Post-herpetic neuralgia: further post-mortem studies of cases with and without pain.

The pathological features associated with post-herpetic neuralgia require further study. We report here 5 cases, 3 with severe post-herpetic neuralgia (PHN) and 2 with no persistent pain. The findings of dorsal horn atrophy and cell, axon and myelin loss with fibrosis in the sensory ganglion were found only in patients with persistent pain. Marked loss of myelin and axons in the nerve and/or sensory root were found in cases with and without pain. Some evidence is presented for a more generalized subacute or chronic inflammatory process which may explain the clinical features of some patients. Further studies will be necessary to fully describe the morbid anatomy of this disorder.     

Technology-based nursing education: overview and call for further dialogue.

With the rapid growth of technology has come increasing reliance among health science disciplines to integrate technology into many courses. It is apparent that this reliance on technology in nursing education is increasing rapidly regardless of any guiding philosophy of education or pedagogy. The two-fold purpose of this article is to review the development of technology-based nursing education and to identify areas requiring further dialogue among nurse educators. It is becoming clear that nurse educators need to analyze values, communication, and social processes when deciding, judging, and assessing technological use within curricula. Nurse educators need to reflect on the tidal wave of change brought by technology and begin an earnest dialogue regarding its impact on the discipline.     

Acupuncture for the relief of cancer-related pain--a systematic review.

AIMS: This systematic review summarises the existing evidence on acupuncture for cancer-related pain. METHODS: Literature searches were conducted in seven databases. All clinical studies of acupuncture, electroacupuncture and ear acupuncture in cancer patients with the main outcome measure of pain were included. Data were extracted according to pre-defined criteria by two independent reviewers and methodological quality was assessed using the Jadad scale. RESULTS: Of the seven studies included, one high quality randomised clinical trial of ear acupuncture showed statistically significant pain relief in comparison with placebo ear acupuncture. All the other studies were either non-blinded (n=2) or uncontrolled clinical trials (n=4). Most investigations suffered from methodological flaws such as inadequate study design, poor reporting of results, small sample size and overestimation of the results. CONCLUSIONS: The notion that acupuncture may be an effective analgesic adjunctive method for cancer patients is not supported by the data currently available from the majority of rigorous clinical trials. Because of its widespread acceptance, appropriately powered RCTs are needed.     

内眼术后冷敷的实验和临床研究

为探讨内眼术后冷敷方法并观察其临床效果,对６只家兔眼实验研究,并应用于临床。内眼术后２０ｍｉｎ开始冷敷,持续１２０ｍｉｎ,对比观察３０例６０眼。结果表明：冷敷时兔眼结膜囊温度最大下降４．５℃,前房内温度最大下降３．２℃。如维持结膜囊和前房内温度下降值不低于最大值的５０％,则乙醇冰袋每２０ｍｉｎ需更换１次,甘油冰袋每４０ｍｉｎ更换１次。临床观察冷敷组（３０眼）患者的自觉症状、术后刺激征和房水混浊程度均较未冷敷组（３０眼）明显减轻。自制价廉易取的乙醇或甘油冰袋进行内眼术后冷敷,可增加患者舒适感,减轻术眼的炎症反应     

A systematic review of clinical supervision evaluation studies in nursing

According to the international, extant literature published during the last 20 years or so, clinical supervision (CS) in nursing is now a reasonably common phenomenon. Nevertheless, what appears to be noticeably ‘thin on the ground’ in this body of literature are empirical evaluations of CS, especially those pertaining to client outcomes. Accordingly, the authors undertook a systematic review of empirical evaluations of CS in nursing to determine the state of the science. Adopting the approach documented by Stroup et al. (JAMA, 283, 2000, 2008), the authors searched for reports of evaluation studies of CS in nursing – published during the years 1995 to 2015. Keywords for the search were ‘clinical supervision’, ‘evaluation’, ‘efficacy’, ‘nursing’, and combinations of these keywords. Electronic databases used were CINAHL, MEDLINE, PsychLIT, and the British Nursing Index. The research evidence from twenty‐eight (28) studies reviewed is presented, outlining the main findings with an overview of each study presented. The following broad themes were identified and are each discussed in the study: narrative/anecdotal accounts of positive outcomes for clinical supervision, narrative/anecdotal accounts of negative outcomes for clinical supervision, empirical positive outcomes reported by supervisee, and empirical findings showing no effect by supervisee.     

