OBJECTIVE: To compare the efficacy of periprostatic nerve block (PPNB) alone versus periprostatic nerve block plus oral Tramadol+Paracetamol Tablet for pain control during and after transrectal ultrasound-guided (TRUS) biopsy of the prostate gland. METHODS: This was a double-blind, placebo-controlled randomized clinical trial. The authors randomized 40 male patients each to either PPNB or PPNB plus oral tramadol and paracetamol (37.5mg/325mg) an hour prior to prostate biopsy. A ten-point visual analog scale was used to measure pain intensity and was recorded upon insertion of the ultrasound probe, during the biopsy, and one hour after the procedure. RESULTS: The two groups were similar in terms of baseline characteristics. Reductions in pain scores were statistically significantly different (p<.001) for each group when comparing pain from at point of insertion of the probe versus during biopsy and versus one-hour post-operatively. However, when comparing the two groups, the pain scores were not statistically significantly different upon insertion of the probe (p=.68), during the biopsy (p=.26) and one-hour post-operatively (p=.54). CONCLUSION Tramadol and paracetamol combination in addition to periprostatic nerve block produces pain relief similar to standard periprostatic nerve block alone.
Male ; Prostate ; Nerve Block ; Biopsy ; Ultrasonography

BACKGROUND AND OBJECTIVES

Heart Failure (HF) remains a major health concern worldwide. In the Philippine General Hospital (PGH), HF is consistently a top cause of mortality and readmissions among adults. The American College of Cardiology (ACC) and European Society of Cardiology (ESC) published guidelines for interventions that improve quality of life and survival, but they are underused and untested for local acceptability. Hospitals overseas used order sets created from these guidelines, which resulted in a considerable decrease in in-hospital mortality and healthcare costs. We aimed to develop an order set for adult patients with acute heart failure (AHF) admitted to the PGH Emergency Department (ED) to improve care outcomes.

METHODS

This study utilized a mixed methods approach to create the AHF order set. ESC and ACC HF guidelines were appraised using the AGREE II tool. Class I interventions for AHF were included in the initial order set. Through focused group discussions (FGD), clinicians and other care team members involved in the management of AHF patients at PGH ED modified and validated the order set. Stakeholders were asked to use online Delphi and FGD to get a consensus on how to amend, approve, and carry out the order given.

RESULTS

Upon review of HF guidelines, 29 recommendations on patient monitoring, initial diagnostic, and therapeutic interventions were adopted in the order set. Orders on subspecialty referrals and ED disposition were introduced. The AHF patient was operationally defined in the setting of PGH ED. The clinical orders fit the PGH context, ensuring evidence-based, cost-effective, and accessible care responsiveness to patients’ needs and suitable for local practice. Workflow changes due to COVID-19 were considered. Potential barriers to implementation were identified and addressed. The final order set was adopted for implementation through stakeholder consensus.

CONCLUSION

The PGH developed and adopted its own AHF order set that is locally applicable and can potentially optimize outcomes of care.

Human ; Quality Of Life ; Critical Pathways ; Quality Improvement