Knowledge Of Contraindications Research Articles

Prehospital Use of Ketamine in Mountain Rescue: A Survey of Emergency Physicians of a Single-Center Alpine Helicopter-Based Emergency Service

Although ketamine use in emergency medicine is widespread, studies investigating prehospital use are scarce. Our goal was to assess the self-reported modalities of ketamine use, knowledge of contraindications, and occurrence of adverse events associated with its use by physicians through a prospective online survey. The survey was administered to physicians working for Air-Glaciers, a Swiss alpine helicopter-based emergency service, and was available between September 24 and November 23, 2018. We enrolled 39 participants (participation rate of 87%) in our study and collected data regarding their characteristics, methods of ketamine use, knowledge of contraindications, and encountered side effects linked to the administration of ketamine. We also included a clinical scenario to investigate an analgesic strategy. Ketamine was considered safe and judged irreplaceable by most physicians. The main reason for ketamine use was acute analgesia during painful procedures, such as manipulation of femur fractures. The doses of ketamine administered with or without fentanyl ranged from 0.2 to 0.7 mg·kg-1 intravenously. Most physicians reported using fentanyl and midazolam along with ketamine. The median dose of midazolam was 2 (interquartile range 1-2) mg for a 70-kg adult. Monitoring and oxygen administration were used infrequently. Hallucinations were the most common adverse events. Knowledge of ketamine contraindications was poor. Ketamine use was reported by mountain rescue physicians to be safe and useful for acute analgesia. Most physicians use fentanyl and midazolam along with ketamine. Adverse neuropsychiatric events were rare. Knowledge regarding contraindications to the administration of ketamine should be improved.

Thoracic thrust joint manipulation: An international survey of current practice and knowledge in IFOMPT member countries

BackgroundThe perceived relative safety of thoracic thrust joint manipulation (TTJM) has contributed to a growth in evidence supporting use in practice. Yet adverse events (AE) have been documented following TTJM. Knowledge of current practice is therefore required to support further research. PurposeTo investigate TTJM knowledge and pre-TTJM examination across IFOMPT Member Organisations (MO) and Registered Interest Groups (RIG). MethodsAn e-survey was designed based on existing evidence and piloted. Eligibility criteria: physiotherapists from member countries of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) who use TTJM. Recruitment was through IFOMPT networks (May 2018–March 2019). Data analyses included descriptive analyses and content analysis for free text data. ResultsRespondents (n = 363) from 20 countries. Pre-TTJM examination included patient history (22%, n = 81) and physical examination (69%, n = 248). Across presentations (>80% threshold of agreement) contraindications included osteomyelitis, fracture and metastatic disease. Spinal deformity, respiratory disease, serious joint disease and hypermobility achieved >60% agreement as precautions. Consent was obtained by 93% respondents (n = 250). Preferred technique was PA/AP thrust (61%, n = 144). Perception of primary effect was neurophysiological (52%, n = 134), biomechanical (42%, n = 109) and placebo (3%, n = 8). From those who reported AE (n = 100), these included fractures (36%, n = 42) and cord signs/symptoms (6%, n = 7). ConclusionPre-TTJM examination is common, although bias towards physical examination. Differential testing for upper versus lower thoracic spine is limited. Inconsistencies across knowledge of contraindications and precautions, and beliefs for biomechanical effect were found. Findings highlight the importance of high levels of clinical reasoning during patient history for TTJM.

Znajomość przeciwwskazań do stosowania antykoncepcji hormonalnej wśród studentów Uniwersytetu Medycznego w Lublinie

Znajomość przeciwwskazań do stosowania antykoncepcji hormonalnej wśród studentów Uniwersytetu Medycznego w Lublinie

A questionnaire study to bridge the gap in teaching and prescribing of analgesics by dentists

This study focus on the current trend of prescribing of non-steroidal anti-inflammatory drug at a tertiary care teaching dental hospital in Jaipur. After taking permission from the Institutional Ethical Committee, this questionnaire study was carried out with the final year and intern students at tertiary care centre. Our study revealed paracetamol (41.4%) as the commonly prescribed analgesics followed by ibuprofen (24.5%). More than 60% of the respondents had good knowledge of contraindications to the use of these analgesics. Respondent’s knowledge regarding drug-drug interactions was fair. More than 70% were aware of interactions of diuretics and non-steroidal anti-inflammatory drugs, while about 95% correctly recognized the interaction of these analgesics with corticosteroids. Our study highlights the importance of knowledge of concurrent drug administration by the dentists to prevent adverse drug events.

