Higher VAS Score Research Articles

Acceptability, Accuracy, and Safety of Disposable Transnasal Capsule Endoscopy for Barrett's Esophagus Screening

Screening for Barrett's esophagus (BE) with conventional esophagogastroduodenoscopy (C-EGD) is expensive. We assessed the performance of a clinic-based, single use transnasal capsule endoscope (EG Scan II) for the detection of BE, compared to C-EGD as the reference standard. We performed a prospective multicenter cohort study of patients with and without BE recruited from 3 referral centers (1 in the United States and 2 in the United Kingdom). Of 200 consenting participants, 178 (89%) completed both procedures (11% failed EG Scan due to the inability to intubate the nasopharynx). The mean age of participants was 57.9 years and 67% were male. The prevalence of BE was 53%. All subjects underwent the 2 procedures on the same day, performed by blinded endoscopists. Patients completed preference and validated tolerability (10-point visual analogue scale [VAS]) questionnaires within 14 days of the procedures. A higher proportion of patients preferred the EG Scan (54.2%) vs the C-EGD (16.7%) (P < .001) and the EG Scan had a higher VAS score (7.2) vs the C-EGD (6.4) (P= .0004). No serious adverse events occurred. The EG Scan identified any length BE with a sensitivity value of 0.90 (95% CI, 0.83-0.96) and a specificity value of 0.91 (95% CI, 0.82-0.96). The EG Scan identified long segment BE with a sensitivity value of 0.95 and short segment BE with a sensitivity values of 0.87. In a prospective study, we found the EG Scan to be safe and to detect BE with higher than 90% sensitivity and specificity. A higher proportion of patients preferred the EG Scan to C-EGD. This device might be used as a clinic-based tool to screen populations at risk for BE. ISRCTN registry identifier: 70595405; ClinicalTrials.gov no: NCT02066233.

Saturday, September 29, 2018 9:00 am–10:00 am A Fresh Look at Opioids: 270. Comparing posterior approach lumbar and neck surgery with and without multimodal methadone

Saturday, September 29, 2018 9:00 am–10:00 am A Fresh Look at Opioids: 270. Comparing posterior approach lumbar and neck surgery with and without multimodal methadone

Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia

BackgroundPreoperative fasting is a major cause of perioperative discomfort in paediatric anaesthesia and leads to postoperative insulin resistance, thus potentially enhancing the inflammatory response to surgery. Addressing these problems by preoperative carbohydrate intake has not been a well-defined approach in children. MethodsWe randomised 120 children scheduled for gastroscopy under general anaesthesia to either a control group of standard preoperative fasting or a study group receiving a carbohydrate beverage (PreOp™; Nutricia, Erlangen, Germany). Their stomach contents were aspirated endoscopically, and the volume and pH measured. Perioperative discomfort was evaluated using, among other parameters, an observational pain scale in ≤4-yr-olds and a VAS in >4-yr-olds. The investigators doing the endoscopies and outcome evaluations were blinded to the study group allocation. ResultsCompared with fasting, carbohydrate loading was associated with significantly less gastric content (P=0.01), fewer patients experiencing postoperative nausea (P=0.028), with no significant difference in postoperative vomiting. High preoperative VAS scores (>5) were recorded for only one child in the carbohydrate group vs five children in the fasting group. Bowel cleansing for simultaneous colonoscopies (n=61) made no difference to any of the intergroup findings. ConclusionsPreoperative carbohydrates can reduce nausea and gastric content, the latter being a surrogate parameter for the risk and severity of gastric aspiration into the lungs during anaesthesia. Our study adds knowledge for preoperative fasting guidelines in paediatric anaesthesia. Clinical trial registrationDRKS00005020.

Comparing the efficacy of Morphine alone with Morphine and mgso4 in pain management after coronary artery bypass surgery.

