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Primary care, pain

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https://www.readbyqxmd.com/read/28814096/ankle-block-vs-single-shot-popliteal-fossa-block-as-primary-anesthesia-for-forefoot-operative-procedures-prospective-randomized-comparison
#1
Oliver N Schipper, Kenneth J Hunt, Robert B Anderson, W Hodges Davis, Carroll P Jones, Bruce E Cohen
BACKGROUND: Postoperative pain is often difficult to control with oral medications, requiring large doses of opioid analgesia. Regional anesthesia may be used for primary anesthesia, reducing the need for general anesthetic and postoperative pain medication requirements in the immediate postoperative period. The purpose of this study was to compare the analgesic effects of an ankle block (AB) to a single-shot popliteal fossa block (PFB) for patients undergoing orthopedic forefoot procedures...
August 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28813764/incidental-finding-of-giant-left-ventricular-aneurysm-case-report-and-literature-review
#2
Muhammad Omar, Shenjing Li, Amornpol Anuwatworn
Left ventricular aneurysms and pseudoaneurysms are complications of myocardial infarction. With advances in percutaneous coronary intervention, development of thrombolytic agents, and early initiation of treatment with angiotensin-converting enzyme inhibitors to decrease afterload and inhibit left ventricular remodeling, these complications have become much less common. Here, we report an incidental finding of a giant aneurysm of the left ventricle with associated thrombus and mural calcifications in an elderly male patient who presented to his primary care physician for abdominal pain and denied any prior coronary artery disease...
June 2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28810814/acceptability-of-a-vocational-advice-service-for-patients-consulting-in-primary-care-with-musculoskeletal-pain-a-qualitative-exploration-of-the-experiences-of-general-practitioners-vocational-advisers-and-patients
#3
Tom Sanders, Gwenllian Wynne-Jones, Bie Nio Ong, Majid Artus, Nadine Foster
AIMS: Using qualitative interviews, this study explored the experiences of GPs, vocational advisers and patients towards a new vocational advice (VA) service in primary care. METHODS: This study was nested within the Study of Work and Pain (SWAP) cluster randomised controlled trial. The SWAP trial located a VA service within three general practices in Staffordshire. Interviews took place with 10 GPs 12 months after the introduction of the VA service, four vocational advisers whilst the VA service was running and 20 patients on discharge from the VA service...
August 1, 2017: Scandinavian Journal of Public Health
https://www.readbyqxmd.com/read/28810024/effect-of-an-intensive-lifestyle-intervention-on-glycemic-control-in-patients-with-type-2-diabetes-a-randomized-clinical-trial
#4
Mette Yun Johansen, Christopher Scott MacDonald, Katrine Bagge Hansen, Kristian Karstoft, Robin Christensen, Maria Pedersen, Louise Seier Hansen, Morten Zacho, Anne-Sophie Wedell-Neergaard, Signe Tellerup Nielsen, Ulrik Wining Iepsen, Henning Langberg, Allan Arthur Vaag, Bente Klarlund Pedersen, Mathias Ried-Larsen
Importance: It is unclear whether a lifestyle intervention can maintain glycemic control in patients with type 2 diabetes. Objective: To test whether an intensive lifestyle intervention results in equivalent glycemic control compared with standard care and, secondarily, leads to a reduction in glucose-lowering medication in participants with type 2 diabetes. Design, Setting, and Participants: Randomized, assessor-blinded, single-center study within Region Zealand and the Capital Region of Denmark (April 2015-August 2016)...
August 15, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28809134/cancer-treatment-experiences-among-survivors-of-childhood-sexual-abuse-a-qualitative-investigation-of-triggers-and-reactions-to-cumulative-trauma
#5
Julie B Schnur, Matthew J Dillon, Rachel E Goldsmith, Guy H Montgomery
OBJECTIVE: Some 25% of women and 8% of men in the United States have experienced childhood sexual abuse (CSA) before the age of 18. For these individuals, healthcare visits and interactions can be retraumatizing due to perceived similarities to past abuse (e.g., pain, undressing, lack of control). However, no prior studies have provided formal qualitative analyses regarding CSA survivors' reactions to cancer treatment. Therefore, our study's objective was to identify key themes pertaining to CSA survivors' cancer treatment experiences...
