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Ingelson B, Dahlke S, O'Rourke H, Hunter KF. Nurses' knowledge and beliefs on pain management practices with hospitalised persons living with dementia: A qualitative descriptive study. J Clin Nurs 2024. [PMID: 38590077 DOI: 10.1111/jocn.17164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/10/2024]
Abstract
AIM To understand nurses' knowledge, beliefs and experiences affect pain management practices in hospitalised persons living with dementia (PLWD). DESIGN Naturalistic inquiry using qualitative descriptive design. METHODS Semi-structured interviews were conducted with 12 registered nurses who worked in one acute care hospital in Southern California from October to November 2022. Data were analysed using content analysis to identify themes. RESULTS Two themes were developed: improvising pain assessment, which included how pain was documented, and administration hesitancy referring to nurse's concerns about PLWD's confusion. Nurses described the challenges of assessing pain in hospitalised PLWD particularly if they were non-verbal and/or demonstrating responsive behaviours. Nurse's years of experience, dementia stigma, and their unconscious biases affected nurses' pain management practices. CONCLUSIONS The study findings highlight the complex challenges of pain management in hospitalised PLWD that are exacerbated by nurses' knowledge deficits, negative stereotypical beliefs, dementia stigma and unconscious biases towards older people that contributes to undermanaged pain in hospitalised PLWD. IMPLICATIONS A comprehensive strategy using an implementation framework is needed to address nurse's knowledge gaps, unconscious bias, dementia stigma and techniques that enhance communication skills is suggested. Building a foundation in these areas would improve pain management in hospitalised PLWD. IMPACT Improving pain management in hospitalised PLWD would improve the quality of life, decrease hospital length of stay, prevent readmissions, and improve nurse satisfaction. REPORTING METHOD The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT CONTRIBUTIONS Improving pain management in hospitalised PLWD would prevent long term confusion, episodes of delirium and improve quality of life as they recover from their acute illness for which they required hospital care.
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Affiliation(s)
- Beverly Ingelson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah O'Rourke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Dornellas AP, Marques JV, Aníbal Oliveira dos Santos I, Ramos M, Mulder J, Haddad AE. A novel questionnaire to perform teletriage of dental emergencies in children: A before-and-after study nested within a randomized clinical trial. F1000Res 2023; 12:1610. [PMID: 38840981 PMCID: PMC11150902 DOI: 10.12688/f1000research.126388.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 06/07/2024] Open
Abstract
Background: This will be a before-and-after study nested within a randomized clinical trial. Its objective will be to analyze the effectiveness of a teleconsultation and validate a questionnaire for performing teletriage in dental urgency/emergency situations in children aged 3 to 13, whose parents will have signed a free and informed consent form, and who have had full access to the internet. Methods: The Questionnaire for Teletriage of Emergencies and Urgencies in Pediatric Dentistry (QuesT-Odontoped)-will be validated by applying it to 140 randomized child parents/guardians. After validation, another 260 children seeking emergency dental care in the municipality of Carangola, Minas Gerais, Brazil, will receive a remote consultation, be randomized, and then allocated into two groups: G1, teleconsultation, and G2, teleconsultation and face-to-face consultation (immediately after the former) with a blinded evaluator, involving anamnesis and conventional clinical examination. The G2 sample will be used in the before-after study. Both groups will be followed-up for 7 and 14 days using pain and quality-of-life scales, applied at baseline and after each follow-up period. Clinical follow-up will be carried out after 12 and 24 months to assess the outcome of the tooth that had been indicated for treatment in the teletriage. The Mann-Whitney test will be used to assess pain; Student's t test or the Mann-Whitney test will be used to assess quality of life and the number of missing teeth after 24 months; and Poisson's regression analysis will be used to assess the influence of other variables. The significance level will be set at 5%. Conclusions: In conclusion, this study expects to confirm the hypothesis that remote urgency consultation (teletriage), through a validated questionnaire, will be able to define the planning of the clinical situation, reducing the chance of displacements and progression of infection, helping to eliminate patient pain and discomfort.
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Affiliation(s)
- Ana Paula Dornellas
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, 05508000, Brazil
| | - João Vitor Marques
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, 05508000, Brazil
| | | | - Marcelo Ramos
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, 05508000, Brazil
| | - Júlia Mulder
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, 05508000, Brazil
| | - Ana Estela Haddad
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, 05508000, Brazil
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Lor M, Yang NB, Backonja U, Bakken S. Evaluating and refining a pain quality information visualization tool with patients and interpreters to facilitate pain assessment in primary care settings. Inform Health Soc Care 2023; 48:353-369. [PMID: 37603830 PMCID: PMC10962645 DOI: 10.1080/17538157.2023.2240411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Information visualization (InfoViz) tools offer a potential solution to pain communication challenges. Incongruencies in communication styles between patients with limited English proficiency (LEP), interpreters, and providers contribute to significant disparities in pain care and outcomes. This study's purpose is to evaluate and refine a culturally appropriate InfoViz pain quality assessment tool for LEP Hmong patients. We conducted a three-part iterative user-centered study with LEP Hmong, bilingual Hmong, and Hmong interpreters with (1) participatory design sessions to evaluate and refine pain infographics for inclusion on the tool, (2) card-sorting to organize the infographics to match the mental models of LEP patients, and (3) a tool assessment to identify which tool accurately represented LEP patients' mental models and was preferred in clinical settings. Fifty-five participants provided three common themes for pain infographics refinement: culturally-relevant colors, infographics resembling human anatomy, and action-specific squiggle lines. The card-sorting sessions revealed three organizational themes: sensation (n = 15; 71.4%), localization (n = 6; 28.6%), and severity of pain quality (n = 5; 24.3%). Most participants selected the localization as the most accurate tool and preferred it in clinical settings. Using a multi-step, user-centered approach resulted in a culturally appropriate pain InfoViz tool for LEP Hmong patients.
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Affiliation(s)
| | | | - Uba Backonja
- University of Wisconsin-Madison and University of Washington, USA
| | - Suzanne Bakken
- School of Nursing and Biomedical Informatics, New York, NY, USA
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Muldoon J. Timescaled monitoring to manage venous leg ulcers and chronic oedema. Br J Community Nurs 2023; 28:S24-S30. [PMID: 37643115 DOI: 10.12968/bjcn.2023.28.sup9.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Venous leg ulcers and chronic oedema including lymphoedema are lifelong conditions that cause great distress to sufferers due to psychophysical symptoms. Time and resources spent on managing chronic wounds place an economic burden on healthcare providers, particularly with an anticipated increase in an ageing population and diminishing numbers of those providing long-term care. Resources are further challenged if wounds remain unhealed. The human costs are even greater, with patients often facing a lifetime of discomfort due to low awareness of venous disease, despite epidemiological studies. Possible causes of persistent venous disease may be misdiagnosis, mismanagement, or simply, no management if help is not sought. Therefore, it is important that chronic leg ulcers are managed with clinically effective regimes, reassessment, monitoring and appropriate referrals for adjunct management, alongside patient education. This article provides simple timescaled measurements to ensure timely interventions and appropriate care at each stage.
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Seilhamer C, Miller K, Holstine J. Reducing Postoperative Length of Stay for Idiopathic Scoliosis Patients using Quality Improvement Methodology. Pediatr Qual Saf 2023; 8:e672. [PMID: 37551258 PMCID: PMC10403041 DOI: 10.1097/pq9.0000000000000672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023] Open
Abstract
Approximately 1%-3% of the US population is diagnosed with scoliosis. In addition, 80% of those diagnosed have idiopathic scoliosis, with about 10% requiring surgical intervention. This Quality Improvement initiative aimed to reduce the length of stay (LOS) after posterior spinal fusion for these patients. According to the Pediatric Health Information System, our institution had a poorer performance, with an actual LOS greater than or equal to the expected LOS compared with peer institutions. METHODS The aim was to increase the percentage of idiopathic scoliosis patients with a procedure to discharge LOS of less than or equal to 4 days after posterior spinal fusion from 39.13% to 90%. Interventions included implementing a new pain management protocol, a daily checklist, education on expectations of postoperative pain, and updated order sets. RESULTS Interventions improved patients discharged in less than 4 days from 39.13% to 93.48% (P ≤ 0.001), reducing the average postprocedure LOS from 4.93 to 2.59 (P ≤ 0.001) days. A key process measure tracked was the percentage of patients off the patient-control analgesia pump by postoperative day 2, which increased from 13% to 97.75% (P ≤ 0.001). These improvements did not affect the balancing measure of readmissions or Emergency Department visits for pain. CONCLUSIONS By implementing a more standardized pathway, including a patient-focused daily checklist for providers and families, we established expectations for LOS and pain. This checklist and updates to the pain management protocol successfully reduced the length of stay in idiopathic scoliosis patients after posterior spinal fusion.
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Affiliation(s)
- Crystal Seilhamer
- From the Center for Comprehensive Spine Care, Department of Orthopedics, Nationwide Children's Hospital, Columbus, Ohio
| | - Kelly Miller
- From the Center for Comprehensive Spine Care, Department of Orthopedics, Nationwide Children's Hospital, Columbus, Ohio
| | - Jessica Holstine
- Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio
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Kaya E, Yıldırım S. Effect of a needle-free system versus traditional anesthesia on pain perception during palatal injections in children. Int J Paediatr Dent 2023; 33:132-140. [PMID: 36151976 DOI: 10.1111/ipd.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/21/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Needle-free injection systems can contribute to the prevention of needle-related pain during palatal infiltration anesthesia (PIA) in children. Research on this topic in children is required. AIM The purpose of this clinical study was to evaluate the effectiveness and patient preference of a needle-free system versus traditional anesthesia (TA) on pain perception during PIA in children. DESIGN The study was designed as a randomized, controlled crossover clinical study with 48 children aged 6-12 years requiring dental treatment with PIA in bilateral maxillary primary molars. TA was applied on one side and the Comfort-in™ injection system (CIS) on the other side in two separate sessions. Then, patient preference was recorded. The pain perception during PIA was evaluated using the Wong-Baker FACES Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The data were analyzed for statistical significance (p < .05). RESULTS There were statistically significant differences between the TA and the CIS according to the PRS and FLACC Scale scores. On both scales, significantly higher pain ratings were observed in the TA group during PIA (p < .001). There was a statistically significant difference in terms of patient preference (p < .001). Although 77.1% (n = 37) of the children preferred the CIS, 22.9% (n = 11) preferred the TA. Moreover, patient preference for the CIS was significantly higher in older children (p < .01). CONCLUSIONS The application of a needle-free system during PIA ensured a decrease in pain perception in children.
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Affiliation(s)
- Emine Kaya
- Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul Okan University, Istanbul, Turkey
| | - Sinem Yıldırım
- Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul Okan University, Istanbul, Turkey
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Ferrazzano GF, Di Fabio G, Gatto R, Caruso S, Botticelli G, Caruso S. Effectiveness and Tolerability of a New Formulation of a Topical Anesthetic in Reduction of Pain and Parents’ Satisfaction in Pediatric Dentistry. CHILDREN 2023; 10:children10030444. [PMID: 36980002 PMCID: PMC10047767 DOI: 10.3390/children10030444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
Abstract
The aim of the present study was to test a new topical anesthetic gel with a different formulation (10% lidocaine, 10% prilocaine) to analyze its effectiveness in pain control, during the subsequent injection of local anesthetic, and the presence of any side effects. Methods: The study’s research design was a randomized controlled clinical trial on 300 children, aged 5–8 years, divided into two groups, each of 150 patients, according to pre-injection procedures (presence or absence of topical anesthesia). The injection pain was analyzed using the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability Scale (FLACC). At the end of the procedures, patients’ parents’ satisfaction was recorded. The data were analyzed using the Student’s T test, Mann–Whitney U test and Chi-square test. Results: There were statistically significant differences between the two groups both in the PRS and FLACC ratings. Both in subjective and objective pain evaluations, significantly higher pain ratings were observed in the group without topical anesthesia. There was also a statistically significant difference in terms of patients’ parents’ judgment, as in the group with the use of topical anesthetic the level of parental satisfaction is statistically higher. Conclusion: The experimental anesthetic has proved very effective in its use as a topical gel in both pain measurement scales, thus validating its use on the oral mucosa, for its pharmacological and psychological effect, in the total absence of local and systemic side effects.
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Affiliation(s)
- Gianmaria Fabrizio Ferrazzano
- UNESCO Chair in Health Education and Sustainable Development, Paediatric Dentistry Section, University of Naples “Federico II”, 80138 Naples, Italy
| | - Giuseppe Di Fabio
- Department of Life, Health and Environmental Sciences, Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
- Correspondence: (G.D.F.); (S.C.)
| | - Roberto Gatto
- Department of Life, Health and Environmental Sciences, Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
| | - Sara Caruso
- Department of Life, Health and Environmental Sciences, Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
| | - Gianluca Botticelli
- Department of Life, Health and Environmental Sciences, Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
| | - Silvia Caruso
- Department of Life, Health and Environmental Sciences, Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
- Correspondence: (G.D.F.); (S.C.)
