Numerical Scale Research Articles

Stability of noise annoyance

Noise has been shown to have negative health consequences and studies have linked these consequences in part to the subjective annoyance caused by the noise. Subjective noise annoyance is often measured using a 11-point numeric scale (e.g. annoyance scale in ISO 15666:2021 previously ISO/TS 15666:2003). Thereby the mean annoyance rating of a group of participants is commonly used as the default measure of the annoyance induced by a specific sound. However, the quality of these annoyance measures (which were developed only for the use in field studies) in terms of stability in a controlled laboratory setting has not been evaluated yet. The aim of the current study was therefore to evaluate the between- and within participant stability of noise annoyance, as well as the stability of the mean annoyance within a group of participants and between two groups of participants as well as between different experimental settings. The results revealed a low between- and a low within participant stability, but a high stability of the mean annoyance. The general sound context (other sounds included in the experiment) had an influence on the noise annoyance ratings. The results were used to develop a mathematical model of noise annoyance. According to this model, the mean annoyance is not the measure of central tendency of the tested group but the cleaned annoyance. The cleaned annoyance is thereby not an estimate of the actual annoyance a person is expected to experience in relation to a certain sound. It is rather a measure of the part of noise annoyance that is explained by the acoustical properties and the sound context. Our model can explain the results from the current study as well as results from previous studies. Recommendations are made concerning the evaluation of noise annoyance in laboratory studies and future development of the mathematical model.

Why does tinnitus vary with naps? A polysomnographic prospective study exploring the somatosensory hypothesis

(1) BackgroundTinnitus, defined as the conscious awareness of a noise without any identifiable corresponding external acoustic source, can be modulated by various factors. Among these factors, tinnitus patients commonly report drastic increases of tinnitus loudness following nap sleep. Previous studies have suggested that this clinical pattern could be attributed to a somatosensory modulation of tinnitus. To our knowledge, no polysomnographic study has been carried out to assess this hypothesis. (2) MethodsFor this observational prospective study, 37 participants reporting frequent increases of tinnitus following naps were recruited. They participated to six full-polysomnography nap attempts over two days. Audiological and kinesiologic tests were conducted before and after each nap attempt. (3) Results197 naps were collected. Each nap at each time of day elicited an overall significant increase in tinnitus minimum masking level (MML). Each inter nap period elicited an overall significant decrease. Tinnitus modulations were found significantly correlated with nap sleep duration (Visual numeric scale on tinnitus loudness, VNS-L, p< 0.05), with snoring duration (MML, p< 0.001), with snoring average sound level (VNS on tinnitus intrusiveness, VNS-I, p< 0.05) and with sleep apnea count (VNS-I, p< 0.001). (4) ConclusionsThis study confirms objectively that tinnitus may increase following naps. No association was found between these modulations and somatosensory modulations involving the temporomandibular joint and cervical areas. However, it may be possible that nap-induced tinnitus modulations are a hidden form of somatosensory modulation as snoring and sleep apnea events are often related to tensor veli palatini muscle dysfunction.

Perspectives of people with schizophrenia on clinical outcome scales and patient-reported outcome measures: a qualitative study

BackgroundOver the past half-century, numerous scales have been designed to quantify outcomes in people with severe mental health disorders. However, little is known about the views of people diagnosed with schizophrenia on individual outcome scales, particularly outside of European countries.AimWe conducted a qualitative study to examine the perspectives of people with schizophrenia on multiple scales in Japan.MethodsEleven participants took part in focus group interviews. Five had extensive experience as mental health peer supporters; the others had no such experience. To address potential power imbalances and facilitate dynamic discourse, participants were intentionally divided into two groups on the basis of peer support experience, and two simultaneous two-hour focus group interviews were conducted in separate rooms. The participants reviewed 12 clinical and patient-reported outcome measures and discussed their views on each measure. Interview data for each group were combined prior to analysis and qualitatively analyzed by four researchers using a thematic analysis approach.ResultsThe average age of the participants was 42.7 years (SD = 8.3), and six were male. On average, the participants had been living with schizophrenia for 22.2 years (SD = 11.1). After analyzing the interview data, the following five themes were identified, each containing two to seven subthemes: 1) validity and format of the scale construct, 2) factors affecting the accuracy of responses, 3) plain language and familiar words in Japanese culture, 4) psychological impact on the respondents, and 5) containing important items in everyday life.ConclusionThe participants provided both favorable and unfavorable feedback on each scale. When implementing research utilizing clinical outcome scales and patient-reported outcome measures, researchers should exercise caution considering the potential emotional impact on respondents. Furthermore, scale development should take into account the cultural background and psychological burden experienced by the respondents.

