scholarly journals LO20: Emergency department initiated drug therapy and patient compliance in acute renal colic

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S13-S13
Author(s):  
A. Watt ◽  
J. Brubacher ◽  
L. Cuthbertson ◽  
R. Stenstrom ◽  
J. E. Andruchow ◽  
...  
Keyword(s):  
Renal Colic ◽  
Medication Compliance ◽  
Study Group ◽  
Discharge Instructions ◽  
High Quality ◽  
Convenience Sample ◽  
Acute Renal Colic ◽  
Ureteral Colic ◽  
Effective Analgesia

Introduction: NSAIDS offer more effective analgesia than opioids, require less rescue medication, and decrease the incidence of nausea and vomiting in renal colic patients. Alpha blockers and Opioids are also prescribed frequently, but doses used and treatment durations are not well described. Our objective was to investigate ED prescribing decisions and medication compliance by patients with acute renal colic. Methods: In this prospective two-city cohort study, we invited patients with a first ED visit for image-confirmed 2-10 mm ureteric stones to consent to a telephone survey 10 days after their ED visit. During follow-up interviews, patients were asked what drugs they were prescribed and how many doses they required. This study was REB approved. Results: A convenience sample of 224 patients, including 152 males (67.9%) and 72 females (median age= 52.4 years) completed 10-day surveys. NSAIDS were prescribed for 48.7%, tamsulosin for 65.2% and opioids for 81.7%. One-third received a tamsulosin-NSAID combination, 40% an opioid-NSAID combination and 28% a tamsulosin-NSAID-opioid combination. Of 109 patients prescribed an NSAID, only 70 (64.2%) took 1 dose/day; however an additional 28 who were not prescribed NSAIDs took 1 NSAID dose/day. Mean (sd) NSAID intake in the overall study group was 1.1 (1.5) doses/day from day 1-5 and 0.6 (1.1) doses/day on days 6-10, with 90%ile values of 3.0 and 2.0 doses/day. NSAID compliance was more common in patients who stated they received high quality discharge instructions (63.8% vs. 32.6%; RR=1.95; 95% CI 1.47-2.60). Mean opioid intake in the overall study group was 1.2 (1.7) doses/day from day 1-5 and 0.5 (1.3) doses/day on days 6-10, with 90%ile values of 4.0 and 2.0 doses/day. Among patients prescribed tamsulosin, the average was 4.0 days of compliance (sd=4.3), with a 90%ile value of 10 days. Conclusion: This study provides estimates for the amount of drug actually used by renal colic patients during the 10-days after their ED visit. Patients used fewer opioid doses than expected, and NSAID and tamsulosin compliance appears relatively poor. NSAID compliance was better in patients who perceived high quality discharge instructions. This study suggests there is room for improvement in medication prescribing and discharge instructions for ED patients with an acute episode of ureteral colic.

scholarly journals 84 Optimising The Assessment and Management of Acute Renal Colic in Secondary Care

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Fonseka ◽  
R Ellis ◽  
A Gowda ◽  
L Tuckwood ◽  
A Careless ◽  
...  
Keyword(s):  
Best Practice ◽  
Current Practice ◽  
Renal Colic ◽  
Electronic Patient Records ◽  
X Ray ◽  
Improved Outcomes ◽  
Acute Renal Colic ◽  
The Impact ◽  
First Time

Abstract Aim The latest guidance in acute renal colic states that patients should have serum calcium and urate (stone bloods) measured during inpatient admission. The guidance also states that follow-up imaging should be in the form of computed tomography (CT)-, ultrasound (USS)-, or X-ray- kidney, ureters and bladder (KUB). X-ray intravenous urogram (IVU) is now considered obsolete as it can result in over-exposing patients to radiation. Aims of this 2-cycle QIP were twofold; Method Data was extracted from electronic patient records on whether or not they had stone bloods measured during admission and also what follow-up imaging was requested. In the first cycle baseline data was extracted. A stone proforma was then created, incorporating the latest guidelines. In the second cycle the impact of the stone proforma was assessed. Results The study included 119 patients. After introducing the stone proforma we were successful in improving the rate of stone bloods being measured, increasing from 13% to 53%. We were also successful in reducing the rate of performing X-ray IVU, decreasing from 25% to 14% of patients. Conclusions This QIP demonstrates that management of acute renal colic can be optimised using a stone proforma and move current practice towards best practice. This is supported by the ‘Getting it Right First Time’ (GIRFT) Urology report 2018. The third cycle is currently underway, and we hope to see further improved outcomes.