Objective:To compare the effectiveness of Morphine alone and Morphine with MgSo4 in pain management after CABG surgery.Methods:This randomized control trial was conducted in the department of anesthesia and critical care Choudhary Pervaiz Ellahi Institute of Cardiology, Multan from November 2016 to June 2017. All collected data was entered and analyzed by using computer software SPSS version 23.1. Quantitative data like age, VAS score was analyzed and presented as mean and standard deviation. Similarly qualitative data like gender and ASA status was calculated and presented as frequency and percentages. Independent sample T-test was applied for significance of VAS score. P value ≤0.05 was considered as significant.Results:A total number of 150 patients of both genders were included in this study. The main outcome variables of our study were VAS score. It was observed that, in group (M), the mean VAS score after 4, 12 and 24 hours of operation was 5.24±1.61, 5.8±2.27 and 5.44±2.27 respectively. And in group (MM), the mean VAS score after 4, 12 and 24 hours of operation was 4.36±2.58, 3.48±2.10 and 4.12±1.05 respectively. It was noted that both groups had statically significant difference of VAS score, as group (M) had higher VAS score than group (MM).Conclusion:Morphine with Mgso4 has better efficacy as compared to morphine alone when used as analgesic agent after CABG surgery.

Incidence and risk factors of deep venous thrombosis following arthroscopic posterior cruciate ligament reconstruction.

The objective of this study was to identify the incidence and associated risk factors for deep venous thrombosis (DVT) after arthroscopic posterior cruciate ligament (PCL) reconstruction.This study included 128 patients who underwent arthroscopic PCL reconstruction. Venography was performed on the operated leg 3 days postoperatively. The patients were divided into 2 groups based on whether they had DVT. A correlation analysis was performed to determine the factors associated with DVT.Of all the 128 patients, 28 patients (21.9%) developed DVT, with 4 (3.1%) in a proximal location. Significant differences were found in the mean age, time of application of tourniquet, mean VAS scores, mean d-dimer level, mean cholesterol level, and various surgical procedures in patients with DVT compared with those without DVT. DVT is difficult to diagnose solely based on clinical symptoms.The incidence of DVT was 21.9% in patients who underwent arthroscopic PCL reconstruction. The rate of asymptomatic clots in the calf region was rather high after PCL reconstruction, and the rate of proximal clots was 4%. Older age, longer durations of tourniquet application, higher VAS scores and D-dimer levels, and complex surgical procedures were all substantial risk factors for DVT after PCL reconstruction. The treatment of DVT with batroxobin and anticoagulants was effective and safe.

Radial versus femoral access in cardiac catheterization and angioplasty. a comparative study

Introduction: The radial artery’s use for performing cardiac catheterization, angiography and angioplasty of the coronary vessels, is an alternative way versus the access widely utilized femoral artery.Aim: The aim of this study was to assess the potential advantages of radial versus femoral access.Material and Method: The study population was 202 patients, who were referred to coronary angiography or intervention coronary angioplasty.Statistical analysis was performed using the statistical package SPSS ver.18. For evaluation of pain was used Visual Numeric Pain Intensity Scale (visual analogue scale, VAS), which comprises using a calibrated scale of 0- 10.Results: From 1 to 30 May 2014 underwent coronary angiography in 202 patients, of whom 112 (55.4%) with RA and 90 (44.6%) with FA.Patients in the RA group showed higher VAS scores (1 ± 0.1) than those in FA group after catheterization (0.2 ± 0.4) P &lt;0.001 + . In contrast, patients in the FA group had higher percentage of injuries / extravasations (13.3%) compared with the RA group (0.9%) P &lt;0.001. Τhe time fluoroscopic was significantly higher in the FA (12.6 ± 10.5) compared to RA (7.6 ± 8.3) P &lt;0.001. About the time of hospitalization, those who underwent femoral access were hospitalized significantly longer (2.6 ± 1.3) compared to patients who underwent radial access (2 ± 1.3) P &lt;0.001+ .Conclusions: The efficacy and safety of the method in combination with the smallest rate of local complications are able to establish access way first choice in hemodynamically laboratories.

Methods of administering oral formulations and child acceptability

IntroductionChildren may be unable or unwilling to swallow medicines. In order to avoid or accommodate any such problems, parents may decide to administer medicines other than intended. The aim of this study was to investigate how parents administered four oral placebo formulations to infants and preschool children and how the applied methods correlated with child acceptability. MethodsParents were asked to administer a 4 mm mini-tablet, powder, suspension and syrup to their child twice on one day and to report the child characteristics and administration details in a participant diary. ResultsA 151 children were included. The tablet, syrup and suspension were mostly given on their own, whereas the powder was commonly given with food or drink. Generally, the higher the child acceptability (VAS-score) of the first administration of a specific formulation, the less frequently its method of administration was changed. A change in the method of administration of the same formulation involving (a larger quantity of) food or drink generally resulted in a higher VAS-score. ConclusionsThe joint administration of medicines with food or drink is an effective strategy to ensure swallowing. This study supports earlier findings that 4mm mini-tablets are a suitable dosage form from infant age.

