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Sarridou DG, Mouratoglou SA, Mitchell JB, Cox F, Boutou A, Braoudaki M, Lambrou GI, Konstantinidou M, Argiriadou H, Walker CPR. Post-Operative Thoracic Epidural Analgesia and Incidence of Major Complications according to Specific Safety Standardized Documentation: A Large Retrospective Dual Center Experience. J Pers Med 2023; 13:1672. [PMID: 38138898 PMCID: PMC10744802 DOI: 10.3390/jpm13121672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Thoracic epidural analgesia is considered the gold standard in post-operative pain management following thoracic surgery. This study was designed to explore the safety of thoracic epidural analgesia and to quantify the incidence of its post-operative complications and side effects in patients undergoing thoracotomy for major surgery, such as resection of lung malignancies and lung transplantation. (2) Methods: This is a retrospective, dual-center observational study including patients that underwent major thoracic surgery including lung transplantation and received concurrent placement of thoracic epidural catheters for post-operative analgesia. An electronic system of referral and documentation of complications was used, and information was retrieved from our electronic critical care charting system. (3) Results: In total, 1145 patients were included in the study. None of the patients suffered any major complication, including hematoma, abscess, or permanent nerve damage. (4) Conclusions: the present study showed that in experienced centers, post-operative epidural analgesia in patients with thoracotomy is a safe technique, manifesting minimal, none-serious complications.
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Affiliation(s)
- Despoina G. Sarridou
- Department of Anesthesia and Intensive Care, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.A.M.); (H.A.)
- Department of Anesthesia and Intensive Care, The Royal Brompton and Harefield Hospital NHS, Middlesex, London UB9 6JH, UK; (J.B.M.); (F.C.)
| | - Sophia Anastasia Mouratoglou
- Department of Anesthesia and Intensive Care, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.A.M.); (H.A.)
| | - Jeremy B. Mitchell
- Department of Anesthesia and Intensive Care, The Royal Brompton and Harefield Hospital NHS, Middlesex, London UB9 6JH, UK; (J.B.M.); (F.C.)
| | - Felicia Cox
- Department of Anesthesia and Intensive Care, The Royal Brompton and Harefield Hospital NHS, Middlesex, London UB9 6JH, UK; (J.B.M.); (F.C.)
| | - Afroditi Boutou
- Respiratory Medicine Department, Hippokration Hospital, 54942 Thessaloniki, Greece;
| | - Maria Braoudaki
- Department of Clinical, Pharmaceutical and Biological Science, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK;
| | - George I. Lambrou
- Choremeio Research Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Maria Konstantinidou
- Department of Respiratory Medicine, G. Papanikolaou General Hospital, 57010 Thessaloniki, Greece;
| | - Helena Argiriadou
- Department of Anesthesia and Intensive Care, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.A.M.); (H.A.)
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Cox F, Knaggs R. All Change at the BJP. Br J Pain 2023; 17:116. [PMID: 37057250 PMCID: PMC10088423 DOI: 10.1177/20494637231167722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
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Sarridou DG, Boutou AK, Konstantinidou M, Cox F, Argiriadou H, Walker CP. Chronic pain treatment with pregabalin in end stage respiratory failure patients awaiting lung transplantation on ambulatory veno-venous extra corporeal membrane oxygenator support; a series of nine cases. Hippokratia 2023; 27:22-24. [PMID: 38533227 PMCID: PMC10908312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Background End-stage respiratory failure is non-treatable with mechanical ventilation and can be treated with veno-venous extracorporeal membrane oxygenators (VV-ECMO). It can also be used as a bridge to lung transplantation or recovery of lung function. This patient group can suffer from chronic pain, which is further exacerbated by painful procedures required as part of treatment. Pregabalin is licensed for chronic neuropathic pain and generalized anxiety disorder. Thus far, it has not been tried in routine analgesia protocols for pain relief of patients on VV-ECMO. Case Series We included nine patients aged 17-54 years on VV-ECMO awaiting lung transplantation. Exclusion criteria were acute kidney injury and chronic kidney disease. All patients had morphine patient-control analgesia. In addition, pregabalin 50 mg twice daily was initiated in all patients with dose escalation as required. Pain scores and quality of sleep were evaluated daily. All patients experienced significant pain relief, demonstrated by reduced pain scores after treatment commencement. The mean visual analogue scale score was reduced significantly from 6 ± 2 to 3 ± 1. A significant increase in good-quality sleep duration was recorded from 5 ± 1.7 hours per day before to 8 ± 2.1 hours per day after pregabalin treatment. All patients except for two reported reduced anxiety levels of at least 2 ± 1 scale improvement (p <0.05). Conclusions Pregabalin is an efficient analgesic with accompanying anxiolytic effects in this group of patients with unique characteristics such as high analgesia requirements and exacerbated psychological and emotional stress. HIPPOKRATIA 2023, 27 (1):22-24.
