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1.
Raafat M. Reyad Azza F. Omran Dina N. Abbas Mahmoud A. Kamel Ehab H. Shaker Jhon Tharwat Ehab M. Reyad Tarek Hashem 《Journal of pain and symptom management》2019,57(1):1-9
Context
Chronic postmastectomy pain syndrome (PMPS) has a considerable negative impact on the quality of life of breast cancer patients.Objective
The objective of this study was to assess the possible preventive role of perioperative pregabalin in PMPS.Methods
This randomized controlled study included 200 patients with breast cancer scheduled for elective breast cancer surgery. They were randomly assigned to one of two treatment groups. The pregabalin group received 75 mg of pregabalin twice daily for seven days and the control group received oral equivalent placebo capsules. The primary outcome was development of neuropathic PMPS. Neuropathic pain was assessed using the Grading System for Neuropathic Pain. Secondary outcome measures were safety and Visual Analogue Scale scores.Results
Neuropathic pain was significantly less frequent in the pregabalin group compared to the control group at four weeks (P = 0.005), 12 weeks (P = 0.002), and 24 weeks (P < 0.001) postoperatively. PMPS was diagnosed in 11 patients (11%) of the pregabalin group and 29 patients (29%) of the control group (P < 0.001, relative risk: 0.26, 95% CI: 0.12–0.56). At the three follow-up time points, Visual Analogue Scale scores during the first three postoperative weeks were comparable in both groups while they were significantly lower in the pregabalin group at 4, 12, and 24 weeks. These two groups were comparable in the frequency of adverse events (P = 0.552).Conclusion
Perioperative oral pregabalin 75 mg twice daily, starting at the morning of surgery and continued for one week, could reduce the frequency of postmastectomy pain syndrome. 相似文献2.
Adriana Segura Olson Lauren Rosenblatt Nicholas Salerno Julie Odette Ronnie Ren Tatiana Emanuel Joel Michalek Qianqian Liu Liem Du Kourosh Jahangir Gillian R. Schmitz 《The Journal of emergency medicine》2019,56(4):405-412
Background
Povidone-iodine (PVP-I) antiseptic solutions have been shown to be effective against methicillin-resistant Staphylococcal aureus, a common cause of superficial skin abscesses.Objectives
Our objective was to study the feasibility of using PVP-I as a treatment adjunct in patients with superficial skin abscesses and determine if it confers any benefit over incision and drainage (I&D) alone.Methods
This was a randomized controlled pilot study of adult patients with an uncomplicated skin abscess. Patients were randomized to PVP-I or standard treatment. All patients had I&D and abscess packing. Patients randomized to PVP-I were instructed on daily application of the agent to hands, wound, and surrounding skin with dressing changes. Subjects returned at 48–72 h and 7–10 days and followed-up by phone at 30 days. The primary outcome was clinical cure 7–10 days after I&D. The secondary outcomes were rate of development of new skin lesions and spread in household contacts within 30 days.Results
Clinical cure occurred in 91.3% of patients in the standard group vs. 88.2% of patients in the PVP-I group (difference, 3.1%; 95% confidence interval [CI] ?10.7 to 16.8; p = 0.53). There was a significantly higher adverse event rate in the group who received PVP-I (59.6%) vs. standard care (26.5%) (difference 33.1%, 95% CI 13.2–50.2; p < 0.001).Conclusions
There was no difference in clinical cure rates among patients using PVP-I (88.2%) vs. standard care (91.3%) after I&D. There were no major adverse events, but the addition of PVP-I was commonly associated with local skin irritation. 相似文献3.
