scholarly journals The Use of Epidural Analgesia in a New Zealand Tertiary Hospital before and after Publication of the Master Study

2008 ◽  
Vol 36 (1) ◽  
pp. 79-83 ◽  
Author(s):  
G. C. Werrett ◽  
H. Horton ◽  
R. Craig ◽  
R. A. French
2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 856.1-856
Author(s):  
C. Lao ◽  
D. Lees ◽  
D. White ◽  
R. Lawrenson

Background:Osteoarthritis of the hip and knee is one of the most common causes of reduced mobility. It also causes stiffness and pain. Opioids can offer pain relief but is usually used for severe acute pain caused by major trauma or surgery. The use of opioids for relief of chronic pain caused by arthritis has increased over the last few decades.[1]Objectives:This study aims to investigate the use of strong opiates for patients with hip and knee osteoarthritis before and after joint replacement surgery, over a 13 years period in New Zealand.Methods:This study included patients with osteoarthritis who underwent publicly funded primary hip and knee replacement surgeries in 2005-2017 in New Zealand. These records were identified from the National Minimum Dataset (NMD). They were cross referenced with the NZJR data to exclude the admissions not for primary hip or knee replacement surgeries. Patients without a diagnosis of osteoarthritis were excluded.The PHARMS dataset was linked to the NMD to identify the use of strong opiates before and after surgeries. The strong opiates available for community dispensing in New Zealand and included in this study are: dihydrocodeine, fentanyl, methadone, morphine, oxycodone and pethidine. Use of opiate within three months prior to surgery and within 12 months post-surgery were examined by gender, age group, ethnicity, Charlson Comorbidity Index score and year of surgery. Differences by subgroup was examined with Chi- square test. Logistic regression model was used to calculate the adjusted odds ratios of strong opiate use before and after surgery compared with no opiate use.Results:We identified 53,439 primary hip replacements and 50,072 primary knee replacements with a diagnosis of osteoarthritis. Of patients with hip osteoarthritis, 6,251 (11.7%) had strong opiate before hip replacement surgeries and 11,939 (22.3%) had opiate after surgeries. Of patients with knee osteoarthritis, 2,922 (5.8%) had strong opiate before knee replacement surgeries and 15,252 (30.5%) had opiate after surgeries.The probability of patients with hip and knee osteoarthritis having opiate decreased with age, increased with Charlson comorbidity index score, and increased over time both before and after surgeries. Male patients with hip and knee osteoarthritis were less likely to have opiate than female patients both before and after surgeries. New Zealand Europeans with hip and knee osteoarthritis were more likely to receive opiate than other ethnic groups prior to surgeries, but were less likely to have opiate than Asians post-surgeries.Patients who had opiate before surgeries were more likely to have opiate after surgeries than those who did not have opiate before surgeries. The odds ratio was 8.34 (95% confidence interval (CI): 7.87-8.84) for hip osteoarthritis and 11.94 (95% CI: 10.84-13.16) for knee osteoarthritis after adjustment for age, gender, ethnicity, year of surgery and Charlson comorbidity index score. Having opiate prior to surgeries also increased the probability of having opiate for 6 weeks or more after surgeries substantially. The adjusted odds ratio was 21.46 (95% CI: 19.74-23.31) for hip osteoarthritis and 27.22 (95% CI: 24.95-29.68) for knee osteoarthritis.Conclusion:Preoperative opiate holidays should be encouraged. Multiple strategies need to be used to develop analgesic plans that allow adequate rehabilitation, without precipitating a chronic opiate dependence. Clinicians would also benefit from clear guidelines for prescribing strong opiates.References:[1] Nguyen, L.C., D.C. Sing, and K.J. Bozic,Preoperative Reduction of Opioid Use Before Total Joint Arthroplasty.J Arthroplasty, 2016.31(9 Suppl): p. 282-7.Disclosure of Interests:None declared


2017 ◽  
Author(s):  
Andreas Kääb ◽  
Bas Altena ◽  
Joseph Mascaro

Abstract. Satellite measurements of coseismic displacements are typically based on Synthetic Aperture Radar (SAR) interferometry or amplitude tracking, or based on optical data such as from Landsat, Sentinel-2, SPOT, ASTER, very-high resolution satellites, or airphotos. Here, we evaluate a new class of optical satellite images for this purpose – data from cubesats. More specific, we investigate the PlanetScope cubesat constellation for horizontal surface displacements by the 14 November 2016 Mw7.8 Kaikoura, New Zealand, earthquake. Single PlanetScope scenes are 2–4 m resolution visible and near-infrared frame images of approximately 20–30 km × 9–15 km in size, acquired in continuous sequence along an orbit of approximately 375–475 km height. From single scenes or mosaics from before and after the earthquake we observe surface displacements of up to almost 10 m and estimate a matching accuracy from PlanetScope data of up to ±0.2 pixels (~ ±0.6 m). This accuracy, the daily revisit anticipated for the PlanetScope constellation for the entire land surface of Earth, and a number of other features, together offer new possibilities for investigating coseismic and other Earth surface displacements and managing related hazards and disasters, and complement existing SAR and optical methods. For comparison and for a better regional overview we also match the coseismic displacements by the 2016 Kaikoura earthquake using Landsat8 and Sentinel-2 data.