The conclusions of the systematic revision with the results from the major clinical and experimental studies

In this issue, we would complete the conclusions of the systematic revision with the results from the major clinical and experimental studies. First of all, we outline that the use of bone mineral density is controversial and opposed of the major studies in the field that show that the bone density is only one of the factors which describe bone resistance, and not the bone quality. In fact, often, a dramatic variation of bone strength is linked to the fact that the newly bone is located in the only in the surfaces where mechanical stress is greatest and this doesn't change completely the density. To study the optimal exercises program we have to remember that the ideal timing in the remodelling unit of the bone was estimated at 4-6 months: therefore any treatment which has the aim of preventing bone loss should last at least 2-3 times this period to ensure that the registered effect on bone density is evaluated in a period of balance. According to Frost, the strength of the bone is determined by 4 factors: the mechanical property characteristic of bony tissue, the amount of micro damage from fatigue, bone mass factors (amount and type of bone in the bone) and the size and shaper of the bone (architectural factors). Moreover, it is very important the role of muscular strength on the bone: the muscles work like a lever in such a manner that to move every kilo of body weight, the muscular force is usually over 2 kg. This explains why strong muscles are usually associated with strong bones. About the specific role of the strain on the bone, from studies of the past 10 years there seems to be more precise and useful information for our queries: new formation of bone took place in rabbits only with dynamic stimuli and not static, and it is very important also the frequency of the stimulus and the speed. Moreover, some authors have shown that the stimuli of ostegoenesis depends on the fluid shear stresses though the lacunar-canalicular network system. So: exercises at high impact which can produce significant deformation of the bone matrix, better carry the fluid through the canalicular network and furthermore the strains applied at high frequency stimulate in a effective manner osteogenesis. Therefore, the mechanical strain necessary to begin osteogenesis decreases with the increase of the frequency of the strain. Rubin and Lanyon have shown that the prolongation of the stimulation with strain the osteogenic response did non increase if the regimen is prolonged more. In fact, Turner demonstrated that the bone presents a phenomenon of desensitisation following a prolonged strain stimulus. He proposed the osteogenic index of exercises like the osteogenic response to exercise which could be increased in a regimen of exercises which foresee also a period of rest between brief sessions of significant strain. So, concerning the effects of exercises, the stimulus produced by the strain must be such that it exceeds a threshold of a minimum effective stimulus, must be applied in a intermittent and dynamic manner, should produce a stimulus which is distributed differently to the norm, should be applied with high speed and few repetitions.     

芬太尼缓释透皮贴剂治疗疱疹及疱疹后神经痛的可行性

目的观察芬太尼缓释透皮贴剂(多瑞吉)对带状疱疹及疱疹后神经痛的疗效. 方法 31例患者在抗病毒治疗的同时均使用芬太尼缓释透皮贴剂进行疼痛治疗,通过视觉模拟评分观察其对患者疼痛的缓解、对患者情绪、睡眠及日常活动进行考核以判断其生活质量的改善,同时观察在治疗中可能出现的胃肠道和呼吸抑制等并发症. 结果 31例患者经芬太尼缓释透皮贴剂治疗后, 2例因副反应而终止治疗,其余患者疼痛明显缓解, VAS评分从( 8.51± 1.12)分降至( 2.47± 1.23)分,总有效率达 100%,生活质量明显提高,与曲马朵缓释片治疗的患者相比疗效显著提高,虽有并发症,患者可耐受,且部分并发症随时间延长而减少. 结论芬太尼缓释透皮贴剂能有效地控制带状疱疹及疱疹后神经痛,改善患者的生活质量.     

Quantitative sensory testing before and after regional guanethidine block in patients with neuralgia in the hand.

