通迪胶囊与芬必得胶囊镇痛疗效对照研究

目的：将通迪胶囊与芬必得胶囊用于急慢性疼痛性疾病的镇痛疗效进行对照研究。方法：选择100例急慢性颈、肩、腰、腿痛和骨性膝关节炎患者，随机分为通迪组和对照组，每组为50例患者。通迪组口服通迪0．92g／次，3次／日；对照组口服芬必得0．3g／次，2次／日，分别记录治疗前、治疗4天后、治疗8天后的VAS评分。结果：两组治疗后各时点VAS评分与治疗前比较有显著差异，两组间治疗前、治疗后各时点VAS评分无差异。结论：通迪胶囊用于急慢性颈、肩、腰、腿痛和骨性膝关节炎的镇痛治疗有明显疗效，与芬必得胶囊镇痛作用相似，副作用少，是一种安全、有效的镇痛药物。     

Prevalence of morphine use and time to initial analgesia in an Australian emergency department

Objective: To explore the association of morphine use with factors influencing time to initial analgesia (T‐A). Methods: A retrospective cohort review was conducted. Morphine data were collected from a register for restricted drugs located in the ED. T‐A was the time interval between triage and signing out of morphine's first dose. Statistical analyses were performed to determine the association between morphine use and patient volume. Results: In total, 8% of ED attendees received at least one dose of morphine sulphate in the ED. Prevalence of morphine use significantly (P < 0.05) varied by patient's age, Australasian Triage Scale category, time of arrival and type of illness. The median time of T‐A was 79 min (95% CI 71–85) with substantially longer (median 107 min) for those who arrived during the afternoon and triaged as less urgent (median 127 min). Patients who arrived late at night (median 47 min), triaged as immediately/imminently life‐threatening (median 58 min) and diagnosed as renal colic (median 27 min) or fractures/injuries (median 67 min) were more likely to receive i.v. morphine faster than other patients. The findings confirmed that large volume of patients in ED was associated with longer T‐A. Patient volume in the ED showed a significant positive association with T‐A (r = 0.568, 32% variation explained, P < 0.01). Conclusion: T‐A is an important indicator of the quality of ED services. Severity of illness and patient volume were significant factors associated with extended T‐A. Strategies for improving pain management in the complex ED environment are discussed.     

Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache.

Referred pain and pain characteristics evoked from the upper trapezius muscle was investigated in 20 patients with chronic tension-type headache (CTTH) and 20 age- and gender-matched controls. A headache diary was kept for 4 weeks in order to confirm the diagnosis and record the pain history. Both upper trapezius muscles were examined for the presence of myofascial trigger points (TrPs) in a blinded fashion. The local and referred pain intensities, referred pain pattern, and pressure pain threshold (PPT) were recorded. The results show that referred pain was evoked in 85% and 50% on the dominant and non-dominant sides in CTTH patients, much higher than 55% and 25% in controls (P<0.01). Referred pain spread to the posterior-lateral aspect of the neck ipsi-lateral to the stimulated muscle in both patients and controls, with additional referral to the temple in most patients, but none in controls. Nearly half of the CTTH patients (45%) recognized the referred pain as their usual headache sensation, i.e. active TrPs. CTTH patients with active TrPs in the right upper trapezius muscle showed greater headache intensity and frequency, and longer headache duration than those with latent TrPs. CTTH patients with bilateral TrPs reported significantly decreased PPT than those with unilateral TrP (P<0.01). Our results showed that manual exploration of TrPs in the upper trapezius muscle elicited referred pain patterns in both CTTH patients and healthy subjects. In CTTH patients, the evoked referred pain and its sensory characteristics shared similar patterns as their habitual headache pain, consistent with active TrPs. Our results suggest that spatial summation of perceived pain and mechanical pain sensitivity exists in CTTH patients.     

