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Biomedical subjects

G Carrougher

Publications and source records attributed to G Carrougher.

7 recordsLinked to original sources
PubMed2000

Project Hope: changing care delivery for the substance abuse patient.

Project Hope is a program designed to assist healthcare providers in the assessment, care, referral, and follow-up of the hospitalized substance abuse patient. First implemented in 1990 at what is now called University Hospital in San Antonio, Texas, the program has influenced care in a positive way through change in the attitude and knowledge of personnel, administrators, and community. In this paper, the authors provide an overview of the approaches utilized, improvement process, and outcomes obtained from this project. To formally evaluate the effectiveness of Project Hope, a quasi-experimental, Solomon-Four design study was conducted. Eighty nurses from various educational backgrounds and experience with alcohol were divided into groups by nursing unit. A normative-reeducative intervention was applied as described by Chin and Benne. Test of cognition showed significant change (p < .01) in the experimental group; no significance was found for attitudes change. Reasons for these findings and lessons learned from the process are described.

Attitude of Health Personnel↗
PubMed1998

Hypnosis after an adverse response to opioids in an ICU burn patient.

OBJECTIVE: Burn injuries produce severe wound care pain that is ideally controlled on intensive burn care units with high-dosage intravenous opioid medications. We report a case illustrating the use of hypnosis for pain management when one opioid medication was ineffective. SETTING: Intensive burn care unit at a regional trauma center. PATIENT: A 55-year-old man with an extensive burn suffered from significant respiratory depression from a low dosage of opioid during wound care and also experienced uncontrolled pain. INTERVENTION: Rapid induction hypnotic analgesia. OUTCOME MEASURES: Verbal numeric pain scale, and pain and anxiolytic medication usage. RESULTS: The introduction of hypnosis, supplemented by little or no opioids, resulted in excellent pain control, absence of need for supplemental anxiolytic medication, shortened length of wound care, and a positive staff response over a 14-day period. CONCLUSIONS: This case illustrates that hypnosis can not only be used easily and quite appropriately in a busy medical intensive care unit environment, but that sometimes this treatment may be a very useful alternative when opioid pain medication proves to be dangerous and ineffective. This case also illustrates possible clinical implications both pain relief and side-effect profiles for opioid receptor specificity. Although this report does not provide data regarding hypnotic mechanisms, it is clear that with some patients nonopioid inhibitory mechanisms can be activated in a highly effective manner, that clinical context may be important for the activation of those pathways, and that those mechanisms may be accessed more easily than opioid mechanisms.

Analgesics↗
PubMed1994

Insulin-like growth factor-1 lowers protein oxidation in patients with thermal injury.

OBJECTIVE: The effect of insulin-like growth factor-1 (IGF-1) on energy expenditure and protein and glucose metabolism in a group of patients with thermal injury was determined. SUMMARY BACKGROUND DATA: Accelerated protein catabolism is a constant feature of the hypermetabolic response to thermal injury. Insulin-like growth factor-1 has been reported to minimize protein catabolism and normalize energy expenditure in animal models of thermal injury. METHODS: To determine the efficacy of IGF-1 in human burn patients, resting energy expenditure (metabolic cart), whole body protein kinetics (N15 Lysine), and glucose disposal (glucose tolerance test) were assessed in eight burn patients before and after a 3-day infusion of IGF-1 (20 micrograms/kg/hr). All patients were fluid-resuscitated uneventfully and were without obvious infection at the time of study. Enteral nutrition was administered at a constant rate before and during the IGF-1 infusion. RESULTS: Resting energy expenditure was not altered by IGF-1 (40.3 +/- 2.2 vs. 39.1 +/- 2.3 kcal/kg/day). However, glucose uptake was promoted, and protein oxidation decreased significantly (0.118 +/- 0.029 vs. 0.087 +/- 0.021 g/kg/d, p < 0.05) by IGF-1. In addition, insulin secretion, in response to a glucose challenge, was blunted. CONCLUSIONS: Insulin-like growth factor-1 therapy has a beneficial effect in preserving lean body mass during severe stress conditions by minimizing the flux of amino acids toward oxidation.

Adult↗
PubMedDate not supplied

Burn nursing Delphi study: pain management.

In 1989 a Delphi study was undertaken to identify the nursing priorities in burn research. The Delphi technique is a series of questionnaires used to reach consensus. Ninety-four nurses involved in burn care completed four rounds of questionnaires containing 101 research questions. This, the seventh and final report, concerns a significant area of burn research, which is pain management. Eleven (10%) of the 101 questions dealt with pain, whereas five were rated among the top 20 priority questions. As a category the questions concerning pain management had a mean score of 5.91 on a 0 to 7 Likert scale. The questions collectively were cited as having the most impact on the welfare of the patient with burns.

Analgesics↗
PubMedDate not supplied

The 2002 Lindberg Award. PRN vs regularly scheduled opioid analgesics in pediatric burn patients.

Very little has been published on treating acute pain in children younger than the age of 3 for burns or any other trauma etiology. This study prospectively monitored the pain behavior and opioid analgesic intake of 31 pediatric burn patients (mean age = 23.71 months; SD = 15.75). Twelve of those children were randomized to conditions in which they either received opioid analgesics pro re nata (ie, as needed, pain contingent) or on a regular basis. The two groups did not show differences in demonstrable pain but, interestingly, they received equivalent does of opioid analgesics. As such, the pro re nata group was likely medicated largely on a regularly scheduled basis. For most of the remaining (nonrandomized) subjects, physicians ordered regularly scheduled opioid analgesics, suggesting that this practice has become largely institutionalized in the study setting. Information on pediatric opioid analgesic dosing and pain measurement strategies for nonverbal subjects can be derived from the findings.

Acute Disease↗