Effect of mannitol plus hypertonic saline combination versus hypertonic saline monotherapy on acute kidney injury after traumatic brain injury

PurposeTo compare the effect of mannitol plus hypertonic saline combination (MHS) versus hypertonic saline monotherapy (HS) on renal function in patients with traumatic brain injury (TBI).Materials and methodsThis was a secondary analysis of data from the Resuscitation Outcomes Consortium Hypertonic Saline Trial Shock Study and Traumatic Brain Injury Study. The study cohort included a propensity matched subset of patients with TBI who received MHS or HS. The primary outcome measure was the maximum serum creatinine value during critical illness.ResultsThe cohort consisted of 163 patients in the MHS group and 163 patients in the HS group (n = 326). The maximum serum creatinine value during hospitalization was 82 ± 47 μmol/L (0.86 ± 0.26 mg/dL) in the MHS group and 76 ± 23 μmol/L (0.92 ± 0.53 mg/dL) in the HS group (difference −6 μmol/L, 95% CI −14 to 2 μmol/L, p = .151). The lowest eGFR during hospitalization was 108 ± 25 mL/min in the MHS group and 112 ± 24 mL/min in the HS group (difference −4 mL/min, 95% CI −1 to 9 mLmin, p = .150).ConclusionsThe addition of mannitol to HS did not increase the risk of renal dysfunction compared to HS alone in patients with TBI.     

Intravenous metoclopramide versus dexketoprofen trometamol versus metoclopramide+ dexketoprofen trometamol in acute migraine attack in the emergency department: A randomized double-blind controlled trial

Study objectiveThe objective of this study was to determine the analgesic efficacy and safety of intravenous, single-dose metoclopramide versus dexketoprofen trometamol versus metoclopramide+ dexketoprofen trometamol in patients presenting with acute migraine attack to the emergency department (ED).MethodsThis single-center, randomized, double-blind study was conducted in a tertiary care ED. Eligible patients met the migraine criteria of the International Headache Society were randomized to receive 10 mg intravenous metoclopramide, 50 mg intravenous dexketoprofen trometamol, or 50 mg dexketoprofen trometamol +10 mg metoclopramide. Visual analogue scale (VAS) was used for pain measurement at baseline, after 15 and 30 min. The primary outcome measure was the changes in the VAS scores at the 15th and 30th minutes of treatment. The secondary outcome measures were the presence of adverse effects and the requirement of rescue medicine.ResultsPatients (n = 150) were randomized into 3 groups with similar VAS scores at baseline. While there was no significant difference between metoclopramide and dexketoprofen trometamol in reducing pain at the 15th and 30th minute (p = 0.618 and p = 0.862, respectively) and between metoclopramide and metoclopramide + dexketoprofen trometamol at the 15th minute (p = 0.074), metoclopramide + dexketoprofen trometamol was superior to both metoclopramide [mean difference: −13.2 mm (95% CI −23.1 to −3.3)] and dexketoprofen trometamol [mean difference: −11.02 mm (95% CI −20.9 to −1.1)] at the 30th min (p = 0.006 and p = 0.025 respectively). The rescue drug was required by 3 patients (6%) were in metoclopramide group, 4 patients (8%) in dexketoprofen trometamol group and one patient (2%) in the metoclopramide + dexketoprofen trometamol group. No side effects were observed in subjects in three treatment groups.ConclusionNo significant difference in VAS was found between three treatment groups at the 15th minute, but metoclopramide + dexketoprofen trometamol was superior to both metoclopramide and dexketoprofen trometamol at the 30th min.     

