Regional analgesia for Labour

2020 ◽  
pp. 237-272
Author(s):  
Sarah Harries ◽  
Rachel Collis
Keyword(s):  
Epidural Analgesia ◽  
Epidural Space ◽  
Regional Analgesia ◽  
Safety And Efficacy ◽  
Anatomy And Physiology ◽  
Technological Advances ◽  
The Uk

Epidural analgesia is the most effective way of managing pain associated with labour. Pharmacological and technological advances, as well as a greater understanding of anatomy and physiology, have contributed to its safety and efficacy, with >25% of women receiving epidural analgesia during labour in the UK today. The pharmacokinetics of drugs administered into the epidural space are explained, and the evidence for using different methods of administration to establish optimum analgesia, i.e. intermittent top-ups vs continuous infusions vs patient controlled epidural analgesia, is discussed. How to accurately assess a block is emphasized. Epidurals that do not work are a source of anxiety and frustration to women and anaesthetists alike. Therefore understanding why an epidural may not behave as expected, and suggestions to trouble-shoot problematic epidurals are described based on authors’ experience.

Digital Ophthalmology in the UK – Diabetic Retinopathy Screening and Virtual Glaucoma Clinics in the National Health Service

2020 ◽  
Vol 237 (12) ◽  
pp. 1400-1408
Author(s):  
Heinrich Heimann ◽  
Deborah Broadbent ◽  
Robert Cheeseman
Keyword(s):  
Diabetic Retinopathy ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Daily Practice ◽  
Diabetic Retinopathy Screening ◽  
Technological Advances ◽  
Imaging Results ◽  
The Uk ◽  
Retinopathy Screening

AbstractThe customary doctor and patient interactions are currently undergoing significant changes through technological advances in imaging and data processing and the need for reducing person-to person contacts during the COVID-19 crisis. There is a trend away from face-to-face examinations to virtual assessments and decision making. Ophthalmology is particularly amenable to such changes, as a high proportion of clinical decisions are based on routine tests and imaging results, which can be assessed remotely. The uptake of digital ophthalmology varies significantly between countries. Due to financial constraints within the National Health Service, specialized ophthalmology units in the UK have been early adopters of digital technology. For more than a decade, patients have been managed remotely in the diabetic retinopathy screening service and virtual glaucoma clinics. We describe the day-to-day running of such services and the doctor and patient experiences with digital ophthalmology in daily practice.

scholarly journals THE VALUE OF ROBUST STATISTICAL FORECASTS IN THE COVID-19 PANDEMIC

2021 ◽  
Vol 256 ◽  
pp. 19-43
Author(s):  
Jennifer L. Castle ◽  
Jurgen A. Doornik ◽  
David F. Hendry
Keyword(s):  
Structural Change ◽  
Measurement Errors ◽  
Epidemiological Models ◽  
Short Term ◽  
Data Measurement ◽  
Policy Interventions ◽  
Changing Trends ◽  
Technological Advances ◽  
The Difference ◽  
The Uk

The Covid-19 pandemic has put forecasting under the spotlight, pitting epidemiological models against extrapolative time-series devices. We have been producing real-time short-term forecasts of confirmed cases and deaths using robust statistical models since 20 March 2020. The forecasts are adaptive to abrupt structural change, a major feature of the pandemic data due to data measurement errors, definitional and testing changes, policy interventions, technological advances and rapidly changing trends. The pandemic has also led to abrupt structural change in macroeconomic outcomes. Using the same methods, we forecast aggregate UK unemployment over the pandemic. The forecasts rapidly adapt to the employment policies implemented when the UK entered the first lockdown. The difference between our statistical and theory based forecasts provides a measure of the effect of furlough policies on stabilising unemployment, establishing useful scenarios had furlough policies not been implemented.

scholarly journals Safety and Efficacy of Oral Melatonin When Combined with Thoracic Epidural Analgesia in Patients with Bilateral Multiple Fracture Ribs

2020 ◽  
Vol Volume 13 ◽  
pp. 21-28
Author(s):  
Ahmed M Fetouh Abdelrahman ◽  
Amany Faheem Abdel Salam Omara ◽  
Alaa Ali M Elzohry
Keyword(s):  
Epidural Analgesia ◽  
Thoracic Epidural Analgesia ◽  
Multiple Fracture ◽  
Safety And Efficacy ◽  
Thoracic Epidural

