Is antibiotic prophylaxis required for flexible cystoscopy? A truncated randomized double-blind controlled trial

PURPOSE: To examine the incidence of urinary tract infection (UTI) after flexible cystoscopy (FC) and determine whether prophylactic norfloxacin reduces this incidence compared with placebo. Patients and METHODS: A double-blind trial was performed, randomizing 234 patients to either 400 mg of norfloxacin or placebo prior to FC. All patients provided a midstream urine specimen (MSU) before the procedure, as well as at day 3 and day 7 after FC. In addition, a telephone questionnaire was performed to correlate the nature and severity of any symptoms associated with UTI. RESULTS: Interim analysis was performed because of the low recruitment rate, and a significantly lower infection rate than expected meant that the trial was discontinued. There was one symptomatic UTI in the placebo group (0.82%) and one in the norfloxacin group (0.89%). The UTI in the placebo group was de novo, while the infection in the norfloxacin group was secondary to pre-FC bacteriuria. There was no difference in the infection rates in the two groups. The overall infection rate (de novo and secondary to existing bacteruria) after FC was 0.85%. CONCLUSION: Infection after flexible cystoscopy is rare and not associated with significant morbidity. A much larger study would be required to determine whether antibiotic prophylaxis significantly reduces the rate of postprocedure UTI.     

Does orthotics use improve comfort,speed and injury rate during running? Preliminary analysis of a randomised control trial

BACKGROUNDEvidence regarding the effectiveness of using orthotics in improving comfort, increasing running speed and helping to reduce injury rate during running is limited and mixed. Alongside the increasing popularity of running is the increasing rate of running-related injuries (RRIs). Further research into whether orthotics could be used to help reduce RRIs would be highly beneficial for those affected. Additionally, there is a need to clarify whether orthotics use increases comfort during running and helps improve running speed.AIMTo investigate whether running with Aetrex Orthotics improves comfort and performance and reduces injury whilst running.METHODSRunners were recruited on a voluntary basis if they were 18 or older with no serious health conditions, ongoing foot pain or deformity, previous foot surgery in their lifetime or any surgery in the past 6 mo. Participants were randomly assigned to either an intervention group or a control group. All participants were asked to complete runs and provide quantitative data regarding comfort during running, running time and distance, and any RRIs over an 8-wk study period. Participants in the intervention group ran with Aetrex L700 Speed Orthotics, whilst participants in the control group ran without orthotics. Other than the addition of orthotics for participants in the intervention group, all participants were asked to run as they usually would. This report presents preliminary data from the first 47 participants recruited for this study. Running speed was calculated from running distance and time and given in miles per hour. For each outcome variable, the mean for each group, effect size and 95% confidence interval were calculated, and a t-test was performed to determine if between-group differences were statistically significant.RESULTSData for all three primary outcomes was provided from a total of 254 runs by the 23 participants in the intervention group and a total of 289 runs by the 24 participants in the control group. Participants in the intervention group reported higher comfort scores (8.00 ± 1.41 vs 6.96 ± 2.03, P ≤ 0.0001), faster running speeds (6.27 ± 1.03 vs 6.00 ± 1.54, P = 0.013), and lower RRI rates (0.70 ± 1.01 vs 1.21 ± 1.53, P = 0.18) than those in the control group. These findings were statistically significant for comfort and running speed but not for RRI rate, with statistical significance considered if P < 0.05. No adjustments were made for group differences in age, gender, tendency for RRIs or usual running speed. CONCLUSIONThis preliminary report provides evidence for orthotics use in increasing comfort levels and running speed, but no significant difference in RRI rate.     

