Common Causes of Pain in Systemic Sclerosis: Frequency,Severity, and Relationship to Disease Status,Depression, and Quality of Life

BackgroundIn routine clinical practice, healthcare professionals draw little attention to pain in patients with systemic sclerosis (SSc). Pain has adverse effects on functional ability, social and emotional wellbeing.AimsThis study aims to assess the frequency and severity of different types of pain in patients with SSc, and the relationship of pain with disease status, depression and quality of life.DesignConsecutive patients with SSc were included in this cross-sectional study. Patients with previously diagnosed painful diseases or conditions (other rheumatic diseases, angina pectoris, neurological disorders, etc.) were excluded.SettingsPatients, who visited our rheumatology outpatient clinic from February to November 2016, participated in this study.Participants/Subjects42 consecutive patients with SSc (38 women and 4 men), mean age 56.5 years, mean disease duration 9.5 years, were included.MethodsAll patients filled in a questionnaire, to indicate the presence or absence of some predefined pain syndromes. Disease status was assessed using the Scleroderma Assessment Questionnaire (SAQ), symptoms of depression by the Beck’s Depression Inventory (BDI), whilst the quality of life was evaluated using the EuroQol questionnaire.ResultsIt was found that 92.9% of SSc patients suffer from different types of pain, and 45.2% of patients have pain every day. Joint pain was the most common type of pain, present in 78.6% of patients, followed by pain associated with Raynaud’s phenomenon (69%), back pain (47.6%), headache (31%), chest pain (23.8%), odynophagia (21.4%) and painful digital ulcers (19%). Symptoms of neuropathic pain were noticed in 26.2% of patients. Severe joint pain, everyday pain and symptoms of neuropathic pain in SSc were associated with more severe disease and poorer quality of life. Pain related to Raynaud’s phenomenon, digital ulcers, odynophagia and joint pain were associated with significant symptoms of depression.ConclusionThe majority of patients with SSc suffer from different types of pain. Pain is associated with more severe disease, depression and poor quality of life.     

Abuse during Pregnancy: Frequency, Severity, Perpetrator, and Risk Factors of Homicide

Abstract To determine the frequency, severity, and perpetrator of abuse during pregnancy as well as the occurrence of risk factors of homicide, a stratified, prospective cohort analysis was completed on 1,203 African-American, Hispanic, and Anglo women in urban public health prenatal clinics. All women were assessed for abuse at the first prenatal visit and twice again during the pregnancy. All women were administered the Conflicts Tactics Scale, the Index of Spouse Abuse and the Danger Assessment Scale. Prevalence of physical abuse during pregnancy was 16%, one in every six women. Women abused during pregnancy had significantly higher scores on all instruments and more risk factors of homicide when compared with women abused prior to but not during pregnancy. To protect women's safety, a protocol of assessment and intervention for abuse must be standard care for all pregnant women.     

药物临床试验中受试者脱落的原因分析及处理

目的分析药物临床试验中影响受试者脱落的主要因素,探讨降低受试者脱落率的管理方法。方法回顾性分析我院2002年10月至2006年12月期间的1181例药物临床试验病例资料,其中门诊病历789例,住院病历392例,对药物临床试验中受试者脱落原因进行分析。结果影响受试者脱落的主要因素有治疗环境、用药途径、不良反应、个人原因等。门诊受试者的脱落例数明显多于住院受试者,差异有统计学意义（P〈0．01）;无不良反应的受试者脱落例数明显多于有不良反应的受试者,差异有统计学意义（P〈0．01）;注射用药的受试者脱落例数多于口服用药受试者,差异有统计学意义（P〈0．01）;注射用药受试者脱落例数亦多于吸入用药受试者,差异有统计学意义（P〈0．01）;有个人原因的受试者脱落例数明显多于无个人原因的受试者,差异有统计学意义（P〈0．01）。1181例病例中由于受试者个人原因导致脱落的人数为62人,在各脱落原因中,以用药不便和受试者自认为缺乏疗效为主要的脱落原因。结论采用适当灵活多样的方式对受试者及家属进行系统教育,并及早发现、立即有效处理不良反应,对提高药物临床试验质量有重要意义。     

Procedural Pain Management: Clinical Practice Recommendations

Undergoing potentially painful procedures is necessary among patients of all ages. Nurses are responsible to optimize safety and minimize harm for patients. The American Society for Pain Management Nursing (ASPMN) holds the position that all patients undergoing painful procedures have the right to safe and effective pain management throughout the phases of care, and that the interprofessional healthcare team ensures such ethical obligation is fulfilled within a framework of the patients or their designees’ goals and preferences. From that position, all nurses, clinicians, and health care organizations are strongly encouraged to offer multimodal pain management that includes integrative interventions when managing procedure related pain.     