Maureen E. Lyon Leah Squires Lawrence J. D&#x;Angelo Debra Benator Rachel K. Scott Isabella H. Greenberg Patricia Tanjutco Melissa M. Turner Tara E. Weixel Yao I. Cheng Jichuan Wang 《Journal of pain and symptom management》2019,57(3):607-616
Context
No prospective studies address disease-specific advance care planning (ACP) for adults living with HIV/AIDS.Objective
To examine the efficacy of FAmily-CEntered (FACE) ACP in increasing ACP and advance directive documentation in the medical record.Methods
Longitudinal, two-arm, randomized controlled trial with intent-to-treat design recruited from five hospital-based outpatient HIV clinics in Washington, DC. Adults living with HIV and their surrogate decision-makers (N = 233 dyads) were randomized to either an intensive facilitated two-session FACE ACP (Next Steps: Respecting Choices goals of care conversation and Five Wishes advance directive) or healthy living control (conversations about developmental/relationship history and nutrition).Results
Patients (n = 223) mean age: 51 years, 56% male, 86% African-American. One hundred ninety-nine dyads participated in the intervention. At baseline, only 13% of patients had an advance directive. Three months after intervention, this increased to 59% for the FACE ACP group versus 17% in the control group (P < 0.0001). Controlling for race, the odds of having an advance directive in the medical record in the FACE ACP group was approximately seven times greater than controls (adjusted odds ratio = 6.58, 95% CI: 3.21–13.51, P < 0.0001). Among African-Americans randomized to FACE, 58% had completed/documented advance directives versus 20% of controls (P < 0.0001).Conclusions
The FACE ACP intervention significantly improved ACP completion and advance directive documentation in the medical record among both African-American and non-African-American adults living with HIV in Washington, DC, providing health equity in ACP, which can inform best practices. 相似文献4.
Jennifer Turney Ann Lowther Jeanine Pyka Deene&#x; Mollon Willa Fields 《Nursing for Women's Health》2019,23(1):31-37
Objective
To develop an evidence-based practice project to evaluate the effect of delaying a newborn’s first bath on exclusive breastfeeding rates at discharge.Design
A pre- and post-implementation evaluation of the effect of delaying the first bath on exclusive breastfeeding rates at discharge.Setting
A postpartum unit in a southern California community hospital.Participants
Breastfeeding dyads of women and newborns (>37 weeks gestational age) who were admitted to the postpartum unit.Intervention/Measurements
Postpartum nurses involved in the unit practice council, in collaboration with unit leadership, changed the newborn’s first bath practice through development of a bathing guideline, nurse education, and mother education. Measurements of the practice change included time of the first bath and exclusive breastfeeding rates at discharge.Results
We observed an increased time for the newborn’s first bath from 6.88 hours to 13.71 hours (p ≤ .001). The number of times women chose not to bathe their newborns while in the hospital also increased by approximately seven times, from 0.16% to 1.1%. The rate of exclusive breastfeeding at discharge did not change significantly after implementation (p ≥ .05), regardless of when the first bath was given.Conclusion
Delaying a newborn’s first bath was not associated with an increase in exclusive breastfeeding rates. More research is needed to determine the effect of bath times. 相似文献5.
Aasha I. Hoogland Hailey W. Bulls Brian D. Gonzalez Brent J. Small Lianqi Liu Joseph Pidala Heather S.L. Jim Asmita Mishra 《Journal of pain and symptom management》2019,57(5):952-960.e1
Context
Quality of life (QoL) is increasingly recognized as an important outcome of cancer treatment. Previous studies have examined clinical predictors of QoL, but with the increasing prevalence of wearable sensors that monitor sleep and activity patterns, further investigation into whether these behaviors are predictive of post-treatment QoL is now feasible. Among patients receiving aggressive cancer treatment such as hematopoietic cell transplantation (HCT), analysis of circadian rhythms (24-hour patterns of sleep and activity) via wearable sensors is limited.Objective
To evaluate the relationship between overall QoL and circadian rhythms in patients receiving allogeneic HCT.Methods
Patients wore an ActiGraph GT3X (Pensacola, FL) activity monitor for at least 72 hours before the initiation of conditioning chemotherapy and transplantation and completed a QoL (Functional Assessment of Cancer Therapy-General [FACT-G]) assessment. QoL assessments were also completed 1, 3, and 6 months after HCT.Results
Patients (n = 45, M age = 55) were mostly male (66%) with a total FACT-G score of 80.96 (SD = 16.05) before HCT. Mixed models revealed robust cross-sectional associations between overall QoL and multiple circadian rhythmicity parameters, including durations of high physical activity, overall circadian rhythmicity, and earlier starts of daily activity (P's < .01). Recovery of QoL after transplant was predicted by longer pre-transplant durations of high physical activity (P = .04) and earlier evening retirement (P = .04).Conclusion
Our findings suggest that wearable sensor information is a promising method of predicting recovery of QoL after HCT. Additional studies are needed to confirm these findings in a larger sample. 相似文献6.
