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Amalia L, Ardo RT. Clinical Significance of D-dimer Level and Numeric Rating Scale with Amount of Sinus Involvement in Cerebral Sinus Thrombosis Patients. Int J Gen Med 2024; 17:2143-2149. [PMID: 38766601 PMCID: PMC11102121 DOI: 10.2147/ijgm.s460407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Cerebral venous sinus thrombosis (CVST) is a cerebral vascular disorder that currently occurs quite often and has very varied clinical symptoms. Headache is the main symptom most commonly found in patients with CVST and multiple sinus involvement often have a more severe prognosis and poor clinical outcome. This study aimed to learn the relationship between D-dimer level, numeric rating scale (NRS), and amount of sinus involvement in CVST patients. Methods This study was a retrospective observational analytic study with a cross-sectional approach using medical records and supporting data (D-dimer level and imaging finding) on patients diagnosed with CVST at Dr Hasan Sadikin Hospital Bandung. Results Sixty-five CVST patients met the study criteria with mean age of 47 years and mostly female (76.9%). Patients with single sinus involvement had a median initial NRS of 4 (range 2-6) and multiple sinus involvement was higher at 8 (range 5-9). Statistical test results showed a significant difference between D-dimer level, NRS and amount of sinus involvement (P<0.001). Conclusion D-dimer level, NRS, and amount of sinus involvement are associated with amount of sinus involvement in CVST patients. Involvement of multiple sinus will cause higher NRS with higher D-dimer level.
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Affiliation(s)
- Lisda Amalia
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ryan Tantri Ardo
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
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Fathy W, Hussein M, Magdy R, Elmoutaz H, Youssef NA, Abd Alla MF, El Shaarawy AM, Abdelbadie M. Predictive value of S100B and brain derived neurotrophic factor for radiofrequency treatment of lumbar disc prolapse. BMC Anesthesiol 2024; 24:161. [PMID: 38671372 PMCID: PMC11046968 DOI: 10.1186/s12871-024-02527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND This work aimed to analyze serum S100B levels and brain-derived neurotrophic factor (BDNF) in patients with lumbar disc prolapse to test their predictive values concerning the therapeutic efficacy of pulsed radiofrequency. METHODS This prospective interventional study was carried out on 50 patients candidates for radiofrequency for treating symptomatic lumbar disc prolapse. Pain severity and functional disability were assessed using the Numeric Rating Scale (NRS) and Functional rating index (FRI) before as well as two weeks, 1, 3, and 6 months after the radiofrequency. Quantitative assessment of serum S100B level and BDNF was done for all the included patients one day before radiofrequency. RESULTS The scores of NRS and FRI were significantly improved at two weeks, 1, 3, and 6 months following radiofrequency (P-value < 0.001 in all comparisons). Statistically significant positive correlations were found between duration of pain, NRS, and S100B serum level before radiofrequency, and both NRS (P-value = 0.001, 0.035, < 0.001 respectively) and FRI (P-value = < 0.001, 0.009, 0.001 respectively) 6 months following radiofrequency. Whereas there were statistically significant negative correlations between BDNF serum level before radiofrequency and both NRS and FRI 6 months following radiofrequency (P-value = 0.022, 0.041 respectively). NRS and S100B serum levels before radiofrequency were found to be independent predictors of NRS 6 months following radiofrequency (P-value = 0.040. <0.001, respectively). CONCLUSION Serum level of S100B is a promising biomarker that can predict functional outcomes after pulsed radiofrequency in patients with lumbar disc prolapse.
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Affiliation(s)
- Wael Fathy
- Department of Anesthesiology, Surgical ICU and Pain Management, Beni-Suef University, Salah Salem Street, Beni-Suef, 62511, Egypt.
| | - Mona Hussein
- Department of Neurology, Beni-Suef University, Beni-Suef, Egypt
| | - Rehab Magdy
- Department of Neurology, Cairo University, Cairo, Egypt
| | - Hatem Elmoutaz
- Department of Anesthesiology, Surgical ICU and Pain Management, Beni-Suef University, Salah Salem Street, Beni-Suef, 62511, Egypt
| | - Neveen A Youssef
- Department of Clinical and Chemical Pathology, Beni-Suef University, Beni-Suef, Egypt
| | - Marwa F Abd Alla
- Department of Medical Biochemistry and Molecular Biology, Beni Suef University, Beni-Suef, Egypt
| | - Ahmed M El Shaarawy
- Department of Anesthesiology, Surgical ICU and Pain Management, Beni-Suef University, Salah Salem Street, Beni-Suef, 62511, Egypt
| | - Mohamed Abdelbadie
- Department of Anesthesiology, Surgical ICU and Pain Management, Beni-Suef University, Salah Salem Street, Beni-Suef, 62511, Egypt
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3
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Nagy Z, Kiss N, Szigeti M, Áfra J, Lekka N, Misik F, Mucsi I, Banczerowski P. [Comparison of pain intensity measurements among patients with low-back pain]. Ideggyogy Sz 2024; 77:131-135. [PMID: 38591924 DOI: 10.18071/isz.77.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Background and purpose Pain intensity is the most frequently assessed health domain in clinical studies among patients with low-back pain. Visual analogue scale (VAS) and Numeric rating scale (NRS) have been the mostly used measurement tools for pain intensity. We proposed to correlate these instruments to a generic health-related quality of life measurement tool in order to show the scale with superior clinical relevance. . Methods We used cross-sectional, convenience sampling. 120 patients with chronic low-back pain administered the 29-item Patient Reported Outcomes Measurement Information System Profile with NRS included, and the VAS scale in the National Institute of Mental Health, Neurology and Neurosurgery. We determined the correlation between PROMIS domain T-scores and VAS and NRS scores. . Results We performed Spearman rank correlation test to calculate the correlation coefficient. We found VAS scales measuring pain had weak to moderate correlations with all PROMIS health domains (r = 0.24–0.55). Therefore, we compared correlation of PROMIS domain scores with PROMIS pain intensity numeric rating scale and VAS scales. PROMIS domains had moderate to strong correlations with pain intensity scale (r = 0.45–0.71). PROMIS physical function short form [r = –0.65, 95% CI (–0.75) – (–0.55)] and PROMIS pain interference short form (r = 0.71, 95% CI 0.63 – 0.79) had the strongest correlation with pain intensity item. . Conclusion NRS has showed greater correlation with PROMIS domain T-scores than VAS scale. This may prove that NRS has greater connection to another health domains, thus it correlated more to health-related quality of life than visual scale. We recommend NRS to use in further clinical studies conducted among patients with low-back pain. .
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Affiliation(s)
- Zoltán Nagy
- Országos Mentális, Ideggyógyászati, és Idegsebészeti Intézet, Budapest, Magyarország
- Semmelweis Egyetem, Idegsebészeti Tanszék, Budapest, Magyarország
| | - Nóra Kiss
- Semmelweis Egyetem, Idegsebészeti Tanszék, Budapest, Magyarország
| | - Mátyás Szigeti
- Imperial Clinical Trials Unit, Imperial College London, London, Egyesült Királyság
- Élettani Szabályozások Kutatóközpont, Óbudai Egyetem, Budapest, Magyarország
| | - Judit Áfra
- Országos Mentális, Ideggyógyászati, és Idegsebészeti Intézet, Budapest, Magyarország
| | - Norbert Lekka
- Országos Mentális, Ideggyógyászati, és Idegsebészeti Intézet, Budapest, Magyarország
| | - Ferenc Misik
- Országos Mentális, Ideggyógyászati, és Idegsebészeti Intézet, Budapest, Magyarország
| | - István Mucsi
- Ajmera Transplant Center, University Health Network and Division of Nephrology, University of Toronto, Torontó, Kanada
| | - Péter Banczerowski
- Országos Mentális, Ideggyógyászati, és Idegsebészeti Intézet, Budapest, Magyarország
- Semmelweis Egyetem, Idegsebészeti Tanszék, Budapest, Magyarország
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Paller AS, Siegfried E, Marron SE, Clark M, DiBenedetti D, Nelson L, Chao J, Bansal A, Chuang CC, Wang Z. Development and validation of a caregiver-reported Numeric Rating Scale for measuring worst scratch/itch in patients aged 6 months to younger than 6 years with atopic dermatitis. J Am Acad Dermatol 2024; 90:382-385. [PMID: 37778662 DOI: 10.1016/j.jaad.2023.08.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Dermatology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois.
| | - Elaine Siegfried
- Department of Pediatrics, Saint Louis University, St. Louis, Missouri; Department of Pediatric Dematology, Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | - Servando E Marron
- Department of Dermatology, Aragon Psychodermatology Research Group (GAI + PD), Partnered with Aragon Health Sciences Institute (IACS), University Hospital Miguel Servet, Zaragoza, Spain; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Marci Clark
- Department of Patient-Centered Outcomes Assessment, RTI Health Solutions, Ann Arbor, Michigan
| | - Dana DiBenedetti
- Department of Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, North Carolina
| | - Lauren Nelson
- Department of Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, North Carolina
| | - Jingdong Chao
- Department of Health Economics and Outcomes Research, Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Ashish Bansal
- Department of Immunology and Inflammation Clinical Development, Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Chien-Chia Chuang
- Department of Health Economics and Value Assessment, Sanofi, Cambridge, Massachusetts
| | - Zhixiao Wang
- Department of Health Economics and Outcomes Research, Regeneron Pharmaceuticals Inc., Tarrytown, New York
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Tschoner T, Mueller KR, Zablotski Y, Feist M. Pain Assessment in Cattle by Use of Numerical Rating and Visual Analogue Scales-A Systematic Review and Meta-Analysis. Animals (Basel) 2024; 14:351. [PMID: 38275811 PMCID: PMC10812761 DOI: 10.3390/ani14020351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Subjective pain assessment in cattle is contingent upon the observer's experience and attitude. Studies of pain assessment in cattle by veterinarians and farmers using different pain scales have been published. This systematic review and meta-analysis aimed to describe and compare the pain scores given by veterinarians and producers for different procedures and conditions using either a NRS or VAS. The literature search was conducted with PubMed (MEDLINE) and Agricola, using defined search terms (e.g., peer-reviewed). A total of 842 articles were identified. After screening of duplicates, abstracts, and full texts, a total of 16 articles were included in this systematic review. Different pain scales were used for the included studies (NRS 0-10 for eight studies, NRS 1-10 for six studies, NRS 1-10 and VAS 0-10 for one study, and VAS 0-1 for one study). Most studies (n = 11) originated from the European Union. Mean values for pain scores differed significantly between studies included in the meta-analysis for both NRS 0-10 and 1-10. The findings of this study indicated that comparison of pain scoring used in different studies is difficult due to use of different pain scales and varying nomenclature, and that many variables (such as age and gender) influence pain scoring.
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Affiliation(s)
- Theresa Tschoner
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany; (Y.Z.); (M.F.)
| | - Kristina R. Mueller
- School of Veterinary Science, Massey University, Private Bag 11 222, Palmerston North 4474, New Zealand;
| | - Yury Zablotski
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany; (Y.Z.); (M.F.)
| | - Melanie Feist
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany; (Y.Z.); (M.F.)
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Stollings JL, Rumbaugh KA, Wang L, Hayhurst CJ, Ely EW, Hughes CG. Correlation of the Critical Care Pain Observation Tool and Numeric Rating Scale in Intensive Care Unit Patients. J Intensive Care Med 2024; 39:12-20. [PMID: 37455408 PMCID: PMC10666505 DOI: 10.1177/08850666231187336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/22/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE We sought to determine the correlation between the Numeric Rating Scale (NRS) and Critical-Care Pain Observation Tool (CPOT) to determine whether clinical factors modified the relationship between NRS and CPOT assessments. MATERIALS AND METHODS We included nonventilated adults admitted to the MICU or SICU who could self-report pain and had at least 3 paired NRS and CPOT assessments. We performed Spearman correlation to assess overall correlation and performed proportional odds logistic regression to evaluate whether the relationship between NRS and CPOT assessments was modified by clinical factors. RESULTS Nursing staff performed NRS and CPOT assessments every 4 h in 1302 patients, leading to 61,142 matched assessments. We found that the NRS and CPOT have a Spearman correlation coefficient of 0.56 and an intraclass correlation coefficient of 0.32 in intensive care unit patients. Factors that modified the relationship between the NRS and CPOT included the presence of delirium (P < .001) and lower mean daily Richmond Agitation Sedation Scale (<0.001). CONCLUSIONS The correlation coefficient between the NRS and the CPOT was found to be 0.56. The presence of delirium, decreased level of arousal, modified the relationship between the NRS and CPOT. Self-reported and behavioral pain assessments cannot be used interchangeably in critically ill adults.
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Affiliation(s)
- Joanna L Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA
| | - Kelli A Rumbaugh
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina J Hayhurst
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA
- Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Quality Aging – All at Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research Education and Clinical Center (GRECC) Service at the Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Christopher G Hughes
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA
- Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Anesthesia Service at the Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
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Mantovani G, Sgarbanti L, Indaimo A, Cavallo MA, De Bonis P, Flacco ME, Scerrati A. Effects of a sphenopalatine ganglion block on postcraniotomy pain management: a randomized, double-blind, clinical trial. Neurosurg Focus 2023; 55:E13. [PMID: 38262005 DOI: 10.3171/2023.9.focus23549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/28/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Postcraniotomy pain (PCP) is a common finding after neurosurgical procedures, occurring in as many 87% of patients. The sphenopalatine ganglion (SPG) has a pivotal role in several headache syndromes, and its anesthetic block is currently used in different clinical conditions with benefit. The aim of this study was to evaluate the efficacy of an SPG block (SPGB) via a transnasal approach as adjunctive therapy in reducing pain scores during the postcraniotomy period. METHODS In this single-center, double-blind, randomized controlled trial, patients undergoing elective surgery with a supratentorial craniotomy were randomly assigned to a scalp block, local anesthetic infiltration of the wound, and systemic analgesia during the first 48 postoperative hours (standard therapy), or to standard therapy as well as an SPGB (experimental therapy). According to the available evidence, assuming a 50% reduction in the incidence of the main outcome in patients with an SPGB (vs standard treatment), 82 patients were needed to achieve 80% statistical power in an intent-to-treat analysis. Pain intensity was recorded during the first 180 postoperative days at selective time points (5 times in the hospital, 3 times by telephone interview) with different pain rating systems (a visual analog scale [VAS], numeric rating scale [NRS], and pain assessment in advanced dementia [PAINAD] scale), together with demographic, clinical, and surgical variables and complications. Heart rate and blood pressure were recorded during surgery. Differences in all variables were evaluated using a paired t-test and confirmed through Wilcoxon matched-pairs signed-rank and Kruskal-Wallis tests. RESULTS No complications occurred among the 83 patients enrolled. Statistically significant differences were found in the mean VAS score at postoperative days 0 (p = 0.05), 2 (p = 0.03), and 3 (p = 0.03). The PAINAD scale score showed significant differences between groups at postoperative days 1 (p = 0.006), 2 (p = 0.001), 3 (p = 0.03), and 4 (p = 0.05). The proportion of patients reporting a VAS score ≥ 3 in the first day after surgery was lower in the SPGB group than in the standard treatment group (71.9% vs 89.5%), although this difference did not reach statistical significance. At postoperative day 180, 5 patients (2 in the control group, 3 in the treatment group) had developed chronic PCP (NRS score ≥ 3). CONCLUSIONS SPGB is a safe and effective procedure as an adjunctive treatment for PCP management in elective supratentorial craniotomy during the first 4 postoperative days compared with standard therapy. Further studies are needed to better define the clinical impact of SPGB use and its indications. Clinical trial registration no.: NCT05136625 (ClinicalTrials.gov).