Surveillance Practice for Sonographic Detection of Intracranial Abnormalities in Premature Neonates: A Snapshot of Current Neonatal Cranial Ultrasound Practice in Australia

There are no publications reporting on scan duration and Doppler use during neonatal cranial ultrasound scans. We investigated current practice of neonatal cranial ultrasound at four large tertiary neonatal intensive care units in Australia. Cranial scans were prospectively recorded between March 2015 and November 2016. Variables, including total number of scans, scan duration and frequency and duration of colour and spectral Doppler mode, were extracted. A total of 196 scans formed the final cohort. The median (range) number of scans for each neonate was 1 (1–12). The median (range) overall total scan duration was 309 (119–801) s. Colour mode with or without spectral Doppler mode was used in approximately half of the cohort (106/196, 54%). Our findings comport with our hypotheses. Operators performing neonatal cranial scans in Australia have low overall scan durations. Although the use of Doppler mode during neonatal cranial scans is not standard practice in all neonatal intensive care units, it is used widely irrespective of the degree of prematurity or the presence of brain pathology. Further efforts are required to incorporate recommendations on scan duration and the routine use of Doppler mode during neonatal cranial scans. This is especially imperative given that the most vulnerable neonates with the greater neural tissue sensitivity are likely to be scanned more often.     

Management of Chronic Daily Headache: Challenges in Clinical Practice

Chronic daily headache (CHD) refers to a category of headache disorders that are characterized by headaches occurring on more than 15 days per month. This category is subdivided into long- and short-duration (>4 or <4 hours) CDH disorders based on the duration of individual headache attacks. Examples of long-duration CDH include transformed migraine (TM), chronic migraine (CM), new daily persistent headache (NDPH), acute medication overuse headache, and hemicrania continua (HC). The goal of this review is to enable clinicians to accurately diagnose and effectively manage patients with long-duration CDH. Patients with CDH often require an aggressive and comprehensive treatment approach that includes a combination of acute and preventive medications, as well as nondrug therapies.     

Yttrium-90 Radioembolization: Current Clinical Practice and Review of the Recent Literature

Curative options for the treatment of primary or secondary hepatic malignancies are transplant and surgical resection. Transplant and surgical resection offers the best clinical outcome; however, it is only available to a limited number of patients who present with early-stage disease. For patients beyond curative resection or outside transplant criteria, locoregional therapies remain an excellent treatment option. Yttrium-90 (⁹⁰Y) radioembolization is a transarterial catheter–based technique that is increasingly being used in the management of primary and secondary liver malignancies. The focus of this article is to discuss the use of ⁹⁰Y radioembolization for the treatment of unresectable hepatic malignancies along with a review of the relevant literature.     

Procedural Pain Management: Clinical Practice Recommendations American Society for Pain Management Nursing

Throughout the life span procedures are common within health care and have the potential to cause pain. Nurses have an ethical responsibility involving the care of people with pain. The American Society for Pain Management Nursing holds the position that all patients undergoing painful procedures have the right to safe and effective pain management throughout the phases of care and that the interprofessional health care team ensures such ethical obligation is fulfilled within a framework of patients or their designees’ goals and preferences. It is recommended that nurses, other health care providers, and health care organizations offer the use of integrative intervention for managing pain during procedures.     

低血钾与急性心肌梗死冠脉病变程度及预后的关系

[目的]探讨低血钾与急性心肌梗死冠脉病变程度及预后的关系.[方法]根据心肌梗死初期血钾将100例急性心肌梗死患者分为两组:A组血钾＜3.5 mmol/L;B组血钾≥3.5 mmol/L.将两组冠脉造影结果及预后进行比较分析.[结果]A组梗死相关血管近端病变41例(占82%)、梗死相关血管为前降支为27例(占54%)、心力衰竭10例(占20%)、严重心律失常23例(占46%)、梗死后心绞痛14例(占28%),与B组分项比较差异显著.[结论]急性心肌梗死合并低血钾的梗死相关血管多为前降支,梗死相关血管多为近端病变,预后不好.     

Best Clinical Practice: Controversies in Outpatient Management of Acute Pulmonary Embolism

Background

Pulmonary embolism (PE) is a common condition managed in the emergency department (ED), with a wide range of morbidity and mortality. Patients are classically admitted for treatment and monitoring of anticoagulation.