Marcia A. Clevesy Tricia K. Gatlin Callie Cheese Kord Strebel 《Nursing for Women's Health》2019,23(1):21-30
Objective
The purpose of this project was to improve health care providers’ postpartum depression (PPD) knowledge and screening practices with the implementation of a standardized screening tool.Design
The plan–do–study–act model was used as a framework to measure and implement a practice change aimed at universal screening for PPD.Setting/Local Problem
Health care providers’ screening practices for PPD were inconsistent and lacked use of a standardized screening tool at a southwestern U.S. community women’s health care clinic serving minority women of lower socioeconomic status.Participants
Health care providers at a community women’s health care clinic.Intervention/Measurements
A single educational in-service was presented to health care providers regarding preventive PPD screening practices and documentation recommendations. Measurements included pre- and post-education questionnaire results and electronic health record chart reviews.Results
PPD screening documentation rates increased from 56% to 92.7% (p < .5).Conclusion
PPD screening education for health care providers and the addition of EPDS criteria to the electronic health record were associated with increased screening rates for PPD at a community women’s health care clinic. 相似文献7.
Seng-Beng Tan Chong-Kin Liam Yong-Kek Pang Diana Leh-Ching Ng Tat-Seng Wong Kelvin Wei-Shen Khoo Chieh-Yin Ooi Chee-Shee Chai 《Journal of pain and symptom management》2019,57(4):802-808
Context
Dyspnea is a common and distressing symptom in respiratory diseases. Despite advances in the treatment of various lung diseases, the treatment modalities for dyspnea remain limited.Objectives
This study aims to examine the effect of 20-minute mindful breathing on the rapid reduction of dyspnea at rest in patients with lung cancer, chronic obstructive pulmonary disease, and asthma.Methods
We conducted a parallel-group, nonblinded, randomized controlled trial of standard care plus 20-minute mindful breathing vs. standard care alone for patients with moderate to severe dyspnea due to lung disease, named previously, at the respiratory unit of University Malaya Medical Centre in Malaysia, from August 1, 2017, to March 31, 2018.Results
Sixty-three participants were randomly assigned to standard care plus a 20-minute mindful breathing session (n = 32) or standard care alone (n = 31), with no difference in their demographic and clinical characteristics. There was statistically significant reduction in dyspnea in the mindful breathing group compared with the control group at minute 5 (U = 233.5, n1 = 32, n2 = 31, mean rank1 = 23.28, mean rank2 = 37.72, z = ?3.574, P < 0.001) and minute 20 (U = 232.0, n1 = 32, n2 = 31, mean rank1 = 23.00, mean rank2 = 36.77, z = ?3.285, P = 0.001).Conclusion
Our results provide evidence that a single session of 20-minute mindful breathing is effective in reducing dyspnea rapidly for patients with lung cancer, chronic obstructive pulmonary disease, and asthma. 相似文献8.
