Analisis Faktor yang Berhubungan dengan Pelaksanaan Manajemen Nyeri Non Farmakologis Oleh Perawat Pelaksana di Irna Non Bedah RSUP Dr M Djamil Padang Tahun 2015

The comfort rate of patients or patients free from pain is one indicator of the quality of health services in inpatient rooms. One of the nurse's efforts to improve the quality rate is non-pharmacological pain management. Non-surgical Irna has a fairly high pain rate, but the number of pain management performed by nurses is still low. The purpose of this study was to analyze the factors associated with the implementation of non-pharmacological pain management by nurses at Irna Non-Surgical. This study uses an analytical design with a Cross Sectional approach. The sample of this study was 89 people who were taken purposively. This research instrument was made by researchers who have been tested for validity and reliability. The results showed that more than half (59.6%) of nurses were not good at implementing non-pharmacological pain management. Based on the Chi-square statistical test, there is a significant relationship between training, knowledge, attitudes and motivation towards the implementation of non-pharmacological pain management with each P-value (0.001; 0.007; 0.001; 0.001). The factor that has the greatest contribution to the implementation of non-pharmacological pain management is training. Therefore, it is expected that service institutions can create sustainable training programs on non-pharmacological pain management.

Acupuncture Combined with Three-Step Analgesic Drug Therapy for Treatment of Cancer Pain: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

Objective. The purpose of this study was to systematically evaluate the efficacy and safety of acupuncture combined with the WHO three-step analgesic drug ladder for cancer pain. Methods. The Cochrane Library, PubMed, and CNKI Database of Systematic Reviews were searched. Using the Cochrane Register for Randomized Controlled Trials, the quality of the included literature was evaluated, and the meta-analysis was carried out with RevMan 5.3 software. Results. Compared with three-step analgesia alone, acupuncture combined with three-step analgesia for cancer pain increased pain relief response rates (RR = 1.12, 95% CI: 1.08∼1.17, P < 0.00001 ), reduced NRS score (SMD = −1.10, 95% CI: −1.86∼−0.35, P = 0.004 ), reduced the rate of side effects (RR = 0.45, 95% CI: 0.38∼0.53, P < 0.00001 ), including nausea ( P < 0.00001 ), vomiting ( P = 0.008 ), constipation ( P < 0.00001 ), and dizziness ( P = 0.010 ), reduced the burst pain rate (SMD = −1.38; 95% CI: −2.44∼−0.32, P = 0.01 ), shortened analgesia effect onset time ( P = 0.004 ), and extended the duration of response ( P < 0.0001 ). Conclusion. For the treatment of cancer pain, acupuncture combined with three-step analgesic drugs is better than using only three-step analgesic drugs.

Emergency Procedure Applied to Tackle the Lack of Sphericity after Cutting the Bone Bed for Cementless Hip Arthroplasty - The Acetabular Screw-Cup System Developed by Aesculap

BACKGROUND The study aimed to analyze the complications following cementless arthroplasty surgery where original sphericity was not obtained and screw-cap system was required. METHOD The study inclusion criteria were met by 39 patients aged 47 - 90 and the mean follow-up period was 54 months. Patients were operated in a lateral position, through the posterolateral or minimal posterior approach.To assess postoperative functionality, Harris Hip Score and Hoos questionnaire were applied. RESULTS According to the Harris Hip Score, 64.3% of the scores were very good and good and the mean score was 96 according to the Hoos questionnaire. The incision type, BMI and the type of cutaneous suture had no impact on the functional outcome, incidence of complications and a pain rate in the groin. Scar esthetics received highest scores from the patients operated through the minimal posterior approach and treated with a running intra-cutaneous suture. Yet a lateral position during the surgery made any intraoperative assessment of the limb length considerably more difficult. Consequently, 30% of the operated patients reported different limb lengths, which significantly (p = 0.036) lowered a functional outcome measured according to the HOOS and Harris Hip Score. The functional outcomes demonstrate a considerably negative correlation with age but not with gender although men are more vulnerable to the postoperative complications (p = 0.18). CONCLUSION Despite a relatively large number of complications following the surgery using a screw-cap system, 75% of the patients declared they would not mind another surgery using such system.

