Psychological management of wound pruritus.

OBJECTIVE: To explore the psychological treatment options for pruritus in patients with wounds. METHOD: This study employed a narrative design with a search being completed using the databases Academic Search Complete, Google Scholar, PsycInfo, PsycARTICLES, Medline and CINAHL Plus. All articles between 1980-2013 that included the following search terms: [pruritus OR itch OR itching] AND [management OR psychological interventions OR treatment] AND [wounds OR burns OR wounds burns] were included in the review. RESULTS: A number of psychological treatments options emerged from the literature search that were suggested to be effective for treating itching. These included methods such as habit reversal, suggestions, relaxation, massage and itch-coping programmes. Each of these methods showed potential for improving the patient experience by reducing itching, although the research evidence is currently somewhat limited. CONCLUSION: Although itching is a common symptom in wounds, the use of psychological treatments for this may be rather limited. The treatments discussed show promise and their use should be a welcome addition to the healthcare professional's armoury for working with people with wounds. DECLARATION OF INTEREST: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.

Comparison of aminoglycoside clearance and calculated serum creatinine clearances.

Calculated creatinine clearance (CrCL) estimates are frequently used as estimates of aminoglycoside clearance (AGCL), despite being inadequately studied. Thirty surgical intensive care unit (SICU) patients with stable serum creatinines (0.6-6.3 mg/dl) and steady-state aminoglycoside levels were studied. A one-compartment pharmacokinetic infusion model was used to calculate k and Vd; AGCL = (k) (Vd). CrCLs using the equations of Cockroft-Gault (CGCL), Jelliffe (JCL), and Jelliffe uncorrected for body surface area (JCLu) were calculated, then compared to the AGCL. The JCLu was a better fit to the data (y = 0.98x + 0.44, r = 0.91) with a superior regression correlation (p less than 0.02) than CGCL (y = 0.91x + 6.07, R = 0.89) and JCL (y = 1.11x + 2.11, R = 0.89) correlations. CGCL overpredicted the AGCL whereas JCL and JCLu underpredicted the AGCL. All three methods showed a precision of approximately 20 ml/min. Relative bias and precision show JCLu better than JCL, CGCL better than JCL only for bias, and CGCL and JCLu not different. The absolute percentage error of the CrCL estimates tended to be lower at higher AGCL and did not differ for CGCL, JCL, and JCLu. In the SICU setting, we suggest the use of the JCLu for estimating the AGCL.

The anesthesia record.

The standard format of preoperative, perioperative, and postoperative patient anesthesia records, the categories of information included, and pharmacists use of this information are described. On the preoperative evaluation form, the anesthesiologist or anesthetist records information on the physical status of the patient and an overall impression of the anesthetic risk. The perioperative record is used for notation of the administration of anesthetic agents, fluids, blood products, and other medications and for recording vital signs, anesthetic and surgical interventions, and airway maintenance; this record shows a dynamic account of the patient's responses throughout the operation. Finally, the anesthesiologist notes postoperative problems related to anesthesia on the postoperative section of the record. The anesthesia record can be used by pharmacists for medication scheduling and therapeutic drug monitoring, assessment of fluid status, evaluation of hemodynamic response to drug and fluid interventions, quality assurance, and drug-use reviews.

Postoperative enhancement of urinary output in patients with acute renal failure using continuous furosemide therapy.

Three cardiac surgical patients with acute postoperative renal failure were treated with a constant infusion of furosemide (Lasix) after furosemide given in bolus proved ineffective. Furosemide given continuously brought about a prompt resolution of the oliguria and tended to hasten the resolution of acute renal failure.