Victoria L. Zhou Frances S. Shofer Nikita G. Desai Ilona S. Lorincz Nikhil K. Mull David H. Adler John C. Greenwood 《The Journal of emergency medicine》2019,56(2):127-134
Background
The resuscitation and critical care unit is a novel emergency department–intensive care unit designed to provide early critical care to emergency department patients for ≤24 h.Objectives
This study sought to identify clinical variables associated with short intensive care unit (ICU) stays in patients with diabetic ketoacidosis (DKA), who commonly require ICU-level care.Methods
We conducted a retrospective, single-center, cross-sectional study of DKA patients ≥18 years of age who presented to an academic, urban hospital emergency department over 16 months. Patient demographics and clinical variables extracted from medical records were compared between prolonged ICU stay patients of ≥24 h versus short ICU stay patients (SSPs) of <24 h. ICU care was defined as treatment in the resuscitation and critical care unit or inpatient ICU.Results
One hundred sixty-eight emergency department visits with a primary diagnosis of DKA were analyzed. There were 53 prolonged ICU stay patients, 58 SSPs, and 57 patients required no ICU time. SSPs had significantly higher initial serum bicarbonate (13.0 vs. 9.0 mEq/L, p = 0.01) and shorter anion gap closure time (9.8 vs. 14.4 hours, p = 0.003). Medication nonadherence was a significantly more frequent precipitant in SSPs (67.2% vs. 47.2%, p = 0.03). Initial anion gap, glucose, beta-hydroxybutyrate, and severity of illness scores were not significantly different between groups. After multivariate logistic regression adjusting for variables significant from univariate analysis, higher initial bicarbonate (p = 0.04) and medication nonadherence (p = 0.03) remained significantly associated with SSPs.Conclusions
Patients with DKA with short ICU stays have higher initial bicarbonate levels and are more likely to have medication nonadherence than patients requiring prolonged critical care. These variables may identify patients with DKA who are best treated in an emergency department–intensive care unit to potentially reduce inpatient ICU use. 相似文献9.
Brent Harper Larry Steinbeck Adrian Aron 《Journal of bodywork and movement therapies》2019,23(1):115-121
Background
Connective tissue mobility alters motor unit recruitment, but the restoration of fascial mobility allows for optimal motor function. The Fascial Manipulation® (FM®) method is a multiplanar approach that assesses and treats the mobility of deep fascia in specific anatomical locations where motor units converge.Objectives
To assess the effects of FM® vs. standard physical therapy treatment (SPT) in patients with low back pain (LBP).Design
Six-months controlled clinical trial.Method
102 participants with LBP received SPT or FM®. Numeric Pain Rating Scale (NPRS), 15- point Global Rating of Change (GROC), and Oswestry Disability Index (ODI) were used to monitor progress.Results
The FM® group had a significantly lower ODI (p?<?0.009) and NPS scores (p?<?0.0001) and significantly higher GROC scores (p?<?0.003) once their means were adjusted for initial scores. When comparing the SPT to FM®, the final ODI decreased by at least 1 category in 48.9% of the SPT cases, while in 36.2% of the cases was no change. ODI minimal clinical importance difference (MCID) change of 10% decrease in scores occurred in 70.2% of the SPT group compared to 96% of the FM® group (p?=?0.003). ODI MCID change of 50% decrease in scores occurred in 40% of the SPT group compared to 64.6% of the FM® group (p = 0.02) 44.7% of the participants in the SPT group had final GROC values above +5 at discharge, compared to 92% of the participants from the FM® group (p?=?0.0001). The FM® subjects had almost three times the change in NPRS compared to SPT counterparts (-4.3?±?2.2 to -1.5? ± 2.4, p=0.0001).Conclusions
FM® appears to improve NPRS, GROC, and ODI more than SPT. FM® may provide an effective treatment technique for LBP. 相似文献10.
