Emergency physicians have been successful in implementing procedural sedation and analgesia (PSA) to treat emergency department (ED) patients who need to undergo painful procedures. However, 25% of the EDs in the Neth...Emergency physicians have been successful in implementing procedural sedation and analgesia (PSA) to treat emergency department (ED) patients who need to undergo painful procedures. However, 25% of the EDs in the Netherlands are not staffed by emergency physicians. The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians. METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands. Data were gathered using a standardized questionnaire. RESULTS: The response rate was 34.3% (148/432). Of the respondents, 84/148 (56.8%) provided adult PSA and 30/148 (20.3%) provided paediatric PSA. Main reasons for not providing PSA were insuf cient numbers of trained staff to support PSA in the ED and insuf cient training and exposure. The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients. CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both quali ed in PSA and available in the ED.展开更多
Objective To evaluate the safety and analgesic efficacy of patient controlled intravenous analgesia (PCIA) with tramadol, and to compare its benefits and risks with combined spinal-epidural analgesia (CSEA) + patient ...Objective To evaluate the safety and analgesic efficacy of patient controlled intravenous analgesia (PCIA) with tramadol, and to compare its benefits and risks with combined spinal-epidural analgesia (CSEA) + patient controlled epidural analgesia (PCEA).Methods Eighty American Society of Anesthesiologist (ASA) Ⅰ - Ⅱ at term parturients in active labor were randomly divided into 3 groups: the control group (n =30) received no analgesia; group A (n =30) received spinal administration with ropivacaine 2. 5 mg and fentanyl 5μg, then with PCEA; group B (n = 20) received 1 mg/kg tramadol loading dose i. v.. PCIA with 0. 75% tramadol and it included: PCA dose 2 ml, lockout time 10 minutes, background infusion 2 ml/h, total dose no more than 400 mg. The intensity of pain was evaluated using Visual Analogue Scale (VAS).Results Both group A and B showed good pain relief. VAS pain scores were significantly decreased in group A and B compared with those in the control group (P<0. 01). In comparison with group B, the VAS pain scores decreased in group A (P<0. 05). The onset times of analgesia in group A were shorter than those in group B (P<0. 05). Apgar scores in group B were lower than those in group A (P<0. 05). The periods of second stage of labor in group A were longer than those in the control group and group B (P<0. 05). The cesarean delivery rate was significantly higher in the control group (16. 7%) than in group A (3. 3%) and group B (5. 0%), but it did not differ between group A and B. There were no significant differences in vital signs, fetal heart rate, degree of motor block, and uterine contractions among the 3 groups.Conclusions PCIA with tramadol is now a useful alternative when patients are not candidates for CSEA for labor, or do not want to have a neuraxial block anesthesia. However, sometimes it may not provide satisfactory analgesic effect.展开更多
目的分析以案例为基础的教学法(Case Based Learning,CBL)联合纠错教学应用于妇产科规范化培训中的价值。方法选取2022年1月—2023年12月在潍坊医学院附属医院妇产科轮转的40名规范化培训医师为研究对象,采用随机数表法将其分为两组,每...目的分析以案例为基础的教学法(Case Based Learning,CBL)联合纠错教学应用于妇产科规范化培训中的价值。方法选取2022年1月—2023年12月在潍坊医学院附属医院妇产科轮转的40名规范化培训医师为研究对象,采用随机数表法将其分为两组,每组20名。对照组实施传统规范化培训,观察组实施CBL联合纠错教学规范化培训,对比两组医师专业理论知识考试成绩、临床技能操作考核成绩及满意度。结果观察组专业理论知识考试成绩高于对照组,差异有统计学意义(P<0.05);观察组病例问询、查体、病例分析、治疗计划分数及总分均高于对照组,差异有统计学意义(P均<0.05);观察组教学模式、学习兴趣、自学能力、表达沟通能力、团队协作能力评分均高于对照组,差异有统计学意义(P均<0.05)。结论在妇产科规范化培训中,采用CBL联合纠错教学方法具有显著的价值,能够提高住培医师的专业理论知识水平,增强他们在实践中的能力,并促进他们的自主学习和团队合作能力。展开更多
BACKGROUND: Migraine is a common neurological condition that frequently presents to the emergency department(ED). Many medications are available to treat migraine. This study aims to characterize the demographics of p...BACKGROUND: Migraine is a common neurological condition that frequently presents to the emergency department(ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this condition.METHODS: This study is a retrospective database interrogation of clinical records, used to collect quantitative data on patient demographics and medication prescriptions in the ED.RESULTS: A total of 2 228 patients were identified as being treated for migraine over a 10-year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females(71%) more commonly presented to the ED with migraine than males. The migraine population was signifi cantly younger(M=37.05, SD=13.23) than the whole ED population(M=46.17 SD=20.50)(P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and intravenous(IV) fluids with phenothiazine additives were commonly used. Over 20% of patients were prescribed oral or parenteral opiates(42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely used.CONCLUSION: Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a signifi cant variation from published guidelines.展开更多
文摘Emergency physicians have been successful in implementing procedural sedation and analgesia (PSA) to treat emergency department (ED) patients who need to undergo painful procedures. However, 25% of the EDs in the Netherlands are not staffed by emergency physicians. The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians. METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands. Data were gathered using a standardized questionnaire. RESULTS: The response rate was 34.3% (148/432). Of the respondents, 84/148 (56.8%) provided adult PSA and 30/148 (20.3%) provided paediatric PSA. Main reasons for not providing PSA were insuf cient numbers of trained staff to support PSA in the ED and insuf cient training and exposure. The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients. CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both quali ed in PSA and available in the ED.