August 15, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/28807736/uterine-didelphys-with-bilateral-cervical-agenesis-in-a-15-year-old-female
#6
Kate C Arnold, Theresa C Thai, LaTasha B Craig
BACKGROUND: Isolated uterine didelphys requires no treatment in contrast to cervical agenesis, which requires a hysterectomy. Given this, correct diagnosis of Müllerian anomalies is paramount for making recommendations for patient care. CASE: A 15-year-old presented to clinic with pelvic pain and primary amenorrhea. Uterine didelphys with bilateral cervical agenesis was diagnosed by imaging. Hysterectomy was recommended and diagnosis was confirmed at surgery and by anatomic pathology...
August 11, 2017: Journal of Pediatric and Adolescent Gynecology
https://www.readbyqxmd.com/read/28806026/physician-perceptions-of-barriers-to-advance-care-planning
#7
Lauren Fanta, Jill Tyler
BACKGROUND: Numerous studies have confirmed the importance of advance care planning. Despite the benefits of directed end-of-life discussions, a variety of barriers including discomfort with the topic, physician ideology, lack of time and reimbursement, delaying discussions, and lack of training impede physicians from facilitating these crucial conversations with their patients. This study aims to understand physicians' perceptions to additional barriers to advance care planning with patients and their families...
July 2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28803601/ultrasound-guided-transversus-abdominis-plane-block-improves-postoperative-analgesia-and-early-recovery-in-patients-undergoing-retroperitoneoscopic-urologic-surgeries-a-randomized-controlled-double-blinded-trial
#8
Ge Qu, Xu-Lei Cui, Hong-Ju Liu, Zhi-Gang Ji, Yu-Guang Huang
Objective To evaluate the effects of ultrasound-guided transversus abdominis plane (TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries. Methods This was a randomized, controlled, double-blinded trial. Eligible patients scheduled for retroperitoneoscopic urologic surgeries were randomly assigned to two groups. Group TAP received ultrasound-guided TAP block with 0.5% ropivacaine 20 ml at 30 minutes before surgery, and Group C received TAP sham block with normal saline...
September 20, 2016: Chinese Medical Sciences Journal, Chung-kuo i Hsüeh K'o Hsüeh Tsa Chih
https://www.readbyqxmd.com/read/28802594/intraoperative-ketorolac-dose-of-15mg-versus-the-standard-30mg-on-early-postoperative-pain-after-spine-surgery-a-randomized-blinded-non-inferiority-trial
#9
Kaylene M Duttchen, Andy Lo, Andrew Walker, Duncan McLuckie, Cecilia De Guzman, Helen Roman-Smith, Melinda Davis
STUDY OBJECTIVE: The primary aim of this study is to show the non-inferiority of 15mg intraoperative dose of ketorolac as compared to the standard 30mg ketorolac by looking at the visual analog scale pain (VAS) scores 4h after an adult spine surgery. DESIGN: The study design is a prospective randomized non-inferiority clinical trial looking at non-inferiority of intraoperative 15mg ketorolac from the standard 30mg dose. SETTING: Quaternary care center...
September 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28801412/health-practitioners-perceptions-of-adopting-clinical-prediction-rules-in-the-management-of-musculoskeletal-pain-a-qualitative-study-in-australia
#10
Joan Kelly, Michele Sterling, Trudy Rebbeck, Aila Nica Bandong, Andrew Leaver, Martin Mackey, Carrie Ritchie
OBJECTIVES: To investigate health practitioners' understanding and practice behaviours with regards to clinical prediction rules (CPRs) and explore their perceptions of adopting a new whiplash CPR. DESIGN: Qualitative study using six semistructured focus groups. SETTING: Primary and secondary care in New South Wales and Queensland, Australia. PARTICIPANTS: Physiotherapists (n=19), chiropractors (n=6) and osteopaths (n=3) were purposively sampled to include health practitioners who provide routine treatment to people with whiplash-associated disorders...
