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Lancet (London, England) Jul 2021Pain management after caesarean delivery is important because acute pain in the postoperative period is associated with persistent pain, increased opioid use and...
BACKGROUND
Pain management after caesarean delivery is important because acute pain in the postoperative period is associated with persistent pain, increased opioid use and postpartum depression, and delayed functional recovery. We investigated the role of nurse-supported care in acute pain management after caesarean delivery, which as far as we know has not previously been investigated in Gaza.
METHODS
This was a comparative study done from March, 2018, to October, 2018, among women assigned to undergo caesarean delivery. Research nurses at the Al-Helal Al-Emirati Hospital, Rafah, Gaza Strip, occupied Palestinian territory, were trained to give supportive pain management care to women after caesarean delivery, including individualised care and educational sessions on pain, nutrition, exercise, and wound care. Women were randomly assigned to receive nurse-supported care or usual care. Pain assessment scales (range 1-5, where 1=no pain and 5=pain as bad as it could be) were used to record pain at 1, 6, 12, 18, and 24 h after caesarean delivery. The time from the end of the caesarean delivery to the first request for analgesia and the total amounts and types of analgesics (pethidine ampules, diclofenac ampules, or indometacin suppositories) used in the first 24 h were recorded as primary outcomes. Secondary outcomes were nausea and vomiting scores (0-3, where 0=no nausea or vomiting and 3=severe and unresponsive to antiemetic drugs), sedation scores (0-3, where 0=patient awake and 3=severe sedation and patient difficult to rouse), and pruritis scores (0-2, where 0=no pruritis and 2=severe pruritis needing treatment). Data were analysed with SPSS (version 22.0). Groups were compared by using the Student's t-test and χ. P values less than 0·05 were significant. The study was approved by the Ministry of Health and Helsinki Committee, Gaza Strip. Women provided verbal informed consent for inclusion in the study when they were assigned to the caesarean delivery.
FINDINGS
108 women participated, with a mean age of 29·2 years (SD 5·50). 49 women were randomly assigned to nurse-supported care and 59 to usual care. Pain was reduced in the nurse-supported care group compared with in the usual care group at 12 h (mean score 1·15 [SD 0·25] vs 1·60 [0·67], p=0·002) and at 18 h (1·08 [0·22] vs 1·26 [0·21], p=0·049) but did not differ significantly at other times. The time to first requesting analgesia was shorter in the nurse-supported care group than in the usual care group (mean 3·38 h [SD 1·01] vs 6·16 h [2·01], p=0·038). The proportions of women who asked for a first analgesic were similar in the two groups (30 [61%] and 36 [61%]), whereas seven (14%) women in the nurse-supported care group requested a second analgesic compared with 13 (22%) in the usual care group (p=0·045). There were no significant differences between the two groups for nausea and vomiting, sedation, or pruritis.
INTERPRETATION
Nurse-supported care provided better analgesia than usual care in women who had undergone caesarean delivery. A multicentre study is needed to explore the types, duration, and repeatability of the effects of nurse supportive care on pain perception and duration of hospital stay after caesarean delivery.
FUNDING
None.
PubMed: 34227956
DOI: 10.1016/S0140-6736(21)01510-5 -
Saudi Pharmaceutical Journal : SPJ :... Mar 2023The objectives of this study were to explore the wastage of narcotics and controlled medications and, their financial impact in a tertiary care setting over a one-year...
OBJECTIVE
The objectives of this study were to explore the wastage of narcotics and controlled medications and, their financial impact in a tertiary care setting over a one-year period.
METHODOLOGY
The study period was of one year, i.e., October 2020 - September 2021. The venue of study was a tertiary care hospital. The narcotic medications included Fentanyl, Tramadol, Morphine, and Meperidine. The controlled medications included Midazolam, Phenobarbital, Diazepam, Ketamine and Lorazepam. The annual consumption and wastage of the narcotic and controlled medications were documented using data report generated by narcotics and controlled medication in-charge pharmacist through the hospital's online system. Data was reported using average, minimum and maximum values. Quantities of wastage is expressed in terms of ampoules. Costs per ampoule were calculated and expressed in both Saudi Riyal (SAR) and United States Dollar (USD). The study was approved by an ethics committee.
RESULTS
The annual wastage of narcotics was 3.19 % while the same for controlled medications was 21.3 %. An annual wastage of 3.81 % was reported for narcotics and controlled medications combined. The total wastage cost of narcotics and controlled medications was 15,443.1 SAR that was equivalent to USD 4085.5. Fentanyl 500mcg formulations had the highest consumption, i.e., 28,580 ampoules followed by Morphine 10 mg formulations, i.e., 27,122 ampoules. The highest ampoule wastage was observed for Morphine 10 mg formulations, i.e., 1956 ampoules. The highest % wastage was observed for Midazolam formulations, i.e., 29.3 %.
