The impact of chest pain center on treatment delay of STEMI patients: a time series study

Objective To study the effect of the establishment of a Chest Pain Center (CPC) on the treatment delay of ST-elevation myocardial infarction (STEMI) patients and the influencing factors of treatment delay in a large hospital in China. Methods The study subjects are 318 STEMI patients admitted between August 2016 and July 2019 to a large general hospital in Henan, China. Data were extracted from the electronic medical records after removing personal identifiable information. The interrupted time series regression was used to analyze the treatment delay of patients before and after the CPC establishment. Results After the CPC establishment, the patients’ pre-hospital and in-hospital treatment delays were significantly reduced. SO-to-FMC (Symptom Onset to First Medical Contact time) decreased by 49.237 min and D-to-B (Door to Balloon time) decreased by 21.931 min immediately after the CPC establishment. In addition, SO-to-FMC delay is significantly correlated with age, occupation, nocturnal onset, and the way to hospital. D-to-B delay is significantly associated with time from initial diagnosis to informed consent of percutaneous coronary intervention (PCI), catheterization lab activation time, and time for PCI informed consent. Conclusion The CPC significantly reduced the treatment delay of STEMI patients undergoing PCI.

Cancer, cancer pain and the ‘Cancer Pain Initiative’

The number of cancer patients has been steadily increasing and with it the number of cancer related pain patients is also increasing. Cancer pain (CP) is the most unique and versatile pain, regarding type, intensity, site, variations and the needed management modalities. No one pain specialist or the pain center can be capable of adequately manage every cancer patient. In this background, an idea to confront this menace at a national level with a combined effort is presented. If implemented it is hoped that the CP patients will get rid of at least the worry about their excruciating pain. The idea of the ‘Cancer Pain Initiative’ has been in circulation for quite some time, but needs to be discussed at various levels. Key words: Cancer; Cancer pain; Pain management Citation: Khan TH. Cancer, cancer pain and the ‘Cancer Pain Initiative’. Anaesth. pain intensive care 2021;25(2):126–12. DOI: 10.35975/apic.v25i2.1482

Integrating a Clinical Pharmacist into a Multidisciplinary Pain Center: Feedback and Perspectives

Background:In January 2017, two clinical pharmacists joined our institution’s multidisciplinary pain center care team. They help optimize management of chronic pain patients. The purpose of this study is to present and discuss an innovative model of clinical pharmacy development in France.Method:A retrospective study for the period January 1, 2017 to June 30, 2019 was conducted.The care team evaluated the clinical pharmacy service using a satisfaction questionnaire.The outcome measures were the type of activities, number of interventions and healthcare team satisfaction.Results:During this period, the clinical pharmacists intervened 1839 times. Conventional clinical pharmacy activities do not represent the majority of solicitations, which shows the advantage of both adapting the activities deployed to the expectations of care teams and expanding care packages to those needs.Pharmaceutical advice was the main activity, mostly given to physicians (55%) and patients (35%).They consisted in contributing to the choice of drug strategy, explaining the treatment, adjusting a dosage, and improving relations between hospital and community caregivers.The feedback forms showed that caregivers believe that clinical pharmacy has positive impacts on patient care and healthcare team quality of life. Conclusion:The numerous requests for clinical pharmacist interventions show the care team’s significant interest in this new activity. Clinical pharmacy has shown its added value in patient quality of care and helps optimize the patient's care pathway by decompartmentalizing hospital and community medicine.This clinical pharmacy development model is innovative in France, as pharmacists are full members of the care team. Specific activities were set up progressively according to the care team’s needs. Caregivers’ expectations and requests made in clinical pharmacy progressed over time to more specialized activities. Assessment of team satisfaction showed that this model was very well accepted by caregivers and highlights the relevance of adapting and specializing clinical pharmacy development to the care team’s needs.

5G-Enabled intelligent construction of a chest pain center with up-conversion lateral flow immunoassay

Acute myocardial infarction (AMI) has become a worldwide health problem because of its rapid onset and high mortality.

Does the presence of cranial contrast spread during a sacroiliac joint injection predict short-term outcome?

BackgroundThe innervation of the sacroiliac joint (SIJ) is complex, with a dual innervation originating from the lumbosacral plexus anteriorly as well as the sacral lateral branches posteriorly. Nociceptors are found in intra-articular structures as well as periarticular structures. In patients with SIJ pain, a fluoroscopy-guided SIJ injection is usually performed posteriorly into the bottom one-third of the joint with local anesthetic and corticosteroids, but this does not always reach all intra-articular structures. The correlation between a cranial contrast spread and clinical success is undetermined in patients with SIJ pain.MethodsIn a tertiary referral pain center, electronic medical records of patients who underwent an SIJ injection were retrospectively analyzed. Only patients with at least three positive provocation maneuvers for SIJ pain were selected. Contrast images of the SIJ were classified as with or without cranial spread on fluoroscopy as a marker of intra-articular injection. Clinical success was defined as ≥50% improvement in the patient’s global perceived effect after 3–4 weeks. The primary outcome was defined as the correlation between cranial contrast spread and clinical success after an SIJ injection.Results128 patients in total were included. In 68 patients (53.1%) fluoroscopy showed cranial contrast spread. Clinical success was higher in patients with cranial spread of contrast (55 of 68, 81%) versus those without (35 of 60, 58%) (p=0.0067). In a multivariable analysis with age, gender, presence of rheumatoid arthritis, side, and number of positive provocation maneuvers, the cranial spread of contrast remained the only independent factor of clinical success (p=0.006; OR 3.2, 95% CI 1.4 to 7.7).ConclusionIn patients with SIJ pain, identified by positive pain provocation maneuvers, cranial contrast spread as a marker of intra-articular injection, with subsequent injection of 3 mL of local anesthetic and methylprednisolone 40 mg, was significantly correlated with clinical success up to 4 weeks. Therefore, attempts should be made to reach this final needle position before injecting local anesthetic and corticosteroids. This result needs to be confirmed in a high-quality prospective trial.

WeChat Group of Chest Pain Center for Patients with Acute ST-segment Elevation Myocardial Infarction: Faster Treatment Speed and Better Prognosis

Objective: To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).Methods: The chest pain center, established by the creation of a WeChat group, included primary hospitals in Chongqing that are not able to perform PPCI and the First Affiliated Hospital of Chongqing Medical University, which is the core of the center and which includes medical staff of the catheter laboratory, the cardiology department, the emergency, the vascular surgery department, and the cardiothoracic surgery department. Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affiliated Hospital of Chongqing Medical University were enrolled. The patients (including emergency department visitors, 120 callers, and patients transferred from the critical care unit or other departments) were divided into a WeChat pre-admission startup group (n=311) and a non-WeChat pre-admission startup group (control group, n=172). Patients’ door-to-balloon time, standard door-to-balloon time achievement rate, artery puncture to balloon dilation time, heart failure rate, length of stay, and incidence of adverse events (including fatal arrhythmia, cardiogenic shock, and death) during hospitalization were compared between the two groups.Results: Four hundred eight-three consecutive patients were enrolled. There was no significant difference in patients’ sex, age, length of stay, and cardiovascular events during hospitalization between the two groups (P>0.05). The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group (27.35±10.58 min vs. 88.15±53.79 min, P<0.05). The standard door-to-balloon time achievement rate was significantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group (100% vs. 72.09%, P<0.05).Conclusion: The application of a WeChat platform significantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI. In addition, the platform is also conducive to integrating medical resources and sharing medical information. The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.