Using reference values from healthy volunteers, thermal and vibration-induced pain thresholds and the sensibility for warm and cold were studied in 18 patients with neuralgia in one hand following a traumatic injury or surgery. All patients had spontaneous pain and allodynia to vibration. They were treated with intravenous regional guanethidine block (RGB). Quantitative sensory testing was performed on both hands before and 1-3 days after treatment. Eleven patients benefitted considerably from the block, with pain relief for 2 weeks or more. Ten of these 11 patients had mild nerve injuries caused by compressive trauma to the nerve. Before RGB they showed a moderate loss in temperature discrimination capacity; their heat pain thresholds were reduced and they exhibited allodynia to cold and vibration on the injured side. After RGB, the pain thresholds were normalised both to thermal and vibratory stimuli. These patients were classified as having sympathetically maintained pain (SMP). Seven patients reported no or only minor pain-relieving effect of RGB lasting 1-5 days. Severe nerve injuries were most frequent in this group of patients. On the injured side, before RGB, their ability to discriminate between warm and cold was markedly impaired, thermal pain thresholds were normal, and they showed allodynia to vibration. After RGB, there was no change in thermal pain thresholds and the allodynia to vibration persisted. These patients were classified as having sympathetically independent pain (SIP). The results indicate that quantitative thermal sensory tests, together with clinical evaluation of the nerve trauma, can help to predict which patients will have long-lasting pain alleviation after RGB treatment.     

Transcutaneous electrical nerve stimulation for relief of parturition pain. A clinical report

The purpose of this clinical report is to share procedures and results using transcutaneous electrical nerve stimulation (TENS) in the management of pain associated with labor and delivery. Although favorable reports of the use of TENS during labor have been published in Europe, its application in the United States to the labor and delivery process has received little attention and is relatively unknown. We decided to use US equipment in the obstetric department of a US community hospital to verify the European studies. Fifteen patients selected by two obstetricians evaluated the effectiveness of a 3M TENS unit Model 6240. The criteria for inclusion were willingness to try TENS and ability to understand the procedure. The patients served as their own control and turned the unit off for several contractions during the middle and late periods of the first stage of labor to judge the effectiveness of TENS. Twenty-four hours after delivery, a physical therapist recorded the subjective response of patients and obstetricians separately on a questionnaire, which gave a rating scale of poor, moderate, or excellent for relief. We found TENS provided some form of relief to 87 percent of the participants, and 20 percent reported excellent relief. Most participants expressed a willingness to use TENS if they gave birth again.     

Early mobilisation for patients following acute myocardiac infarction: A systematic review and meta-analysis of experimental studies

Objective

To determine the impact of early mobilisation (EM) on total mortality and non-fatal re-infarction after acute myocardial infarction (AMI).

Design

Systematic review and meta-analysis.

Data sources

MEDLINE, CINAHL, HealthStar, EMBASE, the Cochrane Library Controlled Trials Registry and experts.

Methods

Target studies included published and unpublished experimental, controlled studies in any language comparing AMI patients allocated to any in-hospital early mobilisation or a control/standard treatment. Two reviewers independently assessed study eligibility and quality and performed data extraction. We calculated relative risks (RRs) and 95% confidence intervals (CIs) using the random-effects model.

Outcomes

All-cause mortality or re-infarction up to 1-year post-AMI.

Results

Out of 385 potentially relevant studies, 14 met our eligibility criteria (13 published before 1983). There were 149 deaths (9.3% of 1607) and 82 non-fatal re-infarctions (5.2% of 1580) among post-AMI patients receiving EM, compared with 179 deaths (11.6% of 1541) and 80 non-fatal re-infarctions (5.3% of 1518) among AMI patients receiving control treatment (RR = 0.85, 95% CI 0.68, 1.05 and RR = 1.02, 95% CI 0.75, 1.39 respectively).

Conclusion

Our meta-analysis demonstrated a trend towards decreased mortality with EM after AMI. However, there is uncertainty about early mobilisation and more research should be developed having into account all kind of differences among patients receiving treatment after AMI worldwide.     

A systematic approach to trauma relief. The management of the A&E wound

Nurses working in A&E departments are faced with a variety of wounds and an ever increasing choice of dressings. It is vital, therefore, that they maintain an up-to-date awareness of the developments in wound care.     

