A review of postoperative pain assessment records of nurses.

Background: Although there are many recommendations and guidelines for adequate pain assessment, the quality of postoperative pain documentation does not meet the acceptable standards. Aim: The aim of the study is to review the pain assessment and analgesic records of nurses within the first 48 h in the postoperative period. Methods: This retrospective and descriptive study was conducted in a University Hospital. The records of a total of 421 patients who underwent surgery between January 2014 and January 2015 were analysed. The data of the patients were obtained using the patient files. Results: Pain assessment scale was not used, and the pain records did not include intensity, location, duration and quality of the pain. The analgesic records indicated that the highest percentage (70.8%) of analgesic use was within the first postoperative two hours. Diclofenac sodium was the most commonly administered and recorded analgesic, while pethidine HCl was the least used one. More than half of the all analgesic injections (63.9%) were administered by intramuscular route. No non-pharmacological intervention including massage, hot­cold application, or positioning was reported in the nursing records. Conclusion: The postoperative pain was not assessed properly as recommended in the acute pain guidelines. Therefore, nurses should increase the awareness on the pain assessment records for effective pain management. In addition, the administration of the hospital should support the use of standard pain assessment and recording via electronic patient record system, continue online education courses and give feedback on the records of nurses regarding pain management.

Lymphocytes infiltrate the quadriceps muscle in lymphocytic myocarditis patients: a potential new diagnostic tool.

BACKGROUND: Diagnosing lymphocytic myocarditis (LM) is challenging because of the large variation in clinical presentation and the limitations inherent in current diagnostic tools. The objective of this study was to analyze infiltration of inflammatory cells in quadriceps skeletal muscle of LM patients and investigate the potential diagnostic value of assaying infiltrating inflammatory cells. METHODS: Quadriceps muscle tissue, obtained at autopsy from control patients (n = 9) and LM patients (n = 21), was analyzed using immunohistochemistry for infiltration of lymphocytes (CD45), macrophages (CD68), neutrophilic granulocytes (myeloperoxidase), and several lymphocyte subtypes (CD3, CD4, CD8, CD20) and using polymerase chain reaction for a panel of myocarditis-associated viruses. Additionally, quadriceps muscle from mice with acute coxsackievirus B3-induced myocarditis and control mice was analyzed for presence of lymphocytes and virus. RESULTS: In quadriceps muscle of LM patients the number of infiltrating lymphocytes were significantly increased and LM was diagnosed with specificity of 100% and sensitivity of 71%. Parvovirus B19 was the primary virus found in our patient groups, found in quadriceps tissue of 3 LM patients (although it was also found in 1 control patient). In the mice, enteroviral RNA was present in the quadriceps muscle, although enteroviral capsid proteins and lymphocyte infiltration were found primarily in the adipose tissue within and directly adjacent to the myocyte tissue, rather than in the myocyte tissue itself. CONCLUSIONS: LM is associated with lymphocyte infiltration and viral presence in quadriceps muscle. This indicates that skeletal muscle biopsy/lymphocyte quantification might be a potential diagnostic tool for LM patients.