Use Of Analgesic Drugs Research Articles

Impact of sedation and analgesia during noninvasive positive pressure ventilation on outcome: a marginal structural model causal analysis.

There are limited data available about the role of sedation and analgesia during noninvasive positive pressure ventilation (NPPV). The objective of study was to estimate the effect of analgesic or sedative drugs on the failure of NPPV. We studied patients who received at least 2 h of NPPV as first-line therapy in a prospective observational study carried out in 322 intensive care units from 30 countries. A marginal structural model (MSM) was used to analyze the association between the use of analgesic or sedative drugs and NPPV failure (defined as need for invasive mechanical ventilation). 842 patients were included in the analysis. Of these, 165 patients (19.6%) received analgesic or sedative drugs at some time during NPPV; 33 of them received both. In the adjusted analysis, the use of analgesics (odds ratio 1.8, 95% confidence interval 0.6-5.4) or sedatives (odds ratio 2.8, 95% CI 0.85-9.4) alone was not associated with NPPV failure, but their combined use was associated with failure (odds ratio 5.7, 95% CI 1.8-18.4). Slightly less than 20% of patients received analgesic or sedative drugs during NPPV, with no apparent effect on outcome when used alone. However, the simultaneous use of analgesics and sedatives may be associated with failure of NPPV.

Manejo de la sedación y la analgesia en unidades de cuidados intensivos neonatales españolas

IntroductionPain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. MethodA multicenter, observational, longitudinal and prospective study. ResultsThirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam.The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P<.001; OR=23.79), a CRIB score >3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (P<.001; OR=3.82), and a pain leader (P=.034; OR=2.35). ConclusionsAlmost half of the neonates admitted to intensive care units receive sedatives or analgesics.There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the “state of the art”, and could serve as the basis of preparing clinical practice guidelines at a national level.

Psychometric Analysis of Behavioral Pain Scale Brazilian Version in Sedated and Mechanically Ventilated Adult Patients: A Preliminary Study.

Pain assessment in Intensive Care Units (ICU) can be performed based on validated instruments as the Behavioral Pain Scale (BPS). Despite the existence of this clinical score, there is no Brazilian version of it to assess critically ill patients. This study aimed to translate the BPS into Brazilian Portuguese, verify its psychometric properties (reliability, validity, and responsiveness) and the correlation between pain measured and heart rate (HR), blood pressure (BP), Ramsay, and RASS scores. Pain intensity by using Brazilian BPS version, HR, and BP were observed by 2 investigators during 3 different moments: at rest; during eye cleaning (EC); and tracheal suctioning (TS) in 15 adult subjects sedated and mechanically ventilated. Sedation level, severity of disease, and use of sedatives and analgesic drugs were also recorded. There was a high responsiveness coefficient (coefficient=1.72) and pain was significantly higher during tracheal suctioning (P≤0.003) and eye cleaning (P≤0.04) than at rest. It was evidenced a low reliability and no significant correlation between translated BPS scores and physiological parameters during tracheal suctioning, sedation scales, flow of the sedatives drugs, or with the general health status (P>0.07). Brazilian BPS has high responsiveness and capacity to detect pain intensity in different situations in the ICU routine. This preliminary study proved the feasibility and importance of valid this scale in Brazil in order to improve critically ill patients care.

How to Become Mother-Friendly: Policies and Procedures for Hospitals, Birth Centers, and Home Birth Services

