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1.
Leslie R. M. Hausmann Larissa Myaskovsky Christian Niyonkuru Michelle L. Oyster Galen E. Switzer Kelly H. Burkitt Michael J. Fine Shasha Gao Michael L. Boninger 《The journal of spinal cord medicine》2015,38(1):102-110
Context
Despite evidence that healthcare providers have implicit biases that can impact clinical interactions and decisions, implicit bias among physicians caring for individuals with spinal cord injury (SCI) has not been examined.Objective
Conduct a pilot study to examine implicit racial bias of SCI physicians and its association with functioning and wellbeing for individuals with SCI.Design
Combined data from cross-sectional surveys of individuals with SCI and their SCI physicians.Setting
Four national SCI Model Systems sites.Participants
Individuals with SCI (N = 162) and their SCI physicians (N = 14).Outcome measures
SCI physicians completed online surveys measuring implicit racial (pro-white/anti-black) bias. Individuals with SCI completed questionnaires assessing mobility, physical independence, occupational functioning, social integration, self-reported health, depression, and life satisfaction. We used multilevel regression analyses to examine the associations of physician bias and outcomes of individuals with SCI.Results
Physicians had a mean bias score of 0.62 (SD = 0.35), indicating a strong pro-white/anti-black bias. Greater physician bias was associated with disability among individuals with SCI in the domain of social integration (odds ratio = 4.80, 95% confidence interval (CI) = 1.44, 16.04), as well as higher depression (B = 3.24, 95% CI = 1.06, 5.41) and lower life satisfaction (B = −4.54, 95% CI= −8.79, −0.28).Conclusion
This pilot study indicates that SCI providers are susceptible to implicit racial bias and provides preliminary evidence that greater implicit racial bias of physicians is associated with poorer psychosocial health outcomes for individuals with SCI. It demonstrates the feasibility of studying implicit bias among SCI providers and provides guidance for future research on physician bias and patient outcomes. 相似文献2.
Mário Augusto Cray da Costa Conrado Auer Trentini Marcelo Derbli Schafranski Oswaldo Pipino Ricardo Zanetti Gomes Elise Souza dos Santos Reis 《Brazilian Journal Of Cardiovascular Surgery》2015,30(5):552-556
OBJECTIVE
The aim of the present study was to investigate the factors associated with chronic post-sternotomy pain in heart surgery patients.METHODS
Between January 2013 and February 2014, we evaluated 453 patients with >6 months post-sternotomy for cardiac surgery at a surgical outpatient clinic. The patients were allocated into a group with chronic post-sternotomy pain (n=178) and a control group without pain (n=275). The groups were compared for potential predictors of chronic post-sternotomy pain. We used Cox proportional hazards regression to determine which independent variables were associated with the development of chronic post-sternotomy pain.RESULTS
In total, 39.29% of the patients had chronic poststernotomy pain. The following factors were significantly associated with chronic post-sternotomy pain: (a) use of the internal thoracic artery in coronary bypass grafting (P=0.009; HR=1.39; 95% CI, 1.08 to 1.80); (b) a history of antidepressant use (P=0.0001; HR=2.40; 95% CI, 1.74 to 3.32); (c) hypothyroidism (P=0.01; HR=1.27; 95% CI, 1.03 to 1.56); (d) surgical wound complication (P=0.01; HR=1.69; 95% CI, 1.08 to 2.63), and (e) patients on disability benefits or scheduled for a consultative medical examination for retirement (P=0.0002; HR=2.05; 95% CI, 1.40 to 3.02).CONCLUSION
The factors associated with chronic poststernotomy pain were: use of the internal thoracic artery; use of antidepressants; hypothyroidism; surgical wound complication, and patients on disability benefits or scheduled for a consultative examination. 相似文献3.
Tan G Rintala DH Jensen MP Richards JS Holmes SA Parachuri R Lashgari-Saegh S Price LR 《The journal of spinal cord medicine》2011,34(3):285-296
Background
Chronic pain is a significant problem for many individuals following spinal cord injury (SCI). Unfortunately, SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments. Cranial electrotherapy stimulation (CES) has been effective in managing some types of pain. It involves the application of a small amount of current through the head via ear clip electrodes.Objective
Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain.Study design
Multi-site, double-blind, sham-controlled study.Participants
Adults with SCI and chronic neuropathic pain at or below the level of injury were randomized to receive active or sham CES.Intervention
Application of active CES or sham CES 1 hour daily for 21 days. Six-month open-label phase to assess ‘as-needed’ CES use.Outcome measures
Change in pre- to post-session pain ratings as well as change in pain intensity, pain interference, pain quality, pain beliefs and coping strategies, general physical and mental health status, depressive symptomatology, perceived stress, and anxiety pre- to post-treatment.Results
The active group reported a significantly greater average decrease in pain during daily treatments than the sham group (Kruskal–Wallis chi-square = 4.70, P < 0.05). During the 21-day trial, there was a significant group × time interaction for only one outcome variable; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did (F = 8.50, P < 0.01, d = 0.59).Conclusions
On average, CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects. Individual results varied from no pain relief to a great deal of relief. 相似文献4.
