Editor-We would like to highlight an infrequent but serious adverse effect of tramadol. We report a case of generalized tonic-clonic seizure associated with sympathetic nervous system hyperactivity, which included profuse diaphoresis, tachycardia (HR: 136 beats min 21 ), hypertension (BP: 160/110 mm Hg), and widespread erythema after the administration of tramadol. A healthy 49-yr-old male was admitted to hospital for management of a fractured humerus. The only medication the patient received was morphine 30 mg followed by oral tramadol 100 mg approximately 40 min before the grand mal seizure.Tramadol can precipitate seizures in epileptic patients 1 -3 by lowering the seizure threshold. There have been several case reports of tramadol precipitating a seizure in non-epileptic patients. However, our patient had a more complicated seizure presentation, which included generalized erythema, and profuse sustained diaphoresis. Tramadol increases cerebral serotonin activity by partial inhibition of its uptake, particularly when it is given in combination with other drugs including morphine. This increased serotonin activity can produce serotonin syndrome which is characterized by disorders in cognitive-behavioural, neuromuscular, and autonomic function. 4 5 To qualify for the diagnosis, it has been suggested that a patient should have at least one or two manifestations from each of these functional categories. There is no formal test for the diagnosis of serotonin syndrome. The onset of clinical effects is relatively rapid (minutes to a few hours). Management is discontinuation of the causative agents with supportive treatment and the clinical symptoms and signs usually resolve within 24 h. Hyperthermia should be treated with active cooling. Rigidity, seizures, and agitation should be treated with benzodiazepines. Severe symptoms have been treated successfully with cyproheptadine-a 5-HT2 antagonist.
IntroductionTelepsychiatry (TP) uses communication technology to provide psychiatric consultation to patients unable to reach consultation services. Due to COVID-19 outbreak, many mental health services implemented TP. The University of Milan developed a patient-specialist video consultation service: the Cure Ospedaliere Domiciliari (Home Hospital Care system; COD20).ObjectivesThe aim of the study was to assess the digital skills of the mental health professionals and to assess both the confidence and the satisfaction with the COD20 platform, as well as their skills in handling certain degrees of technostress.MethodsMental health professionals of the outpatient clinics of the department were interviewed through an online anonymous survey. Data collected were sociodemographic, job position, educational level, digital skills, adequacy of devices in the workplace, satisfaction degree, ease of use of the COD20 tool, as well as main technostress score. Data were analyzed using SPSS v.27.ResultsAmong 95 subjects, more than 95% of the sample is familiar with the use of electronic devices, such as smartphones, tablets, and computers; 93% employs appropriate devices in the workplace. Only 12% had an ECDL certificate, while the majority of the sample (77%) learnt the use of electronic devices independently. The levels of the digital skills were considered intermediate-advanced for communication and information research. Despite all the respondents being aware of the use of COD20, only 50% received adequate training; 77% deemed it worthwhile to attend an individual or a group training (40% vs 43%). Telemedicine was used for clinical interviews by 80% of the sample: 41% of these used Telemedicine at least 10 times/year, 18% between 10 and 20 times/year, and 42% more than 20 times/year. With regard to the appreciation of the COD20 platform, 75% of the sample considered this tool useful, while 61% considered it easy to use. There is a significant correlation between the ease of use and a higher level of education (p<0,00). Among all categories, psychologists were more likely to use the platform compared to other workers ( p=0,016). The average score of technostress among operators was 22.78±6.84 (maximum score: 45).Image:Image 2:ConclusionsTP can improve mental health professionals’ working conditions. The COD20 platform represents a valid implementation in mental health care. It is necessary to provide training and updated programs for healthcare workers in order to facilitate the use of TP tools.Disclosure of InterestNone Declared
The evolution of care delivery from an acute care and inpatient standard to the outpatient setting and health promotion model is generating the need for innovative workforce and infrastructure adjustments to meet the new paradigm of population health management. Successful transformation of the nursing workforce necessitates a positive style of thinking that addresses rational concerns during times of difficult transition. Nurse leaders are called to recognize and appreciate the strengths of the nursing workforce by involving them in the course of change through collaboration, planning, and discussion. One unique way to plan and develop new care delivery models is to adopt the framework used in health facility planning and design for new services, units, or hospitals. This framework is flexible and can be adjusted easily to meet the objectives of a small nursing workforce innovation project or expanded to encompass the needs of a large-scale hospital transformation. Structured questioning further helps the team to identify barriers to care and allows for the development of new concepts that are objective and in accord with evidence-based practice and data. This article explores the advantages and disadvantages of implementing innovative workforce redesign and workforce reduction strategies.
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