The effect of using vapocoolant spray for pain reduction in arteriovenous fistula cannulation among patients undergoing hemodialysis: A randomized control trial

AimThe aim of this study was to assess the effects of alkane vapocoolant spray in reducing pain during arteriovenous access cannulation in adult patients undergoing hemodialysis.BackgroundDeveloping and applying various approaches for pain relief remain important responsibility for nurses.MethodsThis study was designed as an experimental study with a cross-over design. Thirty-eight patients on hemodialysis volunteered to undergo cannulation of their arteriovenous access, after the application of vapocoolant or placebo spray or no intervention. Subjective and objective pain levels were assessed, along with various physiological parameters pre- and post-cannulation.ResultsStatistically significant between-group differences were observed in subjective pain at the venous (F = 4.97, p = 0.009) and arterial (F = 6.91, p = 0.001) puncture sites. The mean arterial site subjective pain scores were 4.45 ± 1.31 (no treatment), 4.04 ± 1.82 (placebo), and 2.98 ± 1.53 (vapocoolant spray). Significant between-group differences were observed in objective pain scores during arteriovenous fistula puncture (F = 5.13, p = 0.007). The mean objective pain scores after arteriovenous fistula puncture were 3.25 ± 2.66 (no treatment), 2.17 ± 1.76 (placebo), and 1.78 ± 1.66 (vapocoolant spray). Post-hoc test results indicated vapocoolant spray application was associated with significantly lower pain scores than no treatment or placebo. Patient blood pressure and heart rate recordings did not differ among the interventions.ConclusionVapocoolant application was significantly more effective than the placebo or no treatment in reducing the pain of cannulation in adult patients undergoing hemodialysis.     

Treatment of migraine attacks by transcutaneous electrical nerve stimulation in emergency department: A randomize controlled trial

PurposeThe primary purpose of this trial is to evaluate the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) therapy application in the emergency department.MethodsThe patients were divided into 2 groups: a sham group, and a verum group. Patients in the verum group include those who use the device for the first time. Both groups were connected to visually indistinguishable devices. Both groups underwent therapy for a total of 20 min. Using the Visual Analog Scale (VAS), the patients' perceived changes in pain intensity were recorded at the 20th and 120th minutes after initiation therapy. After the 120th minute, patients' individual needs for additional treatment were assessed. Additionally, their self-reported well-being was assessed using a Likert-type verbal scale.ResultsIn total 151 patients that were admitted to the emergency ward were assessed, with the sham and verum group being assigned 39 patients each from this pool. For the verum group the VAS change from 0 to 120 min was −65 ± 25 and for the sham group it was −9 ± 2 (p < 0.001). Verbal scores in the 120th minute were found to be 1.2 for sham group and 4.5 in the verum group (p < 0.001). Thirty patients (76.92%) in the sham group and 1 (2%) in the verum group had additional analgesic requirement after 120 min.ConclusionTENS therapy is a fast-acting, effective therapy for the treatment of acute migraine in the emergency department.     

The evolution of radiographic edema in ARDS and its association with clinical outcomes: A prospective cohort study in adult patients

PurposeTo assess the longitudinal evolution of radiographic edema using chest X-rays (CXR) in patients with Acute Respiratory Distress Syndrome (ARDS) and to examine its association with prognostic biomarkers, ARDS subphenotypes and outcomes.Materials and methodsWe quantified radiographic edema on CXRs from patients with ARDS or cardiogenic pulmonary edema (controls) using the Radiographic Assessment of Lung Edema (RALE) score on day of intubation and up to 10 days after. We measured baseline plasma biomarkers and recorded clinical variables.ResultsThe RALE score had good inter-rater agreement (r = 0.83, p < 0.0001) applied on 488 CXRs from 129 patients, with higher RALE scores in patients with ARDS (n = 108) compared to controls (n = 21, p = 0.01). Baseline RALE scores were positively correlated with levels of the receptor for end-glycation end products (RAGE) in ARDS patients (p < 0.05). Baseline RALE scores were not predictive of 30- or 90-day survival. Persistently elevated RALE scores were associated with prolonged need for mechanical ventilation (p = 0.002).ConclusionsThe RALE score is easily implementable with high inter-rater reliability. Longitudinal RALE scoring appears to be a reproducible approach to track the evolution of radiographic edema in patients with ARDS and can potentially predict prolonged need for mechanical ventilation.     

