Practices and Predictors of Analgesic Interventions for Adults Undergoing Painful Procedures

2002 ◽  
Vol 11 (5) ◽  
pp. 415-429 ◽  
Author(s):  
Kathleen A. Puntillo ◽  
Lorie Rietman Wild ◽  
Ann Bonham Morris ◽  
Julie Stanik-Hutt ◽  
Carol Lynn Thompson ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Pain Intensity ◽  
Regression Models ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Factors Associated ◽  
Anesthetic Agents ◽  
Multiple Regression Models ◽  
Tracheal Suctioning ◽  
To Receive

• Background Research is limited on analgesic practices associated with the commonly performed procedures of turning, inserting central venous catheters, removing wound drains, changing dressings on nonburn wounds, suctioning the trachea, and removing femoral sheaths. • Objective To determine types of analgesics administered for procedures, the prevalence and amounts of drugs given, and factors predictive of analgesic administration. • Methods Pain was assessed before and immediately after procedures. Analgesic, sedative, and anesthetic agents administered within 1 hour before and/or during each procedure were noted. • Results A total of 5957 adult patients at 164 national and 5 international sites participated. Pain intensity increased at the time of procedure for all procedures. More than 63% of patients received no analgesics. Less than 20% received opiates; mean total dose of opiate was 6.44 mg (SD, 8.96 mg). Only 10% of patients received combination therapy. Factors associated with the likelihood of receiving opiates were pain intensity before a procedure, femoral sheath removal, being white, and the duration of a procedure. Patients less likely to receive opiates had a medical diagnosis or were having tracheal suctioning. Only 14.5% of the variance in the amount of opiate administered was explained by factors entered into multiple regression models. Type of procedure was the only significant predictor of amount of opiate administered. • Conclusions Most patients were not intentionally medicated even though pain intensity increased during their procedure. When used, analgesic amounts were low, and combination therapy was infrequent. Clinical trials are needed to evaluate optimal pain management for patients undergoing procedures.

Abstract P258: Factors Associated With Imaging Choice of Acute Ischemic Stroke Patients and the Related Health Outcomes

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Jason J Wang ◽  
Artem Boltyenkov ◽  
Gabriela Martinez ◽  
Jeffrey M Katz ◽  
Angela Hoang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Health Outcomes ◽  
Acute Ischemic Stroke ◽  
Regression Models ◽  
Critical Role ◽  
Clear Understanding ◽  
Negatively Associated ◽  
Factors Associated ◽  
To Receive ◽  
Iv Tpa

Introduction: Acute ischemic stroke (AIS) presents an ongoing challenge for population health and availability of healthcare resources. Imaging plays a critical role in both diagnosis and treatment decisions in AIS, but optimal utilization regarding advanced imaging with angiography and perfusion using either CTAP or MRAP remain uncertain according to national guidelines. Consequently, wide variation in AIS imaging exists in clinical practice, mostly defaulted to physician preferences and institutional factors, without a clear understanding of the benefits and risks involved in stroke care. Although CTAP and MRAP each have unique benefits and risks in the AIS setting, the effect of this risk-benefit tradeoff on health outcomes and utilization of resources is unknown. This study analyses the factors associated with imaging preferences and the related health outcomes. Method: We performed a retrospective study on an AIS registry consisting of consecutive patients admitted to our institution from November 1, 2011, through October 1, 2018. Imaging and treatment selections and modified Rankin Score (mRS) at discharge were the main outcomes. Independent variables include age, gender, race-ethnicity, and NIH stroke score (NIHSS) at admission. Multivariable logistic regression models were performed. P<0.05 was considered statistically significant. Results: 1884 patients with curated imaging data during hospitalization were included. Among them, 32% were ≥80 years old, 47.4% female, 15.53% black, 60.3% white, and 24.4% with NIHSS≥10 at admission. CTAP and MRAP were performed in 21.1% and 72.2% patients, respectively. 46.1% received thrombolytics (IV-tPA), 1.3% had endovascular therapy (EVT), and 52.7% were not treated. The two clinical outcomes were independent functionality at discharge (mRS0-2) at 48.4%, and patients expired in hospital at 7.1%. Adjusted by all the factors, regression models showed that patients with NIHSS≥10 were more likely to receive CTAP (p<0.0001, OR=3.39) and less likely to receive MRAP (p<0.0001, OR=0.48); whereas age ≥80 was less likely to receive CTAP (p<0.0001, OR=0.37) or MRAP (p<0.0001, OR=0.37). NIHSS≥10 (p<0.0001, OR=0.15) and IV-tPA (p=0.0006, OR=0.69) were negatively related to independent functionality at discharge, and MRAP (p<0.0001, OR=1.97) was positively related to it. NIHSS≥10 (p=0.0212, OR=1.69) were positively related to mortality, while utilization of MRAP showed a negative relationship (p<0.0001, OR=0.26) with it. Conclusion: Higher NIHSS was positively associated with mortality and utilization of CTAP, while it is negatively associated with MRAP. MRAP was positively related to independent functionality at discharge. Older age was negatively associated with CTAP or MRAP utilization.