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Affiliation(s)
- Giorgio Mantovani
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
| | - Lorenzo Sgarbanti
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
| | - Antonino Indaimo
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
| | - Michele Alessandro Cavallo
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
| | - Pasquale De Bonis
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
| | - Maria Elena Flacco
- 3Department of Environmental and Preventive Sciences, University of Ferrara, Italy
| | - Alba Scerrati
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
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Usamah U, Sumartono C, Fitriati M, Wirabuana B, Tjokroprawiro BA. Comparative analysis of lumbar quadratus lumborum block and epidural block for analgesia in uterine surgery at Dr. Soetomo Hospital, Surabaya. J Med Life 2023; 16:1707-1713. [PMID: 38406774 PMCID: PMC10893563 DOI: 10.25122/jml-2023-0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/13/2023] [Indexed: 02/27/2024] Open
Abstract
Over 80% of surgical patients experience postoperative pain, which, if inadequately managed, can lead to complications, prolonged rehabilitation, chronic pain, and decreased quality of life. Epidural block and quadratus lumborum block are techniques commonly used for postoperative pain management. This comparative analytic study aimed to analyze the differences in the analgesic effects of quadratus lumborum block and epidural block in uterine surgery at Dr. Soetomo General Hospital. The outcomes assessed were the numerical rating score (NRS) as a pain score and the administration of opioids as an adjuvant analgesic. Statistical analysis employed the Mann-Whitney test and Chi-square test. The study included 32 patients who underwent uterine surgery at Dr. Soetomo General Hospital and met the inclusion and exclusion criteria. Among the patients, 90.6% experienced mild pain, and 9.4% experienced moderate pain. Epidural blocks were performed in 50% of the patients, while quadratus lumborum blocks were performed in the other 50%. Additionally, 9.4% of the patients received opioids as adjuvant analgesics. The Mann-Whitney test revealed no significant difference in NRS between the epidural block and quadratus lumborum block groups (p-value>0.05). However, the Chi-square test indicated a significant difference in NRS between patients who received additional opioids as adjuvant analgesics and those who did not (p-value<0.00). There was no significant difference in NRS between patients who underwent epidural block and quadratus lumborum block as analgesic techniques.
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Affiliation(s)
- Usamah Usamah
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia
| | - Christrijogo Sumartono
- Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia
| | - Mariza Fitriati
- Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia
| | - Belindo Wirabuana
- Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia
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Yang J, Luo K, Chen ZJ, Zhang GH, Yao X, Feng SX, Weng ZL. Clinical efficacy and metabolomic analysis of ozone major autohemotherapy for the treatment of herpes zoster. Postepy Dermatol Alergol 2023; 40:693-698. [PMID: 38028414 PMCID: PMC10646704 DOI: 10.5114/ada.2023.130522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/02/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction It is essential to understand the underlying changes in the patients' metabolic profiles that may be indicative of the therapy's effectiveness. Aim To prospectively analyse the clinical efficacy of ozone autohemotherapy in the treatment of acute herpes zoster and investigate its impact on serum metabolomics. Material and methods A total of 76 patients with acute herpes zoster between May 2018 and June 2020 were enrolled and divided into an experimental group and a control group. The pain location, Numeric Rating Scale (NRS) scores before and after treatment (1 week, 1 month, 3 months, and 6 months post-treatment), medication usage, and Quality of Sleep (QS) scores were prospectively analysed. Additionally, serum metabolomic data were obtained and analysed before and 6 months after the treatment. Results There were statistically significant differences in the total NRS scores before and after ozone autohemotherapy (p < 0.05). The NRS scores of both groups significantly decreased (p < 0.05). At the 6-month follow-up, no patients were lost, and 83 patients completed the follow-up. The NRS improvement at 1 week, 1 month, 3 months, and 6 months post-treatment in the experimental group was significantly lower than that in the control group (p < 0.05). There was no significant difference in the medication usage (pregabalin or tramadol sustained-release tablets) between the two groups (p > 0.05). One month after treatment, the QS score improvement in the diabetes group was significantly lower than that in the non-diabetes group (p < 0.05). Serum metabolomics analysis revealed three significantly decreased metabolites, namely creatine, adipate, and glucose, after treatment. Conclusions Ozone autohemotherapy is an effective treatment for acute herpes zoster patients and can rapidly and effectively alleviate pain symptoms in the short term. The changes in serum metabolomics may provide further insights into the treatment mechanism.
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Affiliation(s)
- Jing Yang
- Department of Pain Medicine, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Kai Luo
- Department of Pain Medicine, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Zhi-Ji Chen
- Department of Pain Medicine, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Gua-Hui Zhang
- Department of Pain Medicine, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xin Yao
- Department of Pain Medicine, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Shu-Xiu Feng
- Quality Control Department, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Ze-Lin Weng
- Department of Pain Medicine, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
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Amberbir WD, Bayable SD, Fetene MB. The prevalence and factors associated with acute postoperative pain in elective gynecologic surgical patients at two referral hospitals in Addis Abeba, Ethiopia, 2021: a cross-sectional study. Ann Med Surg (Lond) 2023; 85:2506-2511. [PMID: 37363541 PMCID: PMC10289485 DOI: 10.1097/ms9.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/16/2023] [Indexed: 06/28/2023] Open
Abstract
Postoperative pain is an expected and undesirable by-product of all surgical procedures. The provision of effective and safe postoperative pain management should be one of the top priorities of any healthcare, where surgical procedures are carried out. Major abdominal surgical operations require pain management services, regular pain assessment, and timely management of breakthrough pains in the postoperative period. Objective This study aimed to determine the prevalence and factors associated with acute postoperative pain. Methods A cross-sectional study was conducted at Minilik and Zewditu Referral hospitals from October to December 2021 and chart review and face-to-face interviews were the methods of data collection. The pain was measured at the 2, 12, and 24 h postoperatively through a numerical rating scale, and the pain was categorized as no pain (score=0), mild pain (score 1-3), moderate pain (score 4-6), or severe pain (score 7-10). All independent variables with P less than or equal to 0.2 in the univariable logistic regression were reanalyzed with multivariable logistic regression at 95% CI to determine predictive factors and a P-value of less than 0.05 was considered statistically significant. Results In the study period, a total of 368 eligible patients were involved, out of this 11 patients were discharged before 24 h, four patients refuse to participate two incomplete documentation and one patient was ICU admitted, therefore 350 patients were involved with a response rate of 95.1%. Among those patients 73.1% of respondents' experience at least one episodes of moderate to severe postoperative pain within the first 24 h. Preoperative anxiety (AOR: 2.2, 95% CI: 1.2, 5.1), urban residency (AOR: 2.3, 95% CI: 1.2, 50), participants who have not formal education (AOR: 2.5, 95% CI: 1.3, 4.1), surgical patients without pre-emptive analgesia (AOR: 2.7, 95% CI: 1.3, 3.6), abdominal incision greater than 10 cm (AOR: 3.5, 95% CI: 2.1, 7.2), and surgical duration greater than or equal to 60 min (AOR: 2.3, 95% CI: 1.1, 3.1) were factors associated with acute postoperative pain following elective gynecologic surgery. Conclusion In this study, the overall incidence of moderate to severe postoperative pain after gynecologic surgery was unacceptably high, and patients undergoing gynecologic surgical procedures suffer sufficient postoperative pain need of intervention.
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Affiliation(s)
| | - Samuel Debas Bayable
- Department of Anesthesia, College of Medicine and Health Science, Debre Markos University, Debre Markos
| | - Melaku Bantie Fetene
- Department of Anesthesia, College of Medicine and Health Science, Debre Berhan University, Shewa, Ethiopia
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Konecka M, Kuczyńska M, Schneider-Matyka D, Stanisławska M, Grochans E, Kamińska M. Analysis of Changes in the Selected Nutritional Parameters of Patients within a Year from the Admission to the Enteral Nutrition Clinic. Nutrients 2023; 15:1803. [PMID: 37111024 PMCID: PMC10145203 DOI: 10.3390/nu15081803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/13/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
(1) The following research question was formulated: What are the relationships between enteral nutrition and selected anthropometric and blood biochemical parameters? The aim of this study was to provide an assessment of the nutritional status of patients within one year from their admission to the Enteral Nutrition Clinic. (2) The study group included 103 participants. For the purpose of analysing their nutritional status, the Subjective Global Assessment (SGA) and Nutritional Risk Score (NRS) scales were used, anthropometric measurements were taken, and blood laboratory tests were performed. The assessment of changes in the indicated parameters was conducted at three time intervals: upon admission (T0) and 6 and 12 months after admission (T6 and T12, respectively). (3) The study group showed a significant improvement in the circumference of their upper and lower limbs. Nutrition therapy had an effect on the levels of erythrocytes, iron concentration, the activity of liver enzymes, and C-reactive protein levels. (4) The enrolment of patients into the Nutritional Therapy Programme had a positive effect on the selected results. 1. Twelve months after the introduction of nutritional intervention, an increase in erythrocyte count was particularly marked, and there was a decrease in the CRP (C Reactive Protein) level as well as the activity of liver enzymes. There was no significant effect of enteral nutrition on albumin and protein values. 2. To ensure the greatest efficiency of enteral nutritional therapy, it is to be continued for more than six months. 3. Nutritional interventions resulted in a significant increase in upper and lower limb circumferences among the study group. 4. For the purpose of identifying patients at risk of malnutrition, medical personnel should systematically raise their qualifications, and educational measures on this issue should be implemented at the stage of medical training at medical universities.
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Affiliation(s)
- Mariola Konecka
- Subdepartment of Long-Term Care and Palliative Medicine, Department of Social Medicine, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
| | - Magdalena Kuczyńska
- Subdepartment of Long-Term Care and Palliative Medicine, Department of Social Medicine, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
| | - Daria Schneider-Matyka
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
| | - Marzanna Stanisławska
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
| | - Magdalena Kamińska
- Subdepartment of Long-Term Care and Palliative Medicine, Department of Social Medicine, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
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Szymczak-Paluch M, Kłosek S. Stress control as a method to reduce perceived pain in oral lichen planus. Postepy Dermatol Alergol 2023; 40:241-245. [PMID: 37312924 PMCID: PMC10258711 DOI: 10.5114/ada.2023.127641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023] Open
Abstract
Introduction Oral lichen planus (OLP) is a common chronic, T-cell-mediated, inflammatory and non-infectious mucodermatosis. Patients diagnosed with oral lichen planus are more prone to depression, anxiety and higher perceived mental stress than the rest of the population. Aim This study investigated stress control methods as a means of reducing pain levels in patients with oral lichen planus. Material and methods The study involved 62 adult oral lichen planus patients who have never received any OLP treatment before. Patients with a high level of perceived mental stress received, in addition to standard pharmacological treatment, herbal sedative medication or Jacobson's Progressive Muscle Relaxation guidance (JPMR), and the patients without a high level of perceived mental stress level did not receive any additional stress control methods. The research tool was the PSS questionnaire and NRS pain level scale. Results Before the treatment, the level of perceived pain did not differ in any of analysed groups. After the treatment, in the group not using any stress control methods, the mean NRS level was significantly higher than in the group performing Jacobson's Progressive Muscle Relaxation (2.79 ±1.76 vs. 1.08 ±1.29), and also significantly higher than in the group receiving the herbal sedative (2.79 ±1.76 vs. 1.41 ±2.06). Conclusions The use of mental stress control methods as an additional element of therapy has a positive effect on the success of oral lichen planus treatment since it helps to reduce the perceived pain level in the oral mucosa better than a standard pharmacological therapy alone.
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Affiliation(s)
| | - Sebastian Kłosek
- Department of Oral Pathology, Medical University of Lodz, Lodz, Poland
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Thorninger R, Wæver D, Tjørnild M, Lind M, Rölfing JD. Prospective Evaluation of Two Cohorts of Non-Operatively Treated Patients with Displaced vs. Minimally and Non-Displaced Distal Radius Fractures. J Clin Med 2023; 12. [PMID: 36902861 DOI: 10.3390/jcm12052076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Distal radius fractures (DRFs) in the elderly are common. Recently, the efficacy of operative treatment of displaced DRFs in patients above 65 years of age has been questioned and it has been suggested that non-operative treatment should be the gold standard. However, the complications and functional outcome of displaced vs. minimally and non-displaced DRFs in the elderly has not been evaluated yet. The aim of the present study was to compare non-operatively treated displaced DRFs vs. minimally and non-displaced DRFs in terms of complications, PROMs, grip strength and range of motion (ROM) after 2 weeks, 5 weeks, 6 months and 12 months. METHODS We used a prospective cohort study that compared patients with displaced DRFs (n = 50), i.e., >10 degrees of dorsal angulation after two reduction attempts, with patients with minimally or non-displaced DRFs after reduction. Both cohorts received the same treatment of 5 weeks of dorsal plaster casting. Complications and functional outcomes (quick disabilities of the arm, shoulder and hand (QuickDASH), patient-rated wrist/hand evaluation (PRWHE), grip strength and EQ-5D scores) were assessed after 5 weeks, 6 months and 12 months post-injury. The protocol of the VOLCON RCT and present observational study has been published (PMC6599306; clinicaltrials.gov: NCT03716661). RESULTS One year after 5 weeks of dorsal below-elbow casting of low-energy DRFs in patients ≥ 65 years old, we found a complication rate of 6.3% (3/48) in minimally or non-displaced DRFs and 16.6% (7/42) in displaced DRFs (p = 0.18). However, no statistically significant difference was observed in functional outcomes in terms of QuickDASH, pain, ROM, grip strength or EQ-5D scores. DISCUSSION In patients above 65 years of age, non-operative treatment, i.e., closed reduction and dorsal casting for 5 weeks, yielded similar complication rates and functional outcomes after 1 year regardless of whether the initial fracture was non-displaced/minimally displaced or still displaced after closed reduction. While the initial closed reduction should still be attempted in order to restore the anatomy, failure to achieve the stipulated radiological criteria may not be as important as we thought in terms of complications and functional outcome.