Flavonoid-containing supplements for preventing acute respiratory tract infections: A systematic review and meta-analysis of 20 randomized controlled trials

BackgroundThis systematic review and meta-analysis was conducted to investigate the efficacy and safety of flavonoid-containing supplements in preventing acute respiratory tract infection (ARTI).MethodsRandomized controlled trials (RCTs) investigating the effects of flavonoid-containing supplements on ARTI prevention in the aspects of ARTI incidence, mean ARTI sick days, symptoms, bio-immune markers, and adverse effects were searched in 5 databases. Data were searched from inception to November 26, 2021. Stata 16.0 was used to perform the meta-analysis.ResultsTwenty RCTs (n = 4521) were included in this systematic review and meta-analysis. Pooled results showed that in the flavonoid-containing supplement group, the ARTI incidence and mean ARTI sick days were significantly decreased compared to those in the control group (RR = 0.81, 95% CI: 0.74–0.89, p < 0.001; WMD = −0.56, 95% CI: −1.04 to −0.08, p = 0.021; respectively). In 8 RCTs, flavonoids were singly used for interventions, ARTI incidence in the experimental group significantly decreased compared to that in the control group (RR = 0.85, 95% CI: 0.72–1.00, p = 0.047). In ten RCTs, flavonoid-containing mixtures were applied for interventions, and ARTI incidence in the experimental group significantly decreased compared to that in the control group (RR = 0.79, 95% CI: 0.71–0.89, p < 0.001). Furthermore, the ARTI incidence and mean ARTI sick days were significantly decreased in the experimental group compared to those in the control group in the flavan-3-ols subgroup (RR = 0.79, 95% CI: 0.67–0.92, p = 0.002; WMD = −2.75, 95% CI: −4.30 to −1.21, p < 0.001; respectively) and the multiple subclasses subgroup (RR = 0.75, 95% CI: 0.63–0.88, p = 0.001; WMD = −0.56, 95% CI: −1.11 to −0.01, p = 0.046; respectively). However, the bio-immune markers including interleukin-6, hypersensitive-c-reactive-protein, tumor necrosis factor-α, and interferon-γ did not differ between the flavonoid group and the control group. Moreover, in the flavonoid-containing supplement group, the incidence of adverse reactions did not increase compared to that in the control group (RR = 1.16, 95% CI: 0.78–1.73, p = 0.469).ConclusionsThis systematic review and meta-analysis showed that flavonoid-containing supplements were efficacious and safe in preventing ARTIs. The most important limitations result from the small number of trials, poor quality of some included RCTs, differences in the composition and types of interventions, principal subclasses of flavonoids, methods of administration, and methodology. Moreover, only a few RCTs conducted independent verification of the flavonoid supplements used in the trial in terms of purity and potency, which may lead to a potential source of bias. Thus, larger and better-designed studies are needed to further verify this conclusion.     

Laser Acupuncture Analgesia on Postpartum Low Back Pain: A Prospective Randomized Controlled Study

BackgroundUnresolved postpartum LBP may affect women...s physical and psychological health.AimTo investigate the analgesic effects of laser acupuncture therapy (LAT) for postpartum LBP.MethodPostpartum women with LBP were recruited and randomly assigned to the intervention group or the control group from November 2017 to July 2018. The participants in the intervention group received LAT and standard care. The participants in the control group received only standard care. The primary outcome was the Visual Analogue Scale for LBP. Secondary outcomes were limitation of daily activities and physical activity; perceived stress scale; and salivary cortisol values.ResultsIn all, 106 participants were recruited and assigned to the intervention group or the control group. As compared with the control group, the participants in the LAT group had significantly lower intensity of LBP (mean ± SD: 1.21 ± 0.99 vs 3.25 ± 1.14; p < .001), limitations of daily activities (mean ± SD: 3.17 ± 2.09 vs 10.40 ± 4.72; p < .001) and physical activity (mean ± SD: 3.04 ± 2.17 vs 9.79 ± 4.71; p < .001), perceived stress (mean ± SD: 26.13 ± 3.97 vs 28.85 ± 4.26; p = .001), and salivary cortisol levels (mean ± SD: 0.194 ± 0.131 vs 0.280 ± 0.234; p = .02) post-intervention.ConclusionsFor postpartum LBP, LAT combined with standard care had greater analgesic efficacy, lower perceived stress, lower limitations of daily activities and physical activity, and lower salivary cortisol levels than standard care alone.     