scholarly journals Toxoplasma gondii and Neospora caninum infections and factors associated in goats in the Parana state, Southern Brazil

2020 ◽  
Vol 29 (4) ◽  
Author(s):  
Paulo Roberto Romanelli ◽  
Andressa Maria Rorato Nascimento de Matos ◽  
Fernanda Pinto-Ferreira ◽  
Eloiza Teles Caldart ◽  
Juliana Silva de Oliveira ◽  
...  
Keyword(s):  
Toxoplasma Gondii ◽  
Regression Models ◽  
Production Management ◽  
Indirect Elisa ◽  
Neospora Caninum ◽  
Serum Samples ◽  
Factors Associated ◽  
Reproductive Management ◽  
Multiple Regression Models ◽  
South Brazil

Abstract The aim of this study was to determine the occurrence of anti-Toxoplasma gondii and anti-Neospora caninum antibodies and their associated factors among goats in farms from the Paraná state, South Brazil. The serological analysis was performed by indirect ELISA on 629 goat serum samples collected from 32 farms distributed in five mesorregions from the state. Seropositivity was observed in 30.7% of the animals for T. gondii, 6.3% for N. caninum, and 3.0% for both agents. Final multiple regression models showed that the use of assisted reproduction decreased the chance of seropositivity for T. gondii (PR=0.70) and the slaughtering site on the farm (PR=2.03) increased it. To N. caninum, the supplying concentrated feed to animals (OR=4.80) and animal pre-weaning death (OR=9.96) increased the chance of seropositivity. The variables associated with these seropositivities suggest deficiencies in sanitation and reproductive management. In addition, it recognizes critical points of infection for animal production management.

scholarly journals Clinical profile of Candidiasis in neonates

2017 ◽  
Vol 4 (5) ◽  
pp. 1875
Author(s):  
Latha G. S. ◽  
Veeresh Babu D. V. ◽  
Thejraj H. K.
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Birth Asphyxia ◽  
Central Venous Catheters ◽  
Clinical Profile ◽  
Central Venous ◽  
Factors Associated

