Articles: patients.
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Violence in the emergency department, a not uncommon but complex phenomenon, may become more serious when patients possess weapons. Searches are used frequently to reduce this danger, though guidelines for searches are not well delineated. We examined our practices in order to formalize our guidelines. ⋯ Although various factors contributed to a clear bias toward searching psychiatric patients, we believe that the rate of weapons possession did not support this bias.
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The purpose of this study was to identify which variables are the best predictors of a do-not-resuscitate (DNR) classification and develop a model to predict the nursing care required by DNR patients in the ICU. Data collected on DNR and non-DNR patients included nursing care requirements, severity of illness, resource allocation and sociodemographic characteristics. One model identified the best predictors of a DNR classification in intensive care as the origin of admission and the severity of illness score on the day of admission to intensive care. The second model identified the best predictors of nursing care requirements for DNR patients in intensive care as the number of days spent in intensive care prior to the DNR order, the average daily resource allocation points after the DNR order, and the severity of illness score on the day the DNR order was designated.
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Thirty patients who had undergone elective anterolateral thoracotomy were studied in the surgical intensive care unit to compare the analgesic effectiveness of i.v. self-administered buprenorphine (group A) with that of epidural administration (group B) and of s.c. administration by a nurse of 0.3 mg buprenorphine every 3-4 h (group C, controls). Every 2 h the patients were asked to record their subjektive pain level as a percentage on an analogue scale: zero was to be used for no pain and 100% for the most severe pain they could imagine. the mean of all analogue scores for pain in the first 36 h was 19.4+/-3.1 for group A; 18.4+/-2.3 for group B and 42.0+/-7.4 for group C (P<0.025). When the mean scores were referred to time, it seemed that groups A and B suffered a little more pain immediately after the operation; however, after 4 h the mean scores for these groups were far lower than that for the control group. ⋯ Nurses should be instructed to provide analgesic medication on demand. Epidural administration of buprenorphine is superior to self-administration in terms of the amount of drugs used and the dosing intervals. In the quality of analgesia epidural administration and self-administration are equal and superior to the control procedure.
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Despite all of the progress that has been made in diagnostic procedures and the increasing number of treatment facilities available the number of people suffering from chronic pain conditions seems to be growing constantly in all industrialized countries, a fact which is demonstrated impressively by the epidemiology of low back pain. "Chronic" means "life-determining"-chronic pain, as all chronic illnesses represent a turning point in the life situation of the people concerned. They not only affect the patients, but also the members of their immediate social environment. Chronic pain becomes a destructive stigma when society reduces the afflicted persons to the status of the chronically ill. ⋯ The introduction of the concept of the "healthy pain patient" has the goal of raising the competence of the individual and his/her social environment to improve the quality of life in spite of chronic pain. The educational aim is to enable patients with pain to be autonomous and to maximize their potential health. The therapeutic approach is demonstrated by individual case histories.
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In this study carried out in a sample of 80 patients suffering from rheumatoid arthritis (RA) tried an attempt was made to answer the following questions: 1. are there pain factors with a wider range that are more generally applicable than those covered by current German questionnaires? 2. To what extent can somatic parameters predict pain factors? 3. To what extent can a patient's pain behavior (a patient's activity scores) predict pain factors? The study was based on data collected by means of the Pain Experience Questionnaire (PEQ), the McGill Pain Questionnaire MPQ, the West Haven-Yale Multidimensional Pain Inventory WHYMPI, the Measurement Of Patient Outcome Scale MOPO, as well as six different clinical parameters. ⋯ At a statistically significant level, the first factor can be predicted by the clinical variables. Regression of the activity scores on the factor "socio-emotional consequences" suggests a close correlation between the two variables, although the results failed to reach statistical significance. On the whole, the results strongly support the notion of integrating clinical, behavioral and cognitive findings in the diagnostic assessment of chronic rheumatoid pain patients.