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Affiliation(s)
- D G Sarridou
- Department of Anaesthesia and Intensive Care, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A K Boutou
- Department of Respiratory Medicine, Hippokratio General Hospital, Thessaloniki, Greece
| | - M Konstantinidou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - F Cox
- Department of Anaesthesia, Intensive Care and Pain, The Royal Brompton NHS Foundation Trust, London, UK
| | - H Argiriadou
- Department of Anaesthesia and Intensive Care, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C P Walker
- Department of Anaesthesia, Intensive Care and Pain, The Royal Brompton NHS Foundation Trust, London, UK
- Institute of Critical Care and Anaesthesia, Cleveland Clinic London, London, UK
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Mittal TK, Evans E, Pottle A, Lambropoulos C, Morris C, Surawy C, Chuter A, Cox F, de Silva R, Mason M, Banya W, Thakrar D, Tyrer P. Mindfulness-based intervention in patients with persistent pain in chest (MIPIC) of non-cardiac cause: a feasibility randomised control study. Open Heart 2022; 9:openhrt-2022-001970. [PMID: 35545356 PMCID: PMC9096570 DOI: 10.1136/openhrt-2022-001970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/21/2022] [Indexed: 12/02/2022] Open
Abstract
Objective The study evaluated the feasibility of mindfulness-based cognitive therapy (MBCT) in patients with non-cardiac chest pain by assessing their willingness to participate and adhere to the programme, and for these data to help further refine the content of MBCT for chest pain. Patients and methods This prospective 2:1 randomised controlled trial compared the intervention of adapted MBCT as an addition to usual care with just usual care in controls. Among 573 patients who attended the rapid access chest pain clinic over the previous 12 months and were not diagnosed with a cardiac cause but had persistent chest pain were invited. The intervention was a 2-hour, weekly, online guided 8-week MBCT course. Compliance with attendance and the home practice was recorded. Enrolled patients completed the Seattle angina questionnaire (SAQ), Hospital Anxiety and Depression Scale, Cardiac Anxiety Questionnaire, Five-Facet Mindfulness Questionnaire, and Euro Quality of Life–5 Dimensions–5 Level at baseline assessment and after 8-week period. Results Persistent chest pain was reported by 114 patients. Of these, 33 (29%) patients with a mean age of 54.2 (±12.2) years and 68% women, consented to the study. Baseline questionnaires revealed mild physical limitation (mean SAQ, 76.8±25), high levels of anxiety (76%) and depression (53%), modest cardiac anxiety (CAQ,1.78±0.61) and mindfulness score (FFMQ, 45.5±7.3). Six patients subsequently withdrew due to bereavement, caring responsibilities and ill health. Of the remaining 27 participants, 18 in the intervention arm attended an average of 5 sessions with 61% attending ≥6 sessions. Although not statistically powered, the study revealed a significant reduction in general anxiety, improved mindfulness and a trend towards improvement in SAQ scores in the intervention arm. Conclusion One-third of patients with persistent non-cardiac chest pain were willing to participate in mindfulness-based therapy. An improvement in anxiety and mindfulness was detected in this feasibility study. A larger trial is required to demonstrate improvement in chest pain symptoms.