Danielle B. Tometich Brent J. Small Judith E. Carroll Wanting Zhai George Luta Xingtao Zhou Lindsay C. Kobayashi Tim Ahles Andrew J. Saykin Jonathan D. Clapp Heather S.L. Jim Paul B. Jacobsen Arti Hurria Deena Graham Brenna C. McDonald Neelima Denduluri Martine Extermann Claudine Isaacs Jeanne S. Mandelblatt 《Journal of pain and symptom management》2019,57(3):596-606
Context
Symptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied.Objectives
The objectives of this study were to identify prototypical presystemic therapy psychoneurological symptom clusters among older breast cancer survivors and determine whether these symptom clusters predicted cognition and QOL over time.Methods
Women with newly diagnosed nonmetastatic breast cancer (n = 319) and matched noncancer controls (n = 347) aged 60+ years completed questionnaires and neuropsychological tests before systemic therapy and 12 and 24 months later. Latent class analysis identified clusters of survivors based on their pretherapy depression, anxiety, fatigue, sleep disturbance, and pain. Linear mixed-effects models examined changes in objective cognition, perceived cognition, and functional status (Instrumental Activities of Daily Living disability, functional well-being, and breast cancer–specific QOL) by group, controlling for covariates.Results
Nearly one-fifth of older survivors were classified as having high pretherapy symptoms (n = 51; 16%); the remainder had low symptoms (n = 268; 84%); both groups improved over time on all outcomes. However, compared to the low symptom group and controls, survivors with high symptoms had lower baseline objective cognition and lower perceived cognition at baseline and 24 months, lower functional well-being at baseline and 12 months, greater Instrumental Activities of Daily Living disability at baseline, and lower breast cancer–specific QOL at all time points (all P < 0.05).Conclusion
Nearly one-fifth of older breast cancer survivors had high psychoneurological symptoms at diagnosis, which predicted clinically meaningful decrements in perceived cognition and function in the first 24 months after diagnosis. Pretreatment psychoneurological symptom clusters could identify survivors for monitoring or intervention. 相似文献11.
Tatsuro Inoue Shogo Misu Toshiaki Tanaka Hiroki Sakamoto Kentaro Iwata Yuki Chuman Rei Ono 《Archives of physical medicine and rehabilitation》2019,100(1):32-38
Objective
To investigate whether postoperative voluntary energy intake (EI) affects functional recovery with hip fracture during the acute phase.Design
Prospective cohort study.Setting
Three acute care hospitals.Participants
Hip fracture patients (N=200) who were consecutively admitted to 3 acute hospitals because of falling.Interventions
Not applicable.Main Outcome Measures
Patients were stratified into 3 groups based on the ratio of measured EI to estimated total energy expenditure (TEE) as inadequate (EI/TEE<0.7), intermediate (0.7≤EI/TEE<1), and adequate (EI/TEE≥1) groups. The functional status was evaluated using the motor domain of a FIM. We calculated efficiency based on the motor FIM scores (change in postoperative motor FIM scores/length of the rehabilitation period) to assess the beneficial effect of rehabilitation.Results
The median hospital stay was 24 days. The inadequate group comprised 73 (36.5%) patients (median EI/TEE, 0.54; interquartile range, 0.42-0.64); intermediate group comprised 92 (46.0%) patients (median EI/TEE, 0.87; interquartile range, 0.78-0.94), and adequate group comprised 35 (17.5%) patients (median EI/TEE, 1.10; interquartile range, 1.04-1.15). Absolute functional gain (AFG) and efficiency of motor FIM gain (EFG) scores were higher in the adequate group than in the others (P<.01). After adjustment for potential confounders, a significant association between postoperative EI/TEE group and logarithm of EFG scores was observed to persist (inadequate group, standardized β =?0.14; reference: adequate group; P=0.03; R2 for the entire model =0.25).Conclusions
Postoperative EI that is less than 70% of TEE diminishes functional recovery with hip fracture. 相似文献12.
Laura C. Hanson Christine E. Kistler Kyle Lavin Stacey L. Gabriel Natalie C. Ernecoff Feng-Chang Lin Greg A. Sachs Susan L. Mitchell 《Journal of pain and symptom management》2019,57(1):10-19
Context
Persons with late-stage dementia have limited access to palliative care.Objective
The objective of this study was to test dementia-specific specialty palliative care triggered by hospitalization.Methods
This pilot randomized controlled trial enrolled 62 dyads of persons with late-stage dementia and family decision-makers on admission to hospital. Intervention dyads received dementia-specific specialty palliative care consultation plus postacute transitional care. Control dyads received usual care and educational information. The primary outcome was 60-day hospital or emergency department visits. Secondary patient- and family-centered outcomes were patient comfort, family distress, palliative care domains addressed in the treatment plan, and access to hospice or community-based palliative care. Secondary decision-making outcomes were discussion of prognosis, goals of care, completion of Medical Orders for Scope of Treatment (MOST), and treatment decisions.Results
Of 137 eligible dyads, 62 (45%) were enrolled. The intervention proved feasible, with protocol completion ranging from 77% (family two-week call) to 93% (initial consultation). Hospital and emergency department visits did not differ (intervention vs. control, 0.68 vs. 0.53 transfers per 60 days, P = 0.415). Intervention patients had more palliative care domains addressed and were more likely to receive hospice (25% vs. 3%, P < 0.019). Intervention families were more likely to discuss prognosis (90% vs. 3%, P < 0.001) and goals of care (90% vs. 25%, P < 0.001) and to have a MOST at 60-day follow-up (79% vs. 30%, P < 0.001). More intervention families made decisions to avoid rehospitalization (13% vs. 0%, P = 0.033).Conclusion
Specialty palliative care consultation for hospitalized patients with late-stage dementia is feasible and promising to improve decision-making and some treatment outcomes. 相似文献13.