HOW TO BECOME MOTHER-FRIENDLY: POLICIES AND PROCEDURES FOR HOSPITALS, BIRTH CENTERS, AND HOME BIRTH SERVICES Barbara Hotelling and Helen Gordon, Editors New York: Springer Publishing Compan y, 2014, 184 pp., $75.00 (paperback)The Mother-Friendly Childbirth Initiative (MFCI) is the first and only consensus document on maternity care in the United States. It was originally published in 1997 by the Coalition for Improving Maternity Services (CIMS), composed of more than 26 organizations that focused on perinatal health. CIMS intended to promote maternity care, which improves birth outcomes and reduces the costs of maternity care. The MFCI consisted of 10 evidence-based steps for birth facilities to deliver motherfriendly health care.Hotelling and Gordon's book, How to Become Mother-Friendly: Policies and Procedures for Hospitals, Birth Centers, and Home Birth Services, translates the steps of MFCI into discrete policies and procedures applicable to the environment of birth facilities. I outline the policies and procedures for each of the steps.* Step 1 ; A mother-friendly hospital, birth center, or home birth service offers all birthing mothers unrestricted access to birth companions, labor support, and professional midwifery care.* Step 2: A mother-friendly hospital, birth center, or home birth service provides accurate descriptive and statistical information to the public about the practices and procedures for birth, including measures of intervention and outcomes.* Step 3: A mother-friendly hospital, birth center, or home birth service provides culturally competent care; that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother's ethnicity and religion.* Step 4: A mother-friendly hospital, birth center, or home birth service provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.* Step 5: A mother-friendly hospital, birth center, or home birth service has clearly defined policies and procedures for collaborating and consulting with other maternity services and linking the mother and baby to appropriate community resources during both the prenatal and postpartum periods.* Step 6: A mother-friendly hospital, birth center, or home birth service does not routinely employ practices and procedures that are unsupported by scientific evidence.* Step 7: A mother-friendly hospital, birth center, or home birth service educates staff in nondrug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.* Step 8: A mother-friendly hospital, birth center, or home birth service encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.* Step 9: A mother-friendly hospital, birth center, or home birth service discourages nonreligious circumcision of the newborn. …

Coblation Intracapsular Tonsillectomy and Coblation Complete Tonsillectomy for Obstructive Sleep Apnea

Objective: Total tonsillectomy and intracapsular tonsillectomy are common procedures for the treatment of obstructive sleep apnea (OSA) in children. The objective of this study was to compare the effectiveness of coblation intracapsular tonsillectomy (ICT) and coblation complete tonsillectomy (CT) as treatments for OSA. Study design: A retrospective study of all the children ages 2 - 18 years with OSA who underwent coblation intracapsular tonsillectomy (ICT) or coblation complete tonsillectomy (CT) from January 2007 to August 2010 by the same surgeons at one institution. Methods: Data were retrieved from children’s charts and from telephone interviews with children’s parents, regarding pre and postoperative OSA-18 scores, postoperative pain, postoperative complications, use of analgesic drugs, and time to return to a solid food diet. Results: All 43 children who underwent ICT and 37 children who underwent CT suffered from OSA before surgery, and none did postoperatively. There were no minor complications in the ICT group, compared to 13.5% in the CT group (p = 0.01). According to parental report, 72% and 21% suffered a low level of postoperative pain, and 9% and 33% severe pain in the ICT and CT groups, respectively. For these respective groups, 49% and 73% needed analgesic drugs (p < 0.05); and 65% and 35% ate solid food during the first 3 days post surgery. Conclusions: Both ICT and CT were safe, with few complications; however recovery was faster in the ICT group, as demonstrated by less pain, and more rapid return to a solid food diet.

Bethametasone Prevents Plasmatic Glutamine Precipitation: An In-Vivo Study

Glutamine (Gln) is an amino acid which plays an important regulatory role in many physiological functions and during acute or chronic human pathologies. The primary purpose of this study was to investigate potential changes of glutamine levels in the plasma of women that needed minor gynaecological surgery. The changes in glutamine levels were then evaluated in a group of patients pre-medicated with Bethametasone. In this study 46 patients were subdivided into two groups. All of them were anesthetized with loco-regional administration of mepivacaine 0.2%. Subsequently, to the first group was given placebo, whereas the second group of women was pre-medicated with Bethametasone 4 mg (i.v.). We report that in 34 patients out of 46, the minor gynaecologic surgery caused a significant decrease of glutamine (>20%) associated with an increase of postoperative pain. Interestingly, 10 out of 12 patients received Betamethasone, had increased levels of glutamine (>25%) and the use of analgesic drugs in the postoperative time was not required. In conclusion, in this study we found that minor gynaecological surgery causes a significant decrease of plasma level of glutamine that is associated with increase of postoperative pain. In contrast, the premedication with Betamethasone increases the plasma levels of glutamine, correlating with a good control of postoperative pain.

Auditing Analgesic Use in Post-operative Setting in a Teaching Hospital.