Elizabeth J. Richardson PhD J. Scott Richards PhD Christopher C. Stewart PhD Timothy J. Ness MD PhD 《Topics in spinal cord injury rehabilitation》2012,18(2):101-105
Background:
One factor affecting spinal cord injury (SCI)–related pain may be nicotine. Case reports have described a worsening of neuropathic pain from smoking and relief from abstinence. Neurobiological correlates also implicate the potential effect of nicotine on SCI-related pain.Method:
The current study employed a randomized, placebo-controlled crossover design to examine the effect of nicotine exposure on subtypes of SCI-related pain among smokers and nonsmokers.Results:
Whereas nonsmokers with SCI showed a reduction in mixed forms of pain following nicotine exposure, smokers with SCI showed a converse increase in pain with regard to both mixed and neuropathic forms of pain. The exacerbation of pain in chronic nicotine or tobacco users may not only elucidate possible pain mechanisms but may also be of use in smoking cessation counseling among those with SCI. 相似文献5.
Swati Mehta Katherine Orenczuk Amanda McIntyre Gabrielle Willems Dalton L. Wolfe Jane T. C. Hsieh Christine Short Eldon Loh Robert W. Teasell SCIRE Research Team 《Topics in spinal cord injury rehabilitation》2013,19(1):78-86
Background:
Pharmacotherapy may not sufficiently reduce neuropathic pain in many individuals post spinal cord injury (SCI). The use of alternative therapies such as surgery may be effective in reducing neuropathic pain in these individuals. However, because of the invasive nature of surgery, it is important to examine the evidence for use of this treatment.Objective:
The purpose of this study was to conduct a systematic review of published literature on the surgical treatment of neuropathic pain after SCI.Methods:
MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles in which surgical treatment of pain after SCI was examined. Articles were restricted to the English language. Article selection was conducted by 2 independent reviewers with the following inclusion criteria: the subjects participated in a surgical intervention for neuropathic pain; at least 50% of the subjects had an SCI; at least 3 subjects had an SCI; and a definable intervention involving the dorsal root entry zone (DREZ) procedure was used to reduce pain. Data extracted included study design, study type, subject demographics, inclusion and exclusion criteria, sample size, outcome measures, and study results. Randomized controlled trials (RCTs) were assessed for quality using the Physiotherapy Evidence Database (PEDro) assessment scale. Levels of evidence were assigned to each intervention using a modified Sackett scale.Results:
Eleven studies met the inclusion criteria. One study provided level 2 evidence, and the rest provided level 4 evidence. The DREZ procedure was shown to be more effective for segmental pain than for diffuse pain after SCI. Further, individuals with conus medullaris level injury were found to have a higher level of neuropathic pain relief than those with cervical, thoracic, or cauda equina injury.Conclusions:
The studies demonstrated that the DREZ procedure may be effective in reducing segmental pain. Hence, DREZ may be important in treatment of neuropathic pain in individuals resistant to less invasive treatments. Because the studies lacked control conditions and examination of long-term effects, there is a need for larger trials with more stringent conditions.Key words: pain, spinal cord injury, surgical treatmentPain is a major cause of distress and disability in persons with spinal cord injury (SCI). It has been shown to lead to social isolation, unemployment, decreased function, decreased quality of life, depression, and even suicide.1,2 More than 77% of individuals with an SCI indicated that pain interfered with one or more of their daily activities including sleep (40%), exercise (34.9%), and work (33.6%).2 The International Association for the Study of Pain (IASP) defines neuropathic pain as “pain caused by a lesion or disease of the somatosensory nervous system.”3 After an SCI, individuals often report the onset of chronic neuropathic pain caudal to the level of the lesion or at the same level within the associated spinal cord segment.4 Dijkers et al5 reported no difference in the prevalence of pain based on level or completeness.The reported incidence of neuropathic pain after SCI varies greatly among studies, but between 10% and 30% of patients with SCI experience pain severe enough to interfere with their activities of daily living6,7 and may require surgical intervention to relieve persistent and refractory pain.4,8 Unmanageable neuropathic pain occurs more often in individuals with conus medullaris and cauda equina lesions where damage also involves the peripheral nerve roots.8When pharmacological and other noninvasive treatments fail to reduce pain, surgical spinal cord stimulation and dorsal root entry zone (DREZ) ablation treatments, such as DREZ lesioning and microsurgical DREZotomy (MDT), can be considered as options for the management of refractory pain.9 Neurosurgical procedures to reduce neuropathic pain should be reserved for cases in which medical therapies have failed to sufficiently reduce pain.4 The risks associated with ablative surgeries can be significant for individuals with incomplete neurological deficits; therefore, DREZ ablation is generally only considered a treatment option when neuropathic pain is present after a complete SCI.8 The MDT procedure targets for ablation the nociceptive fibers in the lateral bundle of the dorsal rootlet, the deafferented neurons of the dorsal horn, and the medial portion of the Lissauer tract.4,6 This systematic review was conducted to assess the effectiveness of DREZ ablation therapies in reducing neuropathic pain in individuals following SCI. 相似文献6.
