Pain relief for the removal of femoral sheath in interventional cardiology adult patients (Review)

Pain relief for removal of femoral sheath after cardiac procedures
Procedures for the non-surgical management of coronary heart disease include balloon angioplasty and intracoronary stenting. At the start of each procedure an introducer sheath is inserted through the skin (percutaneously) into an artery, frequently a femoral artery in the groin. This allows the different catheters used for the procedure to be exchanged easily without causing trauma to the skin. At the end of the procedure the sheath is removed and, if the puncture site isn't "sealed" using a device closure, firm pressure is required over the site for 30 minutes or more to control any bleeding and reduce vascular complications. Removing the sheath and the firm pressure required to control bleeding can cause pain, although this is generally mild. Some centres routinely give pain relief before removal such as intravenous morphine, or an injection of a local anaesthetic in the soft tissue around the sheath (called a subcutaneous injection). Adequate pain control during sheath removal is also associated with a reduced incidence of a vasovagal reaction, a potentially serious complication involving a sudden drop of blood pressure and a slowed heart rate. Four studies were reviewed in total. Three trials involving 498 participants compared subcutaneous lignocaine, a short acting local anaesthetic, with a control group (participants received either no pain relief or an inactive substance known as a placebo). Two trials involving 399 people compared intravenous opioids (fentanyl or morphine) and an anxiolytic (midazolam) with a control group. One trial involving 60 people compared subcutaneous levobupivacaine, a long acting local anaesthetic, with a control group. Intravenous pain regimens and subcutaneous levobupivacaine appear to reduce the pain experienced during femoral sheath removal. However, the size of the reduction was small. A significant reduction in pain was not experienced by participants who received subcutaneous lignocaine or who were in the control group. There was insufficient data to determine a correlation between pain relief administration and either adverse events or complications. Some patients may benefit from routine pain relief using levobupivacaine or intravenous pain regimens. Identifying who may potentially benefit from pain relief requires clinical judgement and consideration of patient preference. The mild level of pain generally experienced during this procedure should not influence the decision as some people can experience moderate levels of pain.

Aid, debt relief and new sources of finance for meeting the millennium development goals

This article focuses on aid, debt relief and new sources of finance for meeting the Millennium Development Goals (MDGs). It was said that MDGs provide a clear set of objectives for mobilizing the international development community, especially in the area of development finance. The call for increased aid as well as for more debt relief in the creation of new sources of development finance has increased since the United Nations Financing for Development Summit and the subsequent report of the panel chaired by then President Ernesto Zedillo of Mexico on development finance. The goal of reducing the proportion of people living in extreme poverty by 2015 cannot be achieved in Sub-Saharan Africa (SSA). Such optimistic forecast suggests that MDG income poverty target will not be achieved in SSA until 2147.

Law, Theology, and Morality: Conceptions of the Rights to Relief of the Poor in the Twelfth and Thirteenth Centuries

This article presents an analysis of certain ways of thinking about law and its relationship to the poor, in particular the rights and entitlements of the poor to the basic necessities of life and the obligations of society to provide those necessities. It focuses on the works of Peter the Chanter and his “circle” at Paris in the late twelfth and early thirteenth centuries. Significant in their writings on the quandary between respect for private property and the need to allow those in need to take a share of this private property in order to survive is their negotiation of the intellectual boundaries and understandings between law, theology, and morality. In addition, an understanding of their discussions in light of canonistic and theological works of the time reveal a hitherto under-appreciated contribution to the “subjective rights” language in Peter the Chanter.

Insights into casual relief teaching: casual relief teachers’ perceptions of their knowledge and skills

Research into the experiences of casual relief teachers (CRTs)(substitute or supply teachers) across Australia and internationallyhas reported feelings of marginalisation among participants. Thesefindings are concerning when one considers that students mightbe in the care of CRTs for an equivalent of 1 year or morethroughout their schooling. When CRTs describe such feelingsthere is a suggestion that they do not feel a part of the communityof practice in which they work. Accordingly, their opportunities forprofessional learning are often compromised, which has implicationsfor their ability to maintain pedagogical knowledge andskills. This study used cluster sampling survey data to offer insightsinto professional challenges faced by CRTs. The discussion examinesthe self-determined skills of 59 Australian CRTs and the wayschooling is organised that may leave them feeling excludedrather than members of what should be their “communities ofpractice.”

Aid in post-conflict states: The relief-development relationship.

This thesis explores how aid can be most effectively implemented in the post-conflict transition from emergency to development assistance, across three sectors: water, sanitation and hygiene (WASH), health, and nutrition and food security. Perceptions of transition are examined and recommendations are made for aid implementation in the field.