11 research outputs found

    Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

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    BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

    Managing Low Back Pain in Pregnant Women at the General Hospital of Prizren

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    Introduction and objectives: Low back pain (LBP) is a common complaint in pregnant women [1]. LBP is more prevalent in pregnant women than non-pregnant women at the same age (25% vs. 6.3%) [2]. Low back pain (LBP) is a prevalent disorder associated with increased medical expenses and work loss [3]. The objective of this study is to evaluate the frequency of LBP during pregnancy and the characteristics of the pain. Methodology: The approach of the study was cross\u27sectional study; there were included women with low risk of pregnancy. Part of the study was women over the age of 18, there have been excluded from the study women with psychiatric disorders, those with previous lumbar spine or who had or were in medication for back pain. Results: Were interviewed 350 pregnant women in the third trimester, which were presented in the General Hospital of Prizren, at obstetric ward, during the year 2018. The prevalence of LBP was 59.1%, mostly in the third trimester. The average age was 25.7 ± 4.2, the average gestational age of the appearance of pain was 31 weeks. Social data: 91% were married or in relationship, 26% worked outside the home and 87.1% had completed secondary education. Back pain was most common during the second trimester (50.0%). According to the data from the respondents, the symptoms worsened at night (77.1%). Bed regime reduced the pain for 50% of women. Based on the responses given, physical exercises have reduced the pain in 34.3% of the cases. Conclusions: LBP is common in pregnant women. This cross-sectional showed that about 1 in 2 women have LBP in any stage of pregnancy. It is necessary to draft preventive strategies and multidisciplinary cooperation in order to improve the quality of life of pregnant women. Receiving no housework assistance is another risk factor

    Epidemiology of chronic pain in Kosovo and its impact on public health

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    Background Chronic pain is a common, complex, and distressing problem that significantly impacts public health. Worldwide, the burden caused by chronic pain is escalating: 1.9 billion people were affected by recurrent tension-type headaches, the most common symptomatic chronic condition. In the literature review was found that chronic pain affects 10-55% of the adult population. This paper aimed to learn more about chronic pain and its impact on public health. Methodology The research was of retrospective type. There was a literature review of the epidemiological data on chronic pain, separating cancer pain and non-cancer pain where possible. The medical protocols in the Main Center of Family Medicine in Prizren and in the General Hospital of Prizren were analyzed, specifically in the internal ward, rheumatology service, neurology ward, orthopedic ward, and emergency service. Data are obtained for the period January-December 2021. Results As long as we do not have a register at the national level, we can not conclude what is the incidence of cases of chronic pain in Kosovo. However, according to the results obtained from the protocols of MFMC and the Hospital in Prizren, chronic pain has been the most common symptom of patient visits. Based on the data from the analysis, it was noticed that the female gender (62%) was more affected by chronic pain, while no case was under 18 years old. Of the identified chronic pains, headache has dominated, then back pain, neck pain, and muscle pain in general. There was no protocol for the treatment of chronic pain in either the MFMC or the Prizren Hospital. Conclusion The risk factors related to chronic pain need to be addressed by managing the causes and effects of chronic pain. As there is no chronic pain registry and chronic pain treatment protocol nationwide, it is important to establish them to improve the well-being of the population

    Possibility of improving postoperative pain management by improving daily practices

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    Persistent postoperative pain is common after most surgical procedures.1 The burden of untreated postoperative pain is high.2 Postoperative pain has been poorly managed for decades. There is good quality evidence that supports many of the common agents utilized in multimodal therapy, however, there is a lack of evidence regarding optimal postoperative protocols or pathways.3 Multimodal pain management provides additional pain relief until the fourth postoperative day, improves patient satisfaction at discharge, and reduces total narcotic consumption for postoperative pain management

    Men detta är vanligt, nästan alla mina kollegor har blivit hotade. : En kvalitativ studie om sex socialsekreterares upplevelser av klientutövat hot och våld.

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    The purpose of this study is to investigate social workers' experiences of threats and violence from clients, the strategies they use to handle these situations and the impact on social workers in their professional practice. The empirical data were collected through a qualitative method involving semi-structured interviews with six social workers from various municipal departments in Sweden. The results are analyzed through the theories Coping and KASAM along with previous research. The findings reveal that both direct and indirect forms of threats and violence are common occurrences directed at social workers by clients. It is evident that psychological violence is more prevalent than physical violence. The coping strategies mentioned included low affective engagement and support from colleagues. The respondents state that they have been influenced in their professional practice, reporting that they are now more vigilant, reserved, and fearful. These experiences have also resulted in heightened awareness and professional development. In the interviews, the importance of awareness, being prepared for client reactions and clarity in communication are emphasized to create a more effective and client oriented social service. The conclusion was that social workers are confronted with widespread client-perpetrated threats and violence, particularly psychological violence, which may become normalized and thereby influence risk assessments. Keywords: social worker, threat, violence, social services, coping strategies