Quantitative-analysis of computed tomography in COVID-19 and non COVID-19 ARDS patients: A case-control study

PurposeThe aim of this study was to assess whether the computed tomography (CT) features of COVID-19 (COVID+) ARDS differ from those of non-COVID-19 (COVID−) ARDS patients.Materials and methodsThe study is a single-center prospective observational study performed on adults with ARDS onset ≤72 h and a PaO₂/FiO₂ ≤ 200 mmHg. CT scans were acquired at PEEP set using a PEEP-FiO₂ table with VT adjusted to 6 ml/kg predicted body weight.Results22 patients were included, of whom 13 presented with COVID-19 ARDS. Lung weight was significantly higher in COVID− patients, but all COVID+ patients presented supranormal lung weight values. Noninflated lung tissue was significantly higher in COVID− patients (36 ± 14% vs. 26 ± 15% of total lung weight at end-expiration, p < 0.01). Tidal recruitment was significantly higher in COVID− patients (20 ± 12 vs. 9 ± 11% of VT, p < 0.05). Lung density histograms of 5 COVID+ patients with high elastance (type H) were similar to those of COVID− patients, while those of the 8 COVID+ patients with normal elastance (type L) displayed higher aerated lung fraction.     

Effects of Neurofeedback on Fibromyalgia: A Randomized Controlled Trial

BackgroundFibromyalgia is a chronic widespread pain condition that is associated with sleep disturbances and cognitive impairments. Neurofeedback has been demonstrated to improve pain, sleep quality, and fatigue. However, few studies have examined the effect of neurofeedback for patients with fibromyalgia.AimTo determine the effects of neurofeedback on pain intensity, symptom severity, sleep quality, and cognitive function in patients with fibromyalgia.DesignThis study was a randomized controlled trial.MethodEighty participants were randomized to a neurofeedback group (N = 60), receiving sensorimotor and alpha rhythm feedback for 8 weeks, or a telephone support group (N = 20).ResultsResults from the generalized estimating equation modelling revealed significant group-by-time interactions for Brief Pain Inventory pain severity (B = −1.35, SE = 0.46, p = .003) and pain interference (B = −1.75, SE = 0.41, p < .001), Revised Fibromyalgia Impact Questionnaire total scores (B = −16.41, SE = 3.76, p < .001), sleep onset latency (B = −25.33, SE = 9.02, p = .005), and Psychomotor Vigilance Test error (B = −1.38, SE = 0.55, p = .013) after adjustments for age, sex, duration of illness, and group differences at baseline.ConclusionsAn 8-week neurofeedback training regimen of sensorimotor rhythm and alpha brain waves significantly improved pain severity and interference, fibromyalgia symptom severity, sleep latency, and sustained attention in patients with fibromyalgia.     

Recurrence of chronic pulmonary aspergillosis after discontinuation of maintenance treatment by antifungal triazoles

ObjectiveTo assess the prevalence and risk factors of recurrence of chronic pulmonary aspergillosis (CPA) after discontinuation of antifungal triazoles.MethodWe reviewed the medical records of CPA patients who achieved resolution of clinical and radiographic manifestations and stopped taking antifungal triazoles between June 2006 and June 2012 at Tokyo National Hospital. We evaluated whether there was CPA recurrence within 1 year after treatment cessation and investigated risk factors for relapse. The association of anti-Aspergillus antibody conversion with CPA recurrence was also reviewed.ResultsA total of 39 patients were included in this study and there was CPA recurrence in 14 patients. Compared with the Non-recurrence group, the Recurrence group exhibited 1) younger age (p = 0.017), 2) more than one lung lobe affected by CPA more frequently (p = 0.008), 3) longer duration needed to remit manifestations of chest radiograph (p = 0.031), 4) longer antifungal treatment duration (p = 0.042). The present study did not reveal an association between negative conversion of serum anti-Aspergillus antibody and recurrence risk. Multivariate logistic regression analysis revealed that patients with CPA with affected area of more than one lung lobe had increased risk (odds ratio, 10.20; 95% confidence interval, 1.49–69.77; p = 0.018).ConclusionCPA recurrence can be seen in about one-third of cases after discontinuing azole treatment. We should make decisions about treatment duration and follow up depending on the severity of each case, particularly on the expansion of CPA-affected area.     