A Comparison of Cylindrical and Tapered Stem Designs in Femoral Revision Hip Arthroplasty

Background Both cylindrical and tapered stems are commonly used in revision total hip arthroplasty, it is unclear whether the geometry of prosthesis stem has an effect on the patient's efficacy and prognosis. we assume the tapered stem is superior to the cylindrical stem for better clinical outcome. Methods A multicenter review of 120 femoral revisions with Paprosky I, II and III defects using cobalt cylindrical stem (54 hips) or titanium tapered stem (66 hips) was performed with an average follow-up of 6 years. Demographic data was comparable between groups. Results There were no significant group differences were found in surgery time, bleeding volume and the postoperative Harris Hip Score, the level of overall satisfaction, 8-year cumulative survival. However, intraoperative fractures in the tapered group (4.5%) occurred significantly less than in the cylindrical group (14.8%), and stem subsidence was significantly less in the tapered group (2.17mm) than in the cylindrical group (4.17 mm). There was a higher ratio of bone repair and lower bone loss in the tapered group compared to the cylindrical group. The postoperative thigh pain rate was higher in the cylindrical group (12.9%) than in the tapered group (4.5%). Conclusion Both cylindrical stem and tapered stem can achieve satisfactory mid-term clinical results in revision THA; The tapered stem has better bone restoration of proximal femur, low incidence of intraoperative fracture, and low postoperative thigh pain rate compared with the cylindrical stem.

A Comparison of Cylindrical and Tapered Stem Designs in Femoral Revision Hip Arthroplasty

Background Both cylindrical and tapered stems are commonly used in revision total hip arthroplasty, it is unclear whether the geometry of prosthesis stem has an effect on the patient's efficacy and prognosis. we assume the tapered stem is superior to the cylindrical stem for better clinical outcome. Methods A multicenter review of 120 femoral revisions with Paprosky I, II and III defects using cylindrical stem (54 hips) or tapered stem (66 hips) was performed with an average follow-up of 6 years. Demographic data was comparable between groups. Results There were no significant group differences were found in surgery time, bleeding volume and the postoperative Harris score, the level of overall satisfaction, 8-year cumulative survival. However, intraoperative fractures in the tapered group (4.5%) occurred significantly less than in the cylindrical group (14.8%), and stem subsidence was significantly less in the tapered group (2.17mm) than in the cylindrical group (4.17 mm). There was a higher ratio of bone repair and lower bone loss in the tapered group compared to the cylindrical group. The postoperative thigh pain rate was higher in the cylindrical group (12.9%) than in the tapered group (4.5%). Conclusion Both cylindrical stem and tapered stem can achieve satisfactory mid-term clinical results in revision THA; The tapered stem has better bone restoration of proximal femur, low incidence of intraoperative fracture, and low postoperative thigh pain rate compared with the cylindrical stem.

Paracetamol (acetaminophen) route in palliative care (PC) patients: Intravenous versus subcutaneous route pharmacokinetics study protocol for a randomized trial = ParaSCIVPallia

Background: Among palliative care (PC) patients who are administered paracetamol, the subcutaneous (SC) route is often an alternative to the intravenous (IV) route. Yet pharmacological and clinical data are lacking. Many French palliative teams are now empirically using paracetamol by the SC route, but there are no data to support this practice.Aim: Compare pharmacokinetic (PK) parameters between the IV and SC routes for PC patients.Design: A randomized, open, crossover study in two PC centers. The primary endpoints are AUC0-t, AUC0-, Cmax, and Vd et t1/2. All adverse events will be reported for a safety analysis.Setting/participants: 20 adult PC patients with an IV device, having spontaneous pain, not related to care, with a numeric pain rate scale > 3/10, or having a systematic prescription of paracetamol in the usual treatment. They also have to meet all eligibility criteria.Conclusion: First study comparing PK parameters for IV paracetamol versus SC paracetamol.Trial registration:Clinical trial register number NCT03944044, 2019-06-04https://clinicaltrials.gov/ct2/show/NCT03944044Committee for the protection of persons (CPP) 18.09.05.58206 approval 2018/10/4National Drug Safety Agency (ANSM: Agence Nationale de Sécurité Médicament) MEDAECNAT-2018-09-00009 approval 2018/11/29

Paracetamol (acetaminophen) route in palliative care (PC) patients: Intravenous versus subcutaneous route pharmacokinetics study protocol for a randomized pilot trial = ParaSCIVPallia

Background :Among palliative care patients, the subcutaneous route is often an alternative to the intravenous route, yet pharmacological and clinical data are lacking. Many French palliative teams are now empirically using paracetamol by the subcutaneous route, but there are no data to support this practice. Aim :Compare pharmacokinetic parameters between the intravenous and subcutaneous routes for PC patients. Design : A randomized, open, crossover study in two palliative care centres. The primary endpoints are AUC0-t, AUC0-∞, Cmax, and Vd et t1/2. All adverse events will be reported for a safety analysis. Setting/participants 20 adult palliative care patients with an IV device, having spontaneous pain, not related to care, with a numeric pain rate scale > 3/10, or having a systematic prescription of paracetamol in the usual treatment. They also have to meet all eligibility criteria. Conclusion : First pilot study comparing paracetamol intravenous versus subcutaneous route pharmacokinetics.

