Comparative study of efficacy and tolerability of flupirtine versus tramadol in non-steroidal anti-inflammatory drug intolerant mechanical low back pain

BackgroundMechanical low back pain (MLBP) is a commonly encountered entity in clinical practice. Pain relief and restoration of functional capacity are management goals.Aims and objectivesTo compare the efficacy and tolerability of flupirtine, a selective neuronal potassium channel-opener (SNEPCO), with tramadol, a widely-used opioid analgesic, in MLBP.MethodsThis randomized, single-blinded, intention to treat (ITT) trial started with 240 non-steroidal anti-inflammatory drug (NSAID) intolerant patients who were prescribed either tablet flupirtine (100 mg twice daily) or capsule tramadol (50 mg twice daily), for 4 weeks. Follow-up was done on days 14, 28 and 4 weeks after treatment completion. Assessment of improvements in Indian Health Assessment Questionnaire Disability Index (Indian HAQ-DI), Visual Analogue Scale (VAS), Numerical Rating Scale (NRS) and measurement of Pain Relief Rate (PRR) were performed. Adverse events were recorded.ResultsOne hundred and seven patients receiving flupirtine and 103 receiving tramadol were analyzed on an ITT basis. Scores in Indian HAQ-DI, VAS and NRS improved significantly in both groups in the last visit, but more so with flupirtine. PRR was reasonably higher with flupirtine, [59 (55.14%)] patients experiencing significant to complete pain relief at the end of the study, compared to tramadol [41 (39.81%)]. Adverse effects were less with flupirtine [26 (24.30%) versus 41 (39.81%), p < 0.05], minimizing drop-outs.ConclusionFlupirtine has better sustained efficacy and tolerability than tramadol in MLBP.     

Five-year results of no-fault compensation related to childbirth injuries in Taiwan

ObjectiveIncreasing obstetric medical litigations had great impacts in health care system resulted in lower recruitment of residents and higher medical cost of defensive medicine in Taiwan. In order to reduce medical litigation, the “Childbirth Accident Emergency Relief Act” was implemented in June 2016. This study presented five-year results of a novel childbirth accident compensation system.Materials and methodsThe purpose of the Relief Act was to establish a national relief system to ensure timely relief, reduce medical disputes, promote the partnership between patient and medical personnel. The compensations included maximal 2 million NTD for maternal death, maximal 0.3 million NTD for neonatal and fetal deaths, and 3, 2, and 1.5 million NTD for maternal or neonatal profound, severe, and moderate disabilities, respectively. Puerperal hysterectomy was included with maximal 0.8 million NTD compensation.ResultsSince June 30, 2016 to June 30, 2021, there were 1340 applications reviewed by Committee and 1258 were approved with total relief of 744.7 million NTD (26.6 million USD) with approve rate of 93.9%. It took an average of 109.8 days to start application from childbirth and 102.4 days to get compensation from application. 66.1% of accident victims agreed this system can restore doctor–patient relationship by immediate care and assistance from medical institutions.ConclusionThe Relief Act is the first government leading compensation system to establish a national relief system. It was enacted to reduce medical disputes, promote the partnership between patient and medical personnel, and enhance health and safety of women during childbirth. A no-fault compensation would be an efficient alternative disputes resolution to childbirth accidents.     

Breastfeeding and infant health outcomes at 9 months of age in the Gaza Strip: a cross-sectional randomised trial

Background

There are limited studies about optimal duration and benefits of breastfeeding—and in particular, exclusive breastfeeding—on infant health and growth in the occupied Palestinian territory. This study aimed to evaluate the effect of exclusive breastfeeding on the health of infants in the Gaza Strip (at age 9 months), in terms of anthropometric measurements, growth, and morbidity.

