14 results on '"Narinder Rawal"'
Search Results
2. PAIN OUT: The making of an international acute pain registry
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Margarita M. Puig, Dominique Fletcher, Yigal Leykin, Ragnar Backström, Lucian Fodor, Judith Rothaug, Thomas Volk, Marcus Komann, Ruth Zaslansky, Kristin Ullrich, Narinder Rawal, E. Pogatski-Zahn, Silviu Brill, Christoph Konrad, Debra B. Gordon, Winfried Meissner, and C.R. Chapman
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medicine.medical_specialty ,business.industry ,Psychological intervention ,MEDLINE ,Alternative medicine ,Missing data ,medicine.disease ,Preliminary analysis ,Anesthesiology and Pain Medicine ,Chart ,medicine ,Physical therapy ,Registry data ,Medical emergency ,business ,Acute pain - Abstract
Background: About 240 million patients undergo surgery every year, worldwide. Roughly 50% of these patients report clinically significant pain. Numerous barriers impede provision of adequate management. Lack of evidence about appropriateness and effectiveness of interventions is one. A registry can provide such information, eventually facilitating better management. This paper reports the development and feasibility of PAIN OUT, the first international acute pain registry, established with funds from the European Commission, and presents preliminary analysis to illustrate the nature of investigations that registry data make possible. Methods: On the first postoperative day, 6347 adult patients undergoing orthopaedic or general surgery, in 11 medical centres in Europe and Israel, provided Patient Reported Outcomes (PROs) using a validated questionnaire. Clinical data were abstracted from the patient’s chart. Results: Feasibility worked well. Over a period of 1 year, surveyors accrued targeted data sets and entered them into an online browser. Collaborators could receive online feedback comparing their findings about PROs against anonymized findings from other centres. Missing data for the majority of variables were low. Despite considerable variability between institutions, a large number of patients were treated according to the generic, evidence-based recommendations we assessed. However, this was not sufficient to result in acceptable outcomes for the majority of patients. Conclusion: The initial development of PAIN OUT has been achieved. From 2013, it continues as a not-for-profit academic project, open to clinicians and researchers worldwide. The International Association for Study of Pain and PAIN OUT will work together to maintain, disseminate and develop the registry.
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- 2014
3. PAIN OUT: an international acute pain registry supporting clinicians in decision making and in quality improvement activities
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Judith Rothaug, Thomas Volk, Winfried Meissner, Silviu Brill, Andreas Kopf, Narinder Rawal, Yigal Leykin, Ragnar Backström, Lucian Fodor, Maryam Yahiaoui-Doktor, Esther M. Pogatzki-Zahn, Dominique Fletcher, Christoph Engel, Marcus Komann, Margarita M. Puig, Rod S Taylor, Christoph Konrad, Debra B. Gordon, Kristin Ullrich, Matthias Schwenkglenks, Peter Funk, Richard C. Chapman, and Ruth Zaslansky
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Quality management ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Benchmarking ,Evidence-based medicine ,Perioperative ,Clinical decision support system ,Patient satisfaction ,Quality of life (healthcare) ,Nursing ,Health care ,Medicine ,business - Abstract
Rationale, aims and objectives: Management of post‐operative pain is unsatisfactory worldwide. An estimated 240 million patients undergo surgery each year. Forty to 60% of these patients report clinically significant pain. Discrepancy exists between availability of evidence‐based medicine (EBM)‐derived knowledge about management of perioperative pain and increased implementation of related practices versus lack of improvement in patient‐reported outcomes (PROs). We aimed to assist health care providers to optimize perioperative pain management by developing and validating a medical registry that measures variability in care, identifies best pain management practices and assists clinicians in decision making. Methods: PAIN OUT was established from 2009 to 2012 with funding from the European Commission. It now continues as a self‐sustaining, not‐for‐profit project, targeting health care professionals caring for patients undergoing surgery. Results: The growing registry includes data from 40 898 patients, 60 hospitals and 17 countries. Collaborators upload data (demographics, clinical, PROs) from patients undergoing surgery in their hospital/ward into an Internet‐based portal. Two modules make use of the data: (1) online, immediate feedback and benchmarking compares PROs across sites while offline analysis permits in‐depth analysis; and (2) the case‐based clinical decision support system offers practice‐based treatment recommendations for individual patients; it is available now as a prototype. The Electronic Knowledge Library provides succinct summaries on perioperative pain management, supporting knowledge transfer and application of EBM. Conclusion: PAIN OUT, a large, growing international registry, allows use of ‘real‐life’ data related to management of perioperative pain. Ultimately, comparative analysis through audit, feedback and benchmarking will improve quality of care.