Managing postoperative pain efficiently is one important therapeutic challenge in the hospitals. Combination use of analgesics is in vogue, where in drugs from the opioid and non-opioid group are given synergistically. The aim of this study is to audit the use of different analgesics on the first postoperative day. Effort has been made to look into the drug or drug combinations used and other factors associated with their use. Retrospective, cross sectional observational study was conducted over a period of 11 months in a tertiary care teaching hospital at Hyderabad with approval from institutional ethics committee. Medical records of 649 patients on the first postoperative day were analysed for analgesics by various indicators. Average number of drugs per encounter was 4.23. Percentage of patients prescribed drugs from national essential drug list/WHO was 81.94%. Most common analgesic (monotherapy) prescribed was tramadol followed by diclofenac and the most common combination drugs prescribed were tramadol+Paracetamol. The most common route of administration was intravenous. All the drugs except piroxicam, were in the lower limit of the recommended daily dose. The present study gives an idea of the overall pattern of analgesic drug use in postoperative patients. The drug combinations used, the most common single use drug can be made out. The health professionals can be encouraged to prescribe by generic name and from the National List of Essential Medicines NLEMs.

Treatment with α-Lipoic Acid over 16 Weeks in Type 2 Diabetic Patients with Symptomatic Polyneuropathy Who Responded to Initial 4-Week High-Dose Loading.

Effective treatment of diabetic sensorimotor polyneuropathy remains a challenge. To assess the efficacy and safety of α-lipoic acid (ALA) over 20 weeks, we conducted a multicenter randomized withdrawal open-label study, in which 45 patients with type 2 diabetes and symptomatic polyneuropathy were initially treated with ALA (600 mg tid) for 4 weeks (phase 1). Subsequently, responders were randomized to receive ALA (600 mg qd; n = 16) or to ALA withdrawal (n = 17) for 16 weeks (phase 2). During phase 1, the Total Symptom Score (TSS) decreased from 8.9 ± 1.8 points to 3.46 ± 2.0 points. During phase 2, TSS improved from 3.7 ± 1.9 points to 2.5 ± 2.5 points in the ALA treated group (p < 0.05) and remained unchanged in the ALA withdrawal group. The use of analgesic rescue medication was higher in the ALA withdrawal group than ALA treated group (p < 0.05). In conclusion, in type 2 diabetic patients with symptomatic polyneuropathy who responded to initial 4-week high-dose (600 mg tid) administration of ALA, subsequent treatment with ALA (600 mg qd) over 16 weeks improved neuropathic symptoms, whereas ALA withdrawal was associated with a higher use of rescue analgesic drugs. This trial is registered with ClinicalTrials.gov Identifier: NCT02439879.

Application of self-management intervention based on the law of Ebbinghaus forgetting curve in hospitalized patients with gynecologic malignancies

Objective To investigate the value of self-management intervention based on the law of Ebbinghaus forgetting curve in hospitalized patients with gynecologic malignancies .Methods From October 2012 to March 2014 , 128 cases of gynecologic cancer patients admitted to our hospital were randomly divided into the observation group and the control group , with 64 cases in each group .The control group was treated with＆amp;nbsp;conventional self-management education .The observation group was taught by the self-management intervention according to the Ebbinghaus forgetting curve .The postoperative abdominal distention , nausea and vomiting and other symptoms were observed between the two groups seven days later after the operation .The time eating solid food, hospital stays, quality of life and patients satisfaction were compared .Results In the observation group , 10 patients （15.63%） had postoperative abdominal distention , 12 patients （18.75%） had postoperative nausea and vomiting, and the incidence and analgesic drug usage was 17.19%, which were significantly lower than those in the control group （χ^2 =11.094, 10.152, 13.227, respectively;P〈0.05）.In the observation group, patients’ first time out of bed were （33.58 ±7.07） hours, the first flatus time was （39.79 ±1.22） hours, the first time eating solid food was （49.51 ±8.48） hours, and the length of hospital stay was （10.55 ±3.62） days, which were significantly lower than those in the control group （t=2.261, 7.411, 9.584, 2.019, respectively;P〈0.05）.The score of QOL-BREF one month after surgery in the observation group was （66.88 ±5.61）, which was significantly higher than （49.64 ±5.54） in the control group （t =8.146,P 〈0.05）.The patients satisfaction in the observation group was （91.08 ±3.63）, which was significantly higher than （63.52 ±4.05） in the control group （t=11.521,P〈0.05）.Conclusions Based on the Ebbinghaus forgetting curve regular self-management interventions for patients with gynecological malignancies can significantly reduce the incidence of postoperative chemotherapy and adverse events , and promote functional recovery of patients and improve their quality of life .And the self-management education with scientific guidance can help consolidate the effect of self -management education . Key words: Genital neoplasms,female; Ebbinghaus forgetting curve law; Quality of life; Satisfaction; Self-management intervention

Long-term opioid use in non-cancer pain.

