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Inadequate pain

Wayne W Morriss, Miodrag S Milenovic, Faye M Evans
There are inadequate numbers of anesthesia providers in many parts of the world. Good quality educational programs are needed to increase provider numbers, train leaders and teachers, and increase knowledge and skills. In some countries, considerable external support may be required to develop self-sustaining programs. There are some key themes related to educational programs in low- and middle-income countries:(1) Programs must be appropriate for the local environment-there is no "one-size-fits-all" program...
April 2018: Anesthesia and Analgesia
Mohan Giri, Mamata Giri, Rabin Jung Thapa, Bibhuti Upreti, Bijay Pariyar
Breast cancer is the second most common malignancy among Nepalese women. Breast cancer places a substantial burden on the Nepalese healthcare system, but information regarding the number of women living with breast cancer is not well recorded. In countries with lower levels of resources such as Nepal, breast cancers are commonly diagnosed at late stages and women may receive inadequate treatment, pain relief or palliative care. Socioeconomic disparities and insufficient financial resources hinder prevention of breast cancer in Nepal...
April 2018: Biomedical Reports
Sindy Villacres, Corrie E Chumpitazi
Pain is a chief complaint in children seeking medical care, yet it may also be experienced in evaluation and treatment during office visits. Inadequate relief of children's procedural pain and distress not only affects the experience of the children and their parents, but also adversely affects procedural outcomes. Despite increasing awareness and research, management of procedural pain and anxiety in children is often inadequate. In addition, parent and patient satisfaction is often tied to pain management...
March 1, 2018: Pediatric Annals
H T Sun, M Xu, G L Chen, J He
Objective: This study aimed to compare dexmedetomidine with remifentanil for conscious sedation in patients undergoing radiofrequency ablation of hepatocellular carcinoma. Methods: Sixty patients, who were aged 41 to 73 years with American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, and scheduled for elective radiofrequency ablation of hepatocellular carcinoma under conscious sedation in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from January 2014 to June 2016, were allocated randomly to receive dexmedetomidine maintenance regimen(group D, n =30)or remifentanil maintenance regimen(group R, n =30)by random digital table...
February 27, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Michael W M Gerrickens, Roel H D Vaes, Bastiaan Govaert, Joep A W Teijink, Marc R Scheltinga
INTRODUCTION: Some hemodialysis patients with a brachial arteriovenous fistula (AVF) have an unsuitable upper arm needle access segment (NAS) necessitating basilic vein transposition (BVT). It was frequently observed that a portion of these patients spontaneously experienced a warmer and less painful dialysis hand after BVT. Aim of this study was to determine whether BVT for an inadequate NAS attenuated hemodialysis access-induced distal ischemia in patients with a brachial AVF. METHODS: Patients with a brachial AVF and an unsuitable NAS also reporting hand ischemia and scheduled to undergo BVT between 2005 and 2016 in a single facility were studied...
March 8, 2018: Hemodialysis International
Zi-Ming Zhao, Jin Wang, Ugochukwu C Ugwuowo, Liming Wang, Jeffrey P Townsend
Background: Primary hepatic neuroendocrine carcinoma (PHNEC) is extremely rare. The diagnosis of PHNEC remains challenging-partly due to its rarity, and partly due to its lack of unique clinical features. Available treatment options for PHNEC include surgical resection of the liver tumor(s), radiotherapy, liver transplant, transcatheter arterial chemoembolization (TACE), and administration of somatostatin analogues. Case presentation: We report two male PHNEC cases and discuss the diagnosis and treatment options...
2018: BMC Clinical Pathology
J P H Wong, M Vahabi, J Miholjcic, V Tan, M Owino, A T W Li, M K L Poon
Cervical cancer rates are disproportionately high among women living with the human immunodeficiency virus (wlhiv). Cervical cancer is preventable through hpv screening, regular Pap tests, and early cancer detection. Evidence indicates that hpv and cervical cancer screening are suboptimal among wlhiv, who face a myriad of access barriers. Considering that screening is an effective first-line defense to cervical cancer, we conducted a scoping review with the aim of gaining a better understanding about: (1) the knowledge and perceptions of hpv and cervical cancer screening among wlhiv; and (2) the acceptability of self-sampling for hpv among wlhiv...
