Neurogenic pain

Effective preoperative communication and an awareness of the mechanisms and treatment of neurogenic pain by nursing staff directly influence the choice of intraoperative and postoperative pain management. This article describes the case study of a young woman with neurogenic pain and highlights the importance of having a working knowledge of this type of pain, its assessment, and treatment.     

Lower Fat Intake as a Predictor of Initial and Sustained Weight Loss in Obese Subjects Consuming an Otherwise ad Libitum Diet

Objective To determine what predicts initial and sustained weight loss in subjects consuming a reduced-fat diet ad libitum and the relationship between achieved level of fat intake and weight loss.Design Placebo arm of a randomized, controlled trial of a weight-loss drug (dexfenfluramine) in the context of an ad libitum, reduced-fat, diet.Subjects Thirty-nine subjects (initial mean body mass index±standard deviation=34.9±3.4; body mass index is calculated as kg/m²) from the placebo group who completed the 9-month study.Intervention Dietary assessment and education (month 0) followed by monthly meetings during the single intervention of reducing fat intake (months 1 through 6); one follow-up at 9 months.Main outcome measures Initial weight loss (first 3 months) and sustained weight loss (over 9-month period).Statistics Dietary intake, body size, exercise levels, age, and gender were included in multiple regression linear models of initial and sustained weight loss if they were significant independent predictors.Results Greater initial weight loss was associated with a greater decrease in fat intake and a lower achieved fat intake at 3 months. Greater sustained weight loss was associated with a lower achieved fat intake, a higher baseline waist circumference, and higher moderate-intensity exercise levels (months 3 and 6). Weight loss occurred in all subjects who reported a fat intake of 40 g/day or less.Applications The obese persons most likely to achieve and sustain weight loss on an ad libitum, reduced-fat diet are those who can substantially reduce fat intake, those with high initial levels of abdominal fat, and those who undertake regular moderate-intensity exercise. A target of less than 40 g fat per day might be an appropriate goal to ensure weight loss, but dietary underreporting and the difficulty of sustaining very-low-fat intakes need to be considered. J Am Diet Assoc. 1998;98:35-39.     

A systems approach to the reduction of medication error on the hospital ward

AIMS: To discuss a potentially powerful approach to safer medication administration on the hospital ward, based on principles of safety developed in other high-risk industries, and consistent with recent national reports on safety in health care released in the United Kingdom (UK) and United States of America (USA). To discuss why punitive approaches to safety on the hospital ward and in the nursing literature do not work. BACKGROUND: Drug administration error on the hospital ward is an ever-present problem and its occurrence is too frequent. Administering medication is probably the highest-risk task a nurse can perform, and accidents can lead to devastating consequences for the patient and for the nurse's career. Drug errors in nursing are often dealt with by unsystematic, punitive, and ineffective means, with little knowledge of the factors influencing error generation. Typically, individual nurses are simply blamed for their carelessness. By focusing on the individual, the complete set of contributing factors cannot be known. Instead, vain attempts will be made to change human behaviour - one of the most change-resistant aspects of any system. A punitive, person-centred approach therefore, severely hampers effective improvements in safety. By contrast, in other high-risk industries, such as aviation and nuclear power, the systems-centred approach to error reduction is routine. CONCLUSIONS: Accidents or errors are only the tip of the incident iceberg. Through effective, nonpunitive incident reporting, which includes reports of near-misses and system problems in addition to actual accidents, the systems-approach allows the complete set of contributing factors underlying an accident to be understood and addressed. Feedback to participants and targeted improvement in the workplace is also important to demonstrate that incident data are being used appropriately, and to maintain high levels of on-going reporting and enthusiasm for the scheme. Drug administration error is a serious problem, which warrants a well-reasoned approach to its improvement.