The long-term use of opioid analgesic drugs to treat chronic non-cancer pain (CNCP) is a major component of pain pharmacotherapy. The interpretation of the evidence concerning its efficacy and risks is currently debated. An interdisciplinary evidence- and consensus-based S3 guideline was updated on the basis of a systematic literature search (CENTRAL, Medline, and Scopus databases, from October 2008 to October 2013); meta-analyses of randomized controlled trials (≥ 4 weeks); and a consensus procedure, as specified by the AWMF regulations, including 22 medical and psychological societies and 2 patient self-help organizations. 119 publications were used to update the guideline, and 6 systematic reviews with meta-analyses were performed. A nominal group process was used to formulate recommendations concerning the indications and contraindications for the treatment of CNCP with opioid analgesics and the manner in which such treatments should be carried out. Opioid analgesics are an option for the short-term treatment (4-12 weeks) of chronic pain due to osteoarthritis (pain intensity, standardized mean difference [SMD]: -0.22 and -0.26), diabetic polyneuropathy (SMD -0.74), post-herpetic neuralgia (SMD -0.58), and chronic low back pain (SMD: -0.29 and -0.74). Long-term opioid treatment (≥ 26 weeks) for these diseases benefits only about 25% of patients. For other conditions, either short- or long-term treatment with opioid analgesics should be considered an individual therapeutic trial. Opioid treatment for pain is contraindicated by primary headaches and by any functional or mental disorder of which pain is a leading manifestation. To minimize the risks of opioid analgesic treatment, physicians must be aware of its contraindications and must regularly reassess its efficacy and side effects. Pharmacotherapy should be combined with other types of treatment.

Myofascial pain: from Virchow's to our days

Myalgia is not a definite nosological entity and fixes the attention of neurologists, rheumatologists, and physicians in other specialties. This is first of all associated with the high incidence of chronic pain syndrome that leads to long-term disability mainly in young and middle-aged persons. One of the most common reasons for seeking advice from a therapist and neurologist is low back pain that may be due to the involvement of three key anatomical players: facet joints (arthrosis treatment should make an emphasis on hondroprotectors), intervertebral disks (in case of discopathy, clinicians tend to favor nonsteroidal anti-inflammatory drugs – NSAIDs), and a muscular frame. In this case, two thirds of patients with pain syndromes in the trunk and limbs are found to have myofascial dysfunction that is defined as impaired function of one or other muscle, which occurs with its overload and manifests itself as muscle spasm and the presence of painful muscle infiltrations or local muscle hypertonus and trigger points in the tense muscles. Ignoring this fact gives rise to the irrational use of analgesic and anti-inflammatory drugs and further to the increase of their doses because the treatment is ineffective. Modern-day therapy for myofascial syndrome is multimodal and encompasses physiotherapic and manual procedures and the use of myorelaxants rather than NSAIDs. To prescribe myorelaxants, it is necessary to understand their mechanisms of action and the effects of different agents in this group.

Drug use during early pregnancy: Cross-sectional analysis from the Childbirth and Health Study in Primary Care in Iceland

Objective. To analyse drug use in early pregnancy with special focus on socio-demographic factors associated with psychotropic and analgesic drug use. Design. Cross-sectional study. Setting and subjects. A total of 1765 women were invited via their local health care centres, and 1111 participated at 11–16 weeks of pregnancy by filling out a postal questionnaire concerning socio-demographic and obstetric background, stressful life events, and drug use. Main outcome measures. Drug use prior to and early on in pregnancy, socio-demographic factors, smoking, and adverse life events were investigated. Drug categories screened for were psychotropics (collective term for antidepressants, relaxants, and sleep medication), analgesics, hormones, nicotine, vitamins/minerals, and homeopathic medicine. Results. Drug use from the aforementioned drug categories, excluding vitamins/minerals and homeopathic medicine, was reduced by 18% during early pregnancy, compared with six months prior to conception (49% vs. 60%). Psychotropic drug use during early pregnancy was associated with elementary maternal education (p < 0.5), being unemployed (p < 0.001), being single/divorced/separated (p < 0.01), smoking prior to or during pregnancy (p < 0.01), forced to change job/move house (p < 0.001), and psychotropic drug use six months prior to pregnancy (p < 0.001). No items on the stressful life events scale were associated with increased analgesic use, which increased only with multiparity. Conclusions. Use of analgesics and psychotropic drugs seems common in pregnancy. Our results indicate that lack of a support network, stressful life events, and lower status in society may predispose women to more drug use. GPs and midwives responsible for maternity care could take this into account when evaluating risk and gain for women and foetuses in the primary care setting.