February 2018: Current Oncology
Nathan R Blue, Cristina Murray-Krezan, Shana Drake-Lavelle, Daniel Weinberg, Bradley D Holbrook, Vivek R Katukuri, Lawrence Leeman, Ellen L Mozurkewich
BACKGROUND: Non-steroidal anti-inflammatory drug use has been shown to increase blood pressure in non-pregnant adults. Because of this, the American College of Obstetricians and Gynecologists suggests avoiding their use in women with postpartum hypertension; however, evidence to support this recommendation is lacking. OBJECTIVES: Our goal was to test the hypothesis that non-steroidal anti-inflammatory drugs, such as ibuprofen, adversely affect postpartum blood pressure control in women with preeclampsia with severe features...
March 2, 2018: American Journal of Obstetrics and Gynecology
Arvind G Kulkarni, Shashidhar Bangalore Kantharajanna, Abhilash N Dhruv
Study Design: Retrospective case series. Purpose: To compare minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) outcomes in primary and revision surgeries. Overview of Literature: Revision spinal fusion is often associated with an increased risk of approach-related complications. Patients can potentially benefit from the decreased approach-related morbidity associated with MI-TLIF. Methods: Sixty consecutive MI-TLIF patients (20 failed back [Fa group], 40 primary [Pr group]) who underwent surgery between January 2011 and May 2012 were reviewed after Institutional Review Board approval to compare operative times, blood loss, complications, Oswestry Disability Index (ODI) scores, and Visual Analog Scale (VAS) scores for back and leg pain before surgery and at the last follow-up...
February 2018: Asian Spine Journal
Beliz Özen, Y Özay Özdemir, E Emrem Beştepe
Objective: Causes such as childhood trauma, negative attitude about sexuality, inadequate sexual knowledge and education, relationship problems, and unconscious motivation are reported about psychosexual development in the etiology of genito-pelvic pain/penetration disorder (GPP/PD). There are few studies that focus directly on research etiology of GPP/PD and use structured scales. The aim of this study was to research childhood trauma and dissociation forms among women with GPP/PD. Patients and methods: Fifty-five women with GPP/PD according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and 61 healthy women with no complaints of sexual function as a control group, in the age range of 18-60 years, were included in this study...
2018: Neuropsychiatric Disease and Treatment
Chris Gilleard
Much of the literature on ageing is presaged upon a model of advocacy that seeks to combat what is seen as the negative stereotyping of old age and old people. One consequence is that ageing studies has difficulty in confronting the darker side of ageing except in so far as age associated disability and distress can be attributed to extrinsic disadvantage, such as low income, poor housing and inadequate services. The pain and suffering associated with age itself tend to be neglected as subject experiences. This paper seeks to shed some light on these topics, considered under the general heading of 'suffering'...
March 2018: Journal of Aging Studies
Gary Groesbeck, Donna Bach, Peta Stapleton, Katharina Blickheuser, Dawson Church, Rebecca Sims
This study investigated changes in psychological and physiological markers during a weekend meditation workshop (N = 34). Psychological symptoms of anxiety, depression, posttraumatic stress disorder (PTSD) and happiness were assessed. Physiological markers included cortisol, salivary immunoglobulin A (SigA), heart rate variability (HRV), blood pressure (BP), and resting heart rate (RHR). On posttest, significant reductions were found in cortisol (-29%, P < .0001), RHR (-5%, P = .0281), and pain (-43%, P = ...
January 2018: J Evid Based Integr Med
Mikkel Bek Clausen, Thomas Bandholm, Michael Skovdal Rathleff, Karl Bang Christensen, Mette Kreutzfeldt Zebis, Thomas Graven-Nielsen, Per Hölmich, Kristian Thorborg
BACKGROUND: Subacromial impingement syndrome (SIS) is a painful, and often long lasting, shoulder condition affecting patient function and quality of life. In a recent study, we observed major strength impairments in shoulder external rotation and abduction (~30%) in a population of patients with pronounced and long-lasting SIS. However, the current rehabilitation of such strength impairments may be inadequate, with novel rehabilitation programmes including exercise therapy only improving external rotation strength by 4-13%...
