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https://www.readbyqxmd.com/read/28427740/a-study-of-the-incidence-and-management-of-admissions-for-cancer-related-symptoms-in-a-district-general-hospital-the-potential-role-of-an-acute-oncology-service
#1
C M Bruce, J Smith, A Price
AIMS: The non-specialist management of cancer patients is becoming increasingly complex. Acute oncology services (AOS), aiming to provide rapid access to specialist advice, have been shown to improve patient experience and reduce length of inpatient stay. The present study aimed to inform service provision in a district general hospital (DGH) by investigating cancer patients, not on active anti-cancer treatment, where the disease itself precipitated admission. This is a vulnerable group who are potentially disenfranchised of focused oncological input due to having less robust care pathways established to date...
April 17, 2017: Clinical Oncology: a Journal of the Royal College of Radiologists
https://www.readbyqxmd.com/read/28426255/pregabalin-for-the-treatment-of-neuropathic-pain-a-narrative-review-for-primary-care-providers
#2
Yvonne D'Arcy, Bill McCarberg, Bruce Parsons, Regina Behar, Andrew Thorpe, Andrea Alexander
Neuropathic pain (NeP) is a distinct type of pain caused by damage to the nervous system itself. This often severe and chronic type of pain requires specific treatments that target the underlying pain pathophysiology. The purpose of the current narrative review is to provide an overview of pregabalin (Lyrica®) for the treatment of NeP including its effects on pain, pain-related sleep interference, and other health-related outcomes, timing of therapeutic effect, safety and tolerability, and dosing. The information provided here, along with that in our companion review [1], will help primary care providers develop more effective NeP treatment strategies...
April 20, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28422517/neuropathic-pain-a-narrative-review-of-etiology-assessment-diagnosis-and-treatment-for-primary-care-providers
#3
Bill McCarberg, Yvonne D'Arcy, Bruce Parsons, Alesia Sadosky, Andrew Thorpe, Regina Behar
Neuropathic pain (NeP) is a distinct type of chronic pain that is a direct result of damage to the nervous system itself. Studies have shown that training on the topic of chronic pain in medical schools is lacking and many practitioners are not confident in their ability to effectively manage patients with such pain. The purpose of this narrative review is to provide a brief high-level overview of NeP for primary healthcare providers that includes a discussion of mechanisms, prevalence, burden, assessment, and treatment...
April 19, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28419979/clinical-profile-of-persistent-genito-pelvic-postpartum-pain
#4
Jaclyn Cappell, Caroline F Pukall
OBJECTIVE*: the primary aim was to describe the pain characteristics of persistent genito-pelvic postpartum pain (PPP) and compare these characteristics by mode of delivery. The secondary aim was to incorporate psychosocial variables into the conceptualization of PPP by exploring the relationship among postpartum depressive symptoms, fatigue, and PPP. DESIGN: cross-sectional study design. SETTING: online survey. PARTICIPANTS: 106 women recruited from the community who gave birth within twelve months prior to completing the survey...
April 8, 2017: Midwifery
https://www.readbyqxmd.com/read/28418966/clinical-effectiveness-and-safety-of-intraoperative-methadone-in-patients-undergoing-posterior-spinal-fusion-surgery-a-randomized-double-blinded-controlled-trial
#5
Glenn S Murphy, Joseph W Szokol, Michael J Avram, Steven B Greenberg, Torin D Shear, Mark A Deshur, Jeffery S Vender, Jessica Benson, Rebecca L Newmark
BACKGROUND: Patients undergoing spinal fusion surgery often experience severe pain during the first three postoperative days. The aim of this parallel-group randomized trial was to assess the effect of the long-duration opioid methadone on postoperative analgesic requirements, pain scores, and patient satisfaction after complex spine surgery. METHODS: One hundred twenty patients were randomized to receive either methadone 0.2 mg/kg at the start of surgery or hydromorphone 2 mg at surgical closure...