2020 ◽  
Author(s):  
J Wailling ◽  
Brian Robinson ◽  
M Coombs

© 2018 John Wiley & Sons Ltd Aim: This study explored how doctors, nurses and managers working in a New Zealand tertiary hospital understand patient safety. Background: Despite health care systems implementing proven safety strategies from high reliability organisations, such as aviation and nuclear power, these have not been uniformly adopted by health care professionals with concerns raised about clinician engagement. Design: Instrumental, embedded case study design using qualitative methods. Methods: The study used purposeful sampling, and data was collected using focus groups and semi-structured interviews with doctors (n = 31); registered nurses (n = 19); and senior organisational managers (n = 3) in a New Zealand tertiary hospital. Results: Safety was described as a core organisational value. Clinicians appreciated proactive safety approaches characterized by anticipation and vigilance, where they expertly recognized and adapted to safety risks. Managers trusted evidence-based safety rules and approaches that recorded, categorized and measured safety. Conclusion and Implications for Nursing Management: It is important that nurse managers hold a more refined understanding about safety. Organisations are more likely to support safe patient care if cultural complexity is accounted for. Recognizing how different occupational groups perceive and respond to safety, rather than attempting to reinforce a uniform set of safety actions and responsibilities, is likely to bring together a shared understanding of safety, build trust and nurture safety culture.


2021 ◽  
Vol 19 (12) ◽  
pp. 2683-2689
Author(s):  
Xiaoping Yang ◽  
Danjie Zhang ◽  
Deling Kong ◽  
Jin Zhang ◽  
Bingwen Dang

Purpose: To compare the efficacy and safety profiles of epidural analgesia (EA) and opioid analgesia (OA) in Chinese patients with thoracic trauma (TT). Methods: Patients with confirmed diagnosis of thoracic trauma were given either EA (via a catheter) or slow-release OA. The following efficacy variables were assessed in the two treatment groups: pain score, and changes in cytokine and catecholamine levels from baseline after treatment. Moreover, respiratory parameters were determined before and after treatment. The safety associated with each anesthesia was also evaluated. Quantitative data were analyzed either with Student’s t-test or MannWhitney test, while  categorical data were analyzed using Fisher exact or Chi-square test, based on data size. Results: A total of 200 patients completed the study (100 patients in each group). Pain, as assessed by verbal rating scale (VRS), was slightly lower in patients after treatment with EA, when compared to the patients treated with OA. However, the difference was not statistically significant (p < 0.05). Maximum inspiratory force (cmH2O) and tidal volume (liters) were slightly improved in patients  treated with EA, when compared to OA-treated patients, although the difference was not statistically significant (p < 0.05). Moreover,  the two treatments produced comparable levels of cytokines and catecholamines. Conclusion: The efficacy and safety data for EA and OA in Chinese non-obese patients with TT indicate numerically favorable outcome for EA, when compared to OA. Keywords: Epidural analgesia, Opioid analgesia, Chinese patients, Thoracic trauma


2021 ◽  
Author(s):  
◽  
Roald Egbert Harro Bomans

<p>Introduced mammalian predators, namely possums, stoats and rats, are the leading cause of decline in native avifauna in New Zealand. The control of these species is essential to the persistence of native birds. A major component of mammal control in New Zealand is carried out through the aerial distribution of the toxin sodium monofluoroacetate (otherwise known as 1080). The use of this toxin, however, is subject to significant public debate. Many opponents of its use claim that forests will ‘fall silent’ following aerial operations, and that this is evidence of negative impacts on native bird communities. With the continued and likely increased use of this poison, monitoring the outcomes of such pest control operations is necessary to both address these concerns and inform conservation practice. The recent growth in autonomous recording units (ARUs) provides novel opportunities to conduct monitoring using bioacoustics. This thesis used bioacoustic techniques to monitor native bird species over three independent aerial 1080 operations in the Aorangi and Rimutaka Ranges of New Zealand.  In Chapter 2, diurnal bird species were monitored for 10-12 weeks over two independent operations in treatment and non-treatment areas. At the community level, relative to non-treatment areas, the amount of birdsong recorded did not decrease significantly in treatment areas across either of the operations monitored. At the species level, one species, the introduced chaffinch (Fringilla coelebs), showed a significant decline in the prevalence of its calls in the treatment areas relative to non-treatment areas. This was observed over one of the two operations monitored. Collectively, these results suggest that diurnal native avifaunal communities do not ‘fall silent’ following aerial 1080 operations.  The quantity of data produced by ARUs can demand labour-intensive manual analysis. Extracting data from recordings using automated detectors is a potential solution to this issue. The creation of such detectors, however, can be subjective, iterative, and time-consuming. In Chapter 3, a process for developing a parsimonious, template-based detector in an efficient, objective manner was developed. Applied to the creation of a detector for morepork (Ninox novaeseelandiae) calls, the method was highly successful as a directed means to achieve parsimony. An initial pool of 187 potential templates was reduced to 42 candidate templates. These were further refined to a 10-template detector capable of making 98.89% of the detections possible with all 42 templates in approximately a quarter of the processing time for the dataset tested. The detector developed had a high precision (0.939) and moderate sensitivity (0.399) with novel recordings, developed for the minimisation of false-positive errors in unsupervised monitoring of broad-scale population trends.  In Chapter 4, this detector was applied to the short-term 10-12 week monitoring of morepork in treatment and non-treatment areas around three independent aerial 1080 operations; and to longer-term four year monitoring in two study areas, one receiving no 1080 treatment, and one receiving two 1080 treatments throughout monitoring. Morepork showed no significant difference in trends of calling prevalence across the three independent operations monitored. Longer-term, a significant quadratic effect of time since 1080 treatment was found, with calling prevalences predicted to increase for 3.5 years following treatment. Collectively, these results suggest a positive effect of aerial 1080 treatment on morepork populations in the lower North Island, and build on the small amount of existing literature regarding the short- and long-term response of this species to aerial 1080 operations.</p>


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