Safety and efficacy of epidural analgesia

2017 ◽  
Vol 30 (6) ◽  
pp. 736-742 ◽  
Author(s):  
Elke M.E. Bos ◽  
Markus W. Hollmann ◽  
Philipp Lirk
Keyword(s):  
Epidural Analgesia ◽  
Safety And Efficacy

scholarly journals Beyond the lab: Virtual reality for undergraduate Anatomy and Physiology students

2021 ◽  
Vol 82 (4) ◽  
pp. 186
Author(s):  
Kathleen Phillips ◽  
Valerie A. Lynn ◽  
Amie Yenser ◽  
Christina Wissinger
Keyword(s):  
Virtual Reality ◽  
Teaching Practice ◽  
Mixed Reality ◽  
Cleveland Clinic ◽  
Physical Models ◽  
Human Anatomy ◽  
Anatomy And Physiology ◽  
Instructional Methodologies ◽  
Technological Advances ◽  
Microsoft Hololens

Current teaching practice in undergraduate higher education anatomy and physiology courses incorporates the use of various instructional methodologies to reinforce the anatomical relationships between structures.1,2 These methods can include basic hands-on physical models, human and animal dissection labs, and interactive technology. Technological advances continue to drive the production of innovative anatomy and physiology electronic tools, including:virtual dissection in 3-D (e.g., Virtual Dissection Boards from Anatomage, 3D4Medical, and Anatomy.TV),augmented reality (AR) (e.g., Human Anatomy Atlas),mixed reality (e.g., Microsoft HoloLens Case Western Reserve Medical School and Cleveland Clinic digital anatomy app), and3-D virtual reality (VR) (e.g., 3D Organon VR Anatomy and YOU by Sharecare apps).

Postural Stability following Ambulatory Regional Analgesia for Labor

2002 ◽  
Vol 97 (6) ◽  
pp. 1576-1581 ◽  
Author(s):  
Jeremy Davies ◽  
Roshan Fernando ◽  
Andrew McLeod ◽  
Sonia Verma ◽  
Philip Found
Keyword(s):  
Epidural Analgesia ◽  
Low Dose ◽  
Sitting Position ◽  
Balance Function ◽  
Regional Analgesia ◽  
Spinal Injection ◽  
Real Time Analysis ◽  
Combined Spinal Epidural ◽  
Standing Up ◽  
Spinal Epidural

Background The safety of mobilization following low-dose regional analgesia in parturients remains controversial. Previous studies have demonstrated preserved balance function despite clinically elicited sensory deficits. The aim of this study was to use the Balance Master 6.1, a device capable of real-time analysis of ambulation, to score the performance of basic maneuvers following initiation of low-dose combined spinal-epidural analgesia in laboring women compared with pregnant and nonpregnant controls. Methods Using the Balance Master, balance function during the performance of several simple tasks, including walking and standing up from a sitting position, was evaluated in a prospective, controlled, observational study with 50 laboring women after combined spinal-epidural analgesia compared with 50 pregnant and 50 nonpregnant controls. Results Nonpregnant women scored significantly better results in 6 of the 13 measured balance function parameters compared with both the combined spinal-epidural and pregnant control groups. Compared with the nonpregnant subjects, the pregnant groups generated less force standing up from the sitting position (P < 0.0001), walked more slowly (P = 0.0067), and took shorter steps (P < 0.0001). They also took longer to step up onto and over a 20-cm-high obstacle (P < 0.0001), and they generated less force while stepping up. Initial spinal analgesia in laboring women did not significantly affect performance in comparison to the pregnant controls. Thirty-four percent of women in the combined spinal-epidural group required supplemental epidural analgesia following the initial spinal injection (n = 17) before testing; they had significantly impaired balance function in four tests compared with those receiving a spinal injection only (n = 33). Conclusions Being pregnant at term significantly affects balance function, although initial low-dose spinal-epidural analgesia does not impair function further. Subsequent supplemental epidural analgesia may have a detrimental effect on balance, but properly designed studies are awaited to confirm this. This study supports the practice of allowing laboring women with initial low-dose spinal-epidural analgesia to ambulate, but indicates that further studies need to be conducted on the effects of subsequent epidural supplementation.