Handerson Nunes dos Santos Ellen Hettwer Magedanz Jo?o Carlos Vieira da Costa Guaragna Natalia Nunes dos Santos Luciano Cabral Albuquerque Marco Antonio Goldani Jo?o Batista Petracco Luiz Carlos Bodanese 《Brazilian Journal Of Cardiovascular Surgery》2014,29(2):140-147
Objective
To determine the risk factors related to the development of stroke in patients undergoing cardiac surgery.Methods
A historical cohort study. We included 4626 patients aged > 18 years who underwent coronary artery bypass surgery, heart valve replacement surgery alone or heart valve surgery combined with coronary artery bypass grafting between January 1996 and December 2011. The relationship between risk predictors and stroke was assessed by logistic regression model with a significance level of 0.05.Results
The incidence of stroke was 3% in the overall sample. After logistic regression, the following risk predictors for stroke were found: age 50-65 years (OR=2.11 - 95% CI 1.05-4.23 - P=0.036) and age >66 years (OR=3.22 - 95% CI 1.6-6.47 - P=0.001), urgent and emergency surgery (OR=2.03 - 95% CI 1.20-3.45 - P=0.008), aortic valve disease (OR=2.32 - 95% CI 1.18-4.56 - P=0.014), history of atrial fibrillation (OR=1.88 - 95% CI 1.05-3.34 - P=0.032), peripheral artery disease (OR=1.81 - 95% CI 1.13-2.92 - P=0.014), history of cerebrovascular disease (OR=3.42 - 95% CI 2.19-5.35 - P<0.001) and cardiopulmonary bypass time > 110 minutes (OR=1.71 - 95% CI 1.16-2.53 - P=0.007). Mortality was 31.9% in the stroke group and 8.5% in the control group (OR=5.06 - 95% CI 3.5-7.33 - P<0.001).Conclusion
The study identified the following risk predictors for stroke after cardiac surgery: age, urgent and emergency surgery, aortic valve disease, history of atrial fibrillation, peripheral artery disease, history of cerebrovascular disease and cardiopulmonary bypass time > 110 minutes. 相似文献7.
Miriam Hwang Kathy Zebracki Kathleen M. Chlan Lawrence C. Vogel 《The journal of spinal cord medicine》2014,37(2):171-178
Objectives
To determine longitudinal changes in the occurrence of medical complications in adults with pediatric-onset spinal cord injury (SCI).Design
Longitudinal study of long-term outcomes.Setting
Community.Participants
Individuals who had sustained an SCI before age 19, were 23 years of age or older at initial interview, and followed annually between 1996 and 2011. They were classified into four American Spinal Injury Association (ASIA) Impairment Scale (AIS) severity groups: C1–4 AIS ABC, C5–8 AIS ABC, T1–S5 AIS ABC, AIS D.Outcome measures
Generalized estimating equation (GEE) models were formulated to obtain the odds ratio (OR) of having a medical complication over time.Results
A total of 1793 interviews were conducted among 226 men and 125 women (86% Caucasian; age at baseline, 26.7 ± 3.6 years; time since injury at baseline, 12.9 ± 5.2 years). Odds of complication occurrence over time varied among severity groups, with increased ORs of severe urinary tract infection (1.05, confidence interval (CI) 1.02–1.09), autonomic dysreflexia (AD) (1.09, CI 1.05–1.14), spasticity (1.06, CI 1.01–1.11), pneumonia/respiratory failure (1.09, CI 1.03–1.16), and hypertension/cardiac disease (1.07, CI 1.01–1.15) in the C1-4 ABC group; AD (1.08, CI 1.04–1.13) and pneumonia/respiratory failure (1.09, CI 1.02–1.16) in the C5–8 ABC group; and hypertension/cardiac disease (1.08, CI 1.02–1.14) in the T1–S5 ABC group. Upper extremity joint pain had increased odds of occurrence in all injury severity groups.Conclusion
The significantly increased odds of having medical complications over time warrants awareness of risk factors and implementation of preventive measures to avoid adverse consequences of complications and to maintain independence in individuals with pediatric-onset SCI. 相似文献8.