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Affiliation(s)
- Tarun Kumar Mittal
- Heart Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK .,Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Emma Evans
- Oxford Psychological Medicine Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alison Pottle
- Heart Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Christina Surawy
- Oxford Mindfulness Centre, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Antony Chuter
- Heart Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Felicia Cox
- Heart Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ranil de Silva
- Heart Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Mark Mason
- Heart Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Winston Banya
- Department of Medical Statistics, Research & Development, Royal Brompton and Harefield Hospitals, London, UK
| | | | - Peter Tyrer
- Centre of Psychiatry, Imperial College London, London, UK
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Abstract
Pain is a distressing, subjective and complex phenomenon that all nurses will encounter in their clinical practice. Effective pain management requires nurses to undertake a structured assessment to identify the probable causes of pain and guide management. Interventions used to reduce pain can be varied and multimodal. This article provides an overview of pain including its definition, classifications, assessment and management. It emphasises the importance of a person-centred approach to care which reflects Margo McCaffery's seminal quote that pain is 'whatever the experiencing person says it is'.
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Affiliation(s)
- Felicia Cox
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, England
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Kerr C, Dunne J, Hughes G, Cox F, Healy M, Holmes P, O'Rourke F, O'Brien C, Coyne D, Crowley V, Crowley B, Conlon N, Bergin C. A Comparison of the Performance of SARS-CoV-2 Antibody Assays in Healthcare Workers with COVID-19. Ir Med J 2021; 114:414. [PMID: 34520649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Aims Since its emergence, significant interest surrounds the use of SARS-CoV-2 serological tests as an alternative or as an adjunct to molecular testing. However, given the speed of this pandemic, paralleled with the pressure to develop and provide serological tests in an expediated manner, not every assay has undergone the rigorous evaluation that is usually associated with medical diagnostic assays. We aimed to examine the performance of several commercially available SARS-CoV-2 IgG antibody assays among participants with confirmed COVID-19 disease and negative controls. Methods Serum taken between day 17 and day 40 post onset of symptoms from 41 healthcare workers with RT-PCR confirmed COVID-19 disease, and pre-pandemic serum from 20 negative controls, were tested for the presence of SARS-CoV-2 IgG using 7 different assays including point-of-care (POC) and laboratory-based assays. Results Assay performance varied. The lab-based Abbott diagnostics SARS-CoV-2 IgG assay proved to be the assay with the best positive and negative predictive value, and overall accuracy. The POC Nal von Minden GmbH and Biozek assays also performed well. Conclusion Our research demonstrates the variations in performance of several commercially available SARS-CoV-2 antibody assays. These findings identify the limitations of some serological tests for SARS-CoV-2. This information will help inform test selection and may have particular relevance to providers operating beyond accredited laboratories.
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Affiliation(s)
- C Kerr
- Genitourinary Medicine and Infectious Diseases Department (GUIDe), St. James's Hospital, Dublin
- Department of Medicine, School of Medicine, Trinity College Dublin, Dublin
| | - J Dunne
- Department of Immunology, St. James's Hospital, Dublin
| | - G Hughes
- Genitourinary Medicine and Infectious Diseases Department (GUIDe), St. James's Hospital, Dublin
- Department of Medicine, School of Medicine, Trinity College Dublin, Dublin
| | - F Cox
- Department of Immunology, St. James's Hospital, Dublin
| | - M Healy
- Department of Biochemistry, St. James's Hospital, Dublin
| | - P Holmes
- Department of Biochemistry, St. James's Hospital, Dublin
| | - F O'Rourke
- Department of Microbiology, St. James's Hospital, Dublin
| | - C O'Brien
- Department of Immunology, St. James's Hospital, Dublin
| | - D Coyne
- Department of Virology, National Blood Centre, St James's Hospital, Dublin
| | - V Crowley
- Department of Biochemistry, St. James's Hospital, Dublin
| | - B Crowley
- Department of Microbiology, St. James's Hospital, Dublin
| | - N Conlon
- Department of Immunology, St. James's Hospital, Dublin
| | - C Bergin
- Genitourinary Medicine and Infectious Diseases Department (GUIDe), St. James's Hospital, Dublin
- Department of Medicine, School of Medicine, Trinity College Dublin, Dublin