May 2017: Anesthesiology
https://www.readbyqxmd.com/read/28418520/rapid-rule-out-of-acute-myocardial-infarction-with-a-single-high-sensitivity-cardiac-troponin-t-measurement-below-the-limit-of-detection-a-collaborative-meta-analysis
#6
John W Pickering, Martin P Than, Louise Cullen, Sally Aldous, Ewoud Ter Avest, Richard Body, Edward W Carlton, Paul Collinson, Anne Marie Dupuy, Ulf Ekelund, Kai M Eggers, Christopher M Florkowski, Yonathan Freund, Peter George, Steve Goodacre, Jaimi H Greenslade, Allan S Jaffe, Sarah J Lord, Arash Mokhtari, Christian Mueller, Andrew Munro, Sebbane Mustapha, William Parsonage, W Frank Peacock, Christopher Pemberton, A Mark Richards, Juan Sanchis, Lukas P Staub, Richard Troughton, Raphael Twerenbold, Karin Wildi, Joanna Young
Background: High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI). Purpose: To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults presenting to the emergency department (ED) with chest pain. Data Sources: EMBASE and MEDLINE without language restrictions (1 January 2008 to 14 December 2016)...
April 18, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28414006/unit-cost-of-common-illness-management-a-comparison-between-a-primary-care-unit-and-a-community-pharmacy-in-thailand
#7
Kritsanee Saramunee, Chanuttha Ploylearmsang, Surasak Chaiyasong, Wiraphol Phimarn, Phayom Sookaneknun
Aim This study was to perform unit cost analysis of managing common illnesses comparing between a primary care unit (PCU) and a community pharmacy. BACKGROUND: PCU is a key point of access for primary care in Thailand. Although a community pharmacy is an ideal setting, it has not been successfully incorporated in Thailand's health service. Common illnesses are encountered everyday by community pharmacists, an appropriate compensation for this service has not been established. METHODS: A primary care service of one educational institution was a study site...
April 17, 2017: Primary Health Care Research & Development
https://www.readbyqxmd.com/read/28413270/the-effect-of-perioperative-esmolol-on-early-postoperative-pain-a-systematic-review-and-meta-analysis
#8
REVIEW
Richard Watts, Venkatesan Thiruvenkatarajan, Marni Calvert, Graeme Newcombe, Roelof M van Wijk
Esmolol has been shown to improve postoperative pain and reduce opioid requirements. The aim of this systematic review was to evaluate the effect of perioperative esmolol as an adjunct on early postoperative pain intensity, recovery profile, and anesthetic requirement. Databases were searched for randomized placebo-controlled trials evaluating the effects of esmolol during general anesthesia. Primary outcomes were related to early postoperative pain whereas secondary outcomes were related to emergence time, postoperative nausea and vomiting, and intraoperative anesthetic requirement...
January 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28409655/9-1-1-triage-of-non-traumatic-chest-pain-association-with-hospital-diagnosis
#9
Greg Scott, Jeff J Clawson, Isabel Gardett, Meghan Broadbent, Nathan Williams, Conrad Fivaz, Gigi Marshall, Tracey Barron, Christopher Olola
OBJECTIVE: Chest pain is one of the most common reasons people seek emergency care-and one of the most critical. In the United States, chest pain is the second most common reason for emergency department (ED) visits. A patient's primary complaint of "chest pain" may reflect a broad range of underlying causes; therefore, it is important that emergency medical service (EMS) agencies gain a thorough understanding of these cases, beginning with the initial management of chest pain in the 9-1-1 center...
April 14, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28409615/peritonsillar-abscess
#10
Nicholas J Galioto
Peritonsillar abscess is the most common deep infection of the head and neck, occurring primarily in young adults. Diagnosis is usually made on the basis of clinical presentation and examination. Symptoms and findings generally include fever, sore throat, dysphagia, trismus, and a "hot potato" voice. Drainage of the abscess, antibiotic therapy, and supportive therapy for maintaining hydration and pain control are the cornerstones of treatment. Most patients can be managed in the outpatient setting. Peritonsillar abscesses are polymicrobial infections, and antibiotics effective against group A streptococcus and oral anaerobes should be first-line therapy...