Electroencephalography Longitudinal Markers of Central Neuropathic Pain Intensity in Spinal Cord Injury: A Home-Based Pilot Study

Background: It is well known from cross-sectional studies that pain intensity affects brain activity as measured by electroencephalography (EEG) in people with neuropathic pain (NP). However, quantitative characterisation is scarce. Methods: In this longitudinal study, ten people with spinal cord injury-related NP recorded their home EEG activity ten days before and after taking medications over a period of several weeks. Results: The reduction in pain due to medications was accompanied by changes in the resting state EEG and its reactivity to eyes opening (EO) and closing (EC). There was a significant positive correlation between the frontal theta band and the intensity of pain (visual numerical scale) pre-medication (p = 0.007, Pearson R = 0.29) and theta, alpha, and lower beta (6–15 Hz) band power and the intensity of pain after post-medication over the frontal, central, and parietal cortices. Reactivity had a negative correlation with pain intensity at all locations and frequency bands and showed similar behaviour in wider frequency bands like 8–15 Hz at the occipital cortex and 2–12 Hz at the frontal cortex. Conclusions: EEG could be used to detect the intensity of NP to serve as a surrogate or pharmacodynamic marker.

SDMPH 10-year Anniversary Conference Modified Delphi Study.

The SDMPH 10-year anniversary conference created an opportunity for a researcher to present at a professional association conference to advance their research by seeking consensus of statements using Delphi methodology. Conference attendees and SDMPH members who did not attend the conference were identified as Delphi experts. Experts rated their agreement of each statement on a 7- point linear numeric scale. Consensus amongst experts was defined as a standard deviation < = 1. Presenters submitted statements relevant to advancing their research to the authors to edit to fit Delphi statement formatting.Statements attaining consensus were included in the final report after the first round. Those not attaining consensus moved to the second round in which experts were shown the mean response of the expert panel and their own response for opportunity to reconsider their rating for that round. If reconsideration attained consensus, these statements were included in the final report. This process repeated in a third and final round. 37 Experts agreed to participate in the first round; 35 completed the second round, and 34 completed the third round; 35 statements attained consensus; 3 statements did not attain consensus. A Delphi technique was used to establish expert consensus of statements submitted by the SDMPH conference presenters to guide their future education, research, and training.

Bleaching efficacy of in-office bleaching with violet light using low-concentration hydrogen peroxide nanoparticulate photocatalyst gel: A randomized controlled trial

ObjectiveThis randomized controlled trial aimed to evaluate the bleaching efficacy and tooth sensitivity (TS) of participants submitted to different application protocols of in-office bleaching with violet light using 6 % hydrogen peroxide (HP) nanoparticulate photocatalyst gel. Materials and methodsSixty-six participants were randomized and bleached using either a 6 % HP (Nano White, DMC), and/or violet light (Bright Max Whitening, MMOptics), according to the following protocols: 1) only violet light (VIOL); 2) only bleaching gel application (BG) and; 3) combined bleaching gel application + violet light (BG+VIOL). The bleaching efficacy was evaluated with the Vita Easyshade spectrophotometer, Vita Classical and Vita Bleachedguide scales. The risk and intensity of TS were recorded using a 0–10 visual analogue scale (VAS) and a 0–4 numerical scale (NRS). Color change and intensity of TS values were compared using one-way ANOVA and Tukey's test were used. The absolute risk of TS was compared using the Chi-square test (α = 0.05). ResultsA significant and higher degree of bleaching was observed in the BG and BG+VIOL groups compared to the VIOL group (p < 0.003). Despite no significant differences in the risk (p > 0.07) and intensity (p > 0.28) of TS among groups, a higher risk of TS was observed in the BG and BG+VIOL groups. ConclusionsUsing VIOL reduced the risk of TS but did not improve bleaching. However, BG+VIOL with low-concentration HP nanoparticulate photocatalyst gel achieved equal efficacy and was less likely to cause TS compared to BG.