Postoperative Pain Control with Epidural Catheter after Posterior Lumbar Spine Fusion

Introduction Pain management after posterior spinal fusion surgeries is a challenging topic. Epidural analgesia (CEA) technique has been developed to resolve some deleterious effects related with conventional intravenous patient-controlled analgesia (IV-PCA) method. However, studies are scanty in adult lumbar deformity patients. We hypothesized that CEA would be beneficial in adult lumbar deformity patients and conducted a study to observe effectiveness and safety of the procedure with a special consideration of the catheter level. Patients and Methods Forty-six patients scheduled for elective posterior lumbar spine fusion, in one spine-center clinic, were enrolled into the study. Three patients' dataset about pain control and/or sedation status were inconclusive and they were excluded from the final analysis. Pain and sedation status were evaluated with VAS and Ramsay sedation scales, respectively. Epidural catheter was inserted under direct visualization intraoperatively. Results There were 43 patients in the final analysis. Twenty-one patients had epidural catheters at or below the L2 level, 22 patients had their catheters above the predefined level. There was significant difference between the groups only in the 24th hour VAS scores. Patients with catheters of higher level location in the spinal canal, had higher VAS scores at the immediate postoperative period, however VAS scores in this group lessened more than the lower level catheter group at the 24th hour. Ramsay sedation scale score was significantly slightly higher in the patients with lower level catheters than the other group at 0 and the 2nd hour. Conclusion Continuous epidural analgesia is an effective and safe method in controlling postoperative pain in adult lumbar deformity patients treated with PSF method. Higher placement of epidural catheter in the spinal canal causes more pain at the beginning; however, drug release at this level has more effect over pain than lower levels.

Lateral Pressure and VAS Pain Score Analysis for the Lateral Lumbar Interbody Fusion Procedure.

The lateral lumbar interbody fusion (LLIF) procedure is a minimally invasive procedure that has become widely utilized. The LLIF procedure typically involves bending the table to access the disc spaces of interest due to anatomical constraints. It is unknown if this bending process is painful or what pressures are exhibited on the downside part of the body. The goal of the study was to determine whether sex, height, weight, body mass index, bed angle, or positioning relative to the break of the bed affects the downside skin pressures and VAS pain scores in awake volunteers. Fifty-six volunteers were placed in the lateral decubitus position and pressure sensors were placed at the downside part of their anatomy (shoulder, T10 rib , iliac crest, and greater trochanter). The pressures were checked with the iliac crest or greater trochanter at 0, 10, 20, 30, 40 degree bed angles. VAS scores were checked when the iliac crest or greater trochanter were at the maximum bed break angles. A significant positive association was found between increased bed angle and pressure at all five areas on the downside body locations (p<0.0001). The greatest pressures were located at the iliac crest and greater trochanter when these specific locations were centered over the break of the bed (p<0.0001). When the iliac crest was placed at maximal bed break, each unit increase in BMI increased the VAS pain by 0.13 (p<0.0001)and men had 1.96 (p=0.0009)higher VAS scores then women. When the greater trochanter was placed at the maximal bed break, each unit increase in BMI decreased VAS pain by 0.19 (p<0.0001) and women had 1.55 (p=0.0002)higher VAS pain scores then men. In awake volunteers, the pressure at the iliac crest or greater trochanter at the break of the bed increases by increasing the bed angle. Women with a lower BMI had high VAS pain scores when their greater trochanter was at maximal bed break. Men with higher BMI had high VAS pain scores when their iliac crest was at maximal bed break. An awareness of the iliac crest or greater trochanter at the break of the bed should be considered to prevent pain and increased pressure based on the patient's sex and BMI.

The dynamics of the pain system is intact in patients with knee osteoarthritis: An exploratory experimental study