scholarly journals Application of Skin Electrical Conductance of Acupuncture Meridians for Ureteral Calculus: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Wu-Chou Lin ◽  
Yung-Hsiang Chen ◽  
Jian-Ming Xu ◽  
Der-Cherng Chen ◽  
Wen-Chi Chen ◽  
...  
Keyword(s):  
Renal Colic ◽  
Electrical Conductance ◽  
Diagnostic Methods ◽  
Helical Computed Tomography ◽  
Ureteral Calculus ◽  
Lower Quadrant ◽  
Bladder Meridian ◽  
Acute Renal Colic ◽  
High Level

Renal colic is a common condition seen in the emergency department (ED). Our recent study showed that measures of electrical conductance may be used as supplementary diagnostic methods for patients with acute renal colic. Here, we describe the case of a 30-year-old male subject with a left ureteral calculus who presented with frequency and normal-looking urine. He had already visited the outpatient department, but in vain. Normal urinalysis and nonobstructive urogram were reported at that time. Two days later, he was admitted to the ED because of abdominal pain in the left lower quadrant. The urinalysis did not detect red blood cells. Ultrasonography did not indicate hydronephrosis. The meridian electrical conductance and index of sympathovagal balance were found to be abnormal. High level of electrical conductance on the left bladder meridian was found. An unenhanced helical computed tomography was scheduled to reveal a left ureterovesical stone. Ureteroscopic intervention was later uneventfully performed, and the patient's pain was relieved. The follow-up measurements showed that the meridian parameters had returned to normal one month after treatment. This case suggests that bladder meridian electrical conductance might be used as a supplemental method for ureteral calculus diagnosis.

C-reactive protein to predict the need for surgical intervention in acute renal colic

2013 ◽  
Vol 7 (6) ◽  
pp. 380-383 ◽  
Author(s):  
ST McSorley ◽  
M Drury ◽  
P Majumdar ◽  
A Halsall ◽  
SK Nalagatla
Keyword(s):  
Renal Colic ◽  
Surgical Intervention ◽  
Strong Predictor ◽  
Serum Marker ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
A Value ◽  
Acute Renal Colic ◽  
Emergency Surgical Intervention

Objectives: C-reactive protein (CRP) is a serum marker of systemic inflammation which has been suggested to predict need for emergent surgical intervention in patients with acute renal colic at a value of > 28 mg/l on admission.1 We aimed to determine if this applied to our patients. Patients and methods: We prospectively collected data from all patients admitted with symptomatic urolithiasis, confirmed by CT-KUB, over three months. Fifty-nine patients were included; however, four were excluded because of co-morbidites which could influence CRP, or recent urological surgery, giving N = 55, age 50.0±14.6 years (mean±SD), M:F 40:15. The decision to proceed to intervention was made by each patient’s clinical team and not by the authors; however, there was no blinding to CRP. Results: A total of 24 of 55 patients required intervention on their index admission (22 retrograde ureteric stent, one nephrostomy, one ureteroscopic stone extraction), and 31 were managed conservatively. Those undergoing intervention had higher CRP on admission (mean 16.3 vs 9.4 mg/l, p = 0.06) and higher maximum CRP (mean 94.7 vs 25.7 mg/l, p < 0.001) than those managed conservatively. Nineteen (79%) of those requiring intervention had CRP < 28 mg/l on admission. There were no deaths, no intensive care admissions and all were discharged to outpatient follow-up. Conclusion: Rising CRP during admission is a strong predictor of the need for emergency surgical intervention in patients with acute renal colic; however, CRP at admission is less useful.

scholarly journals The NARC (Nonsteroidal Anti-inflammatory in Renal Colic) Trial. Single-dose intravenous ketorolac versus titrated intravenous meperidine in acute renal colic: a randomized clinical trial