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Saikiran KV, Elicherla SR, Mounika SVM, Hemanth Kumar R, Kolavali PSP, Nuvvula S. Memojis Pain Scale: A novel pain assessment tool. Int J Paediatr Dent 2023. [PMID: 36631986 DOI: 10.1111/ipd.13044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/14/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Dental pain exerts a considerable impact on the psychosocial well-being of children; reliable management of pain depends on the ability to assess pain intensity. AIM To validate and compare a new memojis pain assessment scale with the Faces Pain Scale-Revised (FPS-R) and Wong-Baker FACES Pain Rating Scale (WBFPS) in assessing dental pain experienced by children. DESIGN Two hundred and fifty healthy children aged 5-9 years without any past dental experience and requiring local anaesthesia (LA) administration were recruited. Three different scales [FPS-R, WBFPS and Memojis Pain Scale (MPS)] were applied to assess the children's pain during LA administration. The preferences of each child based on the ease of understanding the faces were recorded. RESULTS Pearson correlation test was performed to determine the correlation between MPS with WBFPS and MPS with FPS-R. A strong correlation was seen when comparing MPS with WBFPS (r = .966; p < .001) and MPS with FPS-R (r = .969; p < .001), and 81.6% of the children preferred MPS. CONCLUSION The Memojis Pain Scale was an effective pain assessment tool. It can be employed as an alternative scale for pain assessment in children.
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Affiliation(s)
| | - Sainath Reddy Elicherla
- Department of pediatric and preventive dentistry, Narayana dental college and hospital, Nellore, India
| | | | - Raichurkar Hemanth Kumar
- Department of pediatric and preventive dentistry, Sri venkata sai institute of dental sciences, Mahabubnagar, India
| | - Purna Sai Prasad Kolavali
- Department of pediatric and preventive dentistry, Sri venkata sai institute of dental sciences, Mahabubnagar, India
| | - Sivakumar Nuvvula
- Department of pediatric and preventive dentistry, Narayana dental college and hospital, Nellore, India
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Li L, Wu S, Wang J, Wang C, Zuo W, Yu L, Song J. Development of the Emoji faces pain scale and its validation on mobile device in adult surgery patients: A longitudinal observational study (Preprint). J Med Internet Res 2022; 25:e41189. [PMID: 37067854 PMCID: PMC10152337 DOI: 10.2196/41189] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/05/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Measuring pain on digital devices using classic unidimensional pain scales such as the visual analog scale (VAS), numerical rating scale (NRS), and faces pain scale (FPS) has been proven to be reliable and valid. Emoji are pictographs designed in colorful form following the Unicode standard. It could be more beneficial to use emoji as faces of FPS on digital devices because emoji can easily fit on most devices and emoji are open-source so no approval would be needed before use. With a concise and user-friendly design, the emoji faces pain scale (Emoji-FPS) might be more generalizable to a wider population and more preferred by digital device users. OBJECTIVE This study was designed to develop an Emoji-FPS as well as to evaluate its reliability, validity, and preference on mobile devices in adult patients who underwent surgery. METHODS A modified Delphi technique with 2 rounds of web-based surveys was applied to obtain panelists' consensus on the sequence of emoji that can best represent 6 levels of pain. The initial candidate sequences of emoji for the Delphi process were constructed referring to 2 well-validated FPSs (Wong-Baker FACES pain rating scale [Wong-Baker FACES] and faces pain scale-revised [FPS-R]). Then, a prospective cohort of patients scheduled to receive perianal surgery was recruited and asked to complete a web-based questionnaire on a mobile device at 5 time points (before surgery [T1], wake up after surgery [T2], 4 hours after surgery [T3], the second day after surgery [T4], and 15 minutes after T4 [T5]). The 4 well-validated pain scales (NRS, VAS, Wong-Baker FACES, and FPS-R) were used as reference scales. RESULTS After 2 rounds of surveys on 40 Delphi panelists, an Emoji-FPS was finally determined to represent 6 pain levels (0, 2, 4, 6, 8, and 10) from "no hurt" to "hurts worst." For validation, 300 patients were recruited and 299 were analyzed, the mean age of whom was 38.5 (SD 10.5) years, and 106 (35.5%) were women. For concurrent validity, the Emoji-FPS was highly correlated with 4 reference scales with Spearman correlation coefficient ρ ranging from 0.91 to 0.95. Excellent agreements were observed between 4 versions of Emoji-FPS (iOS, Android, Microsoft, and OpenMoji), with weighted κ coefficients ranging from 0.96 to 0.97. For discriminant validity, patients' mean preoperative Emoji-FPS score (T1) was significantly higher than their postoperative Emoji-FPS score (T4) with a difference of 1.4 (95% CI 1.3-1.6; P<.001). For test-retest reliability, Emoji-FPS scores measured at T4 and T5 were highly correlated with a ρ of 0.91. The Emoji-FPS was mostly preferred, followed by the Wong-Baker FACES, FPS-R, NRS, and VAS. CONCLUSIONS The Emoji-FPS is reliable and valid compared with traditional pain scales in adult surgery patients.
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Affiliation(s)
- Lili Li
- Anesthesiology Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sicheng Wu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China (Hong Kong)
| | - Jian Wang
- Anesthesiology Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chunchun Wang
- Anesthesiology Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weixin Zuo
- Anesthesiology Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liping Yu
- Anesthesiology Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiangang Song
- Anesthesiology Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Acupuncture and Anesthesia Research Institute, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Namba S, Sato W, Matsui H. Spatio-Temporal Properties of Amused, Embarrassed, and Pained Smiles. JOURNAL OF NONVERBAL BEHAVIOR 2022. [DOI: 10.1007/s10919-022-00404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractSmiles are universal but nuanced facial expressions that are most frequently used in face-to-face communications, typically indicating amusement but sometimes conveying negative emotions such as embarrassment and pain. Although previous studies have suggested that spatial and temporal properties could differ among these various types of smiles, no study has thoroughly analyzed these properties. This study aimed to clarify the spatiotemporal properties of smiles conveying amusement, embarrassment, and pain using a spontaneous facial behavior database. The results regarding spatial patterns revealed that pained smiles showed less eye constriction and more overall facial tension than amused smiles; no spatial differences were identified between embarrassed and amused smiles. Regarding temporal properties, embarrassed and pained smiles remained in a state of higher facial tension than amused smiles. Moreover, embarrassed smiles showed a more gradual change from tension states to the smile state than amused smiles, and pained smiles had lower probabilities of staying in or transitioning to the smile state compared to amused smiles. By comparing the spatiotemporal properties of these three smile types, this study revealed that the probability of transitioning between discrete states could help distinguish amused, embarrassed, and pained smiles.
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Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis. Br J Anaesth 2021; 127:608-619. [PMID: 34340838 DOI: 10.1016/j.bja.2021.06.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Procedural pain and anxiety in children can be poorly controlled, leading to significant short- and long-term sequelae, such as longer procedure times or future healthcare avoidance. Caregiver anxiety can exacerbate these effects. We aimed to evaluate the effect of interactive video game interventions on children's procedural pain and anxiety, including the effect of different types of video games on those outcomes. METHODS We conducted a systematic review and meta-analysis of the effectiveness of interactive video games compared with standard care in children (0-18 yr) undergoing painful procedures. We searched the databases MEDLINE, Embase, and PsycINFO. We conducted random-effects meta-analysis using 'R' of children's procedural pain and anxiety and caregivers' anxiety. RESULTS Of 2185 studies screened, 36 were eligible (n=3406 patients). Studies commonly involved venous access (33%) or day surgery (31%). Thirty-four studies were eligible for meta-analyses. Interactive video games appear to reduce children's procedural pain (standardised mean difference [SMD]=-0.43; 95% confidence interval [CI]: -0.67 to -0.20), anxiety (SMD=0.61; 95% CI: -0.88 to -0.34), and caregivers' procedural anxiety (SMD=-0.31; 95% CI: -0.58 to -0.04). We observed no difference between preparatory and distracting games, or between virtual reality and non-virtual reality games. We also observed no difference between interactive video games compared with standard care for most medical outcomes (e.g. procedure length), except a reduced need for restraint. Studies reported minimal adverse effects and typically had high intervention acceptability and satisfaction. CONCLUSIONS Our findings support introducing easily available video games, such as distraction-based conventional video games, into routine practice to minimise paediatric procedural pain and child/caregiver anxiety.
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Lammers CR, Schwinghammer AJ, Hall B, Kriss RS, Aizenberg DA, Funamura JL, Senders CW, Nittur V, Applegate RL. Comparison of Oral Loading Dose to Intravenous Acetaminophen in Children for Analgesia After Tonsillectomy and Adenoidectomy: A Randomized Clinical Trial. Anesth Analg 2021; 133:1568-1576. [PMID: 34304234 DOI: 10.1213/ane.0000000000005678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Acetaminophen is a frequently used adjunct analgesic in pediatric patients undergoing tonsillectomy and adenoidectomy. We compared opioid administration following preoperative intravenous (IV) or oral acetaminophen in addition to a standard multimodal regimen to test the hypothesis that 1 loading dose approach would provide superior opioid sparing effects among pediatric surgical patients undergoing tonsillectomy and adenoidectomy. METHODS This single-center, double-blind, double-dummy prospective randomized study was conducted in patients ages 3 to 15 years undergoing tonsillectomy and adenoidectomy with or without myringotomy and tube placement between September 2017 and July 2019. Subjects received 1 dose of either oral acetaminophen 30 mg/kg with IV placebo (oral group) or IV acetaminophen 15 mg/kg with oral placebo (IV group). Acetaminophen plasma levels were measured at 2 timepoints to evaluate safety and determine plasma levels attained by each dosing regimen. Intraoperative opioid administration and postoperative analgesia were standardized. Standardized postoperative multimodal analgesia included opioid if needed to control pain assessed by standardized validated pediatric pain scales. The primary outcome measure was total opioid administration in the first 24 hours after surgery. Continuous data were not normally distributed and were analyzed using the Wilcoxon rank sum test and the Hodges-Lehman estimator of the median difference. Clinical significance was defined as a 100 µg/kg IV morphine equivalents per day difference. RESULTS Sixty-six subjects were randomized into and completed the study (29 women, 37 men; age 5.9 ± 3.0 years; percentile weight for age 49.5 ± 30.2; no differences between groups). There was no opioid dose difference between oral (median 147.6; interquartile range [IQR], 119.6-193.0 µg/kg) and IV groups (median 125.4; IQR, 102.8-150.9 µg/kg; median difference 21.3; 95% confidence interval [CI] -2.5 to 44.2 µg/kg IV morphine equivalents; P = .13). No acetaminophen levels exceeded the predefined safety threshold (40 mg/L). No difference was found in the percentage of patients with severe pain: 50.0% oral group, 47.2% IV group; relative risk of severe pain in IV 0.94; 95% CI, 0.57-1.6; P = .82. Postoperative plasma acetaminophen levels were higher in oral (22; IQR, 16-28 mg/L) than IV (20; IQR, 17-22 mg/L) group (median difference 7.0; 4.0-8.0 mg/L; P = .0001). CONCLUSIONS Opioid-sparing effects did not differ following an oral or standard IV acetaminophen loading dose with no identified acetaminophen toxicity in pediatric patients undergoing tonsillectomy and adenoidectomy who received standardized multimodal postoperative analgesia. An oral loading dose may provide more consistent serum acetaminophen levels at lower cost compared to a standard IV dose.
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Affiliation(s)
| | | | | | | | | | | | | | - Vinay Nittur
- School of Medicine, University of California Davis, Sacramento, California
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Blood pressure in adults with cerebral palsy: a systematic review and meta-analysis of individual participant data. J Hypertens 2021; 39:1942-1955. [PMID: 34102658 PMCID: PMC8452335 DOI: 10.1097/hjh.0000000000002912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: This systematic review and meta-analysis was designed to determine the overall mean blood pressure and prevalence of hypertension among a representative sample of adults living with cerebral palsy by combining individual participant data. Additional objectives included estimating variations between subgroups and investigating potential risk factors for hypertension. Methods: Potential datasets were identified by literature searches for studies published between January 2000 and November 2017 and by experts in the field. Samples of adults with cerebral palsy (n ≥ 10, age ≥ 18 years) were included if blood pressure data, cerebral palsy-related factors (e.g. cerebral palsy subtype), and sociodemographic variables (e.g. age, sex) were available. Hypertension was defined as at least 140/90 mmHg and/or use of antihypertensive medication. Results: We included data from 11 international cohorts representing 444 adults with cerebral palsy [median (IQR) age of the sample was 29.0 (23.0–38.0); 51% men; 89% spastic type; Gross Motor Function Classification System levels I–V]. Overall mean SBP was 124.9 mmHg [95% confidence interval (CI) 121.7–128.1] and overall mean DBP was 79.9 mmHg (95% CI 77.2–82.5). Overall prevalence of hypertension was 28.7% (95% CI 18.8–39.8%). Subgroup analysis indicated higher blood pressure levels or higher prevalence of hypertension in adults with cerebral palsy above 40 years of age, men, those with spastic cerebral palsy or those who lived in Africa. BMI, resting heart rate and alcohol consumption were risk factors that were associated with blood pressure or hypertension. Conclusion: Our findings underscore the importance of clinical screening for blood pressure in individuals with cerebral palsy beginning in young adulthood.