The opioid crisis: evaluating the safety and efficacy of opioid analgesia in the management of acute post-operative dental pain

Dental Update ◽  
2021 ◽  
Vol 48 (10) ◽  
pp. 859-864
Author(s):  
Daniel Merrick ◽  
Michael O'Sullivan ◽  
Mary Clarke
Keyword(s):  
Management Strategies ◽  
Opioid Analgesics ◽  
Dental Pain ◽  
Opioid Analgesia ◽  
Dental Practice ◽  
Opioid Use ◽  
Safety And Efficacy ◽  
Post Operative Pain ◽  
The Us ◽  
The Uk

The use and misuse of opioid analgesics have been highlighted in recent years. This review assesses dental opioid use, the effectiveness of opioid-containing analgesics versus non-opioid alternatives and the implications for post-operative pain management strategies in the dental practice. Guidelines for the management of acute post-operative dental pain differ from country to country. The UK has a low dental opioid use rate when compared to the US. The combination of paracetamol and ibuprofen has similar, if not better, analgesic properties compared to opioid-containing alternatives, with fewer adverse effects. CPD/Clinical Relevance: Non-opioid analgesics are both a safe and effective alternative to opioid analgesics in the management of post-operative dental pain.

The NICE Guidelines and Pediatric Sedation in the United Kingdom

2018 ◽  
pp. 306-312
Author(s):  
Michael Sury ◽  
Sarah Greenaway
Keyword(s):  
United Kingdom ◽  
National Health Service ◽  
Clinical Excellence ◽  
Nice Guidelines ◽  
Safety And Efficacy ◽  
Government Organization ◽  
The United Kingdom ◽  
Pediatric Sedation ◽  
Consensus View ◽  
The Uk

Pediatric procedural sedation is required for children across the globe in a wide variety of circumstances. In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) is a government organization whose purpose is to provide guidelines to help ensure that patients receive effective, good-value healthcare across the whole of the National Health Service. In 2010 NICE published a guideline for the use of pediatric sedation. The overarching aims were to review the safety and efficacy of sedation for common procedures and to form a consensus view on the necessary resources to do this safely. This chapter summarizes the key recommendations and describes how pediatric sedation has since evolved in the UK.

scholarly journals Visceral Language: A Phenomenological Approach to Contemporary Letterpress-Printed Artist’s Book Practice in the UK

Arts ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 151
Author(s):  
Angie Butler
Keyword(s):  
United Kingdom ◽  
Phenomenological Approach ◽  
Influential Factors ◽  
The United Kingdom ◽  
Technological Advances ◽  
Letterpress Printing ◽  
Artist's Book ◽  
Publishing Practice ◽  
The Uk ◽  
Contemporary Practice

The decline of commercial letterpress printing and technological advances in industry were major influential factors with respect to the establishment of independent small presses in the United Kingdom (UK). Although unlike work from commercial, private or fine press printers, utilisation of the letterpress process embedded a phenomenological approach to artist-led publishing where physicality and experience of using the letterpress process was reflected within the practice of making artists’ books and printed matter. Major concepts and inclusion of tools, equipment, technologies and studio methods used in historical small publishing practice can be considered in relation to today’s practitioners making letterpress-printed artists’ books to understand how skills are learnt and developed to support the evolution of a reflexive approach within contemporary practice.

A vision of dairy production in the UK

2001 ◽  
Vol 28 ◽  
pp. 51-57
Author(s):  
C. H. Knight
Keyword(s):  
Dairy Production ◽  
Niche Markets ◽  
Political Pressure ◽  
Dual Purpose ◽  
Technological Advances ◽  
The Future ◽  
The Uk ◽  
Lactation Cycle ◽  
Production Industry ◽  
Peak Lactation

AbstractThis review considers the likely impact of changing consumer requirements, political pressure, economics and technological advances on the dairy production industry of the future. The vision is one of diverse strategies of production, the majority of milk being produced from cows managed technologically with much greater regard for welfare, with a number of ‘romantic’ strategies such as organic, extensive or dual-purpose production supplying niche markets. The important novel feature of the technological strategy will be an escape from the intensive twelve-month lactation cycle to extended lactations of, say, eighteen months, since this will reduce the number of times the cow is exposed to metabolic and other stresses associated with parturition, peak lactation and rebreeding.

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