author Index. Subject Index.

Regression Diagnostics: Identifying Influential Data and Sources of Collinearity

https://www.chpso.org/sites/main/files/file-attachments/chest-2008-geerts-381s-453s.pdf

Prevention of Venous Thromboembolism* American College of Chest Physicians Evidence- Based Clinical Practice Guidelines (8th Edition)

Objective:To revise the “Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult” published in Critical Care Medicine in 2002.Methods:The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task f

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Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit

Major surgery is still associated with undesirable sequelae such as pain, cardiopulmonary, infective and thromboembolic complications, cerebral dysfunction, nausea and gastrointestinal paralysis, fatigue and prolonged convalescence. The key pathogenic factor in postoperative morbidity, excluding failures of surgical and anaesthetic technique, is the surgical stress response with subsequent increased demands on organ function. These changes in organ function are thought to be mediated by trauma-induced endocrine metabolic changes and activation of several biological cascade systems (cytokines, complement, arachidonic acid metabolites, nitric oxide, free oxygen radicals, etc). To understand postoperative morbidity it is therefore necessary to understand the pathophysiological role of the various components of the surgical stress response and to determine if modification of such responses may improve surgical outcome. While no single technique or drug regimen has been shown to eliminate postoperative morbidity and mortality, multimodal interventions may lead to a major reduction in the undesirable sequelae of surgical injury with improved recovery and reduction in postoperative morbidity and overall costs.

Multimodal approach to control postoperative pathophysiology and rehabilitation.

This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations on ERAS® protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly. The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS® Society in this comprehensive consensus review.

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Guidelines for perioperative care in elective colonic surgery: Enhanced recovery after surgery (ERAS®) society recommendations

Epidural anesthesia and analgesia. Their role in postoperative outcome.

ContextWhether epidural analgesia is a better method than parenteral opioids
for postoperative pain control remains controversial.ObjectiveTo systematically review the efficacy of postoperative epidural analgesia
vs parenteral opioids, the primary alternative technique.Data SourcesStudies were identified primarily by searching the National Library
of Medicine's PubMed database (1966 to April 25, 2002) and other sources for
studies related to postoperative epidural analgesia.Study SelectionInclusion criteria were a comparison of epidural therapy vs parenteral
opioids for postoperative analgesia, measurement of pain using a visual analog
scale (VAS) or numeric rating scale, randomization of patients to either therapy,
and adult patients (≥18 years). A total of 1404 abstracts were identified,
100 of which met all inclusion criteria.Data ExtractionEach article was reviewed and data extracted from tables, text, or extrapolated
from figures as needed. Weighted mean pain scores, weighted mean differences
in pain score, and weighted incidences of complications were determined by
using a fixed-effect model.Data SynthesisEpidural analgesia provided better postoperative analgesia compared
with parenteral opioids (mean [SE], 19.40 mm [0.17] vs 29.40 mm [0.20] on
the VAS; P<.001). When analyzed by postoperative
day, epidural analgesia was better than parenteral opioids on each postoperative
day (P<.001 for each day after surgery). For all
types of surgery and pain assessments, all forms of epidural analgesia provided
significantly better postoperative analgesia compared with parenteral opioid
analgesia (P<.001 for all), with the exception
of thoracic epidural analgesia vs opioids for rest pain after thoracic surgery
(weighted mean difference, 0.6 mm; 95% confidence interval, –0.3 to
1.5 mm; P = .12). The complication rates were lower
than expected for nausea or vomiting and pruritus but comparable with existing
data for lower extremity motor block.ConclusionEpidural analgesia, regardless of analgesic agent, location of catheter
placement, and type and time of pain assessment, provided better postoperative
analgesia compared with parenteral opioids.

Efficacy of Postoperative Epidural Analgesia: A Meta-analysis

Although most randomized clinical trials conclude that the addition of continuous peripheral nerve blockade (CPNB) decreases postoperative pain and opioid-related side effects when compared with opioids, studies have included relatively small numbers of patients and the majority failed to show stati

/pdf/does-continuous-peripheral-nerve-block-provide-superior-pain-2fb8a1de38.pdf

Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis.

E A a n ffective postoperative analgesia is important from the atient’s perspective and can also improve clinical outomes. Recent surveys report only modest success in roviding suitable analgesia, as 30% to 86% of surgical atients report moderate to severe pain after a surgical rocedure. Although “advanced” analgesic techniques, uch as epidural analgesia or perineural catheters, can rovide superior analgesia, many of these analgesic moalities are labor-intensive and expensive. A promising odality that might help improve postoperative analgeia is the relatively simple technique in which the sureon directly places a catheter to infuse local anesthetic nto wounds at the end of the procedure. This modality an be widely used, is technically efficient, offers the otential to provide complete analgesia or to substanially reduce the need for opioids and their related side ffects, can be used for several days, and can now, with he introduction of new portable pumps, be used on an mbulatory basis. Although there are multiple reports nd small randomized controlled trials (RCTs) examinng use of continuous wound catheters in multiple surical procedures, there have been conflicting reports of he overall efficacy, and no single, large RCT has defintively assessed the risk benefit of this modality. We conucted this systematic review of randomized trials to etermine the efficacy of this modality.

https://www.journalacs.org/article/S1072-7515(06)01236-1/pdf

Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials.

BackgroundChoice of perioperative analgesia may affect the rate of recovery of gastrointestinal function and thus duration and cost of hospitalization after colonic surgery.

Spencer S. Liu

Papers

Epidural anesthesia and analgesia. Their role in postoperative outcome.

Efficacy of Postoperative Epidural Analgesia: A Meta-analysis

Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis.

Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials.

Effects of Perioperative Analgesic Technique on Rate of Recovery after Colon Surgery