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Cunningham A, McPolin O, Fallis R, Coyle C, Best P, McKenna G. A systematic review of the use of virtual reality or dental smartphone applications as interventions for management of paediatric dental anxiety. BMC Oral Health 2021; 21:244. [PMID: 33962624 PMCID: PMC8103574 DOI: 10.1186/s12903-021-01602-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background Virtual reality (VR) has been used successfully in medicine both as a distraction tool during procedures, and as an acclimatisation tool to prepare for a procedure or experience. It has not yet become widely used in dentistry, but could theoretically have a role in exposure-based acclimatisation for dental experiences. Methods To examine the use of VR or bespoke dental smartphone applications pre- or perioperatively in dentistry, to decrease anxiety in a paediatric population attending for dental examination or treatment, compared with children/adolescents who receive no intervention, or more conventional behavioural management techniques. Searches were made of eight electronic databases: the Cochrane Oral Health Group’s Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE(PubMed), EMBASE, PsycINFO, CINAHL, Scopus and Web of Science. Further searches reference cross‐checks were performed to identify studies that were not discovered online. Results Systematic reviews and randomised control trials have demonstrated the successful use of VR to both distract patients perioperatively during medical procedures, and also preoperatively to prepare them for these interventions. However, to date, VR has only been applied to dentistry in a very limited number of studies. Three studies using virtual reality in a dental setting demonstrated decreased pain and anxiety compared with no intervention. All three of these studies were carried out in the perioperative period. A fourth study used a bespoke dental app and imagery to prepare patients with Autism Spectrum Disorder (ASD) for dental treatment, finding statistically significant decreases in both the number of appointments and number of attempts required to carry out a procedure. Conclusion VR is a promising tool which to date has been under-utilised in dentistry. High quality, clinical studies are required to assess the use of preoperative VR and smartphone applications to prepare patients for dental examination and procedures under local or general anaesthetic.
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Affiliation(s)
| | - Orlagh McPolin
- Centre for Dentistry, Queen's University Belfast, Belfast, UK
| | - Richard Fallis
- Queen's University Belfast Medical Library, Queen's University Belfast, Belfast, UK
| | - Catherine Coyle
- Centre for Dentistry, Queen's University Belfast, Belfast, UK
| | - Paul Best
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Gerald McKenna
- Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Belfast, UK.
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Daniel L, Benson J, Hoover S. Transcutaneous Electrical Nerve Stimulation for Pain Management for Women in Labor. MCN Am J Matern Child Nurs 2021; 46:76-81. [PMID: 33394686 DOI: 10.1097/nmc.0000000000000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine effectiveness of a transcutaneous electrical nerve stimulation (TENS) unit to improve labor pain management and patient satisfaction with overall labor experience among women in labor at term. STUDY DESIGN Prospective, exploratory design using convenience sampling. METHODS Pregnant women at term, anticipating a vaginal birth at our tertiary care hospital, were invited to participate in the TENS study to help manage early labor pain. Pain level was assessed on entry into the study and 2 hours post-TENS application using the Wong-Baker FACES® Pain Rating Scale. A TENS satisfaction survey was conducted during postpartum. Pain scores were analyzed using a matched Wilcoxon signed-rank test. RESULTS There were 272 women enrolled in the study; 255 completed the patient satisfaction survey and 263 had measured pain assessments pre- and post-TENS application. There was a significant reduction in pain scores after application of TENS, (7.09 vs. 6.74, p = 0.02). Most women 78% (199/255) agreed that TENS helped manage early labor pain, 80% (203/255) would recommend TENS for management of early labor pain, and 72% (183/255) would use TENS again. CLINICAL IMPLICATIONS TENS therapy provides nurses with an opportunity to offer women a low-cost, low-intervention treatment for managing early labor. TENS provides a distraction from contractions and generates a sense of control to help women manage the discomforts of labor and possibly remain home longer.
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Blom T, Lurvink R, Aleven L, Mensink M, Wolfs T, Dierselhuis M, van Eijkelenburg N, Kraal K, van Noesel M, van Grotel M, Tytgat G. Treatment-Related Toxicities During Anti-GD2 Immunotherapy in High-Risk Neuroblastoma Patients. Front Oncol 2021; 10:601076. [PMID: 33680926 PMCID: PMC7925836 DOI: 10.3389/fonc.2020.601076] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
The introduction of immunotherapy using an anti-GD2 antibody (dinutuximab, ch14.18) has significantly improved survival rates for high-risk neuroblastoma patients. However, this improvement in survival is accompanied by a substantial immunotherapy-related toxicity burden. The primary objective of this study was to describe treatment-related toxicities during immunotherapy with dinutuximab, IL-2, GM-CSF, and isotretinoin. A retrospective, single center analysis of immunotherapy-related toxicities was performed in twenty-six consecutive high-risk neuroblastoma patients who received immunotherapy as maintenance therapy in the Princess Máxima Center (Utrecht, Netherlands). Toxicities were recorded and graded according to the CTCAE. Particular attention was drawn to pain and fever management and toxicities leading to dose modifications of dinutuximab and IL-2. Twenty-three patients (88%) completed all six courses of immunotherapy. Disease progression, isotretinoin-associated liver toxicity, and catheter-related infection in combination with peripheral neuropathy were reasons for immunotherapy discontinuation. The most common grade ≥3 toxicities for courses 1-5, respectively, were pain, catheter-related infections, and fever. In total, 310 grade ≥3 toxicities were recorded in 124 courses. Thirty-three grade 4 toxicities in 19/26 patients and no grade 5 toxicities (death) were seen. Fifty-nine percent of grade ≥3 toxicities were recorded in the two courses with IL-2. Catheter-related bloodstream infections were identified in 81% of patients. Four of these episodes led to intensive care admission followed by full recovery (grade 4).
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Affiliation(s)
- Thomas Blom
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Leonie Aleven
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Maarten Mensink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Tom Wolfs
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | - Kathelijne Kraal
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Max van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Godelieve Tytgat
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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Gochenour KS, Ellis RS, Meredith SL, Vesely KC, Kang P, Haefner S. Music and Medicine Come Together Over Pain in the Air Medical Transport Environment. Air Med J 2020; 39:484-488. [PMID: 33228899 DOI: 10.1016/j.amj.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to determine if noise-canceling headphones (NCHs) with music supersedes pain reduction of other hearing protection for patients transported by Guardian Air Transport via rotor or fixed wing aircraft from 2017 to 2019. METHODS We designed a randomized pilot study in which patients who received NCHs with or without music were compared with controls who received non-NCH hearing protection alone. Four hundred fifty-four adults 19 to 64 years of age and 36 pediatric patients 4 to 18 years old who received ≥ 1 dose of opioids were included. RESULTS In the aggregate population, opioid use was reduced by 31% from 14.3 to 10.0 morphine milligram equivalent/h transport (P = .131) with music compared with controls. The mean total pain reduction in the aggregate population from -2.5 (standard deviation [SD] = 3.2) to -4.0 (SD = 2.9) was 1.6-fold more than controls compared with NCH and music (P = .008). This effect was most profound in the pediatric population where the mean total pain reduction with NCHs and music (-5.4, SD = 3.1) was 3.4-fold more than controls (-1.6, SD = 2.7, P = .021). CONCLUSIONS Music may provide greater subjective pain relief when combined with NCHs in the air transport environment; further research is required.
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Affiliation(s)
| | | | | | | | - Paul Kang
- University of Arizona College of Medicine, Phoenix, Arizona
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Wigham S, Watts P, Zubala A, Jandial S, Bourne J, Hackett S. Using Arts-Based Therapies to Improve Mental Health for Children and Young People With Physical Health Long-Term Conditions: A Systematic Review of Effectiveness. Front Psychol 2020; 11:1771. [PMID: 33101097 PMCID: PMC7545424 DOI: 10.3389/fpsyg.2020.01771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Children with physical health long-term conditions (LTCs) have increased risk of mental health difficulties relative to healthy peers. However, availability of psychological support integrated into pediatric physical health settings is limited, and there are long waiting times for access to child mental health services. Arts-based therapies involve using creative media to develop a therapeutic relationship, and offer a potential alternative to talking-based therapies. The aim of this systematic review is to establish the effectiveness of arts-based therapies for improving the mental health of children with physical health LTCs. Methods: The review protocol was published on PROSPERO. Four electronic databases were searched (Medline, Embase, Cinahl, and PsycINFO), plus hand searches of two key journals and relevant reviews, and forward/back citations searches of selected articles were conducted. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess bias in selected articles. Second reviewers completed 10% of article screening and 20% of bias assessments. The findings were synthesized narratively. Results: Sixteen studies met inclusion criteria and demonstrated some improvements on indicators of mental health and well-being including quality of life, coping behaviors, anxiety, self-concept, and mood. However, replication across interventions and outcomes was absent. Overall, the quality of evidence of effectiveness in the studies reviewed was moderate/weak. This was due to bias in study design; other limitations included a lack of detail on intervention components, e.g., use of a manual, and single recruitment sites. Conclusions: The heterogeneity of existing research evaluating arts-based therapies for children with physical health LTCs limits conclusions about effectiveness. Suggestions are made to inform the design of future research studies to help build a robust evidence base.
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Affiliation(s)
- Sarah Wigham
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Ania Zubala
- Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness, United Kingdom
| | - Sharmila Jandial
- Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jane Bourne
- Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Simon Hackett
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Comparison of Four Pain Scales Among Hmong Patients with Limited English Proficiency. Pain Manag Nurs 2020; 22:205-213. [PMID: 32933877 DOI: 10.1016/j.pmn.2020.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little is known about the relevance of existing pain scales for patients with limited English proficiency (LEP). AIMS To determine the ranking and perceptions of four pain intensity scales in LEP Hmong. DESIGN A sequential mixed-method study. SETTINGS A Midwestern city, USA. PARTICIPANTS/SUBJECTS Eight-four Hmong aged 19 to 80 years old. METHODS Participants ranked four pain intensity scales-the Red Gradation Scale, the Black Gradation Scale, the Wong-Baker Faces Pain Rating Scale, and the Faces Pain Scale - Revised- using Likert responses of 1 (most) to 4 (least) on the following factors: the extent to which they liked the scale, perceived it to be accurate, and preferred to use it in clinical settings. A follow-up interview asked participants' scale selection decisions. Spearman correlations and ordered logistic regression assessed the scale rankings. Thematic analysis was used to analyze the qualitative data. RESULTS Participants ranked the Wong-Baker Faces Pain Rating Scale as the most liked (3.22 ± 0.95, 50.6%), the most accurate (3.13 ± 0.93, 44.6%), and the most preferred (3.14 ± 1.03, 49.4%). Older Age predicted the selection of this scale. Six themes influenced participants' ranking decisions: the visual clarity of the scale, their experience or familiarity with the scale, the cultural connotations of pain, the type of emotions provoked by scale, the alignment of pain expression reflected in the scale, and the literacy concerns that the scale addressed. CONCLUSIONS The Wong-Baker Faces could be appropriate for older Hmong. Further validity and reliability studies are needed for the Wong-Baker Faces.
