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https://www.readbyqxmd.com/read/27908840/prescription-opioid-taper-support-for-outpatients-with-chronic-pain-a-randomized-controlled-trial
#1
Mark D Sullivan, Judith A Turner, Cory DiLodovico, Angela D'Appolonio, Kari Stephens, Ya-Fen Chan
Patients receiving long-term opioid therapy for chronic pain and interested in tapering their opioid dose were randomly assigned to a 22-week taper support intervention (psychiatric consultation, opioid dose tapering, and 18 weekly meetings with a physician assistant to explore motivation for tapering and learn pain self-management skills) or usual care (N=35). Assessments were conducted at baseline and 22 and 34 weeks after randomization. Using an intention-to-treat approach, we constructed linear regression models to compare groups at each follow-up...
November 28, 2016: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#2
Matthew B Maas, Andrew M Naidech
The evidence linking delirium to poor outcomes after critical illness is compelling, including higher mortality, prolonged mechanical ventilation, longer length of intensive care unit stay, and long-term cognitive impairments. The attitude toward delirium in the neurologic community is shifting away from viewing it as an unmodifiable, inevitable consequence of severe illness to treating it is as a neurologic emergency, akin to seizures or encephalitis. Delirium, like other manifestations of critical illness encephalopathy, is an organ dysfunction syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27906935/long-term-prednisolone-in-post-stroke-complex-regional-pain-syndrome
#3
Jayantee Kalita, Usha Misra, Ajit Kumar, Sanjeev K Bhoi
BACKGROUND: There is no study on the long-term use of prednisolone in post-stroke complex regional pain syndrome-1 (CRPS1). OBJECTIVE: To evaluate the efficacy and safety of long-term low dose prednisolone in post-stroke CRPS-I. STUDY DESIGN: Open-labeled randomized controlled trial. SETTING: Tertiary care teaching institute. METHODS: Seventy-seven out of 396 (19.4%) patients with stroke had CRPS-1 and 58 met the inclusion criteria...
November 2016: Pain Physician
https://www.readbyqxmd.com/read/27905060/perioperative-risk-adjustment-for-total-shoulder-arthroplasty-are-simple-clinically-driven-models-sufficient
#4
David N Bernstein, Aakash Keswani, David Ring
BACKGROUND: There is growing interest in value-based health care in the United States. Statistical analysis of large databases can inform us of the factors associated with and the probability of adverse events and unplanned readmissions that diminish quality and add expense. For example, increased operating time and high blood urea nitrogen (BUN) are associated with adverse events, whereas patients on antihypertensive medications were more likely to have an unplanned readmission. Many surgeons rely on their knowledge and intuition when assessing the risk of a procedure...
November 30, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27903774/-they-shouldn-t-be-coming-to-the-ed-should-they-a-descriptive-service-evaluation-of-why-patients-with-palliative-care-needs-present-to-the-emergency-department
#5
Emilie Green, Sarah Ward, Will Brierley, Ben Riley, Henna Sattar, Tim Harris
BACKGROUND: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. METHODS: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period...
November 30, 2016: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27903159/recognition-and-treatment-of-central-sensitization-in-chronic-pain-patients-not-limited-to-specialized-care
#6
Jo Nijs, Dorien Goubert, Kelly Ickmans
Modern pain neuroscience has substantially improved our understanding of the (development of) chronic musculoskeletal pain. The time has come for orthopaedic and sports physical therapists to implement modern pain neuroscience in specialized, but definitely also in primary, care settings, including the role of central sensitization (CS) in amplifying and explaining the presence of the pain experience. Central sensitization dominates the clinical picture in a subgroup of the musculoskeletal pain population, ranging from tennis elbow over shoulder pain to osteoarthritis and whiplash...
December 2016: Journal of Orthopaedic and Sports Physical Therapy
https://www.readbyqxmd.com/read/27901398/discriminating-between-neuropathic-pain-and-sensory-hypersensitivity-using-the-chronic-pain-questions-cpq
#7
Karin S Coyne, Brooke M Currie, Sean Donevan, Joseph C Cappelleri, Rozelle Hegeman-Dingle, Lucy Abraham, Christine Thompson, Alesia Sadosky, Marina Brodsky
OBJECTIVE: The Chronic Pain Questions (CPQ) were developed for clinical use with the aim of supporting primary care physicians in the screening, assessment and monitoring of patients with chronic pain. The purpose of this study was to examine the ability of the CPQ to discriminate between patients with neuropathic pain (NeP) versus those with sensory hypersensitivity (SH). METHODS: Adult men and women with a diagnosis of a NeP or SH condition were recruited from 5 clinical sites across the United States...
