中老年人群牙周病发生的危险因素分析

目的探讨中老年人群发生牙周病的危险因素。方法中老年牙周病患者422例为牙周病组,同期就诊的63例无牙周病患者为非牙周病组。收集2组临床资料,多因素logistic回归分析中老年人群牙周病发生的危险因素。结果牙周病组男性、小学及以下文化程度、吸烟、饮酒、合并糖尿病、对牙周病认知不足比率(67.77%、30.33%、71.33%、77.01%、19.91%、68.01%、)高于非牙周病组(50.79%、14.29%、44.44%、57.14%、6.35%、15.87%)(P0.05),年龄60岁、刷牙≥2次/d、定期洁牙、定期口腔检查比率(23.70%、60.43%、10.19%、13.27%)低于非牙周病组(47.62%、79.37%、36.51%、34.92%)(P0.05)。多因素logistic回归分析结果显示,年龄≥60岁(OR=4.268, 95%CI:1.362～5.362,P0.001)、吸烟(OR=3.685, 95%CI:1.254～4.632,P=0.002)、饮酒(OR=2.125, 95%CI:1.569～3.265,P=0.006)、合并糖尿病(OR=1.524, 95%CI:1.326～6.487,P=0.016)、对牙周病认知不足(OR=1.639, 95%CI:1.452～1.965,P=0.012)是中老年人群牙周病发生的危险因素,定期洁牙(OR=0.458, 95%CI:0.155～0.869,P=0.003)、刷牙≥2次/d(OR=0.596, 95%CI:0.369～0.852,P=0.018)是其保护因素。结论中老年人群患牙周病的危险因素较多,包括年龄,合并疾病,吸烟、饮酒等生活习惯以及对牙周病的认知及牙齿清洁习惯。     

老年危重症患者心力衰竭特征及其危险因素分析

目的:探讨老年危重症患者心力衰竭患病率、心力衰竭特点及危险因素。方法:收集2011-12-2014-09我院急诊内科和急诊ICU收治的老年危重症患者216例,回顾性分析老年危重症患者心力衰竭患病率及其特点,并采用多元Logistic回归分析筛选老年危重症患者发生心力衰竭的独立危险因素。结果:216例患者中,59例(27.3%)患者合并心力衰竭,且31例合并心力衰竭患者的左室射血分数(LVEF)≥50%;合并心力衰竭患者的平均年龄明显高于无合并心力衰竭患者[(75.4±10.2)岁vs.(72.0±14.9)岁,t=6.447,P=0.015];左室收缩功能正常的心力衰竭患者平均年龄明显高于左室收缩功能不全的心力衰竭患者[(76.7±9.3)岁vs.(74.3±8.4)岁,t=5.624,P=0.036];多元Logistic回归分析显示,冠心病(OR=8.271,95%CI:5.916~10.821,P=0.000)、瓣膜性心脏病(OR=7.961,95%CI:4.871~11.226,P=0.002)、糖尿病(OR=2.061,95%CI:1.176~3.812,P=0.009)、呼吸衰竭(OR=1.443,95%CI:0.975~2.118,P=0.038)以及肾功能不全(OR=2.038,95%CI:1.661~2.464,P=0.016)均显著增加老年危重症患者心力衰竭发病风险。结论:心力衰竭已成为老年危重症患者不容小觑的问题,通过对老年危重症患者心力衰竭特征及其危险因素进行研究,有助于老年危重症患者的临床救治。     