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- 2014
4. Feasibility of international data collection and feedback on post-operative pain data: Proof of concept
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E. Davidson, E. Karanja, Ruth Zaslansky, C.R. Chapman, A. Lipman, Judith Rothaug, Andreas Kopf, Narinder Rawal, Thomas Volk, Ragnar Backström, K. Elessi, Stephan A. Schug, Silviu Brill, Dominique Fletcher, Christoph Konrad, Winfried Meissner, Lucian Fodor, Margarita M. Puig, Yigal Leykin, and Kristin Ullrich
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Medical education ,Decision support system ,Data collection ,biology ,business.industry ,Online database ,Benchmarking ,Missing data ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Proof of concept ,Toll ,biology.protein ,Medicine ,media_common.cataloged_instance ,030212 general & internal medicine ,European union ,business ,030217 neurology & neurosurgery ,media_common - Abstract
Post-operative pain exacts a high toll from patients, families, healthcare professionals and healthcare systems worldwide. PAIN-OUT is a research project funded by the European Union's 7th Framework Program designed to develop effective, evidence-based approaches to improve pain management after surgery, including creating a registry for feedback, benchmarking and decision support. In preparation for PAIN-OUT, we conducted a pilot study to evaluate the feasibility of international data collection with feedback to participating sites. Adult orthopaedic or general surgery patients consented to participate between May and October 2008 at 14 collaborating hospitals in 13 countries. Project staff collected patient-reported outcomes and process data from 688 patients and entered the data into an online database. Project staff in 10 institutions met the enrolment criteria of collecting data from at least 50 patients. The completeness and quality of the data, as assessed by rate of missing data, were acceptable; only 2% of process data and 0.06% of patient-reported outcome data were missing. Participating institutions received access to select items as Web-based feedback comparing their outcomes to those of the other sites, presented anonymously. We achieved proof of concept because staff and patients in all 14 sites cooperated well despite marked differences in cultures, nationalities and languages, and a central database management team was able to provide valuable feedback to all.
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- 2011
5. Patients' assessment of 4-week recovery after ambulatory surgery
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M. Warrén Stomberg, Märta Segerdahl, Jan G. Jakobsson, Narinder Rawal, Erik Houltz, and Metha Brattwall
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Arthroscopy ,General Medicine ,Ambulatory Surgical Procedure ,medicine.disease ,Surgery ,Inguinal hernia ,Anesthesiology and Pain Medicine ,Anesthesia ,Ambulatory ,medicine ,Hernia ,Prospective cohort study ,business ,Breast augmentation ,Depression (differential diagnoses) - Abstract
Background: Patients’ own assessment of recovery after ambulatory surgery has not been well studied. The aim was to study patients’ self-assessed recovery, the occurrence and time course of post-operative problems in relation to the type of ambulatory surgery.Methods: A questionnaire was filled in by 355 patients at five time points: pre-operative, first day at home, 1, 2 and 4 weeks post-operatively. Consecutive patients who underwent either inguinal hernia repair (IHR), arthroscopic procedures (AS) or cosmetic breast augmentation (CBA) were included.Results: Unplanned return to hospital was rare (3/355). Health care contacts were noted for 9% of the patients during the first week; a total of 70 contacts occurred during the entire period. Pain was the most frequently reported symptom; 40% of the patients reported pain or mobility problems at 1 week, 28% after 2 weeks and 20% after 4 weeks. Pre-operative pain was associated with an increased level of pain during the early post-operative course, in the recovery room and at 1 week post-operatively. IHR was associated with an overall rapid recovery, while AS patients experienced a slower restitution. All AS patients who reported pain after 4 weeks had reported pain problems already pre-operatively. Pain was not present pre-operatively in the CBA group, but was common at 1 and 2 post-operative weeks and was still reported by 11% at 4 weeks.Conclusion: Self-assessed recovery was found to cover several weeks with procedure-specific recovery patterns. Pain and mobility impairment were still frequently reported 4 weeks post-operatively.