August 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28801148/assessing-and-addressing-the-problem-of-pain-and-distress-during-wound-care-procedures-in-paediatric-patients-with-burns
#11
Marianne J E van der Heijden, Alette de Jong, Heinz Rode, Roux Martinez, Monique van Dijk
OBJECTIVE: While the prevalence of burns in children is highest in low and middle-income countries, most research on burn-related pain intensity and distress is carried out in high-income countries. In this study we assessed pain intensity and distress in paediatric patients with burns undergoing wound care procedures without distraction and parental presence in a South-African children's hospital and sought to identify predictors for the outcomes. METHODS: This observational study, carried out as part of a randomized controlled trial, took place at a burns unit in Cape Town, South Africa and included patients between the ages of 0 and 13 years undergoing their first or second wound care procedure...
August 8, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28801032/physiotherapy-for-patients-with-shoulder-pain-in-primary-care-a-descriptive-study-of-diagnostic-and-therapeutic-management
#12
Y H J M Karel, G G M Scholten-Peeters, M Thoomes-de Graaf, E Duijn, J B van Broekhoven, B W Koes, A P Verhagen
BACKGROUND: Shoulder pain is one of the three main musculoskeletal complaints and more than 50% of the patients have symptoms longer than 6 months. Until now, limited data exist about the content of physiotherapy for patients with shoulder pain in primary care. OBJECTIVE: Describe current physiotherapeutic diagnostic- and therapeutic management, including the use of diagnostic ultrasound, in patients with shoulder pain in primary care. DESIGN AND SETTING: A prospective cohort study in primary care physiotherapy with a 12 week follow-up...
November 28, 2016: Physiotherapy
https://www.readbyqxmd.com/read/28800938/using-hospital-use-trends-to-improve-transitional-care
#13
Joe Feinglass, Celeste A Mallama, Angela Rogers, Caroline Teter, Courtney Hurt, Christine Schaeffer
BACKGROUND: This study evaluates the Northwestern Medicine Group Transitional Care clinic (NMG-TC), which transitions patients from an urban hospital to primary care at partner community clinics. We evaluate change over the 55 month study period in emergency department, observation or inpatient use within 90 days of an initial NMG-TC visit. METHODS: Electronic health records were used to determine patient demographic, insurance and clinical characteristics, including inflation-adjusted total hospital charges in the 90 days prior and the 90 days after an initial NMG-TC visit...
August 8, 2017: Healthcare
https://www.readbyqxmd.com/read/28800866/five-year-trends-of-critical-care-practice-and-outcomes
#14
Craig M Lilly, Sunil Swami, Xinggang Liu, Richard R Riker, Omar Badawi
BACKGROUND: Longitudinal analyses of large detailed adult critical care datasets provide insights into practice trends and generate useful outcome and process benchmarks. METHODS: Data representing 991,571 consecutive critical care visits to160 United States adult ICUs during 2009 to 2013 from the eICU Research Institute clinical practice database were used to quantitate patient characteristics, APACHE IV based acuity predictions, treatments, and outcomes. Analyses for changes over time were performed for patient characteristics, entry and discharge locations, primary admission diagnosis, treatments, adherence to consensus ICU best practices, length of stay (LOS), and inpatient mortality...
August 8, 2017: Chest
https://www.readbyqxmd.com/read/28798450/atraumatic-restorative-treatment-and-minimal-intervention-dentistry
#15
J E Frencken
Too many people worldwide suffer from the consequences of untreated dentine carious lesions. This finding reflects the inability of the currently used traditional mode of treatments to manage such lesions. A change is needed. Dental training institutions should depart from the traditional 'drill and fill' treatments and embrace the holistic oral healthcare approach that is minimal intervention dentistry (MID) and includes within it minimally invasive operative skills. Dental caries is, after all, a preventable disease...