Malaria Chemoprophylaxis Advice: Survey of South African Community Pharmacists’ Knowledge and Practices

Over 3 million South African residents travel to malarious areas annually. Given pharmacists' ready accessibility and travel clinics' incapacity to service total potential demand, South African community pharmacists' malaria chemoprophylaxis knowledge and practice were assessed. Covert survey. Pharmacies were approached at random and asked for malaria chemoprophylaxis recommendations. A standard questionnaire indicating a 3-day stay in either Maputo (N= 43; malarious) or Harare (N= 25; non-malarious) was used. Maputo group: 41/43 (95%) pharmacists correctly identified need for chemoprophylaxis; 3/41 (7%) recommended an ineffective drug. Eight of 41 (20%) enquired about diving, and 6/41 (15%) enquired about epilepsy or mental illness; despite positive responses mefloquine, was nevertheless recommended. Harare group: 12/25 (48%) incorrectly advised chemoprophylaxis was necessary; 4/12 (33%) sought contraindications; all prophylaxis recommended was considered effective. Overall, 54/68 (79%) pharmacists correctly determined whether chemoprophylaxis was required or not; 6/53 (11%) of all recommended chemoprophylaxis included "alternative" antimalarials; 1/68 (1%) consulted external advice before making recommendations; 11/53 (21%) referred travelers to a physician; 1/68 (1%) referred to a travel clinic. Pharmacies were significantly more likely (Fisher exact, p < 0.0001) to recommend unnecessary prophylaxis (12/25; 48%) than to advise against necessary prophylaxis (2/43; 5%). Pharmacists are willing to give malaria chemoprophylaxis advice but appear to overprescribe; although unnecessary adverse events may result, this may be the preferred error in a falciparum-dominated region. Pharmacists' knowledge of contraindications, willingness to consult external resources, and knowledge of antimalarials' effectiveness could be improved. Pharmacists appear unwilling to refer to travel clinics. An effective intervention to improve the safety and accuracy of pharmacists' advice might be the provision of a simple aid listing effective antimalarials and their contraindications, illustrated with a malaria risk map. Improving the safety and accuracy of pharmacists' advice would increase significantly travelers' access to reliable travel health information.

Physician knowledge of catch-up regimens and contraindications for childhood immunizations.

To determine physician success at designing catch-up regimens for children delayed in immunizations and physician knowledge regarding contraindications to immunization. A self-administered survey was completed by pediatricians, general practitioners, and family practitioners in Cook County, Illinois. Surveys included 6 open-ended vignettes describing hypothetical children delayed in immunization for whom participants were asked to design catch-up regimens. Bivariate and multivariate logistic regression were used to determine predictors of correct response. The surveys also inquired about management of scenarios that might be perceived as contraindications to immunize with the Haemophilus influenzae type b or measles-mumps-rubella vaccines. The mean score of correct responses was 1.83 of a possible 6.0. Almost one third of respondents answered all 6 vignettes incorrectly. The proportion of incorrect responses was high for all 6 vignettes (39%-86%), but higher for questions that addressed the immunization of children older than 12 months. Errors in vaccine administration were most commonly attributed to omitted vaccines, with varicella-zoster vaccine and pneumococcal conjugate vaccine omitted most frequently. Pediatricians were >4 times more likely to answer correctly than were family practitioners. Participants in the Vaccines for Children (VFC) program were more than twice as likely to answer correctly than were non-VFC providers. Knowledge of contraindications was inconsistent, particularly for measles-mumps-rubella vaccine. Childhood vaccine providers have substantial knowledge deficits of recommended immunization schedules and vaccine contraindications that may contribute to missed opportunities to immunize. Pediatricians and participants in the VFC program were more successful at designing catch-up regimens for children with immunization delay.

Measles/mumps/rubella vaccine (MMR): an audit of Leeds health professionals' knowledge of contraindications and intention to vaccinate assessed by postal questionnaire

An audit of Leeds health professionals' knowledge of valid contraindications to measles/mumps/rubella (MMR) vaccine was undertaken by postal questionnaire, three months after its introduction. The health professional groups were health visitors, clinical medical officers, general practice trainers and general practice vocational trainees. The results indicate that some health professionals would give MMR vaccine to children when it was contraindicated (e.g. to a child receiving chemotherapy or radiotherapy). However, a much greater problem was the number of health professionals stating that they would not vaccinate children with MMR vaccine in clinical situations where there were no valid contraindications to its use. Some health professionals were also applying contraindications to the use of pertussis vaccine to the use of MMR vaccine. The information contained in the Joint Committee on Vaccination and Immunisation handbook Immunisation against infectious disease on contraindications to MMR vaccine use is also reviewed. It is important that false contraindications are not used by health professionals to wrongly deny children the protection provided by MMR vaccine.