Swati Mehta Katherine Orenczuk Amanda McIntyre Gabrielle Willems Dalton L. Wolfe Jane T. C. Hsieh Christine Short Eldon Loh Robert W. Teasell SCIRE Research Team 《Topics in spinal cord injury rehabilitation》2013,19(1):61-77
Background:
Neuropathic pain has various physiologic and psychosocial aspects. Hence, there is a growing use of adjunct nonpharmacological therapy with traditional pharmacotherapy to reduce neuropathic pain post spinal cord injury (SCI).Objective:
The purpose of this study was to conduct a systematic review of published research on nonpharmacological treatment of neuropathic pain after SCI.Methods:
MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing nonpharmacological treatment of pain post SCI. Articles were restricted to the English language. Article selection was conducted by 2 independent reviewers with the following inclusion criteria: the subjects participated in a treatment or intervention for neuropathic pain; at least 50% of the subjects had an SCI; at least 3 subjects had an SCI; and a definable intervention was being studied. Data extracted included study design, study type, subject demographics, inclusion and exclusion criteria, sample size, outcome measures, and study results. Randomized controlled trials (RCTs) were assessed for quality using the Physiotherapy Evidence Database (PEDro) assessment scale. Levels of evidence were assigned to each intervention using a modified Sackett scale.Results:
The 16 articles selected for this review fell into 1 of 2 categories of nonpharmacological management of pain after SCI: physical and behavioral treatments. The pooled sample size of all studies included 433 participants. Of the 16 studies included, 7 were level 1, 3 were level 2, and 6 were level 4 studies.Conclusions:
Physical interventions demonstrated the strongest evidence based on quality of studies and numbers of RCTs in the nonpharmacological treatment of post-SCI pain. Of these interventions, transcranial electrical stimulation had the strongest evidence of reducing pain. Despite a growing body of literature, there is still a significant lack of research on the use of nonpharmacological therapies for SCI pain.Key words: nonpharmacological treatments, pain, spinal cord injuryPain is a common complaint among individuals who have experienced a spinal cord injury (SCI), and its persistence can have a negative impact on their quality of life. The International Association for the Study of Pain (IASP)1 defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” According to research by Siddall et al,2 at least 80% of people with an SCI experience chronic pain, and at least 40% of these people are affected by neuropathic pain. Neuropathic pain is defined by the IASP1 as “pain caused by a lesion or disease of the somatosensory nervous system,” and it can be categorized as central or peripheral neuropathic pain. Neuropathic pain usually has its onset shortly after the injury and can persist for the rest of the patient’s life.3 Neuropathic pain associated with SCI negatively affects quality of life (QOL) including cognitive, emotional, and physical functioning, and ultimately, rehabilitation outcomes.4Neuropathic pain can occur above, at, or below the level of injury. Neuropathic pain above the level of SCI is uncommon. Diagnosis of neuropathic pain can be difficult because of the lack of “validated diagnostic criteria.”5 Hallstrom and Norrbrink6 found that a variety of screening tools are available to assist in the diagnosis of neuropathic pain; the most popular and validated tools include the Doleur Neuropathique (DN4), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Neuropathic Pain Questionnaire (NPQ), and PainDETECT (PD-Q). These tools assist clinicians in screening their patients; however, an assessment should also include the patient’s pain history and somatosensory testing.6 A number of pain symptoms and sensory impairments localized to the same area remain the basis for the diagnosis of neuropathic pain.7Neuropathic pain is unique to each individual and is a persistent problem for many people with SCI; it is typically managed with a range of pharmacological and nonpharmacological treatments. A great deal of research has been conducted on the efficacy of pharmacological interventions to treat neuropathic pain; these interventions are not without adverse effects, and many individuals are concerned about the consequences of long-term use of these medications. As a result, there is growing interest in nonpharmacological interventions for neuropathic pain. Nonpharmacological treatments can be used as an effective adjunct to pharmacological interventions, enhancing the overall impact of pain-relieving interventions for the individual with an SCI. There is some evidence that physical modalities may be used effectively in conjunction with pharmacological treatment.8 Psychological approaches such as visual imagery, cognitive behavioral therapy (CBT), and body awareness training are also often applied in pain management and are used alone or in conjunction with pharmacological and physical therapies. The use of psychological approaches and alternative treatments (eg, cranial electrotherapy [CES], transcranial direct current stimulation [tDCS], and acupuncture) alone or in conjunction with pharmacological intervention may be useful in helping patients manage neuropathic pain while limiting unwanted side effects.This systematic review was conducted to assess the effectiveness of physical and behavioral therapies on neuropathic pain in people with SCI. 相似文献9.