Elise J. Devlin Hayley S. Whitford Linley A. Denson Andrew E. Potter 《Journal of pain and symptom management》2019,57(2):273-281.e4
Context
Previous research has indicated that pretreatment response expectancies of side effects often predict subsequent toxicity severity. However, this has been largely based on female patients undergoing chemotherapy.Objectives
We tested whether this association also occurred in a novel cohort, men with prostate cancer undergoing radiotherapy. We investigated these associations throughout treatment (before and after side effects were medically predicted to occur), controlling known and novel variables.Methods
Homogenous male patients scheduled for radiotherapy (N = 35, mean age 71 years) completed baseline (pretreatment) measures; response expectancies of 18 treatment-related side effects; questions about baseline health and hormonal treatment, emotional state, and coping style. Response expectancies of the side effects were again measured two weeks into treatment. The severity of the same 18 toxicities was assessed two and seven weeks into treatment.Results
Hierarchical multiple linear regressions revealed baseline response expectancies significantly and independently predicted six of 18 toxicities two weeks into radiotherapy, contributing 12%–30% of explained variance (β = 0.39–0.59). Response expectancies assessed two weeks into treatment significantly and uniquely predicted seven of 17 experienced toxicities at seven weeks, explaining 17%–50% of variance (β = 0.49–0.91). Sexual toxicity response expectancies revealed the strongest associations with experience throughout treatment (β = 0.46–0.91), with “inability to reach orgasm” showing the largest effect.Conclusion
In this older male sample, response expectancies of side effects predicted experiences throughout treatment, including the period before toxicities were medically expected. Response expectancies of sexual side effects were robust, independent predictors of subsequent toxicities across treatment, especially issues with orgasm, warranting focus in practice and future research. 相似文献14.
Jessica L. Mckee Ian A. Mckee Melanie D. Bouclin Dennis F. Filips Ian J. Atkinson Chad G. Ball Paul B. McBeth Major Andrew W. Kirkpatrick 《The Journal of emergency medicine》2019,56(4):363-370
Background
Penetrating neck wounds are common in the civilian and military realms. Whether high or low velocity, they carry a substantial morbidity and mortality rate.Objectives
We endeavored to ascertain whether the iTClamp is equivalent to direct manual pressure (DMP) and Foley catheter balloon tamponade (BCT).Methods
Using a perfused cadaver, a 4.5-cm wound was made in Zone 2 of the neck with a 1-cm carotid arteriotomy. Each of the hemorrhage control modalities was randomized and then applied to the wound separately. Time to apply the device and fluid loss with and without neck motion was recorded.Results
There was no significant difference between the fluid loss/no movement (p > 0.450) and fluid loss/movement (p > 0.215) between BCT and iTClamp. There was significantly more fluid lost with DMP than iTClamp with no movement (p > 0.000) and movement (p > 0.000). The iTClamp was also significantly faster to apply than the Foley (p > 0.000).Conclusions
The iTClamp and BCT were associated with significantly less fluid loss than DMP in a perfused cadaver model. The iTClamp required significantly less time to apply than the BCT. Both the iTClamp and the BCT were more effective than simple DMP. The iTClamp offers an additional option for managing hard-to-control bleeding in the neck. 相似文献15.