Strategies to maximise patient comfort during extracorporeal shockwave lithotripsy – A randomised controlled trial

Background/purpose of studyWe aim to assess if distraction techniques improve patient comfort tolerability of SWL.MethodsWe carried out a prospective randomised controlled trial of SWL-naïve patients attending for treatment. Patients were randomised into three groups and offered oral analgesia as standard of care. Group 1 (n = 19) received stress balls to squeeze during treatment. Group 2 (n = 19) listened to music during treatment. Group 3 (n = 17) received standard of care only. All patients completed a validated health anxiety inventory score prior to treatment. All patients completed a validated pain questionnaire and visual analogue scale (VAS) after treatment. Primary outcomes were completion of SWL treatment and pain score results.Results55 patients attending for SWL were randomised. There was no difference in stone size or position, presence of a stent, height or weight between the groups. VAS scores were lower in controls compared to Group 1 (1.93 vs 3.69, p = 0.08). On subgroup analysis of non-anxious patients, pain questionnaire scores were lower in controls compared to Group 1 (2.58 vs 4.77, p = 0.06). VAS scores were lower in patients who received optional analgesia alone than in patients who received stress balls alone (1.92 vs 4.07, p = 0.05). Across all subgroups, pain scores were lower in the control group compared to the distraction groups, but did not achieve significance.ConclusionsIn conclusion, distraction techniques should not replace standard of care for analgesia during SWL.This study was registered with clinicaltrials.gov (identifier NCT03379922).     

Can a self-management programme delivered by a community pharmacist improve asthma control? A randomised trial

BACKGROUND: No randomised studies have addressed whether self-management for asthma can be successfully delivered by community pharmacists. Most randomised trials of asthma self-management have recruited participants from secondary care; there is uncertainty regarding its effectiveness in primary care. A randomised controlled study was undertaken to determine whether a community pharmacist could improve asthma control using self-management advice for individuals recruited during attendance at a community pharmacy. METHODS: Twenty four adults attending a community pharmacy in Tower Hamlets, east London for routine asthma medication were randomised into two groups: the intervention group received self-management advice from the pharmacist with weekly telephone follow up for 3 months and the control group received no input from the pharmacist. Participants self-completed the North of England asthma symptom scale at baseline and 3 months later. RESULTS: The groups were well matched at baseline for demographic characteristics and mean (SD) symptom scores (26.3 (4.8) and 27.8 (3.7) in the intervention and control groups, respectively). Symptom scores improved in the intervention group and marginally worsened in the control group to 20.3 (4.2) and 28.1 (3.5), respectively (p<0.001; difference adjusted for baseline scores=7.0 (95% CI 4.4 to 9.5). CONCLUSIONS: A self-management programme delivered by a community pharmacist can improve asthma control in individuals recruited at a community pharmacy. Further studies should attempt to confirm these findings using larger samples and a wider range of outcome measures.     

Evaluation of pain in bilateral total knee replacement with and without tourniquet; a?prospective randomized control trial

Aim

Thigh pain following tourniquet application is a common complaint in early post operative period following total knee arthroplasty.

Method

Post operative Thigh pain was evaluated in 30 consecutive simultaneous bilateral total knee arthroplasty patients between July 2013 and January 2014. Patient thigh pain was evaluated with the VAS score. The scale was applied on first, second, third day & second and six weeks after surgery.

Result

There were statistically significant difference in VAS score in non-tourniquet group on first, second, third post operative day. We did not find statistically significant difference at Second and Six weeks post operatively.

Conclusion

This Randomized trial demonstrates that non-tourniquet use in TKA has less early postoperative pain and leads to better recovery.     

Effects of religious and spiritual care on burn patients’ pain intensity and satisfaction with pain control during dressing changes

ObjectiveSpiritual care, beside other nursing interventions, creates a balance in body, psyche and soul in order to holistically recover one's health. This research aims to study the effects of a religious and spiritual care program on the intensity of pain and the satisfaction with pain control during the dressing changes for the burn patients in a hospital in Iran in 2017.MethodsThis research is a clinical trial study conducting 68 burn patients. The samples were randomly divided into ‘experimental’ and ‘control’ groups. The experiment consists of three sessions of spiritual care carried out by the help of the nurse, a clergy and the patient’s companion. These sessions have been done before, during and after the dressing change. The pain intensity and the satisfaction with pain control are measured by VAS¹ and NRS² devices. The data is analyzed via SPSS version 20 and through the statistical exams of independent t-test, paired t-test, chi-squared test and Mann-Whitney exam.ResultsBefore the intervention, there was no significant difference in the average rate of pain (P = 0.25) and the satisfaction with pain control (P = 0.59) between the experimental and the control groups. While, after the spiritual care program was conducted, there appeared a significant difference (P < 0.001): there was a substantial reduction of pain intensity in the experimental group and the satisfaction with pain control in this group increased as well.ConclusionsA religious and spiritual care can help decrease the pain intensity caused by the dressing change and can increase the satisfaction of these patients with pain control. Therefore, it is recommended that the nurses apply the spiritual cares to alleviate the pain and to increase the satisfaction with pain control in burn patients.     