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- 2010
6. The Postoperative Recovery Profile (PRP) - a multidimensional questionnaire for evaluation of recovery profiles
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Narinder Rawal, Elisabeth Svensson, Margareta Ehnfors, Renée Allvin, Ewa Idvall, and Anna-Maria Kling
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medicine.medical_specialty ,business.industry ,Health Policy ,Abdomen surgery ,Public Health, Environmental and Occupational Health ,MEDLINE ,Medicine ,Postoperative recovery ,Young adult ,business ,Orthopedic Procedures ,Surgery - Abstract
Background. The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evalu ...
- Published
- 2010
7. Acute Pain Service - what it is, why it is and what is next?
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Ragnar Backström and Narinder Rawal
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Service (business) ,medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,Postoperative pain ,Physical therapy ,medicine ,Pain relief ,University hospital ,business ,Acute pain - Abstract
In this article the organization of Acute Pain Service (APS) in Orebro University Hospital will be described in detail. How this organization works and how it is used to improve pain relief and pain relieving methods will also be described. Future ways to improve this organization and postoperative pain will be discussed.
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- 2008
8. Children in day surgery: clinical practice and routines. The results from a nation-wide survey
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Metha Brattwall, Narinder Rawal, Märta Segerdahl, Jan G. Jakobsson, and Margareta Warren-Stomberg
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Response rate (survey) ,medicine.medical_specialty ,Nausea ,business.industry ,medicine.medical_treatment ,General Medicine ,Ambulatory Surgical Procedure ,Tonsillectomy ,Surgery ,Anesthesiology and Pain Medicine ,El Niño ,Adenoidectomy ,medicine ,Anxiety ,medicine.symptom ,business ,Postoperative nausea and vomiting - Abstract
Background: Day surgery is common in paediatric surgical practice. Safe routines including parental and child information in order to optimise care and reduce anxiety are important. Most day surgery units are not specialised in paediatric care, which is why specific paediatric expertise is often lacking. Methods: We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining an 88% response rate. Three specific paediatric cases were enquired for in more detail. Results: The proportion of paediatric day surgery vs. in-hospital procedures was 46%. Seventy-one out of 88 responding units performed paediatric day surgery. All units had anxiolytic pre-medication as a routine in 1-6-year-olds, and in 7-16-year-olds at 60% of the units. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy. Anaesthesia induction was intravenous in older children, and also in 1-6-year-olds at 50% of the units. Parental presence at induction was mandatory. Post-operatively, 93% of units routinely assessed pain. Paracetamol and NSAIDs were the most common analgesics, as monotherapy or combined with rescue medication in the recovery as IV morphine. At 42% of units, take-home bags of analgesics were provided, covering 1-3 days of treatment. Pain was the most frequent complaint on follow-up. Micturition difficulties were common after circumcision, nausea after adenoidectomy and nutrition difficulties after tonsillectomy. Conclusions: In Sweden, most day surgery units perform paediatric surgery, most children receive pre-medication, anaesthesia is induced IV and take-home analgesics paracetamol and or NSAIDs are often provided. Still, pain is a common complaint after discharge.
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- 2008
9. Clinical practice and routines for day surgery in Sweden: results from a nation-wide survey
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Margareta Warren-Stomberg, Jan G. Jakobsson, Narinder Rawal, Metha Brattwall, and M. Segerdahl
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Response rate (survey) ,medicine.medical_specialty ,Nausea ,business.industry ,medicine.medical_treatment ,General Medicine ,Ambulatory Surgical Procedure ,Surgery ,Tonsillectomy ,Anesthesiology and Pain Medicine ,Pharmacotherapy ,Adenoidectomy ,Epidemiology ,medicine ,medicine.symptom ,Statistics & numerical data ,business - Abstract
Background: Day surgery is common in paediatric surgical practice. Safe routines including parental and child information in order to optimise care and reduce anxiety are important. Most day surgery units are not specialised in paediatric care, which is why specific paediatric expertise is often lacking.Methods: We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining an 88% response rate. Three specific paediatric cases were enquired for in more detail.Results: The proportion of paediatric day surgery vs. in-hospital procedures was 46%. Seventy-one out of 88 responding units performed paediatric day surgery. All units had anxiolytic pre-medication as a routine in 1–6-year-olds, and in 7–16-year-olds at 60% of the units. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy. Anaesthesia induction was intravenous in older children, and also in 1–6-year-olds at 50% of the units. Parental presence at induction was mandatory. Post-operatively, 93% of units routinely assessed pain. Paracetamol and NSAIDs were the most common analgesics, as monotherapy or combined with rescue medication in the recovery as IV morphine. At 42% of units, take-home bags of analgesics were provided, covering 1–3 days of treatment. Pain was the most frequent complaint on follow-up. Micturition difficulties were common after circumcision, nausea after adenoidectomy and nutrition difficulties after tonsillectomy.Conclusions: In Sweden, most day surgery units perform paediatric surgery, most children receive pre-medication, anaesthesia is induced IV and take-home analgesics paracetamol and or NSAIDs are often provided. Still, pain is a common complaint after discharge.
