Acute pain management: Implications of scientific evidence for nursing practice in the postoperative context

Unrelieved acute pain remains prevalent in hospitalized patients despite advances in pain management. A decade after the Australian National Health and Medical Research Council called for improved pain management practices by health professionals, it released clinical guidelines to provide clinicians with current scientific evidence to augment their clinical decision-making. This paper examines the implications of national guidelines on nursing practice and highlights the inadequacies of current implementation policies. Pain management guidelines have failed to decrease patients\u27 postoperative pain because organizations and researchers have ignored the impact of contextual influences on clinicians\u27 decision-making. It is recommended that for successful implementation of national guidelines to occur at the local level of practice, organizations must assist clinicians to identify local influences on their decision-making, to address the issues specific to their own work environment and to evaluate any changes in practice.<br /

Pyroclastic density currents resulting from the interaction of basaltic magma with hydrothermally altered rock:an example from the 2006 summit eruptions of Mount Etna, Italy

After 16 months of quiescence, Mount Etna began to erupt again in mid-July 2006. The activity was concentrated at and around the Southeast Crater (SEC), one of the four craters on the summit of Etna, and eruptive activity continued intermittently for 5 months. During this period, numerous vents displayed a wide range of eruptive styles at different times. Virtually all explosive activities took place at vents at the summit of the SEC and on its flanks. Eruptive episodes, which lasted from 1 day to 2 weeks, became shorter and more violent with time. Volcanic activity at these vents was often accompanied by dramatic mass-wasting processes such as collapse of parts of the cone, highly unusual flowage processes involving both old rocks and fresh magmatic material, and magma–water interaction. The most dramatic events took place on 16 November, when numerous rockfalls and pyroclastic density currents (PDCs) were generated during the opening of a large fracture on the SE flank of the SEC cone. The largest PDCs were clearly triggered explosively, and there is evidence that much of the energy was generated during the interaction of intruding magma with wet rocks on the cone’s flanks. The most mobile PDCs traveled up to 1 km from their source. This previously unknown process on Etna may not be unique on this volcano and is likely to have taken place on other volcanoes. It represents a newly recognized hazard to those who visit and work in the vicinity of the summit of Etna

Risk factors associated with death in patients who initiate treatment for tuberculosis after two different follow-up periods

INTRODUCTION: Mortality from tuberculosis, which should be a rare event, still affects a large portion of the population of developing countries. In this context, Recife, a city in the northeast of Brazil where this study was developed, has the highest tuberculosis mortality rates of the Brazilian capitals. OBJECTIVE: To analyze survival probability and identify risk factors for death from tuberculosis in a cohort of patients living in Recife who started treatment for tuberculosis. METHODOLOGY: A cohort of newly diagnosed TB cases was followed up from the beginning of treatment (in 2001-2003) until June 2007. Survival probability was estimated by Kaplan-Meier method; and Cox Regression analysis was used to identify risk factors. RESULTS: At the end of the follow-up period, the survival probability after beginning TB treatment was 95.9%. Older ages, positivity for HIV and late initial treatment were statistically associated with death from TB in one year follow-up. When the analysis was done considering the total period of follow-up, older ages, positivity serology for HIV, late initial treatment, weight loss, and history of previous treatment remained in the multivariate Cox regression model. CONCLUSION: A more comprehensive analysis, specifically for deaths from tuberculosis as the underlying and non-underlying cause, allowed identification of a greater number of predictive factors that would otherwise not be detected if follow-up had lasted only until the end of treatment. These results can guide feasible interventions for health services aiming to reduce case-fatality from tuberculosis.</jats:p