Attitudes and Experiences of Patients Regarding Gender-Specific Aspects of Pain Management.

Biological, pharmacological, and socio-cultural aspects influence gender-specific effects in pain management. Gender-specific aspects of pain management were assessed in a rural outpatient center via semi-structured patient interview: (i) general gender aspects (total population) from 1 = "fully disagree" to 5 = "fully agree"; and (ii) individual pain (matched pairs) via numeric analog scale (NAS) from 0 = "no pain" to 10 = "maximum pain". Patient charts were assessed for pain management (WHO-ladder). In total, 113 patients were enrolled (59.18 [SD: 12.76] years, 46% female, 54% male, 0% diverse), and 42 were matched into female-male pairs. (i) Women and men agreed that men and women should be treated equally despite biological differences (median: 5 [women] vs. 5 [men]; p = 0.789). As a reason for gender-specific aspects, "medication concentration" was reported more frequently by women (p = 0.038) and "no answer" by men (p = 0.014). (ii) Mean value (SD) of pain (NAS) was 4.0 (SD 2.3) for women and 3.3 (SD 2.6) for men (p = 0.215) with a positive correlation between pain management escalation (WHO-ladder) and the pain score (NAS) only in men (r = 0.704, p = 0.001). Women rather reported an influence of adverse drug reactions on treatment contentment than men (p = 0.042). Although patients pleaded for gender-independent equal treatment, gender-specific differences in pain therapy were found.

Estimating the Distance Between Map Points May Be Related to Forms of Representing the Map´s Scale.

The way a map scale is represented plays a key role in comprehending it. In this research, we examined the relationships between the form of representation of the map's scale (numerical scale, linear graphic scale and circular graphic scale), the user's gender, and the distance between two map objects on user estimates of the distance between two objects on the map (i.e., a 5, 10, 15 and 20-min walk). We gave 183 college students 84 maps of three types: 28 numerical scale, 28 linear graphic scale, and 28 circular graphic scale. Each map presented varied distances to be estimated. We assessed the participants' accurate hits, errors, and their hits minus errors in these distance estimations. Participants had both more hits and more errors on circular scale maps than on linear or numerical scale maps, and the distances between objects and gender also significantly related to the estimated e distance. Both the type of scale and the distance between objects influenced the number of hits minus the number of errors.

A Double-Blinded Randomized Controlled Trial: Can Pulsed Electromagnetic Field Therapy Be a Novel Method for Treating Chronic Rhinosinusitis?

Background and Objectives: Pulsed electromagnetic field (PEMF) therapy offers a promising approach to treating inflammatory diseases. Its notable anti-inflammatory and antimicrobial effects and enhancement of microcirculation in the nasal mucosa make it a valuable treatment option. Despite its potential, the use of PEMF for chronic rhinosinusitis (CRS) is still in its early stages, with limited exploration of its effectiveness. This study aimed to assess the impact of PEMF on alleviating symptoms such as fatigue, headaches, sinus opacifications, and ostiomeatal complex issues associated with CRS. Materials and Methods: Forty-seven patients of both genders with CRS, aged 19 to 40 years, were involved in this study. The participants were randomly assigned to either a magnetic or a control group. The magnetic group underwent a 10 min PEMF session with a 20-gauss magnetic field strength at 7 Hz thrice a week for a month. The control group received the same PEMF application as an inactive device. Before and after the intervention, researchers assessed fatigue levels with a visual analog fatigue scale (VAFS), headache intensity via a numerical pain-rating scale, and the status of sinus opacifications and ostiomeatal complex obstructions by computerized tomography (CT). Results: The study findings showed a significant reduction in fatigue and headache scores in the magnetic group compared to the control group (p < 0.05). Additionally, there was a notable improvement in sinus opacifications and ostiomeatal complex obstructions among participants who received PEMF therapy. Conclusions: PEMF therapy effectively reduces fatigue, headaches, and sinus opacifications in CRS patients, suggesting its potential for inclusion in CRS management guidelines to improve patient outcomes and quality of life. The results of this study indicate that PEMF represents a noninvasive and cost-effective approach for treating adults with mild-to-moderate CRS.