甲状腺激素水平与肥厚型梗阻性心肌病患者心房颤动的发生相关性

目的房颤是肥厚型梗阻性心肌病(HOCM)最常见的持续性心律失常,研究发现每年有2%～3.8%的HOCM患者新诊断为房颤,这增加了此类患者心力衰竭、卒中/栓塞及死亡的风险。本研究探讨了HOCM患者的甲状腺功能状态与其发生房颤的相关性。方法本研究人群共纳入756例,男性456例,女性300例。根据患者是否伴发房颤分为:HOCM合并房颤组(107例),单纯HOCM组(649例)。结果本研究人群中房颤的发生率为14.15%,HOCM合并房颤患者较单纯HOCM组患者年龄更大[(56.99±11.73)岁比(50.18±12.81)岁,P 0.001],血肌酐[(82.77±23.73)μmol/L比(76.56±20.05)μmol/L,P=0.005]、NT-proBNP[(2476.08±1808.93)fmol/mL比(1814.85±1712.95)fmol/mL,P=0.002]及FT4[(1.26±0.26)ng/dL比(1.18±0.23)ng/dL,P=0.002]水平更高(P 0.05),FT3[(2.88±0.59)pg/dL比(2.99±0.54)pg/dL,P=0.046]水平更低。根据患者血浆中TSH水平分成4组,即TSH0.55、0.55～2.49、2.50～9.99和≥10.00mIU/L组,不同TSH水平组间性别、吸烟史、TC、LDL-C、TSH、FT3、FF4、左心室舒张末期前后径、左心室射血分数(LVEF)以及房颤发生率差异有统计学意义(P 0.05)。TSH在0.55～2.49 mlU/L时房颤发生率最低(10.20%),TSH10.00 mIU/L时发生率最高(35.29%),而TSH在0.55、2.50～9.99时房颤发生率分别为27.02%、19.43%,组间比较差异有统计学意义(P 0.001)。另外,与TSH 0.55～2.49mIU/L组(正常对照组)相比,TSH异常组总胆固醇平均水平更高(P=0.012),LDL-C水平更高(P=0.002),而NT-proBNP、肌酸激酶同工酶(CK-MB)、尿酸、LAEDD、LVEDD差异无统计学意义(P0.05)。年龄(OR1.045,95%CI1.027～1.063,P 0.001),NT-proBNP(每100fmol/mL,OR1.017,95%CI1.006～1.029,P=0.003),血肌酐(OR1.013,95%CI 1.004～1.022,P=0.006),FT3(OR0.616,95%CI 0.392～0.968,P=0.035),FT4(OR3.336,95%CI1.483～7.503,P=0.004)。年龄是房颤发生的危险因素。以TSH 0.55～2.49mIU/L水平为基准,TSH 2.50～9.99 mIU/L(OR1.977,95%CI 1.115～3.506,P=0.02)、TSH10.00mIU/L(OR4.301,95%CI1.059～17.476,P=0.04)发生房颤的风险呈上升趋势。结论 TSH升高是HOCM发生房颤的独立危险因素。     

老年心脏起搏器植入患者急性脑卒中相关危险因素的病例对照研究

目的探讨老年心脏起搏器植入患者发生急性脑卒中的相关危险因素并分析其影响因素。方法随机选取于2014年9月至2017年2月心内科或神经内科收治的年龄大于或等于60岁心脏起搏器植入患者合并急性脑卒中113例,按照年龄±5岁、同性别、NIHSS评分严重程度相同、同期入院的无心脏起搏器植入脑卒中患者进行1︰1配对入组113例。对226例患者的一般资料、疾病特征、合并症、临床治疗方案及临床转归等资料进行前瞻性研究,并对有房颤的患者进行CHA2DS2-VASc评分。对226例患者脑卒中的相关危险因素进行评价,并采用二元logistic回归分析影响老年心脏起搏器植入患者发生急性脑卒中的相关危险因素。结果研究组和对照组相比,高血压病、糖尿病、冠心病、心脏瓣膜病、房颤史、吸烟史、颈动脉斑块、高同型半胱氨酸血症相比较无统计学意义;研究组和对照组相比,年龄、年龄大于或等于75岁、既往心力衰竭、脑卒中发作史、BNP、新发或无症状房颤差异有统计学意义(P0.05)。CHA2DS2-VASc评分:226例患者中有105例房颤患者(46.5%),新发或无症状房颤研究组高于对照组(P0.05),两组房颤患者CHA2DS2-VASc评分无统计学差异。对两组差异有统计学意义的因素进行二元logistic回归分析,年龄大于或等于75岁(P=0.0270,OR=3.427)、心力衰竭史(P=0.0314,OR=2.250)、BNP(P=0.0120、OR=12.262)、新发或无症状房颤(P=0.0071,OR=18.305)与急性脑卒中相关。结论老年心脏起搏器植入患者发生急性脑卒中与患者心力衰竭和新发或无症状房颤有关,老年心脏起搏器植入患者预防急性脑卒中需密切关注患者心功能和新发或无症状房颤。     

