British journal of nursing (Mark Allen Publishing)
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Pain following craniotomy is common, however, achieving effective analgesia can be difficult. The assessment of pain postoperatively can be a challenge in patients who are obtunded (not fully alert) and the severity of pain has historically been underestimated. There are also concerns about side-effects from drugs, particularly with opioids, which may lead to reluctance to administer effective doses. ⋯ Opioids are effective but side effects of pupillary constriction and respiratory depression may be problematic in the neurosurgical patient. The total use of systemic analgesia can be minimised with the use of regional techniques, such as local anaesthetic nerve blocks. A multimodal technique, using different agents, is most likely to be effective.
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The latest statistics for the number of new cases of Ebola virus disease (EVD) in West Africa point to the near containment of the virus. While the current threat will not be deemed over until 42 days after the last case to be diagnosed has twice tested negative, there is now a shift in focus from an emphasis on containment to that of policy review and capacity building in light of lessons learned. This article primarily focuses on Sierra Leone. It revisits the issues surrounding the epidemic, seeking to summarise both the negative and positive aspects of the response at local and global levels, as well as highlights fresh perspectives from healthcare workers in the field for the management of similar epidemics.