Objective
To investigate the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) on intractable neuropathic pain in patients with spinal cord injury (SCI).Design
A single center, prospective, randomized, double-blinded, controlled study.Setting
SCI rehabilitation unit of university rehabilitation center.Participants
Seventeen patients with SCI and chronic neuropathic pain who met the inclusion criteria recruited between April 2010 and January 2012.Interventions
Ten daily treatment sessions of real or sham rTMS (30 trains of 10-Hz stimuli for a duration of 5 seconds; a total of 1500 pulses at intensity equal to 110% of the resting motor threshold) was applied over vertex using a figure-of-8-shaped coil.Outcome measures
Pain was assessed with visual analog scale (VAS) at baseline and 10 days, 6 weeks and 6 months after the treatment. Patients’ satisfactions obtained using a 5-point Likert scale at 6 months.Results
Both real and sham rTMS provided a significant reduction in the VAS scores (real rTMS group, P = 0.004; sham rTMS group, P = 0.020). Post hoc analysis revealed the significant difference was at 10 days and 6 weeks compared to baseline in the real rTMS group and only at 10 days compared to baseline in the sham rTMS group. Comparison of VAS scores and patient satisfaction did not show any significant difference at each assessment point (P > 0.05).Conclusion
Our results demonstrated analgesic effect of rTMS on intractable neuropathic pain in SCI was not superior to placebo. However, middle-term (over 6 weeks) pain relief by rTMS is encouraging and suggests the need for future studies with a larger sample size. 相似文献10.
Edward Chaw DO Kazuko Shem MD Kathleen Castillo MA CCC-SLP BRS-S Sandra Lynn Wong BA RCP James Chang BA CBIS 《Topics in spinal cord injury rehabilitation》2012,18(4):291-299
Background:
Dysphagia is a relatively common secondary complication that occurs after acute cervical spinal cord injury (SCI). The detrimental consequences of dysphagia in SCI include transient hypoxemia, chemical pneumonitis, atelectasis, bronchospasm, and pneumonia. The expedient diagnosis of dysphagia is imperative to reduce the risk of the development of life-threatening complications.Objective:
The objective of this study was to identify risk factors for dysphagia after SCI and associated respiratory considerations in acute cervical SCI.Methods:
Bedside swallow evaluation (BSE) was conducted in 68 individuals with acute cervical SCI who were admitted to an SCI specialty unit. Videofluroscopy swallow study was conducted within 72 hours of BSE when possible.Results:
This prospective study found dysphagia in 30.9% (21 out of 68) of individuals with acute cervical SCI. Tracheostomy (P = .028), ventilator use (P = .012), and nasogastric tube (P = .049) were found to be significant associated factors for dysphagia. Furthermore, individuals with dysphagia had statistically higher occurrences of pneumonia when compared with persons without dysphagia (P < .001). There was also a trend for individuals with dysphagia to have longer length of stay (P = .087).Conclusion:
The role of respiratory care practitioners in the care of individuals with SCI who have dysphagia needs to be recognized. Aggressive respiratory care enables individuals with potential dysphagia to be evaluated by a speech pathologist in a timely manner. Early evaluation and intervention for dysphagia could decrease morbidity and improve overall clinical outcomes. 相似文献11.
12.