Effectiveness of lidocaine spray on radial arterial puncture pain: A randomized double-blind placebo controlled trial

ObjectiveRadial arterial puncture is a painful procedure. The aim of this study was to evaluate the effect of lidocaine spray (10%) on pain associated with radial artery blood withdrawal for arterial blood gas analysis.MethodsThis randomized, controlled, double-blind study was performed between December 2018 and September 2019. Before radial arterial puncture, 10% lidocaine or placebo spray was applied to each patient by the attending physician, who was blinded with regard to random assignment. The spray was administered six times on the site from a distance of 5 cm. After waiting for 5 min, a radial arterial puncture was performed routinely. The pain levels of patients during radial arterial puncture and 5 min after puncture were evaluated with the visual analog scale (VAS). The Wilcoxon test was used to compare pain scores during puncture.ResultsThe research was performed with 67 patients (34 patients in the lidocaine group, 33 patients in the placebo group) who were admitted to the emergency department and required ABG analysis. Forty-three patients were men, and 24 were women. The ages of the patients ranged between 19 and 86 years, and the mean (± standard deviation) age was 56.3 ± 16.6 years. Pain levels, as measured by VAS, were significantly lower in the lidocaine group (24.00 mm IQR:[14.75–33.75]) compared with the placebo group (33.00 mm IQR:[22.00–61.50]) during radial arterial puncture (p = 0.011).ConclusionsThe level of pain perceived during radial arterial puncture was significantly lower in those who were administered lidocaine spray. Lidocaine spray application can be used in pain management related to radial arterial puncture.     

Hemodynamic comparison of intravenous push diltiazem versus metoprolol for atrial fibrillation rate control

ObjectiveIntravenous push (IVP) diltiazem and metoprolol are commonly used for management of atrial fibrillation (AF) with rapid ventricular rate (RVR) in the emergency department (ED). This study's objective was to determine if there was a significant difference in blood pressure reduction between agents.MethodsThis was a single-center, retrospective study of adult patients initially treated with IVP diltiazem or metoprolol in the ED from 2008 to 2018. Primary endpoint was mean reduction in systolic blood pressure (SBP) from baseline to nadir during the study period. Study period was defined as time from first dose of IVP intervention to 30 min after last dose of IVP intervention or first dose of maintenance therapy, whichever came first.ResultsA total of 63 diltiazem patients and 45 metoprolol patients met eligibility criteria. Baseline characteristics were similar except for initial ventricular rate (VR) and home beta-blocker use. Median dose of initial intervention was 10 [10−20] mg and 5 [5–5] mg for diltiazem and metoprolol respectively. Mean SBP reduction was 18 ± 22 mmHg for diltiazem compared to 14 ± 15 mmHg for metoprolol (p = .33). Clinically relevant hypotension was similar between groups 14% vs. 16% (p = .86). Rate control was achieved in 35 (56%) of the diltiazem group and 16 (36%) of the metoprolol group (p = .04).ConclusionIVP diltiazem and metoprolol caused similar SBP reduction and hypotension when used for initial management of AF with RVR in the ED. However, rate control was achieved more often with diltiazem.     

