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1.
S. Liu A. E. Patanwala J. M. Naylor N. Levy R. Knaggs J. A. Stevens B. Bugeja D. Begley K. E. Khor E. Lau R. Allen S. Adie J. Penm 《Anaesthesia》2023,78(10):1237-1248
Modified-release opioids are often prescribed for the management of moderate to severe acute pain following total hip and knee arthroplasty, despite recommendations against their use due to increasing concerns regarding harm. The primary objective of this multicentre study was to examine the impact of modified-release opioid use on the incidence of opioid-related adverse events compared with immediate-release opioid use, among adult inpatients following total hip or knee arthroplasty. Data for total hip and knee arthroplasty inpatients receiving an opioid analgesic for postoperative analgesia during hospitalisation were collected from electronic medical records of three tertiary metropolitan hospitals in Australia. The primary outcome was the incidence of opioid-related adverse events during hospital admission. Patients who received modified with or without immediate-release opioids were matched to those receiving immediate-release opioids only (1:1) using nearest neighbour propensity score matching with patient and clinical characteristics as covariates. This included total opioid dose received. In the matched cohorts, patients given modified-release opioids (n = 347) experienced a higher incidence of opioid-related adverse events overall, compared with those given immediate-release opioids only (20.5%, 71/347 vs. 12.7%, 44/347; difference in proportions 7.8% [95%CI 2.3–13.3%]). Modified-release opioid use was associated with an increased risk of harm when used for acute pain during hospitalisation after total hip or knee arthroplasty. 相似文献
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Bobo H. P. Lau Ting-Kin Ng Yat-Lui Fung Tai-Chung Lam Tsz-Him So 《Journal of psychosocial oncology》2020,38(4):389-405
AbstractPurposes/objectives: This paper reports the comparative efficacies of integrative body-mind-spirit intervention (I-BMS) and cognitive behavioral therapy (CBT) in patient-caregiver parallel groups for Chinese patients with lung cancer.Design: Randomized controlled trial (RCT).Methods: One hundred and fifty-seven patient-caregiver dyads with no marked functional impairment were randomized into one of the two interventions with eight weekly patient-caregiver parallel groups. Assessments were conducted at baseline, within one, eight- and sixteen-weeks post-intervention. Effects of treatment group across time were analyzed by multilevel modeling.Findings: CBT led to greater reduction in emotional vulnerability than I-BMS. I-BMS resulted in greater increase in overall QoL and spiritual self-care, and more reduction in depression than CBT. Patients in both interventions experienced improvement in physical, emotional and spiritual, except social, domains of QoL.Conclusion: I-BMS was more efficacious for diverse domains of QoL, and CBT was more effective for emotional well-being, despite the relatively small between-group effect sizes.Implications for psychosocial providers/policy: (1) With the expanding repertoire of psychosocial interventions for families facing lung cancer, it has become imperative to investigate the comparative efficacies of empirically supported and culturally adapted interventions. (2) Our findings show that I-BMS was more effective for diverse domains of QoL, while CBT was more efficacious with emotional well-being, although both interventions led to significant improvements in physical, emotional and spiritual domains of patient QoL. (3) Patient-caregiver parallel groups have been shown to be effective for enhancing QoL of Chinese lung cancer patients. (4) Care professionals are encouraged to dispense interventions based on the idiosyncratic needs and preferences of the patients to maximize the treatment effects. 相似文献
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Malinda Itchins Brandon Lau Amanda L. Hudson Helen Westman Cathy Yi Xia Sarah A. Hayes Viive M. Howell Michael Rodriguez Wendy A. Cooper Heng Wei Michael Buckland Bob T. Li Mark Li Vivek Rathi Stephen B. Fox Anthony J. Gill Stephen J. Clarke Michael J. Boyer Nick Pavlakis 《The oncologist》2020,25(8):641-649
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目的:观察生大黄、芒硝湿敷联合集束化护理对骨折患者甘露醇使用期间静脉炎的预防效果。方法:选取使用20%甘露醇静脉滴注治疗的300例骨折患者,按随机数字表法分为对照组和观察组各150例。2组均实施集束化护理,观察组在甘露醇静脉滴注后使用生大黄、芒硝湿敷。比较2组患者静脉炎发生率、留置针留置时间和针口处疼痛、红肿情况。结果:观察组静脉炎严重程度轻于对照组,差异有统计学意义(P0.05)。观察组和对照组静脉炎发生率分别为12.67%、37.33%,2组比较,差异有统计学意义(P0.05)。观察组留置针留置时间2 d的比率为24.67%,低于对照组的39.33%(P0.05);观察组留置针时间5 d的比率为30.00%,高于对照组的18.67%(P0.05)。干预后,2组针口处疼痛评分、红肿直径均较干预前改善(P0.05);观察组针口处疼痛评分、红肿直径改善情况均优于对照组(P0.05)。结论:生大黄、芒硝湿敷联合集束化护理能减少骨折患者甘露醇使用期间静脉炎发生,延长留置针留置时间,减轻针口处疼痛、肿胀。 相似文献
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Hui Xing Lau Sarah El-Heis Qai Ven Yap Yiong Huak Chan Cheryl Pei Ting Tan Neerja Karnani Karen Mei Ling Tan Elizabeth Huiwen Tham Anne Eng Neo Goh Oon Hoe Teoh Kok Hian Tan Johan Gunnar Eriksson Yap Seng Chong Mary Foong-Fong Chong Hugo Van Bever Bee Wah Lee Lynette P. Shek Keith M. Godfrey Evelyn Xiu Ling Loo 《Clinical and experimental allergy》2021,51(10):1346-1360
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The clinical outcome of upper gastrointestinal bleeding has improved due to advances in endoscopic therapy and standardized peri‐endoscopy care. Apart from validating clinical scores, artificial intelligence‐assisted machine learning models may play an important role in risk stratification. While standard endoscopic treatments remain irreplaceable, novel endoscopic modalities have changed the landscape of management. Over‐the‐scope clips have high success rates as rescue or even first‐line treatments in difficult‐to‐treat cases. Hemostatic powder is safe and easy to use, which can be useful as temporary control with its high immediate hemostatic ability. After endoscopic hemostasis, Doppler endoscopic probe can offer an objective measure to guide the treatment endpoint. In refractory bleeding, angiographic embolization should be considered before salvage surgery. In variceal hemorrhage, banding ligation and glue injection are first‐line treatment options. Endoscopic ultrasound‐guided therapy is gaining popularity due to its capability of precise localization for treatment targets. A self‐expandable metal stent may be considered as an alternative option to balloon tamponade in refractory bleeding. Transjugular intrahepatic portosystemic shunting should be reserved as salvage therapy. In this article, we aim to provide an evidence‐based comprehensive review of the major advancements in endoscopic hemostatic techniques and clinical outcomes. 相似文献
10.
Mario Gaudino Filippo Piatti Christopher Lau Francesco Sturla Jonathan W. Weinsaft Luca Weltert Emiliano Votta Nicola Galea Ilaria Chirichilli Antonino Di Franco Marco Francone Carlo Catalano Alberto Redaelli Leonard N. Girardi Ruggero De Paulis 《The Journal of thoracic and cardiovascular surgery》2019,157(2):455-465