April 15, 2017: American Family Physician
https://www.readbyqxmd.com/read/28409480/genetic-testing-for-opioid-pain-management-a-primer
#11
Deepti Agarwal, Mercy A Udoji, Andrea Trescot
Patients see their primary care physicians (PCPs) for a variety of medical conditions, chronic pain being one of the most common. An increased use of prescription medications (especially opioids) has led to an increase in adverse drug reactions and has heightened our awareness of the variability in response to medications. Opioids and other pain adjuvants are widely used, and drug-drug interactions involving these analgesics can be problematic and potentially lethal. Pharmacogenetics has improved our understanding of drug efficacy and response, opened doors to individual tailoring of medical management, and created a series of ethical and economic considerations...
April 13, 2017: Pain and Therapy
https://www.readbyqxmd.com/read/28407197/autologous-hematopoietic-stem-cell-transplantation-following-high-dose-chemotherapy-for-nonrhabdomyosarcoma-soft-tissue-sarcomas
#12
REVIEW
Frank Peinemann, Heike Enk, Lesley A Smith
BACKGROUND: Soft tissue sarcomas (STS) are a highly heterogeneous group of rare malignant solid tumors. Nonrhabdomyosarcoma soft tissue sarcomas (NRSTS) comprise all STS except rhabdomyosarcoma. In people with advanced local or metastatic disease, autologous hematopoietic stem cell transplantation (HSCT) applied after high-dose chemotherapy (HDCT) is a planned rescue therapy for HDCT-related severe hematologic toxicity. The rationale for this update is to determine whether any randomized controlled trials (RCTs) have been conducted and to clarify whether HDCT followed by autologous HSCT has a survival advantage...
April 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28406791/health-care-systems-support-to-enhance-patient-centered-care-lessons-from-a-primary-care-based-chronic-pain-management-initiative
#13
Charles R Elder, Lynn L Debar, Cheryl Ritenbaugh, Maureen H Rumptz, Charlotte Patterson, Allison Bonifay, Penney Cowan, Lindsay Lancaster, Richard A Deyo
BACKGROUND: Supporting day-to-day self-care activities has emerged as a best practice when caring for patients with chronic pain, yet providing this support may introduce challenges for both patients and primary care physicians. It is essential to develop tools that help patients identify the issues and outcomes that are most important to them and to communicate this information to primary care physicians at the point of care. OBJECTIVE: We describe our process to engage patients, primary care physicians, and other stakeholders in the context of a pilot randomized controlled trial of a patient-centered assessment process implemented in an everyday practice setting...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28405596/associations-between-relative-value-units-and-patient-reported-back-pain-and-disability
#14
Laura S Gold, Matthew Bryan, Bryan A Comstock, Brian W Bresnahan, Richard A Deyo, Srdjan S Nedeljkovic, David R Nerenz, Patrick Heagerty, Jeffrey G Jarvik
Objective: To describe associations between health care utilization measures and patient-reported outcomes (PROs). Method: Primary data were collected from patients ≥65 years with low back pain visits from 2011 to 2013. Six PROs of pain and functionality were collected 12 and 24 months after the index visits and total and spine-specific relative value units (RVUs) from electronic health records were tabulated over 1 year. We calculated correlation coefficients between RVUs and 12- and 24-month PROs and conducted linear regressions with each 12- and 24-month PRO as the outcome variables and RVUs as predictors of interest...
January 2017: Gerontology & Geriatric Medicine
https://www.readbyqxmd.com/read/28404610/hand-exercises-for-patients-with-rheumatoid-arthritis-an-extended-follow-up-of-the-sarah-randomised-controlled-trial
#15
Esther Williamson, Christopher McConkey, Peter Heine, Sukhdeep Dosanjh, Mark Williams, Sarah E Lamb
OBJECTIVES: The Stretching And strengthening for Rheumatoid Arthritis of the Hand (SARAH) randomised controlled trial evaluated the effectiveness of a hand exercise programme and demonstrated it was clinically effective and cost-effective at 12 months. The aim of this extended follow-up was to evaluate the effects of the SARAH programme beyond 12 months. METHODS: Using postal questionnaires, we collected the Michigan Hand Questionnaire hand function (primary outcome), activities of daily living and work subscales, pain troublesomeness, self-efficacy and health-related quality of life...