- Published
- 2007
10. Patient-controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression†
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Gustav Ekbäck, G Lidegran, E Johanzon, Narinder Rawal, K. Axelsson, Anil Gupta, and U Nordenson
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medicine.medical_specialty ,business.industry ,Ropivacaine ,Local anesthetic ,medicine.drug_class ,medicine.medical_treatment ,Surgical wound ,General Medicine ,Prilocaine ,Surgery ,Anesthesiology and Pain Medicine ,Bolus (medicine) ,Anesthesia ,medicine ,Local anesthesia ,business ,Subacromial bursa ,Saline ,medicine.drug - Abstract
Background: The aim of the study was to evaluate postoperative analgesia and safety of wound instillation of ropivacaine either by a single dose or a patient-controlled regional anaesthesia (PCRA) technique. Methods: In 40 patients undergoing arthroscopic subacromial decompression the surgeon placed a catheter into the subacromial space at the end of the operation. In Phase I (10 patients), ropivacaine 250 mg was injected twice within 1 h. In Phase II, 30 patients were randomised into three groups: group prilocaine-ropivacaine (PR) = 20 ml of 1% prilocaine-epinephrine injected preoperatively into the subacromial bursa + 20 ml of 0.5% ropivacaine infused in the catheter postoperatively; group saline-ropivacaine (SR) = saline-epinephrine (20 ml) preoperatively + 0.5% ropivacaine as in group PR; group saline-saline (SS) = saline-epinephrine (20 ml) preoperatively + saline postoperatively. The PCRA pump was filled with local anaesthetic or saline to allow boluses of 10-ml each, maximum one bolus/h, via the catheter. Pain relief, side-effects and venous plasma concentration of ropivacaine were evaluated during a 24-h-test period. Results: The free plasma concentration of ropivacaine was 0.12 + 0.041 mg l−1 in Phase I. No adverse effects were seen. In Phase II pain at rest and on movement was lower in group PR than in group SS during the first 30 min postoperatively (P
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- 2003
11. Analgesia following music and therapeutic suggestions in the PACU in ambulatory surgery; a randomized controlled trial
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Narinder Rawal, Ulrica Nilsson, Björn Enqvist, and Mitra Unosson
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medicine.medical_specialty ,Hypnosis ,Music therapy ,biology ,business.industry ,General Medicine ,Ambulatory Surgical Procedure ,biology.organism_classification ,behavioral disciplines and activities ,humanities ,Surgery ,law.invention ,Pacu ,Clinical trial ,Anesthesiology and Pain Medicine ,Randomized controlled trial ,law ,Anesthesia ,Ambulatory ,medicine ,Physical therapy ,business ,Prospective cohort study ,human activities - Abstract
Background: This study was designed to determine whether music (M), or music in combination with therapeutic suggestions (M/TS) could improve the postoperative recovery in the immediate postoperati ...