An institutional quality improvement initiative for pain management for pediatric cancer inpatients

Health care institutions must use the principles of quality improvement to demonstrate appropriate assessment and effective management of pain. Here, we describe the quality improvement initiative implemented at our pediatric institution to improve the quality of pain management. We conducted chart audits for the previous 24 hours during which patients received inpatient care. Over six years, 2,478 charts were audited for 87 24-hour periods (average 1.2 days/month) to answer the following: (1) Was pain intensity assessed as per the institutional pain standard of care, (2) What proportion of audited inpatients had significant pain (>or=5/10), and (3) When significant pain (>or=5/10) occurred, was treatment effective (pain score 相似文献   

Bilateral pressure pain sensitivity mapping of the temporalis muscle in chronic tension-type headache

Purpose.— To analyze pressure pain sensitivity maps in chronic tension-type headache (CTTH) and healthy controls over nine locations covering the temporalis muscle.
Background.— Lower pressure pain thresholds (PPT) have been found in craniofacial muscles in patients with CTTH. Since the temporalis muscle can play a relevant role in the genesis or maintenance of headache, the determination of pressure pain sensitivity maps of this muscle is needed.
Methods.— A pressure algometer was used to measure PPT over 9 points of the temporalis muscle (3 points in the anterior part of the muscle, another 3 in the middle of the muscle, and the remaining 3 in the posterior part) in 15 females suffering from CTTH and 10 healthy women. A pressure pain sensitivity map of both dominant and nondominant sides in patients and controls was calculated.
Results.— Chronic tension-type headache patients showed lower PPT as compared with healthy subjects ( P  < .01). Further, PPT levels of the nondominant side were lower than those on the dominant side for controls ( P  < .01). Within the CTTH group, more bilaterally homogeneous pressure pain sensitivity maps with PPT decreased from the posterior to anterior column were found, whereas among controls, PPT distribution maps were inhomogeneous with side-to-side differences.
Conclusions.— Our data may provide preliminary new key information about muscle sensitivity, since it seems that pressure pain sensitivity maps could be different between CTTH patients and healthy subjects. Further studies with greater sample sizes and other headache populations are now required to confirm our results.     

The role of inter-professional relationships and support for nurse prescribing in acute and chronic pain

Title.  The role of inter-professional relationships and support for nurse prescribing in acute and chronic pain.
Aim.  This paper is a report of a study to explore nurse prescribers' views on the role of inter-professional relationships and other means of support for nurse prescribing for patients in acute and chronic pain.
Background.  Research indicates that good team relationships are important for supporting nurse prescribing but that poor understanding of the role by other healthcare professionals can act as a barrier. While collaborative working is central to the role of pain nurses, there is a lack of research on the impact of nurse prescribing on inter-professional working or the support needs of these nurses.
Method.  A qualitative approach was adopted using thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were 26 nurses who prescribed medicines for patients with acute and/or chronic pain.
Findings.  Nurses' believed that prescribing encouraged collaborative working and sharing of knowledge across professional boundaries and that this helped to broaden understanding of the wider remit of pain management. Collaboration with doctors served a number of functions, including support and continuous learning. Barriers to effective nurse prescribing were a lack of understanding of its role amongst healthcare professionals and inadequate support. Formal support structures, such as regular clinical supervision, were seen as crucial to meeting nurses' ongoing learning.
Conclusion.  Factors that promote understanding of nurse prescribing and support inter-professional relationships are likely to have a positive impact on the effectiveness of nurse prescribing. A more consistent approach is required within organisations to support nurse prescribing.     

新医改以来我国社区卫生服务中心卫生人力资源配置现状分析

目的 了解新医改以来我国社区卫生服务中心卫生人力资源配置现状和问题,为我国合理配置社区卫生人力资源提供依据。方法 运用描述性分析方法分析我国社区卫生服务中心人力资源的数量、结构,利用洛伦兹曲线和基尼系数分析我国社区卫生服务中心人力资源分布的公平性。结果 2009－2015年,我国社区卫生服务中心卫生人员以省为单位的东、中、西部地区卫生服务中心卫生技术人员Gini系数从0.331 1下降到0.294 6;社区卫生人员数量有所增加,新增卫生人员291.24万人,其中社区卫生人员20.97万人,占新增卫生人员的7.2%;2015年社区卫生服务中心执业(助理)医师本科及以上学历占比为39.8%,医护比从2009年的1.4改善为2015年的1.2。结论 新医改以来,我国社区卫生服务中心人才队伍总的来说向好的趋势变化,我国东、中、西部社区卫生服务中心的卫生人员分布公平上存在的差异在逐步缩小,但仍存在人员数量不足、学历、职称、医护比结构失衡问题。