March 2, 2018: Trials
Tobias Hesper, Sarah D Bixby, Daniel A Maranho, Patricia Miller, Young-Jo Kim, Eduardo N Novais
BACKGROUND: Hip osteoarthritis has been reported in the contralateral hip in patients who had been treated for unilateral slipped capital femoral epiphysis (SCFE) during adolescence. Although this might be related to the presence of a mild deformity, the morphologic features of the contralateral hip in unilateral SCFE remains poorly characterized. QUESTIONS/PURPOSES: Do measurements of (1) femoral head-neck concavity (α angle and femoral head-neck offset), (2) epiphyseal extension into the metaphysis (epiphyseal extension ratio and epiphyseal angle), and (3) posterior tilt of the epiphysis (epiphyseal tilt angle) differ between the contralateral asymptomatic hips of patients treated for unilateral SCFE and hips of an age- and sex-matched control population without a history of hip disease? METHODS: From January 2005 to May 2015, 442 patients underwent surgical treatment for SCFE at our institution...
February 23, 2018: Clinical Orthopaedics and related Research
Aaron Hanson, Amy L Drendel
Objective: Most children treated in the emergency department (ED) with painful conditions are discharged home to the care of their parents. There is growing evidence that at-home pain management is inadequate. No studies have evaluated the child's report of their at-home pain experience. Our objective was to explore the child's perspective on the pain experience at home after ED discharge. Methods: We performed semistructured interviews with children aged 4 to 14 years discharged from the ED with an arm fracture...
July 2017: Paediatrics & Child Health
Joe Alexander, Roger A Edwards, Luigi Manca, Roberto Grugni, Gianluca Bonfanti, Birol Emir, Edward Whalen, Stephen Watt, Bruce Parsons
INTRODUCTION: Achieving a therapeutic response to pregabalin in patients with painful diabetic peripheral neuropathy (pDPN) requires adequate upward dose titration. Our goal was to identify relationships between titration and response to pregabalin in patients with pDPN. METHODS: Data were integrated from nine randomized, placebo-controlled clinical trials as well as one 6-week open-label observational study conducted by 5808 physicians (2642 patients with pDPN) in standard outpatient settings in Germany...
February 23, 2018: Advances in Therapy
Omar Laraqui, Nadia Manar, Salwa Laraqui, Mehdi Boukili, Tarik Ghailan, Frédéric Deschamps, Chakib El Houssine Laraqui
OBJECTIVES: The aim of this study was to evaluate the well-being and occupational perception of healthcare workers in Morocco. METHODS: This observational and cross-sectional survey, carried out by self-administered questionnaire, was conducted in public hospitals in three cities. The target population consisted of 2,453 healthcare workers, comprising physicians and paramedics with at least two years of clinical experience. RESULTS: 1951 healthcare workers returned the questionnaire (29...
November 2017: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
Flavio Marti, Antonella Paladini, Giustino Varrassi, Roberto Latina
INTRODUCTION: Adolescents' pain experiences are complex and multidimensional, and evaluating pain only from a sensory and affective point of view may be in many instances limiting and inadequate; this is the reason why it is of paramount importance to identify the tools which can better assess the pain experienced by young patients. A person-oriented approach is highly encouraged, as it may better investigate the cognitive and behavioral development typical of this age group. The aim of this review paper is to describe the available tools which are able to adequately assess pain intensity in adolescents, in particular those validated in Italian...
February 22, 2018: Pain and Therapy
A Robledo, E Godoy, E Manrique, P Manchado
Retronychia is a recently described cause of ingrowth of the nail plate on the ventral surface of the proximal nail fold. Clinical features are repeated episodes of proximal paronychia, nail plate thickening, and occasionally granulation tissue emergence. The usual treatments for paronychia such as antibiotics and antifungals are ineffective in these cases. Avulsion of the nail plate is the treatment of choice for these patients, but effective treatment is usually delayed owing to inadequate diagnosis. Herein, we describe a 28-year-old woman with a case of retronychia...
July 15, 2017: Dermatology Online Journal
Roberta I Jordan, Matthew R Mulvey, Michael I Bennett
PURPOSE OF REVIEW: Gabapentinoids are frequently used in the management of cancer pain. In recent Cochrane systematic reviews, although there was an abundance of evidence relating to non-cancer pain, only a few studies related to cancer pain. This review summarizes recent randomised controlled trials (RCTs) evaluating the use of gabapentinoids for tumour-related (as monotherapy or part of combination therapy) and treatment-related pain. RECENT FINDINGS: For tumour-related pain, ten out of thirteen studies showed statistically significant benefits in favour of gabapentinoids...
February 19, 2018: Current Opinion in Supportive and Palliative Care
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