Background: Opportunistic infections are increasing in Neonatal Intensive Care Unit (NICU). Neonates often have compromised skin integrity, gastrointestinal tract disease, chronic malnutrition, central venous catheters, long term endotracheal intubation and other factors that lead to increased risk of acquiring such infections. Infections with fungi (candida) and with coagulase-negative staphylococci (CoNS) are especially prevalent. The need of study is to know the clinical profile of candidiasis in neonates in our setup and to determine associated risk factors of candidiasis.Methods: The present study was undertaken by Dept of paediatrics, SSIMS and RC Davangere among 296 neonates of which 96 babies admitted in NICU and 200 were in PNC ward to study clinical profile of candidiasis in neonates and risk factors associated with them. Parents of 296 babies were interviewed using preformed study proforma. Clinical examination was done and investigations included KOH examination of oral swab, Gram stain of the swab and blood culture of suspected sepsis babies. There are several factors associated with development of neonatal candidiosis. Of them, prematurity, LBW, perinatal birth asphyxia, long term antibiotics, central venous catheters, mechanical ventilation, septicemia, played a major role in development of candidosis.Results: In the present study, incidence of candidiasis in neonates revealed 13.8% of babies admitted in NICU. Male babies out numbered the female babies in incidence of candidiasis in neonates. Males formed 69% and females 31% of positive cases. Most of neonates admitted in NICU (96) were of low birth weight between 1.5kg to 2.5 kg. Out of which most of cases positive for candidiasis/candidemia were belonged to 1.0-1.5 kg. In present study, 13 babies were positive for candidiasis, of which 5 babies (38.3%) were of birth weight between 1-1.5kg. Birth asphyxia alone or with mechanical ventilation played an important risk factor in development of candidiasis in neonates. In present study, birth asphyxia and mechanical ventilation per se had played a significant role in development of candidiasis in neonates admitted in NICU.Conclusions: The present study revealed the clinical profile of candidiasis in neonates associated with various risk factors. Study shows that low birth weight, birth asphyxia and mechanical ventilation were significant risk factors for candidiasis in neonates. Blood cultures were positive in babies without mucosal lesions suggesting the importance of diagnosing fungal sepsis. 

scholarly journals Is the removal of a central venous catheter always necessary in the context of catheter-related right atrial thrombosis?

2018 ◽  
Vol 20 (1) ◽  
pp. 98-101 ◽  
Author(s):  
Luigi Rossi ◽  
Pasquale Libutti ◽  
Francesco Casucci ◽  
Piero Lisi ◽  
Annalisa Teutonico ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Combination Therapy ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Young Patients ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Right Atrial ◽  
Central Venous ◽  
Atrial Thrombosis

Catheter-related right atrial thrombosis is a severe and life-threatening complication of central venous catheters in both adult and young patients. Catheter-related right atrial thrombosis can occur with any type of central venous catheters, utilized either for hemodialysis or infusion. Up to 30% of patients with central venous catheter are estimated to be affected by catheter-related right atrial thrombosis; however, neither precise epidemiological data nor guidelines regarding medical or surgical treatment are available. This complication seems to be closely associated with positioning of the catheter tip in the atrium, whereas it is unlikely with a tip located within superior vena cava. Herein, we report the case of a patient affected by catheter-related right atrial thrombosis, who showed a quick resolution of thrombosis with a new therapeutic scheme combining loco-regional thrombolytic therapy (urokinase as a locking solution) and systemic anticoagulation therapy (vitamin K antagonists), thus avoiding catheter removal. Neither complications of the combination therapy were reported, nor recurrence of catheter-related right atrial thrombosis occurred. In conclusion, the combination therapy here described was safe, quick and effective, achieving the goal of not removing the catheter.

Factors associated with chemotherapy receipt and intensity for stage IV colorectal cancer (CRC): A multihealth system, population-based study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6519-6519
Author(s):  
Y. Zafar ◽  
S. C. Grambow ◽  
D. H. Abbott ◽  
J. L. Malin ◽  
L. L. Zullig ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Private Insurance ◽  
Single Agent ◽  
Stage Iv ◽  
Receive Combination Therapy ◽  
Public Insurance ◽  
Factors Associated ◽  
Severe Comorbidity ◽  
Line Of Therapy ◽  
To Receive