Connecting the Numerical Scale Model With Assessing Attitudes and its Application to Hesitant Fuzzy Linguistic Multi-attribute Decision Making

Connecting the Numerical Scale Model With Assessing Attitudes and its Application to Hesitant Fuzzy Linguistic Multi-attribute Decision Making

Beyond the Hip: Clinical Phenotypes of Hip Osteoarthritis Across the Biopsychosocial Spectrum.

Background/Objectives: To identify clinical phenotypes of hip osteoarthritis (OA) within a biopsychosocial framework. Methods: A cross-sectional analysis of 143 individuals with hip OA awaiting total hip arthroplasty (THA) was performed. Phenotyping features included sociodemographic and biomedical information, pain-related cognitions and emotions, mental disorders, traumatic experiences, self-efficacy, social support, perceived stress, and somatosensory function. Outcome measures included the hip disability and osteoarthritis outcome score and the numeric pain-rating scale. Decision tree learning was used to select the most important phenotyping features. K-means clustering analyses were performed to identify clinical phenotypes and a decision tree algorithm was trained to classify individuals in the identified clinical phenotypes. Results: Selected phenotyping features associated with pain and disability included a combination of biomedical, psychological, and social variables. Two distinct clinical phenotypes were identified. Individuals within the maladaptive phenotype (34%) reported more comorbidities, less self-efficacy and higher levels of anxiety, depression, pain-related fear-avoidance, and feelings of injustice. No differences were found regarding social support and somatosensory function. Regarding the outcome measures, individuals within the maladaptive phenotype reported higher levels of pain and disability. Finally, based on the Fear-Avoidance Components Scale (FACS) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), individuals could be classified into the clinical phenotypes with 87.8% accuracy. Conclusions: Two clinical phenotypes, an adaptive and a maladaptive phenotype, can be identified in individuals with hip OA using the FACS and HADS-A. The identification of these clinical phenotypes represents a crucial step toward precision medicine, enabling the development of targeted treatment pathways tailored to the distinct biomedical and psychological features of each phenotype.

Abstract 4139198: A Systematic Approach to Prompting Large Language Models for Automated Feature Extraction from Cardiovascular Imaging Reports

Introduction: Cardiovascular radiology reports contain valuable diagnostic information linked to images, but the unstructured text format makes feature extraction difficult on a large scale. Large language models (LLMs) allow for feature extraction where string parsing alone is insufficient, but require careful prompting for accurate results. Hypothesis: We hypothesize that a systematic prompting approach using LLMs can expedite the extraction of features from unstructured text in transesophageal echocardiography (TEE) reports. Methods: The data consisted of 7106 intraoperative TEE reports, 600 of which were manually reviewed to obtain pre- and post-intervention ground truth values for left ventricular ejection fraction (LVEF), right ventricular systolic function (RVSF), and tricuspid regurgitation (TR). Reports are paired with an imaging study consisting of 50-200 clips. For each feature considered, 100 of the 600 labeled reports were used to engineer a prompt in Llama-2 that maximized feature extraction accuracy. Results: We found that using multiple, shorter prompts yielded higher accuracy than did fewer, longer prompts. Additionally, when imposing semantic information onto a numerical scale, prompt engineering in combination with string parsing (Figure 1) gave the best results. When evaluated on the 500 labeled reports withheld for testing, the finalized prompts had accuracies of 94.1%, 94.8%, and 91.3% for LVEF, RVSF, and TR, respectively. Using this strategy, 5000 intraoperative TEE reports were analyzed and used to train and evaluate a regression model for LVEF estimation from TEE clips (Figure 2). Conclusion: We have shown that performing prompt engineering on Llama-2 can be used to extract features from unstructured TEE reports in an accurate manner. As an extension of these methods, automated feature prediction from echocardiograms can be used to create rapid, low-cost, and accessible cardiac assessments.