Background and aimsDespite the high prevalence of knee osteoarthritis (OA) it remains one of the most frequent knee disorders without a cure. Pain and disability are prominent clinical features of knee OA. Knee OA pain is typically localized but can also be referred to the thigh or lower leg. Widespread hyperalgesia has been found in knee OA patients. In addition, patients with hyperalgesia in the OA knee joint show increased pain summation scores upon repetitive stimulation of the OA knee suggesting the involvement of facilitated central mechanisms in knee OA. The dynamics of the pain system (i.e., the adaptive responses to pain) has been widely studied, but mainly from experiments on healthy subjects, whereas less is known about the dynamics of the pain system in chronic pain patients, where the pain system has been activated for a long time. The aim of this study was to assess the dynamics of the nociceptive system quantitatively in knee osteoarthritis (OA) patients before and after induction of experimental knee pain. MethodsTen knee osteoarthritis (OA) patients participated in this randomized crossover trial. Each subject was tested on two days separated by 1 week. The most affected knee was exposed to experimental pain or control, in a randomized sequence, by injection of hypertonic saline into the infrapatellar fat pad and a control injection of isotonic saline. Pain areas were assessed by drawings on anatomical maps. Pressure pain thresholds (PPT) at the knee, thigh, lower leg, and arm were assessed before, during, and after the experimental pain and control conditions. Likewise, temporal summation of pressure pain on the knee, thigh and lower leg muscles was assessed. ResultsExperimental knee pain decreased the PPTs at the knee (P<0.01) and facilitated the temporal summation on the knee and adjacent muscles (P<0.05). No significant difference was found at the control site (the contralateral arm) (P=0.77). Further, the experimental knee pain revealed overall higher VAS scores (facilitated temporal summation of pain) at the knee (P<0.003) and adjacent muscles (P<0.0001) compared with the control condition. The experimental knee pain areas were larger compared with the OA knee pain areas before the injection. ConclusionsAcute experimental knee pain induced in patients with knee OA caused hyperalgesia and facilitated temporal summation of pain at the knee and surrounding muscles, illustrating that the pain system in individuals with knee OA can be affected even after many years of nociceptive input. This study indicates that the adaptability in the pain system is intact in patients with knee OA, which opens for opportunities to prevent development of centralized pain syndromes.

Psychological distress negatively affects self-assessment of shoulder function in patients with rotator cuff tears.

In many areas of orthopaedics, patients with greater levels of psychological distress report inferior self-assessments of pain and function. This effect can lead to lower-than-expected baseline scores on common patient-reported outcome scales, even those not traditionally considered to have a psychological component. This study attempts to answer the following questions: (1) Are higher levels of psychological distress associated with clinically important differences in baseline scores on the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score in patients undergoing arthroscopic rotator cuff repair? (2) Does psychological distress remain a negative predictor of baseline shoulder scores when other clinical variables are controlled? Eighty-five patients with full-thickness rotator cuff tears were prospectively enrolled. Psychological distress was quantified using the Distress Risk Assessment Method questionnaire. Patients completed baseline self-assessments including the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Age, sex, BMI, smoking status, American Society of Anesthesiologists classification, tear size, and tear retraction were recorded for each patient. Bivariate correlations and multivariate regression models were used to assess the effect of psychological distress on patient self-assessment of shoulder pain and function. Distressed patients reported higher baseline VAS scores (6.7 [95% CI, 4.4-9.0] versus 2.9 [95% CI, 2.3-3.6], p=0.001) and lower baseline Simple Shoulder Test (3.7 [95% CI, 2.9-4.5] versus 5.7 [95% CI 5.0-6.4], p=0.001) and American Shoulder and Elbow Surgeons scores (39 [95% CI, 34-45] versus 58 [95% CI, 53-63], p<0.001). Distress remained associated with higher VAS scores (p=0.001) and lower Simple Shoulder Test (p<0.001) and American Shoulder and Elbow Surgeons scores (p<0.001) when age, sex, BMI, American Society of Anesthesiologists classification, smoking status, tear size, and tear retraction were controlled. Higher levels of psychological distress are associated with inferior baseline patient self-assessment of shoulder pain and function using the VAS, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Longitudinal followup is warranted to clarify the relationship between distress and self-perceived disability and the effect of distress on postoperative outcomes after arthroscopic rotator cuff repair. Level I, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

Normalization of Widespread Pressure Pain Hypersensitivity After Total Hip Replacement in Patients With Hip Osteoarthritis Is Associated With Clinical and Functional Improvements

