Do we have to monitor foetal heart rate during general anesthesia?

We present a case of an emergency Caesarean section due to misinterpretation of the cardiotocography (CTG) trace during general anaesthesia for treatment of dental abscess. Following failure of the dental abscess treatment under local anaesthesia, a 29-year-old female in the 36th week of a twin pregnancy was to undergo general anaesthesia. Foetal well-being was monitored with ultrasonographic evaluations of foetal heart rate. During surgery, senior obstetrician recorded a lack of beat-to-beat variability of the cardiotocography trace. The CTG pattern was interpreted as foetal distress and an emergency Caesarean section was performed under general anaesthesia. That was probably due to general anaesthesia. Then, two infants were extracted without neonatal distress necessitating intubation. This case report underlines the risk to misread an intraoperative CTG monitoring and if the CTG monitoring is normal before anaesthesia, reduced foetal beat-to-beat variability with a normal baseline heart rate during general anaesthesia is probably normal.     

Do findings identified on magnetic resonance imaging predict future neck pain? A systematic review

Background Context

Magnetic resonance imaging (MRI) has the potential to identify pathology contributing to neck pain. However, the importance of findings on MRI remains unclear.

What can we learn from long-term studies on chronic low back pain? A scoping review

European Spine Journal - A scoping review was conducted with the objective to identify and map the available evidence from long-term studies on chronic non-specific low back pain (LBP), to examine...     

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 systematic review on vaginal laser therapy for treating stress urinary incontinence: Do we have enough evidence?

Introduction and hypothesis

Current treatment strategies for stress urinary incontinence (SUI) raise concerns about safety and efficacy. The purpose of this systematic review was to present available evidence related to vaginal laser therapy as a treatment option for SUI.

Methods

We searched the MEDLINE (1966–2017), Scopus (2004–2017), Clinicaltrials.gov (2008–2017) and Cochrane Central Register of Controlled Trials (CENTRAL) (1999–2017) databases for relevant studies in this field. We aimed to include all observational studies (prospective and retrospective, randomized and nonrandomized) that reported outcomes on vaginal laser therapy as a treatment option for SUI.

Results

Thirteen studies were included that recruited 818 patients who underwent laser therapy for SUI. The methodological quality of most included studies was low, as they were either individual case–control studies, case series or poor-quality cohorts (Oxford Level of Evidence 3b and 4). According to the existing evidence, laser therapy may be a useful, minimally invasive approach for treating SUI. However, the methodological limitations of included studies render them prone to significant bias, limiting their scientific integrity.

Conclusions

As the demand for minimally invasive approaches for treating SUI increases, it is expected that more patients will seek alternative treatments over current standards (midurethral slings). Given the limitations of the existing studies, it seems that conducting future trials is necessary to elucidate this field.

     

How do we define the condition ‘recurrent low back pain’? A systematic review

Recurrent low back pain (recurrent LBP) is a common condition, however, it is unclear if uniform definitions are used in studies investigating the prevalence and management of this condition. The aim of this systematic review was to identify how recurrent LBP is defined in the literature. A literature search was performed on MEDLINE, EMBASE, CINAHL, AMED, and PEDro. Studies were considered eligible if they investigated a cohort of subjects with recurrent LBP or if they were measuring the prevalence of recurrent LBP. Two independent reviewers assessed inclusion of studies and extracted definitions of recurrent LBP. Forty-three studies met the inclusion criteria. The majority of studies (63%) gave an explicit definition of recurrent LBP; however, the definitions varied greatly and only three definitions for recurrent LBP were used by more than one study. The most common feature given as part of the definition was the frequency of previous episodes of low back pain. Only 8% (3/36) of studies used previously recommended definitions for recurrent LBP. Large variation exists in definitions of recurrent LBP used in the literature, making interpretation of prevalence rates and treatment outcomes very difficult. Achieving consensus among experts in this area is required.