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Cox F. That was the year that was. Br J Pain 2021; 15:4. [PMID: 33633848 PMCID: PMC7882777 DOI: 10.1177/2049463721991944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cox F. Noise and light are the primary drivers for disrupting sleep in adults in intensive care. Evid Based Nurs 2020; 24:121. [PMID: 32855175 DOI: 10.1136/ebnurs-2020-103327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/03/2022]
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Cox F. Patient-reported improvement in pain with pregabalin for painful diabetic neuropathy and postherpetic neuralgia is promising but needs further investigation. Evid Based Nurs 2020; 23:17. [PMID: 31092541 DOI: 10.1136/ebnurs-2019-103091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Felicia Cox
- Pain Management Service, Royal Brompton & Harefield NHS Foundation Trust, London, UK
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Affiliation(s)
- Felicia Cox
- Pain Management Service, Royal Brompton & Harefield NHS Foundation Trust, Harefield, UK
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Cox F. Marvellous metrics. Br J Pain 2018; 12:200. [DOI: 10.1177/2049463718801695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Schmitt F, Aurlien H, Brøgger J, Hirsch L, Schomer D, Trinka E, Pressler R, Wennberg R, Visser G, Eisermann M, Diehl B, Lesser R, Kaplan P, The Tich S, Lee J, Martins-da-Silva A, Stefan H, Neufeld M, Rubboli G, Fabricius M, Gardella E, Terney D, Meritam P, Eichele T, Asano E, Cox F, van Emde Boas W, Mameniskiene R, Marusic P, Zárubová J, Rosén I, Fuglsang-Frederiksen A, Ikeda A, MacDonald D, Terada K, Ugawa Y, Zhou D, Herman S, Beniczky S. Standardisierter Computer-basiert-organisierter Report des EEG (SCORE) – Eine strukturierende Form der EEG-Befundung. KLIN NEUROPHYSIOL 2018. [DOI: 10.1055/s-0043-125304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ZusammenfassungEine 2013 von der „International Federation of Clinical Neurophysiology“ gegründete Taskforce hat eine international konsensfähige EEG-Terminologie entwickelt. Im Folgenden soll das Resultat – die 2. Version des Standardized Computer-based Organized Reporting of EEG (SCORE) - vorgestellt werden. Die Terminologie wurde im Rahmen eines Softwarepaketes (SCORE-EEG) in der klinischen Praxis an über 12.000 EEGs getestet. Die Auswahl der Begriffe ist kontextabhängig: die initiale Auswahl bestimmt, welche weiteren Auswahlmöglichkeiten zur Verfügung stehen. Im Verlauf wird automatisch ein Befund erstellt und dessen Einzelmerkmale in eine Datenbank eingespeist. SCORE verfügt über Module spezifisch für die Befundung epileptischer Anfälle, sowie charakteristischer neonataler und intensivmedizinische EEG-Merkmale. SCORE ist nicht nur ein nützliches Werkzeug im ambulanten, klinischen und wissenschaftlichen Setting, es erleichtert auch Qualitätssicherung, Datenaustausch und die EEG-Aus und Weiterbildung.
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Affiliation(s)
- F Schmitt
- Universitätsklinik für Neurologie, Otto-von-Guericke Universität, Magdeburg, Deutschland
| | - H Aurlien
- Department of Neurology, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norwegen
| | - J Brøgger
- Department of Neurology, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norwegen
| | - L Hirsch
- Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, CT, USA
| | - D Schomer
- Department of Neurology, Laboratory of Clinical Neurophysiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - E Trinka
- Universitätskliniklinik für Neurologie, Christian Doppler Klinik, Paracelsus Medizinische Universität und Zentrum für Kognitive Neurowissenschaften Salzburg, Österreich und Institut für Public Health, Versorgungsforschung & HTA, UMIT, Hall in Tirol, Österreich
| | - R Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital und Clinical Neuroscience, UCL Great Ormond Street Institute of Child Health, London, Großbritannien
| | - R Wennberg
- Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Kanada
| | - G Visser
- Department of Clinical Neurophysiology, Stichting Epilepsie Instellingen Nederland (SEIN), Niederlande
| | - M Eisermann
- Department of Clinical Neurophysiology, Necker Enfants Malades Hospital, Paris, Frankreich und INSERM U1129, Paris, France, Paris Descartes University, CEA, Gif sur Yvette, Paris, Frankreich
| | - B Diehl
- University College London, Department of Clinical and Experimental Epilepsy, Queen Square, London, Großbritannien
| | - R Lesser
- Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - P Kaplan
- Johns Hopkins University School of Medicine, Baltimore, Maryland, MD, USA
| | - S The Tich
- Department of Pediatric Neurology, University Hospital of Lille, Lille, Frankreich
| | - J Lee
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - A Martins-da-Silva
- Department of Neurophysiology, Hospital Santo António and UMIB/ICBAS – University of Porto, Porto, Portugal
| | - H Stefan
- Abteilung für Neurologie und Biomagnetismus, Universitätsklinikum Erlangen, Deutschland
| | - M Neufeld