Physical activity and predictors of loneliness in community-dwelling older adults: The role of social connectedness

This study sought to examine whether and how social connectedness impacts the association between physical activity and loneliness among older people in Ghana. Data for the analysis were obtained from the 2016–2017 Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AgeHeaPsyWel-HeaSeeB) (N = 1200; mean age 66±12 years; women = 63%). Loneliness was assessed with the Short Form Revised UCLA Loneliness Scale. Multivariate linear regressions showed that increases in physical activity were associated with decreases in loneliness in the overall sample (β= −0.338, p < 0.005) and for men (β= −0.712, p < 0.005) but not in women (β = −0.039, p = 0.840). The negative association between physical activity and loneliness was moderated by social connectedness such that persons highly connected were much less likely to experience loneliness following physical activity engagement (β= −0.709, p = 0.023). Age-based analysis showed differential effects of physical activity on loneliness among the 65+ group (β = −0.437, p = 0.002) compared to the 50–64 group (β= −0.502, p = 0.031). Later life social connectedness tempers with the beneficial impact of physical activity on loneliness. Interventions to heal loneliness and for active aging should target physical activity and interpersonal engagements among older adults.     

The Effect of Remote-Based Monitoring and Education Program on Cancer Pain Management in an Outpatient Pain Clinic

BackgroundPain is one of the most feared consequences of cancer for patients and their families. Many barriers may hinder optimal pain management.AimExamine the effect of remote-based monitoring and education program on cancer pain management, patient-related barriers, and level of adherence to pain medication.MethodsA sample of 134 patients was assigned to two groups; 68 in the intervention group and 66 in the control. The intervention group received three educational sessions by telephone. Both groups completed questionnaires at baseline and one month after the initial visit.ResultsSignificant differences were found between the groups in the levels of pain right now (p = .030), pain at its least (p = .016), and in the percentage of achieved pain relief (p = .048). Moreover, the intervention group experienced lower levels of interference with their general activity (p = < .001), mood (p = .011), and normal work (p = .004) post-intervention. The Attitudinal Barriers differences were statistically significant in the total mean (p = < .001), and the subscales of physiological effects (p = < .001), fatalism (p = < .001), communication (p = < .001), harmful effects (p = < .001). Participants in the intervention group exhibited higher adherence levels (p = .001).ConclusionsPatients suffering from cancer-related pain can benefit from remote-based monitoring and education programs to improve pain management outcomes, overcome barriers, and increase adherence. Further research is needed to investigate the different available educational methods and long-term effects.     

Analgesic efficacy of the serratus anterior plane block in rib fractures pain: A randomized controlled trial

BackgroundSerratus anterior plane block (SAPB) was evaluated that in patients with the complaint of rib fracture pain in terms of total analgesic consumption and pain scores.MethodSixty patients with rib fracture and NRS (Numeric Rating Scala) pain scores equal or greater than four were included in randomized controlled study. Patients were randomized to perform SAPB or control group. Primary outcome was total tramadol consumption in 24 h. Secondary outcomes were NRS scores (after Patient Controlled Analgesia (PCA) application 30 min, first, second, 4 th, 6 th, 12 th, 24 th hour), peripheral oxygen saturation (first and 24 th hour after PCA application), chronic pain. and complications.ResultsThe total tramadol consumption significantly lower in group S (p = 0.02). NRS scores after 30 min, 1 h, 2 h, 4 h, 6 h, 12 h, and 24 h were significantly lower in group S than in group C (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.002, p = 0.026). The total number of patients who reported of chronic pain at rest and during effort was significantly lower in group SAPB than in group C (p = 0.006). Nine patients in group C were reported of pain, four of whom had pain at rest and five had pain during effort. One patient in group S was reported of pain during effort.ConclusionThis study demonstrated that SAPB, as part of multimodal analgesia in pain management due to rib fractures, is safe and effective in reducing acute pain.     

