To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial

Background: Major adverse cardiac events (MACEs) are a common cause of deathafter non-cardiac surgery. Despite evidence for the benefitof aspirin for secondary prevention, it is often discontinuedin the perioperative period due to the risk of bleeding. Methods: We conducted a randomized, double-blind, placebo-controlledtrial in order to compare the effect of low-dose aspirin withthat of placebo on myocardial damage, cardiovascular, and bleedingcomplications in high-risk patients undergoing non-cardiac surgery.Aspirin (75 mg) or placebo was given 7 days before surgery andcontinued until the third postoperative day. Patients were followedup for 30 days after surgery. Results: A total of 220 patients were enrolled, 109 patients receivedaspirin and 111 received placebo. Four patients (3.7%) in theaspirin group and 10 patients (9.0%) in the placebo group hadelevated troponin T levels in the postoperative period (P=0.10).Twelve patients (5.4%) had an MACE during the first 30 postoperativedays. Two of these patients (1.8%) were in the aspirin groupand 10 patients (9.0%) were in the placebo group (P=0.02). Treatmentwith aspirin resulted in a 7.2% absolute risk reduction [95%confidence interval (CI), 1.3–13%] for postoperative MACE.The relative risk reduction was 80% (95% CI, 9.2–95%).Numbers needed to treat were 14 (95% CI, 7.6–78). No significantdifferences in bleeding complications were seen between thetwo groups. Conclusions: In high-risk patients undergoing non-cardiac surgery, perioperativeaspirin reduced the risk of MACE without increasing bleedingcomplications. However, the study was not powered to evaluatebleeding complications.  This is a pre-copy-editing, author-produced PDF of an article accepted for publication in British Journal of Anaesthesia following peer review. The definitive publisher-authenticated version:Anna Oscarsson Tibblin, Anil Gupta, Mats Fredrikson, Johannes Järhult, Matti Nyström, Eva Pettersson, Bijan Darvish, Helena Krook, Eva Swahn and Christina Eintrei, To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial, 2010, British Journal of Anaesthesia, (104), 3, 305-312.is available online at: http://dx.doi.org/doi:10.1093/bja/aeq003Copyright: Oxford University Presshttp://www.oxfordjournals.org

Application of Ergonomic Principles and Communication Skills in the Process of Relocating Patients

Maģistra darba tēma ir ”Ergonomikas principu un komunikācijas prasmju pielietošana pacientu pārvietošanas procesā”. Tēmas aktualitāti nosaka tas, ka māsas ir pakļautas dažādiem fiziska rakstura apdraudējumiem. Lai veiktu pacienta kvalitatīvu un sekmīgu ārstēšanas procesa gaitu, māsai, balstoties uz savām zināšanām, nepieciešams ievērot ergonomikas principus. Ievērojot ergonomikas principus, ir iespējams mazināt traumu un arodslimību skaitu māsām, līdz ar to arī pacients tiks mazāk pakļauts kaitīgās vides riskiem. Maģistra darba pētījuma mērķis ir novērtēt māsu zināšanas par ergonomikas principiem un komunikācijas prasmju pielietošanu guļošu pacientu pārvietošanas procesā. Pētniecības uzdevums ir izstrādāt anketu un novērojuma protokolu, apkopot un analizēt iegūtos rezultātus, veikt secinājumus un izstrādāt ieteikumus. Maģistra darbs sastāv no ievada, literatūras apskata un analīzes, rezultātu apkopojuma, secinājumiem un ieteikumiem. Pētniecības instruments: aptaujas anketa un novērojuma protokols. Pētniecības metode: kvantitatīva un kvalitatīva. Atslēgvārdi: ergonomika, komunikācija, darba vide, māsu zināšanas, pacientu pārvietošanaThe theme of Master’s Thesis is ”Application of Ergonomic Principles and Communication Skills in the Process of Relocating Patients”. Nurses are subjected to various physical hazards and that determines topicality of the theme. In order to provide patients with a qualitative and successful process of care, the nurse, basing on her knowledge, needs to follow the principles of ergonomics. If principles of ergonomics will be taken into account, it is possible to reduce the number of traumas and occupational diseases for nurses, thus, the patient will be less exposed to risks due to harmful environment. The aim of the Master’s Thesis is to evaluate knowledge of the nurses about the principles of ergonomics and the application of communication skills in the process of relocating patients. The research task is to develop a questionnaire and observation protocol, collect and analyze the results, draw conclusions and make recommendations. Master’s Thesis consists of introduction, literature review and analysis, summary of results, conclusions and recommendations. Research instrument: questionnaire and observation protocol. Research method: quantitative and qualitative. Keywords: ergonomics, communication, working environment, knowledge of nurses, patient relocation

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continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical tria

Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study

© 2020 British Journal of AnaesthesiaBackground: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP

Management practices for postdural puncture headache in obstetrics : a prospective, international, cohort study

Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19-1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score <= 3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP