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Enrico De Martino Laura Petrini Siobhan Schabrun Thomas Graven-Nielsen 《The journal of pain》2018,19(11):1296-1307
Changes in excitability of the sensorimotor cortex have been demonstrated in clinical musculoskeletal pain, although the timing is unknown. Eccentric exercise provokes delayed-onset muscle soreness providing a model to study the temporal profile of sensorimotor cortical plasticity during progressively developing muscle soreness. Twelve healthy participants performed eccentric exercise of the wrist extensors. Likert pain scores, pressure pain thresholds at the extensor carpi radialis (ECR) muscle, somatosensory evoked potentials from electrical stimulation of the radial nerve, maximal wrist extension force, and ECR motor evoked potentials to transcranial magnetic stimulation were recorded before (baseline) and at 2 hours (2-h post), 2 days (day 2), and 6 days (day 6) after exercise. Compared with baseline, 1) the Likert pain score was increased at 2-h post and increased further at day 2 (P < .01); 2) the ECR pressure pain thresholds were decreased at day 2 (P < .001); 3) the P45 amplitude of the somatosensory evoked potential from central-parietal recording sites was increased at day 2 (P < .001); 4) maximal wrist extension force was reduced 2-h post and at day 2 (P < .002); and 5) the cortical area from which ECR motor evoked potentials could be elicited was reduced at 2-h post and at day 2 (P < .03). A decrease in the ECR pressure pain thresholds was correlated (P < .027) with an increase in the P45 amplitude at a centroparietal recording site.
Perspective
These novel data demonstrate that the somatosensory cortical excitability may be affected by muscle soreness developing over days in parallel with a deficit in the motor system. Cortical neuroplasticity may thus develop in the subacute phase and be relevant for understanding neural adaptation in the transition from acute to persistent pain. 相似文献94.
Siobhan Rothwell Kimberly McIltrot Zeina Khouri-Stevens 《The Journal for Nurse Practitioners》2018,14(2):e41-e44
Emergency departments (EDs) struggle to manage safe, effective care in the face of increasing patient volume. The role of the nurse practitioner has been shown to improve key factors such as waiting times and the patients’ experience in the ED. This quality improvement project evaluates the effectiveness of a nurse practitioner based in the ED. One nurse practitioner managed patients presenting with minor trauma over 3 months. A pre-post intervention approach was implemented and evaluated. Over 3 months, waiting times and the number of patients who left without being seen were reduced. 相似文献
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Is Going Beyond Rasch Analysis Necessary to Assess the Construct Validity of a Motor Function Scale?
Tiffanie Guillot Sylvain Roche Pascal Rippert Dalil Hamroun Jean Iwaz René Ecochard Carole Vuillerot 《Archives of physical medicine and rehabilitation》2018,99(9):1776-1782.e9
Objective
To examine whether a Rasch analysis is sufficient to establish the construct validity of the Motor Function Measure (MFM) and discuss whether weighting the MFM item scores would improve the MFM construct validity.Design
Observational cross-sectional multicenter study.Setting
Twenty-three physical medicine departments, neurology departments, or reference centers for neuromuscular diseases.Participants
Patients (N=911) aged 6 to 60 years with Charcot-Marie-Tooth disease (CMT), facioscapulohumeral dystrophy (FSHD), or myotonic dystrophy type 1 (DM1).Interventions
None.Main Outcome Measure(s)
Comparison of the goodness-of-fit of the confirmatory factor analysis (CFA) model vs that of a modified multidimensional Rasch model on MFM item scores in each considered disease.Results
The CFA model showed good fit to the data and significantly better goodness of fit than the modified multidimensional Rasch model regardless of the disease (P<.001). Statistically significant differences in item standardized factor loadings were found between DM1, CMT, and FSHD in only 6 of 32 items (items 6, 27, 2, 7, 9 and 17).Conclusions
For multidimensional scales designed to measure patient abilities in various diseases, a Rasch analysis might not be the most convenient, whereas a CFA is able to establish the scale construct validity and provide weights to adapt the item scores to a specific disease. 相似文献97.