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- 2003
12. Improved recovery after music and therapeutic suggestions during general anaesthesia: a double-blind randomised controlled trial
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Mitra Unosson, Carina Zetterberg, Lars Erik Uneståhl, Ulrica Nilsson, and Narinder Rawal
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medicine.medical_specialty ,Music therapy ,Hysterectomy ,business.industry ,Visual analogue scale ,Nausea ,medicine.medical_treatment ,General Medicine ,humanities ,law.invention ,Clinical trial ,Anesthesiology and Pain Medicine ,Randomized controlled trial ,law ,Anesthesia ,Physical therapy ,Medicine ,General anaesthesia ,medicine.symptom ,business ,Period (music) - Abstract
Purpose: This study was designed to determine whether music or music in combination with therapeutic suggestions in the intra-operative period under general anaesthesia could improve the recovery of hysterectomy patients. Methods: In a double-blind randomised clinical investigation, 90 patients who underwent hysterectomy under general anaesthesia were intra-operatively exposed to music, music in combination with therapeutic suggestion or operation room sounds. The anaesthesia was standardised. Postoperative analgesia was provided by a patient-controlled analgesia (PCA). The pain scores were recorded by means of a visual analogue scale. Nausea, emesis, bowel function, fatigue, well-being and duration of hospital stay were studied as outcome variables. Results: On the day of surgery, patients exposed to music in combination with therapeutic suggestions required less rescue analgesic compared with the controls. Patients in the music group experienced more effective analgesia the first day after surgery and could be mobilised earlier after the operation. At discharge from the hospital patients in the music and music combined with therapeutic suggestion group were less fatigued compared to the controls. No differences were noted in nausea, emesis, bowel function, well-being or length of hospital stay between the groups. Conclusion: This double-blind study has demonstrated that intra-operative music and music in combination with therapeutic suggestions may have some beneficial effects on postoperative recovery after hysterectomy. Further controlled studies are necessary to confirm our results.
- Published
- 2001
13. Survey of postoperative analgesia following ambulatory surgery
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I Olofsson, P A Nydahl, A Gupta, Narinder Rawal, and J Hylander
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Nausea ,Analgesic ,Postoperative Complications ,Surveys and Questionnaires ,medicine ,Humans ,Prospective Studies ,Child ,Prospective cohort study ,Aged ,Pain Measurement ,Aged, 80 and over ,Pain, Postoperative ,business.industry ,Hand surgery ,General Medicine ,Middle Aged ,Inguinal hernia surgery ,Surgery ,Anesthesiology and Pain Medicine ,Ambulatory Surgical Procedures ,Child, Preschool ,Anesthesia ,Ambulatory ,Orthopedic surgery ,Vomiting ,Female ,medicine.symptom ,business - Abstract
Background: The quality of pain relief during the first 48 hours following ambulatory surgery has been poorly documented. This questionnaire study was performed to evaluate the nature and severity of pain after the patient leaves the hospital. Methods: 1100 patients in the age group 5–88 years who underwent ambulatory surgery during a period of 6months were asked to complete a questionnaire 48 h after the end of the operation. In thecase of children, parents were asked to complete a similar questionnaire. The questions were related to pain experienced during the first 48 h after surgery and to the nature andseverity of postoperative complications. Results: A total of 1035 out of the 1100 patients returned the questionnaire, 94.1%. Overall the majority (65%) of patients had only mild pain at home; however, patients undergoing certain types of surgery had moderate-to-severe pain: inguinal hernia surgery (62% patients), orthopaedic surgery (41%), hand surgery (37%) and varicose vein surgery (36%). In these patients the severity of pain did not decrease during the 2-day study period. About 10% patients had more severe pain than they had anticipated, and 20% had difficulty in sleeping at night due to severe pain. Despite this, over 95% of patients were satisfied with man-agement of postoperative pain. Nausea (20%), tiredness (20%) and vomiting (8%) were the commonest complications reported during the first 48 h. A significant association was found between the administration of a general anaesthetic and the incidence of nausea postoperatively. A large number of patients were alone at home after the operation (28.4%); some (3.8%) had no access to a relative or friend in case of need. Conclusion: Our results show that about 35% of day-surgery patients experience moderate-to-severe pain at home in spite of analgesic medication. About 20% of patients had sleep problems due to severe pain. However, only 5% of patients were dissatisfied. Better analgesic techniques are necessary for patients undergoing certain types of surgery. Patient information and follow-up routines need to be improved.
- Published
- 1997
14. T624 RELATIVE TREATMENT EFFECTS OF PERIOPERATIVE ETORICOXIB ON PAIN AT REST AND UPON MOVEMENT FOLLOWING ABDOMINAL HYSTERECTOMY
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Dimitris Papanicolaou, Anish Mehta, Eugene R. Viscusi, Tara L. Frenkl, Henrik Kehlet, L. Morgan, Amy T Ko, Paul M. Peloso, Steven S. Smugar, Arnold R. Gammaitoni, and Narinder Rawal
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medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,Anesthesia ,medicine ,Perioperative ,business ,Etoricoxib ,Abdominal hysterectomy ,Rest (music) ,Surgery ,medicine.drug - Published
- 2011
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