April 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28404200/symptoms-and-patient-factors-associated-with-diagnostic-intervals-for-pancreatic-cancer-symptom-pancreatic-study-a-prospective-cohort-study
#16
Fiona M Walter, Katie Mills, Silvia C Mendonça, Gary A Abel, Bristi Basu, Nick Carroll, Sue Ballard, John Lancaster, William Hamilton, Greg P Rubin, Jon D Emery
BACKGROUND: Pancreatic cancer is the tenth most common cancer in the UK; however, outcomes are poor, in part due to late diagnosis. We aimed to identify symptoms and other clinical and sociodemographic factors associated with pancreatic cancer diagnosis and diagnostic intervals. METHODS: We did this prospective cohort study at seven hospitals in two regions in England. We recruited participants aged 40 years or older who were referred for suspicion of pancreatic cancer...
December 2016: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28403822/provider-and-patient-perspectives-on-opioids-and-alternative-treatments-for-managing-chronic-pain-a-qualitative-study
#17
Lauren S Penney, Cheryl Ritenbaugh, Lynn L DeBar, Charles Elder, Richard A Deyo
BACKGROUND: Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues. METHODS: Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14)...
March 24, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28403408/systemic-lidocaine-fails-to-improve-postoperative-morphine-consumption-postoperative-recovery-and-quality-of-life-in-patients-undergoing-posterior-spinal-arthrodesis-a-double-blind-randomized-placebo-controlled-trial
#18
G Dewinter, P Moens, S Fieuws, B Vanaudenaerde, M Van de Velde, S Rex
Background.: It is inconclusive whether the perioperative administration of systemic lidocaine provides effective postoperative analgesia and enhances recovery in major orthopaedic surgery. We hypothesised that in adolescent and adult patients undergoing posterior spinal arthrodesis, a perioperative lidocaine infusion would reduce opioid requirements during the first 24 postoperative h. Methods.: 70 patients undergoing posterior arthrodesis were enrolled in this prospective, randomised, double-blind, placebo-controlled clinical trial...
April 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28401656/improving-access-to-better-care-for-people-with-knee-and-or-hip-pain-service-evaluation-of-allied-health-professional-led-primary-care
#19
A Walker, R Williams, F Sibley, D Stamp, A Carter, M Hurley
INTRODUCTION: Chronic knee and hip pain is prevalent, impairing mobility, function and quality of life. Allied health professions (AHPs) are better trained and have more time than general practitioners in primary care to advise and support people to adopt healthier lifestyles (maintain healthy weight, increase physical activity) that reduce joint pain. We evaluated whether AHP-led primary care delivering person-centred, practical lifestyle coaching was a feasible, effective way to manage chronic knee and/or hip pain...
April 12, 2017: Musculoskeletal Care
https://www.readbyqxmd.com/read/28401118/frequency-of-and-variation-in-low-value-care-in-primary-care-a-retrospective-cohort-study
#20
Ciara Pendrith, Meghan Bhatia, Noah M Ivers, Graham Mecredy, Karen Tu, Gillian A Hawker, Susan B Jaglal, Lynn Wilson, Kimberly Wintemute, Richard H Glazier, Wendy Levinson, R Sacha Bhatia
BACKGROUND: Low-value care, defined as care with a lack of benefit, can lead to higher health care costs, inconvenience to patients and, in some cases, harm to patients. The objectives of this study are to conduct exploratory analyses to understand how frequently selected low-value tests are ordered, to assess the degree of variation in ordering that exists across regions and practices, and to identify services that may warrant further investigation and targeted interventions. METHODS: We conducted a population-based retrospective cohort study using administrative health care databases from Ontario to identify rates of use of the following low-value services between fiscal years 2008/09 and 2012/13: computed tomography (CT) or magnetic resonance imaging (MRI) after a diagnosis of low back pain, Papanicolaou testing in women less than 21 years of age or older than 69 years of age and repeated dual-energy X-ray absorptiometry (DEXA) scanning within 2 years of an index scan...
January 2017: CMAJ Open
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