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Carrougher GJ, Bamer AM, Mason S, Stewart BT, Gibran NS. Defining numerical cut points for mild, moderate, and severe pain in adult burn survivors: A northwest regional burn model system investigation. Burns 2023; 49:310-316. [PMID: 36566097 DOI: 10.1016/j.burns.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/13/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Pain is a common and often debilitating sequela of burn injury. Burn pain develops following damage to peripheral sensory nerves and the release of inflammatory mediators from injury. Burn pain is complex and can include background and procedural pain that result from the injury itself, wound care, stretching, and surgery. Clinicians and researchers need valid and reliable pain measures to guide screening, treatment, and research protocols. Unlike other conditions, visual analog, or numeric pain rating scale (VAS/NRS) scores that represent mild, moderate, and severe pain among people with burn injury have not been established. The aim of this study was to identify the most suitable average pain intensity rating scores for mild, moderate, and severe pain in adult burn survivors using a PROMIS Pain Interference (PROMIS-PI) short form. METHODS An average pain intensity VAS/NRS score (0-10) and customized PROMIS-PI short form were administered to adults with burn injury treated at a regional burn center at hospital discharge (baseline) and at 6, 12, and 24-months after injury. To identify pain intensity scores that represent mild, moderate, and severe pain, we computed F values and Bayesian Information Criterion (BIC) statistics associated with multiple ANOVA comparisons for mean pain interference scores by various pain intensity cut points. Six possible cut points (CP) were compared: CP 3,6; 3,7; 4,6; 4,7; 2,5; and 3,5. Optimal cut points were considered those with the highest ANOVA F statistics. Models with similar F statistics were also compared with BIC. RESULTS Data from a sample of 253 participants (83% white, 66% male, mean age 47 years) with VAS/NRS pain intensity and PROMIS-PI scores at one or more timepoints were analyzed. The optimal classification for mild, moderate, and severe pain was CP 2,5 at baseline and 12-months. Although CP 3,6 had the highest F value at 6-months, there was not strong evidence to support CP 3,6 over CP 2,5 (BIC difference: 2.9); similarly, CP 3,7 had the highest value at 24-months, but the BIC difference over CP 2,5 was only 2.2. CONCLUSIONS VAS/NRS scores for pain among adults with burn injury can be categorized as mild (0-2), moderate (3-5), and severe (6-10). These findings advance our understanding regarding the meaning of pain intensity ratings after burn injury, and provide an objective definition for clinical management, quality improvement, and pain research.
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Affiliation(s)
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Stephanie Mason
- Ross Tilley Burn Centre, University of Toronto, Toronto, Canada
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Nicole S Gibran
- UW Medicine Regional Burn Center, University of Washington, Seattle, WA, USA
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Lopez D, Akhter M. Discrepancy between pain scores and need for analgesics. Am J Emerg Med 2023; 64:184. [PMID: 36470764 DOI: 10.1016/j.ajem.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Daniel Lopez
- Department of Emergency Medicine, HCA Florida Kendall Hospital, Miami, FL, United States
| | - Murtaza Akhter
- Department of Emergency Medicine, HCA Florida Kendall Hospital, Miami, FL, United States; Department of Emergency Medicine, Penn State Hershey Medical Center, Hershey, PA, United States.
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Koster LA, Rassir R, Kaptein BL, Sierevelt IN, Schager M, Nelissen RGHH, Nolte PA. A randomized controlled trial comparing two-year postoperative femoral and tibial migration of a new and an established cementless rotating platform total knee arthroplasty. Bone Joint J 2023; 105-B:148-157. [PMID: 36722052 DOI: 10.1302/0301-620x.105b2.bjj-2022-0414.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS The primary aim of this study was to compare the migration of the femoral and tibial components of the cementless rotating platform Attune and Low Contact Stress (LCS) total knee arthroplasty (TKA) designs, two years postoperatively, using radiostereometric analysis (RSA) in order to assess the risk of the development of aseptic loosening. A secondary aim was to compare clinical and patient-reported outcome measures (PROMs) between the designs. METHODS A total of 61 TKAs were analyzed in this randomized clinical RSA trial. RSA examinations were performed one day and three, six, 12, and 24 months postoperatively. The maximal total point motion (MPTM), translations, and rotations of the components were analyzed. PROMs and clinical data were collected preoperatively and at six weeks and three, six, 12, and 24 months postoperatively. Linear mixed effect modelling was used for statistical analyses. RESULTS The mean MTPM two years postoperatively (95% confidence interval (CI)) of the Attune femoral component (0.92 mm (0.75 to 1.11)) differed significantly from that of the LCS TKA (1.72 mm (1.47 to 2.00), p < 0.001). The Attune femoral component subsided, tilted (anteroposteriorly), and rotated (internal-external) significantly less. The mean tibial MTPM two years postoperatively did not differ significantly, being 1.11 mm (0.94 to 1.30) and 1.17 mm (0.99 to 1.36, p = 0.447) for the Attune and LCS components, respectively. The rate of migration in the second postoperative year was negligible for the femoral and tibial components of both designs. The mean pain-at-rest (numerical rating scale (NRS)-rest) in the Attune group was significantly less compared with that in the LCS group during the entire follow-up period. At three months postoperatively, the Knee injury and Osteoarthritis Outcome Physical Function Shortform score, the Oxford Knee Score, and the NRS-activity scores were significantly better in the Attune group. CONCLUSION The mean MTPM of the femoral components of the cementless rotating platform Attune was significantly less compared with that of the LCS design. This was reflected mainly in significantly less subsidence, posterior tilting, and internal rotation. The mean tibial MTPMs were not significantly different. During the second postoperative year, the components of both designs stabilized and low risks for the development of aseptic loosening are expected.Cite this article: Bone Joint J 2023;105-B(2):148-157.
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Affiliation(s)
- Lennard A Koster
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Rachid Rassir
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Inger N Sierevelt
- SCORE, Specialized Centre of Orthopedic Research and Education, Xpert Orthopedie Amsterdam, Amsterdam, Netherlands
| | - Marjolein Schager
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Peter A Nolte
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
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Holm JH, Licht PB, Toft P, Andersen C. Procedural Aspects of Epidural Catheter Placement: A Prospective Observational Study of 173 Epidural Catheter Insertions. J Cardiothorac Vasc Anesth 2022; 36:4378-4385. [PMID: 36153274 DOI: 10.1053/j.jvca.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The risks and benefits of epidural analgesia have been studied extensively, but information regarding many other aspects of epidural catheter insertion is limited. The authors aimed to add information regarding procedural pain, procedure duration, failure rates, and the effect of experience to the ongoing discussion on this procedure. DESIGN A prospective observational study. SETTING A Danish tertiary hospital. PARTICIPANTS Patients scheduled to undergo video-assisted thoracic surgery. INTERVENTIONS Epidural catheter insertion in 173 patients undergoing video-assisted thoracic surgery for lung cancer. MEASUREMENTS AND MAIN RESULTS The authors recorded the time required for the epidural insertion procedure, the attempts used, insertion level, access use, patient position, placement technique used, and the designation of the physician placing the catheter. Furthermore, the authors asked the patients to evaluate the expected procedural pain, and after the procedure the authors asked them to evaluate the actual level of pain experienced. Six and 24 months after discharge, the authors examined persistent sequelae by using questionnaire assessments. The median procedure duration was 13 minutes, with 75% of the catheters placed within 22 minutes. Actual procedure-related pain (mean score [M] = 3.5, SD = 2.0) was significantly (p < 0.0001) less than that expected before the procedure (M = 4.9, SD = 2.0). The patients' expected pain, attempts required for successful catheter placement, and approach used to access the epidural space significantly affected the actual procedure-related pain (p = 0.001, p ≤ 0.003, and p = 0.023, respectively). Persistent pain and sensory disturbances were observed in 11% and 4% of the patients, respectively, after 6 months and in 6% and 4% of the patients, respectively, after 2 years. CONCLUSIONS In this study, the authors examined several lesser-known aspects of epidural procedures. The use of epidural analgesia as part of the pain management plan after surgery requires a more complex evaluation instead of merely discussing the possibility of procedural infections, hematomas, or neurologic injuries. The procedure time, patients' expected and experienced pain related to the procedure, and the potential long-term side effects should be a part of the decision-making process.
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Affiliation(s)
- Jimmy Højberg Holm
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Odense, Denmark.
| | - Peter Bjørn Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Palle Toft
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Claus Andersen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
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Macki M, Hamilton T, Massie L, Bazydlo M, Schultz L, Seyfried D, Park P, Aleem I, Abdulhak M, Chang VW, Schwalb JM. Characteristics and outcomes of patients undergoing lumbar spine surgery for axial back pain in the Michigan Spine Surgery Improvement Collaborative. Spine J 2022; 22:1651-1659. [PMID: 35803577 DOI: 10.1016/j.spinee.2022.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The indications for surgical intervention of axial back pain without leg pain for degenerative lumbar disorders have been limited in the literature, as most study designs allow some degree of leg symptoms in the inclusion criteria. PURPOSE To determine the outcome of surgery (decompression only vs. fusion) for pure axial back pain without leg pain. STUDY DESIGN/SETTING Prospectively collected data in the Michigan Spine Surgery Improvement Collaborative (MSSIC). PATIENT SAMPLE Patients with pure axial back pain without leg pain underwent lumbar spine surgery for primary diagnoses of lumbar disc herniation, lumbar stenosis, and isthmic or degenerative spondylolisthesis ≤ grade II. OUTCOME MEASURES Minimally clinically important difference (MCID) for back pain, Numeric Rating Scale of back pain, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), MCID of PROMIS-PF, and patient satisfaction on the North American Spine Surgery Patient Satisfaction Index were collected at 90 days, 1 year, and 2 years after surgery. METHODS Log-Poisson generalized estimating equation models were constructed with patient-reported outcomes as the independent variable, reporting adjusted risk ratios (RRadj). RESULTS Of the 388 patients at 90 days, multi-level versus single level lumbar surgery decreased the likelihood of obtaining a MCID in back pain by 15% (RRadj=0.85, p=.038). For every one-unit increase in preoperative back pain, the likelihood for a favorable outcome increased by 8% (RRadj=1.08, p<.001). Of the 326 patients at 1 year, symptom duration > 1 year decreased the likelihood of a MCID in back pain by 16% (RRadj=0.84, p=.041). The probability of obtaining a MCID in back pain increased by 9% (RRadj=1.09, p<.001) for every 1-unit increase in baseline back pain score and by 14% for fusions versus decompression alone (RRadj=1.14, p=.0362). Of the 283 patients at 2 years, the likelihood of obtaining MCID in back pain decreased by 30% for patients with depression (RRadj=0.70, p<.001) and increased by 8% with every one-unit increase in baseline back pain score (RRadj=1.08, p<.001). CONCLUSIONS Only the severity of preoperative back pain was associated with improvement in MCID in back pain at all time points, suggesting that surgery should be considered for selected patients with severe axial pain without leg pain. Fusion surgery versus decompression alone was associated with improved patient-reported outcomes at 1 year only, but not at the other time points.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Lara Massie
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Michael Bazydlo
- Department of Public Health Sciences, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Lonni Schultz
- Department of Public Health Sciences, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Donald Seyfried
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive #5201, Ann Arbor, MI 48109 USA
| | - Ilyas Aleem
- Department of Orthopaedic Surgery, University of Michigan, 1500 East Medical Center Drive, Floor 2 Reception B, Ann Arbor, MI 48109 USA
| | - Muwaffak Abdulhak
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Victor W Chang
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA.
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Larsson SL, Brogren E, Dahlin LB, Björkman A, Ekstrand E. Psychometric properties of patient-reported outcome measures (PROMs) in wrist osteoarthritis: test-retest reliability and construct validity. BMC Musculoskelet Disord 2022; 23:558. [PMID: 35681171 PMCID: PMC9185974 DOI: 10.1186/s12891-022-05511-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are frequently used to assess the effects of treatments in patients with wrist osteoarthritis (OA), but their psychometric properties have not been evaluated in this group of patients. Our aim was to evaluate the psychometric properties of the Numeric Rating Scale (NRS pain at rest, pain on motion without load, and pain on load), the Disabilities of the Arm, Shoulder and Hand (DASH) and the Patient Rated Wrist Evaluation (PRWE) questionnaires in patients with wrist OA regarding test-retest reliability and construct validity. METHODS The NRS, DASH and PRWE were self-administered by 50 patients (40 men and 10 women, mean age 66 years) in a postal survey on two occasions, two weeks apart. Test-retest reliability was evaluated by Kappa statistics and the Spearman rank correlation coefficients (rho) were calculated to evaluate construct validity. RESULTS The Kappa coefficients for DASH, PRWE and NRS pain on motion without load and NRS pain on load were > 0.90, 95% CI ranging from 0.84 to 0.98, while NRS pain at rest was 0.83, 95% CI 0.73-0.92. The construct validity of the PROMs was confirmed by three formulated hypotheses: a higher correlation between PRWE and NRS (rho 0.80-0.91, p < 0.001) was found, compared to DASH and NRS (rho 0.68-0.80, p < 0.001); the NRS pain on motion without load and NRS pain on load correlated more strongly to PRWE and DASH (rho 0.71-0.91, p < 0.001) compared to NRS pain at rest (rho 0.68-0.80) and a high correlation between PRWE and DASH was found (rho 0.86, p < 0.001). CONCLUSIONS The NRS, DASH and PRWE demonstrate excellent test-retest reliability and moderate to high construct validity in patients with wrist OA. These PROMs are highly related, but they also differ. Therefore, they complement each other in ensuring a comprehensive evaluation of perceived disability in wrist OA. As PRWE showed the highest test-retest reliability and the highest relation to the other PROMs, the sole use of the PRWE can be recommended in clinical practice.
