Biomedical subjects

L Power

Publications and source records attributed to L Power.

At least 19 recordsLinked to original sources

PubMed2006

Dose response to intrathecal diamorphine for elective caesarean section and compliance with a national audit standard.

BACKGROUND: This double-blind randomised controlled trial investigated the most appropriate dose of intrathecal diamorphine to use with high-dose diclofenac as part of a multimodal analgesic regimen for caesarean section under subarachnoid block. We also wished to establish whether it was possible to satisfy the Royal College of Anaesthetists postoperative pain audit recommendation for this patient group. METHODS: One hundred and twenty patients presenting for elective caesarean section under subarachnoid block were recruited and divided into four groups. Treatment was standard except that patients were given either placebo or one of three different doses of intrathecal diamorphine (100 microg, 200 microg or 300 microg). All patients were given regular paracetamol, high-dose diclofenac and an hourly subcutaneous diamorphine regimen for breakthrough pain. RESULTS: There was a dose-dependent improvement in analgesia with intrathecal diamorphine. Only 37.9% of patients given 300 microg of intrathecal diamorphine had a visual analogue pain score of 3/10 or less throughout the study. There was a dose-dependent increase in the incidence of itching with intrathecal diamorphine although the incidence of nausea and vomiting was similar between groups. CONCLUSIONS: We found that for elective caesarean section under subarachnoid block with high dose diclofenac, analgesia was optimal with 300 microg of intrathecal diamorphine. Even the highest dose of intrathecal diamorphine did not achieve the Royal College of Anaesthetists postoperative audit target that 90% of patients should have a pain score of no more than 3/10. We believe that this target is too arduous.

Analgesics, Opioid↗

PubMed2005

Preoperative anxiety and postoperative satisfaction in women undergoing elective caesarean section.

BACKGROUND: The primary aim was to investigate whether preoperative anxiety in women undergoing elective caesarean section predicts postoperative maternal satisfaction with the process, perceptions of recovery, analgesic use or length of hospital stay. Other factors that might influence postoperative satisfaction were also explored. METHOD: In 85 women awaiting elective caesarean section, anxiety, social support and aspects of preparation were measured in the 24 hours preceding surgery. Maternal satisfaction and perceptions of recovery were assessed around the third postoperative day. Satisfaction with the preoperative information from the anaesthetist and postoperative pain relief were also measured at this time. Medical notes were used to gather information on analgesia use and length of hospital stay. RESULTS: Preoperative anxiety scores were comparable with those of general surgical/medical patients. Preoperative trait anxiety and state anxiety were inversely associated with postoperative maternal satisfaction. State anxiety was also inversely associated with better recovery. Preoperative anxiety was not associated with analgesic use or length of hospital stay. Linear regression analysis indicated the degree of satisfaction with information from the anaesthetist and perceived emotional support from the partner explained 52% of the variance in postoperative maternal satisfaction. CONCLUSION: Lower preoperative anxiety is associated with greater maternal satisfaction with elective caesarean section and better recovery. Information provided by anaesthetists and perceived emotional support are also of importance. It may be possible to identify women with high anxiety and facilitate satisfaction and recovery through providing additional supportive input.

Adult↗

PubMed2004

Need for coronary artery bypass grafting in Newfoundland and Labrador: the impact of increased demand.

BACKGROUND: In the past decade, growth of coronary revascularization in Canada has been substantial. It was hypothesized that as coronary angiography (CA) rates increased, referral for necessary coronary artery bypass grafting (CABG) would also increase, and include patients with multivessel disease and class I to III angina who required elective surgery. Furthermore, it was proposed that the number of CABG surgeries needed would increase at a similar rate to that of CA. METHODS: An incident cohort of patients who received CA in 1998/1999 was identified, and the group referred for CABG was followed. Clinical characteristics, appropriateness and necessity scores using specific criteria, and waiting times were evaluated and compared with a similar cohort from 1994/1995. Utilization data for coronary revascularization procedures from 1994 to 2002 were reviewed. RESULTS: Between 1994/1995 and 1998/1999, the number of CAs per year increased by 37%. The inappropriateness rate for CA was 4% in 1998/1999. The proportion of patients diagnosed with critical coronary artery disease increased from 68% in 1994/1995 to 74% in 1998/1999. The number referred for CABG increased by 48%, and the number for percutaneous transluminal coronary angioplasty (PTCA) increased by 137%. The increase in the number referred for CABG was attributable to the increase in the number of patients with less severe symptoms who required delayed elective CABG. The necessity rate for CABG in the referred group was 94% in 1994/1995 and 95% in 1998/1999. A further 91 patients were identified who needed CABG but did not receive it, 86% of whom had PTCA. From 1999 to 2002, the annual growth rate in those referred for CABG was higher than the growth rate for CA. CONCLUSIONS: With the growth in CA, the rate of discovery of high risk coronary anatomy actually increased. Growth in CABG volume was attributable to growth in the need for elective surgery in patients with class I to III angina. The rate of CABG increased disproportionately to the rate of CA, despite higher rates of PTCA with stenting. It is likely that the demand for CABG will continue to rise steadily, as expansion of angiography occurs, and may be higher than expected from the growth in CA.

Adult↗

PubMed2003

Effect of previous antimicrobial treatment on fecal shedding of Salmonella enterica subsp. enterica serogroup B in New York dairy herds with recent clinical salmonellosis.

The association of herd- and sample-level factors with the isolation of Salmonella group B from cattle fecal samples was analyzed. Study farms were 65 dairy herds with a recent history of laboratory-confirmed clinical salmonella infections. Herds were visited once per month for three months to collect data and samples for bacteriological culture. Herd size varied widely from 34 to 3700 total cattle on the farm (median=370). Salmonella serogroup B was isolated from 270 of 2726 samples tested. The predominant serotypes identified were S. Typhimurium and S. Typhimurium var. Copenhagen. Logistic regression was used to analyze the relationship between potential risk factors and isolating Salmonella serogroup B. The only herd-level factor which was significantly associated with fecal shedding was total herd size (hundreds of cattle OR=1.09; 95% confidence interval (CI): 1.05, 1.14). The probability of a positive sample decreased substantially for longer intervals between the initial clinical case and sampling (interval in months OR=0.5; 95% CI: 0.3, 0.6). The presence of diarrhea increased the risk of shedding (OR=2.1; 95% CI: 1.4, 3.0). The effect of recent treatment with antimicrobial agents depended on age group. For heifers and cows, recent antimicrobial treatment increased the probability of isolating Salmonella (heifers OR=11.8; 95% CI: 2.9, 48.8; cows OR=4.1; 95% CI: 2.0, 8.4), but this effect was not statistically significant for calves before weaning. Among animals without recent antimicrobial treatment, preweaned calves were more likely to have positive samples than cows (OR=3.5; 95% CI: 1.8, 6.9; heifers OR=4.7; 95% CI: 2.3, 9.6).

Animals↗

PubMed1999