The Fifth Vital

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Historically, the former president of the American Pain Society, James Campbell, introduced the idea of “Pain as the 5 th Vital Sign” (P5VS) in 1996. According to this concept, pain intensity should be regularly assessed, together with the classic four vital signs. However, unlike the classic four vital signs, self-reporting of pain is a subjective measurement, and clinicians should accept patient reports and act upon them. Three years later, the P5VS campaign credibility increased substantially after being adopted by the Veteran’s Health Administration. In the same year of 1999, Assembly Bill 791 (Thomson) was signed in California to implement the assessment and prompt treatment of pain, it is recorded in the patient’s chart in a manner consistent with other vital signs [ 2, 11– 13]. Likewise, the standards of pain assessment, follow-up, and uniform measurement were introduced as patients’ rights by the Joint Commission on Accreditation of Healthcare Organization (JCAHO) in 2000. This fact was followed by the North American pain management guidelines updates, including recommendations for pain assessment and documentation [ 3, 7, 14]. As mentioned earlier, Both Kane Hodder and Robert Englund’s books inspired me to jump into this pool of self-employment, quit my job and fly to LA from the UK a week after quitting to work on a movie. Lucas CE, Vlahos AL, Ledgerwood AM. Kindness kills: the negative impact of pain as the fifth vital sign. J Am Coll Surg. 2007; 205( 1):101–7. S1072-7515(07)00152-4 [pii] doi: 10.1016/j.jamcollsurg.2007.01.062 Within this video was Mike Majlak. Mike always seemed to come across as the wise one, the guy with his head screwed on. The older guy in the group who has the experience and the know-how to guide this crazy train of fame whilst maintaining a level-head. Last month, we announced supplemental grant awards to five institutions to explore potential links between COVID-19 vaccination and menstrual changes.Investigators aim to determine whether post-vaccination menstrual changes may be linked to vaccination itself and to explore the underlying mechanisms. For example, immune responses to a COVID-19 vaccine could affect the interplay between immune cells and signals in the uterus, leading to temporary menstrual cycle changes. The research also will account for other factors that may affect menstruation—including pandemic-related stress, lifestyle changes related to the pandemic, and infection with SARS-CoV-2, the virus that causes COVID-19.

Lorenz KA, Sherbourne CD, Shugarman LR, Rubenstein LV, Wen L, Cohen A, et al. How reliable is a pain as the fifth vital sign? J Am Board Fam Med. 2009; 22( 3):291–8. 22/3/291 [pii] doi: 10.3122/jabfm.2009.03.080162

The questionnaires were filled by the head nurse (63.0%), by the nurse supervisor (13.0%), by the supervisor anaesthesiologist (8.3%), by the head nurse advisor or nurse coordinator (6.5%), by the clinical director (4.6%), by the general nurse (2.8%) and by the chairman of the hospital board (1.9%).

Just like every other human being, I am not so keen on YouTuber books, but Mike is so much more than just a YouTuber - and as someone who has admired his and Logan’s growth over the last two or three years, I really enjoyed the book. Honestly, I was expecting this to be a lot worse than it was. I was genuinely surprised at how much I enjoyed certain aspects of this book and at how engaged I was throughout my reading. That being said, there were quite a few points where I wish a theme had been pushed further or I felt like this book didn't have as much emotional impact as it could have had. I only comment on the potential emotional impact because that seems to be a core goal of the book.Behavioral signs of acute pain may include restlessness (especially among older adults), an inability to concentrate, apprehension, and overall distress. Since pain is now routinely measured due to efforts of the VHA and JCAHO, the NRS is also asked of patients who are seeing physicians that have little to do with pain management on a day to day basis. So what is the role of pain assessment in these settings? There is not a simple answer, but it should be considered that assessing pain at every patient encounter may not be reasonable. Careful thought needs to go into the purpose of the pain assessment and what will be done with the pain assessment once the clinician receives it. This brings us full circle to the importance of provider education and management of pain.