128 research outputs found
Opioid use and effectiveness of its prescription at discharge in an acute pain relief and palliative care unit
The aim of this study was to present how opioids
are used in an acute pain relief and palliative care unit
(APRPCU), where many patients with difficult pain conditions
are admitted from GPs, home palliative care programs,
oncology departments, other hospitals or emergency units,
and other regional places. From a consecutive sample of
cancer patients admitted to an APRPCU for a period of
6 months, patients who had been administered opioids were
included in this survey. Basic information was collected as
well as opioid therapy prescribed at admission and, subsequently,
during admission and at time of discharge. Patients
were discharged once stabilization of pain and symptoms
were obtained and the treatment was considered to be optimized.
One week after being discharged, patients or relatives
were contacted by phone to gather information about
the availability of opioids at dosages prescribed at time of
discharge. One hundred eighty six of 231 patients were
specifically admitted for uncontrolled pain, with a mean
pain intensity of 6.8 (SD 2.5). The mean dose of oral
morphine equivalents in patients receiving opioids before
admission was 45 mg/day (range 10–500 mg). One hundred
seventy five patients (75.7 %) were prescribed around the
clock opioids at admission. About one third of patients
changed treatment (opioid or route). Forty two of 175
(24 %), 27/58 (46.5 %), 10/22 (45.4 %), and 2/4 (50 %)
patients were receiving more than 200 mg of oral morphine
equivalents, as maximum dose of the first, second, third, and
fourth opioid prescriptions, respectively. The pattern of
opioids changed, with the highest doses administered with
subsequent line options. The mean final dose of opioids,
expressed as oral morphine equivalents, for all patients was
318 mg/day (SD 798), that is more than six times the doses
of pre-admission opioid doses. One hundred eighty six
patients (80.5 %) were prescribed a breakthrough cancer
pain (BTcP) medication at admission. Sixty five patients
changed their BTcP prescription, and further 27 patients
changed again. Finally, eight patients were prescribed a
fourth BTcP medication. Of 46 patients available for interview,
the majority of them (n=39, 84 %) did not have
problems with their GPs, who facilitated prescription and
availability of opioids at the dosages prescribed at discharge.
For patients with severe distress, APRPCUs may
guarantee a high-level support to optimize pain and symptom
intensities providing intensive approach and resolving
highly distressing situations in a short time by optimizing
the use of opioids
Should Reinke edema be considered a contributing factor to post-extubation failure?
Clinical signs and risk factors for RE should be systematically assessed when clinicians deal with risks of post-extubation failure
An Atypical Case of Taravana Syndrome in a Breath-Hold Underwater Fishing Champion: A Case Report
Dysbaric accidents are usually referred to compressed air-supplied diving. Nonetheless, some cases of decompression illness are known to have occurred among breath-hold (BH) divers also, and they are reported in the medical literature. A male BH diver ((Ã years old), underwater *shing champion, presented neurological disorders as dizziness, sensory numbness, blurred vision, and le+ frontoparietal pain a+er many dives to a ( meters sea water depth with short surface intervals. Symptoms spontaneously regressed and the patient came back home. )e following morning, pain and neurological impairment occurred again and the diver went by himself to the hospital where he had a generalized tonic-clonic seizure and lost consciousness. A magnetic resonance imaging of the brain disclofsed a cortical T -weighted hypointense area in the temporal region corresponding to infarction with partial hemorrhage. An early hyperbaric oxygen therapy led to prompt resolution of neurological *ndings. All clinical and imaging characteristics were referable to the Taravana diving syndrome, induced by repetitive prolonged deep BH dives. )e reappearance of neurological signs a+er an uncommon ! -hour symptom-free interval may suggest an atypical case of Taravana syndrome
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