Caryl Nowson Karen Lim Carley Grimes Siobhan O’Halloran Mary Anne Land Jacqui Webster Jonathan Shaw John Chalmers Wayne Smith Victoria Flood Mark Woodward Bruce Neal 《Nutrients》2015,7(12):10501-10512
The limited Australian measures to reduce population sodium intake through national initiatives targeting sodium in the food supply have not been evaluated. The aim was, thus, to assess if there has been a change in salt intake and discretionary salt use between 2011 and 2014 in the state of Victoria, Australia. Adults drawn from a population sample provided 24 h urine collections and reported discretionary salt use in 2011 and 2014. The final sample included 307 subjects who participated in both surveys, 291 who participated in 2011 only, and 135 subjects who participated in 2014 only. Analysis included adjustment for age, gender, metropolitan area, weekend collection and participation in both surveys, where appropriate. In 2011, 598 participants: 53% female, age 57.1(12.0)(SD) years and in 2014, 442 participants: 53% female, age 61.2(10.7) years provided valid urine collections, with no difference in the mean urinary salt excretion between 2011: 7.9 (7.6, 8.2) (95% CI) g/salt/day and 2014: 7.8 (7.5, 8.1) g/salt/day (p = 0.589), and no difference in discretionary salt use: 35% (2011) and 36% (2014) reported adding salt sometimes or often/always at the table (p = 0.76). Those that sometimes or often/always added salt at the table and when cooking had 0.7 (0.7, 0.8) g/salt/day (p = 0.0016) higher salt excretion. There is no indication over this 3-year period that national salt reduction initiatives targeting the food supply have resulted in a population reduction in salt intake. More concerted efforts are required to reduce the salt content of manufactured foods, together with a consumer education campaign targeting the use of discretionary salt. 相似文献
98.
Didier Musso Claudine Roche Emilie Robin Tuxuan Nhan Anita Teissier Van-Mai Cao-Lormeau 《Emerging infectious diseases》2015,21(2):359-361
In December 2013, during a Zika virus (ZIKV) outbreak in French Polynesia, a patient in Tahiti sought treatment for hematospermia, and ZIKV was isolated from his semen. ZIKV transmission by sexual intercourse has been previously suspected. This observation supports the possibility that ZIKV could be transmitted sexually.Zika virus (ZIKV) is a mosquitoborne arbovirus in the family Flaviviridae, genus Flavivirus. It was first isolated in 1947 from a rhesus monkey in the Zika forest of Uganda (1). Sporadic human cases were reported from the 1960s in Asia and Africa. The first reported large outbreak occurred in 2007 on Yap Island, Federated States of Micronesia (2). The largest known ZIKV outbreak reported started in October 2013 in French Polynesia, South Pacific (3), a territory of France comprising 67 inhabited islands; an estimated 28,000 persons (11% of the population) sought medical care for the illness (4). The most common symptoms of Zika fever are rash, fever, arthralgia, and conjunctivitis. Most of the patients had mild disease, but severe neurologic complications have been described in other patients in French Polynesia (5). 相似文献
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The effects of intravenous verapamil on the electrocardiogram in 15 patients with heart disease in sinus rhythm and in 44 patients with supraventricular and ventricular tachyarrhythmias were evaluated. Verapamil prolonged the P-R interval without effect on the QRS duration or the Q-Tc interval. In patients with atrial flutter and fibrillation, A-V block was increased, with slowing of the ventricular rate, in almost all cases but sinus rhythm was restored in only 1 of 12 patients in atrial fibrillation and in 2 of the 11 patients with flutter. Verapamil had no effect in 3 patients with atrial fibrillation complicating WPW syndrome; in 1 of 5 patients with ventricular tachycardia it caused reversion to sinus rhythm. Sinus rhythm was restored promptly by verapamil in 13 of 17 patients with paroxysmal supraventricular tachycardias; in 2 others, sinus rhythm became established 1 to 2 hours after administration of the drug. Transient hypotension, not requiring treatment, was the only side effect noted but not in the patients with supraventricular tachycardias, in whom blood pressure generally increased after reversion to sinus rhythm by verapamil. 相似文献