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20
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Characterizing upper extremity motor behavior in the first week after stroke. PLoS One 2020; 15:e0221668. [PMID: 32776927 PMCID: PMC7416933 DOI: 10.1371/journal.pone.0221668] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 06/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background Animal models of brain recovery identify the first days after lesioning as a time of great flux in sensorimotor function and physiology. After rodent motor system lesioning, daily skill training in the less affected forelimb reduces skill acquisition in the more affected forelimb. We asked whether spontaneous human motor behaviors of the less affected upper extremity (UE) early after stroke resemble the animal training model, with the potential to suppress clinical recovery. Methods This prospective observational study used a convenience sample of patients (n = 25, mean 4.5 ±1.8) days after stroke with a wide severity range; Controls were hospitalized for non-neurological conditions (n = 12). Outcome measures were Accelerometry, Upper-Extremity Fugl-Meyer (UEFM), Action Research Arm Test (ARAT), Shoulder Abduction/ Finger Extension Test (SAFE), NIH Stroke Scale (NIHSS). Results Accelerometry indicated total paretic UE movement was reduced compared to controls, primarily due to a 44% reduction of bilateral UE use. Unilateral paretic movement was unchanged. Thus, movement shifted early after stroke; bilateral use was reduced and unilateral use of the non-paretic UE was increased by 77%. Low correlations between movement time and motor performance prompted an exploratory factor analysis (EFA) revealing a 2-component solution; motor performance tests load on one component (motor performance) whereas accelerometry-derived variables load on a second orthogonal component (quantity of movement). Conclusions Early after stroke, spontaneous overall UE movement is reduced, and movement shifts to unilateral use of the non-paretic UE. Two mechanisms that could influence motor recovery may already be in place 4.5 ± 1.8 days post stroke: (1) the overuse of the less affected UE, which could set the stage for learned non-use and (2) skill acquisition in the non-paretic limb that could impede recovery. Accurate UE motor assessment requires two independent constructs: motor performance and quantity of movement. These findings provide opportunities and measurement methods for studies to develop new behaviorally-based stroke recovery treatments that begin early after onset.
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Murrell DF, Paller AS, Bodemer C, Browning J, Nikolic M, Barth JA, Lagast H, Krusinska E, Reha A. Wound closure in epidermolysis bullosa: data from the vehicle arm of the phase 3 ESSENCE Study. Orphanet J Rare Dis 2020; 15:190. [PMID: 32693833 PMCID: PMC7374851 DOI: 10.1186/s13023-020-01435-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background Chronic wounds are a fundamental issue for patients with epidermolysis bullosa (EB). Herein, we assess the natural history of wound closure in patients with EB who were randomly assigned to the vehicle-control arm of the multicenter, randomized, double-blind, phase 3 ESSENCE (NCT02384460) trial. Methods ESSENCE was designed to assess the efficacy and safety of a topical cream formulation of 6% allantoin (SD-101 6%) vs vehicle (SD-101 0%) in patients ≥1 month old who had a diagnosis of EB (simplex, recessive dystrophic, or intermediate junctional) and a target wound 10–50 cm2 present for ≥21 days. Time to complete target wound closure and the proportion of patients with target wound closure over time were analyzed overall and by parameters including patient age and baseline body surface area index (BSAi) of total wound burden (< 5% and ≥ 5%). Changes in BSAi of lesional skin, pain, and itching were also assessed. Results The vehicle-control arm included 87 patients. Mean (standard deviation [SD]) time to target wound closure within 3 months was 53.6 (28.6) days, with a range of 14 to 142 days. The proportion of patients with target wound closure increased over time from 7.1% at day 14 to 53.6% at month 3. Mean (SD) changes from baseline in BSAi of total wound burden and BSAi of lesional skin at month 3 were −2.3% (6.3) and −5.0% (13.5) of total body coverage, respectively. Reductions in pain and itching were observed at day 7 and maintained for 3 months. Faster healing times and a greater proportion of patients with wound closure were observed in patients aged 1 month to < 2 years; those with wounds < 30 days old, and in those with BSAi of total body wound burden < 5%. Conclusions Treatment response observed in the vehicle-control arm of the ESSENCE study was unexpectedly high and may have been due to unforeseen benefits of vehicle or enhanced wound care provided by the clinical trial staff. These observations will help inform the study design of future trials in patients with EB. Trial registration ClinicalTrials.gov, NCT02384460; Date of registration: February 13, 2015; First participant enrollment: March 11, 2015.
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Affiliation(s)
| | - Amy S Paller
- Departments of Dermatology and Pediatric Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 1600, Chicago, IL, 60611-2997, USA.
| | - Christine Bodemer
- EB Expert Centre (MAGEC), Department of Dermatology, Necker-Enfants Malades Hospital, Paris Centre University, Paris, France
| | - John Browning
- Texas Dermatology & Laser Specialists, San Antonio, TX, USA
| | - Milos Nikolic
- Clinical Center of Serbia, Department of Dermatology, University of Belgrade, Belgrade, Serbia
| | - Jay A Barth
- Amicus Therapeutics, Inc., Cranbury, NJ, USA
| | | | | | - Allen Reha
- Amicus Therapeutics, Inc., Cranbury, NJ, USA
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Naidu A, Peters DM, Tan AQ, Barth S, Crane A, Link A, Balakrishnan S, Hayes HB, Slocum C, Zafonte RD, Trumbower RD. Daily acute intermittent hypoxia to improve walking function in persons with subacute spinal cord injury: a randomized clinical trial study protocol. BMC Neurol 2020; 20:273. [PMID: 32641012 PMCID: PMC7341658 DOI: 10.1186/s12883-020-01851-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Restoring community walking remains a highly valued goal for persons recovering from traumatic incomplete spinal cord injury (SCI). Recently, studies report that brief episodes of low-oxygen breathing (acute intermittent hypoxia, AIH) may serve as an effective plasticity-inducing primer that enhances the effects of walking therapy in persons with chronic (> 1 year) SCI. More persistent walking recovery may occur following repetitive (weeks) AIH treatment involving persons with more acute SCI, but this possibility remains unknown. Here we present our clinical trial protocol, designed to examine the distinct influences of repetitive AIH, with and without walking practice, on walking recovery in persons with sub-acute SCI (< 12 months) SCI. Our overarching hypothesis is that daily exposure (10 sessions, 2 weeks) to AIH will enhance walking recovery in ambulatory and non-ambulatory persons with subacute (< 12 months) SCI, presumably by harnessing endogenous mechanisms of plasticity that occur soon after injury. METHODS To test our hypothesis, we are conducting a randomized, placebo-controlled clinical trial on 85 study participants who we stratify into two groups according to walking ability; those unable to walk (non-ambulatory group) and those able to walk (ambulatory group). The non-ambulatory group receives either daily AIH (15, 90s episodes at 10.0% O2 with 60s intervals at 20.9% O2) or daily SHAM (15, 90s episodes at 20.9% O2 with 60s intervals at 20.9% O2) intervention. The ambulatory group receives either 60-min walking practice (WALK), daily AIH + WALK, or daily SHAM+WALK intervention. Our primary outcome measures assess overground walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up & Go Test). For safety, we also measure levels of pain, spasticity, systemic hypertension, and autonomic dysreflexia. We record outcome measures at baseline, days 5 and 10, and follow-ups at 1 week, 1 month, 6 months, and 12 months post-treatment. DISCUSSION The goal of this clinical trial is to reveal the extent to which daily AIH, alone or in combination with task-specific walking practice, safely promotes persistent recovery of walking in persons with traumatic, subacute SCI. Outcomes from this study may provide new insight into ways to enhance walking recovery in persons with SCI. TRIAL REGISTRATION ClinicalTrials.gov, NCT02632422 . Registered 16 December 2015.
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Affiliation(s)
- Avantika Naidu
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, 1575 Cambridge Street, Boston, MA, 02138, USA
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Denise M Peters
- Department of Rehabilitation & Movement Science, University of Vermont, Burlington, VT, USA
| | - Andrew Q Tan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, 1575 Cambridge Street, Boston, MA, 02138, USA
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Stella Barth
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Andrea Crane
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Angela Link
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Swapna Balakrishnan
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Heather B Hayes
- Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Chloe Slocum
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, 1575 Cambridge Street, Boston, MA, 02138, USA
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, 1575 Cambridge Street, Boston, MA, 02138, USA
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Randy D Trumbower
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, 1575 Cambridge Street, Boston, MA, 02138, USA.
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, USA.
- Program in Neuroscience, Graduate School of Arts and Sciences, Harvard University, Cambridge, MA, USA.
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Paller AS, Browning J, Nikolic M, Bodemer C, Murrell DF, Lenon W, Krusinska E, Reha A, Lagast H, Barth JA. Efficacy and tolerability of the investigational topical cream SD-101 (6% allantoin) in patients with epidermolysis bullosa: a phase 3, randomized, double-blind, vehicle-controlled trial (ESSENCE study). Orphanet J Rare Dis 2020; 15:158. [PMID: 32576219 PMCID: PMC7310548 DOI: 10.1186/s13023-020-01419-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Background Epidermolysis bullosa (EB) is a rare genetic disorder that manifests as blistering and/or skin erosion. There is no approved treatment for EB; current standard of care consists of wound and pain management. SD-101 6% is a topical cream containing 6% allantoin that was developed for treating skin lesions in patients with EB. The aim of this phase 3, multicenter, randomized, double-blind, vehicle-controlled study was to assess the efficacy and safety of SD-101 6% cream versus vehicle (0% allantoin) on lesions in patients with EB. Methods Eligible patients were ≥1 month old, had a diagnosis of EB (simplex, recessive dystrophic, or intermediate junctional) and a target wound 10–50 cm2 in size that was present for ≥21 days. Patients were randomly assigned to SD-101 6% cream or vehicle, which was applied topically once a day to the entire body for 3 months. Primary efficacy endpoints were time to complete target wound closure within 3 months and the proportion of patients who experienced complete target wound closure within 3 months. Post hoc subgroup analyses were conducted by patient age and in those with body surface area index of total body wound burden ≥5% at baseline. Results In total, 169 patients were enrolled and randomly assigned to SD-101 6% (n = 82) or vehicle (n = 87). Baseline demographics and disease characteristics were similar between treatment groups. There were no statistically significant differences between treatment groups in time to target wound closure (hazard ratio, 1.004; 95% confidence interval [CI] 0.651, 1.549; P = 0.985) or proportion of patients with complete target wound closure within 3 months (odds ratio [95% CI], 0.733 [0.365, 1.474]; nominal P = 0.390). A positive trend toward faster wound closure with SD-101 6% versus vehicle was observed in patients aged 2 to <12 years and those with total body wound burden ≥5% at baseline. SD-101 6% cream was well tolerated. Conclusions SD-101 6% cream for treatment of EB-associated lesions was not more effective than vehicle in shortening the time to complete target wound closure or achieving complete target wound closure within 3 months. Trial registration ClinicalTrials.gov, NCT02384460; Date of trial registration, February 13, 2015; First participant enrolled, March 11, 2015.
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Affiliation(s)
- Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - John Browning
- Texas Dermatology & Laser Specialists, San Antonio, TX, USA
| | - Milos Nikolic
- Clinical Center of Serbia, Department of Dermatology, University of Belgrade, Belgrade, Serbia
| | - Christine Bodemer
- EB Reference Centre, Department of Dermatology, University Hospital Necker Enfants Malades, Paris, France
| | | | | | | | - Allen Reha
- Amicus Therapeutics, Inc, Cranbury, NJ, USA
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Abstract
OBJECTIVE Gambling disorder (GD) is a common, disabling condition that often is exacerbated by stressful life events. Under stress, the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis are activated. The question, therefore, arises as to whether an abnormal sympathetic response can be found in individuals with GD. METHOD Adult individuals with GD and no current co-occurring mental disorders were enrolled. Participants completed impulsivity and gambling-related questionnaires and underwent cold pressor evaluation. GD participants were compared with controls on measures of heart rate, blood pressure, and pain. RESULTS Fifteen people with GD and 18 controls completed the study. Kaplan-Meier analysis indicated that the GD group withdrew their hand from the painful stimulus more rapidly than controls (Wilcoxon chi-square = 3.87, p = 0.049), suggestive of lesser pain tolerance. Subjective pain ratings and cardiovascular measurements did not significantly differ between groups. CONCLUSIONS Individuals with GD manifested a relative intolerance to pain on the cold pressor paradigm, even though they physiologically did not seem to experience greater pain. Given the role of the opioid system in pain processing, it would be valuable in future work to examine whether cold pressor measures can predict response to treatments in GD, including with opioid antagonists.
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The effect of pre-anesthesia with a needle-free system versus topical anesthesia on injection pain of the inferior alveolar nerve block: a randomized clinical trial. Clin Oral Investig 2020; 24:4355-4361. [PMID: 32382924 DOI: 10.1007/s00784-020-03301-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of pain control between a needle-free system and topical anesthesia applied prior to inferior alveolar nerve block (IANB). MATERIALS AND METHODS The present study was designed as a randomized controlled cross-over clinical study on 60 children (aged 6 to 12 years) requiring dental treatment with IANB in bilateral mandibular molars. As pre-anesthesia, topical anesthesia (TA) was applied on one side and the Comfort-in™ injection system (CIS) on the other side in two separate sessions before IANB. The injection pain during IANB, at both the needle insertion and solution deposition phases, was analyzed using the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability Scale (FLACC). The data were analyzed using the Wilcoxon signed-rank test, Spearman correlation, and Mann-Whitney U test. RESULTS There were statistically significant differences between TA and CIS in subjective and objective pain evaluations during both the needle insertion and solution deposition. The use of a needle-free system in pre-anesthesia yielded a significant decrease in subjective and objective pain scores (p < 0.001). No statistical difference was found between TA and CIS in terms of patient preference, but patient preference for CIS was significantly higher in older patients (p < 0.01). CONCLUSIONS It was determined that the use of a needle-free system in pre-anesthesia yielded a decrease in injection pain of IANB. CLINICAL RELEVANCE Pediatric dentists should be aware of the new injection system in order to decrease the level of injection pain.