To evaluate the relevance of ongoing nociceptive joint inputs to the maintenance of widespread pain hypersensitivity in patients with hip osteoarthritis (OA) and to determine whether a reversal in the widespread pressure hypersensitivity together with an improvement in pain and function occurs after total hip replacement in these patients. Forty patients with hip OA participated. Twenty patients underwent total hip replacement, and the other 20 patients were assigned to a waiting list. Pressure-pain thresholds (PPTs) over the second metacarpal bone and the gluteus medius, vastus medialis, vastus lateralis, and tibialis anterior muscles were assessed bilaterally with a pressure algometer before and 3 months after total hip replacement surgery. Assessments of pain intensity (by visual analog scale [VAS]), physical function (by the Western Ontario and McMaster Universities Osteoarthritis Index), and health status (by the Short Form 12 health survey and the EuroQol 5-domain index) were also performed. Patients who underwent total hip arthroplasty exhibited a reduction in widespread pressure pain hyperalgesia (increases in PPTs) over local and distant pain-free areas, as compared with before surgery and as compared with the patients assigned to the waiting list. PPTs were related to hip pain intensity, and significant correlations were found between higher VAS scores and lower average PPTs over all points assessed (-0.409 < r < -0.306, P < 0.05). Patients who underwent total hip arthroplasty exhibited a greater decrease in pain intensity and greater increases in function and health status than did those who were on the waiting list. Changes in the intensity of hip pain were moderately associated with changes in pressure pain sensitivity in the hip arthroplasty group. Normalization of widespread pressure pain hyperalgesia was found after successful hip joint replacement in patients with hip OA. Altered pain processing seems to be driven by ongoing peripheral joint pathology, which stresses the importance of reducing pain in OA.

Analgesia induced by daring words – a glimpse to the cultural brain

Language is ubiquitous and permeates all dimensions of human life. It is commonly considered a communication tool and an instrument of power. Previous studies have shown that exposure to hurtful or pain-related words affect biological systems including the brain. In this study, the authors sought to examine the analgesic effects of culturally meaningful daring words among the Quichua (Inca) people of the Andes, in South America. This is a pilot, controlled, experimental study. A total of 40 adult men (representing almost the entire small village) in good health were randomly assigned to the experimental or control group. They received a pressure pain stimulation using an algometer applied to the right temporal area. The pain threshold and pain tolerance thresholds were measured in all participants. Only the experimental group received culturally meaningful daring Quichua words and sentences while the algometer pressure over the temporal area was applied. After each threshold measurement, a visual analog scale was administered. The visual analog scale and algometer scores of the experimental and control group were compared with t-tests. Participants receiving culturally meaningful daring words had higher algometer values than those who did not receive it p <.001. Those who received daring words had also higher VAS scores than those who did not receive them p <.001. These results suggest that culturally meaningful daring words increase tolerance to pain among the Quichua (Inca) people. This is a pioneering study that reveals the analgesic effects of daring words. It highlights the remarkable biological effects of language in humans. Language is ubiquitous and permeates all dimensions of human life. It is commonly considered a communication tool and an instrument of power. Previous studies have shown that exposure to hurtful or pain-related words affect biological systems including the brain. In this study, the authors sought to examine the analgesic effects of culturally meaningful daring words among the Quichua (Inca) people of the Andes, in South America. This is a pilot, controlled, experimental study. A total of 40 adult men (representing almost the entire small village) in good health were randomly assigned to the experimental or control group. They received a pressure pain stimulation using an algometer applied to the right temporal area. The pain threshold and pain tolerance thresholds were measured in all participants. Only the experimental group received culturally meaningful daring Quichua words and sentences while the algometer pressure over the temporal area was applied. After each threshold measurement, a visual analog scale was administered. The visual analog scale and algometer scores of the experimental and control group were compared with t-tests. Participants receiving culturally meaningful daring words had higher algometer values than those who did not receive it p <.001. Those who received daring words had also higher VAS scores than those who did not receive them p <.001. These results suggest that culturally meaningful daring words increase tolerance to pain among the Quichua (Inca) people. This is a pioneering study that reveals the analgesic effects of daring words. It highlights the remarkable biological effects of language in humans.

Excessive daytime sleepiness and migraine: a population-based study

Results Of 2,836 all participants, 152 (5.1%) were diagnosed as having migraine. EDS was more prevalent among migraineurs comparing to non-migraine controls (25.7% for migraineurs vs. 16.3% for non-migraine controls, p=0.003). Migraineurs with EDS reported higher attack frequency per month (7.0±9.7 attacks for migraineurs vs. 3.5±5.8 for non-migraine controls, p<0.000), higher VAS score for pain intensity (7.1±1.8 for migraineurs vs. 6.0±1.9 for non-migraine controls, p=0.006), and higher HIT-6 score (60.6±10.3 for migraineurs vs. 52.8±8.3 for non-migraine controls, p<0.000) comparing to migraineurs without EDS. Migraineurs with EDS showed more of depression (OR=5.67, 95% CI 2.5-12.7), insomnia (OR=2.98, 95% CI 1.1-8.4) and sleep disordered breathing (OR=2.78, 95% CI 1.1-7.3) than migraineurs without EDS. Unilateral pain, pulsating quality, aggravation by routine physical activity, nausea, vomiting, photophobia and phonophopbia were not significant according to EDS.

