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121.
Changes in Quality of Life after 3 months of Usual Care in a Large Sample of Patients with Noncancer Pain: The “QOOL: Quality of Life and Pain” Study 下载免费PDF全文
Ignacio Velázquez Rivera BMBS Modesto García Escobar BMBS Jorge Juan Moya Riera BMBS Javier Manuel del Saz de la Torre BMBS Pedro Fenollosa Vázquez BMBS José Manuel González Mesa BM FIPP Alfonso Casado PhD Medicine & Surgery Mayte Martín Fuentes BSc in Pharmacy Javier de Andrés Ares BMBS 《Pain practice》2015,15(7):633-642
Large‐scale observational studies can provide useful information on changes in health outcomes over time. The aim of this study was to investigate the effect of 3 months of usual care on quality of life (QOL) and pain outcomes in noncancer chronic pain patients managed by pain specialists and to examine factors associated with changes in QOL. This was assessed using the EQ‐5D and pain outcomes using the Brief Pain Inventory (BPI). Changes in QOL and pain were studied for the overall sample and in subgroups defined by baseline pain severity. Multivariate regression was used to investigate factors associated with change on EQ‐5D. Three thousand and twenty‐nine patients were included for analysis. After 3 months of usual care, a mean of 40.9% of patients showed improvement on individual EQ‐5D dimensions, with the highest rates of improvement seen on the pain/discomfort (50.8%) and anxiety/depression (48.3%) dimensions. The EQ‐5D Index increased from a mean (SD) of 0.35 (0.2) to 0.58 (0.21) points between baseline and month 3, and the thermometer from 41.5 (19.4) to 58.7 (17.8), indicating a large effect. Improvements in QOL were larger in those with severe baseline pain. The BPI severity summary score improved from a mean (SD) of 6.5 (1.4) to 4.1 (1.7) and the interference summary score from 6.6 (1.5) to 4.2 (1.9). Changes on the BPI severity and interference scores were associated with changes in the EQ‐5D Index and thermometer. In conclusion, 3 months of usual care in noncancer pain patients led to substantial improvements in QOL and pain outcomes. 相似文献
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Total joint replacement has been one of the most remarkable successes of modern medical technology. Once John Charnley had
solved the problems of implant design, choice of materials, implant fixation, and infection (initial rates of infection were
approximately 10%), the way was clear for the widespread use of this valuable treatment, which is highly effective at removing
pain and restoring function. Unfortunately, infection still remains an important, though less common, problem. It is associated
with serious morbidity (pain, loss of function, wound breakdown, wound discharge, implant failure) and sometimes mortality.
It may be impossible to eradicate or suppress infection in the long term without removal of the prosthesis, and most clinicians
would consider it unwise to re-implant a new prosthesis in the presence of infection. Hence, patients with infected prosthetic
joints generally require multiple additional operations and prolonged periods of antibiotic therapy. Even radical attempts
at cure may fail (in 10% to 15% of cases in most series), requiring further cycles of treatment with progressively deteriorating
function. Thus, the treatment of prosthetic joint infection is arduous for the patient and the health care team, with no guarantee
of success. 相似文献
124.
Hall RM; Unsworth A; Wroblewski BM; Siney P; Powell NJ 《Rheumatology (Oxford, England)》1997,36(1):20-26
Charnley prostheses, retrieved at revision surgery, were studied to assess
the effects of friction on the total hip replacement procedure. Frictional
resistance was measured using the Durham hip function simulator under both
dry and lubricated conditions. The friction factor values (f) for the
explanted prostheses were found to have a non- Gaussian distribution with
medians of 0.13 [inter-quartile range (IQR) 0.10-0.16] and 0.06 (IQR
0.005-0.08) for dry and lubricated (n = 0.01 Pa s) regimes, respectively.
New Charnley prostheses had values of f equal to 0.11 +/- 0.025 and 0.04
+/- 0.01 under the same conditions, and showed no large deviation from a
Gaussian distribution. There was found to be a statistically significant
difference in the medians of the friction factors for new and retrieved
prostheses in the lubricated regime. Ingression of cement into the worn
region of the cup was found to increase the friction factor significantly
under dry conditions. There was no evidence of an increase in the friction
factor or torque for those joints that had a loose socket with respect to
those that were fixed at revision. A decrease in the frictional torque
against number of cycles undergone by the joint in vivo may indicate that a
fatigue-type process may have a role in the loosening of the socket.
However, this relationship was found not to be significant for friction
measured under lubricated conditions and it seems unlikely that the
frictional torque generated in this type of prosthesis will contribute
significantly to the long-term loosening of the socket.
相似文献
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Sue Hall Rachael H. DoddIrene J. Higginson BM BS BMedSci PhD FFPHM FRCP OBE FMedSci 《Geriatric nursing (New York, N.Y.)》2014
This study uses the Framework approach to qualitative analysis to explore and compare the views of residents in care homes for older people, their families and care providers on maintaining dignity. We interviewed 33 care home managers, 29 care assistants, 18 care home nurses, 10 community nurses, 16 residents and 15 members of residents' families. The most prevalent themes were: “independence,” and “privacy”; followed by “comfort and care,” “individuality,” “respect,” “communication,” “physical appearance” and “being seen as human.” Residents and their families sometimes described incidents where a resident's dignity had been compromised. How to help residents maintain dignity and focusing on fostering dignity, can be a starting point for improving the quality of care and quality of life of residents. It is, however, important to remove the gap between the rhetoric of dignity conserving care and the reality experienced by residents in these and other care settings. 相似文献
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Paravalvular regurgitation (PVR) is a symptomatic or asymptomatic complication after surgical valve replacement. It may be related to calcification, infection or tissue friability and occurs in 5 % to 17 % of surgical implanted heart valves. Reoperation is associated with a higher morbidity and mortality than the index procedure. Percutaneous closure of PVR can be an effective and lower risk alternative to reoperation. However, feasibility for percutaneous closure has to be assessed by defining the shape, size and location of the defect. Echocardiography with three-dimensional defect reconstruction is a cornerstone for guiding percutaneous PVR closure. Access for aortic PVR is usually retrograde via the femoral artery and access to mitral PVR either retrograde from the aorta, transvenous-transseptal or transapical. Meticulous planning and prudent procedural execution by experienced operators ensuring no impingement of the prosthetic leaflets leads to a high success rate of percutaneous PVR repair. 相似文献
130.