6519 Background: Little is known about chemotherapy practice patterns for patients with stage IV CRC. Methods: Cancer Outcomes Research & Surveillance Consortium (CanCORS) is a prospective cohort study including patients with incident CRC sampled from a set of defined populations and health systems. Eligible patients for this analysis (n = 742) had stage IV CRC and abstracted medical record data, including stage, chemotherapy, comorbidity (measured by the Adult Comorbidity Evaluation 27 index), and sociodemographic data. Logistic regression models were used to evaluate factors associated with chemotherapy receipt and intensity. Results: A majority of patients were male (62%) and white (62%). 27% were ≥75 years old, and 14% had severe comorbidity. 34% had private insurance, 32% had public insurance (including Medicare/Medicaid), 18% were Veterans Affairs patients, 4% had no insurance, and 13% were missing insurance information. Overall, 77% received chemotherapy, and 57% received >1 line of therapy. Patients were less likely to receive chemotherapy if they were older (65–74 vs. <55 years = adjusted odds ratio [OR] 0.14, 95%CI 0.06–0.33, p < 0.001; ≥75 vs. <55 years = OR 0.04, 95%CI 0.02–0.64, p < 0.001), or had severe comorbidity (OR 0.38; 95%CI 0.23–0.64; p < 0.001). When treated, patients ≥75 years were more likely to receive capecitabine vs. 5-fluorouracil (5-FU) (p < 0.001), less likely to receive >1 line of therapy (p < 0.001), and less likely to receive oxaliplatin or irinotecan combination therapy vs. a single-agent fluorouracil (p < 0.001). Although only 4% were uninsured, lack of insurance did not appear to be a factor in receipt of chemotherapy. Patients with public vs. private insurance were more likely to receive chemotherapy (OR 2.58; 95%CI 1.49–4.47; p < 0.001) but were less likely to receive combination therapy versus a single-agent 5-FU (p = 0.02). Conclusions: The elderly are less likely to receive standard therapy. While patients with public insurance are more likely to receive chemotherapy, they are less likely to receive recommended first-line combination regimens. Future research should investigate how insurance coverage and demographics influence physician and patient preferences for advanced CRC treatment. No significant financial relationships to disclose.

Prevention of bacteremia attributed to luminal colonization of tunneled central venous catheters with vancomycin-susceptible organisms.

1990 ◽  
Vol 8 (9) ◽  
pp. 1591-1597 ◽  
Author(s):  
C Schwartz ◽  
K J Henrickson ◽  
K Roghmann ◽  
K Powell
Keyword(s):  
Fungal Infections ◽  
Central Venous Catheters ◽  
First Episode ◽  
Exit Site ◽  
Central Venous ◽  
Suspected Sepsis ◽  
Hematologic Disorders ◽  
Kaplan Meier ◽  
Vancomycin Resistant ◽  
To Receive

Forty-five children with oncologic or hematologic disorders requiring tunneled central venous catheters (TCVC) for the administration of immunosuppressive therapy were randomized to receive either 10 U/mL heparin (H) (24 patients) or a solution of 10 U/mL H and 25 micrograms/mL vancomycin (H-V) (21 patients) for all catheter flushes. Episodes of fever or suspected sepsis were evaluated to determine whether the addition of vancomycin to the flush solution would alter the incidence of symptomatic bacteremia attributed to luminal colonization of TCVC with vancomycin-susceptible bacteria. Patients were enrolled for 247 +/- 150 days, accounting for a total of 11,095 days of catheter use. Bacteremia attributed to luminal colonization with vancomycin-susceptible organisms occurred in five patients (six infections) receiving H alone compared with zero patients receiving H-V (P = .035). The time to the first episode of bacteremia with vancomycin-susceptible organisms, analyzed by Kaplan-Meier survival curves, was significantly longer in patients receiving H-V (P = .04). There were no differences in the incidence of other infections including bacteremia attributed to luminal colonization with vancomycin-resistant organisms, other bacteremias (including those arising from the catheter exit site), exit-site cellulitis, or fungal infections. No organisms resistant to vancomycin were identified. Vancomycin could not be detected in the peripheral blood of patients receiving vancomycin in the flush solution. No vancomycin-related toxicities were noted. We conclude that the use of an H-V flush solution in immunocompromised patients with TCVC can decrease the frequency of bacteremia attributed to luminal colonization with vancomycin-susceptible bacteria.

scholarly journals Central Venous Catheters Revisited— Infection Rates and an Assessment of the New Fibrin Analysing System Brush

1996 ◽  
Vol 24 (3) ◽  
pp. 330-333 ◽  
Author(s):  
P. V. van Heerden ◽  
S. A. R. Webb ◽  
S. Fong ◽  
C. L. Golledge ◽  
B. L. Roberts ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Rate ◽  
Early Warning ◽  
Central Venous Catheters ◽  
Infection Rates ◽  
Central Venous ◽  
Group 4 ◽  
To Receive ◽  
Silver Sulphadiazine