Satisfaction with Appearance and the Desired Treatment to Improve Aesthetics

Objective. To identify participants' satisfaction with appearance and the desired treatment to improve aesthetics. Materials and Methods. 220 participants (127 males and 93 females, mean age = 21.4 ± 1.5 years) were recruited into the study. A structured questionnaire was used to assess patients' satisfaction with appearance and what treatment they desire to improve aesthetics. Participants scored the level of satisfaction with appearance using visual analogue scale. Results. The VAS mean score of satisfaction with general appearance was 6.8 ± 2.3. Half participants were dissatisfied with tooth appearance and 65.9% were dissatisfied with tooth colour. Higher VAS scores were associated with higher desire for all treatments that improve tooth appearance (P < .05). Dissatisfaction with tooth appearance increased with increased dissatisfaction with teeth colour, feeling of poor tooth alignment, presence of fractured anterior teeth, and increased desire for orthodontic, crowns, and dentures treatments (P < .05). Dissatisfaction with tooth colour was associated with increased desire for tooth whitening and tooth coloured fillings (P < .05). Conclusions. Participants had high levels of dissatisfaction with tooth appearance and tooth colour. Dissatisfaction with tooth colour contributed to the increased dissatisfaction with tooth appearance. Dissatisfaction with tooth appearance, colour, alignment, and condition was significantly related to high desire for aesthetic treatments.

Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks for chronic pain after inguinal hernia repair

The aim of this study was to evaluate the outcome of ilioinguinal and iliohypogastric nerve blocks in patients with chronic pain after herniorrhaphy, by comparing nerve stimulator and ultrasound guidance to administer the block. A total of 43 patients who received nerve blocks for chronic inguinal post-herniorrhaphy pain received standardized questionnaires. Nerve stimulator-guided blocks were performed prior to January 2009, and thereafter, ultrasound-guided blocks were performed using a local anaesthetic solution and a corticosteroid. The questionnaire was completed by 38 patients (88 %). The inguinal hernia repair was performed for a median 16 months (range 3-219) ahead of the nerve blocks. A median of 2 pain treatments (range 1-7) was calculated. Median follow-up was 21 months (range 3-68). According to the DN4, 21 patients (55.3 %) no longer reported neuropathic pain. Subjectively, 32 % no longer reported moderate-to-severe pain. After ultrasound-guided blocks, a higher VAS score (at rest and during activities), a higher proportion of daily pain and more anxiety and depression are reported compared to blocks performed after nerve stimulator guidance. Ilioinguinal/iliohypogastric nerve blocks can be effective to treat chronic inguinal pain following surgery of the groin. The use of ultrasound was not superior to nerve stimulator-guided blocks. These blocks could be considered prior to more invasive procedures such as neurectomy.

Comparing Health-Related Quality of Life of Cancer Patients under Chemotherapy and of Their Caregivers

Introduction. Cancer is a major disorder physically and psychologically affecting both patients and their caregivers. In this study, health-related quality of life (HRQoL) of patient-caregiver dyads during the period of chemotherapy was assessed. Material and Methods. Two hundred twenty-two cancer patient-caregiver dyads were enrolled in the study, which was conducted from October 2008 to March 2009. HRQoL was evaluated with EQ-5D. Results. The mean age of the sample was 57.4 and 48.9 for patients and caregivers, respectively. The EQ-5D descriptive system indicates that female patients more frequently experience anxiety and depression than male patients. Male and higher-education caregivers had higher VAS scores, while demographic factors did not seem to influence patients' HRQoL. Anxiety and depression of caregivers were correlated with patients' problems in self-care and usual activities. Conclusions. Quality of life is highly influenced during the period of chemotherapy for both patients and caregivers and is often under reported. Interventions that can improve HRQoL, especially in the domain of mental health for both cancer patients and their caregivers, need to be implemented.

Autonomic modulation and health-related quality of life among schizophrenic patients treated with non-intensive case management.