CONCLUSION
The overall wastage was less than 5% of the total consumption, however, midazolam was observed to have the highest wastage. Shifting to prefilled syringes supplied by pharmacies, making protocols, and safely pooling costly drugs could result in significant savings.
PubMed: 37026053
DOI: 10.1016/j.jsps.2022.12.012 -
Nanomaterials (Basel, Switzerland) Apr 2020Filling of single-walled carbon nanotubes (SWCNTs) and extraction of the encapsulated species from their cavities are perspective treatments for tuning the functional...
Filling of single-walled carbon nanotubes (SWCNTs) and extraction of the encapsulated species from their cavities are perspective treatments for tuning the functional properties of SWCNT-based materials. Here, we have investigated sulfur-modified SWCNTs synthesized by the ampoule method. The morphology and chemical states of carbon and sulfur were analyzed by transmission electron microscopy, Raman scattering, thermogravimetric analysis, X-ray photoelectron and near-edge X-ray absorption fine structure spectroscopies. Successful encapsulation of sulfur inside SWCNTs cavities was demonstrated. The peculiarities of interactions of SWCNTs with encapsulated and external sulfur species were analyzed in details. In particular, the donor-acceptor interaction between encapsulated sulfur and host SWCNT is experimentally demonstrated. The sulfur-filled SWCNTs were continuously irradiated with polychromatic photon beam of high intensity. Comparison of X-ray spectra of the samples before and after the treatment revealed sulfur transport from the interior to the surface of SWCNTs bundles, in particular extraction of sulfur from the SWCNT cavity. These results show that the moderate heating of filled nanotubes could be used to de-encapsulate the guest species tuning the local composition, and hence, the functional properties of SWCNT-based materials.
PubMed: 32344811
DOI: 10.3390/nano10050818 -
Beilstein Journal of Nanotechnology 2023This article describes an approach for synthesizing silicon phosphide nanoparticles with a defective zinc blende structure under mild conditions through thermal...
This article describes an approach for synthesizing silicon phosphide nanoparticles with a defective zinc blende structure under mild conditions through thermal annealing of hydrogenated silicon nanoparticles with red phosphorus. The synthesized SiP nanoparticles were analyzed using FTIR, XRD, electron diffraction, EDX, TEM, Raman spectroscopy, X-ray fluorescence spectrometry, and UV-vis spectrophotometry. For the isolated cubic SiP phase, a cell parameter of = 5.04 Å was determined, and the bandgap was estimated to be equal to 1.25 eV. Because of the nanoscale dimensions of the obtained SiP nanoparticles, the product may exhibit several exceptional properties as a precursor for diffusion doping of wafers and as anode material for Li-ion batteries. A similar method with a hydrogenation step offers the possibility to obtain other compounds, such as silicon selenides, arsenides, and sulfides.
PubMed: 37800121
DOI: 10.3762/bjnano.14.80 -
Journal of Pediatric Intensive Care Sep 2020Sialorrhea is a frequent problem and may lead to aspiration in patients with swallowing dysfunction. We aimed to assess the effectiveness and safety of sublingual...
Sialorrhea is a frequent problem and may lead to aspiration in patients with swallowing dysfunction. We aimed to assess the effectiveness and safety of sublingual atropine sulfate treatment in pediatric patients with sialorrhea. The medical records of patients who had received sublingual atropine sulfate between January 2015 and January 2016 were reviewed retrospectively. The demographic properties, diagnosis, invasive or noninvasive mechanical ventilation need, and the presence of tracheotomy were assessed. Response rates to sublingual atropine were measured using the Teacher Drooling Scale (TDS). Pre and post-treatment drooling scores were compared. Atropine sulfate ampoule was administered at 20 µg/kg/dose. Minimum dose was 0.25 mg, while maximum dose was 0.03 mg/kg.Thirty-five pediatric patients with sialorrhea who had received sublingual atropine sulfate were identified; however, TDS scores had been recorded in only 20 of them. The median age of the patients was 25 months (3-78 months; 7 girls, 13 boys). Sixteen (80%) patients were on invasive mechanical ventilation and seven (30%) had tracheotomy. Nineteen patients had a neurodevelopmental disorder and only one patient had oral and esophageal lesions due to corrosive material intake. The median TDS score prior to sublingual atropine sulfate treatment was 5, and it decreased to 3 on the second day of treatment, a change that was statistically significant ( < 0.001). No side effects were observed. Sublingual atropine sulfate is safe and effective in the short-term treatment of sialorrhea; however, randomized placebo controlled and long-term follow-up studies are necessary.
PubMed: 32685247
DOI: 10.1055/s-0040-1708552 -
International Journal For Quality in... Mar 2021The effects of an early and prolonged lockdown during the coronavirus disease 2019 (COVID-19) pandemic on cardiovascular intensive care units (CICUs) are not well... (Observational Study)
Observational Study
BACKGROUND
The effects of an early and prolonged lockdown during the coronavirus disease 2019 (COVID-19) pandemic on cardiovascular intensive care units (CICUs) are not well established.