地高辛加美托洛尔控制充血性心力衰竭伴快室率房颤

充血性心力衰竭(CHF)伴快室率房颤的器质性心脏病患者,洋地黄为首选,但单用洋地黄对部分患者心室率控制并不满意,因此我们使用自身对照法观察美托洛尔加地高辛治疗CHF并快室率的疗效,现报告如下。     

慢性心力衰竭患者再入院风险因素的Meta分析

目的:通过Meta分析明确慢性心力衰竭患者再入院的相关风险因素。方法:计算机检索PubMed、Cochrane Library、Web of Science、Embase、SinoMed、CNKI、万方数据库和维普数据库,检索时限为建库至2019年12月31日。采用RevMan 5.3软件进行Meta分析。结果:共纳入19篇文献,纳入患者185545例,包括34项相关风险因素。有统计学意义的风险因素包括抑郁情绪(OR=3.87,95%CI:2.87~5.23,P<0.01)、独居(OR=1.12,95%CI:1.01~1.24,P=0.03)、合并高血脂或糖尿病(OR=1.16,95%CI:1.14~1.19,P<0.01)、高盐饮食(OR=3.36,95%CI:2.60~4.35,P<0.01)、肾功能下降(OR=2.00,95%CI:1.95~2.04,P<0.01)、射血分数下降性心力衰竭(OR=2.71,95%CI:1.93~3.73,P<0.01)、贫血(OR=1.43,95%CI:1.27~1.60,P<0.01)、感染(OR=1.12,95%CI:1.00~1.25,P=0.04)。结论:抑郁情绪、独居、合并高血脂或糖尿病、高盐饮食、肾功能下降、射血分数下降性心力衰竭、贫血、感染是慢性心力衰竭患者再入院的相关风险因素。     

不同性别良性阵发性位置性眩晕患者临床特征分析

目的:比较不同性别良性阵发性位置性眩晕(BPPV)患者的临床特征及复发危险因素。方法:回顾性分析424例BPPV患者的临床资料,按性别进行分组比较不同性别患者临床特征,再按是否复发分为亚组,比较不同性别患者复发的危险因素。结果:与女性组比较,男性组BPPV患者发病年龄较大,吸烟和饮酒比例较高,合并骨质疏松比例较低(均P0.05)。男性BPPV患者手法复位后1年内复发率为20.2%,显著低于女性组31.5%(P=0.033)。年龄、家族史、糖尿病、后循环缺血和骨质疏松与男性BPPV患者复发相关(均P0.05);年龄是男性BPPV患者手法复位后1年内复发的危险因素(OR=1.331,95%CI 1.015～4.072,P=0.002)。女性BPPV患者复发亚组的年龄更大,合并高血压、糖尿病、后循环缺血和骨质疏松比例更高(均P0.05);年龄、糖尿病和骨质疏松均是女性BPPV患者手法复位后1年内复发的危险因素(OR=2.040,95%CI 1.314～5.680,P=0.000;OR=1.375,95%CI 1.072～4.044,P=0.007;OR=1.216,95%CI 1.081～5.087,P=0.011)。结论:不同性别BPPV患者临床特征和复发的危险因素均存在差异。     

慢性心力衰竭患者生存质量影响因素相关性分析

目的:探讨慢性心力衰竭患者生存质量的影响因素,为患者的个体化护理提供依据.方法:采用中文版明尼苏达心力衰竭生存质量量表(MLHEQ)评价161例慢性心力衰竭患者的生存质量,并分析其影响因素.结果:房颤者躯体、精神以及总分明显高于窦律者(P＜0.01);通过Logistic回归分析,发现影响慢性心力衰竭患者生存质量的独立相关因素为房颤(OR=1.311,P＜0.01)、年龄(OR=1.016,P＜0.05)、心功能(OR=1.238,P＜0.01).结论:通过分析慢性心力衰竭患者生存质量的影响因素,针对不同的影响因素采用有效的护理干预,从而提高患者生存质量.     

