ABSTRACT
BACKGROUND: In recent years nurses have come to play a professional role in pain management. In Germany, the publication of the national expert standards on pain management in nursing resulted in nurses being educated to be pain resource nurses; however, since education has started the continuance and commitments of specialized pain nurses in clinical practice is basically unclear. The goal of this evaluation was to identify how pain resource nurses are involved in pain management and organizational aspects in German hospitals. METHOD: Online survey of 374 directors of nursing services of different types of hospitals on the assignment of nursing pain experts. RESULTS: Pain resource nurses are involved in pain management in 70.6% of the hospitals responding to the questionnaire. Their task profile depends on the hospital size and 42.2% of the hospitals have documented task profiles. Pain resource nurses are primarily involved in invasive pain management processes (37.1%) and in the management of pain in patients with complex pain problems after surgery (33.2%). Educative tasks are training of colleagues and implementation and conversion of the national expert standards. Of the hospitals 36.1% implemented the national expert standards for acute pain and 57% of the medium-sized hospitals have at least also implemented the national expert standards for chronic pain. DISCUSSION: The study shows a first insight into the task profiles of pain resource nurses. The implementation of this special qualification is meaningful and seems to be well-recognized in the hospitals. The tasks of patient care are orientated to the spectrum of patients treated in the hospital. The tasks of education also show the importance for the education of colleagues.
Subject(s)
Nursing Staff, Hospital , Pain , Germany , Hospitals , Humans , Pain Management , Surveys and QuestionnairesABSTRACT
BACKGROUND: Postoperative pain continues to be undermanaged, at least in part, due to inadequate organization and lack of use of opioids. Especially patients who do not receive consultation from an acute pain service and are therefore not eligible to receive regional anesthesia techniques or patient-controlled devices suffer from severe pain after surgery. The aim of the present prospective observational study was to assess the efficacy and feasibility of an analgesia algorithm for this subgroup of patients. METHODS: An oral opioid concept including controlled-release (cr) oxycodone, immediate-release (ir) hydromorphone and a non-opioid analgesic was implemented at three different departments at the University Clinic of Muenster, Germany. Briefly, cr-oxycodon was administered preoperatively to patients undergoing ear nose and throat (ENT), general or elective trauma surgery on the day of surgery and every 12 h for a maximum of 4 days postoperatively. Inadequately managed pain above 3 on a visual analog scale (VAS 0-10) at rest and above 5 during movement was treated with ir-hydromorphone on patient request. After written informed consent, patients were assessed prospectively for up to 5 days perioperatively using a standardized questionnaire preoperatively, for 4 days postoperatively as well as 6 and 12 months after surgery. RESULTS: A total of 275 patients were included in the present prospective observational study: (ENT surgery: 163, trauma surgery 82 and general surgery 30). Median resting and evoked numeric rating scale (NRS) pain scores were equal or less than 3 and 5, respectively. Less patients received cr-oxycodone after ENT and general surgery compared to trauma surgery (p < 0.001). Constipation was more frequent after general and trauma surgery compared to ENT surgery. Vomiting decreased from 20 %-30 % on the day of surgery to 10 % or less regardless of the type of operation. No severe adverse events were observed. Additionally, patients with an increased depression score before surgery reported greater immediate postoperative pain than non-depressed patients. Of the patients 11 (15.7 %) and 7 (14.9 %) complained about persistent postoperative pain 6 and 12 months after surgery, respectively and these patients had increased acute pain ratings during the first postoperative days. CONCLUSIONS: The present study has demonstrated that the implementation of an oral opioid algorithm for patients without patient-controlled intravenous or regional analgesia is effective and feasible on surgical wards. Patients who underwent trauma surgery needed more cr-oxycodone. Side effects were similar regardless of the operation with the exception of obstipation which was more frequent after trauma and general surgery compared to ENT surgery.