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Affiliation(s)
- Sara L Larsson
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, Malmö, SE-205 02, Sweden. .,Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, 205 03, Malmö, Sweden.
| | - Elisabeth Brogren
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, Malmö, SE-205 02, Sweden.,Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, 205 03, Malmö, Sweden
| | - Lars B Dahlin
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, Malmö, SE-205 02, Sweden.,Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, 205 03, Malmö, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anders Björkman
- Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Ekstrand
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, Malmö, SE-205 02, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
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20
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Nakarai H, Kato S, Kawamura N, Higashikawa A, Takeshita Y, Fukushima M, Ono T, Hara N, Azuma S, Tanaka S, Oshima Y. Minimal clinically important difference in patients who underwent decompression alone for lumbar degenerative disease. Spine J 2022; 22:549-560. [PMID: 34699996 DOI: 10.1016/j.spinee.2021.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/22/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The minimal clinically important difference (MCID) represents the smallest change in an outcome measure recognized as clinically meaningful to a patient after receiving a clinical intervention. Most studies that discussed the MCIDs for lumbar spinal stenosis (LSS) included mixed pathologies or procedures despite that the MCID value should be different depending on the intervention. Moreover, despite the efficacy of adopting percentage-change improvement for the MCID threshold, there are limited reports and discussions in the field of lumbar surgery. PURPOSE The aim of the present study was to elucidate the MCIDs for the Oswestry Disability Index (ODI), EuroQOL 5-dimension 3-level (EQ-5D-3L), physical component summary (PCS) of the Short Form of the Medical Outcomes Study, and Numeric Rating Scale (NRS) in patients with degenerative LSS treated with decompression surgery without fusion. STUDY DESIGN/SETTING A multicenter retrospective cohort study was performed. PATIENT SAMPLE A total of 422 patients who underwent decompression surgery for LSS and answered a complete set of questionnaires were included in the study. Patients who underwent endoscopic or revision surgery were excluded. OUTCOME MEASURES Preoperative and 1-year postoperative scores of each health-related quality of life questionnaires (HRQOLs) and patient satisfaction questionnaire response METHODS: The patient satisfaction question was used as an anchor, and the cutoff values were estimated based on absolute point improvement from baseline using a receiver-operating characteristic (ROC) curve analysis and the "mean change" method for MCIDs. The MCID values for percentage-change in HRQOLs were also calculated using ROC curve analysis. The three cutoff values for each HRQOL were validated using the Youden index for determining the most robust MCIDs. RESULTS Of the patients, 356 (84.4%) were at least "somewhat satisfied" with the treatment results. The two cutoff values of absolute point-change in each HRQOL, which were estimated by two different anchor-based methods, were similar. The area under the curve of the ROC curve for percentage-change tended to be higher than that for absolute point-change. Moreover, the Youden index of the percentage-change in each HRQOL was higher than that of the absolute point-change calculated by either the "mean change" method or the ROC curve analysis. Based on these results, it was proposed that MCID was 42.4% for percentage-change in ODI, 22.0% for EQ-5D-3L, 13.7% for PCS, 25.0% for NRS (low back pain), 55.6% for NRS (leg pain), 22.2% for NRS (leg numbness). CONCLUSIONS The MCIDs of HRQOLs were calculated in patients with LSS treated with decompression surgery without concomitant fusion procedure. The MCID cutoffs based on percentage-change from baseline were more effective than those of absolute point-change.
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Affiliation(s)
- Hiroyuki Nakarai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - So Kato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-2, Hiroo, Shibuya-Ku, Tokyo 150-8935, Japan
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopedic Surgery, Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, Kawasaki City, Kanagawa 211-8510, Japan
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopedic Surgery, Yokohama Rosai Hospital, 3211, Kozukue-Cho, Kohoku-Ku, Yokohama City, Kanagawa 222-0036, Japan
| | - Masayoshi Fukushima
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Spine center, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, Tokyo 105-8470, Japan
| | - Takashi Ono
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, 5-1, Tsukudo-Cho, Shinjuku-Ku, Tokyo 162-8543, Japan
| | - Nobuhiro Hara
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, 1-26-1, Kyonancho, Musashino City, Tokyo 180-0023, Japan
| | - Seiichi Azuma
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopedic Surgery, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama City, Saitama 330-8553, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
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21
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Dubinsky MC, Irving PM, Panaccione R, Naegeli AN, Potts-Bleakman A, Arora V, Shan M, Travis S. Incorporating patient experience into drug development for ulcerative colitis: development of the Urgency Numeric Rating Scale, a patient-reported outcome measure to assess bowel urgency in adults. J Patient Rep Outcomes 2022; 6:31. [PMID: 35362902 PMCID: PMC8975984 DOI: 10.1186/s41687-022-00439-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/18/2022] [Indexed: 01/22/2023] Open
Abstract
Background Bowel urgency, the sudden or immediate need to have a bowel movement, is a common, bothersome and disruptive symptom of ulcerative colitis (UC). UC treatment goals include control of urgency; however, it is not consistently assessed in UC clinical trials. The Urgency Numeric Rating Scale (NRS) is a new patient-reported measure to assess severity of bowel urgency in adults with UC developed in accordance with Food and Drug Administration guidelines. Methods Qualitative interviews were used to develop Urgency NRS. The scale asks patients to report the immediacy status of their UC symptom over the past 24 h on an 11-point horizontal numeric rating scale [0 (No urgency) to 10 (Worst possible urgency)]. Higher scores indicate worse urgency severity. A 2-week diary study assessed floor and ceiling effects, test–retest reliability (intraclass correlation coefficient (ICC) (2,1) between Week 1 and 2), and construct validity (Spearman correlation using Week 1 scores). Weekly scores were calculated as mean score over each 7-day period. Results Qualitative interviews with 16 UC patients (mean age 37.9 ± 11.6 years; 50% female; 56% White) confirmed relevance, content, and comprehensiveness. The 2-week diary study included 41 UC patients (mean age 44.2 ± 14.6 years; 51% female; 56% White). No ceiling or floor effects were identified. Test–retest reliability was high (ICC = 0.877). Average Urgency NRS and patient global rating of severity scores were highly correlated, with a moderate correlation between average Urgency NRS and stool frequency, demonstrating construct validity. Conclusions Bowel urgency is a distinct symptom of UC. The Urgency NRS is a well-defined, content-valid, and reliable measurement of bowel urgency in adults with UC. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00439-w.
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Affiliation(s)
- Marla C Dubinsky
- Department of Pediatrics, Susan and Leonard Feinstein IBD Center, Icahn School of Medicine, Mount Sinai, 17 East 102nd Street, 5th Floor East, New York, NY, 10029, USA.
| | - Peter M Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Remo Panaccione
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | | | | | - Vipin Arora
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Simon Travis
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust and NIHR Biomedical Research Centre, Oxford, UK
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22
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Powelson EB, Chandra NA, Jessen-Fiddick T, Zhou C, Rabbitts J. A Brief Measure Assessing Adolescents' Daily In-Hospital Function Predicts Pain and Health Outcomes at Home After Major Surgery. Pain Med 2022; 23:1469-1475. [PMID: 35201357 PMCID: PMC9434145 DOI: 10.1093/pm/pnac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Pain-related function, an important component of pain assessment, is not systematically assessed in the hospital in part because of a lack of clinically meaningful measures of pain-related function. This prospective cohort study examined whether adolescents' pain-related function during hospitalization, measured daily with the Youth Acute Pain Functional Ability Questionnaire (YAPFAQ) is associated with pain and health-related quality of life (HRQOL) 2 weeks following surgery. DESIGN Adolescents undergoing major musculoskeletal surgery (N = 93) completed YAPFAQ (11 items) daily for up to three days in-hospital following surgery. Adolescents self-reported health-related quality of life on the pediatric quality of life inventory and pain intensity on a NRS at baseline (pre-surgery) and two-weeks following surgery. Regression models examined mean YAPFAQ and YAPFAQ rate of change as predictors of two-week outcomes, adjusting for sex, surgery type, and baseline pain/HRQOL. RESULTS Higher mean YAPFAQ scores (poorer function) were associated with higher pain intensity (β = 0.2, p = 0.04) and poorer HRQOL (β = -0.3, p = 0.01) at home 2 weeks following surgery. YAPFAQ rate of change was not associated with 2-week outcomes. CONCLUSIONS Implementation of the YAPFAQ with in-hospital assessments to measure pain-related function will allow more comprehensive pain assessment. In-hospital YAPFAQ scores can predict important postsurgical outcomes at home and inform post-hospital care. PERSPECTIVE This article provides validation of a measure of pediatric pain-related function, the Youth Acute Pain Functional Ability Questionnaire (YAPFAQ) to predict important post-hospital outcomes after surgery.
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Affiliation(s)
- Elisabeth B Powelson
- Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Nuria Alina Chandra
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington.,Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, Washington
| | - Tricia Jessen-Fiddick
- Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Jennifer Rabbitts
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.,Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington
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23
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Mens RH, Bisseling P, de Kleuver M, van Hooff ML. Relevant impact of surgery on quality of life for adolescent idiopathic scoliosis : a registry-based two-year follow-up cohort study. Bone Joint J 2022; 104-B:265-273. [PMID: 35094577 DOI: 10.1302/0301-620x.104b2.bjj-2021-1179.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To determine the value of scoliosis surgery, it is necessary to evaluate outcomes in domains that matter to patients. Since randomized trials on adolescent idiopathic scoliosis (AIS) are scarce, prospective cohort studies with comparable outcome measures are important. To enhance comparison, a core set of patient-related outcome measures is available. The aim of this study was to evaluate the outcomes of AIS fusion surgery at two-year follow-up using the core outcomes set. METHODS AIS patients were systematically enrolled in an institutional registry. In all, 144 AIS patients aged ≤ 25 years undergoing primary surgery (median age 15 years (interquartile range 14 to 17) were included. Patient-reported (condition-specific and health-related quality of life (QoL); functional status; back and leg pain intensity) and clinician-reported outcomes (complications, revision surgery) were recorded. Changes in patient-reported outcome measures (PROMs) were analyzed using Friedman's analysis of variance. Clinical relevancy was determined using minimally important changes (Scoliosis Research Society (SRS)-22r), cut-off values for relevant effect on functioning (pain scores) and a patient-acceptable symptom state (PASS; Oswestry Disability Index). RESULTS At baseline, 65 out of 144 patients (45%) reported numerical rating scale (NRS) back pain scores > 5. All PROMs significantly improved at two-year follow-up. Mean improvements in SRS-22r function (+ 1.2 (SD 0.6)), pain (+ 0.6 (SD 0.8)), and self-image (+ 1.1 (SD 0.7)) domain scores, and the SRS-22r total score (+ 0.5 (SD 0.5)), were clinically relevant. At two-year follow-up, 14 out of 144 patients (10%) reported NRS back pain > 5. Surgical site infections did not occur. Only one patient (0.7%) underwent revision surgery. CONCLUSION Relevant improvement in functioning, condition-specific and health-related QoL, self-image, and a relevant decrease in pain is shown at two-year follow-up after fusion surgery for AIS, with few adverse events. Contrary to the general perception that AIS is a largely asymptomatic condition, nearly half of patients report significant preoperative back pain, which reduced to 10% at two-year follow-up. Cite this article: Bone Joint J 2022;104-B(2):265-273.
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Affiliation(s)
- Raf H Mens
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Pepijn Bisseling
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Marinus de Kleuver
- Department of Orthopedics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Miranda L van Hooff
- Department of Orthopedics, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands
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24
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Gao Q, Cheng Y, Li Z, Tang Q, Qiu R, Cai S, Xu X, Peng J, Xie H. Association Between Nutritional Risk Screening Score and Prognosis of Patients with Sepsis. Infect Drug Resist 2021; 14:3817-3825. [PMID: 34557005 PMCID: PMC8455294 DOI: 10.2147/idr.s321385] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Malnutrition is one of the most critical factors affecting patients’ risk of infection and length of stay, and it may affect the prognosis of patients with sepsis. There have been no studies that have applied nutritional risk screening tools to stratify patients with sepsis according to prognosis. Methods We retrospectively analyzed the clinical data of 425 adult sepsis inpatients who were grouped based on nutritional risk screening (NRS) score, including a nutrition score, disease severity score, and age score. Prognostic factors were analyzed using univariate and multivariate regression analyses. Results Of the enrolled patients, 174 had an NRS score of ≥3; these patients were older and had a longer hospitalization time but lower body mass index (BMI), albumin (ALB) than others. Univariate Cox regression analysis showed that age, ALB, C-reactive protein (CRP), and NRS score were significantly (P<0.05) associated with in-hospital mortality. Multivariate analysis showed that age (hazard ratio [HR]=1.020, 95% confidence interval [CI]: 1.005–1.036; P=0.008) and ALB (HR=0.924, 95% CI: 0.885–0.966; P<0.001) were independent risk factors for sepsis-related mortality. The Kaplan–Meier analysis revealed that the cumulative in-hospital mortality of sepsis patients with an NRS score of ≥3 was significantly higher than that of patients with an NRS score of <3 (P=0.022). Conclusion NRS scores can effectively risk stratify sepsis patients. Patients with high NRS scores should be monitored more closely to halt further disease progression.