August 11, 2017: British Dental Journal
https://www.readbyqxmd.com/read/28797833/percutaneous-rupture-of-zygapophyseal-joint-synovial-cysts-a-prospective-assessment-of-nonsurgical-management
#16
Gregory E Lutz, Michael R Nicoletti, George E Cyril, Julian R Harrison, Christopher Lutz, Jennifer L Solomon, Paul M Cooke, James F Wyss, Richard J Herzog, Peter J Moley
BACKGROUND: Although lumbar zygapophyseal joint synovial cysts are fairly well recognized, they are an uncommon cause of lumbosacral radicular pain. Non-operative treatments include percutaneous aspiration of the cysts under computed tomography or fluoroscopic guidance with a subsequent corticosteroid injection. However, there are mixed results in terms of long-term outcomes and cyst reoccurrence. This study prospectively evaluates percutaneous ruptures of zygapophyseal joint (Z-joint) synovial cysts for the treatment of lumbosacral radicular pain...
August 7, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28795860/access-to-palliative-care-consultation-and-advance-care-planning-for-adults-with-high-risk-leukemia
#17
Ashley T Freeman, William A Wood, Alexandra Fox, Laura C Hanson
BACKGROUND: Although strong evidence supports early palliative care (PC) and consistent advance care planning (ACP) for patients with poor-prognosis Stage IV solid tumors, best practice standards have not been established for hematologic malignancies. Our primary objective was to describe current access to specialty PC consultation and ACP for inpatients with high-risk leukemia. Secondary objectives were to describe components of ACP and PC practices. METHODS: We enrolled all patients with high-risk leukemia (acute leukemia ≥65 years or relapsed leukemia >18 years) admitted to the University of North Carolina Cancer Hospital from October 1, 2015, to August 1, 2016...
August 10, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28794840/virtual-reality-distraction-decreases-routine-intravenous-sedation-and-procedure-related-pain-during-preoperative-adductor-canal-catheter-insertion-a-retrospective-study
#18
Pooja G Pandya, T Edward Kim, Steven K Howard, Erica Stary, Jody C Leng, Oluwatobi O Hunter, Edward R Mariano
BACKGROUND: Virtual reality (VR) distraction is a nonpharmacological method to prevent acute pain that has not yet been thoroughly explored for anesthesiology. We present our experience using VR distraction to decrease routine intravenous sedation for patients undergoing preoperative perineural catheter insertion. METHODS: This 1-month quality improvement project involved all elective unilateral primary total knee arthroplasty patients who received a preoperative adductor canal catheter...
August 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28793903/latent-class-analysis-derived-subgroups-of-low-back-pain-patients-do-they-have-prognostic-capacity
#19
Anne Molgaard Nielsen, Lise Hestbaek, Werner Vach, Peter Kent, Alice Kongsted
BACKGROUND: Heterogeneity in patients with low back pain is well recognised and different approaches to subgrouping have been proposed. One statistical technique that is increasingly being used is Latent Class Analysis as it performs subgrouping based on pattern recognition with high accuracy. Previously, we developed two novel suggestions for subgrouping patients with low back pain based on Latent Class Analysis of patient baseline characteristics (patient history and physical examination), which resulted in 7 subgroups when using a single-stage analysis, and 9 subgroups when using a two-stage approach...
August 9, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28793876/patient-satisfaction-with-extavipro%C3%A2-30g-a-new-auto-injector-for-administering-interferon-%C3%AE-1b-in-multiple-sclerosis-results-from-a-real-world-observational-exchange-study
#20
Frank A Hoffmann, Anastasiya Trenova, Miguel A Llaneza, Johannes Fischer, Giacomo Lus, Dorothea von Bredow, Núria Lara, Elaine Lam, Marlies Van Hoef, Rajesh Bakshi
BACKGROUND: Patients with multiple sclerosis (MS) receiving long-term, subcutaneous interferon β-1b (IFN β-1b; Extavia®) often experience injection-site reactions and injection-site pain, which together with other side-effects (such as flu-like symptoms) result in suboptimal treatment compliance/adherence. The EXCHANGE study evaluated patient satisfaction with IFN β-1b treatment, administered using ExtaviPro™ 30G, a new auto-injector, in a real-world setting. METHODS: This 26-week, open-label, prospective, non-interventional, observational, multi-country multi-centre study enrolled patients with MS who had been treated with IFN β-1b or other disease-modifying therapies with a self-administered auto-injector for ≥3 months and who were planned to switch to IFN β-1b treatment administered using ExtaviPro™ 30G as part of routine clinical care...
August 9, 2017: BMC Neurology
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