Preoperative pain as a risk factor for chronic post-surgical pain – Six month follow-up after radical prostatectomy

BackgroundChronic post-surgical pain (CPSP) by definition develops for the first time after surgery and is not related to any preoperative pain. Preoperative pain is assumed to be a major risk factor for CPSP. Prospective studies to endorse this assumption are missing.MethodsIn order to assess the incidence and the risk factors for CPSP multidimensional pain and health characteristics and psychological aspects were studied in patients prior to radical prostatectomy. Follow-up questionnaires were completed three and six months after surgery.ResultsCPSP incidences in 84 patients after three and six months were 14.3% and 1.2%. Preoperatively, CPSP patients were assigned to higher pain chronicity stages measured with the Mainz Pain Staging System (MPSS) (p = 0.003) and higher pain severity grades (Chronic Pain Grading Questionnaire) (p = 0.016) than non-CPSP patients. CPSP patients reported more pain sites (p = 0.001), frequent pain in urological body areas (p = 0.047), previous occurrence of CPSP (p = 0.008), more psychosomatic symptoms (Symptom Check List) (p = 0.031), and worse mental functioning (Short Form-12) (p = 0.019). Three months after surgery all CPSP patients suffered from moderate to high-risk chronic pain (MPSS stages II and III) compared to 66.7% at baseline and 82.3% had high disability pain (CPGQ grades III and IV) compared to 41.7% before surgery. CPSP patients scored significantly less favorably in physical and mental health, habitual well-being, and psychosomatic dysfunction three months after surgery.ConclusionsAll patients with CPSP reported on preoperative chronic pain. Patients with preoperative pain, related or not related to the surgical site were significantly at risk to develop CPSP. High preoperative pain chronicity stages and pain severity grades were associated with CPSP. CPSP patients reported poorer mental health related quality of life and more severe psychosomatic dysfunction before and 3 months after surgery.     

Postoperative paediatric pain prevalence: A retrospective analysis in a university teaching hospital

BackgroundOverall pain prevalence in paediatric patients is well documented, but relatively little attention has been paid to pain prevalence and intensity on specific postoperative days within the first week following an operation.ObjectivesTo evaluate reported pain prevalence on the day of surgery and each day during the following week and to analyse pain trajectories.DesignRetrospective study.SettingSingle centre university hospital.Participants815 postoperative children and adolescents (age ≤ 18 years) were included (female: 36%, age 9.8 ± 5.8). Children with ear, nose, throat (e.g. tonsillectomy), eye (e.g. strabismus repair) or dental surgery (e.g. dental extraction) were treated at other departments and therefore were not included in this study.MethodsRetrospective analysis of the overall and clinically relevant (pain score ≥4/10) postoperative pain prevalence in children and adolescents during the first week after surgery. Possible influencing factors (age, sex, body mass index, type of anaesthesia, type of surgery and duration of surgery) on pain trajectories are analysed using mixed model techniques.ResultsOverall, 36% of 815 analysed children and adolescents suffered from pain ≥4 during their entire hospital stay. Compared to the day of surgery, the number of patients with pain ≥4 was slightly higher on day 1 after surgery (21% vs. 25%, respectively). In self-reported pain intensity rating (done for patients age ≥ 4 years) the type of surgery (p < .001) was the only significant variable influencing pain intensity. In observational pain assessment (age < 4 years) pain scores increased with patient's age (p = .004). In this patient group, pain intensity ratings did not differ between types of surgery (p = .278).ConclusionType of surgery is an important predictor for self-reported pain intensity ratings in children but not for observational pain assessment in younger children. In younger children observational pain assessment ratings increase with age.     

Complementary and alternative medicine self-care strategies for nausea in patients undergoing abdominal or pelvic irradiation for cancer: A longitudinal observational study of implementation in routine care

ObjectiveTo longitudinally describe practice of Complementary and Alternative Medicine (CAM) self-care strategies for nausea during radiotherapy.MethodsTwo hundred patients daily registered nausea and practice of CAM self-care strategies, beside conventional antiemetic medications, for nausea during abdominal/pelvic irradiation (median five weeks) for gynecological (69%) colorectal (27%) or other tumors (4%).ResultsDuring radiotherapy, 131 (66%) experienced nausea, and 50 (25%) practiced self-care for nausea at least once, for a mean (m) of 15.9 days. The six of 50 patients who stayed free from nausea practiced self-care more frequent (m = 25.8 days) than the 44 patients experiencing nausea (m = 14.5) (p = 0.013). The CAM self-care strategies were: modifying eating (80% of all self-care practicing patients, 80% of the nauseous patients versus 83% of the patients free from nausea; ns) or drinking habits (38%, 41% vs 17%; ns), taking rests (18%, 20% vs 0%; ns), physical exercising (6%, 2% vs 33%; p = 0.035), acupressure (4%, 5% vs 0%; ns) and self-induced vomiting (2%, 2% vs 0%; ns).ConclusionA fourth of patients undergoing emetogenic radiotherapy practiced CAM self-care for nausea, mostly by modifying eating or drinking habits. The CAM self-care practicing patients who did not become nauseous practiced self-care more frequent than the nauseous patients did. To make such self-care evidence based, we need studies evaluating its efficacy.     

Independent risk factors for postoperative pain in need of intervention early after awakening from general anaesthesia

Despite advances in postoperative pain management, the proportion of patients with moderate to severe postoperative pain is still ranging 20–80%. In this retrospective study, we investigated 1736 patients to determine the incidence of postoperative pain in need of intervention (PPINI)defined as numeric rating scale >4 at rest in the post anaesthesia care unit early after awakening from general anaesthesia, and to identify possible risk factors. The proportion of patients with PPINI was 28.5%. On multivariate analysis, younger age (OR = 1.300 [1.007–1.678], p = 0.044), female gender (OR = 1.494 [1.138–1.962], p = 0.004), obesity (OR = 1.683 [1.226–2.310], p = 0.001), use of nitrous oxide (OR = 1.621 [1.110–2.366], p = 0.012), longer duration of surgery (OR = 1.165 [1.050–1.292], p = 0.004), location of surgery (musculoskeletal OR = 2.026 [1.326–3.095], p = 0.001; intraabdominal OR = 1.869 [1.148–3.043], p = 0.012), and ASA-PS I–II (OR = 1.519 [1.131–2.039], P = 0.005) were identified as independent risk factors for PPINI. Patients with PPINI experienced significantly more PONV (10.3% vs. 6.2%, p = 0.003), more psychomotor agitation (5.5% vs. 2.7%, p = 0.004), needed more application of opioid in PACU (62.8% vs. 24.2%, p < 0.001), stayed significantly longer in PACU (89.6 min [70–120] vs. 80 min [60–100], p < 0.001), had a longer median length of hospital stay (6.6 days [4.0–8.8] vs. 6.0 days [3.2–7.8]], p < 0.001), and longer postoperative stay (5.0 days [3.0–6.5] vs. 4.1 days [2.5–5.8], p < 0.001]). Patients with PPINI required more piritramid (8.0 mg [5.0–12.0] vs. 5.0 mg [3.0–7.8], p < 0.001) in PACU than patients without. The identification of patients at high risk for immediate postoperative pain in need of intervention would enable the formation of effective postoperative pain management programs.     

Are high-sensitivity cardiac troponin I values stable between preoperative visit and day of non-cardiac surgery?

BackgroundIt is unclear if cardiac troponin values are stable in patients prior to undergoing non-cardiac surgery, or if they tend to rise towards the day of surgery.MethodsIn this small pilot study (n = 18) among patients with cardiac risk undergoing non-cardiac surgery, we determined if high-sensitivity cardiac troponin I (hscTnI) changes between the preoperative clinic visit and the day of surgery. HscTnI was measured on an Abbott Architect STAT (Abbott Laboratories, USA) platform.ResultsThe mean duration between preoperative clinic visit and day of surgery was 8.7 ± 2.8 (SD) days. Median hscTnI was 3.4 ng/L [2.0–4.8, IQR] at the preoperative visit and 2.8 ng/L [2.3–4.4] on the day of surgery (mean difference − 0.24 ng/L, 95% CI - 0.73 to 0.24 ng/L, p = 0.30). Only one patient had a large change (> 50%) along with symptoms.DiscussionEvidence from this small study suggests that cardiac troponin values are stable in most high-risk patients, absent clinical events, within 10 days prior to non-cardiac surgery.     

Influence of posture,sex, and age on breathing pattern and chest wall motion in healthy subjects

ObjectiveWe evaluated the effects of posture, sex, and age on breathing pattern and chest wall motion during quiet breathing in healthy participants.MethodsEighty-three participants aged 42.72 (SD = 21.74) years presenting normal pulmonary function were evaluated by optoelectronic plethysmography in the seated, inclined (with 45° of trunk inclination), and supine positions. This method allowed to assess the chest wall in a three dimensional way considering the chest wall as three compartments: pulmonary rib cage, abdominal rib cage and abdomen.ResultsPosture influenced all variables of breathing pattern and chest wall motion, except respiratory rate and duty cycle. Chest wall tidal volume and minute ventilation were reduced (p < 0.05) in both sexes from seated to inclined and from seated to supine positions, mainly in males. Moreover, moving from seated to supine position significantly increased the percentage contribution of the abdomen to the tidal volume in both sexes (p < 0.0001). Regarding sex, women showed higher contribution of thoracic compartment compared to men (p = 0.008). Aging provided reductions on rib cage contributions to tidal volume that were compensated by increases of abdomen contributions (p < 0.0001). In addition, increases in end-inspiratory and end-expiratory volumes over the years were observed.ConclusionThe degree of contribution of chest wall compartments is dependent on posture, sex, and age. Therefore, verticalization increases expansion of pulmonary rib cage as well as horizontalization increases abdominal displacement. Women presented higher thoracic contribution to tidal volume than men. Aging reduces rib cage contributions to tidal volume that were compensated by increases of abdomen contributions.     

Continuous intra-articular infusion of bupivacaine for post-operative pain relief after total hip arthroplasty: A randomized,placebo-controlled,double-blind study

BackgroundInstillation of local anesthetics into a surgical site has been gaining popularity in post-operative pain management.AimTo determine whether continuous intra-articular infusion of bupivacaine via pain-control infusion pumps (PCIP) enhances and sustains analgesia after total hip arthroplasty (THA).MethodsNinety-two patients undergoing THA were randomized to receive continuous intra-articular infusion of either 0.5% bupivacaine or 0.9% normal saline at a flow rate of 2 mL/h via a PCIP for 48 h. The primary outcome measure was pain intensity on Visual Analogue Scale (VAS) scores in the first 72 h. Other measures included time to first rescue dose of narcotics, amount of narcotic use, presence of adverse events, length of hospital stay, and hip function evaluated with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index.ResultsDespite a longer time to first narcotic rescue (56 versus 21 min, p < 0.0001) in patients receiving bupivacaine, the two groups did not differ significantly in overall pain relief (p = 0.54). A lower VAS score was found only at time 0 and 2 h; no difference in VAS score was noted at any other time point. Additionally, no difference was found in terms of amount of narcotic use, incidence of adverse events, hospitalization days, and the WOMAC score.ConclusionContinuous intra-articular infusion of 0.5% bupivacaine at 2 mL/h via a PCIP does not provide sustained post-operative pain relief in patients undergoing THA.     

Effectiveness of Spiritist “passe” (Spiritual healing) for anxiety levels,depression, pain,muscle tension,well-being,and physiological parameters in cardiovascular inpatients: A randomized controlled trial

BackgroundBiofield therapies, such as laying on of hands, are used in association with Conventional Medicine as Spiritist “passe”, among others. The aim of this study was to evaluate anxiety, depression, pain, muscle tension and well-being, as well as physiological parameters in cardiovascular inpatients submitted to the Spiritist “passe”, sham, and no intervention.MethodsIn the total, 41 cardiovascular inpatients submitted to the Spiritist “passe”, sham, and no intervention during a 10-min period on 3 consecutive days. They were evaluated through anxiety and depression level, pain, the perceptions of muscle tension and well-being and physiological parameters, before and after interventions.ResultsA significant reduction (p = 0.001) in anxiety scores and muscle tension (p = 0.011), improvement of well-being (p = 0.003) and a significant increase in peripheral oxyhemoglobin saturation scores (p = 0.028) were observed in Spiritist “passe” patients, and a significant reduction (p = 0.028) of muscle tension and improvement of well-being (p = 0.045) in sham patients. However, muscle tension reduction (p = 0.003) and improvement of well-being (p = 0.003) were more accentuated in the Spiritist “passe” compared to sham and no intervention.ConclusionsResults suggest that the Spiritist “passe” appeared to be effective, reducing anxiety level and the perception of muscle tension, consequently improving peripheral oxyhemoglobin saturation and the sensation of well-being compared to sham and no intervention in cardiovascular inpatients.     

The predictive value of NT-proBNP and hs-TnT for risk of death in cardiac surgical patients

BackgroundEuropean System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is used for risk stratification before cardiac surgery, but whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT) may add prognostic information to EuroSCORE II is not known.MethodsPreoperative (n = 640) and postoperative (n = 629) blood samples were available from cardiac surgical patients with 961-day follow-up (FINNAKI Heart study; cohort #1). The accuracy of a parsimonious risk model with NT-proBNP measurements was also tested in 90 patients with respiratory failure after cardiac surgery (FINNALI study; cohort #2).ResultsSixty-one patients (9.5%) died during follow-up in cohort #1. Preoperative NT-proBNP and hs-TnT concentrations correlated (rho = 0.58; p < 0.001) and were higher in non-survivors compared to survivors: median 2027 (Q1-3 478-5387) vs. 373 (134–1354) ng/L [NT-proBNP] and 39 (16–191) vs. 13 (8–32) ng/L [hs-TnT]; p < 0.001 for both. Preoperative NT-proBNP concentrations were associated with time to death after adjustment for EuroSCORE II (HR [_lnNT-proBNP] 1.33 [95% CI 1.08–1.64]), p = 0.008 and reclassified patients on top of EuroSCORE II (net reclassification index 0.39 [95% CI 0.14–0.64], p = 0.003). Pre- and postoperative NT-proBNP concentrations were closely correlated (rho = 0.80, p < 0.001) and postoperative NT-proBNP concentrations were also associated with long-term mortality after adjustment for EuroSCORE II. A parsimonious risk model that included age, creatinine clearance, chronic pulmonary disease, and NT-proBNP measurements provided comparable prognostic accuracy as EuroSCORE II in cohort #1 and #2 for risk of long-term mortality. hs-TnT measurements did not add to NT-proBNP measurementsConclusionNT-proBNP measurements could improve and simplify risk prediction in cardiac surgical patients.     

Effects of anger and anger regulation styles on pain in daily life of women with fibromyalgia: A diary study

BackgroundFibromyalgia is characterized by an amplified pain response to various physical stimuli. Through biological and behavioural mechanisms, patients with fibromyalgia may also show an increase of pain in response to emotions. Anger, and how it is regulated, may be particularly important in chronic pain.AimTo examine, among patients with fibromyalgia, whether anger during everyday life amplifies pain and whether general and situational anger inhibition and anger expression modulate the anger–pain link.MethodsFor 28 consecutive days, 333 women with fibromyalgia (mean age 47 ± 12 years) reported their transient anger and state anger inhibition (anger-in) and expression (anger-out) responses regarding a significant emotional event during the day as well as end-of-day pain. Trait anger inhibition and expression were assessed by questionnaire. Multilevel regression analyses were performed.ResultsState anger predicted higher end-of-day pain (p < .001) in half of the patients, but lower pain in one-quarter of patients. State anger inhibition was unrelated to pain. Trait anger inhibition was related to more pain (p = .02). The lowest pain level was observed among patients with high trait anger expression who actually expressed their anger in an anger-arousing situation (p = .02).ConclusionsOur study suggests that anger and a general tendency to inhibit anger predicts heightened pain in the everyday life of female patients with fibromyalgia. Psychological intervention could focus on healthy anger expression to try to mitigate the symptoms of fibromyalgia.     

The impact of health literacy on health outcomes in individuals with chronic pain: a cross-sectional study

ObjectiveTo establish if health literacy (HL) is linked to poorer outcomes and behaviours in patients with chronic pain.DesignA prospective cross-sectional observational study.SettingMultidisciplinary out-patient pain clinics in three university teaching hospitals.PatientsNew patients (n = 131) referred to the pain clinic with a history of chronic pain (>12 weeks).MethodsA questionnaire was distributed to chronic pain patients attending their first appointment. Those eligible for inclusion were newly referred patients who had pain lasting longer than three months. The questionnaire comprised the following sections: demographics, chronic pain status and disease-related knowledge, quality of life (SF-36), beliefs (Beliefs About Pain Control Questionnaire), and a validated HL tool (Newest Vital Sign).ResultsOf the 131 participants recruited, 54% had inadequate HL. The group was subsequently stratified according to HL level. In bivariate analysis, inadequate HL was associated with older age (p < 0.001), being unemployed or retired (p = 0.005), less education (p < 0.001), lower income, increased comorbidities (p = 0.038), being less likely to utilise allied health services (p = 0.001), poorer disease-related knowledge (p = 0.002), and poorer beliefs about pain (p < 0.05). In multivariate analysis, disease-related knowledge (OR 2.5, 95%CI 1.0 to 6.3, p = 0.05) and beliefs about pain (B = −2.3, S.E = 0.9, p = 0.01) remained independently associated with HL.ConclusionInadequate HL is prevalent in chronic pain patients, and may impact on the development of certain characteristics necessary for effective self-management.     

Cuidados e implicaciones en los cuidadores de pacientes quirúrgicos en el domicilio

ObjectiveTo identify the care given by informal caregivers to patients who underwent abdominal surgery in the Consorci Hospitalari of Vic (Barcelona). To compare the responsibility burden for those caregivers in all the different stages of the surgical process. To determine the consequences of the care itself on the caregiver's health and to identify the factors that contribute to the need of providing care and the appearance of consequences for the caregivers in the home.MethodologyA longitudinal observational study with follow-up at admission, at discharge and 10 days, of 317 non-paid caregivers of patients who suffer underwent surgery. The characteristics of caregivers and surgical patients were studied. The validated questionnaire, ICUB97-R based on the model by Virginia Henderson, was used to measure the care provided by informal caregivers and its impact on patient quality of life.ResultsMost of the caregivers were women, with an average age of 52.9 ± 13.7 years without any previous experience as caregivers. The greater intensity of care and impact was observed in the time when they arrived home after hospital discharge (p < 0.05). The predictive variables of repercussions were being a dependent patient before the surgical intervention (β = 2.93, p = 0.007), having a cancer diagnosis (β = 2.87, p < .001) and time dedicated to the care process (β = 0.07, p = 0.018).ConclusionsCaregivers involved in the surgical process provide a great amount of care at home depending on the characteristics of patients they care for, and it affects their quality of life.     

Evaluating the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma: A randomized control trial

BackgroundEmpowerment can be an effective strategy for changing an individual's health behaviours. However, how to empower whole families to manage their children's asthma is a challenge that requires innovative nursing intervention based on family-centred care.AimsTo evaluate the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma compared to those receiving traditional self-management only.DesignA randomized control trial.MethodsSixty-five families were recruited from one asthma clinic in a medical centre in Taiwan. After random assignment, 34 families in the experimental group received the family empowerment program consisting of four counselling dialogues with the child and its family. We empowered the family caregiver's ability to manage their child's asthma problems through finding the problems in the family, discovery and discussion about the way to solve problems, and enabling the family's cooperation and asthma management. The other 31 families received the traditional care in asthma clinics. The Parental Stress Index and Family Environment Scale of family caregivers, and pulmonary function, and asthma signs of children with asthma were collected at pre-test, 3-month post-test, and one-year follow-up. We utilized the linear mixed model in SPSS (18.0) to analyze the effects between groups, across time, and the interaction between group and time.ResultsThe family empowerment program decreased parental stress (F = 13.993, p < .0001) and increased family function (cohesion, expression, conflict solving, and independence) (F = 19.848, p < .0001). Children in the experimental group had better pulmonary expiratory flow (PEF) (F = 26.483, p < .0001) and forced expiratory volume in first second (FEV1) (F = 7.381, p = .001) than children in the comparison group; however, no significant change in forced expiratory volume in first second (FEV1)/forced vital capacity (FVC) was found between the two groups. Sleep problems did not show significant changes but cough, wheezing, and dyspnoea were significantly reduced by family caregiver's observations.ConclusionWe empowered families by listening, dialogues, reflection, and taking action based on Freire's empowerment theory. Nurses could initiate the families’ life changes and assist children to solve the problems by themselves, which could yield positive health outcomes.     

The effect of a rotator cuff tear and its size on three-dimensional shoulder motion

BackgroundRotator cuff-disease is associated with changes in kinematics, but the effect of a rotator cuff-tear and its size on shoulder kinematics is still unknown in-vivo.MethodsIn this cross-sectional study, glenohumeral and scapulothoracic kinematics of the affected shoulder were evaluated using electromagnetic motion analysis in 109 patients with 1) subacromial pain syndrome (n = 34), 2) an isolated supraspinatus tear (n = 21), and 3) a massive rotator cuff tear involving the supraspinatus and infraspinatus (n = 54). Mixed models were applied for the comparisons of shoulder kinematics between the three groups during abduction and forward flexion.FindingsIn the massive rotator cuff-tear group, we found reduced glenohumeral elevation compared to the subacromial pain syndrome (16°, 95% CI [10.5, 21.2], p < 0.001) and the isolated supraspinatus tear group (10°, 95% CI [4.0, 16.7], p = 0.002) at 110° abduction. Reduced glenohumeral elevation in massive rotator cuff tears coincides with an increase in scapulothoracic lateral rotation compared to subacromial pain syndrome (11°, 95% CI [6.5, 15.2], p < 0.001) and supraspinatus tears (7°, 95% CI [1.8, 12.1], p = 0.012). Comparable differences were observed for forward flexion. No differences in glenohumeral elevation were found between the subacromial pain syndrome and isolated supraspinatus tear group during arm elevation.InterpretationThe massive posterosuperior rotator cuff-tear group had substantially less glenohumeral elevation and more scapulothoracic lateral rotation compared to the other groups. These observations suggest that the infraspinatus is essential to preserve glenohumeral elevation in the presence of a supraspinatus tear. Shoulder kinematics are associated with rotator cuff-tear size and may have diagnostic potential.     