Terrence M. Fullum Stephanie R. Downing Gezzer Ortega David C. Chang Tolulope A. Oyetunji Kendra Van Kirk Daniel D. Tran Ian Woods Edward E. Cornwell Patricia L. Turner 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2013,17(3):365-370
Background and Objectives:
Previously, risk factors for bile duct injury have been identified as acute cholecystitis, male gender, older age, aberrant biliary anatomy, and laparoscopic cholecystectomy.Methods:
A retrospective analysis of the Nationwide Inpatient Sample from 1998 to 2006 was performed with an inclusion criterion of cholecystectomy performed on hospital day 0 or 1. Patient- and hospital-level factors potentially associated with bile duct injury were examined by logistic regression.Results:
A total of 377,424 cholecystectomy patients were identified. There were 1124 bile duct injuries (0.30%), with 177 (0.06%) in the laparoscopic cholecystectomy group and 947 (1.46%) in the open cholecystectomy group (P < .001). On multivariate analysis, significant risk factors for bile duct injury were male gender (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.06–1.38; P = .006), age >60 years (OR, 2.23; 95% CI, 1.61–3.09; P < .001), and academic hospital status (OR, 1.37; 95% CI, 1.05–1.79; P = .02). Acute cholecystitis was associated with a lower risk of bile duct injury (OR, 0.67; 95% CI, 0.46–0.99; P = .044).Conclusion:
Independent risk factors for bile duct injury included male gender, age >60 years, and academic hospital status. Laparoscopic cholecystectomy, obesity, insurance status, or hospital volume was not associated with an increased risk of bile duct injury. 相似文献13.
Raffaele Nardone Yvonne H?ller Stefan Leis Peter H?ller Natasha Thon Aljoscha Thomschewski Stefan Golaszewski Francesco Brigo Eugen Trinka 《The journal of spinal cord medicine》2014,37(1):19-31
Context
Past evidence has shown that invasive and non-invasive brain stimulation may be effective for relieving central pain.Objective
To perform a topical review of the literature on brain neurostimulation techniques in patients with chronic neuropathic pain due to traumatic spinal cord injury (SCI) and to assess the current evidence for their therapeutic efficacy.Methods
A MEDLINE search was performed using following terms: “Spinal cord injury”, “Neuropathic pain”, “Brain stimulation”, “Deep brain stimulation” (DBS), “Motor cortex stimulation” (MCS), “Transcranial magnetic stimulation” (TMS), “Transcranial direct current stimulation” (tDCS), “Cranial electrotherapy stimulation” (CES).Results
Invasive neurostimulation therapies, in particular DBS and epidural MCS, have shown promise as treatments for neuropathic and phantom limb pain. However, the long-term efficacy of DBS is low, while MCS has a relatively higher potential with lesser complications that DBS. Among the non-invasive techniques, there is accumulating evidence that repetitive TMS can produce analgesic effects in healthy subjects undergoing laboratory-induced pain and in chronic pain conditions of various etiologies, at least partially and transiently. Another very safe technique of non-invasive brain stimulation – tDCS – applied over the sensory-motor cortex has been reported to decrease pain sensation and increase pain threshold in healthy subjects. CES has also proved to be effective in managing some types of pain, including neuropathic pain in subjects with SCI.Conclusion
A number of studies have begun to use non-invasive neuromodulatory techniques therapeutically to relieve neuropathic pain and phantom phenomena in patients with SCI. However, further studies are warranted to corroborate the early findings and confirm different targets and stimulation paradigms. The utility of these protocols in combination with pharmacological approaches should also be explored. 相似文献14.
Patrick Niccola? Lemlih Ouchchane Maurice Libier Fay?ale Beouche Monique Belon Jean-Marc Vedrinne Bilal El Drayi Laurent Vallet Franck Ruiz Céline Biermann Pascal Duchêne Claudine Chirat Sylvie Soule-Sonneville Christian Dualé Claude Dubray Pierre Schoeffler 《Canadian journal of surgery》2015,58(2):114-120
Background
A greater incidence of persistent pain after inguinal herniorrhaphy is suspected with the open mesh procedure than with laparoscopy (transabdominal preperitoneal), but the involvement of neuropathy needs to be clarified.Methods
We examined the cumulative incidence of neuropathic persistent pain, defined as self-report of pain at the surgical site with neuropathic aspects, within 6 months after surgery in 2 prospective subcohorts of a multicentre study. We compared open mesh with laparoscopy using different analysis, including a propensity-matched analysis with the propensity score built from a multivariable analysis using a generalized linear model.Results
Considering the full patient sample (242 open mesh v. 126 laparoscopy), the raw odds ratio for neuropathic persistent pain after inguinal herniorrhaphy was 4.3. It reached 6.8 with the propensity-matched analysis conducted on pooled subgroups of 194 patients undergoing open mesh and 125 undergoing laparoscopy (95% confidence interval 1.5–30.4, p = 0.012). A risk factor analysis of these pooled subgroups revealed that history of peripheral neuropathy was an independent risk factor for persistent neuropathic pain, while older age was protective.Conclusion
We found a greater risk of persistent pain with open mesh than with laparoscopy that may be explained by direct or indirect lesion of nerve terminations. Strategies to identify and preserve nerve terminations with the open mesh procedure are needed. 相似文献15.