文摘Objective To evaluate the safety and analgesic efficacy of patient controlled intravenous analgesia (PCIA) with tramadol, and to compare its benefits and risks with combined spinal-epidural analgesia (CSEA) + patient controlled epidural analgesia (PCEA).Methods Eighty American Society of Anesthesiologist (ASA) Ⅰ - Ⅱ at term parturients in active labor were randomly divided into 3 groups: the control group (n =30) received no analgesia; group A (n =30) received spinal administration with ropivacaine 2. 5 mg and fentanyl 5μg, then with PCEA; group B (n = 20) received 1 mg/kg tramadol loading dose i. v.. PCIA with 0. 75% tramadol and it included: PCA dose 2 ml, lockout time 10 minutes, background infusion 2 ml/h, total dose no more than 400 mg. The intensity of pain was evaluated using Visual Analogue Scale (VAS).Results Both group A and B showed good pain relief. VAS pain scores were significantly decreased in group A and B compared with those in the control group (P<0. 01). In comparison with group B, the VAS pain scores decreased in group A (P<0. 05). The onset times of analgesia in group A were shorter than those in group B (P<0. 05). Apgar scores in group B were lower than those in group A (P<0. 05). The periods of second stage of labor in group A were longer than those in the control group and group B (P<0. 05). The cesarean delivery rate was significantly higher in the control group (16. 7%) than in group A (3. 3%) and group B (5. 0%), but it did not differ between group A and B. There were no significant differences in vital signs, fetal heart rate, degree of motor block, and uterine contractions among the 3 groups.Conclusions PCIA with tramadol is now a useful alternative when patients are not candidates for CSEA for labor, or do not want to have a neuraxial block anesthesia. However, sometimes it may not provide satisfactory analgesic effect.
文摘目的分析以案例为基础的教学法(Case Based Learning,CBL)联合纠错教学应用于妇产科规范化培训中的价值。方法选取2022年1月—2023年12月在潍坊医学院附属医院妇产科轮转的40名规范化培训医师为研究对象,采用随机数表法将其分为两组,每组20名。对照组实施传统规范化培训,观察组实施CBL联合纠错教学规范化培训,对比两组医师专业理论知识考试成绩、临床技能操作考核成绩及满意度。结果观察组专业理论知识考试成绩高于对照组,差异有统计学意义(P<0.05);观察组病例问询、查体、病例分析、治疗计划分数及总分均高于对照组,差异有统计学意义(P均<0.05);观察组教学模式、学习兴趣、自学能力、表达沟通能力、团队协作能力评分均高于对照组,差异有统计学意义(P均<0.05)。结论在妇产科规范化培训中,采用CBL联合纠错教学方法具有显著的价值,能够提高住培医师的专业理论知识水平,增强他们在实践中的能力,并促进他们的自主学习和团队合作能力。
文摘BACKGROUND: Migraine is a common neurological condition that frequently presents to the emergency department(ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this condition.METHODS: This study is a retrospective database interrogation of clinical records, used to collect quantitative data on patient demographics and medication prescriptions in the ED.RESULTS: A total of 2 228 patients were identified as being treated for migraine over a 10-year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females(71%) more commonly presented to the ED with migraine than males. The migraine population was signifi cantly younger(M=37.05, SD=13.23) than the whole ED population(M=46.17 SD=20.50)(P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and intravenous(IV) fluids with phenothiazine additives were commonly used. Over 20% of patients were prescribed oral or parenteral opiates(42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely used.CONCLUSION: Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a signifi cant variation from published guidelines.