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Stonbraker S, Porras T, Schnall R. Patient preferences for visualization of longitudinal patient-reported outcomes data. J Am Med Inform Assoc 2020; 27:212-224. [PMID: 31670816 PMCID: PMC7025335 DOI: 10.1093/jamia/ocz189] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The study sought to design symptom reports of longitudinal patient-reported outcomes data that are understandable and meaningful to end users. MATERIALS AND METHODS We completed a 2-phase iterative design and evaluation process. In phase I, we developed symptom reports and refined them according to expert input. End users then completed a survey containing demographics, a measure of health literacy, and items to assess visualization preferences and comprehension of reports. We then collected participants' perspectives on reports through semistructured interviews and modified them accordingly. In phase II, refined reports were evaluated in a survey that included demographics, validated measures of health and graph literacy, and items to assess preferences and comprehension of reports. Surveys were administered using a think-aloud protocol. RESULTS Fifty-five English- and Spanish-speaking end users, 89.1% of whom had limited health literacy, participated. In phase I, experts recommended improvements and 20 end users evaluated reports. From the feedback received, we added emojis, changed date and font formats, and simplified the y-axis scale of reports. In phase II, 35 end users evaluated refined designs, of whom 94.3% preferred reports with emojis, the favorite being a bar graph combined with emojis, which also promoted comprehension. In both phases, participants literally interpreted reports and provided suggestions for future visualizations. CONCLUSIONS A bar graph combined with emojis was participants' preferred format and the one that promoted comprehension. Target end users must be included in visualization design to identify literal interpretations of images and ensure final products are meaningful.
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Affiliation(s)
| | - Tiffany Porras
- Columbia University School of Nursing, New York, New York, USA
| | - Rebecca Schnall
- Columbia University School of Nursing, New York, New York, USA
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Maguire A, Clarkson JE, Douglas GV, Ryan V, Homer T, Marshman Z, McColl E, Wilson N, Vale L, Robertson M, Abouhajar A, Holmes RD, Freeman R, Chadwick B, Deery C, Wong F, Innes NP. Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: the FiCTION three-arm RCT. Health Technol Assess 2020; 24:1-174. [PMID: 31928611 PMCID: PMC6983909 DOI: 10.3310/hta24010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Historically, lack of evidence for effective management of decay in primary teeth has caused uncertainty, but there is emerging evidence to support alternative strategies to conventional fillings, which are minimally invasive and prevention orientated. OBJECTIVES The objectives were (1) to assess the clinical effectiveness and cost-effectiveness of three strategies for managing caries in primary teeth and (2) to assess quality of life, dental anxiety, the acceptability and experiences of children, parents and dental professionals, and caries development and/or progression. DESIGN This was a multicentre, three-arm parallel-group, participant-randomised controlled trial. Allocation concealment was achieved by use of a centralised web-based randomisation facility hosted by Newcastle Clinical Trials Unit. SETTING This trial was set in primary dental care in Scotland, England and Wales. PARTICIPANTS Participants were NHS patients aged 3-7 years who were at a high risk of tooth decay and had at least one primary molar tooth with decay into dentine, but no pain/sepsis. INTERVENTIONS Three interventions were employed: (1) conventional with best-practice prevention (local anaesthetic, carious tissue removal, filling placement), (2) biological with best-practice prevention (sealing-in decay, selective carious tissue removal and fissure sealants) and (3) best-practice prevention alone (dietary and toothbrushing advice, topical fluoride and fissure sealing of permanent teeth). MAIN OUTCOME MEASURES The clinical effectiveness outcomes were the proportion of children with at least one episode (incidence) and the number of episodes, for each child, of dental pain or dental sepsis or both over the follow-up period. The cost-effectiveness outcomes were the cost per incidence of, and cost per episode of, dental pain and/or dental sepsis avoided over the follow-up period. RESULTS A total of 72 dental practices were recruited and 1144 participants were randomised (conventional arm, n = 386; biological arm, n = 381; prevention alone arm, n = 377). Of these, 1058 were included in an intention-to-treat analysis (conventional arm, n = 352; biological arm, n = 352; prevention alone arm, n = 354). The median follow-up time was 33.8 months (interquartile range 23.8-36.7 months). The proportion of children with at least one episode of pain or sepsis or both was 42% (conventional arm), 40% (biological arm) and 45% (prevention alone arm). There was no evidence of a difference in incidence or episodes of pain/sepsis between arms. When comparing the biological arm with the conventional arm, the risk difference was -0.02 (97.5% confidence interval -0.10 to 0.06), which indicates, on average, a 2% reduced risk of dental pain and/or dental sepsis in the biological arm compared with the conventional arm. Comparing the prevention alone arm with the conventional arm, the risk difference was 0.04 (97.5% confidence interval -0.04 to 0.12), which indicates, on average, a 4% increased risk of dental pain and/or dental sepsis in the prevention alone arm compared with the conventional arm. Compared with the conventional arm, there was no evidence of a difference in episodes of pain/sepsis among children in the biological arm (incident rate ratio 0.95, 97.5% confidence interval 0.75 to 1.21, which indicates that there were slightly fewer episodes, on average, in the biological arm than the conventional arm) or in the prevention alone arm (incident rate ratio 1.18, 97.5% confidence interval 0.94 to 1.48, which indicates that there were slightly more episodes in the prevention alone arm than the conventional arm). Over the willingness-to-pay values considered, the probability of the biological treatment approach being considered cost-effective was approximately no higher than 60% to avoid an incidence of dental pain and/or dental sepsis and no higher than 70% to avoid an episode of pain/sepsis. CONCLUSIONS There was no evidence of an overall difference between the three treatment approaches for experience of, or number of episodes of, dental pain or dental sepsis or both over the follow-up period. FUTURE WORK Recommendations for future work include exploring barriers to the use of conventional techniques for carious lesion detection and diagnosis (e.g. radiographs) and developing and evaluating suitable techniques and strategies for use in young children in primary care. TRIAL REGISTRATION Current Controlled Trials ISRCTN77044005. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anne Maguire
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jan E Clarkson
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | | | - Vicky Ryan
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Robertson
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Alaa Abouhajar
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Richard D Holmes
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Barbara Chadwick
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Christopher Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Ferranti Wong
- Institute of Dentistry, Queen Mary University of London, London, UK
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Tychsen L, Foeller P. Effects of Immersive Virtual Reality Headset Viewing on Young Children: Visuomotor Function, Postural Stability, and Motion Sickness. Am J Ophthalmol 2020; 209:151-159. [PMID: 31377280 DOI: 10.1016/j.ajo.2019.07.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess the safety of VR 3D headset (virtual reality 3-dimensional binocular-stereoscopic near-eye display) use in young children. Product safety warnings that accompany VR headsets ban their use in children under age 13 years. DESIGN Prospective, interventional, before-and-after study. METHODS Recordings were obtained in 50 children (29 boys) aged 4-10 years (mean 7.2 ± 1.8 years). Minimum binocular corrected distance visual acuity (CDVA) was 20/50 (logarithm of the minimum angle of resolution [logMAR] 0.4) and stereoacuity 800 seconds of an arc or better. A Sony PlayStation VR headset was worn for 2 sequential play sessions (of 30 minutes each) of a first-person 3D flying game (Eagle Flight) requiring head movement to control flight direction (pitch, yaw, and roll axes). Baseline testing preceded VR exposure, and each VR session was followed by post-VR testing of binocular CDVA, refractive error, binocular eye alignment (strabismus), stereoacuity, and postural stability (imbalance). Visually induced motion sickness was probed using the Simulator Sickness Questionnaire modified for pediatric use (Peds SSQ). Visual-vestibulo-ocular reflex (V-VOR) adaptation was also tested pre- vs post-trial in 5 of the children. Safety was gauged as a decline or change from baseline in any visuomotor measure. RESULTS Forty-six of 50 children (94%) completed both VR play sessions with no significant change from baseline in measures of binocular CDVA (P = .89), refractive error (P = .36), binocular eye alignment (P = .90), or stereoacuity (P = .45). Postural stability degraded an average 9% from baseline after 60 minutes of VR exposure (P = .06). Peds SSQ scores increased a mean 4.7%-comparing pretrial to post-trial-for each of 4 symptom categories: eye discomfort (P = .02), head/neck discomfort (P = .03), fatigue (P = .03), and motion sickness (P = .01). None of the children who finished both trial sessions (94%) asked to end the play, and the majority were disappointed when play was halted. V-VOR gain remained unaltered in the 5 children tested. Three children (6% of participants) discontinued the trial during the first 10 minutes of the first session of VR play, 2 girls (aged 5 and 6 years) and 1 boy (aged 7 years). The girls reported discomfort consistent with mild motion sickness; the boy said he was bored and the headset was uncomfortable. No child manifested aftereffects ("flashbacks") in the days following the VR exposure. CONCLUSION Young children tolerate fully immersive 3D virtual reality game play without noteworthy effects on visuomotor functions. VR play did not induce significant post-VR postural instability or maladaption of the vestibulo-ocular reflex. The prevalence of discomfort and aftereffects may be less than that reported for adults.
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Affiliation(s)
- Lawrence Tychsen
- St Louis Children's Hospital at Washington University Medical Center, St Louis, Missouri, USA.
| | - Paul Foeller
- St Louis Children's Hospital at Washington University Medical Center, St Louis, Missouri, USA
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Bradshaw E, McClellan C, Whybrow P, Cramp F. Physiotherapy outcome measures of haemophilia acute bleed episodes: What matters to patients? Haemophilia 2019; 25:1066-1072. [PMID: 31522466 DOI: 10.1111/hae.13840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/22/2019] [Accepted: 08/05/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The research was conducted at a UK teaching hospital and Haemophilia Comprehensive Care Centre (CCC) as part of a research programme investigating physiotherapy for acute bleed management. AIM The aim of the study was to understand the perspectives of people with haemophilia (PWH) on validated outcome measures (OM) and whether these measures capture changes relevant to them whilst recovering from an acute bleed episode. METHODS Any person with haemophilia registered to the CCC who reported an acute bleed within the past 2 years was invited to participate. Semi-structured interviews or workshops (activity-focused discussions with small groups) were conducted with PWH who had received physiotherapy treatment in the previous two years. These were used to explore opinions of PWH of commonly used outcome measures. RESULTS Eight male PWH participated, mean age 61 years, ranging between 39 and 71. Seven participants had severe haemophilia A and 1 had von Willebrands. Participants described numerical rating scales of pain as abstract and expressed a preference for verbal or visual descriptors. In relation to function, the men generally found haemophilia-specific OM to be more relevant. The EuroQol 5-Dimension 5-Level (EQ5D-5L) and Haemophilia and Exercise Project Test Questionnaire (HEP-Test-Q) were considered as good measures due to brevity and ability to capture relevant changes promptly. CONCLUSION Participants in this study reported a preference for short OMs that allow them to reference their ability during the acute bleed episode in comparison with their normal function.
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Affiliation(s)
| | - Carey McClellan
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Fiona Cramp
- University of the West of England, Bristol, UK
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Rachel M, Biesiadecki M, Aebisher D, Galiniak S. Exhaled nitric oxide in pediatric patients with respiratory disease. J Breath Res 2019; 13:046007. [PMID: 31234165 DOI: 10.1088/1752-7163/ab2c3d] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Measurement of nitric oxide (NO) levels in exhaled air from the upper and lower airways is currently used as a non-invasive marker of inflammation in respiratory diseases. Assessment of NO exhaled from the lower air respiratory tract is considered to be a quick method for confirmation and control of asthma in patients as well as an estimation of treatment efficiency. The main aim of this study was to determine differences between levels of exhaled nitric oxide (fractional exhaled NO; FeNO) in patients with respiratory disease as measured by an electrochemical analyzer. Measurements were taken in 352 pediatric patients aged 4-17 with cystic fibrosis (CF) (n = 43), asthma (n = 69), allergic rhinitis (AR) (n = 70), asthma and AR (n = 128) and non-diseased children (n = 42) recruited from the Allergology Outpatient Department, Provincial Hospital No 2, Rzeszów. The second objective of this study was to assess any correlations between FeNO and clinical parameters of patients. The level of FeNO in patients with CF was normal when compared with control subjects (10.8 ± 2.9 versus 11.4 ± 6 ppb). We found significantly higher FeNO in patients with asthma (26.6 ± 15.3 ppb, p < 0.001), AR (18.4 ± 9.6 ppb, p < 0.01) as well as in patients with both asthma and AR (43.3 ± 31.1 ppb, p < 0.001) when compared to healthy children. Statistical analysis revealed a positive correlation between FeNO and age, height and weight of control subjects, and height in children with AR. FeNO was independent of sex, BMI, spirometry and blood results as well as the type of residence in control children and subjects with CF, asthma, AR and combined asthma and AR. In conclusion, we found normal levels of FeNO in children with CF and elevated levels in patients with asthma, AR and combined asthma and AR as compared to control subjects. Due to conflicting data, there is still a need for additional research, especially related to regarding factors that affect FeNO levels in respiratory disease.