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Affiliation(s)
- Qiqing Gao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Yao Cheng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhuohong Li
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Qingyun Tang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Rong Qiu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Shaohang Cai
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xuwen Xu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Hongyan Xie
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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25
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Fujiwara A, Watanabe K, Ida M, Kawanishi H, Kimoto K, Yoshimura K, Shinohara K, Kawaguchi M. The short-term effect of COVID-19 pandemic on disability, pain intensity, psychological status, and exercise habits in patients with chronic pain. J Anesth 2021; 35:862-9. [PMID: 34435236 DOI: 10.1007/s00540-021-02992-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022]
Abstract
Purpose The coronavirus disease 2019 (COVID-19) pandemic has affected the lives of people worldwide. The first declaration of a state of emergency in Japan, based on the Act on Special Measures for the Prevention and Control of the Novel Coronavirus, was issued from 16 April 2020 to 14 May 2020 to reduce person-to-person contact. Restrictions on going out, participating in community activities, and visiting hospitals were in place. This study investigates the short-term effects of the COVID-19 pandemic on patients with chronic pain. Methods This study included outpatients with chronic pain undergoing treatment at the Pain Center of Nara Medical University Hospital. The patients had completed questionnaires for a disability during the study period, from 1 July to 30 September 2019 (baseline), 1 October to 31 December 2019 (pre-pandemic), and 1 July to 30 September 2020 (during the pandemic). The questionnaire covered changes in disability, pain intensity, health-related quality of life (QOL), anxiety, depression, catastrophic thinking, and the presence/absence of exercise habits at baseline, pre-pandemic, and during the pandemic. Results Of the 245 eligible patients, there was no significant disability difference between baseline, pre-pandemic, and during the pandemic (p = 0.14). Similarly, pain intensity, health-related QOL, anxiety, depression, and the presence/absence of exercise habits did not significantly differ between baseline, pre-pandemic, and during the pandemic either. The current study observed significant differences in terms of catastrophic thinking (p = 0.02). Conclusion The effects of the COVID-19 pandemic on patients with chronic pain were not apparent in the short-term. Clinical trail registration: UMIN000043174
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Thorninger R, Wæver D, Pedersen J, Tvedegaard-Christensen J, Tjørnild M, Lind M, Rölfing JD. Objective Outcome Measures Continue to Improve from 6 to 12 Months after Conservatively Treated Distal Radius Fractures in the Elderly-A Prospective Evaluation of 50 Patients. J Clin Med 2021; 10:1831. [PMID: 33922371 DOI: 10.3390/jcm10091831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 12/20/2022] Open
Abstract
Distal radius fractures (DRF) in the elderly population above 65 years represent 18% of all fractures and are thereby the second most frequent fracture in the elderly. Fracture dislocation and comminution are often used to determine whether non-operative or operative treatment is indicated. The purpose of this prospective case series of minimally displaced DRF treated with a dorsal cast was to assess the complication rate and patient-reported outcome measures. This single-centre, single-blinded, prospective case series followed 50 conservatively treated DRF patients for one year. Primary outcomes were complications and Quick Disability of Arm Shoulder and Hand (qDASH) score. Secondary outcomes were range of motion (ROM), grip strength and pain, and Patient-Rated Wrist/Hand Evaluation (PRWHE). Results showed only minor complications with a return to prior ROM, qDASH, and pain after 12 months and improvement in outcomes after 6-12 months. In conclusion, the majority of DRF patients who were treated non-operatively with five-week dorsal casting recover fully after minimally displaced DRF. This standard approach is thus considered safe, and the present results provide a reference for other studies.
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Bialka S, Sliwczynska M, Marciniak A, Czyzewski D, Misiolek H. An assessment of the effectiveness of regional analgesia after VATS measured by an objective method for assessing testosterone, cortisol, α-amylase, sIgA, and β-endorphin levels - a randomised controlled trial. Endokrynol Pol 2021; 72:133-142. [PMID: 33619708 DOI: 10.5603/ep.a2021.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Thoracic surgeries are associated with intense postoperative pain. General opioid analgesia is still the main anaesthetic method. Due to the large number of opioid-induced side effects, alternative methods of pain relief are sought. One of them is the use of balanced analgesia, which consists of regional analgesia, non-opioid painkillers, and small doses of opioids. MATERIAL AND METHODS The objective of this study was to assess the effectiveness of preoperative thoracic paravertebral block (ThPVB) in the treatment of postoperative pain after video-assisted thoracic surgery (VATS) by measuring hormone levels in blood serum or saliva. It was a randomised, open-label study conducted in a single university hospital setting between May 2018 and September 2019. In total, 119 patients were scheduled for elective video-assisted thoracic surgery. Performed interventions included: preoperative thoracic paravertebral block with 0.5% bupivacaine, followed by postoperative oxycodone combined with nonopioid analgesics. Follow-up period comprised first 24 hours and one, two, and six months after surgery. Main outcomes were measured by pain intensity assessed using the Numerical Rating Scale (NRS) and the levels of the following hormones: testosterone, cortisol, α-amylase activity, sIgA, and β-endorphin. RESULTS A total of 119 patients were randomised into two groups and, of these, 49 were subsequently excluded from the analysis. The final analysis included 37 patients from the study group and 33 from the control group. There were no statistically significant differences in the analysed parameters the relative change T1-T0. There was a tendency towards statistical significance in the relative change T2-T0 in testosterone levels. At rest, no statistically significant differences were found between groups and time in the percentage of patients with NRS ≥ 1. During cough, the percentage of patients with NRS ≥ 1 was higher at T1 and T2 time points in the ThPVB group. Of the factors considered, only α-amylase levels statistically significantly increased the chance for higher NRS score after a month [OR = 1.013; 95% PU: 1.001-1.025; p < 0.01]. CONCLUSIONS ThPVB is effective and safe for patients undergoing VATS. It can be an effective alternative for general anaesthesia using high doses of opioids.
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Affiliation(s)
- Szymon Bialka
- Department of Anaesthesiology, Intensive Care, and Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland.
| | - Magdalena Sliwczynska
- Department of Anaesthesiology, Intensive Care, and Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Aleksandra Marciniak
- Department of Anaesthesiology, Intensive Care, and Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Damian Czyzewski
- Chair and Department of Thoracic Surgery, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Hanna Misiolek
- Department of Anaesthesiology, Intensive Care, and Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
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Park SJ, Lee DH, Han JK. Reducing Pain by Artificial Ascites Infusion During Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2021; 44:565-73. [PMID: 33388866 DOI: 10.1007/s00270-020-02723-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/19/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate therapeutic effects of artificial ascites (AA) infusion in patients with subcapsular hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA) and to determine whether this infusion can reduce pain. METHODS AND MATERIALS From 2011 to 2016, 123 patients with treatment-naïve single subcapsular HCC (≤ 2.5 cm) who underwent RFA were retrospectively included. Patients were divided into two groups according to AA infusion. After RFA, medical records were used to analyze pain scores during a 24-h period and to determine the opioid used that compared using Mann-Whitney U test. We also conducted subgroup analysis of the patients with HCCs located adjacent to parietal peritoneum. After follow-up period, we analyzed local tumor progression (LTP) and recurrence-free survival using Kaplan-Meier method. RESULTS AA was infused in 76 patients (61.8%, 76/123). Pain score using numeric rating scale (NRS) was significantly lower in AA infusion group than in control group (2.54 ± 2.8 vs. 3.66 ± 3.2, p = 0.048). Dose of opioids used was not significantly different between two groups (1.62 ± 3.4 mg vs. 1.66 ± 3 mg, p = 0.698). However, in subgroup analysis (N = 45), NRS score and dose of opioids used were significantly lower in AA infusion group (p = 0.03, p = 0.032, respectively). LTP rate was not significantly different between two groups (p = 0.673). CONCLUSION AA infusion was an effective and safe way to reduce pain when performing RFA for subcapsular HCC. In particular, in patients with subcapsular HCC adjacent to parietal peritoneum, dose of opioid to use pain control was significantly lower with AA infusion.
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Lian J, Wang H, Cui R, Zhang C, Fu J. Status of Analgesic Drugs and Quality of Life Results for Diabetic Peripheral Neuropathy in China. Front Endocrinol (Lausanne) 2021; 12:813210. [PMID: 35126315 PMCID: PMC8813762 DOI: 10.3389/fendo.2021.813210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study is to describe the current clinical situation of patients with painful diabetic peripheral neuropathy (DPN) and related anxiety, depression, and the quality of life of patients in mainland China, and to report the current status of the use of analgesics. METHODS Between June 15, 2021, and October 15, 2021, a total of 401 participants participated in the study. Recruitment was carried out using a multi-level sampling method. Participants' demographics, medical history, analgesic use, Michigan Symptom Score (MNSI), Numerical Rating Scale (NRS) pain score, Patient Health Questionnaire 9 (PHQ-9) score, Generalized Anxiety Disorder 7 (GAD) -7) Score, quality of life score (SF-12) and diabetes treatment status were collected. RESULTS Among the participants, there were 236 male patients and female patients. Participants were 322 patients over 40 years old. Regarding the use of analgesics: 132 patients reported using analgesics, 221 patients reported not using analgesics, and 48 patients reported having used analgesics. The results of the scale showed that the scores of NRS, GAD-7, PHQ-9 and SF-12 were 5.12 ± 2.15, 6.33 ± 3.67, 8.46 ± 4.07 and 47.84 ± 19.92 for patients who used analgesics, Compared with patients who did not use analgesics (NRS: 1.99 ± 1.7, GAD-7: 1.81 ± 2.81, PHQ-9: 3.13 ± 4.10, SF-12: 78.34 ± 21.66) there are significant differences (p< 0.001). In addition, patients' NRS scores are also closely related to GAD-7, PHQ-9 and SF-12 scores. CONCLUSION The severity of symptoms, mental status and quality of life of patients who used analgesics were more severe than those of patients who did not use analgesics. Pregabalin is still the preferred analgesic for patients with painful DPN, and the use of opioids in my country is extremely low, which is consistent with current international guidelines. Age, diabetic duration, DPN duration, PHQ-9 score, GAD-7 score and SF-12 scores are closely related to NRS pain scores. In addition, there are still a considerable number of patients who have not used analgesics due to financial burdens and other reasons, suggesting that China still has insufficient pain management in DPN patients.
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Affiliation(s)
- Jingxuan Lian
- Department of Endocrinology, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Haijun Wang
- Department of Endocrinology, Yan’an People’s Hospital, Yan’an, China
| | - Rongrong Cui
- Department of Endocrinology, Shangluo Central Hospital, Shangluo, China
| | - Chaoxia Zhang
- Department of Endocrinology, Xi’an Daxing Hospital, Xi’an, China
| | - Jianfang Fu
- Department of Endocrinology, Xijing Hospital, The Air Force Medical University, Xi’an, China
- *Correspondence: Jianfang Fu,
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Lee MK, Schalet BD, Cella D, Yost KJ, Dueck AC, Novotny PJ, Sloan JA. Establishing a common metric for patient-reported outcomes in cancer patients: linking patient reported outcomes measurement information system (PROMIS), numerical rating scale, and patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). J Patient Rep Outcomes 2020; 4:106. [PMID: 33305344 PMCID: PMC7728866 DOI: 10.1186/s41687-020-00271-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Researchers and clinicians studying symptoms experienced by people with cancer must choose from various scales. It would be useful to know how the scores on one measure translate to another. METHODS Using item response theory (IRT) with the single-group design, in which the same sample answers all measures, we produced crosswalk tables linking five 0-10 numeric rating scale (NRS) and 15 items from Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE, scored on a 1-5 scale) to the T-Score metric of six different scales from the NIH Patient reported Outcomes Measurement Information System (PROMIS®). The constructs, for which we conducted linking, include emotional distress-anxiety, emotional distress-depression, fatigue, sleep disturbance, pain intensity, and pain interference. We tested the IRT linking assumption of construct similarity between measures by comparing item content and testing unidimensionality of item sets comprising each construct. We also investigated the correlation of the measures to be linked and, by inspecting standardized mean differences, whether the linkage is invariant across age and gender subgroups. For measures that satisfied the assumptions, we conducted linking. RESULTS In general, an NRS score of 0 corresponded to about 38.2 on the PROMIS T-Score scale (mean = 50; SD = 10); whereas an NRS score of 10 corresponded to a PROMIS T-Score of approximately 72.7. Similarly, the lowest/best score of 1 on PRO-CTCAE corresponded to 39.8 on T-score scale and the highest/worst score of 5 corresponded to 72.0. CONCLUSION We produced robust linking between single item symptom measures and PROMIS short forms.
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Affiliation(s)
- Minji K Lee
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN, 55906, USA.
| | - Benjamin D Schalet
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 27th Floor, Chical, IL, 60611, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 27th Floor, Chical, IL, 60611, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Amylou C Dueck
- Department of Health Sciences Research, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Paul J Novotny
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jeff A Sloan
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Janmohamed SR, Gwillim EC, Yousaf M, Patel KR, Silverberg JI. The impact of prurigo nodularis on quality of life: a systematic review and meta-analysis. Arch Dermatol Res 2020; 313:669-677. [PMID: 33108524 DOI: 10.1007/s00403-020-02148-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/11/2020] [Accepted: 10/09/2020] [Indexed: 12/29/2022]
Abstract
Prurigo nodularis (PN) is a chronic, pruritic, debilitating disease. Previous studies found that chronic pruritus in general negatively affects patients' quality of life (QoL). However, results about the impact of PN on QoL are conflicting. Our objective was to assess the QoL burden of PN. A systematic review was conducted of all published studies that assessed QoL measures in PN. OVID MEDLINE, EMBASE, SCOPUS, and Web of Science were searched. Pooled meta-analysis (means) was performed using random-effects weighting. Overall, 13 studies met inclusion criteria. All studies identified QoL reductions in patients suffering from PN compared to control groups. The most common QoL instrument used was the Dermatology Life Quality Index [n = 9 studies; pooled mean (95% confidence interval): 13.8 (10.6-16.9), denoting a very large effect]. In particular, PN was associated with substantial impact on multiple domains of QoL. No publication bias was detected. In conclusion, QoL is negatively impacted in PN. Future studies are necessary to determine the best instruments of measuring QoL in PN patients, better understand this association, and assess the impact in males and females separately. PROSPERO CRD42019136193.
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Affiliation(s)
- Sherief R Janmohamed
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Jette, Belgium
| | - Eran C Gwillim
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Muhammad Yousaf
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin R Patel
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, 2150 Pennsylvania Avenue, Suite 2B-430, Washington, DC, 20037, USA.