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - G Rubboli
- Department of Neurology, Danish Epilepsy Center, Dianalund and University of Copenhagen, Kopenhagen, Dänemark
| | - M Fabricius
- Department of Clinical Neurophysiology, Rigshospitalet, Kopenhagen, Dänemark
| | - E Gardella
- University of Southern Denmark, Odense, Dänemark
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Dänemark
| | - D Terney
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Dänemark
| | - P Meritam
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Dänemark
| | - T Eichele
- Department of Neurology, Haukeland University Hospital and Department of Biological and Medical Psychology, University of Bergen, Norwegen
| | - E Asano
- Departments of Pediatrics and Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan, US
| | - F Cox
- Department of Clinical Neurophysiology, Stichting Epilepsie Instellingen Nederland (SEIN), Niederlande
| | - W van Emde Boas
- Department of Clinical Neurophysiology, Stichting Epilepsie Instellingen Nederland (SEIN), Niederlande
| | - R Mameniskiene
- Department of Neurology and Neurosurgery, Center for Neurology, Vilnius University, Vilnius, Litauen
| | - P Marusic
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Tschechische Republik
| | - J Zárubová
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Tschechische Republik
| | - I Rosén
- Department of Clinical Sciences, University of Lund, Lund, Schweden
| | | | - A Ikeda
- Department of Epilepsy, Movement Disorders and Physiology Kyoto University Graduate School of Medicine Shogoin, Sakyo-ku Kyoto, Japan
| | - D MacDonald
- Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabien
| | - K Terada
- Department of Neurology, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Y Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - D Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - S Herman
- Department of Neurology, Laboratory of Clinical Neurophysiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - S Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Dänemark
- Department of Clinical Neurophysiology, Aarhus University, Aarhus, Dänemark
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Abstract
Effective management of acute and chronic pain is an important aspect of nursing practice. Relieving patients' pain requires nurses to have an understanding of the latest evidence-based approaches, which will enable them to assess pain, implement appropriate management strategies and monitor their effectiveness. This article outlines the developments in evidence-based guidelines and recommendations for the pharmacological management of acute and chronic pain, including migraine, and in the use of analgesics such as opioids. It also discusses pain management in specific groups such as children and young people, and older people.
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Affiliation(s)
- Felicia Cox
- Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, Middlesex, England
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Abstract
Managing patients with dependence requires knowledge of pharmacology; an understanding of the diagnosis of dependence and recognition of withdrawal; skills in communication and collaborative working; and a nonjudgmental, empathic attitude.
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Affiliation(s)
| | - Felicia Cox
- Pain Management Service, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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Affiliation(s)
- A V Jugrin
- IMS Health RWE Solutions and HEOR, Vilvoorde, Belgium
| | - Y Sun
- UCB Pharma, Brussels, Belgium
| | - F Cox
- UCB Pharma, Smyrna, GA, USA
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Abstract
Methanobrevibacter sp. AbM4 was originally isolated from the abomasal contents of a sheep and was chosen as a representative of the Methanobrevibacter wolinii clade for genome sequencing. The AbM4 genome is smaller than that of the rumen methanogen M. ruminantium M1 (2.0 Mb versus 2.93 Mb), encodes fewer open reading frames (ORFs) (1,671 versus 2,217) and has a lower G+C percentage (29% versus 33%). Overall, the composition of the AbM4 genome is very similar to that of M1 suggesting that the methanogenesis pathway and central metabolism of these strains are highly similar, and both organisms are likely to be amenable to inhibition by small molecule inhibitors and vaccine-based methane mitigation technologies targeting these conserved features. The main differences compared to M1 are that AbM4 has a complete coenzyme M biosynthesis pathway and does not contain a prophage or non-ribosomal peptide synthase genes. However, AbM4 has a large CRISPR region and several type I and type II restriction-modification system components. Unusually, DNA-directed RNA polymerase B' and B'' subunits of AbM4 are joined, a feature only previously observed in some thermophilic archaea. AbM4 has a much reduced complement of genes encoding adhesin-like proteins which suggests it occupies a ruminal niche different from that of M1.