Emotional distress in medical students in the context of university teaching on mental disorders

Numerous studies have shown ahigh incidence and increase in stress-related symptoms and depression-like complaints among students. During teaching on mental disorders at our medical faculty, students repeatedly reported emotionally stressful situations and expressed adesire for support services. The aim of the present study was to objectify the level of stress and the need for such support services. Atotal of 118 students in the 9thsemester (winter semester 2022/2023) were surveyed using aquestionnaire on their emotional stress. The online questionnaire was conducted via LimeSurvey (LimeSurvey GmbH, Hamburg, Germany) and contained atotal of 18items formulated as statements as well as other items. The students rated the individual items on 11-point numerical scales with external anchor ratings. The respondents rated their own stress as increased compared to other modules, particularly for the subject of psychiatry (> 5out of10). Bedside teaching was estimated as being the most stressful, followed by seminars and lectures (all pairwise comparisons p < 0.001). The contents on depression predominantly caused the most stress. Approximately half of the students would like to be offered support services and most frequently aconsultation session (78.0%) and defined contact persons (70.7%). The emotional stress of students in the context of teaching on mental disorders is particularly high in psychiatry and higher with increasing patient contact; offers of support services are needed. Teachers should be sensitized to this and create offers such as open consultation sessions and the provision of defined contact persons.

Interrater reliability of RheuMetric checklist scales for Physician Global Assessment, inflammation, damage and patient distress

Abstract Objective To analyze interrater reliability of four RheuMetric checklist 0–10 visual numerical scales (VNS) of physician global assessment (DOCGL), inflammation or reversible findings (DOCINF), organ damage or irreversible findings (DOCDAM), and patient distress or findings explained by fibromyalgia and/or depression (DOCDIS). Methods A retrospective study was performed of data from a rheumatology fellows’ continuity clinic at Rush University. Each rheumatology patient with any diagnosis seen in routine care completed a multidimensional health assessment questionnaire (MDHAQ). Both the rheumatology fellow and attending rheumatologist independently completed RheuMetric estimates at the same visit for DOCGL, DOCINF, DOCDAM, DOCDIS, and the proportion of DOCGL explained by each subglobal estimate (totaling 100%). Agreement between the two assessors was compared using paired t-tests, Spearman correlation coefficients, intraclass correlation coefficients (ICC), Lin’s concordance correlation coefficients (LCCC), and Bland-Altman plots. Results In 112 patients, mean levels of DOCINF were highest in inflammatory diseases, DOCDAM in osteoarthritis (OA), and DOCDIS in primary fibromyalgia (FM). However, mean DOCDAM was as high as DOCINF in inflammatory diseases. No statistically significant differences were seen between scores from attending rheumatologists and fellows. Agreement within 2/10 units ranged from 60% for DOCGL to 71% for DOICINF and DOCDAM. Spearman correlations were 0.49-0.65, ICCs were 0.46-0.63, LCCC were 0.46-0.62 between rheumatologist and fellow, indicating moderate agreement; reliability was slightly higher for each sub-global VNS than DOCGL. Conclusion RheuMetric 0–10DOCGL, DOCINF, DOCDAM, and DOCDIS have moderate interrater reliability and are feasible in routine care to estimate patient status beyond DOCGL for improved management decisions.

Comparison of the effects of perioperative intravenous infusions of esmolol and lidocaine on the quality of postoperative recovery in patients undergoing functional endoscopic sinus surgery: a randomized, double-blind, noninferiority study.

Perioperative intravenous lidocaine infusion can improve the quality of recovery (QoR) in patients undergoing functional endoscopic sinus surgery (FESS), but the effect of esmolol on recovery has been rarely studied. The aim of this study to compare the effects of esmolol and lidocaine on the QoR in patients with FESS. A total of 60 patients were randomly divided into Group E: intravenous esmolol (0.5mg/kg for 1min, followed by 3.0mg/kg/h); Group L: intravenous lidocaine (2.0mg/ kg for 10min, followed by 2mg/kg/h). The quality of recovery-15 (QoR-15) score was compared. Other parameters compared were the numeric rating pain scale (NRS), haemodynamic data, Surgical fieldconditions, intraoperative drug dosages, number of cases of remedial analgesia, time toawakening and incidence of postoperative sore throat (POST) as well aspostoperative nausea and vomiting (PONV). The mean difference in the QoR-15 score between Group E and Group L on postoperative day 1 (POD1) was - 1.37 (95% CI - 2.75 to 0.01; P < 0.001for noninferiority), indicating the noninferiority of esmolol. Haemodynamic changes and intraoperative nitroglycerine dosages were significantly lower in Group E than in Group L (P < 0.05). The scores of surgical field quality (SSFQ) was higher in Group E than in Group L (P < 0.05). Intravenous infusion of esmolol is not inferior to lidocaine in the quality of postoperative recovery in patients with FESS, and is more advantageous in terms of the quality of the surgical field, attenuation of intraoperative haemodynamic fluctuations, and postoperative awakening.