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Xu H, Li X, Yang B, Shen Z, Li W, Zhou Y, Jiang J, Chen X, Gu Y, Pei Z, Li J. Effects of preconditioning by nasal splint and mouth breathing on emergence delirium after functional endoscopic sinus surgery in Chinese adults: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e033803. [PMID: 32847900 PMCID: PMC7451479 DOI: 10.1136/bmjopen-2019-033803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Emergence delirium (ED) is a common adverse manifestation after general anaesthesia and may result in undesirable consequences. Its causes and mechanisms are diverse and complex, and it is still unavoidable in clinical work. There is a high incidence of ED after otorhinolaryngology surgery, which may result from the sudden loss of functional senses and discomfort of surgical organs. This study aims to test a non-invasive, non-drug treatment modality of nose clamping and mouth-breathing training before surgery to reduce ED. METHODS AND ANALYSIS This prospective randomised controlled trial (RCT) will include 200 patients who undergo functional endoscopic sinus surgery (FESS) at Shanghai General Hospital, China. Study participants will be randomly assigned in two groups with a 1:1 ratio. The pretreatment group (P-group) will receive an intervention by nasal splint and mouth-breathing training before surgery, while the control group (C-group) will not receive any intervention; following which both groups will undergo FESS under general anaesthesia in accordance with the same anaesthesia scheme. After surgery, we will perform a single-blinded assessment of ED occurrence with stratification. IBM SPSS Statistics V.20 statistical software will be used for statistical analyses. A X2 test will be used to compare the two groups, and t-tests will determine the statistical significance of continuous variables. ETHICS AND DISSEMINATION This RCT was designed in accordance with the principles of the Declaration of Helsinki and has been approved by the Ethics Committee of Shanghai General Hospital, ID: 2019KY039.We expect to release the original data in February 2022 on the ResMan original data sharing platform (IPD sharing platform) of the China clinical trial registry, which can be viewed at the following website:http://www.medresman.org.cn/pub/cn/proj/projectshow.aspx?proj=6293. TRIAL REGISTRATION NUMBER ChiCTR1900024925.
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Affiliation(s)
- Hongjiao Xu
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Xiang Li
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Bin Yang
- Department of Anaesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Zhenyuan Shen
- Medical department, Mellon community health service center, Shanghai, China
| | - Weiwen Li
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Yachun Zhou
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Jihong Jiang
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Xia Chen
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Yuyu Gu
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Zhi Pei
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Jinbao Li
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
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Tong Y, Wei P, Wang S, Sun Q, Cui Y, Ning N, Chen S, He X. Characteristics of Postoperative Pain After VATS and Pain-Related Factors: The Experience in National Cancer Center of China. J Pain Res 2020; 13:1861-1867. [PMID: 32765060 PMCID: PMC7382587 DOI: 10.2147/jpr.s249134] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose No final conclusion has yet been reached on characteristics of postoperative pain and pain-related factors after video-assisted thoracoscopic surgery (VATS). This study was designed to explore features of acute severe pain and chronic post-surgical pain (CPSP), and the pain-related factors of VATS. Patients and Methods Data of patients who underwent VATS for lung cancer in Cancer Hospital, Chinese Academy of Medical Sciences between March 2017 and January 2019 were reviewed in this retrospective study. A numerical rating scale (NRS) was used for evaluating the intensity of postoperative pain including no pain (NRS=0), mild pain (NRS=1–3), moderate pain (NRS=4–6), and severe pain (NRS=7–10). Pain intensity was assessed daily within a week after operation, and also evaluated at 3 months postoperatively. Results One hundred and five (3.4%) of the 3072 patients enrolled experienced severe pain (NRS=7–10) on the 1st day after operation, and 17 (0.6%) on the 2nd day. Smoking history, three-port VATS, prolonged operation time, and without patient-controlled analgesia (PCA) were correlated to increased incidence of severe pain. Among all patients, 237 (7.7%) cases generated CPSP, and VATS type, operation time, duration of drainage, and severe pain on the 1st day were four independent risk factors related to CPSP. Conclusion Patients seemed to experience a lower incidence of acute severe pain and CPSP after VATS than traditional open surgery. Acute severe pain was correlated with smoking history, VATS type, operation time, and PCA; VATS type, operation time, duration of drainage, and severe pain on the 1st day postoperatively were four independent risk factors of CPSP.
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Affiliation(s)
- Yao Tong
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Peipei Wei
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Shuang Wang
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Qiuying Sun
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Yanzheng Cui
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Ning Ning
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Sitong Chen
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Xin He
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
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Jeyaraman MM, Al-Yousif N, Robson RC, Copstein L, Balijepalli C, Hofer K, Fazeli MS, Ansari MT, Tricco AC, Rabbani R, Abou-Setta AM. Inter-rater reliability and validity of risk of bias instrument for non-randomized studies of exposures: a study protocol. Syst Rev 2020; 9:32. [PMID: 32051035 PMCID: PMC7017505 DOI: 10.1186/s13643-020-01291-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A new tool, "risk of bias (ROB) instrument for non-randomized studies of exposures (ROB-NRSE)," was recently developed. It is important to establish consistency in its application and interpretation across review teams. In addition, it is important to understand if specialized training and guidance will improve the reliability in the results of the assessments. Therefore, the objective of this cross-sectional study is to establish the inter-rater reliability (IRR), inter-consensus reliability (ICR), and concurrent validity of the new ROB-NRSE tool. Furthermore, as this is a relatively new tool, it is important to understand the barriers to using this tool (e.g., time to conduct assessments and reach consensus-evaluator burden). METHODS Reviewers from four participating centers will apprise the ROB of a sample of NRSE publications using ROB-NRSE tool in two stages. For IRR and ICR, two pairs of reviewers will assess the ROB for each NRSE publication. In the first stage, reviewers will assess the ROB without any formal guidance. In the second stage, reviewers will be provided customized training and guidance. At each stage, each pair of reviewers will resolve conflicts and arrive at a consensus. To calculate the IRR and ICR, we will use Gwet's AC1 statistic. For concurrent validity, reviewers will appraise a sample of NRSE publications using both the Newcastle-Ottawa Scale (NOS) and ROB-NRSE tool. We will analyze the concordance between the two tools for similar domains and for the overall judgments using Kendall's tau coefficient. To measure evaluator burden, we will assess the time taken to apply ROB-NRSE tool (without and with guidance), and the NOS. To assess the impact of customized training and guidance on the evaluator burden, we will use the generalized linear models. We will use Microsoft Excel and SAS 9.4, to manage and analyze study data, respectively. DISCUSSION The quality of evidence from systematic reviews that include NRSE depends partly on the study-level ROB assessments. The findings of this study will contribute to an improved understanding of ROB-NRSE and how best to use it.
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Affiliation(s)
- Maya M Jeyaraman
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba, 363-753 McDermot Avenue, Winnipeg, Manitoba, R3E 0 T6, Canada. .,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Nameer Al-Yousif
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba, 363-753 McDermot Avenue, Winnipeg, Manitoba, R3E 0 T6, Canada
| | - Reid C Robson
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Leslie Copstein
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba, 363-753 McDermot Avenue, Winnipeg, Manitoba, R3E 0 T6, Canada
| | | | - Kimberly Hofer
- Evidinno Outcomes Research Inc., Vancouver, British Columbia, Canada
| | - Mir S Fazeli
- Evidinno Outcomes Research Inc., Vancouver, British Columbia, Canada
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Epidemiology Division, Dalla Lana School of Public Health & Institute of Health, Management, and Policy Evaluation, University of Toronto, Toronto, Canada.,Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Ontario, Canada
| | - Rasheda Rabbani
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba, 363-753 McDermot Avenue, Winnipeg, Manitoba, R3E 0 T6, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ahmed M Abou-Setta
- The George & Fay Yee Center for Healthcare Innovation, University of Manitoba, 363-753 McDermot Avenue, Winnipeg, Manitoba, R3E 0 T6, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Weißenberger M, Heinz T, Boelch SP, Niemeyer P, Rudert M, Barthel T, Reppenhagen S. Is debridement beneficial for focal cartilage defects of the knee: data from the German Cartilage Registry (KnorpelRegister DGOU). Arch Orthop Trauma Surg 2020; 140:373-382. [PMID: 31970506 PMCID: PMC8079301 DOI: 10.1007/s00402-020-03338-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Focal cartilage defects of the knee are often treated with arthroscopic debridement. Existing literature discussing the benefit of debridement for small articular cartilage lesions is scarce, especially if the debridement was not part of a combined operative cartilage procedure including meniscal and ligament repair. The purpose of this study was to examine the patients´ benefit after arthroscopic debridement for the treatment of isolated focal chondral defects with or without partial meniscus resection. MATERIALS AND METHODS Baseline (preoperative data) and 12-month follow-up of the five Knee Osteoarthritis Outcome Score (KOOS) subscores and the Numeric Rating Scale (NRS) for pain were analyzed in 126 patients undergoing debridement for focal chondral defects of the knee from the German Cartilage Registry. Sub-analysis for patients receiving isolated debridement and debridement with concomitant partial resection of meniscal pathologies was performed. Thus, four subgroups were created according to the treated defect size and presence of meniscal pathologies: "debridement-only < 2 cm2", "debridement-only > 2 cm2", "debridement and partial meniscus resection < 2 cm2" and "debridement and partial meniscus resection > 2 cm2". RESULTS KOOS-subscores showed a significant increase from baseline to follow-up evaluation (p = 0.017-0.037) within the 126 patients. Sub-analysis showed significant improvement of all five KOOS-subscores in all three subgroups, except for the "debridement and partial meniscus resection > 2 cm2"-group: in this group the KOOS subscores symptoms and sports showed no significant improvement. The NRS scores revealed no significant changes from baseline to 12-month follow-up within the four subgroups. CONCLUSION An overall benefit of arthroscopic debridement for focal cartilage lesions of the knee could be conducted. Isolated cartilage defects seem to benefit from debridement irrespectively of size. In patients with large cartilage defects (> 2 cm2) and concurrent meniscal pathology expectation to improvement should be humbled. Effective reduction of pain by arthroscopic debridement remains unclear.
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Affiliation(s)
- Manuel Weißenberger
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Tizian Heinz
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Sebastian P. Boelch
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Philipp Niemeyer
- OCM Clinic, Steinerstr. 6, 81369 Munich, Germany ,Department of Orthopaedics and Trauma Surgery, Freiburg University Hospital, Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Thomas Barthel
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Stephan Reppenhagen
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
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Hill-Mündel K, Schlegl J, Biesalski HK, Ehnert S, Schröter S, Bahrs C, Nohr D, Nüssler AK, Ihle C. Preoperative Ascorbic Acid Levels in Proximal Femur Fracture Patients Have No Postoperative Clinical Impact, While Ascorbic Acid Levels upon Discharge Have a Major Effect on Postoperative Outcome. J Clin Med 2019; 9:jcm9010066. [PMID: 31888071 PMCID: PMC7019571 DOI: 10.3390/jcm9010066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 12/24/2019] [Indexed: 12/17/2022] Open
Abstract
Proximal femur fractures show a high prevalence in elderly patients and are associated with an elevated risk of multimorbidity and early mortality. Recovery is impaired by malnutrition and oxidative stress, which is affected by antioxidants such as ascorbic acid (AA). This study monitored AA levels during hospitalization of patients with a proximal femur to investigate the influence of AA status to the clinical outcome. AA levels of 25 elderly patients with a proximal femur fracture were measured during hospitalization using high performance liquid chromatography. Plasma samples were collected preoperatively, on the first day after surgery, on the third day after surgery and on the day of discharge. Nutritional Risk Screening 2002 (NRS) and Mini Nutritional Assessment (MNA) were assessed to evaluate the nutritional status. In patients with proximal femoral fractures, preoperative AA concentrations were significantly lower compared to elderly patients without an acute fracture. A significant decrease of 33.8% in AA plasma level was measured on the day after surgery with a significant recovery up to the time of discharge. The preoperative AA status did not have any significant effect on clinical outcome. However, inadequate AA levels (<50 µmol/L) upon discharge significantly increased the incidence and the severity of postoperative complications. These results indicate that the AA status upon discharge has a greater impact on clinical outcome than assumed, and therefore, AA supplementation during hospitalization should be considered.
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Affiliation(s)
- Katharina Hill-Mündel
- Institute of Nutritional Science, University of Hohenheim, 70599 Stuttgart, Germany; (K.H.-M.); (H.K.B.); (D.N.)
| | - Johannes Schlegl
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
| | - Hans Konrad Biesalski
- Institute of Nutritional Science, University of Hohenheim, 70599 Stuttgart, Germany; (K.H.-M.); (H.K.B.); (D.N.)
| | - Sabrina Ehnert
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
| | - Steffen Schröter
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
| | - Christian Bahrs
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
| | - Donatus Nohr
- Institute of Nutritional Science, University of Hohenheim, 70599 Stuttgart, Germany; (K.H.-M.); (H.K.B.); (D.N.)
| | - Andreas K. Nüssler
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
| | - Christoph Ihle
- Siegfried Weller Research Institute, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany; (J.S.); (S.E.); (S.S.); (C.B.); (A.K.N.)
- Correspondence: ; Tel.: +49-7071-606-1065
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Hersberger L, Bargetzi L, Bargetzi A, Tribolet P, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, Kutz A, Kägi-Braun N, Hoess C, Pavlicek V, Schmid S, Bilz S, Sigrist S, Brändle M, Benz C, Henzen C, Nigg M, Thomann R, Brand C, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Nutritional risk screening ( NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial. Clin Nutr 2019; 39:2720-2729. [PMID: 31882232 DOI: 10.1016/j.clnu.2019.11.041] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The Nutritional Risk Screening 2002 (NRS 2002) identifies patients at risk of malnutrition. We studied the prognostic implications of this score with regard to short-term and long-term clinical outcomes in a well-characterised cohort of medical inpatients from a previous trial. METHODS This is a secondary analysis of an investigator-initiated, prospective randomised controlled multicenter trial in Switzerland (EFFORT) that compared the effects of an individualised nutritional support intervention with standard of care. We investigated associations between admission NRS and several short-term and long-term outcomes using multivariable regression analyses. RESULTS Of the 2028 patients, 31% had an NRS of 3, 38% of 4 and 31% of ≥5 points, and 477 (24%) died during the 180 days of follow-up. For each point increase in NRS, we found a stepwise increase in risk of 30-day mortality (adjusted Hazard Ratio (HR) 1.22 (95% CI 1.00 to 1.48), p = 0.048) and 180-day mortality (adjusted HR 1.37 (95% CI 1.22 to 1.55), p < 0.001). NRS was associated with length of hospital stay (adjusted difference of 0.60 days per NRS point increase, 95%CI 0.23 to 0.97, p = 0.002) and functional outcomes at 180 days (adjusted decrease in Barthel index of -4.49 points per NRS point increase, 95%CI -6.54 to -2.45, p < 0.001). In a subgroup analysis, associations of NRS and short-term adverse outcomes were less pronounced in patients receiving nutritional support (intervention group) compared to control group patients (adjusted HR for 30-day mortality 1.12 [95%CI 0.83 to 1.52, p = 0.454] vs. 1.33 [95%CI 1.02 to 1.72, p = 0.032]). CONCLUSION The NRS is a strong and independent risk score for malnutrition-associated mortality and adverse outcomes over 180 days. Our data provide strong evidence that the nutritional risk, however, is modifiable and can be reduced by the provision of adequate nutritional support.