November 30, 2016: Postgraduate Medicine
https://www.readbyqxmd.com/read/27899166/pain-management-of-acute-appendicitis-in-canadian-pediatric-emergency-departments
#8
Andrea L Robb, Samina Ali, Naveen Poonai, Graham C Thompson
OBJECTIVES: Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs). METHODS: A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital...
November 30, 2016: CJEM
https://www.readbyqxmd.com/read/27894731/content-and-evaluation-of-the-benefits-of-effective-exercise-for-older-adults-with-knee-pain-trial-physiotherapist-training-programme
#9
Melanie A Holden, Rebecca Whittle, Emma L Healey, Susan Hill, Ricky Mullis, Edward Roddy, Gail Sowden, Stephanie Tooth, Nadine E Foster
OBJECTIVE: To explore whether participating in the BEEP trial training programme (ISRCTN93634563) increased physiotherapists' self-confidence, and changed their intended clinical behaviour, regarding exercise for knee pain in older adults. DESIGN: Before/after training programme evaluation. Physiotherapists were asked to complete a questionnaire before the BEEP trial training programme, immediately afterwards, and 12-18 months later (post-intervention delivery in the BEEP trial)...
November 25, 2016: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/27892990/zika-virus-what-the-otolaryngologist-should-know-a-review
#10
Demetri Arnaoutakis, Tapan Padhya
Importance: Initially discovered in 1947, Zika virus infection received little notoriety as a tropical disease until 2015 when an outbreak of microcephaly cases was reported in Brazil. Zika is a single-stranded RNA arbovirus of the Flaviviridae family. The primary source of infection in humans stems from Aedes aegypti mosquito bites but can also occur through sexual, blood, and perinatal transmission. With expectations that 3 to 4 million people across the Americas will be infected over the next year, the World Health Organization has declared this event a Public Health Emergency of International Concern...
November 17, 2016: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/27892753/severe-hip-displacement-reduces-health-related-quality-of-life-in-children-with-cerebral-palsy
#11
Kjersti Ramstad, Reidun B Jahnsen, Terje Terjesen
Background and purpose - Hip displacement is common in children with severe cerebral palsy (CP) and can cause problems such as pain, contractures, and nursing difficulties. Caregiver priorities and child health index of life with disabilities (CPCHILD) is a recently developed measure of health-related quality of life (HRQL) in children with severe CP. The associations between CPCHILD scores and hip displacement have not been investigated. We explored the effect of hip displacement on HRQL. Patients and methods - 67 children were recruited from the population-based Norwegian CP register...
November 28, 2016: Acta Orthopaedica
https://www.readbyqxmd.com/read/27892676/palliative-care-for-patients-with-gynecologic-cancer-in-japan-a-japan-society-of-gynecologic-palliative-medicine-jsgpm-survey
#12
Futagami Masayuki, Yokoyama Yoshihito, Sato Tetsumi, Hirota Kazuyoshi, Shimada Muneaki, Miyagi Etsuko, Suzuki Nao, Fujimura Masaki
Purpose: To evaluate palliative care for patients with gynecologic cancer in Japan. Materials and Method: A questionnaire asking facility characteristics, systems to coordinate palliative care, current status of end-of-life care, provision of symptom relief, palliative radiation therapy and chemotherapy, and cases of death from gynecological cancer, was mailed to facilities treating gynecologic cancer. Results: A total of 115 facilities (29.3% of the total) responded to the questionnaire. Of these, 33.0 (29...
January 10, 2016: Asian Pacific Journal of Cancer Prevention: APJCP
https://www.readbyqxmd.com/read/27889366/intranasal-lidocaine-in-acute-treatment-of-migraine-a-randomized-controlled-trial
#13
Nazire Avcu, Nurettin Özgür Doğan, Murat Pekdemir, Elif Yaka, Serkan Yılmaz, Cansu Alyeşil, Latif Erdem Akalın
STUDY OBJECTIVE: The study aims to evaluate the efficacy and safety of intranasal lidocaine administration for migraine treatment. METHODS: This single-center, double-blind, randomized, controlled trial was conducted in a tertiary care emergency department. Included patients met the migraine criteria of the International Headache Society. Patients were randomized to intranasal lidocaine or saline solution; all participants received 10 mg of intravenous metoclopramide...