    Improving perioperative pain management: a preintervention and postintervention study in 7 developing countries

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    CITATION: Zaslansky, R. et al. 2019. Improving perioperative pain management: a preintervention and postintervention study in 7 developing countries. PAIN Reports, 4(1). doi:10.1097/PR9.0000000000000705The original publication is available at https://journals.lww.com/painrpts/pages/default.aspxIntroduction: The burden of untreated postoperative pain is high. Objective: This study assessed feasibility of using quality improvement (QI) tools to improve management of perioperative pain in hospitals in multiple developing countries. Methods: The International Pain Registry and Developing Countries working groups, from the International Association for the Study of Pain (IASP), sponsored the project and PAIN OUT, a QI and research network, coordinated it, and provided the research tools. The IASP published a call about the project on its website. Principal investigators (PIs) were responsible for implementing a preintervention and postintervention study in 1 to 2 surgical wards in their hospitals, and they were free to choose the QI intervention. Trained surveyors used standardized and validated web-based tools for collecting findings about perioperative pain management and patient reported outcomes (PROs). Four processes and PROs, independent of surgery type, assessed effectiveness of the interventions. Results: Forty-three providers responded to the call; 13 applications were selected; and PIs from 8 hospitals, in 14 wards, in 7 countries, completed the study. Interventions focused on teaching providers about pain management. Processes improved in 35% and PROs in 37.5% of wards. Conclusions: The project proved useful on multiple levels. It offered PIs a framework and tools to perform QI work and findings to present to colleagues and administration. Management practices and PROs improved on some wards. Interpretation of change proved complex, site-dependent, and related to multiple factors. PAIN OUT gained experience coordinating a multicentre, international QI project. The IASP promoted research, education, and QI work.https://journals.lww.com/painrpts/Fulltext/2019/02000/Improving_perioperative_pain_management__a.5.aspxPublisher’s versio

    Oxime-type acetylcholinesterase reactivators in pregnancy: an overview

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    Oxime-type acetylcholinesterase reactivators (oxime-AChER) are used as an adjunct in the treatment for organophosphorus anticholinesterase poisoning. Because of the widespread usage and exposure of organophosphorus compounds (OPCs), its poisoning and fatalities is obvious in pregnant women, embryos and fetuses. OPCs irreversibly inhibit acetylcholinesterase (AChE) at nerve synapses. Furthermore, the role of AChE other than neurotransmission termination has been defined in the literature. The growing evidences show that cholinergic mechanisms are involved during growth and development of other organ systems. In contrary to the fact, the data on the use of oxime-AChER in OPC poisoning in pregnancy are scanty. The present review aimed to comprehend the status of oximes in pregnancy in lieu of the published literature. A thorough literature search was performed in January 2013, using ten popular search engines including Medline/PubMed, Google scholar, etc., using nine standard keywords. The search period was set from 1966 to present. The search did not reveal substantial data. No considerable studies were retrieved which could really demonstrate either the beneficial, harmful or even null effect of oxime-AChER usage in pregnancy. Only eighteen relevant articles were obtained for a period of about 47 years. In the literature, there is no report available to demonstrate the risk of using oxime-AChER in pregnancy for the treatment of OPC poisoning. The study reveals that the use of oxime-AChER in pregnancy is largely un-addressed, inconclusive and based on speculation albeit the incidences of OPC poisoning are quite prevalent. Well-designed studies are warranted for a tangible conclusion. © 2013 Springer-Verlag Berlin Heidelberg

    Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients: post-hoc analysis of LAS VEGAS study

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    Background: Limited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients. Methods: Post-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs. Results: Seven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (VT) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH20. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs. Conclusions: Neurosurgical patients are ventilated with low VT and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs

    Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications

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    Background: The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs). Methods: LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during 'daytime' when induction of anaesthesia was between 8: 00 AM and 7: 59 PM, and as 'night-time' when induction was between 8: 00 PM and 7: 59 AM. Results: Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P = 0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P = 0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P = 0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09-1.90; P = 0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89-1.90; P = 0.15). Conclusions: Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events

    Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients: Post-hoc analysis of LAS VEGAS study

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    Background: Limited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients. Methods: Post-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs. Results: Seven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (VT) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH20. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs. Conclusions: Neurosurgical patients are ventilated with low VT and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs
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