儿科治疗过程中缓解家长心理问题及护理干预的临床效果

目的:研究儿科治疗过程中缓解家长心理问题及护理干预的临床效果。方法:选取我院儿科2015年6月至2016年6月收治的120例肺炎患儿,按患儿入院顺序将其分为对照组和观察组各60例。予以对照组家长常规护理,观察组家长在对照组基础上给予心理护理干预。比较两组患儿家长心理问题发生率及抑郁、焦虑心理改善情况,观察两组患儿治疗总有效率。结果:心理护理后观察组患儿家长心理问题发生率为16.67%,显著低于对照组的78.33%(χ2=45.748,P0.05);两组患儿家长护理前焦虑自评量表(SAS)、抑郁自评量表(SDS)评分差异无统计学意义(P0.05);心理护理后观察组患儿家长SAS、SDS评分显著低于对照组(t=15.590,14.584;P0.05);观察组患儿治疗总有效率为95.00%,显著高于对照组的66.67%(χ2=15.545,P0.05)。结论:儿科治疗过程中缓解家长心理问题及护理干预的临床效果显著,值得在临床上广泛应用。     

强的松在下颌阻生智齿拔除术中的临床应用

目的 :观察强的松在下颌阻生智齿拔除术的价值和可行性。方法 :选用实验组 4 8例患者 ,给拔除术后口服强的松片 ,对照组 4 7例不服用强的松片作比较。术后d1复诊 ,作对照检查。结果 :实验组在张口受限程度上明显较对照组减轻。二者之间有显著性差别 (P <0 .0 5 )。结论 :强的松应用在下颌阻生齿拔除术后 ,明显减轻术后张口受限程度     

间苯三酚对结石性肾绞痛患者疼痛缓解的影响

目的探究间苯三酚对结石性肾绞痛(stone renal colic,SRO)患者疼痛缓解的影响。方法选取2015年1月至2017年12月本院收治的SRO患者126例,依据随机数字表法分为间苯三酚组与对照组,各63例。对照组给予双氯芬酸钠盐酸利多卡因注射液联合黄体酮治疗,间苯三酚组给予间苯三酚联合双氯芬酸钠盐酸利多卡因注射液治疗。比较两组治疗前及治疗1 h后疼痛得分及肾积水量、肾绞痛发作次数、缓解时间、结石排出情况、不良反应等指标。结果治疗后1 h,间苯三酚组疼痛得分低于对照组(P<0.05)。间苯三酚组肾绞痛发作次数少于对照组,缓解时间短于对照组(P<0.05)。间苯三酚组结石排出率、总有效率均高于对照组(P<0.05)。两组不良反应发生率比较差异无统计学意义。结论间苯三酚治疗SRO可快速缓解患者疼痛,促进结石排出,临床疗效显著,无明显不良反应,值得临床推广。     

重大自然灾害三级医学救援体系的初步探讨

文章结合汶川地震医疗救援实践,提出了建立重大自然灾害三级医学救援体系的设想。文章较为系统地探讨了现场救治力量、区域救治中心和后方救治机构三级医学救援体系的能力要求、配置原则,并对如何做好三级救援体系的日常建设和训练提出了建议。     

Pain in neonate

Anatomical, functional and neurochemical maturation of pain pathways is well developed in fetus and neonates. Various physiological and behavioural responses to painful stimuli in neonates substantiate their ability to feel pain. Biological effects of pain are systematically studied in human fetus and neonates. Pain expressions in the newborn not only reflect tissue damage but are a function of ongoing behavioural state. The ultimate aim should be to keep neonates free from pain and other stressful stimuli as far as possible, by advocating minimal handling protocol, giving comforts after painful procedures, local anesthesis while carrying out painful procedures like cutdown and insertion of chest tubes, and if a baby is ventilated fentanyl and/or midazalam infusion must be carried out during initial periods of ventilation.     

药品不良反应损害救济机制探讨

药品不良反应损害是否应当救济,或在多大范围内救济,采用何种方式救济?这一系列问题都需由法律予以判断和裁决。而我国现行法律制度对药品不良反应的法律责任规定缺位,亦无相应的损害救济制度,受到药品不良反应损害的消费者或其他相关人员因而难以得到补偿或赔偿。文章通过比较药品不良反应各类救济制度,认为采用保险基金制度来建立药品不良反应救济制度是一项有效的途径,同时对我国药品不良反应救济制度的建立提供了初步意见。