Relationship between bone resorption,oxidative stress and inflammation in severe COPD exacerbation

BackgroundThe natural course of chronic obstructive pulmonary disease (COPD) is complicated by the development of systemic consequences and co-morbidities. Increasing evidence indicates that COPD and osteoporosis are strongly linked. The common features in COPD pathology, history of smoking, age, inactivity, systemic inflammation, and use of systemic corticosteroids, are important risk factors for osteoporosis.MethodsPulmonary function, matrix metalloproteinase, tissue inhibitor of metalloproteinases, oxidative stress parameters, inflammatory markers and bone resorption marker were measured in 85 COPD patients and 47 healthy subjects. In patients, all parameters were assessed at two time points: one day after admission during exacerbation and about 30 days after, in the stable state of disease.ResultsIn patients, bone resorption marker collagen type I β-isomerized C-terminal telopeptide (beta CL) was increased during exacerbation: geometric mean 0.521, compared with stable patients 0.408, p < 0.01, and control subjects 0.362 ng/ml, p < 0.001. During exacerbation high sensitivity C-reactive protein (hsCRP) and neutrophil count were significantly higher in COPD patients compared with the control group, p < 0.001. Matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) concentrations were significantly higher in COPD patients, stable state or exacerbation, compared with control subjects, p < 0.001. In patients during exacerbation, total oxidative status (TOS) was higher compared with the stable state, p < 0.05 and control group, p < 0.001. Multiple linear regression for the joint influence of inflammation, hypoxia and oxidative status during exacerbation showed almost 60% influence on the variability of beta CL concentrations.ConclusionIntensification of disease characteristic symptoms such as inflammation, hypoxia, protease/antiprotease imbalance and oxidative stress, during exacerbation episodes in COPD patients may also contribute to increased bone resorption.     

Strict versus liberal insulin therapy in the cardiac surgery patient: An evidence-based practice development,implementation and evaluation project

BackgroundHyperglycemia post-cardiac surgery is associated with poor clinical outcomes. Recent studies suggest maintaining liberal glycemic control (< 180 mg/dL) using a continuous insulin infusion (CII) versus strict control achieves optimal outcomes and prevents hypoglycemia.PurposeTo develop, implement and evaluate a nurse managed liberal CII protocol.MethodsRetrospective review of 144 strict CII patient records and 147 liberal CII patient records.ResultsMean blood glucose was 159.8 mg/dL (liberal CII) compared to 143.3 mg/dL (strict CII) (p ≤ 0.001). No surgical site infections occurred in either group. Mean ICU length of stay was 4.5 days (liberal) versus 4.4 days (strict) (p = 0.74). Two 30-day mortalities occurred for the liberal cohort compared to no deaths in the strict group (p = 0.49). Hypoglycemia incidence within 24 h after surgery was 0.1% (liberal) compared to 0.3% (strict) compared to (p = 0.16).ConclusionUse of a nurse managed liberal CII resulted in similar outcomes with fewer incidents of hypoglycemia.     

Effectiveness of focused meditation for patients with chronic low back pain—A randomized controlled clinical trial

ObjectivesWe aimed to evaluate the effectiveness of an 8-week meditation program (focused meditation) in patients with chronic low-back pain.DesignA randomized clinical trial was conducted on 68 patients (55 years;75% female) with chronic low-back pain who scored >40 mm on a 100 mm Visual-Analogue-Scale. Subjects were allocated to an 8-week meditation program (focused meditation) with weekly 75 min classes or to a self-care exercise program with a wait-list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed baseline and after 4 and 8 weeks. The primary outcome measure was the change in mean back pain at rest after 8 weeks. Secondary outcomes included function, pain-related bothersomeness, perceived stress, quality-of-life (QOL), and psychological outcomes.ResultsTwelve (meditation) and 4 (exercise) patients were lost to follow-up. The primary outcome, pain at rest after 8 weeks, was reduced from 59.3 ± 13.9 mm to 40.8 ± 21.8 mm with meditation vs. 52.9 ± 11.8 mm to 37.3 ± 18.2 mm with exercise (adjusted group difference: −1.4 (95%CI:11.6;8.8;p = n.s.) Perceived stress was significantly more reduced with meditation (p = 0.011). No significant treatment effects were found for other secondary outcomes as pain-related bothersomeness, function, quality-of-life and psychological scores, although the meditation group consistently showed non-significant better improvements compared to the exercise group.ConclusionsFocused meditation and self-care exercise lead to comparable, symptomatic improvements in patients with chronic low back pain. Future studies should include longer-term follow-ups and develop guided meditation programs to support compliance.     