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Affiliation(s)
- Lara Hersberger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Laura Bargetzi
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Annika Bargetzi
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | | | - Rebecca Fehr
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Valerie Baechli
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Martina Geiser
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Manuela Deiss
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Filomena Gomes
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York City, NY, USA
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Nina Kägi-Braun
- Internal Medicine, Kantonsspital Muensterlingen, Switzerland
| | - Claus Hoess
- Internal Medicine, Kantonsspital Muensterlingen, Switzerland
| | | | - Sarah Schmid
- Internal Medicine, Kantonsspital Muensterlingen, Switzerland
| | - Stefan Bilz
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Sarah Sigrist
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Michael Brändle
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Carmen Benz
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | | | - Melina Nigg
- Internal Medicine, Kantonsspital Luzern, Switzerland
| | | | - Claudia Brand
- Internal Medicine, Buergerspital Solothurn, Switzerland
| | | | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Zeno Stanga
- Division of Diabetology, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
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Svalebjørg M, Storm H, Olsen RB, Bugge JF. Measurement of skin conductance responses to evaluate procedural pain in the perioperative setting. Scand J Pain 2019; 18:639-644. [PMID: 30048238 DOI: 10.1515/sjpain-2018-0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/01/2018] [Indexed: 11/15/2022]
Abstract
Background and aims The subjective nature of pain makes objective, quantitative measurements challenging. The current gold standard for evaluating pain is patient self-reporting using the numeric rating scale (NRS) or Visual Analog Scale. Skin conductance responses per second (SCR) measured in the palmar region reflect the emotional part of the autonomous nervous system. SCR ≥0.20 have been shown to indicate moderate or severe pain in the postoperative setting. We examined whether SCR can detect procedure-related pain before major surgery. Methods In 20 patients being prepared for major surgery SCR was recorded before and during arterial cannulation, after induction of anaesthesia, and on the first postoperative day. Self-reported pain was evaluated using NRS. NRS >3 was considered to represent moderate or severe pain. Results NRS was 0 [0-0] before arterial cannulation, increasing to 5 [3-6] during arterial cannulation (p<0.05). Before arterial cannulation SCR was 0.27 [0.20-0.27], increasing to 0.33 [0.30-0.37] during arterial cannulation (p<0.01). On the first postoperative day both SCR and reported pain indicated no more than mild pain, SCR 0.13 [0.00-0.20] and NRS 2.0 [0.5-2.0]. The sensitivity of SCR to indicate moderate or severe pain (NRS >3) was 0.93 (0.68-1.0) and specificity was 0.33 (0.25-0.35) when the cut-off established in the postoperative setting (SCR ≥0.20) was used on all data. Conclusions SCR increased during arterial cannulation. Before major surgery the SCR was above the threshold demonstrated to indicate pain in the postoperative setting, even without painful stimuli and no reported pain. Using the threshold established for postoperative pain, SCR cannot reliably discriminate between pain and other stressors before major surgery. Implications Before major surgery, the diagnosis of moderate or severe pain should not be made based on SCR ≥0.20.
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Affiliation(s)
- Morten Svalebjørg
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Hanne Storm
- The Simulation Centre, Division of Emergencies and Critical Care, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Jan Frederik Bugge
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Stollhof LE, Braun JM, Ihle C, Schreiner AJ, Kufeldt J, Adolph M, Wintermeyer E, Stöckle U, Nüssler A. The continuous downgrading of malnutrition in the German DRG system: possible effects on the treatment of patients at risk for malnutrition. EXCLI J 2019; 18:370-381. [PMID: 31338008 PMCID: PMC6635725 DOI: 10.17179/excli2019-1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022]
Abstract
It has been internationally recognized that malnutrition is an independent risk factor for patients' clinical outcome. A new mandatory fixed price payment system based on diagnosis-related groups (G-DRG) went into effect in 2004. The aim of our study was to demonstrate the importance of carefully coding the secondary diagnosis of "malnutrition" in the G-DRG system and to highlight how the economic relevance of malnutrition in the G-DRG system has changed from 2014 to 2016. 1372 inpatients at the Berufsgenossenschaftliche Unfallklinik (Trauma Center) in Tübingen were screened for the risk of malnutrition using Nutritional Risk Screening (NRS-2002). Patient data were compared with the NRS values collected during the study and a case simulation was carried out separately for each year. We used the codes E44.0 for NRS = 3 and E43.0 for NRS > 3. The ICD codes were entered as an additional secondary diagnosis in the internal hospital accounting system DIACOS to determine possible changes in the effective weight. In 2014 the highest additional revenue by far was calculated by coding malnutrition. For the 638 patients enrolled in the study in 2014, we were able to calculate an average additional revenue per patient coded with malnourishment of €107. In 2016, we were unable to calculate any additional revenue for the 149 patients enrolled. Although it is well known that malnutrition is an independent risk factor for poor patient outcomes, nationwide screening for a risk of malnutrition when patients are admitted to a hospital is still not required. For this reason, malnutrition in German hospitals continues to be insufficiently documented. Due to the continuous downgrading of diagnosis-related severity (CCL) of malnutrition in the G-DRG system in trauma surgery patients, it is no longer possible to refinance the costs incurred by malnourished patients through the conscientious coding of malnutrition. We assume that the indirect positive effects of nutritional interventions will have to be taken into account more in the costing calculations and possibly lead to indirect cost compensation.
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Affiliation(s)
- Laura E Stollhof
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Jessica M Braun
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Christoph Ihle
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Anna J Schreiner
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Johannes Kufeldt
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Michael Adolph
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Elke Wintermeyer
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Ulrich Stöckle
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
| | - Andreas Nüssler
- Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen
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Kulkarni J, Pettifer S, Turner S, Richardson C. An investigation into the effects of a virtual reality system on phantom limb pain: a pilot study. Br J Pain 2019; 14:92-97. [PMID: 32537147 DOI: 10.1177/2049463719859913] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background There is no first-line treatment available for phantom limb pain (PLP). For some years, there has been interest in the use of mirrors and other techniques based on visual feedback. Unfortunately, up until now, all published studies have had methodological weaknesses with two recent systematic reviews concluding that therapies of this kind need more evidence to support their use. Aim To evaluate the effects of a virtual reality (VR) activity on PLP. Methods This was a prospective pilot study of upper limb amputees using questionnaires to evaluate a VR system. Eleven participants were recruited, with nine completing all three sessions of VR. Participants undertook three sessions of VR, one a month for 3 months. Outcome measures were PLP pain intensity using an 11-point numerical rating scale (NRS), number of PLP episodes and duration of the PLP episodes. All participants were also asked for their judgement of change. Open-ended questions captured the qualitative experience of all aspects of the VR experience. Results The mean PLP pain score following three VR sessions reduced (6.11 v 3.56) but this was not a statistical difference (t = 2.1, df = 8, p = 0.07). No statistical difference was found for the number of PLP episodes (Pearson chi-square = 3.43, df = 2, p = 0.18) or the duration of each PLP episode (Pearson chi-square = 22.50, df = 16, p = 0.13). Three groups emerged: those whose pain reduced (the majority), those whose pain remained the same (small number) and one those whose pain increased slightly. Discussion There is insufficient evidence from these results to identify an effect of VR on PLP; however, this is a small group and qualitatively most were content with the treatment and wanted a longer trial.
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Affiliation(s)
- Jai Kulkarni
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Sue Turner
- Manchester University NHS Foundation Trust, Manchester, UK
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Srinivas S, Paquet J, Bailey C, Nataraj A, Stratton A, Johnson M, Salo P, Christie S, Fisher C, Hall H, Manson N, Rampersaud YR, Thomas K, McIntosh G, Dea N. Effect of spinal decompression on back pain in lumbar spinal stenosis: a Canadian Spine Outcomes Research Network (CSORN) study. Spine J 2019; 19:1001-8. [PMID: 30664950 DOI: 10.1016/j.spinee.2019.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical decompression is usually offered for improvement of neurogenic claudication in patients with symptomatic lumbar canal stenosis. These patients often have associated low back pain (LBP) and little is known about the effect of decompression on this symptom. PURPOSE The goal of the present study is to specifically quantify the improvement in LBP following surgical decompression for lumbar canal stenosis and to identify factors associated with changes in LBP in this population. STUDY DESIGN This is a multicenter, retrospective review of consecutive spine surgery patients enrolled by the Canadian Spine Outcomes and Research Network. PATIENT SAMPLE Consecutive patients who underwent surgical treatment for symptomatic lumbar spine stenosis without instability between 2014 and 2017. OUTCOME MEASURES Change in LBP on the Numeric Rating Scale (NRS). METHODS Patient-reported outcomes were collected at baseline and at 3, 12, and 24 months after surgery. The primary outcome was change in LBP on the NRS. Multivariable logistic regression was used to model the relationship between the outcome and potential factors associated with achieving minimal clinical important difference in back pain using a backward selection procedure. RESULTS In all, 1,221 patients were included in the analysis. Mean age was 64 years and 58% were males. Baseline back pain scores were available in 1,133 patients and follow-up evaluations were available in 968/1,133 (85%) patients at 3 months, 649/903 (72%) patients at 12 months, and 331/454 (73%) at 24 months. LBP significantly improved 3 months after surgery and the improvement was sustained at 24 months (p<.001). We found that 74% of patients reached the minimal clinical important difference in back pain. Predictive factors for sustained improvement (12 and 24 months) in LBP after surgical intervention were absence of narcotic usage or compensation claims and increased severity of LBP before surgery (high NRS). CONCLUSIONS Alleviation of clinically significant LBP was observed at 3 months after lumbar decompression surgery for neurogenic claudication and was maintained at 12 and 24 months after surgery in the majority of patients.
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Abstract
Lab studies have shown that marijuana can severely impair driving skills. Epidemiological studies, however, have been inconclusive regarding the contribution of marijuana use to crash risk. In the United States, case-control studies based on the merging of comparable crash Fatality Analysis Reporting System (FARS) and non-crash National Roadside Survey (NRS) data have been applied to assess the contribution of drugs to crash risk, but these studies have yielded confusing, even contradictory results. We hypothesize that such a divergence of results emanates from limitations in the databases used in these studies, in particular that of the FARS. The goal of this effort is to examine this hypothesis, and in doing so, illuminate the pros and cons of using these databases for drugged-driving research efforts. We took advantage of two relatively recent cannabis crash risk studies that, despite using similar databases (the FARS and the NRS) and following similar overall approaches, yielded opposite results (Li, Brady, & Chen, 2013; Romano, Torres-Saavedra, Voas, & Lacey, 2014). By identifying methodological similarities and differences between these efforts, we assessed how the limitations of the FARS and NRS databases contributed to contradictory and biased results. Because of its limitations, we suggest that the FARS database should neither be used to examine trends in drug use nor to obtain precise risk estimates. However, under certain conditions (e.g., based on data from jurisdictions that routinely test for drugs, with as little variation in testing procedures as possible), the FARS database could be used to assess the contribution of drugs to fatal crash risk relative to other sources of risk such as alcohol.
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Karikari IO, Bridwell KH, Elsamadicy AA, Lenke LG, Sugrue P, Bumpass D, Ahmad A, Gum J. Decompression in Adult Lumbar Deformity Surgery Is Associated With Increased Perioperative Complications but Favorable Long-Term Outcomes. Global Spine J 2018; 8:110-113. [PMID: 29662739 PMCID: PMC5898680 DOI: 10.1177/2192568217735509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To analyze the impact of performing a formal decompression in patients with adult lumbar scoliosis with symptomatic spinal stenosis on perioperative complications and long-term outcomes. METHODS Adult patients undergoing at least 5 levels of fusion to the sacrum with iliac fixation from 2002 to 2008 who had a minimum 5-year follow-up at one institution were studied. Patients who had 3-column osteotomy were excluded from the study. Perioperative complications and clinical outcomes (Scoliosis Research Society [SRS], Oswestry Disability Index [ODI], and Numerical Rating Scale [NRS] back/leg pain) were analyzed. Patients who underwent formal laminectomy/decompressions were compared with those who did not. Differences between the 2 groups were analyzed using Student's t test. RESULTS A total of 147 patients were included in the study (Decompression: n = 55 [37%], No decompression: n = 92 [63%]). Average fusion levels for the decompression and no decompression groups were 11 and 12 levels, respectively (P = .26). Mean improvements in SRS domains for decompression versus no decompression patients, respectively, were pain (1.1 vs 0.9, P = .3), function (0.7 vs 0.5, P = .09), self-image (1.1 vs 1.1, P = .9), and mental health (0.5 vs 0.4, P = .5). Furthermore, additional mean improvements were ODI (21 vs 21, P = .14), NRS-Back pain (3.0 vs 1.3, P = .16), and NRS-Leg pain (3.9 vs 0.5, P = .002). Complication rates between the decompression group and no decompression group differed in incidental durotomies (18.2% vs 0%) and cardiac-related (9.1% vs 1.1%). CONCLUSIONS Performing a formal decompression in adult lumbar scoliosis with symptomatic spinal stenosis is associated with increased perioperative complications but favorable long-term clinical outcomes.