Pengaruh slow deep breathing terhadap nyeri pada pasien post op apendisitis di rsud sleman

Slow Deep Breathing (SDB) is a breathing technique that can be used below 10 times per minute with a long phase of breathing. Objective: Effects of Slow Respiratory In the decrease of pain level in RSUD Sleman Method: Experimental design with pre-post test type without control group design. Samples of 30 respondents with Acidental Sampling Result: There is effect of Slow Deep Breathing on the pain decrease p 0,001@ 0,05 where P <0,05 can be concluded that there is significant difference. Conclusion: Slow Respiratory Exercise Slowly Reduces Pain Rate in Post-Appendicitis Patients at RSUD Sleman

Reemplazo total de cadera con un tallo corto no cementado tipo 2B: resultados a los 2-5 años de seguimiento. [Total hip replacement with a short cementless stem type 2B: Results of 2 to 5 years of follow-up]

Objetivo: Determinar los resultados clínicos, la supervivencia y la incidencia de fractura periprotésica intraoperatoria con un tallo corto tipo 2B de fijación cervicometafisaria.Métodos: Se analizaron prospectivamente los primeros 100 tallos (84 pacientes) MiniHipTM (Corin, Cirencester, Reino Unido) colocados, en forma consecutiva, por un mismo cirujano. La edad promedio fue de 47 años. La indicación para un tallo corto fue: edad <55 años (85 casos) o la participación previa en deportes de impacto en pacientes de entre 56 y 60 años (15 casos). El diagnóstico inicial fue artrosis primaria de cadera en el 82% de los casos. El seguimiento promedio fue de 42 meses. Resultados: El puntaje en la escala de Harris modificada mejoró de 55 a 96 al final del seguimiento (p = 0,02) y ningún paciente refirió dolor de muslo en el posoperatorio. La supervivencia del tallo fue del 99% (IC95% 93,1-99,8). Un caso presentó una perforación de la cortical lateral intraoperatoria, tratado con revisión con un tallo no cementado convencional. Un paciente tuvo una infección aguda, que fue tratada con desbridamiento, retención de componentes y antibióticos, con resultado favorable a los 48 meses de la cirugía. Se produjeron 3 fracturas incompletas del calcar intraoperatorias (3%).Conclusiones: Se obtuvieron resultados excelentes en esta serie de pacientes jóvenes y activos operados por un mismo cirujano con un tallo corto tipo 2B, a los 2-5 años de seguimiento, con un 1% de falla por falsa vía femoral intraoperatoria. AbstractObjectives: We sought to determine our 2 to 5-year survivorship, intraoperative fractures, subsidence and thigh pain rate in a consecutive, independent, one surgeon series of patients in whom a type-2B short stem was implanted.Patients and Methods: The first 100 type 2B consecutive short femoral stems implanted in 84 patients with a mean age of 47 years old were reviewed. Indications included age younger than 55 years (85 hips), or participation in impact sports in patients aging 56 to 60 years old (15 hips). Initial diagnosis was osteoarthritis in 82% of the cases. Median follow-up was 42 months.Results: Stem survival rate was 99% at 2 to 5 years for stem revision for any aseptic reason and 98% when infection was included. The mean Harris Hip Score improved significantly from 55 to 96 at final follow-up (p 0.02). There was one lateral cortex perforation, and three intraoperative calcar incomplete fractures (3%), only one of them required cerclage wiring and delayed weightbearing. No patient referred thigh pain at final follow-up. Only one case subsided 4 mm and then stabilized. The risk of revision was 1% at 2 to-5 years (95%CI 93.1-99.8%).Conclusions: Promising short-term results with this design were observed in this single surgeon, non-designerconsecutive series including the learning curve period using a type 2B short stem in young active patients, in which bone preservation is justified.