Effect of Cognitive-Behavioral Therapy or Mindfulness Therapy on Pain and Quality of Life in Patients with Diabetic Neuropathy: A Systematic Review and Meta-Analysis

ObjectivesThis study aimed to evaluate the effectiveness of cognitive behavioral therapy (CBT) and mindfulness therapy (MT) for pain relief and quality of life (QOL) in patients with diabetic neuropathy.Review/Analysis methodsFour databases were systematically searched from their respective inception dates to 29 June 2021. Relevant randomized controlled trials (RCTs) were screened and assessed for risk of bias. Eight RCTs evaluating CBT or MT were included. Statistical analysis was performed using Review Manager 5.4.ResultsEight RCTs involving 384 patients with painful diabetic neuropathy (PDN) tested psychological interventions, including three CBT and five MT studies. The results showed that patients’ pain severity (standardized mean difference [SMD] = -0.60, 95% confidence interval [CI; -0.93 to -0.27], P = .0003) and QOL (SMD = -0.43, 95% CI [-0.83 to -0.04], p = .03) were improved immediately after treatment. Besides, the pain intensity (SMD = -0.67, 95% CI [-1.37 to 0.03], p = .06), pain interference (SMD = -0.75, 95% CI [-1.20 to -0.30], p = .001) and depressive symptoms (SMD = -0.62, 95% CI [-0.96 to -0.28], p = .0003) were superior to the control group after follow up. The subgroup analysis results of different intervention type showed that the CBT group could immediately improve pain (SMD = -0.44, 95% CI [-0.78 to -0.10], p = .01) after treatment. However, there was no statistically significant difference in the CBT group after follow-up (SMD = -0.15, 95% CI [-0.52 to 0.22], p = .42).ConclusionsCognitive behavioral therapy or MT is effective for treating pain in patients with diabetic peripheral neuropathy, improving the QOL, and reducing depressive symptoms. However, large-scale, multi-centre, rigorously designed RCTs are needed to further verify the long-term effects.     

Anti-spastic effects of footbaths in post-stroke patients: A proof-of-principle study

ObjectivesTo investigate whether a footbath inhibits spasticity in the hemiplegic lower limbs of post-stroke patients.DesignRandomized, controlled study.SettingRehabilitation education and research hospital.InterventionsTwenty-two post-stroke patients were randomly allocated to control or experimental groups. After relaxing in a supine posture for 30 min, the experimental group subject's legs were immersed in 41 °C water below the knee joint for 15 min, while the control group remained in a resting posture.Main outcome measuresModified Ashworth Scale (MAS) scores of the affected triceps surae muscle and F-wave parameters (i.e., F-wave amplitude, F/M ratio, and F-wave persistence) were recorded before, immediately after, and 30 min after each intervention. Physiological parameters were simultaneously monitored to determine the thermo-therapeutic mechanisms and side effects of footbath usage.ResultsAt the time immediately after the intervention, F-wave amplitudes decreased significantly in the experimental group, compared to the control group (p < 0.01, difference: −106.8; 95% CI; −181.58 to −32.09). F-wave amplitudes decreased significantly after 30-min intervention in the experimental group, with a total reduction of 161.2 μV being recorded compared to 8.8 μV increase in the control group (p < 0.01, difference: −170.0; 95% CI; −252.73 to −87.33). There were also significant differences between the experimental and control group for both F/M ratio and F-wave persistence, immediately after and 30 min after the intervention. Further, there were significant differences between the experimental and control group for the MAS scores immediately after the intervention (p < 0.05, difference: −0.72; 95% CI; −1.262 to −0.193), and 30 min after the intervention (p < 0.05, difference: −0.73; 95% CI; −1.162 to −0.293).ConclusionThese findings demonstrate that the use of footbaths is an effective non-pharmacological anti-spastic treatment for use in stroke rehabilitation.     

Effect of Spray Use on Mouth Dryness and Thirst of Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Study