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Affiliation(s)
- Isaac O. Karikari
- Duke University Medical Center, Durham, NC, USA,Isaac O. Karikari, DUMC Box 3807, Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | - David Bumpass
- Washington University in St. Louis, St. Louis, MO, USA
| | - Azeem Ahmad
- Washington University in St. Louis, St. Louis, MO, USA
| | - Jeffrey Gum
- Norton Leatherman Spine Center, Louisville, KY, USA
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Abraham A, Barnett C, Katzberg HD, Lovblom LE, Perkins BA, Bril V. Sex differences in neuropathic pain intensity in diabetes. J Neurol Sci 2018; 388:103-106. [PMID: 29627001 DOI: 10.1016/j.jns.2018.03.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/12/2018] [Accepted: 03/04/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Sex and gender play roles in the pain experience, such that pain is more frequent in women. Explanations for this observation range from factors related to biological sex to those related to psychosocial gender. OBJECTIVES To explore neuropathic pain characteristics in females with diabetes with and without established polyneuropathy. METHODS We compared the presence and intensity of pain in males and females in 2 separate cohorts of patients with type II diabetes, with and without established diabetic polyneuropathy. Cohort #1 was recruited prospectively, while cohort #2 was studied retrospectively. RESULTS Cohort #1 of 223 patients with diabetes with a relatively broad spectrum of nerve injury, showed more frequent pain in females (68% versus 53% in males), a higher frequency of additional neuropathic symptoms, and evidence of milder nerve injury. Cohort #2 of 128 patients with established diabetic polyneuropathy, showed a similar frequency of pain and additional neuropathic symptoms in both sexes. In both cohorts, females reported greater pain intensity (7.9-8.5 versus 6.8-6.9 in males, on visual analog scale). DISCUSSION Though nerve injury and polyneuropathy are more common in males, females with diabetes report a higher frequency and intensity of pain despite milder polyneuropathy. Prospective epidemiological studies are required in order to confirm these findings in the community setting.
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Affiliation(s)
- Alon Abraham
- Neuromuscular Diseases Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Carolina Barnett
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Hans D Katzberg
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
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Kuroda H, Mizuno H, Dejima H, Watanabe K, Yoshida T, Naito Y, Sakao Y. A retrospective study on analgesic requirements for thoracoscopic surgery postoperative pain. J Pain Res 2017; 10:2643-2648. [PMID: 29180890 PMCID: PMC5697447 DOI: 10.2147/jpr.s147691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Thoracoscopic surgery (TS) has been performed as a minimally invasive procedure since the beginning of the 1990s. This has led to a dramatic change in the postoperative condition of these patients, facilitating early ambulation and easier management of postoperative pain. However, empirical evidence on postoperative pain management after TS is limited. The aims of this study were to determine the efficacy and adequacy of postoperative analgesic medications and to simplify the choice of additional drugs based on a numerical rating scale (NRS). Materials and methods A retrospective study of patients who underwent TS was performed to evaluate postoperative pain, analgesia requirements, and the number of drugs needed during the perioperative period based on the NRS score. Results Of the 524 patients, mild pain was noted in 87% patients on the day of the operation and in 75.6% patients on ambulation. The mean NRS score was 1.83±1.49 on the day of the operation and 2.73±1.75 on ambulation. An NRS score of 3 on both the day of operation and on ambulation was defined as the necessary condition for improved pain management. Multivariate analysis showed that high surgical stress significantly influenced pain scores. Reduction in pain with an NRS score of ≥1 was significant with the addition of pentazocine hydrochloride (p<0.01) and flurbiprofen (p<0.01). Interestingly, the addition of tramadol was borderline efficacious (p=0.05) in patients with an NRS score of >3 on ambulation. Conclusion A small number of patients have moderate-to-severe pain after TS. Tramadol demonstrated borderline efficacy in controlling postoperative intense pain with an NRS score of ≥3.
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Affiliation(s)
| | | | | | | | - Tatsuya Yoshida
- Departent of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Barr LG, Kubilius B, Ansley B, Whiteman R, Sahlas DJ. Does the NRS Capture Changes in Communication during Inpatient Stroke Rehabilitation? J Stroke Cerebrovasc Dis 2017; 26:2181-90. [PMID: 28595967 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/29/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Ontario, the National Rehabilitation Reporting System (NRS) is mandated for use as a measurement of change for stroke patients after admission to and discharge from rehabilitation. The NRS includes the functional independence measure (FIM) and supplementary measurement items developed by the Canadian Institute for Health Information (CIHI). Uncertainty exists regarding the efficacy of the NRS as the sole measure of outcome for communication in stroke rehabilitation patients. The use of additional speech-language pathology outcome measurement tools for this population has therefore been suggested. OBJECTIVES This study sought to establish whether the FIM and CIHI communication items capture quantifiable gains during stroke rehabilitation and therefore whether additional measures are needed to assess outcomes. METHODS A retrospective analysis was completed of 1252 complete data records of stroke patients discharged from inpatient rehabilitation at Hamilton Health Sciences between 2006 and 2011. RESULTS AND IMPACT Statistically significant improvements were observed in all total matched FIM scores (M = 72.68 to M = 96.39, P < .001) and for each expression (M = 4.61 to M = 5.35, P < .001) and comprehension (M = 4.69 to M = 5.33, P < .001) subscale. The most severely affected group demonstrated the greatest gains. These findings were independent of stroke severity. Additional outcome measurement tools for communication are therefore not required to assess outcomes in rehabilitation of stroke patients, although additional research is necessary to evaluate the clinical significance of the improvements that are observed using existing measurements of change.
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Farčić N, Barać I, Pačarić S, Lovrić I, Ilakovac V. Acute Postoperative Pain in Trauma Patients - The Fifth Vital Sign. Open Access Maced J Med Sci 2017; 5:310-315. [PMID: 28698748 PMCID: PMC5503728 DOI: 10.3889/oamjms.2017.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/20/2017] [Accepted: 04/18/2017] [Indexed: 11/05/2022] Open
Abstract
AIM To determine average pain intensity perceived by trauma patients at hospital admission, lowest and highest pain intensity during their hospitalisation and their satisfaction with provided pain treatment. PATIENTS AND METHODS The research included 114 operated patients at the Clinical Department of Trauma Surgery. We used the standard Numerical Rating Scale (NRS) for a clinical measure of pain. RESULTS The average pain intensity at hospital admission was NRS median 7 (range 4-10), the severest perceived rate of pain during hospitalisation was NRS median 5 (range 4-7). Ninety-four percent of our respondents were satisfied with provided pain treatment. Thirty-two percent of patients were not asked to assess their pain during their hospitalisation, and 40.4% of patients assessed their pain occasionally. CONCLUSION Female patients, as well as patients admitted to the emergency department, reported higher NRS scores. Those respondents who perceived severe pain answered more often that medical staff didn't ask them to assess their pain on any occasion. Good communication between medical staff and patients, together with adequate assessment and evaluation of acute pain are of great importance in its treatment.
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Affiliation(s)
- Nikolina Farčić
- University Hospital Centre Osijek, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croati
| | - Ivana Barać
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Stana Pačarić
- University Hospital Centre Osijek, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croati
| | - Ivana Lovrić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vesna Ilakovac
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Lambert C, Nüssler A, Biesalski HK, Freude T, Bahrs C, Ochs G, Flesch I, Stöckle U, Ihle C. Age-dependent risk factors for malnutrition in traumatology and orthopedic patients. Nutrition 2017; 37:60-67. [PMID: 28359364 DOI: 10.1016/j.nut.2016.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/25/2016] [Accepted: 12/18/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of risk of malnutrition (RoM) in an orthopedic and traumatology patient cohort with a broad range of ages. In addition to the classical indicators for risk assessment (low body mass index, weight loss, and comorbidity), this study aimed to analyze the effects of lifestyle factors (eating pattern, smoking, physical activity) on RoM. METHODS The prospective cohort study included 1053 patients in a level 1 trauma center in Germany. RoM was assessed by Nutritional Risk Screening (NRS) 2002 and for the elderly additionally by Mini Nutritional Assessment (MNA). Age-dependent risk factors identified in univariate statistical analysis were used for multivariate logistic regression models. RESULTS The prevalence of patients at RoM (NRS ≥3) was 22%. In the three age categories (<50 y, 50-69 y, and ≥70 y), loss of appetite, weight loss, number of comorbidities, drugs and gastrointestinal symptoms significantly increased RoM in univariate statistical analysis. In patients ages ≥70 y, several disease- and lifestyle-related factors (not living at home, less frequent consumption of vegetables and whole meal bread, low physical activity, and smoking) were associated with RoM. Multivariate logistic regression model for the total study population identified weight loss (odds ratio [OR], 6.09; 95% confidence interval [CI], 4.14-8.83), loss of appetite (OR, 3.81; 95% CI, 2.52-5.78), age-specific low BMI (OR, 1.87; 95% CI, 1.18-2.97), number of drugs taken (OR, 1.19; 95% CI, 1.12-1.26), age (OR, 1.03; 95% CI, 1.02-1.04), and days per week with vegetable consumption (OR, 0.938; 95% CI, 0.89-0.99) as risk factors. CONCLUSION Malnutrition in trauma and orthopedic patients is not only a problem related to age. Lifestyle-related factors also contribute significantly to malnutrition in geriatric patients.
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Affiliation(s)
- Christine Lambert
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany.
| | - Andreas Nüssler
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Hans Konrad Biesalski
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| | - Thomas Freude
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Christian Bahrs
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Gunnar Ochs
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ingo Flesch
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ulrich Stöckle
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Christoph Ihle
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Borhofen SM, Gerner C, Lehmann J, Fimmers R, Görtzen J, Hey B, Geiser F, Strassburg CP, Trebicka J. The Royal Free Hospital-Nutritional Prioritizing Tool Is an Independent Predictor of Deterioration of Liver Function and Survival in Cirrhosis. Dig Dis Sci 2016; 61:1735-43. [PMID: 26725059 DOI: 10.1007/s10620-015-4015-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 12/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Malnutrition might affect survival and severity of complications in cirrhotic patients. However, adequate evaluation of the nutritional status is a difficult task since the common assessment tools are either inappropriate or too complicated. A simpler method could evaluate the patient's risk for malnutrition instead of the nutritional status itself. This study evaluated the prediction of clinical deterioration and transplant-free survival in patients with chronic liver disease by two nutritional risk scores. METHODS In 84 cirrhotic patients, Nutritional Risk Screening (NRS), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), and the chronic liver disease questionnaire have been assessed. These patients were evaluated at a second time point after a median observation time of 500 days. Another cohort of 64 patients was collected to validate the findings. RESULTS Of the included patients, 67.7 % were male with a median age of 57 years and a median Child score of 9. RFH-NPT classified 50.7 % of the patients as high-risk patients, and NRS assessed 44.6 % of the patients as moderate- to high-risk patients. RFH-NPT correlated with clinical deterioration, severity of disease (Child score, MELD score), and clinical complications such as ascites, hepatorenal syndrome, and episodes of hepatic encephalopathy. RFH-NPT was an independent predictor of clinical deterioration and transplant-free survival. Furthermore, improvement in RFH-NPT within 500 days was associated with improved survival. CONCLUSION Assessing the patients' risk for malnutrition by RFH-NPT may be a useful predictor of disease progression and outcome for patients with chronic liver disease.
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Telletxea S, Gonzalez J, Portugal V, Alvarez R, Aguirre U, Anton A, Arizaga A. Analgesia with interfascial continuous wound infiltration after laparoscopic colon surgery: A randomized clinical trial. Rev Esp Anestesiol Reanim 2016; 63:197-206. [PMID: 26675536 DOI: 10.1016/j.redar.2015.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 07/17/2015] [Accepted: 07/24/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES For major laparoscopic surgery, as with open surgery, a multimodal analgesia plan can help to control postoperative pain. Placing a wound catheter intraoperatively following colon surgery could optimize the control of acute pain with less consumption of opioids and few adverse effects. METHODS We conducted a prospective, randomized, study of patients scheduled to undergo laparoscopic colon surgery for cancer in Galdakao-Usansolo Hospital from January 2012 to January 2013. Patients were recruited and randomly allocated to wound catheter placement plus standard postoperative analgesia or standard postoperative analgesia alone. A physician from the acute pain management unit monitored all patients for pain at multiple points over the first 48 hours after surgery. The primary outcome variables were verbal numeric pain scale scores and amount of intravenous morphine used via patient controlled infusion. RESULTS 92 patients were included in the study, 43 had a wound catheter implanted and 49 did not. Statistically significant differences in morphine consumption were observed between groups throughout the course of the treatment period. The mean total morphine consumption at the end of the study was 5.63±5.02mg among wound catheter patients and 21. 86±17.88mg among control patients (P=.0001). Wound catheter patients had lower pain scale scores than control patients throughout the observation period. No adverse effects associated with the wound catheter technique were observed. The wound catheter group showed lower hospital stays with statistically significant difference (P=.02). CONCLUSIONS In patients undergoing laparoscopic colon surgery, continuous infusion of local anaesthetics through interfascial wound catheters during the first 48h aftersurgery reduced the level of perceived pain and also reduced parenteral morphine consumption with no associated adverse effects and lower hospital stays.
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Affiliation(s)
- S Telletxea
- Departamento de Anestesiología y Reanimación, Hospital de Galdakao- Usansolo, Bizkaia, España.
| | - J Gonzalez
- Departamento de Anestesiología y Reanimación, Hospital de Galdakao- Usansolo, Bizkaia, España
| | - V Portugal
- Departamento de Cirugía General, Hospital de Galdakao- Usansolo, Bizkaia, España
| | - R Alvarez
- Departamento de Anestesiología y Reanimación, Hospital de Galdakao- Usansolo, Bizkaia, España
| | - U Aguirre
- Unidad de investigación, Hospital de Galdakao-Usansolo, Bizkaia, España; Red de Investigación en Servicios Sanitarios y enfermedades Crónicas (REDISSEC) Bizkaia, España
| | - A Anton
- Unidad de investigación, Hospital de Galdakao-Usansolo, Bizkaia, España; Red de Investigación en Servicios Sanitarios y enfermedades Crónicas (REDISSEC) Bizkaia, España
| | - A Arizaga
- Departamento de Anestesiología y Reanimación, Hospital de Galdakao- Usansolo, Bizkaia, España
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