Patientenkontrollierte Analgesie (PCA) bei ambulanten Tumorschmerzpatienten

Introduction

In the home-care setting, cancer pain patients in need of parenteral analgesia have to be switched to patient-controlled analgesia using portable pumps. But there is a paucity on data on the logistic requirements or the success rate of such a cost-intensive therapy performed by specialized home-care services.

Methods

In a retrospective study we analyzed data on care intensity, logistics and outcome of 46 consecutive palliative cancer patients with patient-controlled analgesia (PCA) in a home-care setting.

Results

On days 1, 2, and 3 of PCA the switch to parenteral analgesia resulted in a significant increase of the median daily opioid dose in comparison to the dose just prior to PCA. Concurrently, pain scores were significantly reduced. The median duration of PCA was 25 days (range 2–189 days). On average, each patient was seen by the home-care team every 7.4 days. The median duration of the home visits was 60 min (range, 10–190 min). Of the visits 20% were unscheduled, most of these visits being due to problems regarding analgesia. Most patients died at home. Insufficient analgesia required prefinal hospitalization in only a single case.

Conclusion

If the indications are correct, intravenous PCA for palliative cancer pain patients results in higher opioid consumption and better pain control. Home-care PCA requires a lot of human and financial resources, but pain-related hospitalization can be prevented.     

Performance studies on the Technicon "SMAC" analyzer: Precision and comparison of values with methods in routine laboratory service.

We present performance studies on the Technicon "SMAC" analyzer. Precision was estimated from control data during routine operation and from blind duplicates of sera from patients. Patients' specimens were analyzed with the SMAC and the SMA 12/60 during initial evaluation studies. Comparisons were also made with the Du Pont aca and other methods during routine service. Performance is judged relative to medical usefulness requirements, by using previously developed criteria and recommendations for decision levels and allowable errors.     

Recovering the X-ray projection geometry for three-dimensional tomographic reconstruction with additional sensors: attached camera versus external navigation system

Three-dimensional tomographic reconstruction using intra-operative mobile C-arms could provide physicians with new and exciting tools for image-guided surgery. Recovery of the projection geometry of mobile X-ray systems is a crucial step for such reconstruction procedures. Recent work on medical imaging describes the use of optical or electro-magnetic sensor systems in order to navigate surgical instruments. These systems can also be used for the estimation of C-arm motion, and therefore for the recovery of the projection geometry of the X-ray C-arm. In this case, the mathematical problem that needs to be solved is equivalent to the hand-eye calibration well studied by both the computer vision and robotics community. We first study the recovery of the motion and projection geometry using five different hand-eye calibration methods proposed in the literature. The optical navigation system POLARIS from Northern Digital Inc. was used in our experiments. The results of the estimated motion and projection geometry using the five hand-eye calibration methods are compared with the same results obtained using an off-the-shelf CCD camera attached to the mobile C-arm. The experimental results include three-dimensional tomographic reconstruction results using our mobile C-arm. We show that even though the motion of the C-arm is more precisely recovered using the navigation system, the projection geometry is better estimated using the attached CCD camera.     

Working to learn and learning to work: placement experience of Project 2000 nursing students in Scotland

It is evident that the Scottish colleges have designed and provided very different curricular arrangements to support students' learning to practise in placements. Evaluation has demonstrated that some of these arrangements are of fundamental importance in facilitating or constraining the educational experience of students, including opportunities for reflection on experience, students' preparation for placements, the role of tutors in students' placement learning, the preparation of mentors and the utility of instruments for the assessment of students' practice-based learning. In addition to the formal provision in support of students' learning to work, students have developed their own informal strategies in order to meet their (sometimes conflicting) needs to maximize practical learning opportunities, ease entry into the nursing team and achieve favourable assessment of learning. Some of these involve working in order to learn. This paper is based on the work of the National Board-funded Evaluation of Project 2000 in Scotland (1992-96). The remit of the evaluation was to examine the teaching/learning processes of the Project 2000 nursing programmes and the new midwifery programmes, and their relationship to the educational outcomes for individual students, giving particular emphasis to the experience of students.     

US in the evaluation of abdominal pain in a department of internal medicine

Introduction

US (US) examination of the abdomen has acquired a growing role in the investigation of abdominal pain; however its role in the diagnosis of some important causes of abdominal pain is still under investigation. The aim of this study was to evaluate the role of US of the abdomen in the diagnosis of abdominal pain in patients referred to a department of internal medicine.

Materials and methods

A retrospective analysis was carried out on 248 US examinations performed in our department due to abdominal pain. For each examination the data written on the request form were registered as well as US findings which could be correlated with abdominal pain.

Results

In 105 patients (42%), US examination of the abdomen resulted in a relevant clinical finding and was thus considered positive. A high percentage of patients were elderly (>65 years; 52%) and very elderly (>80 years; 24%); these patients showed a significantly higher percentage of positive US scans. The proportion of positive scans was not significantly different between localized and non-localized pain. Specific pain location was associated with US findings such as hepatic masses, ovarian masses and renal stones, whereas non-localized pain was associated with abdominal free fluid and fluid-distended bowel loops.

Discussion

A high percentage of US examinations identified conditions that could possibly cause abdominal pain. Diagnostic yield of abdominal US was higher in elderly and very elderly patients. When a US examination is requested, it should always be evaluated within the clinical context. The physician should be aware of the great value of abdominal US in the diagnosis of the various causes of abdominal pain, but also of its possible limitations.     

Creating and maintaining 'optimism' in cancer care communication

This study investigates nurse-patient communication in the cancer care context. Interviews with nurses and patients about their communication experiences and audio-recorded nurse-patient conversations were collected and analysed. A theme of 'optimism' largely manifesting as 'constructive realism' was one of four features identified by the qualitative analysis. The health professional has traditionally been viewed as the party with the power and control over conversation progression and topics. In particular, the superficial, positive and chatty nature of nurse-patient interaction has often been attributed to a lack of nurses' communication skills training. This research indicates that both patient and nurse are active in its construction and argues that the optimistic cheerful nature of nurse-patient interaction may be better viewed as a jointly produced institutional feature of cancer care. This paper illustrates and examines some of the ways this outcome was created and maintained by participants and discusses the implications of this.