OBJECTIVE. The objectives of this study were to review the use of oral sucrose for procedural pain management in NICUs, develop potentially better practice guidelines that are based on the best current evidence, and provide ideas for the implementation of these potentially better practices.
METHODS.A collaboration of 12 centers of the Vermont Oxford Network worked together to review the strength of the evidence, clinical indications, dosage, administration, and contraindications and identify potential adverse effects for the use of sucrose analgesia as the basis of potentially better practices for sucrose analgesia guidelines. Several units implemented the guidelines.RESULTS. Through reviews and inputs from all centers of the evidence, consensus was reached and guidelines that included indication, dosage per painful procedure, age-related dosage over 24 hours, method of delivery, and contraindications were developed.CONCLUSIONS. Guidelines now are available from a consensus group, and suggestions for implementation of guidelines, based on implementation of other pain management strategies, were developed.www.pediatrics.org/cgi
The authors, who are members of the Dalhousie Academic Detailing Service and the Palliative and Therapeutic Harmonization program, recommend that antihypertensive treatment be less intense in elderly patients who are frail. This paper reviews their recommendations and the evidence behind them.
OBJECTIVE. Collaborative quality improvement techniques were used to facilitate local quality improvement in the management of pain in infants. Several case studies are presented to highlight this process.METHODS. Twelve NICUs in the Neonatal Intensive Care Quality Improvement Collaborative 2002 focused on improving neonatal pain management and sedation practices. These centers developed and implemented evidence-based potentially better practices for pain management and sedation in neonates. The group introduced changes through plan-do-study-act cycles and tracked performance measures throughout the process.RESULTS. Strategies for implementing potentially better practices varied between centers on the basis of local characteristics. Individual centers identified barriers to implementation, developed tools for improvement, and shared their experience with the collaborative. Baseline data from the 12 sites revealed substantial opportunities for improved pain management, and local potentially better practice implementation resulted in measurable improvements in pain management at participating centers.CONCLUSIONS. The use of collaborative quality improvement techniques enhanced local quality improvement efforts and resulted in effective implementation of potentially better practices at participating centers.www.pediatrics.org/cgi
The use of ephedrine for medicinal purposes dates back over 5000 years, when native Chinese physicians Ma Huang in the late 1800s, but was considered too toxic for clinical use; it was rediscovered by Chen & Schmidt (1930), who demonstrated its sympatho mimetic action and introduced it into Western medicine, where it was found to be a big improvement on adrenaline in the treatment of asthma. That the structure of ephedrine is very similar to that of amphetamine is not a coincidence, since Alles (1933) synthesised the latter as a synthetic substitute for ephedrine.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.