Mackenzie C. Lees Shaheed Merani Keerit Tauh Rachel G. Khadaroo 《Canadian journal of surgery》2015,58(5):312-317
Background
Older adults (≥ 65 yr) are the fastest growing population and are presenting in increasing numbers for acute surgical care. Emergency surgery is frequently life threatening for older patients. Our objective was to identify predictors of mortality and poor outcome among elderly patients undergoing emergency general surgery.Methods
We conducted a retrospective cohort study of patients aged 65–80 years undergoing emergency general surgery between 2009 and 2010 at a tertiary care centre. Demographics, comorbidities, in-hospital complications, mortality and disposition characteristics of patients were collected. Logistic regression analysis was used to identify covariate-adjusted predictors of in-hospital mortality and discharge of patients home.Results
Our analysis included 257 patients with a mean age of 72 years; 52% were men. In-hospital mortality was 12%. Mortality was associated with patients who had higher American Society of Anesthesiologists (ASA) class (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.43–10.33, p = 0.008) and in-hospital complications (OR 1.93, 95% CI 1.32–2.83, p = 0.001). Nearly two-thirds of patients discharged home were younger (OR 0.92, 95% CI 0.85–0.99, p = 0.036), had lower ASA class (OR 0.45, 95% CI 0.27–0.74, p = 0.002) and fewer in-hospital complications (OR 0.69, 95% CI 0.53–0.90, p = 0.007).Conclusion
American Society of Anesthesiologists class and in-hospital complications are perioperative predictors of mortality and disposition in the older surgical population. Understanding the predictors of poor outcome and the importance of preventing in-hospital complications in older patients will have important clinical utility in terms of preoperative counselling, improving health care and discharging patients home. 相似文献16.
Charlesnika T. Evans Jennifer N. Hill Marylou Guihan Amy Chin Barry Goldstein Michael S. A. Richardson Vicki Anderson Kathleen Risa Susan Kellie Kenzie A. Cameron 《The journal of spinal cord medicine》2014,37(2):152-161
Objectives
To assess the feasibility and effect of a nurse-administered patient educational intervention about Methicillin-resistant Staphylococcus aureus (MRSA) prevention on knowledge and behavior of Veterans with spinal cord injuries and disorders (SCI/D).Design
Blinded, block-randomized controlled pilot trial.Setting
Two Department of Veterans Affairs (VA) SCI Centers.Participants
Veterans were recruited March–September 2010 through referral by a healthcare provider from inpatient, outpatient, and residential care settings.Intervention
Thirty participants were randomized to the nurse-administered intervention and 31 to the usual care group. The intervention included a brochure and tools to assist nurses in conducting the education.Outcome measures
Pre- and post-intervention measurement of knowledge and behaviors related to MRSA and prevention strategies and feasibility measures related to implementation.Results
Participants were primarily male (95.1%), white (63.9%), with tetraplegia (63.9%) and mean age and duration of injury of 64.3 and 20.5 years, respectively. The intervention groups mean knowledge score significantly increased between pre- and post-test (mean change score = 1.70, 95% confidence interval, CI 0.25–3.15) while the usual care groups score did not significantly change (mean change score = 1.45, 95% CI −0.08–2.98). However, the mean knowledge change between intervention and usual care groups was not significantly different (P = 0.81). Overall behavior scores did not significantly differ between treatment groups; however, the intervention group was more likely to report intentions to clean hands (90.0% vs. 64.5%, P = 0.03) and asking providers about MRSA status (46.7% vs. 16.1%, P = 0.01). Nurse educators reported that the quality of the intervention was high and could be implemented in clinical care.Conclusions
A targeted educational strategy is feasible to implement in SCI/D clinical practices and may improve some participants’ knowledge about MRSA and increase intentions to improve hand hygiene and engagement with providers about their MRSA status. 相似文献17.