BackgroundSchizophrenia is associated with autonomic dysfunction and this may increase cardiovascular mortality. Past studies on autonomic modulation of schizophrenic patients focused on inpatients rather than individuals in a community setting, especially those receiving non-intensive case management (non-ICM). Besides, autonomic modulation and its association with health-related quality of life (HRQoL) in this population remain unexplored.MethodsA total of 25 schizophrenic patients treated by non-ICM and 40 healthy volunteers were matched by age, gender and body mass index; smokers were excluded. Between the two groups, we compared the individuals' 5 min resting assessments of heart rate variability and their HRQoL, which was measured using EuroQoL-5D (EQ-5D). Patients with schizophrenia were assessed for psychopathology using the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). We examined the relationship between heart rate variability measurements, HRQoL scores, PANSS scores, and other clinical variables among the schizophrenic patients treated by non-ICM.ResultsCompared to the controls, patients with schizophrenia showed a significant impairment of autonomic modulation and a worse HRQoL. Cardiovagal dysfunction among the schizophrenic patients could be predicted independently based on lower educational level and more negative symptoms. Sympathetic predominance was directly associated with anticholinergics use and EQ-5D using a visual analogue scale (EQ-VAS).ConclusionPatients with schizophrenia treated by non-ICM show a significant impairment of their autonomic function and HRQoL compared to the controls. Since the sympathovagal dysfunction is associated with more negative symptoms or higher VAS score, the treatment of the negative symptoms as well as the monitoring of HRQoL might help to manage cardiovascular risk among these individuals. In addition, EQ-VAS scores must be interpreted more cautiously in such a population.

Effect of age, impaction types and operative time on inflammatory tissue reactions following lower third molar surgery

BackgroundPostoperative mobidity following third molar surgery is affected by a number of factors. The study of these factors is essential for effective planning and limitation of morbidity. The aim of this study was to determine the effect of age, type of impaction and operative time on immediate postoperative tissue reactions following mandibular third molar surgery.MethodsConsecutive patients with impacted mandibular third molar teeth were studied. All the third molars were classified according to Winter's classification. Surgical extraction was performed on all the patients by a single surgeon under local anaesthesia. The operation time was determined by the time lapse between incision and completion of suturing. Postoperative pain, swelling and trismus were evaluated.ResultsThere were 120 patients with an age range of 19-42 years. Patients in the age range of 35-42 years recorded a lower pain score (p = 0.5) on day 1. The mouth opening was much better in the lower age group on day 2 and 5 (p = 0.007 and p = 0.01 respectively). Pain, swelling and trismus increased with increasing operative time. Distoangular impaction was significantly associated with higher VAS score on day 1 and 2 (p = 0.01, 0.0, 04). Distoangular and horizontal impaction are associated with a higher degree of swelling and reduced mouth opening on postoperative review days. Vertical impaction was associated with the least degree of facial swelling and best mouth opening.ConclusionsIncreasing operating time and advancing age are associated with more postoperative morbidity, likewise distoangular and horizontal impaction types.

Relationship between plasma concentrations of morphine and its metabolites and pain in cancer patients

This study was undertaken to investigate the relationship between the plasma concentration of morphine, morphine-3-glucuronide and morphine-6-glucuronide and pain in cancer patients receiving oral morphine. The trough value of plasma concentrations of morphine and its metabolites were measured by high performance liquid chromatography using an ultraviolet detector. Using this assay system, the plasma concentrations of morphine, morphine-3-glucuronide and morphine-6-glucuronide in 26 cancer pain patients were measured and compared with pain intensity. The pain intensity was assessed at the time of blood sampling using the visual analog scale. The trough value of morphine and morphine-6-glucuronide did not show a significant correlation with pain intensity by visual analog scale assessment, but morphine-3-glucuronide and the ratio of morphine-3-glucuronide/morphine showed a significantly positive correlation (r = 0.528, P = 0.006 and r = 0.671, P < 0.001, respectively). By dividing the group according to low (≤ median value) or high (> median value) VAS scores a significant difference was found between the two groups in morphine-3-glucuronide and the ratio of morphine-3-glucuronide/morphine (P = 0.045 and P = 0.007, respectively). These results indicated that the level of morphine-3-glucuronide is related to the patient's perception of morphine effect, and the plasma concentration of morphine-3-glucuronide and the ratio of morphine-3-glucuronide/morphine indicated potency to assess clinical effect.