Differences in pain perception in women using concentric and monopolar needles

OBJECTIVE: To examine pain perception using concentric needle electrodes and monopolar needle electrodes in an all-female study group without underlying hand or arm pain complaints, using study subjects as their own controls. DESIGN: Prospective randomized study. Two muscles--the biceps and abductor pollicis brevis (APB)--were examined using both a concentric needle electrode and a monopolar needle electrode. SETTING: University community. PARTICIPANTS: Eighty healthy female employees at the University of Utah and Primary Children's Hospital were enrolled. All completed the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain scores. Posttest verbal analog pain scale (0-10) measures were obtained after each muscle was studied. A subset of subjects (n=51) was asked to identify needle preference after completion of the study. RESULTS: There was no significant difference in mean pain scores between the concentric needle electrode and the monopolar needle electrode (3.06 and 3.10, respectively; P=.803). The APB muscle was significantly more painful than the biceps muscle with both needle types (mean pain scores, 3.92 and 2.24, respectively; P<.001). In the subset of subjects asked to identify needle preference after completion of the study, 21 chose a concentric needle electrode and 30 a monopolar needle electrode. This difference was not statistically significant. However, verbal analog pain scores were lower with the needle preferred by each subject (P<.20). CONCLUSIONS: There is no significant difference in mean pain scores reported between a concentric needle electrode and a monopolar needle electrode. Subjects were clear on the needle they preferred, and the pain scores reported for the less painful needle were lower than those for the other needle.     

Improving Postpartum Care: Identifying Opportunities to Reduce Postpartum Emergency Room Visits Among Publicly-Insured Women of Color

Maternal and Child Health Journal - The purpose of this study was to explore the postpartum experiences of publicly-insured women of color, and identify how postpartum care can be improved to...     

An intervention to reduce postpartum depressive symptoms: a randomized controlled trial

Depressive symptoms and depression are a common complication of childbirth, and a growing body of literature suggests that there are modifiable factors associated with their occurrence. We developed a behavioral educational intervention targeting these factors and successfully reduced postpartum depressive symptoms in a randomized trial among low-income black and Latina women. We now report results of 540 predominantly white, high-income mothers in a second randomized trial. Mothers in the intervention arm received a two-step intervention that prepared and educated mothers about modifiable factors associated with postpartum depressive symptoms (e.g., physical symptoms, low self-efficacy), bolstered social support, and enhanced management skills. The control arm received enhanced usual care. Participants were surveyed prior to randomization, 3 weeks, 3 months, and 6 months postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS of 10 or greater). Prevalence of depressive symptoms postpartum was unexpectedly low precluding detection of difference in rates of depressive symptoms among intervention versus enhanced usual care posthospitalization: 3 weeks (6.0 vs. 5.6 %, p?=?0.83), 3 months (5.1 vs. 6.5 %, p?=?0.53), and 6 months (3.6 vs. 4.6 %, p?=?0.53).     

Prolonged paralysis after treatment with neuromuscular junction blocking agents.

OBJECTIVES: Previous reports have described prolonged paralysis after treatment with neuromuscular junction blocking agents in critically ill patients. The purpose of this study was to further describe a group of patients who developed prolonged weakness after treatment with these agents. DESIGN: Clinical information, electrodiagnostic and muscle pathology results are described in this group of patients. Clinical information includes diagnoses, dosage of neuromuscular junction blocker, other medications affecting the neuromuscular system, and neuromuscular examination and clinical course. SETTING: All patients were seen in the ICUs of three local hospitals. PATIENTS: Included were critically ill patients with a variety of diagnoses, all of whom developed severe weakness after discontinuation of neuromuscular junction blocking agents. INTERVENTIONS: Electrodiagnostic studies and muscle biopsies were performed on several of the patients. MEASUREMENTS AND MAIN RESULTS: All patients had pronounced weakness without sensory loss. Electrodiagnostic and muscle pathology findings were consistent with failed neuromuscular transmission. Although many patients had disorders or were taking medications that can injure the neuromuscular system, no disorder or medication was common to all. Recovery of strength often took several months and most patients were slow to wean from mechanical ventilator support. CONCLUSIONS: Although alternative explanations cannot be excluded with certainty, the use of neuromuscular junction blocking agents may lead to neurogenic atrophy and care must be taken when using them.     

Observations of absorption of immunolactoglobulins in calves.

The aim of this study was to ascertain whether administration of one liter of stilulated saliva from a healthy cow as first food to newborn calves blocks absorption of immunolactoglobulins administered later in colostrum or milk. The study material consisted of 12 calves, divided into two groups, one of which received colostrum, and the other milk. Blood samples were drawn immediately after birth and 3 and 6 hours after administration of saliva and 3 and 6 hours after administration of colostrum (group I) or milk (group II). Only some of the calves of each group absorbed immunolactoglobulins from colostrum or milk. In these calves, immunoglobulins could be demonstrated in their serum as early as 3 hours after birth. Absorption of immunolactoglobulins was independent of their concentration in food as their levels were similar in calves fed colostrum or milk. The experiment failed, however, to give an unequivocal answer to the question whether feeding calves before the first administration of colostrum restricts or inhibits absorption of immunolactoglobulins from colostrum.     

Complete hemidiaphragmatic paralysis in a patient with multiple sclerosis

We present a case history of a patient with definite multiple sclerosis who developed an abrupt onset of unilateral diaphragmatic paralysis, minor increase in lower extremity spasticity and complaint of marked neck stiffness. Her vital capacity during this episode was 600 mL and she was in impending respiratory failure. The diaphragmatic paralysis was demonstrated by radiographic plain films and fluoroscopy. Phrenic nerve stimulation was performed during fluoroscopy and the evoked motor response from the diaphragm recorded. There was a normal amplitude diaphragmatic twitch observed with an evoked motor response latency of 1 ms and amplitude of 300 microV. After high dose intravenous steroids, her neck stiffness and spasticity improved, her vital capacity improved to 1500 mL and her diaphragm regained its normal position and movement confirmed by followup radiographic plain films and fluoroscopy. We postulate the presence of a demyelinating plaque in the brainstem fibers descending to the phrenic nucleus as the etiology of the diaphragmatic paralysis. We are unaware of any other case reports of unilateral "upper motor neuron" phrenic nerve paralysis secondary to multiple sclerosis.