Cardiac surgery is a common intervention that involves several pain-sensitive structures, and intense postoperative pain is a predictor of persistent pain. To describe pain characteristics (i.e. intensity, location, interference, relief) and analgesic intake preoperatively and across postoperative days 1 to 4 after cardiac surgery, and to explore associations between postoperative pain and demographic and clinical characteristics. Four hundred and sixteen patients (24% women) undergoing elective coronary artery bypass grafting and/or valve surgery were enrolled in a randomized controlled trial. Data were collected using standardized measures including the Brief Pain Inventory-short form. A linear mixed model analysis estimated the impact of sex, age, body mass index, analgesic intake and preoperative pain on postoperative worst pain ratings in the previous 24 hours from postoperative days 1 to 4 prior to discharge Thirty-eight per cent of the cardiac surgery patients reported preoperative pain. Postoperative worst pain remained in the moderate to severe range for the majority of patients across day 1 (85%) to day 4 (57%), mainly around the chest incision area for the majority (70%). Mean oral morphine intake was 17 mg/24 h (day 1: 27mg; day 4: 10mg). Lower age, female sex, preoperative pain and analgesic intake had a statistically significant association with higher postoperative worst pain ratings. Study findings demonstrated a high prevalence of moderate to severe pain after cardiac surgery and insufficient analgesic administration. Results indicated that patients were discharged from hospital with unrelieved pain and a potential risk for further postoperative complications.

The first month after discharge for Coronary artery bypass graft (CABG) is particularly challenging for the patients. A larger interview study is warranted to elicit CABG patients' detailed experiences, and give direction for future clinical practice. To explore the CABG patients' symptoms and needs in the early rehabilitation phase. A qualitative, mixed method design integrating qualitative and quantitative approaches was used. Ninety-three CABG patients aged 39-77, participated in interviews at home after 2 and 4 weeks. The semi-structured interview guide covered: experiences of relief of angina pectoris after surgery, experiences with prescribed discharge medications, psychological experiences: anxiety, depression, sexuality, health professional contact persons, and patient defined experiences. Two weeks after CABG the patients symptoms and needs were characterised by a substantial amount of uncertainty and worries related to what to expect and what was normal for postoperative pain, assessment and sensation of surgical site, different experiences with physical activity/exercise, uncertainty about medications, difficulties with sleep pattern, irritability, postoperative complications,uncertainty about return to work, and insufficient information at discharge. Four weeks after surgery the patients' symptom level was decreased, and they experienced life beginning to return back to normal. Patency with grafts after CABG, decision to drive a car, impotence (erectile dysfunction), and a missing link to the hospital remained challenges. CABG patients' experiences indicate a need to extend the hospital's discharge care to the first month after surgery for specific themes to promote rehabilitation outcomes.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Non-invasive telemonitoring (TM) can be used in heart failure (HF) patients to perform early detection of decompensation at home, prevent unnecessary healthcare utilization, and decrease healthcare costs. However, the evidence is not sufficient to be part of HF guidelines for follow-up care and we have no knowledge of how TM is used in the Nordic Baltic region. Objective: The aim was to describe health care professionals’ (HCPs) (1) perception of and presumed experience with non-invasive TM in daily HF patient care, (2) perspectives of the relevance of and reasons for applying non- invasive TM and (3) barriers to the use of non-invasive TM. Methods: A cross-sectional survey was performed between September and December 2016 in Norway and in Lithuania with physicians and nurses treating HF patients at either a hospital ward or an outpatient clinic. A total of 784 questionnaires were sent nationwide by postal mail to 107 hospitals. The questionnaire consisted of 43-items with closed- and open- ended questions. In Norway, the response rate was 69%, with 57 of 60 hospitals participating, whereas the response rate was 68% in Lithuania, with 41 of 47 hospitals participating. Responses to the closed questions were analyzed using descriptive statistics and the open-ended questions were analyzed using summative content analysis. Results: This study showed that non-invasive TM is not part of current daily clinical practice in Norway or Lithuania. A minority of HCPs responded to be familiar with non-invasive TM in HF care in Norway (48 of 226, 21%) and in Lithuania (64 of 310, 20%). Around half of the HCPs in both countries perceived non-invasive TM to be relevant in follow-up of HF patients in Norway (58%) and Lithuania (49%). For physicians in both countries and nurses in Norway the three most mentioned reasons for introducing non-invasive TM were: to improve self-care, to reduce hospitalizations and to provide high quality care, while the Lithuanian nurses described: ability to treat more patients and reducing their workload. The main barriers to implement non-invasive TM were lack of funding from health care authorities or the Territorial Patient Fund. Moreover, HCPs perceive HF patients’ themselves could represent barriers due their physical or mental condition in addition to a lack of internet access. Conclusions: HCPs in Norway and Lithuania are currently non-users of TM in daily HF care. However, they perceive a future with TM to improve the quality of care for HF patients. Financial barriers and HF patients’ condition may have an impact on the use of TM, whereas sufficient funding from health care authorities and improved knowledge may encourage the more widespread use of TM in the Nordic Baltic region and beyond.

Relevant discharge information about the use of analgesic medication and other strategies may help patients to manage their pain more effectively and prevent postoperative persistent pain. To examine patients’ pain characteristics, analgesic intake and the impact of an educational pain management booklet intervention on postoperative pain control after cardiac surgery. Concerns about pain and pain medication prior to surgery will also be described. From March 2012 to September 2013, 416 participants (23% women) were consecutively enrolled in a randomized controlled trial. The intervention group received usual care plus an educational booklet at discharge with supportive telephone follow-up on postoperative day 10, and the control group received only usual care. The primary outcome was worst pain intensity (The Brief Pain Inventory – Short Form). Data about pain characteristics and analgesic use were collected at 2 weeks and at 1, 3, 6 and 12 months post-surgery. General linear mixed models were used to determine between-group differences over time. Twenty-nine percent of participants reported surgically related pain at rest and 9% reported moderate to severe pain at 12 months post-surgery. Many participants had concerns about pain and pain medication, and analgesic intake was insufficient post-discharge. No statistically significant differences between the groups were observed in terms of the outcome measures following surgery. Postoperative pain and inadequate analgesic use were problems for many participants regardless of group allocation, and the current intervention did not reduce worst pain intensity compared with control. Further examination of supportive follow-up monitoring and/or self-management strategies post-discharge is required.