Jennifer Nagy MPT Amy Winslow MPT Jessica M. Brown BS Lisa Adams Kathleen O’Brien Michael Boninger MD Gregory Nemunaitis MD 《Topics in spinal cord injury rehabilitation》2012,18(2):140-142
Objective:
To assess the peak force during wheelchair propulsion of individuals with spinal cord injury propelling over obstacles from the Wheelchair Skills Test.Participants/Methods:
Twenty-three individuals with spinal cord injury (SCI) who are full-time manual wheelchair users were included in this prospective study. A SmartWheel (Three Rivers Holdings, LLC) was used to analyze each push while subjects negotiated standardized obstacles used in the Wheelchair Skills Test, including tile, carpet, soft surface, 5° and 10° ramps, 2 cm, 5 cm, and 15 cm curbs.Results:
When the peak forces of the advanced skills were compared to level 10 m tile/10 m carpet, there was a statistically significant increase in all peak forces (P value ranged from .0001 to .0268).Discussion:
It is well documented that a large number of individuals with SCI develop upper limb pain. One of the recommendations to preserve the upper limb is to minimize force during repetitive tasks.Conclusion:
Advanced wheelchair skills require an increase in force to accomplish. The increase in forces ranged from 18% to 130% over that required for level 10 m tile/10 m carpet. 相似文献18.
Nefyn H. Williams Ruth Lewis Nafees Ud Din Hosam E. Matar Deborah Fitzsimmons Ceri J. Phillips Alex Sutton Kim Burton Maggie Hendry Sadia Nafees Clare Wilkinson 《European spine journal》2013,22(9):1921-1935
Purpose
Systematic review comparing biological agents, targeting tumour necrosis factor α, for sciatica with placebo and alternative interventions.Methods
We searched 21 electronic databases and bibliographies of included studies. We included randomised controlled trials (RCTs), non-RCTs and controlled observational studies of adults who had sciatica treated by biological agents compared with placebo or alternative interventions.Results
We pooled the results of six studies (five RCTs and one non-RCT) in meta-analyses. Compared with placebo biological agents had: better global effects in the short-term odds ratio (OR) 2.0 (95 % CI 0.7–6.0), medium-term OR 2.7 (95 % CI 1.0–7.1) and long-term OR 2.3 [95 % CI 0.5 to 9.7); improved leg pain intensity in the short-term weighted mean difference (WMD) −13.6 (95 % CI −26.8 to −0.4), medium-term WMD −7.0 (95 % CI −15.4 to 1.5), but not long-term WMD 0.2 (95 % CI −20.3 to 20.8); improved Oswestry Disability Index (ODI) in the short-term WMD −5.2 (95 % CI −14.1 to 3.7), medium-term WMD −8.2 (95 % CI −14.4 to −2.0), and long-term WMD −5.0 (95 % CI −11.8 to 1.8). There was heterogeneity in the leg pain intensity and ODI results and improvements were no longer statistically significant when studies were restricted to RCTs. There was a reduction in the need for discectomy, which was not statistically significant, and no difference in the number of adverse effects.Conclusions
There was insufficient evidence to recommend these agents when treating sciatica, but sufficient evidence to suggest that larger RCTs are needed.Electronic supplementary material
The online version of this article (doi:10.1007/s00586-013-2739-z) contains supplementary material, which is available to authorized users. 相似文献19.
Fernando A. Atik Isaac Azevedo Silva Claudio Ribeiro da Cunha 《Brazilian Journal Of Cardiovascular Surgery》2014,29(4):487-493
Objective
To determine the prevalence and profile of ascending aorta or aortic arch atheromatous disease in cardiovascular surgery patients, its risk factors and its prognostic implication early after surgery.Methods
Between January 2007 and June 2011, 2042 consecutive adult patients were analyzed, with no exclusion criteria. Atheromatous aorta diagnosis was determined intraoperatively by surgeon palpation of the aorta. Determinants of atheromatous aorta, as well as its prognostic implication were studied by multivariate logistic regression.Results
Prevalence of atheromatous aorta was 3.3% (68 patients). Determinants were age > 61 years (OR= 2.79; CI95%= 2.43 - 3.15; P<0.0001), coronary artery disease (OR=3.1; CI95%=2.8 - 3.44; P=0.002), hypertension (OR=2.26; CI95%=1.82 - 2.7; P=0.03) and peripheral vascular disease (OR=3.15; CI95%= 2.83 - 3.46; P=0.04). Atheromatous aorta was an independent predictor of postoperative cerebrovascular accident (OR=3.46; CI95%=3.18 - 3.76; P=0.01).Conclusion
Although infrequent, the presence of atheromatous aorta is associated with advanced age, hypertension, coronary artery disease and peripheral vascular disease. In those patients, a more detailed preoperative and intraoperative assessment of the aorta is justified, due to greater risk of postoperative cerebrovascular accident. 相似文献20.
Zane Dodd Simon Driver Ann Marie Warren Shelley Riggs Mike Clark 《Topics in spinal cord injury rehabilitation》2015,21(2):156-165