Intranasal Sufentanil Versus Intravenous Morphine for Acute Pain in the Emergency Department: A Randomized Pilot Trial 总被引：1，自引：0，他引：1
Billy Sin Iain Jeffrey Zachary Halpern Adebanke Adebayo Tom Wing Amy S. Lee Josel Ruiz Kevin Persaud Lilia Davenport Sylvie de Souza Mollie Williams 《The Journal of emergency medicine》2019,56(3):301-307
Background
Patients in the United States frequently seek medical attention in the emergency department (ED) to address their pain. The intranasal (i.n.) route provides a safe, effective, and painless alternative method of drug administration. Sufentanil is an inexpensive synthetic opioid with a high therapeutic index and rapid onset of action, making it an attractive agent for management of acute pain in the ED.Objective
The objective of our study was to evaluate the safety and efficacy of i.n. sufentanil as the primary analgesic for acute pain in the ED.Methods
This was a single-center, prospective, randomized, double-blind, double-dummy, controlled trial that evaluated the use of i.n. sufentanil 0.7 μg/kg via mucosal atomizer device vs. intravenous morphine 0.1 mg/kg in adult patients who presented to the ED with acute pain. The primary outcome was patient's pain score at 10 min after administration of intervention. Secondary outcomes were adverse events, the need for rescue analgesia, and patient satisfaction after treatment.Results
Thirty patients were enrolled in each group. There was no significant difference in pain scores at 10 min after administration of intervention (sufentanil: 2.0, interquartile range = 2.0–3.3 vs. morphine: 3.0, interquartile range = 2.0–5.3, p = 0.198). No serious adverse events were reported. Rescue analgesia was not requested in either group. No significant difference in median satisfaction scores was found.Conclusion
The use of i.n. sufentanil at 0.7 μg/kg/dose resulted in rapid and safe analgesia with comparable efficacy to i.v. morphine for up to 30 min in patients who presented with acute pain in the ED. 相似文献16.
Shin-ichiro Ohmura Taio Naniwa Shin-ya Tamechika Toshiaki Miyamoto Daisuke Shichi Nobukata Kazawa Shiho Iwagaitsu Shinji Maeda Jun-ichi Wada Akio Niimi 《Journal of infection and chemotherapy》2019,25(4):253-261
Objectives
To evaluate the effectiveness and safety of lower-dose sulfamethoxazole/trimethoprim therapy (SMX/TMP) for Pneumocystis jirovecii pneumonia (PCP) in patients with systemic rheumatic diseases.Methods
In this multicenter retrospective study, we compared effectiveness and safety of SMX/TMP for the treatment of PCP among patients divided into three groups according to the initial dosage of SMX/TMP: the low, ≤10 mg/kg/day; the intermediate, 10–15 mg/kg/day; and the high and conventional, 15–20 mg/kg/day for TMP dose.Results
Eighty-one patients, including 22, 30, and 29 patients in the low-, the intermediate- and the high-dose group could be analyzed and the 30-day survival rate were 100%, 93.3%, and 96.7%, respectively (P = 0.28). There were significant dose-dependent increasing trends of severe adverse drug reactions (ADRs) for SMX/TMP that were graded as ≥3 according to the Common Terminology Criteria for Adverse Events. When stratified by presence of severe hypoxemia defined by alveolar-arterial O2 gradient ≥45 mmHg, the 30-day survival and treatment modification rate were similar among the three groups, but frequency of severe ADRs were significantly decreased in the low-dose group. The low-dose group was independently and negatively associated with treatment modification within 14 days and severe ADRs.Conclusions
Lower dose SMX/TMP therapy with ≤10 mg/kg/day for TMP was as effective as higher dose therapy for the treatment of PCP and associated with lower rates of treatment modification and severe ADRs in patients with systemic rheumatic diseases. 相似文献17.