A PET study of regional cerebral blood flow after experimental cardiopulmonary resuscitation

Cerebral blood flow (CBF) during cardiopulmonary resuscitation and after restoration of spontaneous circulation (ROSC) from cardiac arrest has previously been measured with the microspheres and laser Doppler techniques. We used positron emission tomography (PET) with [15O]--water to map the haemodynamic changes after ROSC in nine young pigs. After the baseline PET recording, ventricular fibrillation of 5 min duration was induced, followed by closed-chest cardiopulmonary resuscitation (CPR) in conjunction with IV administration of three bolus doses of adrenaline (epinephrine). After CPR, external defibrillatory shocks were applied to achieve ROSC. CBF was measured at intervals during 4h after ROSC. Relative to the mean global CBF at baseline (32+/-5 ml hg(-1)min(-1)), there was a substantial global increase in CBF at 10 min, especially in the diencephalon. This was followed by an interval of cortical hypoperfusion and a subsequent gradual return to baseline values.     

Waveforms for defibrillation and cardioversion: recent experimental and clinical studies

PURPOSE OF REVIEW: The advent of biphasic waveforms for external defibrillation has generated extensive experimental and clinical investigation. At the same time, it has led to the development and clinical use of biphasic waveforms of several different designs. Finally, other types of waveforms, primarily triphasic, have entered experimental evaluation. RECENT FINDINGS: There is virtually universal agreement that biphasic waveforms, regardless of design, have greater efficacy in defibrillation of ventricular fibrillation and in cardioversion of atrial fibrillation when compared with monophasic waveforms. It remains unresolved, however, whether any specific biphasic waveform has greater clinical superiority than others. Likewise, it remains to be demonstrated whether any biphasic waveform is less injurious to myocardial function than another and whether injury, if it is incurred, is secondary to peak delivered current or to delivered energy. Biphasic truncated exponential waveforms are used by most manufacturers, whereas a rectilinear biphasic waveform and a pulsed waveform also are being used clinically. SUMMARY: Biphasic waveforms have supplanted monophasic waveforms for defibrillation and cardioversion. They include biphasic truncated exponential, rectilinear, and pulsed biphasic versions. At this time, there is no certain evidence of clinical superiority of one waveform over another in terms of either efficacy or myocardial injury.     

Pulsed radiofrequency treatment for idiopathic trigeminal neuralgia: A retrospective analysis of the causes for ineffective pain relief

We retrospectively analyzed the reasons for ineffective pain relief in patients with idiopathic trigeminal neuralgia (TN) who had undergone pulsed radiofrequency (PRF) treatment guided by computed tomography scan. We found that intraoperative PRF output voltage and electrical field intensity was significantly higher (p < 0.05) in the group who had received effective treatment than in the ineffective group. These findings suggest that optimizing PRF parameters and increasing the intraoperative output voltage (electric field intensity) may therefore, provide better pain relief in patients with TN.     

Molecular and clinical markers of pain relief in complex regional pain syndrome: An observational study

Background

Complex regional pain syndrome (CRPS) is marked by disproportionate pain after trauma. Whilst the long-term outcome is crucial to patients, predictors or biomarkers of the course of pain or CRPS symptoms are still lacking. In particular, microRNAs, such as miR-223, decreased in CRPS, have been described only in cross-sectional studies.

Methods

In this study, we characterised CRPS patients over a course of 2.5 years of standard treatment. The patient underwent clinical examination including pain measurement, symptom questionnaires, quantitative sensory testing (QST) and blood sampling. Exosomal microRNA levels were measured via qPCR. After follow-up, patients were stratified into ‘pain relief’ (mean pain reduced by ≥2 numeric rating scale) or ‘persistence’ (mean pain unchanged or worsened). The primary outcome was miR-223 and miR-939 expression, secondary outcomes were differences in clinical parameters between groups and time points.

Results

Thirty-nine patients were included, 33 of whom qualified for stratification. Overall, patients reported lower pain and improved clinical characteristics after 2.5 years, but no significant changes in QST or miR-223 and miR-939 expression levels. 16 patients met the criteria for pain relief. This was associated with stable exosomal miR-223 expression, whilst levels further decreased in pain persistence. Clinically, pain relief was marked by shorter disease duration and correlated positively with high initial pain.

Conclusion

We identified progressively reduced miR-223 as a putative biomarker of chronic CRPS pain. Clinically, this study underlines the importance of early diagnosis and treatment showing that high initial pain does not predict an unfavourable outcome. Finally, pain relief and recovery of sensory disturbances seem independent processes.