PurposeThe aim of this study was to determine the effect of spray use on mouth dryness and thirst of patients undergoing major abdominal surgery during the postoperative periodDesignThis research was conducted as a randomized controlled trial.MethodsOne hundred thirty patients undergoing abdominal surgery were assessed for eligibility; the sample consisted of N = 104. Subjects were randomized into one of three groups. Subjects in the control group were administered a small amount of water at room temperature using a syringe (clinic routine application, approximately 1-2 mL). Subjects in the second group were administered cold water spray orally (0.4 mL per application). Subjects in the third group were administered cold saline (0.9% NaCl) spray orally (0.4 mL per application). Applications were performed twice every hour. Subjects’ postoperative thirst severity, mouth dryness severity, oral health condition, and pH values of saliva were evaluated after 8, 20, 24, 36 and 40 hours. Subject satisfaction was evaluated at the end of the second postoperative day.FindingsIn our study, no significant difference was found between the three groups in terms of age, gender, American Society of Anesthesiologists grade (ASA), preoperative thirst and mouth dryness, and preoperative oral health condition (P > .05). A significant difference was found between the groups in terms of subjects’ thirst and mouth dryness severity scores after 8, 20, 24, 36, and 40 hours (P < .05). The intervention group that received cold water spray demonstrated statistically significant differences when compared to the control and saline moistening groups. No significant difference was found between subjects’ oral health condition and pH scores after 4, 8, 20, 24, 36, and 40 hours (P > .05).ConclusionsThe results of our study show that cold water spray was more effective on the thirst and mouth dryness scores of subjects undergoing major abdominal surgery compared to cold normal saline spray and water applied using a syringe, although it was not an effective factor on oral health condition and pH values of saliva.     

Effects of self-management education on quality of life of patients with chronic obstructive pulmonary disease

PurposeTo explore the effects of self-management education on the quality of life of patients living with chronic obstructive pulmonary disease (COPD).MethodsEighty-four stable or discharged COPD subjects were recruited from April 2011 to January 2012 following treatment at Beijing Hospital or Peking Union Medical College Hospital. Subjects were divided into an intervention group who underwent self-management education or a control group who received usual care without additional education (n = 42 each). The St George's Respiratory Questionnaire (SGRQ) was used to measure quality of life at three and six months.ResultsSGRQ impact domain scores revealed significant differences between the groups (t = −2.167, p < 0.05) at three months. SGRQ symptom, impact, activity domain and total scores revealed significant differences between groups (t = −3.482 to −2.530, p < 0.05) at six months.ConclusionA nurse-led, simple, structured self-management education program provided an effective method for the management of patients with COPD.     

Lymphocyte-to-monocyte ratio predicts mortality in cirrhotic patients with septic shock

IntroductionPatients with liver cirrhosis and septic shock have a significantly higher risk of mortality and morbidity compared with non-cirrhotic patients. The peripheral blood lymphocyte-to-monocyte ratio (LMR) can determine the prognosis of cirrhotic patients. Our study aimed to investigate the usefulness of LMR as a predictive marker of mortality risk in cirrhotic patients with septic shock.MethodsThis single-center, retrospective case-control study included adult patients who visited the emergency department between January 1, 2018 and June 30, 2020 and diagnosed with liver cirrhosis and septic shock. They were divided into survivor and non-survivor groups according to their survival status at the 60-day follow-up. We used a Cox proportional hazards regression model to identify independent factors associated with mortality risk and tested the mortality discriminative ability of those factors using the area under a receiver operating characteristic curve.ResultsA total of 93 patients were eligible for this study. Compared with the patients in the survivor group, those in the non-survivor group had significantly higher Child-Pugh (11 ± 2 vs. 9 ± 2, p < 0.001) and MELD scores (29 ± 6 vs. 22 ± 8, p < 0.001), higher serum international normalized ratio (1.7 vs.1.4, p = 0.03), bilirubin (6.0 vs. 3.3 mg/dL, p = 0.02), lactate (5.4 vs. 2.7 mmol/L, p < 0.01), creatinine (2.2 vs. 1.6 mg/dL, p = 0.04), higher neutrophil-to-lymphocyte ratio (13.0 vs. 10.3, p = 0.02), and lower LMR (1.1 vs. 2.3, p < 0.01). The LMR (adjusted hazard ratio [aHR] = 1.54, p = 0.01) and lactate (aHR = 1.03, p < 0.01) were identified as independent predictive factors for mortality in the multivariate regression model. Furthermore, LMR (area under curve [AUC]: 0.87) revealed a superior discrimination ability in mortality prediction compared with the Child-Pugh (AUC: 0.72) and MELD (AUC: 0.76) scores.ConclusionsThe LMR can be used to predict mortality risk in cirrhotic patients with septic shock.