Objective
The aim of this evidence-based practice change was to implement use of nitrous oxide as a pain management option during labor and to examine women’s satisfaction with that option.Design
Evidence-based practice change guided by the model for evidence-based practice change.Setting
Labor and delivery unit in a tertiary medical center in the southwestern United States.Participants
Laboring women who met eligibility criteria were offered the option of nitrous oxide during a 2-month period.Measurements
Process indicators to measure compliance with the practice change among staff, uptake of nitrous oxide among women, and women’s satisfaction with the choice to use nitrous oxide.Results
Nitrous oxide was offered to 26% (n = 55) of eligible women. Most of the 55 women who used nitrous oxide during the implementation period reported satisfaction with it and indicated that they would consider nitrous oxide for a future labor.Conclusion
Our experience implementing a practice change to offer nitrous oxide to laboring women indicated that use of nitrous oxide was feasible in this setting and that women were receptive to this option, were satisfied with its use, and would use nitrous oxide for a future labor. 相似文献18.
Objective
To assess whether robot-assisted reach training (RART) with an active assistant protocol can improve upper extremity function and kinematic performance in chronic stroke survivors.Design
This study was conducted as a randomized controlled trial.Setting
National rehabilitation center.Participants
Chronic stroke survivors (N=38) were randomized into 2 groups: a robot-assisted reach training with assist-as-needed (RT-AAN) group and a robot-assisted reach training with guidance force (RT-G) group.Intervention
The RT-AAN group received robot-assisted reach training with an assist-as-needed mode for 40 minutes per day, 3 times per week over a 6-week period, and the RT-G group participated in the RART with a guidance mode for 40 minutes per day, 3 times per week over a 6-week period.Main Outcome Measures
Upper extremity functions were measured with Fugl–Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box and Block Test. In addition, movement velocities were measured as an index for upper extremity kinematic performances in 6 directions.Results
Both groups showed significant improvements in FMA, ARAT, and kinematics (movement velocity) in all directions (targets 1-6, P<.05). However, the RT-AAN group showed significantly more improvement than the RT-G group in FMA and ARAT (P<.05).Conclusions
RART with an active assistant protocol showed improvements of upper extremity function and kinematic performance in chronic stroke survivors. In particular, assist-as-needed robot control was effective for upper extremity rehabilitation. Therefore robot-assisted training may be suggested as an effective intervention to improve upper extremity function in chronic stroke survivors. 相似文献19.
Objective
To determine whether prehospital point-of-care lactate (pLA) is associated with mortality, admission, and duration of hospital stay.Design
A retrospective clinical audit, where elevated lactate was defined as ≥2 mmol/L.Setting
The ambulance service and primary referral hospital in the Australian Capital Territory from 1st July 2014 to 30th June 2015.Participants
Adult patients (≥18 years) who had pLA measured and were transported to the primary referral hospital.Main outcome measures
Mortality, admission, and duration of hospital stay.Results
Two hundred fifty-three patients with a median pLA of 2.5 mmol/L (interquartile range [IQR]: 1.5–3.7) were analysed. Overall mortality was 8.3%; 68% were admitted to the hospital; 8.3% to the intensive care unit (ICU). pLA was non-significantly higher in those who died compared to survivors (3.5 [IQR: 2.75–5.85] vs 2.4 [1.5–3.6]; W = 1631.5; p = 0.053). pLA was higher for those admitted to the hospital (2.9 [1.9–3.9] vs 2.0 [1.4–3.1]; W = 5094.5, p = 0.001) and the ICU (3.2 [2.4–5.7] vs 2.4 [1.5–3.6]; W = 1578.5; p = 0.008). There was no relationship between pLA and duration of stay. Considered as a screening tool, at a cut-off of 2.5 mmol/L, pLA had a likelihood ratio+ of 1.61 for mortality and 1.44 for ICU admission; the odds ratio for mortality was 3.76 (95% confidence interval = 1.30, 13.89).Conclusions
Elevated prehospital lactate was associated with significantly increased ICU and hospital admissions. There may be value in pLA as a screening tool. 相似文献20.
Jordan R. Atkins J. Frank Titch William P. Norcross Julie A. Thompson Virginia C. Muckler 《Nursing for Women's Health》2019,23(2):105-113