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Affiliation(s)
- Marta Rachel
- Faculty of Medicine, University of Rzeszów, Warzywna 1, 35-315 Rzeszów, Poland. Allergology Outpatient Department, Provincial Hospital No 2, Lwowska 60, 35-301 Rzeszów, Poland
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Haploinsufficiency of the brain-derived neurotrophic factor gene is associated with reduced pain sensitivity. Pain 2019; 160:1070-1081. [PMID: 30855519 DOI: 10.1097/j.pain.0000000000001485] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Rare pain-insensitive individuals offer unique insights into how pain circuits function and have led to the development of new strategies for pain control. We investigated pain sensitivity in humans with WAGR (Wilms tumor, aniridia, genitourinary anomaly, and range of intellectual disabilities) syndrome, who have variably sized heterozygous deletion of the 11p13 region. The deletion region can be inclusive or exclusive of the brain-derived neurotrophic factor (BDNF) gene, a crucial trophic factor for nociceptive afferents. Nociceptive responses assessed by quantitative sensory testing demonstrated reduced pain sensitivity only in the WAGR subjects whose deletion boundaries included the BDNF gene. Corresponding behavioral assessments were made in heterozygous Bdnf knockout rats to examine the specific role of Bdnf. These analogous experiments revealed impairment of Aδ- and C-fiber-mediated heat nociception, determined by acute nociceptive thermal stimuli, and in aversive behaviors evoked when the rats were placed on a hot plate. Similar results were obtained for C-fiber-mediated cold responses and cold avoidance on a cold-plate device. Together, these results suggested a blunted responsiveness to aversive stimuli. Our parallel observations in humans and rats show that hemizygous deletion of the BDNF gene reduces pain sensitivity and establishes BDNF as a determinant of nociceptive sensitivity.
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Senno R, Schonfeld E, Nagar C. OnabotulinumtoxinA injections: treatment of reversible cerebral vasoconstriction syndrome chronic daily headaches. BMJ Case Rep 2019; 12:12/5/e228562. [DOI: 10.1136/bcr-2018-228562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare condition characterised by repetitive, multifocal, vasofluctuations of cerebral arteries. A key symptom is chronic, disabling ‘thunderclap’ headaches, which are extremely difficult to treat as established medications may exacerbate the pathophysiology of RCVS. OnabotulinumtoxinA (OBT-A) injections are used for the prophylaxis of chronic daily headaches (CDH). The mechanism of action of OBT-A significantly differs from oral headache treatments. Thus, OBT-A may be an effective, safe treatment of RCVS-CDH. A 51-year-old woman with RCVS-CDH presented to outpatient clinic. This case report describes the first, believed, documented treatment of RCVS-CDH by OBT-A injections. In 2018, the consented patient received a total of 200 units of OBT-A, 155 units to the 31 approved U.S. Food and Drug Administration (FDA) sites and 45 units injected into the bilateral occipital belly of occipitofrontalis muscles. The patient reported 3 months of excellent pain relief (60% reduction). Three rounds of OBT-A injection, each 3 months apart, resulted in 80% reduction. OBT-A injections may prove a successful, novel treatment for RCVS-CDH.
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Kumar A, Das S, Chauhan S, Kiran U, Satapathy S. Perioperative Anxiety and Stress in Children Undergoing Congenital Cardiac Surgery and Their Parents: Effect of Brief Intervention—A Randomized Control Trial. J Cardiothorac Vasc Anesth 2019; 33:1244-1250. [DOI: 10.1053/j.jvca.2018.08.187] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Indexed: 11/11/2022]
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Manini TM, Mendoza T, Battula M, Davoudi A, Kheirkhahan M, Young ME, Weber E, Fillingim RB, Rashidi P. Perception of Older Adults Toward Smartwatch Technology for Assessing Pain and Related Patient-Reported Outcomes: Pilot Study. JMIR Mhealth Uhealth 2019; 7:e10044. [PMID: 30912756 PMCID: PMC6454335 DOI: 10.2196/10044] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 11/09/2018] [Accepted: 01/06/2019] [Indexed: 12/23/2022] Open
Abstract
Background Chronic pain, including arthritis, affects about 100 million adults in the United States. Complexity and diversity of the pain experience across time and people and its fluctuations across and within days show the need for valid pain reports that do not rely on patient’s long-term recall capability. Smartwatches can be used as digital ecological momentary assessment (EMA) tools for real-time collection of pain scores. Smartwatches are generally less expensive than smartphones, are highly portable, and have a simpler user interface, providing an excellent medium for continuous data collection and enabling a higher compliance rate. Objective The aim of this study was to explore the attitudes and perceptions of older adults towards design and technological aspects of a smartwatch framework for measuring patient report outcomes (PRO) as an EMA tool. Methods A focus group session was conducted to explore the perception of participants towards smartwatch technology and its utility for PRO assessment. Participants included older adults (age 65+), with unilateral or bilateral symptomatic knee osteoarthritis. A preliminary user interface with server communication capability was developed and deployed on 10 Samsung Gear S3 smartwatches and provided to the users during the focus group. Pain was designated as the main PRO, while fatigue, mood, and sleep quality were included as auxiliary PROs. Pre-planned topics included participants’ attitude towards the smartwatch technology, usability of the custom-designed app interface, and suitability of the smartwatch technology for PRO assessment. Discussions were transcribed, and content analysis with theme characterization was performed to identify and code the major themes. Results We recruited 19 participants (age 65+) who consented to take part in the focus group study. The overall attitude of the participants toward the smartwatch technology was positive. They showed interest in the direct phone-call capability, availability of extra apps such as the weather apps and sensors for tracking health and wellness such as accelerometer and heart rate sensor. Nearly three-quarters of participants showed willingness to participate in a one-year study to wear the watch daily. Concerns were raised regarding usability, including accessibility (larger icons), notification customization, and intuitive interface design (unambiguous icons and assessment scales). Participants expressed interest in using smartwatch technology for PRO assessment and the availability of methods for sharing data with health care providers. Conclusions All participants had overall positive views of the smartwatch technology for measuring PROs to facilitate patient-provider communications and to provide more targeted treatments and interventions in the future. Usability concerns were the major issues that will require special consideration in future smartwatch PRO user interface designs, especially accessibility issues, notification design, and use of intuitive assessment scales.
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Affiliation(s)
- Todd Matthew Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Tonatiuh Mendoza
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Manoj Battula
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, FL, United States
| | - Anis Davoudi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Matin Kheirkhahan
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, FL, United States
| | - Mary Ellen Young
- Department of Occupational Therapy, University of Florida, Gainesville, FL, United States
| | - Eric Weber
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
| | - Roger Benton Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
| | - Parisa Rashidi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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Resnik L, Acluche F, Borgia M, Cancio J, Latlief G, Sasson N. Function, quality of life, and community integration of DEKA Arm users after discharge from prosthetic training: Impact of home use experience. Prosthet Orthot Int 2018; 42:571-582. [PMID: 29779455 DOI: 10.1177/0309364618774054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Research on adaptation to advanced upper limb prostheses is needed. OBJECTIVES: To (1) examine change in function, quality of life and community integration after prosthetic training, (2) determine whether change in outcomes varied by prosthesis complexity, and (3) compare patterns of change at 1 month for those who withdrew from the study and those who did not. STUDY DESIGN: Quasi-experimental time series. METHODS: Data were analyzed for 22 participants (18 completers). Performance and self-report outcome measures were collected after in-laboratory training (Part A) and every 4 weeks of home use (Part B). Outcomes from End of A to End of B were compared statistically. Outcomes across assessments and by configuration level were compared graphically. Changes in scores were compared graphically for completers and non-completers. RESULTS: Quality of life scores did not change between End of A and End of B, whereas scores improved for one activity measure, two measures of self-reported function, and three dexterity measures ( p < 0.05). Outcomes of community integration, self-reported function, four dexterity measures, and one activity measure varied by prosthesis level. For participants who withdrew early, dexterity and activity scores worsened, perceived disability increased, and prosthesis satisfaction decreased after 4 weeks of home use. CONCLUSION: Study completers adapted to the DEKA Arm. CLINICAL RELEVANCE Findings suggest that for the majority of upper limb amputees discharged from prosthetic rehabilitation, function continues to improve with home use. However, a minority experience a decline in function, greater perceived disability, and greater dissatisfaction after 4 weeks, suggesting a need for continued therapy after intensive prosthetic training ends.
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Affiliation(s)
- Linda Resnik
- 1 Providence VA Medical Center, Rhode Island, Providence, RI, USA.,2 The Department of Health Services, Policy, and Practice, Brown University, Providence, RI, USA
| | - Frantzy Acluche
- 1 Providence VA Medical Center, Rhode Island, Providence, RI, USA
| | - Matthew Borgia
- 1 Providence VA Medical Center, Rhode Island, Providence, RI, USA
| | - Jill Cancio
- 3 Extremity Trauma and Amputation Center of Excellence (EACE), Military Performance Laboratory, Center for the Intrepid, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Gail Latlief
- 4 Regional Amputation Center, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Nicole Sasson
- 5 Physical Medicine & Rehabilitation, VA NY Harbor Healthcare System and Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
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Resnik LJ, Acluche F, Borgia M, Cancio J, Latlief G, Phillips S, Sasson N. EMG pattern recognition compared to foot control of the DEKA Arm. PLoS One 2018; 13:e0204854. [PMID: 30335781 PMCID: PMC6193636 DOI: 10.1371/journal.pone.0204854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction EMG pattern recognition control (EMG-PR) is a promising option for control of upper limb prostheses with multiple degrees of freedom (DOF). The purposes of this study were to 1) evaluate outcomes of EMG-PR and inertial measurement units (IMU) control of the DEKA Arm as compared to personal prosthesis; and 2) compare outcomes of EMG-PR to IMU control of DEKA Arm. Methods This was a quasi-experimental, multi-site study with repeated measures that compared non-randomized groups using two types of controls: EMG-PR and IMUs. Subjects (N = 36) were transradial (TR) and transhumeral (TH) amputees. Outcomes were collected at Baseline (using personal prosthesis), and after in-laboratory training (Part A), and home use (Part B). Data was compared to personal prosthesis, stratified by amputation level and control type. Outcomes were also compared by control type. Results The EMG-PR group had greater prosthesis use after Part A, but worse dexterity, lower satisfaction, and slower activity performance compared to Baseline; the IMU group had slower activity performance. After Part B, the EMG-PR group had less perceived activity difficulty; the IMU group had improved activity performance, improved disability and activity difficulty, but slower performance. No differences were observed for TH group by control type in Part A or B. The TR group using EMG-PR had worse dexterity (Parts A & B), and activity performance (Part A) as compared to IMU users. Discussion/Conclusion Findings suggest that for the TR group that IMUs are a more effective control method for the DEKA Arm as compared to the EMG-PR prototypes employed in this study. Further research is needed to refine the EMG-PR systems for multi-DOF devices. Future studies should include a larger sample of TH amputees. Trial registration ClinicalTrials.gov NCT01551420.