老年高血压合并糖尿病患者医院感染的Nomogram预测模型建立

目的分析老年高血压合并糖尿病患者发生医院感染(HAI)的危险因素,并建立预测HAI的Nomogram模型。方法回顾性分析148例老年高血压合并糖尿病患者的临床资料,根据是否发生HAI将患者分为HAI组和非HAI组。通过单因素、多因素Logistic回归分析筛选出HAI发生的独立危险因素,同时应用Nomogram法对各个因素进行评分,构建预测模型。应用受试者工作特征(ROC)曲线评估模型的预测价值,并对模型进行内部验证,计算一致性指数(C-index),绘制校准图。结果 148例患者平均年龄为(64.21±12.84)岁,其中32例(21.62%)患者发生HAI。单因素分析显示,年龄、吸烟、共患病程、血压控制情况、血糖控制情况、合并其他基础疾病、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、意识障碍、白蛋白水平均是HAI发生的影响因素(P 0.10)。多因素Logistic回归分析显示,共患病程≥10年(OR=3.589,95%CI为1.056～12.193,P=0.041),血糖控制不达标(OR=4.538,95%CI为1.287～16.002,P=0.019),合并其他基础疾病(OR=8.893,95%CI为2.624～30.132,P 0.001),APACHEⅡ评分≥20分(OR=6.259,95%CI为1.934～20.256,P=0.002),存在意识障碍(OR=9.365,95%CI为2.744～34.477,P=0.001)均是HAI发生的独立危险因素。基于上述预测因子建立Nomogram预测模型,经验证,该模型贴合度、C-index、ROC曲线下面积均良好,提示该模型具有良好的预测效能和区分度。结论共患病程≥10年、血糖控制不达标、合并其他基础疾病、APACHEⅡ评分≥20分、存在意识障碍均是老年高血压合并糖尿病患者发生HAI的独立危险因素,基于上述危险因素建立的Nomogram模型具有良好的预测效能,可为HAI防控工作提供参考依据。     

不同心室率控制水平对慢性心房颤动患者生活质量的影响

目的 探讨不同心室率控制水平对慢性心房颤动(房颤)患者生活质量的影响.方法 选择慢性房颤118例并以健康调查(SF-36)量表测评生活质量,以静息心室率控制目标随机分为低心率组(心率＜80/min) 62例及高心率组(心率80 ～110/min)56例,分别于心室率达标后及随访6个月后再次测评生活质量并比较两者差异,以患者的SF-36总分为因变量对可能影响生活质量的因素进行单因素及多因素回归分析.结果 心室率达标后低心率组生理功能、生理职能、总体健康、活力、社会功能和精神健康评分,高心率组生理功能、生理职能、活力、社会功能评分,均较心室率控制前明显提高,差异有统计学意义(P＜0.05),余项与控制前比较差异无统计学意义(P＞0.05).随访6个月低心率组生理功能、生理职能、活力、精神健康及高心率组的生理功能、生理职能仍较心室率控制前高,差异有统计学意义(P＜0.05),但与心室率达标后比较差异无统计学意义(P＞0.05)；组间控制前、控制后、随访6个月各项目评分比较差异均无统计学意义(P＞0.05).回归分析显示心室率对患者生活质量影响不明显,在P =0.05水平筛选出影响因素为年龄、主要症状、心脏超声参数、心功能分级、随访期间入院次数、并发出血、合并糖尿病等.结论 控制心室率可改善慢性房颤患者的生活质量,但不同的心室率控制水平对患者生活质量的影响差异不明显,原发病严重程度、症状、年龄、并发症及某些伴随疾病是影响患者生活质量的重要因素.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.