Penthrox Is an Effective Analgesic but Is It Patient Approved?

Background Penthrox is a handheld inhaler that administers methoxyflurane. Its use is approved for analgesia in moderate-to-severe trauma-related pain in adults in the ED. The literature currently lacks methodologically robust qualitative data on individual patient experiences. Using a structured qualitative study, we set out to address this shortcoming. Methods Five patients were selected as a focus group to identify key themes they felt were important to explore, and these were included in the questionnaire design. We retrospectively identified all uses of Penthrox in the ED from June to August 2021. Qualitative data was gathered using the Trickett short interview method, and responses were grouped into positive and negative descriptors. In addition, quantitative data concerning their experience using the 5-point Likert scale was also gathered. Results A total of 101 participants responded to the questionnaire. Penthrox was utilised mainly for the manipulation of fractures, most commonly those of the ankle and wrist. Around 90% reported an overall satisfaction of ≥ good, and 97% reported the ease of use to be ≥ good. Its analgesic effectiveness was rated as excellent by 52%, and ≥ good by 89%. The most reported side effects were drowsiness (13%) and nausea (7%). The majority reported no side effects (74%). About 94% of the participants said they would take it again if required. An NVivo word cloud (Lumivero, Denver, CO, USA) was created visually, confirming an overall positive experience amongst the patients. Conclusions This study shows that Penthrox is a well-tolerated and user-friendly means of alleviating trauma-related pain in the ED. It highlights the importance of taking into consideration the individual patient journey alongside robust evidence-based data on safety and efficacy for the development of a holistic treatment.

Incidence and root causes of surgical site infections after gastrointestinal surgery at a public teaching hospital in Sudan.

BACKGROUND: Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays, additional financial burden, and significantly hamper the potential benefits of surgical interventions. Causes of SSIs are multi-factorials and patients undergoing gastrointestinal tract procedures carry a high risk of bacterial contamination. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries. METHODS: A hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between 1st September and 31st December 2017. We collected data about the socio-demographic characteristics, risk factors of SSI, and isolated microorganisms from patients with SSIs. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05. RESULTS: A total of 80 participants were included in the study. The mean age was 51 +/- 16 years and most of the patients (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) of them underwent large bowel surgery. Twenty-two patients (27.5%) developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated from SSI patients was E coli (47.8%), followed by Enterococcus fecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%). CONCLUSIONS: The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.

Success, but not failure feedback guides learning during neurofeedback: An ERP study.

Neurofeedback is a promising self-regulation technique used to modify specific targeted brain patterns. During neurofeedback, target brain activity is monitored in real time and fed back to the subject in a chosen format (e.g. visual stimulus). To date, we do not know how success and failure feedback are processed during neurofeedback learning. Here we analysed the event-related potentials (ERPs) in response to success and failure feedback during a single neurofeedback session in two experiments. Participants in experiment 1 (n = 127) took part in one of the three neurofeedback conditions: RLA: trained to increase alpha power on the right frontal in relation to the left; LRA: the reverse of the RLA; FPA: trained to increase alpha power on the mid-frontal in relation to the mid-parietal region. In experiment 2 (n = 45), participants took part in a similar session but one group received random feedback whereas the other received valid feedback to increase right frontal alpha power. We analysed the feedback related negativity (FRN), correct positivity (CP), and P3a and P3b in response to success and failure feedback. We observed stronger FRN and CP in response to success compared to failure feedback. Additionally, the P3a in response to success feedback was higher in epochs preceding subsequent good adjustments. Our findings indicate that people respond more strongly to success than failure feedback and that the P3a might mediate the encoding of the reinforced patterns in the brain.