A bio-psycho-social exercise program (RÜCKGEWINN) for chronic low back pain in rehabilitation aftercare - Study protocol for a randomised controlled trial

Background  

There is strong, internationally confirmed evidence for the short-term effectiveness of multimodal interdisciplinary specific treatment programs for chronic back pain. However, the verification of long-term sustainability of achieved effects is missing so far. For long-term improvement of pain and functional ability high intervention intensity or high volume seems to be necessary (> 100 therapy hours). Especially in chronic back pain rehabilitation, purposefully refined aftercare treatments offer the possibility to intensify positive effects or to increase their sustainability. However, quality assured goal-conscious specific aftercare programs for the rehabilitation of chronic back pain are absent.     

Altered breathing patterns during lumbopelvic motor control tests in chronic low back pain: a case–control study

The objective of the study was to evaluate the breathing pattern in patients with chronic non-specific low back pain (LBP) and in healthy subjects, both at rest and during motor control tests. Ten healthy subjects and ten patients with chronic LBP participated at this case–control study. The breathing pattern was evaluated at rest (standing and supine position during both relaxed breathing and deep breathing) and while performing clinical motor control tests, i.e. bent knee fall out and active straight leg raise. A blinded observer analyzed the breathing pattern of the participants using visual inspection and manual palpation. Costo-diaphragmatic breathing was considered as optimal breathing pattern. Subjects filled in visual analog scales for the assessment of pain intensity during the tests. At rest, no significant differences were found between the breathing pattern of patients and healthy subjects (P > 0.05). In contrast, significantly more altered breathing patterns were observed in chronic LBP-patients during motor control tests (P = 0.01). Changes in breathing pattern during motor control tests were not related to pain severity (P > 0.01), but were related to motor control dysfunction (P = 0.01).     

Does ultrasound-guided popliteal-sciatic nerve block have superior pain control in pediatric foot and ankle surgery? A randomized control trial

BackgroundTendon surgery in the pediatric foot and ankle could cause severe postoperative pain, which may lead to psychologic distress and chronic pain. This study was aimed to compare the efficacy of a peripheral nerve block (PNB) and local surgical site infiltration (LSI) in pediatric foot and ankle tendon surgery.MethodsForty pediatric patients, who underwent foot and ankle tendon surgery were enrolled. Patients age 1–6 years old were allocated to group 1 and 7–15 years old were group 2. The popliteal-sciatic nerve block with 0.5% Bupivacaine (0.25 ml/kg) for group 1A and 2A. Group 1B and 2B received 0.5% Bupivacaine (0.25 ml/kg) local injection before wound closure. Pain score was recorded using CHEOPS in 1–6 years (Group1A, 1B), NRS in age 7–15 years (Group 2A, 2B). The post-operative morphine consumption and complications were recorded.ResultsFor 7–15 years, pain score in group 2B was more than group 2A at postoperative 2 and 6 h [Mean difference (95% CI); -3.4 (-6.4 to -0.3), and -2 (-4.4 to 0.5), respectively], and reached MCID of 2. The number of morphine consumption was significantly higher in group 2 B at 0–6 and 6–12 h post-operatively [Mean difference (95% CI); -0.8 (-1.4 to -0.2), and -0.6 (-1.1 to -0.1), respectively, with p-value < 0.05]. For 1–6 years, there was no significant difference in pain score and number of postoperative morphine consumption.ConclusionsPNB and LSI provided effective pain management in patients aged 1–6 years old with no statistically significant difference. PNB showed significant superior pain control in patients aged 7–15 years old.