OBJECTIVES
This study analyses patterns of admission, mortality and performance indicators in a CICU before and during the Argentine lockdown in the COVID-19 pandemic.
METHODS
This is a retrospective observational cross-sectional study of all consecutive patients aged 18 years or more admitted to the cardiac intensive care unit at a high-volume reference hospital in Buenos Aires, Argentina, comparing hospitalization rates, primary causes of admission, inpatient utilization indicators, pharmacy supplies' expenditures and in-hospital mortality between 5 March and 31 July 2020, with two corresponding control periods in 2019 and 2018.
RESULTS
We included 722 female patients [mean age of 61.6 (SD 15.5) years; 237 (32.8%)]. Overall hospitalizations dropped 53.2% (95%CI: 45.3, 61.0%), from 295.5 patients/year over the periods 2018/2019 to 137 patients in 2020. Cardiovascular disease-related admissions dropped 59.9%, while admission for non-cardiac causes doubled its prevalence from 9.6% over the periods 2018/2019 to 22.6% in the study period (P < 0.001).In the period 2020, the bed occupancy rate fell from 82.2% to 77.4%, and the bed turnover rate dropped 50% from 7.88 to 3.91 monthly discharges/bed. The average length of stay doubled from 3.26 to 6.75 days, and the turnover interval increased from 3.8 to 8.39 days in 2020.Pharmacy supplies' expenditures per discharge increased 134% along with a rise in antibiotics usage from 6.5 to 11.4 vials/ampoules per discharge (P < 0.02).Overall mortality increased from 7% (n = 41) to 13.9% (n = 19) (P = 0.008) at the expense of non-cardiac-related admissions (3.6-19.4%, P = 0.01).
CONCLUSIONS
This study found a significant reduction in overall and cardiovascular disease-related causes of admission to the cardiac intensive care unit, worse performance indicators and increased in-hospital mortality along the first 5 months of the early and long-lasting COVID-19 lockdown in Argentina. These results highlight the need to foster public awareness concerning the risks of avoiding hospital attendance. Moreover, health systems should follow strict screening protocols to prevent potential biases in the admission of patients with critical conditions unrelated to the COVID-19 pandemic.
Topics: Adult; Aged; Argentina; Bed Occupancy; COVID-19; Cardiovascular Diseases; Cross-Sectional Studies; Female; Health Policy; Hospital Mortality; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Pandemics; Patient Admission; Pharmacy Service, Hospital; Quality Indicators, Health Care; Retrospective Studies; SARS-CoV-2
PubMed: 33620065
DOI: 10.1093/intqhc/mzab029 -
Acta Ophthalmologica Nov 2022Since July 2021, a worldwide shortage of verteporfin (Visudyne®) occurred: an essential medicine required for photodynamic therapy (PDT). PDT with verteporfin has a...
INTRODUCTION
Since July 2021, a worldwide shortage of verteporfin (Visudyne®) occurred: an essential medicine required for photodynamic therapy (PDT). PDT with verteporfin has a broad range of indications in ophthalmology, including chronic central serous chorioretinopathy, polypoidal choroidal vasculopathy and choroidal haemangioma. For these disorders, PDT is either the first-choice treatment or regarded as a major treatment option.
MATERIALS AND METHODS
A questionnaire was sent to key opinion leaders in the field of medical retina throughout the world, to assess the role of PDT in their country and the effects of the shortage of verteporfin. In addition, information on the application of alternative treatments during shortage of verteporfin was obtained, to further assess the impact of the shortage.
RESULTS
Our questionnaire indicated that the shortage of verteporfin had a major impact on ophthalmic care worldwide and was regarded to be a serious problem by most of our respondents. However, even though there is ample evidence to support the use of PDT in several chorioretinal diseases, we found notable differences in its use in normal patient care throughout the world. Various alternative management strategies were noted during the verteporfin shortage, including lowering the dose of verteporfin per patient, the use of alternative treatment strategies and the use of a centralized system for allocating the remaining ampoules of verteporfin in some countries.
CONCLUSION
The shortage of verteporfin has had a large effect on the care of ophthalmic patients across the world and may have resulted in significant and irreversible vision loss. Mitigation strategies should be developed in consultation with all stakeholders to avoid future medication shortages of verteporfin and other unique ophthalmic medications. These strategies may include mandatory stock keeping, compulsory licensing to an alternative manufacturer or incentivizing the development of competition, for example through novel public-private partnerships.