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Affiliation(s)
- S C Leahy
- New Zealand Agricultural Greenhouse Gas Research Centre ; Rumen Microbiology, Animal Nutrition and Health, AgResearch Limited, Grasslands Research Centre, New Zealand
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Doyle P, Cox F, Tollyfield R, Seraj A. Let's go round again! Quality improvement through intentional rounding. Crit Care 2013. [PMCID: PMC3643168 DOI: 10.1186/cc12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- P Doyle
- Harefield Hospital, Harefield, UK
| | - F Cox
- Harefield Hospital, Harefield, UK
| | | | - A Seraj
- Harefield Hospital, Harefield, UK
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Cox F. Plus ça change. J Perioper Pract 2011; 21:291. [PMID: 22474770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Cox F. Rules are not made to be broken. J Perioper Pract 2011; 21:152. [PMID: 21834284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Felicia Cox
- Pain Services, Royal Brompton & Harefield NHS Foundation Trust
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Abstract
This article, the first in a series written by pain nurse specialists, provides an overview of the nature, causes and structured management of acute, chronic and neuropathic pain. The differences between nociceptive and neuropathic pain, and treatment options are identified. The pain management service's roles are described in the context that a person's experience of pain is the result of biological, psychological and social factors. Future articles will explore the physiology and pharmacology of pain, how patients express pain and interventions for acute and chronic pain. They will also provide guidance on managing pain in challenging circumstances.
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Affiliation(s)
- Felicia Cox
- Royal Brompton and Harefield NHS Foundation Trust, London.
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Cox F. Veterinary surgeons receive more pain relief education than nurses. Nurs Times 2010; 106:8. [PMID: 21180334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
This two-part article, the fourth in a series on pain, explores the four main divisions of pharmacology: pharmacodynamics--what the medicine does to the body; pharmacokinetics--what the body does to the medicine; pharmacoeconomics--the cost and benefit ratio compared to other treatments; and pharmacovigilance--a medicine's safety profile. Part two, which will published next week, will explore the main categories of analgesic medicines.
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Affiliation(s)
- F Cox
- Royal Brompton and Harefield NHS Trust, London.
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41
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Cox F. An overview of pharmacology and acute pain: part two. Nurs Stand 2010; 25:35-39. [PMID: 21133016 DOI: 10.7748/ns2010.10.25.5.35.c8022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This article explores the role of medicines in the management of acute pain. The main categories of analgesic drugs are outlined and the different routes of administration are explored. The characteristics and precautions associated with the different classes of medicines are also highlighted.
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Affiliation(s)
- F Cox
- Royal Brompton and Harefield NHS Trust, London.
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Affiliation(s)
- Felicia Cox
- Royal Brompton and Harefield NHS Foundation Trust, London.
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Cox F. Dancing with the white rabbit. J Perioper Pract 2010; 20:272. [PMID: 20860185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Felicia Cox
- Royal Brompton & Harefield NHS Foundation Trust
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Cox F, Bhudia N. Anaesthetic medicines: back to basics. J Perioper Pract 2009; 19:387-394. [PMID: 20041626 DOI: 10.1177/175045890901901103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Anaesthesia has developed since the first description of curare. Today there are a myriad of anaesthetic and analgesic medicines available. This article explores the function of medicines in a patient's perioperative journey and describes how pharmacokinetics and pharmacodynamics play such a large role. The different routes of administration are described and the main categories of anaesthetic medicines outlined. The characteristics and precautions associated with the different classes of medicines are highlighted.
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Affiliation(s)
- Felicia Cox
- Royal Brompton & Harefield NHS Foundation Trust, Department of Pain Management, Harefield Hospital, Middlesex UB9 6JH
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Cox F. Boogie woogie bugle boy. J Perioper Pract 2009; 19:369. [PMID: 20041620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Cox F. Reubenesque (sic)--pain's Mr Big. J Perioper Pract 2009; 19:269. [PMID: 19842514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Cox F. Elementary my dear Watson. J Perioper Pract 2009; 19:233. [PMID: 19753885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Cox F. Five mile high club. J Perioper Pract 2009; 19:197. [PMID: 19743673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Cox F. What a difference a drain makes. J Perioper Pract 2009; 19:157. [PMID: 19591318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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