Sixty-one consecutive patients in the Intensive Care Unit requiring central venous lines (CVC) for five or more days were randomized to receive either a standard triple lumen CVC (STD/CVC) or a silver sulphadiazine and chlorhexidine impregnated CVC (SSD/CVC). Data from the 54 patients who completed the trial show a reduced infection rate (positive tip culture) in the SSD/CVC group (4 out of 28) compared to the STD/CVC group (10 out of 26) (P<0.05). In addition, the new Fibrin Analysing System (FAS) brush was evaluated and used to determine the presence of infection in all the CVCs (STD/CVC and SSD/CVC combined, n=54) at day 3 (i.e. early warning of CVC colonization/infection) and at the time of removal of the CVC. The FAS brush was able to detect an infected CVC on only one occasion on day 3 out of the 14 CVC tips which were later found to be colonized/infected at the time of removal. The sensitivity of the FAS brush in detecting colonized/infected CVCs at the time of CVC removal compared with CVC tip culture was 21% with a specificity of 100%. These findings would currently not support the routine use of the FAS brush in determining CVC infection/colonization.

scholarly journals Double-Blind Prospective Randomized Study Comparing Topical Mupirocin and Placebo for the Prevention of Infection Associated with Central Venous Catheters

1997 ◽  
Vol 8 (4) ◽  
pp. 213-220 ◽  
Author(s):  
John M Conly ◽  
Robert Rennie ◽  
Leonard Tan ◽  
Colin Bagg ◽  
Karen Stein ◽  
...  
Keyword(s):  
Placebo Group ◽  
Insertion Site ◽  
Central Venous Catheters ◽  
Stepwise Logistic Regression ◽  
Exit Site ◽  
Central Venous ◽  
Double Blind ◽  
Distal Catheter ◽  
Catheter Related Infection ◽  
To Receive

OBJECTIVE: To compare the incidence of exit site colonization, local catheter-related infection and catheter-related bacteremia in patients randomized to receive either topical 2% mupirocin or placebo at the catheter exit site.PATIENTS AND METHODS: Patients requiring central venous catheters for more than three days were randomized to receive in a double-blind fashion either topical mupirocin or an identical placebo at the exit site three times weekly at the time of dressing change. Insertion, site care and removal of catheters were standardized. Serial semiquantitataive cultures of the skin at the catheter insertion site were performed using a sterile 25 cm2template. The distal and proximal catheter segments were cultured using a standardized semiquantitative technique, and any suspect catheter-related bacteremia was investigated with two sets of peripheral blood cultures, a 10 mL sample of infusate and clinical assessment. Both univariate and multivariate analyses were conducted on individual risk factors to determine factors that might influence the outcomes of local or systemic catheter-related infection.RESULTS: Local catheter-related infection (defined as more than 15 colony forming units [cfu] on culture of the proximal or distal catheter segment) occurred in six of 57 (10.5%) in the mupirocin group versus 18 of 69 (26%) in the placebo group (P<0.05) for the distal catheter segments and in one of 40 (2.5%) versus 13 of 47 (27.6%) for the proximal segments in the mupirocin and placebo groups (P<0.006), respectively. Catheter-related bacteremia occurred in one of 57 (1.8%) of the mupirocin group but in five of 69 (7.2%) of the placebo group (P=0.15). Stepwise logistic regression revealed that cutaneous colonization at the insertion site of at least 103cfu/mL/25 cm2(OR 2.6; CI 1.0 to 6.9) and the use of placebo (OR 3.3; CI 1.2 to 9.0) were significant factors predicting local catheter-related infection; whereas mupirocin was associated with reciprocal protective effect (OR 0.3; 95% CI 0.1 to 0.8).CONCLUSIONS: These findings suggest that patients receiving topical mupirocin at the exit site for long term central venous catheters have significantly less local catheter-related infection, and there is a trend towards less catheter-related bacteremia.

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