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Affiliation(s)
- Linda J. Resnik
- Research Department, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Health Services, Policy and Practice, Brown University, Providence, Rhode Island, United States of America
- * E-mail:
| | - Frantzy Acluche
- Research Department, Providence VA Medical Center, Providence, Rhode Island, United States of America
| | - Matthew Borgia
- Research Department, Providence VA Medical Center, Providence, Rhode Island, United States of America
| | - Jill Cancio
- Center for the Intrepid, Brooke Army Medical Center JBSA-Ft. Sam Houston, Fort Sam Houston, TX, United States of America
- Extremtiy Trauma and Amputation Center of Excellence, Fort Sam Houston, Texas, United States of America
| | - Gail Latlief
- Department of PM&R James A Haley Veteran’s Hospital, Tampa, FL, United States of America
| | - Samuel Phillips
- Department of PM&R James A Haley Veteran’s Hospital, Tampa, FL, United States of America
| | - Nicole Sasson
- NYU School of Medicine, New York, New York, United States of America
- VA NY Health Harbor System, New York, New York, United States of America
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Raffaini M, Cocconi R, Spinelli G, Agostini T. Simultaneous Rhinoseptoplasty and Orthognathic Surgery: Outcome Analysis of 250 Consecutive Patients Using a Modified Le Fort I Osteotomy. Aesthetic Plast Surg 2018; 42:1090-1100. [PMID: 29560545 DOI: 10.1007/s00266-018-1121-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/09/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of the present study was to assess the safety and efficacy of both functional intranasal procedures and cosmetic rhinoplasty combined with bimaxillary surgery. METHODS The author executed a retrospective cohort study derived from patients who underwent combined rhinoseptoplasty and bimaxillary surgery at a private practice setting (Face Surgery Center, Parma, Italy) between April 2006 and 2015 by a single surgeon. The minimum follow-up was 12 months. Patients underwent bimaxillary orthognathic surgery, functional nasal surgery and cosmetic rhinoplasty. RESULTS Two-hundred and fifty (250) consecutive, non-randomized patients met the inclusion criteria to enter the study. The overall complication rate was 5%, whereas the revision rate was 9%, showing an overall low rate, comparable to that of primary rhinoplasty (control group). About 94% of the patients polled after this procedure asserted they definitely accepted to have rhinoplasty only because it was included in one single surgical act together with orthognathic surgery. CONCLUSION Cosmetic rhinoplasty shows great potentials to change our patients' appearance, whereas orthognathic surgery corrects jaw skeletal deformities and builds the right foundation for facial harmony. The combination of both procedures magnifies the single results reciprocally and significantly enhances the final outcomes. The quality of the overall aesthetic results, the scarcity of complications and the low percentage of defects that require revisions lead to the conclusion that when alterations to both the jaws and the nose are detected, a single intervention can grant great benefit to the patients in terms of morbidity and costs. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- M Raffaini
- Face Surgery Center, Via R. Bormioli 5/A, 43122, Parma, Italy
| | - R Cocconi
- Face Surgery Center, Via R. Bormioli 5/A, 43122, Parma, Italy
| | - G Spinelli
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Largo Palagi 1, 50134, Florence, Italy
| | - T Agostini
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Largo Palagi 1, 50134, Florence, Italy.
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Ngo DYJ, Thomson WM, Subramaniam M, Abdin E, Ang KY. The oral health of long-term psychiatric inpatients in Singapore. Psychiatry Res 2018; 266:206-211. [PMID: 29870958 DOI: 10.1016/j.psychres.2018.05.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/15/2018] [Accepted: 05/21/2018] [Indexed: 11/19/2022]
Abstract
This cross-sectional study aims to describe the dental caries experience, treatment needs, and experience of dry mouth of 191 long-term psychiatric inpatients in Singapore. Medical history, dental caries experience [represented by the Decayed Missing or Filled Teeth index (DMFT)], salivary flow, and treatment needs were recorded. Information on brushing, pain (when eating), and xerostomia was gathered. Bivariate analysis was used to examine the associations of DMFT, saliva flow, the presence of salivary gland hypofunction (SGH), and xerostomia. Simple linear regression was used to examine the association between SGH and DMFT. The sample comprised 143 men (74.9%) and 48 women (25.1%), aged 24 to 80 years old. 169 patients (88.5%) had schizophrenia. DMFT ranged from 0 to 32, with a mean of 21.6 (SD 9.7). Mean DMFT scores were significantly higher among males and older patients. 77 of 176 patients (43.8%) were found to have SGH. SGH was associated with a higher mean DMFT. Those taking classical antipsychotics and anticholinergics had significantly lower mean saliva flow and tended to have SGH. 107 of 165 patients (64.8%) were found to experience xerostomia. Long-term psychiatric inpatients in Singapore have poor oral health, unmet treatment needs, and suffer from dry mouth.
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Affiliation(s)
- Di Ying Joanna Ngo
- Research Division, Institute of Mental Health, Singapore; Oral Health Unit, Auckland District Health Board, Auckland, New Zealand.
| | - W Murray Thomson
- Department of Oral Sciences, University of Otago School of Dentistry, Otago, New Zealand
| | | | | | - Kok-Yang Ang
- Dental Department, Tan Tock Seng Hospital, Singapore
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Ruggieri DG, Bass SB, Alhajji M, Gordon TF. Understanding Parents' Perceptions of School-Based BMI Screening and BMI Report Cards Using Perceptual Mapping: Implications for School Nurses. J Sch Nurs 2018; 36:144-156. [PMID: 30033842 DOI: 10.1177/1059840518789243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Half of U.S. states measure students' body mass index (BMI), with many communicating that information to parents through a "BMI report card" or notification letter. School nurses are usually responsible for implementing these programs and communicating results to parents. The purpose of this study was to understand parents' perceptions of BMI screening programs to help inform school nurses about messages that are most helpful to use in report cards to motivate parents to follow-up with a health-care provider or to make behavioral changes for their child. Using a cluster analysis and perceptual mapping methods, a commercial marketing technique that creates three-dimensional graphic maps, we identified four unique clusters of parents based on their core attitudes and beliefs related to BMI screenings and report cards. Based on vector modeling techniques, key message strategies were developed that can be used by school nurses to enhance parent response to a BMI report card.
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Affiliation(s)
- Dominique G Ruggieri
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mohammed Alhajji
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Thomas F Gordon
- Psychology Department, College of Fine Arts, Humanities and Social Sciences, University of Massachusetts Lowell, Lowell, MA, USA
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Resnik L, Borgia M, Acluche F. Timed activity performance in persons with upper limb amputation: A preliminary study. J Hand Ther 2018; 30:468-476. [PMID: 28487130 DOI: 10.1016/j.jht.2017.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 03/23/2017] [Accepted: 03/30/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN 55 subjects with upper limb amputation were administered the T-MAP twice within one week. PURPOSE To develop a timed measure of activity performance for persons with upper limb amputation (T-MAP); examine the measure's internal consistency, test-retest reliability and validity; and compare scores by prosthesis use. INTRODUCTION Measures of activity performance for persons with upper limb amputation are needed The time required to perform daily activities is a meaningful metric that implication for participation in life roles. METHODS Internal consistency and test-retest reliability were evaluated. Construct validity was examined by comparing scores by amputation level. Exploratory analyses compared sub-group scores, and examined correlations with other measures. RESULTS Scale alpha was 0.77, ICC was 0.93. Timed scores differed by amputation level. Subjects using a prosthesis took longer to perform all tasks. T-MAP was not correlated with other measures of dexterity or activity, but was correlated with pain for non-prosthesis users. DISCUSSION The timed scale had adequate internal consistency and excellent test-retest reliability. CONCLUSIONS Analyses support reliability and construct validity of the T-MAP. LEVEL OF EVIDENCE 2c "outcomes" research.
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Affiliation(s)
- Linda Resnik
- Providence VA Medical Center, Providence, RI, USA; Health Services, Policy and Practice, Brown University, Providence, RI, USA.
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A PROSPECTIVE, RANDOMIZED TRIAL COMPARING PLAIN GUT TO POLYGLACTIN 910 (VICRYL) SUTURES FOR SCLEROTOMY CLOSURE AFTER 23-GAUGE PARS PLANA VITRECTOMY. Retina 2018; 38:1216-1219. [DOI: 10.1097/iae.0000000000001684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sruthi S, Mandal B, Rohit MK, Puri GD. Dexmedetomidine versus ketofol sedation for outpatient diagnostic transesophageal echocardiography: A randomized controlled study. Ann Card Anaesth 2018; 21:143-150. [PMID: 29652275 PMCID: PMC5914214 DOI: 10.4103/aca.aca_171_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Moderate sedation is required for out-patient transesophageal echocardiography (TEE). Our objective was to compare the effect of Ketofol and dexmedetomidine for outpatient procedural sedation in diagnostic TEE with a hypothesis that Ketofol would be as effective as dexmedetomidine. Patients and. Methods Fifty adult patients of age group 18-60 years with atrial septal defect, rheumatic valvular heart disease undergoing diagnostic TEE in the outpatient echocardiography laboratory were randomized into two groups, group D and group KF. GROUP D: Dexmedetomidine infusion -200 μg in 20 ml normal saline. GROUP KF: Ketofol infusion: (ketamine: propofol, 1mg: 3 mg in 20 ml syringe). Loading dose of drug at 1ml/kg/hour IV till Ramsay sedation score (RSS) ≥ 3 achieved followed by maintenance infusion at 0.05 ml/kg/hour till end of procedure. Results The primary outcome - time to achieve Ramsay sedation score ≥ 3 was significantly lesser with Ketofol as compared to Dexmedetomidine 260[69] seconds vs 460 [137], (p value<0.05). Conclusion In out-patient setting, ketofol is favourable over dexmedetomidine for sedation regimen for diagnostic TEE as lesser time is taken to achieve optimal sedation with lesser hemodynamic perturbations, post procedure complications and better cardiologist satisfaction.
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Affiliation(s)
- S Sruthi
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Banashree Mandal
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Abstract
BACKGROUND Measures of activity performance for adults with upper limb amputation are needed. The purposes of this study were to evaluate the measurement properties of a new measure of activity performance for adults with upper limb amputation, which we call the Brief Activity Measure for Upper Limb Amputees (BAM-ULA) and to compare BAM-ULA scores for users of different types of prostheses. METHODS In all, 35 persons with upper limb amputation were administered the BAM-ULA, twice within 1 week. Internal consistency and test-retest reliability were evaluated. Construct validity was examined by comparing scores by amputation level. Concurrent validity was evaluated by examining correlations with other measures. Exploratory analyses using linear regression compared sub-group scores for users of myoelectric and body-powered devices, and for users of single-degree-of-freedom and multi-articulating devices, controlling for amputation level. RESULTS The scale alpha was 0.83; intraclass correlation coefficient was 0.91. Item scores differed by amputation level and device type. Persons with transradial amputation completed more items than those with amputations at the transhumeral or shoulder level ( p < 0.05). Users of myoelectric devices completed more items than users of body-powered devices ( p < 0.05). The BAM-ULA strongly correlated with the Activities Measure for Upper Limb Amputees; R = 0.86) and three modified Jebsen-Taylor Hand Function Tests ( R = 0.62-0.68) and moderately correlated with one Jebsen-Taylor Hand Function Test ( R = 0.46) as well as with the Wong-Baker FACES Pain Rating Scale. No differences in scores were found by degree of freedom of the terminal device after controlling for amputation level. CONCLUSION Analyses support reliability, construct validity, and concurrent validity of the Brief Activity Measure for Upper Limb Amputees. This new briefer measure is easier to score than the Activities Measure for Upper Limb Amputees. Clinical relevance This article reported on the development and evaluation of a brief 10-item measure of activity performance for persons with upper limb impairment, the BAM-ULA. The BAM-ULA takes 10 min to administer and has a simple scoring method, which may facilitate its adoption by clinicians in the field.
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Affiliation(s)
- Linda Resnik
- Providence VA Medical Center, Providence, RI, USA
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Resnik LJ, Borgia ML, Acluche F, Cancio JM, Latlief G, Sasson N. How do the outcomes of the DEKA Arm compare to conventional prostheses? PLoS One 2018; 13:e0191326. [PMID: 29342217 PMCID: PMC5771605 DOI: 10.1371/journal.pone.0191326] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022] Open
Abstract
Objectives Objectives were to 1) compare self-reported function, dexterity, activity performance, quality of life and community integration of the DEKA Arm to conventional prostheses; and 2) examine differences in outcomes by conventional prosthesis type, terminal device type and by DEKA Arm configuration level. Methods This was a two-part study; Part A consisted of in-laboratory training. Part B consisted of home use. Study participants were 23 prosthesis users (mean age = 45 ± 16; 87% male) who completed Part A, and 15 (mean age = 45 ± 18; 87% male) who completed Parts A and B. Outcomes including self-report and performance measures, were collected at Baseline using participants’ personal prostheses and at the End of Parts A and B. Scores were compared using paired t-tests. Wilcoxon signed-rank tests were used to compare outcomes for the full sample, and for the sample stratified by device and terminal device type. Analysis of outcomes by configuration level was performed graphically. Results At the End of Part A activity performance using the DEKA Arm and conventional prosthesis was equivalent, but slower with the DEKA Arm. After Part B, performance using the DEKA Arm surpassed conventional prosthesis scores, and speed of activity completion was equivalent. Participants reported using the DEKA Arm to perform more activities, had less perceived disability, and less difficulty in activities at the End of A and B as compared to Baseline. No differences were observed in dexterity, prosthetic skill, spontaneity, pain, community integration or quality of life. Comparisons stratified by device type revealed similar patterns. Graphic comparisons revealed variations by configuration level. Conclusion Participants using the DEKA Arm had less perceived disability and more engagement of the prosthesis in everyday tasks, although activity performance was slower. After home use experience, activity performance was improved and activity speed equivalent to using conventional prostheses.
