[Nursing pain experts in German hospitals : A compilation of activity profiles and tasks]

BACKGROUND

In recent years nurses have come to play a professional role in pain management. In Germany, the publication of the national expert standards on pain management in nursing resulted in nurses being educated to be pain resource nurses; however, since education has started the continuance and commitments of specialized pain nurses in clinical practice is basically unclear. The goal of this evaluation was to identify how pain resource nurses are involved in pain management and organizational aspects in German hospitals.

METHOD

Online survey of 374 directors of nursing services of different types of hospitals on the assignment of nursing pain experts.

RESULTS

Pain resource nurses are involved in pain management in 70.6% of the hospitals responding to the questionnaire. Their task profile depends on the hospital size and 42.2% of the hospitals have documented task profiles. Pain resource nurses are primarily involved in invasive pain management processes (37.1%) and in the management of pain in patients with complex pain problems after surgery (33.2%). Educative tasks are training of colleagues and implementation and conversion of the national expert standards. Of the hospitals 36.1% implemented the national expert standards for acute pain and 57% of the medium-sized hospitals have at least also implemented the national expert standards for chronic pain.

DISCUSSION

The study shows a first insight into the task profiles of pain resource nurses. The implementation of this special qualification is meaningful and seems to be well-recognized in the hospitals. The tasks of patient care are orientated to the spectrum of patients treated in the hospital. The tasks of education also show the importance for the education of colleagues.

Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data

BACKGROUND

Approximately 30-80% of postoperative patients complain about moderate to severe post-surgical pain, indicating that postoperative pain treatment is still a problem.

METHODS

We analysed prospectively collected data on patients in a university hospital receiving systemic and epidural patient-controlled analgesia and continuous peripheral nerve block (CPNB) documented by the acute pain service team in a computer-based system.

RESULTS

Of 18 925 patients visited in the postoperative period between 1998 and 2006, 14 223 patients received patient-controlled epidural analgesia (PCEA), 1591 i.v. patient-controlled analgesia (IV-PCA), 1737 continuous brachial plexus block, and 1374 continuous femoral/sciatic nerve block. Mean dynamic and resting pain scores (VAS 0-100) were significantly lower for peripheral or neuroaxial regional analgesia compared with patient-controlled systemic opioid analgesia (P<0.05). The risk of a symptomatic spinal mass lesion including epidural haematoma (0.02%; 1:4741) or epidural abscess (0.014%; 1:7142) after PCEA was 1:2857 (0.04%). Neurological complications after CPNB occurred in two patients who received interscalene brachial plexus block.

CONCLUSIONS

We demonstrated that PCEA, IV-PCA, and CPNB are safe and efficient. Although all of these treatment strategies provide effective analgesia, PCEA and CPNB provided superior pain relief compared with IV-PCA. We demonstrated that serious complications of analgesic techniques are rare but possibly disastrous necessitating a close supervision by an acute pain service. We found a low rate of adverse effects including hypotension and motor impairment and a low incidence of epidural haematoma for thoracic PCEA compared with lumbar PCEA.

[15 new serotypes of Salmonella of subgenus I isolated in Africa]

Filteen new serotypes of Salmonella belonging to the sub-genus I have been isolated in Africa. Isolated in Ivory Coast: S. dabou (8,20:Z4,Z23,l,W), S. elokate (9,12:c:1,7), S. assinie (3,10:1,w:Z5), S. anna (13,23:Z35:e,n,Z16), S. mpouto (16:m,t:-), S. banco (28:r:1,7), S. abidjan (38:b:l,w); in Senegal: S. bignona (17:b:e,n,Z15), S. lode (17:r:1,2), S. derkle (52,e,h:1,7); in Tchad: S. moussoro (1,6,14,25:i:e,n,Z15), S. drogana (1,4,12,27:r,i:e,n,Z15); in Algeria: S. hydra (21:c:1,6); in Haute-Volta S. farakan (28:Z10:1,5); in Republique Centrafricaine: S. babili (28:Z35:1,7).

[Sensibility study to antibiotics of Neisseria gonorrhoeae by serotype]

A study to 100 N. gonorrhoeae strains demonstrated a sensitivity to antibiotics similar to that observed in 1973. On the other hand, an antibiogram for each of the 5 serotypes showed the peculiar sensitivity of the D serotype to penicillin in vitro.