Assessment of potential opioid toxicity and response to naloxone by rapid response teams at an urban Melbourne hospital.

Opioid prescriptions have significantly increased in recent years and are used for a wide variety of indications. Electronic medical records of 45 patients who received naloxone by a rapid response team over an 18-month period were retrospectively reviewed. This study found inconsistencies in the management of possible opioid toxicity with variation in the total naloxone dose and number of doses administered. This highlights the importance of a standardised protocol for recognition and management of opioid overdose.

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

INTRODUCTION: Our objective was to determine whether unilateral calculus-induced ureteric obstruction on computed tomography (CT) was independently associated with the need for urological intervention and 30-day return to the emergency department (ED). METHODS: We performed a retrospective cohort study of patients with symptomatic urinary calculi diagnosed by unenhanced helical CT. Stepwise regression analysis was used to determine the predictors of urological intervention and 30-day return to the ED. Potential predictors assessed included: patient demographics, calculus size, calculus location, degree of obstruction, analgesic doses, signs and symptoms of infection, serum creatinine, cumulative intravenous fluid administered, and the prescription of medical expulsive therapy. RESULTS: Of 195 patients, 81 (41.5%) underwent urological intervention. The size of the calculus, its location, and the cumulative opioid dose were all independent predictors for urological intervention. Every 1 mm increase in calculus size increased the likelihood of intervention 2.2 times (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.67-2.85). Proximal stones were 4.7 times more likely to require intervention than distal calculi (OR 0.21; 95% CI 0.09-0.49). Every 10 mg increase in morphine was associated with a 30% increase in the odds of intervention (OR 1.30; 95% CI 1.07-1.58). Degree of obstruction was not associated with the need for urological intervention. Finally, none of the variables were predictors for 30-day return to the ED. CONCLUSIONS: Although stone size, proximal location, and severe pain, as indicated by higher opioid doses, were associated with the need for intervention, the degree of obstruction did not influence the management of patients with CT-defined urinary calculi.

Effects of infant and maternal sensory processing on infant fussing, crying, and sleep.

This study investigated the effects of infant and maternal sensory processing on sleep, fussing, and crying in a sample of 55 firstborn, 4- to 7-month-old infants and their mothers. Mothers completed self-report questionnaires to assess maternal and infant sensory processing styles and a 4-day diary of infant behavior, including sleep, fussing, and crying. Higher levels of infant Sensation Avoiding were associated with less sleep, more fussing, and more crying whereas higher levels of Sensory Sensitivity were associated with less sleep and more fussing. The positive association between infant Sensation Avoiding and crying was strengthened by lower levels of Low Registration in mothers. The effect of infant Sensory Sensitivity on reducing total sleep also was strengthened by lower levels of maternal Low Registration. Assessment of infant sensory processing as well as the moderating effect of maternal sensory processing on the relationship between infant sensory processing and infant regulatory capacities need to be considered when assessing and designing interventions for families in which infant regulation is problematic.