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Affiliation(s)
- Linda J. Resnik
- Research Department, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Health Services, Policy and Practice, Brown University, Providence, Rhode Island, United States of America
- * E-mail:
| | - Matthew L. Borgia
- Research Department, Providence VA Medical Center, Providence, Rhode Island, United States of America
| | - Frantzy Acluche
- Research Department, Providence VA Medical Center, Providence, Rhode Island, United States of America
| | - Jill M. Cancio
- Center for the Intrepid, Brooke Army Medical Center JBSA, Ft. Sam Houston, TX, United States of America
- Extremtiy Trauma and Amputation Center of Excellence, Ft. Sam Houston, TX, United States of America
| | - Gail Latlief
- Department of PM&R, James A Haley Veteran’s Hospital, Tampa, FL, United States of America
| | - Nicole Sasson
- NYU School of Medicine, New York, New York, United States of America
- VA NY Health Harbor System, New York, New York, United States of America
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Kleinknecht‐Dolf M, Spichiger E, Müller M, Bartholomeyczik S, Spirig R. Advancement of the German version of the moral distress scale for acute care nurses-A mixed methods study. Nurs Open 2017; 4:251-266. [PMID: 29085651 PMCID: PMC5653387 DOI: 10.1002/nop2.91] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/03/2017] [Indexed: 12/25/2022] Open
Abstract
AIM Moral distress experienced by nurses in acute care hospitals can adversely impact the affected nurses, their patients and their hospitals; therefore, it is advisable for organizations to establish internal monitoring of moral distress. However, until now, no suitable questionnaire has been available for use in German-speaking contexts. Hence, the aim of this study was to develop and psychometrically test a German-language version of the Moral Distress Scale. DESIGN We chose a sequential explanatory mixed methods design, followed by a second quantitative cross-sectional survey. METHODS An American moral distress scale was chosen, translated, culturally adapted, tested in a pilot study and subsequently used in 2011 to conduct an initial web-based quantitative cross-sectional survey of nurses in all inpatient units at five hospitals in Switzerland's German-speaking region. Data were analysed descriptively and via a Rasch analysis. In 2012, four focus group interviews were conducted with 26 nurses and then evaluated using knowledge maps. The results were used to improve the questionnaire. In 2015, using the revised German-language instrument, a second survey and Rasch analysis were conducted. RESULTS The descriptive results of the first survey's participants (n = 2153; response rate: 44%) indicated that moral distress is a salient phenomenon in Switzerland. The data from the focus group interviews and the Rasch analysis produced information valuable for the questionnaire's further development. Alongside the data from the second survey's participants (n = 1965; response rate: 40%), the Rasch analysis confirmed the elimination of previous deficiencies on its psychometrics. A Rasch-scaled German version of the Moral Distress Scale is now available for use.
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Affiliation(s)
- Michael Kleinknecht‐Dolf
- Department of Nursing and Allied Health Care ProfessionalsUniversity Hospital ZurichZurichSwitzerland
- Faculty for HealthSchool of Nursing ScienceUniversity Witten/HerdeckeWittenGermany
| | - Elisabeth Spichiger
- Directorate of NursingMedical‐Technical and Medical‐Therapeutic Areas, InselspitalBern University HospitalSwitzerland
- Nursing ScienceFaculty of MedicineDepartment Public HealthUniversity of BaselBaselSwitzerland
| | - Marianne Müller
- Institute of Data Analysis and Process DesignSchool of EngineeringZurich University of Applied SciencesWinterthurSwitzerland
| | | | - Rebecca Spirig
- Department of Nursing and Allied Health Care ProfessionalsUniversity Hospital ZurichZurichSwitzerland
- Faculty for HealthSchool of Nursing ScienceUniversity Witten/HerdeckeWittenGermany
- Nursing ScienceFaculty of MedicineDepartment Public HealthUniversity of BaselBaselSwitzerland
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Chi NC, Demiris G, Pike KC, Washington K, Oliver DP. Pain Management Concerns From the Hospice Family Caregivers' Perspective. Am J Hosp Palliat Care 2017; 35:601-611. [PMID: 28875732 DOI: 10.1177/1049909117729477] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pain management is a challenging task for family caregivers in home hospice care. However, there are limited studies that examine the challenges regarding pain management in hospice care from family caregivers' perspectives. OBJECTIVES To identify the challenges related to pain management faced by family caregivers in hospice care and to examine the validity of an existing framework that outlines pain management challenges for hospice family caregivers. DESIGN We conducted a theory-driven, deductive content analysis of secondary data obtained from hospice family caregivers' interviews from a randomized clinical trial. SETTING/PARTICIPANTS We included baseline interviews of 15 hospice caregivers of patients from hospice agencies in the States of Washington. The majority of the participants were white and female caregivers. They were spouse/partner or adult child living with the patient. RESULTS The study identified 5 out of the 6 major themes in the original framework and confirmed that hospice family caregivers face a variety of challenges: caregiver-centric issues, caregiver's medication skills and knowledge, communication and teamwork, organizational skill, and patient-centric issues. A couple of the subthemes in the original framework were not present in our findings. We also expanded the original framework by adding 1 subtheme and revised 2 definitions in the original framework. CONCLUSION The study provided an investigation on hospice family caregivers' difficulties in pain management. The results can inform health-care providers and researchers of family caregivers' challenges and provide insights for future designs of educational tools targeting pain management strategies, so that family caregivers can perform pain management effectively at home.
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Affiliation(s)
- Nai-Ching Chi
- 1 College of Nursing, University of Iowa, Iowa City, IA, USA
| | - George Demiris
- 2 Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA.,3 Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kenneth C Pike
- 4 Department of Psychosocial and Community Health, School of Nursing, Universality of Washington, Seattle, WA, USA
| | - Karla Washington
- 5 Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Debra Parker Oliver
- 5 Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
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Anderson LJ, Baker LL, Schroeder ET. Blunted Myoglobin and Quadriceps Soreness After Electrical Stimulation During the Luteal Phase or Oral Contraception. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2017; 88:193-202. [PMID: 28388333 DOI: 10.1080/02701367.2017.1300229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Acute muscle damage after exercise triggers subsequent regeneration, leading to hypertrophy and increased strength after repeated exercise. It has been debated whether acute exercise-induced muscle damage is altered under various premenopausal estrogen conditions. Acute contraction-induced muscle damage was compared during exogenous (oral contraceptive, OC), endogenous (luteal phase, HI), or low (menses, LO) estrogen in healthy young women aged 21 to 30 years old. METHODS Women (OC, n = 9; HI, n = 9; LO, n = 8; total N = 26) performed 1 neuromuscular electrical stimulation (NMES) bout. Soreness, measured via visual analog scale and the Likert Scale of Muscle Soreness for Lower Limb (LSMSLL), quadriceps strength, and plasma myoglobin (Mb), interleukin (IL)-6, IL-8, and granulocyte-colony stimulating factor were measured before and after NMES. RESULTS NMES performance was similar across groups. Meaningful within-group increases in Mb (effect size [ES] = 1.12) and IL-8 (ES = 0.38) occurred in LO; ES for HI and OC were trivial. ES of the between-group difference in change was moderate for Mb (LO vs. HI = 1.15) and IL-8 (LO vs. HI = 0.86; LO vs. OC = 0.73). 17-β estradiol correlated moderately and negatively with Mb relative change (r = -.52, p < .05). LO had ~5% greater strength loss than OC and HI. The mean change score for the LSMSLL 2 days post-NMES was clinically greater in LO than OC or HI. CONCLUSIONS Acute NMES-induced indicators of muscle fiber damage and qualitative muscle soreness may be attenuated during the luteal phase or active OC pill consumption compared with the menstrual phase.
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Srinivasan V, Pung D, O’Neill SP. Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children. World J Clin Pediatr 2017; 6:110-117. [PMID: 28540195 PMCID: PMC5424279 DOI: 10.5409/wjcp.v6.i2.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/04/2017] [Accepted: 03/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To describe our institutional experience with conversion from intravenous (IV) fentanyl infusion directly to enteral methadone and occurrence of withdrawal in critically ill mechanically ventilated children exposed to prolonged sedation and analgesia.
METHODS With Institutional Review Board approval, we retrospectively studied consecutively admitted invasively mechanically ventilated children (0-18 years) sedated with IV fentanyl infusion > 5 d and subsequently converted directly to enteral methadone. Data were obtained on subject demographics, illness severity, daily IV fentanyl and enteral methadone dosing, time to complete conversion, withdrawal scores (WAT-1), pain scores, and need for rescue opioids. Patients were classified as rapid conversion group (RCG) if completely converted ≤ 48 h and slow conversion group (SCG) if completely converted in > 48 h. Primary outcome was difference in WAT-1 scores at 7 d. Secondary outcomes included differences in overall pain scores, and differences in daily rescue opioids.
RESULTS Compared to SCG (n = 21), RCG (n = 21) had lower median WAT-1 scores at 7 d (2.5 vs 5, P = 0.027). Additionally, RCG had lower overall median pain scores (3 vs 6, P = 0.007), and required less median daily rescue opioids (3 vs 12, P = 0.003) than SCG. The starting daily median methadone dose was 2.3 times the daily median fentanyl dose in the RCG, compared to 1.1 times in the SCG (P = 0.049).
CONCLUSION We observed wide variation in conversion from IV fentanyl infusion directly to enteral methadone and variability in withdrawal in critically ill mechanically ventilated children exposed to prolonged sedation. In those children who converted successfully from IV fentanyl infusion to enteral methadone within a period of 48 h, a methadone:fentanyl dose conversion ratio of approximately 2.5:1 was associated with less withdrawal and reduced need for rescue opioids.
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Video Nasoendoscopic-Assisted Transoral Adenoidectomy with the PEAK PlasmaBlade: A Preliminary Report of a Case Series. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1536357. [PMID: 28459055 PMCID: PMC5387823 DOI: 10.1155/2017/1536357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 03/06/2017] [Indexed: 11/17/2022]
Abstract
Objectives. The primary objective for this study is to evaluate the advantages, disadvantages, surgical applicability, and outcome of the pulsed electron avalanche knife (PEAK) PlasmaBlade in transoral adenoidectomy under direct visualization using video nasoendoscopy. Patients and Methods. In this series, six cases of adenoid hypertrophy showing varying clinical presentations in relation to its clinical course were surgically treated using a PEAK PlasmaBlade. Before and after surgery, all patients underwent nasal endoscopy to define the grading of hypertrophic adenoids and postoperative outcome. Pure tone audiometry and tympanometry tests were carried out to investigate the change in middle and inner ear functions. Results. The mean follow-up period was 23.8 months. Postoperatively, symptoms of otitis media with effusion were all relieved with closure of the air-bone gap (6/6). Other relevant ear complaints like tinnitus were resolved (1/1) and aural fullness disappeared in 87.5% of ears (7/8). Nasal obstruction (2/2) and postnasal drip (2/2) were improved after surgery. Conclusions. Based on this preliminary report of a case series in a limited sample size, we suggest that using the transoral PEAK PlasmaBlade for adenoidectomy guided by video nasoendoscopy is a safe and feasible surgical technique, allowing remarkable outcomes by providing precise tissue removal, effective hemostasis, and painless postoperative recovery.
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Hendawy FAEM, Mahmoud SH. Factors Affecting Self-Reported Pain in Children Receiving Dental Treatment. THE EUROPEAN JOURNAL OF SOCIAL & BEHAVIOURAL SCIENCES 2017; 19:185-198. [DOI: 10.15405/ejsbs.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The aim of the current study is to investigate the ability of self-reported pain tools to help dentists during pederatic patient managment and to determine the effect of different interpersonal and treatment variables as well as the level of dental anxiety on a child’s self-report pain and change after dental injection procedure. A randomized multicenter two arms clinical trial was conducted with a total of fifty children who were enrolled and divded into two groups (n = 25). The mean Group I age was 7.99 ± 0.81 and was randomly selected from pedodontics clinics at the faculty of dentistry (October 6 university, Egypt); Group II’s mean age was 7.73 ± 0.60 and was randomly selected from outpatient Tanta governmental hospitals. The tools used in the current research were personal interview, dental operator questionnaire, Venham picture test, Visual analogue scale and Wong Baker faces pain scale. İt was concluded that self reported pain in children is a relevant tool that can be used successfully for assessment of dental pain which can help dental practitioners deliver effective treatment. The most powerful factors which influence self-reported pain are age, previous positive dental experience and level of dental anxiety. This study will enable dental practioners to empathise with and deal successfully with children undergoing dental procedures.
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