Subject(s)
Algorithms , Analgesics, Opioid/administration & dosage , Elective Surgical Procedures , Hydromorphone/administration & dosage , Otorhinolaryngologic Surgical Procedures , Oxycodone/administration & dosage , Pain, Postoperative/drug therapy , Wounds and Injuries/surgery , Administration, Oral , Adult , Analgesics, Opioid/adverse effects , Delayed-Action Preparations , Drug Administration Schedule , Drug Therapy, Combination , Feasibility Studies , Female , Germany , Humans , Hydromorphone/adverse effects , Male , Middle Aged , Oxycodone/adverse effects , Pain Measurement/drug effects , Patient Satisfaction , Preoperative Care , Prospective StudiesABSTRACT
BACKGROUND: Approximately 30-80% of postoperative patients complain about moderate to severe post-surgical pain, indicating that postoperative pain treatment is still a problem. METHODS: We analysed prospectively collected data on patients in a university hospital receiving systemic and epidural patient-controlled analgesia and continuous peripheral nerve block (CPNB) documented by the acute pain service team in a computer-based system. RESULTS: Of 18 925 patients visited in the postoperative period between 1998 and 2006, 14 223 patients received patient-controlled epidural analgesia (PCEA), 1591 i.v. patient-controlled analgesia (IV-PCA), 1737 continuous brachial plexus block, and 1374 continuous femoral/sciatic nerve block. Mean dynamic and resting pain scores (VAS 0-100) were significantly lower for peripheral or neuroaxial regional analgesia compared with patient-controlled systemic opioid analgesia (P<0.05). The risk of a symptomatic spinal mass lesion including epidural haematoma (0.02%; 1:4741) or epidural abscess (0.014%; 1:7142) after PCEA was 1:2857 (0.04%). Neurological complications after CPNB occurred in two patients who received interscalene brachial plexus block. CONCLUSIONS: We demonstrated that PCEA, IV-PCA, and CPNB are safe and efficient. Although all of these treatment strategies provide effective analgesia, PCEA and CPNB provided superior pain relief compared with IV-PCA. We demonstrated that serious complications of analgesic techniques are rare but possibly disastrous necessitating a close supervision by an acute pain service. We found a low rate of adverse effects including hypotension and motor impairment and a low incidence of epidural haematoma for thoracic PCEA compared with lumbar PCEA.
Subject(s)
Pain, Postoperative/prevention & control , Patient Satisfaction , Quality of Health Care , Adolescent , Adult , Aged , Aged, 80 and over , Analgesia, Epidural/adverse effects , Analgesia, Epidural/standards , Analgesia, Epidural/statistics & numerical data , Analgesia, Patient-Controlled/adverse effects , Analgesia, Patient-Controlled/methods , Analgesia, Patient-Controlled/standards , Analgesia, Patient-Controlled/statistics & numerical data , Catheterization, Peripheral/adverse effects , Epidural Abscess/etiology , Female , Germany , Hematoma, Epidural, Spinal/etiology , Humans , Male , Meningitis, Bacterial/etiology , Middle Aged , Nerve Block/adverse effects , Nerve Block/standards , Nerve Block/statistics & numerical data , Pain Clinics/standards , Pain Clinics/statistics & numerical data , Pain Measurement/methods , Pain, Postoperative/psychology , Prospective Studies , Treatment OutcomeABSTRACT
After reviewing the histo-pathological characteristics of Kaposi's sarcoma, the authors show particular patterns of this disease in equatorial Africa (especially Cameroon). They note 3 associations with lymphomas, with special emphasis on 13 new observations of general lymph node enlargement in children. For 2 of these cases, remissions were observed. Finally, they stress the lack of information on the histogenesis with the mysterious links between lymphocytes and Kaposi's sarcoma.
Subject(s)
Lymphoma/pathology , Neoplasms, Multiple Primary/pathology , Sarcoma, Kaposi/pathology , Skin Neoplasms/pathology , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Lymph Nodes/pathology , Lymphoma/diagnosis , Male , Middle Aged , Neoplasms, Multiple Primary/diagnosis , Sarcoma, Kaposi/complications , Sarcoma, Kaposi/diagnosis , Skin/pathology , Skin Neoplasms/diagnosisABSTRACT
Filteen new serotypes of Salmonella belonging to the sub-genus I have been isolated in Africa. Isolated in Ivory Coast: S. dabou (8,20:Z4,Z23,l,W), S. elokate (9,12:c:1,7), S. assinie (3,10:1,w:Z5), S. anna (13,23:Z35:e,n,Z16), S. mpouto (16:m,t:-), S. banco (28:r:1,7), S. abidjan (38:b:l,w); in Senegal: S. bignona (17:b:e,n,Z15), S. lode (17:r:1,2), S. derkle (52,e,h:1,7); in Tchad: S. moussoro (1,6,14,25:i:e,n,Z15), S. drogana (1,4,12,27:r,i:e,n,Z15); in Algeria: S. hydra (21:c:1,6); in Haute-Volta S. farakan (28:Z10:1,5); in Republique Centrafricaine: S. babili (28:Z35:1,7).
Subject(s)
Salmonella/classification , Adult , Algeria , Animals , Birds/microbiology , Burkina Faso , Carrier State/microbiology , Chad , Child , Cote d'Ivoire , Feces/microbiology , Female , Goats/microbiology , Humans , Lizards/microbiology , Lymph Nodes/microbiology , Male , Salmonella/immunology , Salmonella/isolation & purification , Salmonella Infections/microbiology , Senegal , Sheep/microbiology , Swine/immunologyABSTRACT
A study to 100 N. gonorrhoeae strains demonstrated a sensitivity to antibiotics similar to that observed in 1973. On the other hand, an antibiogram for each of the 5 serotypes showed the peculiar sensitivity of the D serotype to penicillin in vitro.