Comparative effects of 12 weeks of equipment based and mat Pilates in patients with Chronic Low Back Pain on pain,function and transversus abdominis activation. A randomized controlled trial

BackgroundPilates method has been recommended for patients with chronic low back pain (CLBP) and the activation of transversus abdominis has been deemed to play an important role in the improvement of these patients. Nevertheless, the evidence of the activation of TrA in Pilates practitioners remains unclear.ObjectiveTo assess the effectiveness of 12 weeks of Pilates practice in disability, pain, kinesiophobia and transversus abdominis activation in patients with chronic nonspecific Low Back Pain.DesignA randomized controlled trial was carried out.MethodsA single-blind randomized controlled trial with repeated measures at 6 and 12 weeks was carried out. A total of ninety eight patients with low back pain were included and randomly allocated to a Pilates Mat group (PMG) equipment based with apparatus Pilates (PAG) or control group (CG). Roland Morris Disability Questionnaire (RMDQ), visual analog scale (VAS) Tampa Scale of Kinesiophobia (TSK), and transversus abdominis (TrA) activation assessed by real time ultrasound measurement (US) were assessed as outcome measures.ResultsImprovement were observed in both intervention groups in all the included variables at 6 and 12 weeks (p < 0.001). Faster enhancement was observed in the equipment based Pilates group (p = 0.007).ConclusionsEquipment based and mat Pilates modalities are both effective in the improvement of TaA activation in patients with CLBP with associate improvement on pain, function and kinesiophobia. Significant differences were observed after 12 weeks of intervention in PMG and PAG with faster improvement in PAG suggesting that, feedback provided by equipment could help in the interiorization of Pilates principles.     

The Mental Activity and eXercise (MAX) trial: Effects on physical function and quality of life among older adults with cognitive complaints

BackgroundOlder adults with cognitive complaints are vulnerable to dementia, physical impairments, and poor quality of life. Exercise and mental activity may improve physical function and health-related quality of life (HRQOL) but combinations have not been investigated systematically. The Mental Activity and eXercise (MAX) trial found that mental activity plus exercise over 12 weeks improved cognitive function (primary outcome) in sedentary older adults with cognitive complaints.ObjectiveTo investigate the effects of combinations of two mental activity and exercise programs on physical function and HRQOL (secondary outcomes).MethodsParticipants (n = 126, age 73 ± 6 years, 65% women) were randomized to 12 weeks of exercise (aerobic exercise or stretching/toning, 3 × 60 min/week) plus mental activity (computer-based cognitive training or educational DVDs, 3 × 60 min/week) using a factorial design. Assessments included the Senior Fitness Test (physical function), Short Form-12 physical and mental sub-scales (HRQOL), and CHAMPS questionnaire (physical activity).ResultsThere were no differences between groups at baseline (p > 0.05). We observed improvements over time in most physical function measures [chair stands (p-for-time = 0.001), arm curls (p-for-time < 0.001), step test (p-for-time = 0.003), sit & reach (p-for-time = 0.01), and back scratch (p-for-time = 0.04)] and in physical HRQOL (p-for-time = 0.04). There were no differences in change between groups (group 1 time p > 0.05). Changes in most physical function measures and physical HRQOL correlated with physical activity changes.ConclusionCombined mental activity and exercise interventions of various types can improve both physical function and physical HRQOL among sedentary older adults with cognitive complaints. Exercise control group design should be carefully considered as even light exercise may induce benefits in vulnerable older adults.