Welcome to the PAIN OUT clinical Point of Care (PoC) system help and instructions
This is the first version of the PAIN OUT Point of Care system prototype. This version includes some
features of a future Point of Care system for PAIN OUT. The main purpose is to exemplify some parts of a
future PoC system and collect feedback to direct our further R&D and product development.
This research prototype is intended only for evaluation of the features we present here and
clinical use is not allowed in any form. The purpose is to enable evaluation of selected parts
of the system to obtain feedback and comments from potential users which will assist the research
and development team to improve the prototype.
We are aware that there is major work to be done before the PAIN OUT PoC system will be an everyday
tool in hospitals, but this is a first step in this direction and your feedback will bring our ambition
closer. By testing the system you are obliged to give feedback to the project. If you wish to test
the PAIN OUT PoC system prototype and give feedback, please contact firstname.lastname@example.org,
peter.funk#mdh.se or mobyen.ahmed#mdh.se
For more on the PAIN OUT FP7 project, please visit www.pain-out.eu
PAIN OUT & the PoC-team
User manual PAIN OUT PoC system
enables you to search and browse cases from the PAIN OUT registry.
You can compare pain levels and medications between different patient groups. This may in
some situation help you to make a more informed and personalised decision for your
current patient. The main limitation today is the flexibility of the search, the
number of cases in the case library (currently 17.000) and the completeness of
cases (e.g. missing age/weight/length data). Ultimately you may wish to ask the
question 'how is the pain outcome prognosis for my patient compared to other similar
patients and how can I improve it if necessary?
You can give a number of constraints to select cases from the case library (se figure).
By selecting Show report
a report on all cases meeting the constraints are shown including the
distribution between different medications and the pain ands ide effect distribution (currently only nausea and dizziness).
There are many calculation involved when selecting 'Show report' so you may have to wait a moment until the list
is shown (in this prototype version we have not spent time on optimizing performance).
We have given a set of the most common search criteria (please give us feedback on the
selection of search criteria for the next version). When testing the system please consider
how you would use it if you have a specific patient at hand, e.g. a patient with both hypertension and diabetes.
Show report - inspect pain and medication for patient groups similar to your patient
Selecting Show report
creates a report based on all cases meeting the given constraints and filtering
criteria. If you wish to compare reports for different patient groups you could open more than one web browser window.
The first table shows the distribution of the highest pain level. The second list shows the distribution of
the lowest pain patients had. -1 is when the information is not available. All cases make up 100%.
EXAMPEL: If you have a patient with hypertension and diabetes you may wish to compare the pain
outcome for these groups of patients with all patients. For example you may notice that 17% of
patients in the sample registry with both hypertension and diabetes are medicated with Paracetamol
while only 10% are medicated with Paracetamol in average including all patients in the PAIN OUT
registry. This may be relevant information that may help you make a more informed decision when
deciding how to medicate your current patient with hypertension and diabetes.
Find cases - constraint section
Age / Height / Weight
Here you can select the age, height and weight range suitable for the patient at hand. You may test if there are differences between different settings, e.g. if
gender has an effect on pain outcome
Off: age range is not used in filtering cases and values are shadowed
On: cases outside the range are excluded
Off: height range is not used in filtering cases
On: cases outside the range are excluded
Off: Weight range is not used in filtering cases
On: cases outside the range are excluded
If you are exploring e.g. differences in pain outcome between male and female patients
then select gender, otherwise select 'All' to include all cases (also cases
where gender is not specified).
Comorbidity is known to influence pain outcome and side effects in some patients.
By selecting a comorbidity profile similar to your patient you can see the pain outcome
on similar past patients and what medication they received.
If you select "include all" all cases are included with or without comorbidity.
Selecting "exclude all cases with comorbidity" will only include cases
with no comorbidity.
If you select "Only cases with comorbidity" the only cases included are are patients with any form of comorbidity
or other registered conditions. You may notice that patient with comorbidity or other registered
conditions considerably more often have pain level 8-10 than patient with no comorbidity.
If Only cases with comorbidity
is selected you have the option to refine your selection
of cases further by selecting one or more co-morbidities.
The most frequently occurring comorbidities in the registry are listed here. Here you can compare your
current patient with different groups of patients.
Example: if your patient has 'Hypertension' and other condition 'diabetes' then you may like to
se how this group of patients are medicated and what their pain outcome is compared with other
patients groups, an analysis of the reports may show that twice as much
intra-operative prescription of Paracetamol occurs in this group of patients compared with other patients.
You may also find out that it is less frequent with pain level 8-10.
Select which cases to include all/general/regional. Here you can compare the difference between
patient groups, and you may notice that patients with regional anaesthesia have 50% higher
probability to have pain levels between 8-10.
If left empty all surgical procedures are included. In the example below we are looking at
patients with total hip replacement (ICDM9 code: 81.51)
Since the current case library has some limitation in the number of cases please see how many cases there are in your category
before using this selection criteria. For current status of cases in the case library please follow
(note that the CDSS system currently only uses a
subset of the complete PAIN OUT registry). Please select and manually type in the ICD9 code in the window (better interface in next version). For information on ICD9 codes please follow
this external link
. Currently only one surgical procedure can be selected, example: 80.51 (Total hip replacement).
If you wish to include all surgical procedures starting with 80 then type in '80.'
If you only wish to only include patients with high or low pain intensity
you can make your selection here. This may give interesting information on the pain level and medication fr different patient groups.
If you only wish to see a summary report or list of patient cases with a high or low degree of side effects please
make your selection here (currently we only look at nausea in this prototype). This may give interesting information
on the side effect level and medication for different patient groups.
Pain level summary for all cases meeting the given constraints.
The number of cases and the calculation time is shown in the header.
Distribution of medication among the cases meeting the given constraints. Not that only
Intra-operative analgesics are shown in the prototype.
There are cases in the case library that do not have any information on the type of analgesics (frequent in "Nonopioid analstetics/Intra operative" question M2)
and some patient have non or more than one prescribed medication. The first percentage figure (32,36% in example) are all patient
where Question M2 "Non-opioids (pre-medication)" = yes, but in this case half have not any specific medication indicated.
Selecting the Show cases
button will produce a list with all cases that meet the constraints and the filtering criteria.
If additional sorting criteria have been selected in the blue section this will direct the order in which the cases are shown.
You may open specific cases and inspect them in detail. This list may be long and may take up to a minute to generate,
preferable first see how many cases are included in Show report
before you select Show cases
. The search constraints
given for Show report
are preserved for Show cases
If you wish to inspect any case in detail then you can see exactly what the case contains by
selecting 'details' (last column in the list with cases).
If you have made a search and wish to change the constraints select Edit constraints
This choice is a safety feature so results and constraints always are consistent.
Find cases - Sorting section
This section is only relevant for Show cases
and when you select Show report
this section is hidden.
The input section Sorting
has a light blue background. Here you select a number
of additional sorting/ordering criteria.
Sort pain intensity
Select how the list with cases are sorted
Descending: The highest pain cases are first in the list
Ascending: The lowest pain cases are listed first
Sort side effects
Descending: The patients with most side effects are listed first
Ascending: The patients with the least side effects are listed first
If you also selected sorting on pain level then this sorting criteria
will be among cases with the same pain level.
Please also select which pain level is most relevant for you:
Nausea Dizziness Drowsiness Itching