Topics: Central Serous Chorioretinopathy; Choroidal Neovascularization; Fluorescein Angiography; Humans; Photochemotherapy; Photosensitizing Agents; Porphyrins; Treatment Outcome; Verteporfin
PubMed: 35388619
DOI: 10.1111/aos.15148 -
Annals of Medicine and Surgery (2012) Feb 2022In poor countries, due to the limited resources, mostly they prescribe medications without proper diagnosis. The aim of this report is to show diagnostic bias of...
INTRODUCTION
In poor countries, due to the limited resources, mostly they prescribe medications without proper diagnosis. The aim of this report is to show diagnostic bias of COVID-19 case.
CASE PRESENTATION
A 17-year-old male patient was presented to the Hospital with a fever up to 39 °C associated with rigor, sweating, generalized body pain, myalgia, fatigue, loss of appetite, headache, and multiple joint pain with no swelling and redness. The vital signs were steady on physical examination, except temperature which was 39 °C. The chest was clear, and the pulse rate was 90 beats per minute. The heart rate relative bradycardia and lungs were normal. Both a PCR test for COVID-19, and a viral assay ELISA were negative. After further investigations, the culture findings revealed the strong development of Gram-negative coccobacilli ( serotype Typhi) bacteria under the microscope, which was confirmed by using VITEK 2 to identify it. and treated with ciprofloxacin tab, two times per day for five days and amikacin ampule 500 mg IV every 24 hours for 10 days.
DISCUSSION
Fever is a well-known sign of COVID-19 infection which has been observed in 83%-98% of patients with COVID19. As a result, it may be difficult to tell the difference between COVID-19 and other febrile infections, causing delays in diagnosis and treatment and may blind the physician from considering other febrile illnesses.
CONCLUSION
Physicians should construct more comprehensive differential diagnoses for people who experience fever, headache, or myalgia symptoms that are linked to a pandemic. COVID-19.
PubMed: 35096387
DOI: 10.1016/j.amsu.2022.103282 -
Acta Crystallographica. Section E,... Oct 2023A new solid-state inorganic compound, indium dilead penta-chloride, InPbCl, was synthesized by melting InCl and PbCl in a vacuum-sealed quartz ampoule. The ampoule was...
A new solid-state inorganic compound, indium dilead penta-chloride, InPbCl, was synthesized by melting InCl and PbCl in a vacuum-sealed quartz ampoule. The ampoule was heated to 793 K and then slowly cooled to room temperature to induce crystallization of InPbCl. InPbCl crystallizes in the monoclinic crystal system adopting a space group of type 2/, which is isostructural with other metal halides such as RbPbCl, KPbCl and TlPbCl. The bulk InPbCl exhibits a metallic black/grey colour, allowing it to be separated from white/yellow PbCl crystals. Due to the incongruent nature of the compound, the pure bulk InPbCl was not obtained. The black/grey InPbCl crystals were characterized by powder and single-crystal X-ray diffraction. InPbCl was also explored, however the growth was unsuccessful.
PubMed: 37817955
DOI: 10.1107/S2056989023007892 -
European Journal of Hospital Pharmacy :... Jan 2021To develop methods for surface bioburden determination of ampoules and vials to be used in the validation of the disinfection procedures and in routine monitoring of...
OBJECTIVES
To develop methods for surface bioburden determination of ampoules and vials to be used in the validation of the disinfection procedures and in routine monitoring of ampoules and vials.
METHODS
The surface bioburdens of ampoules and vials are determined before and after disinfection by contact plates and total immersion.
RESULTS
The mean surface bioburdens of non-disinfected ampoules and vials taken straight from the original boxes are 2.4 and 5.01 cfu (total immersion; n = 20), and 0.97 and 0.94 cfu (contact plates; n = 60). The mean surface bioburdens of ampules and vials after disinfection by wiping are 1.15 and 7.50 cfu (total immersion; n = 20), and 0.12 and 0.10 cfu (contact plates; n = 60). The high number of cfu on vials (total immersion) indicate hidden cfu around the neck not removable by wiping and not detected by contact plates. Total immersion needs special laboratory facilities and is expensive (about €50 a sample). Therefore, it is less appropriate for use in routine monitoring. However, because of the high recovery, it is the method of choice for the validation of the disinfection procedure. Surface bioburden determination by contact plates is relatively simple. Non-flat surfaces cannot be reached, but the recovery from the touched flat part of the surface is high (around 50%). The recovery from swabs is low (around 10%). Another disadvantage of swabs is the laboratory work after sampling. We therefore advise contact plates for routine monitoring. To get a reliable value of the mean surface bioburden at least 30 samples need to be examined.
CONCLUSION
Total immersion is the method of choice for the determination of the effectiveness of a disinfection procedure for ampoules and vials. Contact plate is the method of choice for routine monitoring of the surfaces of ampoules and vials.
Topics: Disinfection; Hospitals; Pharmacies
PubMed: 33355282
DOI: 10.1136/ejhpharm-2018-001672