Correlation between analgesia in the postanesthesia care unit and intraoperative remifentanil

To analyze the correlation between analgesia in the postanesthesia care unit and intraoperative remifentanil. The data of 5 594 patients in the postanesthesia care unit were retrospectively retrieved from the database of electronic medical record. The use of analgesic drugs in the postanesthesia care unit and intraoperative remifentanil was recorded, and case-control study was performed based on these enumeration data. A total of 205 (3.66%) patients out of 5 594 in the postanesthesia care unit were administered with analgesic drugs. In the grouped case-control study, remifentanil was intraoperatively used in 87 patients in the case group (n=205) and in 1 224 patients in the control group (n=5 389) (OR = 2.51, 95% CI=1.87-3.36, P=0.000). There were 205 "paired numbers" in the matched case-control study (OR=1.67, 95% CI=1.12-2.80, P=0.011). The analgesia in the postanesthesia care unit may be correlated with intraoperative remifentanil to a certain extent.

Anesthesia in neurologic and psychiatric diseases: is there a 'best anesthesia' for certain diseases?

Patients with diseases affecting the central nervous system present a wide range of clinical manifestations increasing the perioperative risk. The following review focused on recommendations for anaesthesiological management in patients with both neurologic and psychiatric diseases. The heterogeneity of disorders affecting the central nervous system and the variability of comorbidities make definition of standards for anaesthesiological management difficult. Anatomical malpositions, pulmonary and cardiac co-morbidities determine the perioperative risk. Patients require a careful preoperative assessment, including interdisciplinary communication between neurologists, psychiatrists or paediatric physicians. Adequate devices and equipment for airway management should be available before induction of general anesthesia. For premedication in patients with limited respiratory function, clonidine, given orally, is a good alternative. The use of short-acting hypnotic and analgesic drugs (e.g. propofol/remifentanil) can be safely administered for induction and maintenance of anesthesia. The use of volatile agents and succinylcholine is strictly avoided in patients with muscular dystrophy and myopathies. Peripheral and neuroaxial regional anesthesia is not contraindicated in patients with neuromuscular diseases unless there is a rapid deterioration of the neurological status. The 'best' anesthesia includes adequate preoperative evaluation of the individual risk, optimization of comorbidities before elective surgery, the use of short-acting anesthetic agents for induction and maintenance of general anesthesia, avoidance of volatile agents and succinylcholine in muscular dystrophy and myopathies.

Guidelines for recognition, assessment and treatment of pain: WSAVA Global Pain Council members and co-authors of this document:.

Karol Mathews DVM DVSc DACVECC (Canada) Peter W Kronen Dr Vet Med, DVM DECVAA (Switzerland) Duncan Lascelles BSc BVSc PhD DSAS DECVS DACVS MRCVS (USA) Andrea Nolan MVB DVA PhD DECVAA DECVPT MRCVS (UK) Sheilah Robertson BVMS (Hons) PhD DACVAA DECVAA DECAWBM (WSEL) DACAW MRCVS (USA) Paulo VM Steagall MV MS PhD DACVAA (Brazil/Canada) Bonnie Wright DVM DACVAA (USA) Kazuto Yamashita DVM MS PhD DJCVS (Japan)

Dehorning of Calves – Methods of Pain and Stress Alleviation – A Review

Abstract Dehorning of calves is intended to facilitate handling and increase the safety of people and animals. The study aimed to review the methods of calf dehorning and use of pharmacological analgesic, anaesthetic and sedation drugs, as well as their impact on pain perception. Regardless of the age of calves, dehorning is always associated with pain and stress. The changes in behaviour, physiological parameters, changes in heart rate, respiratory rate and increased cortisol secretion are observed during this procedure. The welfare of calves is significantly reduced during dehorning. Many studies point to minimization of the pain perceived by the use of pharmacological agents. Beneficial effects were observed with the combined use of anaesthetics and non-steroidal antiinflammatory drugs

CP-128 Evaluation of hospitalised patients’acute pain: preliminary survey to promote use of behavioural tools

BackgroundPatients with limited ability to communicate cannot have a proper evaluation of pain using self-evaluation tools. Therefore they might not receive the appropriate analgesic treatment. Our audience was the medical...

Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymphadenectomy for advanced gastric cancer

BackgroundThe aim of this study was to compare surgical outcomes and oncologic efficacy of laparoscopy-assisted gastrectomy (LAG) versus open gastrectomy (OG) for advanced gastric cancer. MethodsFor this study, 87 consecutive advanced gastric cancer (AGC) patients who underwent LAG with D2 lymph node dissection between April 2005 and October 2009 were enrolled, compared with 87 AGC patients who underwent OG during the same period. ResultsOperative procedure and surgical margin were similar between the 2 groups. The operative time was significantly longer in the LAG group than the OG group, while the estimated blood loss was significantly less in the LAG group. There were no significant differences in postoperative complications and in the number of lymph nodes retrieved. The use of analgesic drugs was significantly less after LAG. Length of postoperative stay was significantly shorter in the LAG group. The 5-year overall survival rate and recurrence-free survival rate were comparative between the 2 groups. ConclusionThis 5-year case–control study presented that laparoscopy-assisted gastrectomy may be a safe and acceptable procedure in terms of long-term results for AGC.

USE OF COMPLEMENTARY ALTERNATIVE THERAPIES FOR DYSMENORRHEA MANAGEMENT

SUMMARY OBJECTIVE: This study was planned for detecting the use cases of complementary alternative medicine (CAM) methods by people having dysmenorrhea. METHOD: It was planned as a descriptive cross-sectional study between February-June 2014. The research population consisted of students studying at a public university. Without going to the sample selection, the entire universe is intended to achieve. Eventually, 660 female participants who are 18 years old and over, having primer dysmenorrhea and suit to be diagnosed with primer dysmenorrhea were got involved in the research. Data were collected on the basis of participants' self-report. Before the study, approval was obtained from the institutions and participants. SPSS program was used to evaluate the data. In collecting the data, a questionnaire including demographic characterictics and features related to dysmenorrhea are used. FINDINGS: The mean age of participants 20,40 ± 1,54 and the average duration of participants’ menstruation 5,81 ± 1,26 days. In the majority of the participants, it is seen that the dysmenorrhea started with menstruation (%39,9); dysmenorrhea pain lasted only the first day (%52,6) and not consulted a doctor due to dysmenorrhea (%83). It is determined that %51,7 of participants use the analgesic drugs, the majority (%80,9) apply to any CAM therapies. The most commonly used CAM therapies are detected as application of heat to the abdomen (%67,2) and massage (%42,6). Participants who use herbal methods prefer chamomile tea (%15%), black tea and sage (%11,8). Analgesic usage rate, usually 1-2 times per day (%87,9); %39,6 of participants were using drugs with the suggestion of a friend. RESULT: It has been observed on participants having primary dysmenorrhea, complementary therapy methods are used more compared to the use of analgesic drugs and most preferred method is the application of heat to the abdomen. In addition, the majority of participants use the drugs accoarding to friend suggestions ,without physician recommendation. Accoarding to these findings women see the dysmenorrhea as a condition they can handle themselves.

Can Baroreflex Sensitivity and Heart Rate Variability Predict Late Neurological Outcome in Patients With Traumatic Brain Injury?

Previous studies have suggested that depressed heart rate variability (HRV) and baroreflex sensitivity (BRS) are associated with early mortality and morbidity in patients with acute brain injuries of various etiologies. The aim of the present study was to assess changes in HRV and BRS in isolated traumatic brain injury (TBI), with the hypothesis that measurement of autonomic nervous system dysfunction can provide prognostic information on late neurological outcome. Nineteen patients with TBI, requiring mechanical ventilation, sedation and analgesia, and with arterial and intracranial pressure monitoring for at least 1 week, were included. Physiological and treatment variables were collected and power spectral analyses of HRV and BRS analyses in time domain were performed daily. HRV in the high-frequency (HF) and low-frequency (LF) domains, as well as LF/HF ratio and total power, were investigated. The power of these variables to predict poor (Glasgow Outcome Scale Extended [GOSE] score <5), late (1 y) neurological outcome was assessed. Total power, LF, HF, and BRS were all significantly depressed in patients with GOSE score <5. This difference could not be explained by a more severe brain injury at admission or more extensive use of sedative or analgesic drugs. The autonomic variables predicted the late neurological outcome with areas under the receiver-operating curves between 0.78 and 0.83 (sensitivity: 0.63 to 0.88 and specificity: 0.73 to 0.82). HRV and BRS measures in TBI patients during intensive care treatment, including sedative, analgesic, and vasoactive drugs, may identify patients with poor late neurological outcome.