November 23, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27886938/implementation-of-musculoskeletal-models-of-care-in-primary-care-settings-theory-practice-evaluation-and-outcomes-for-musculoskeletal-health-in-high-income-economies
#14
REVIEW
Krysia S Dziedzic, Simon French, Aileen M Davis, Elizabeth Geelhoed, Mark Porcheret
Musculoskeletal conditions represent one of the largest causes of years lived with disability in high-income economies. These conditions are predominantly managed in primary care settings, and yet, there is a paucity of evidence on which approaches work well in increasing the uptake of best practice and in closing the evidence-to-practice gap. Increasingly, musculoskeletal models of service delivery (as components of models of care) such as integrated care, stratified care and therapist-led care have been tested in primary health care pathways for joint pain in older adults, for low back pain and for arthritis...
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886697/nonsurgical-management-of-osteoarthritis-knee-pain-in-the-older-adult
#15
REVIEW
Nora Taylor
Symptomatic knee osteoarthritis is a common complaint of many elderly patients in primary care offices. For those unable or unwilling to undergo knee replacement, the primary practitioners' understanding of the strengths and weaknesses of the available treatment modalities for pain relief is critical to successful in-office counseling and expectation management. Treatment requires a multimodal approach of nonpharmacologic and pharmacologic therapies to achieve a maximal clinical benefit. The focus of this review is on the nonsurgical options for treatment of knee osteoarthritis in patients aged 65 and older...
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27885658/early-skin-to-skin-contact-for-mothers-and-their-healthy-newborn-infants
#16
REVIEW
Elizabeth R Moore, Nils Bergman, Gene C Anderson, Nancy Medley
BACKGROUND: Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs...
November 25, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27884458/risk-of-carotid-stroke-after-chiropractic-care-a-population-based-case-crossover-study
#17
J David Cassidy, Eleanor Boyle, Pierre Côté, Sheilah Hogg-Johnson, Susan J Bondy, Scott Haldeman
BACKGROUND: Chiropractic manipulation is a popular treatment for neck pain and headache, but may increase the risk of cervical artery dissection and stroke. Patients with carotid artery dissection can present with neck pain and/or headache before experiencing a stroke. These are common symptoms seen by both chiropractors and primary care physicians (PCPs). We aimed to assess the risk of carotid artery stroke after chiropractic care by comparing association between chiropractic and PCP visits and subsequent stroke...
November 21, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27884218/the-current-state-of-perioperative-pain-management-challenges-and-potential-opportunities-for-nurses
#18
Melanie H Simpson, Patricia Bruckenthal
Achievement of adequate postoperative pain management is a critical challenge in health care, with an estimated three out of four adult surgical patients reporting moderate to extreme pain after surgery. Overreliance on opioids in acute care settings has persisted, despite well-known adverse side effects frequently associated with this class of drugs. Furthermore, patients with a history of chronic opioid use present additional challenges in terms of postsurgical pain management. Advances in the development of newer analgesic agents and anesthetic techniques may be useful in surgical patients with a history of chronic opioid use and in the overall surgical patient population...
December 2016: AORN Journal
https://www.readbyqxmd.com/read/27881926/improving-pain-care-through-implementation-of-the-stepped-care-model-at-a-multisite-community-health-center
#19
Daren R Anderson, Ianita Zlateva, Emil N Coman, Khushbu Khatri, Terrence Tian, Robert D Kerns
PURPOSE: Treating pain in primary care is challenging. Primary care providers (PCPs) receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM) at a large, multisite Federally Qualified Health Center...
2016: Journal of Pain Research
https://www.readbyqxmd.com/read/27881523/effects-of-culture-sensitive-adaptation-of-patient-information-material-on-usefulness-in-migrants-a-multicentre-blinded-randomised-controlled-trial
#20
Lars P Hölzel, Zivile Ries, Levente Kriston, Jörg Dirmaier, Jördis M Zill, Christine Rummel-Kluge, Wilhelm Niebling, Isaac Bermejo, Martin Härter
OBJECTIVES: To evaluate the usefulness of culture-sensitive patient information material compared with standard translated material. DESIGN: Multicentre, double-blind randomised controlled trial. SETTING: 37 primary care practices. PARTICIPANTS: 435 adult primary care patients with a migration background with unipolar depressive disorder or non-specific chronic low back pain were randomised. Patients who were unable to read in the language of their respective migration background were excluded...
November 23, 2016: BMJ Open
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