CJEM ◽  
2000 ◽  
Vol 2 (02) ◽  
pp. 83-89 ◽  
Author(s):  
Victor M. Wood ◽  
James M. Christenson ◽  
Grant D. Innes ◽  
Mary Lesperance ◽  
R. Douglas McKnight
Keyword(s):  
Single Dose ◽  
Adverse Effects ◽  
Functional Status ◽  
Renal Colic ◽  
Usual Activity ◽  
Double Blind ◽  
Convenience Sample ◽  
Acute Renal Colic ◽  
Anti Inflammatory ◽  
Primary Hypothesis

ABSTRACTObjectives:Intravenous (IV) opioid titration is an accepted method of relieving acute renal colic. Studies have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) are also effective in this setting. Our objective was to compare single-dose ketorolac and titrated meperidine, both administered intravenously, with respect to speed and degree of analgesia, adverse effects and functional status. Our primary hypothesis was that these agents provide equivalent analgesia within 60 minutes. Our secondary hypotheses were that ketorolac-treated patients would experience fewer adverse effects and would be better able to resume usual activity.Methods:This was a multicentre, double-blind randomized equivalence trial in a convenience sample of patients age 18–65 with moderate or severe renal colic, documented by intravenous pyelogram, ultrasound or stone passage. Meperidine-treated patients received 50 mg IV meperidine at 0 minutes, then 25–50 mg every 15 minutes as needed for ongoing pain. Ketorolac-treated patients received 30 mg IV ketorolac at 0 minutes and placebo injections every 15 minutes as needed. Pain levels and adverse effects were assessed every 15 minutes, and functional status was evaluated at 60 minutes. Our primary outcome was the proportion of patients with mild or no pain at 60 minutes.Results:Overall, 49 of 77 meperidine-treated patients (64%; 95% confidence interval [CI], 53%–75%) and 47 of 65 ketorolac-treated patients (72%; 95% CI, 61%–83%) achieved successful pain relief at 60 minutes (pvalue for equivalence = 0.002). Ten percent of meperidine-treated patients and 44% of ketorolac-treated patients were able to resume usual activity at 60 minutes (p= 0.001).Conclusions:In the doses studied, single-dose IV ketorolac is as effective as titrated IV meperidine for the relief of acute renal colic and causes less functional impairment.

Feasibility and effectiveness of ultra-low dose CTKUB for follow up of acute renal colic

2019 ◽  
Vol 18 (7) ◽  
pp. e2830
Author(s):  
S. Mukherjee ◽  
D.I. Feflea ◽  
H. Chana ◽  
A. Raza
Keyword(s):  
Low Dose ◽  
Renal Colic ◽  
Acute Renal Colic

scholarly journals Chinese Herbal Medicine Dingji Fumai Decoction for Ventricular Premature Contraction: A Real-World Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Bo Liang ◽  
Fei-Hu Zou ◽  
Ling Fu ◽  
Hui-Ling Liao
Keyword(s):  
Herbal Medicine ◽  
Chinese Herbal Medicine ◽  
Clinical Symptoms ◽  
Medication Compliance ◽  
Controlled Trial ◽  
Ventricular Premature Contraction ◽  
Traditional Chinese Medicine Syndrome ◽  
Chinese Herbal ◽  
Double Blinded

Background. Chinese herbal medicine Dingji Fumai Decoction (DFD) is widely clinically used for ventricular premature contraction (VPC). This real-word trial was designed to assess the safety and effectiveness of DFD for VPC. Methods. This was a double-blinded, randomized placebo-controlled trial. Patients with VPC were randomized (1 : 1) to treatment with DFD combined with metoprolol (DFD arm) or metoprolol combined with placebo (MET arm). A primary end point was a composite of clinical symptoms and signs determined by the traditionalChinese medicine syndrome score and the number of VPC determined by the Holter examination. Second outcomes were adverse events, medication compliance, and laboratory examination. Results. 144 patients were randomized to DFD arm (76 patients) or MET arm (68 patients), and 136 cases (71 in DFD arm and 65 in MET arm) finally completed this trial. After a 12-week follow-up, DFD arm significantly decreased traditional Chinese medicine syndrome score and the number of VPC compared with MET arm (P=0.003 and 0.034, respectively). There was no adverse drug effect and patient medication compliance was good. Conclusions. Superiority with DFD arm for VPC was demonstrated over MET arm for both the safety and effectiveness end points.

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