Non-cadaveric spine surgery simulator training in neurosurgical residency

BackgroundSpine surgical training faces increasing challenges due to restricted working hours and greater subspecialization. Modern simulators offer a promising approach to teaching both simple and complex spinal procedures. This study evaluated the acceptance and efficacy of spine simulator training using a lumbar herniated disc model tested by 16 neurosurgical residents (PGY-1-6), and compared 3D and 2D teaching methods. MethodsSixteen residents utilized the Realists RealSpine L4/L5 disc simulator with both microscope and exoscope. A mixed-methods analysis assessed the efficacy and acceptance of the training. Six PGY-1 residents participated in a learning curve study, divided into exoscopic and microscopic cohorts. Each group watched a tutorial in either 3D or 2D, followed by three surgical sessions. Endpoints included surgical progress within 30 minutes and complication rates. Microsurgical skills and mental concepts were evaluated on a numeric Likert Scale. ResultsParticipants rated the simulator training favorably, with a median score of 8/10 across six categories. The learning curve study showed a 30% improvement in microsurgical performance. The completion rate of herniated disc removal increased from 50% at T2 to 100% at T3 and T4. Significant improvement in mental concept was observed (p=0.035), with slightly better consolidation in the exoscope group. Self-assessments revealed significantly improved skills across all participants. ConclusionSpine simulator training was well-received and resulted in improvements in both mental concept and microsurgical performance, with enhanced outcomes in the 3D teaching/exoscope group. This study supports the integration of spine simulators into spine surgical residency, particularly for early-stage training, to improve both cognitive and practical surgical skills.

Does hand dominance influence clinical outcomes and implant survival in shoulder arthroplasty?

BackgroundTotal shoulder arthroplasty (TSA) is a successful treatment method for patients with end-stage glenohumeral osteoarthritis and different factors influencing the clinical outcome have been determined. However, the role of hand dominance on the postoperative clinical results and implant survival is not well analyzed. Hypothesis: Hand Dominance does not influence the outcome after TSA. Patients and methodsIn this single center cohort study, 138 consecutive patients with primary Osteoarthritis (OA)were treated with a TSA and evaluated with a mean follow-up of 45 months (range 24–158 months). 62.32 % (86 patients) underwent TSA on the dominant side (DOM group) and 37.68 % (52 patients) on their non-dominant side (NON-DOM group). For clinical evaluation the adjusted Constant-Murley (CS) score, pain (Numeric analog scale (NAS)), subjective satisfaction and range of motion (ROM) were recorded. Furthermore, survivorship analysis was performed for the endpoint revision for any reason. ResultsBoth dominant (DOM) and non-dominant (NON-DOM) groups demonstrated significant improvement in all clinical outcomes from pre-to postoperative (p < 0.0001) with no between-group differences (p > 0.05). Implant survival was 98.8 % at 123 months (DOM) and 90 % at 158 months (NON-DOM) (p = 0.89). ConclusionHand dominance did not influence postoperative outcomes, survivorship, or age at time of surgery. Patients can expect excellent results after TSA regardless of their predominant dexterity. Level of evidenceRetrospective cohort study, Level III.

Labor epidural analgesia among Han and Uyghur parturients: a prospective observational study in China

BackgroundDisparities in pain sensitivity and tolerance have been described, however, little is known about variability in the experience of labor pain and childbirth in China. MethodsThis prospective observational study was conducted at a tertiary hospital in Xinjiang, China with two major ethnic groups: Han and Uyghur women. Women with a vaginal delivery with labor epidural analgesia were enrolled. The primary outcome was cervical dilation at labor epidural analgesia request, and multivariable linear regression analysis was performed to determine associated variables. Secondary outcomes were pain score at epidural request and epidural analgesics use. Data presented as mean ± standard deviation. ResultsCervical dilatation at labor epidural analgesia request was significantly lower (1.2 ± 0.7 vs. 0.8 ± 0.6 cm; p=0.0095), and pain score (numerical pain scale 0-10) was significantly higher (0.8 ± 1.0 vs. 4.2 ± 1.2; p=0.0002) among Uyghur compared to Han women. In the multivariate model, Uyghur women had a lower cervical dilation (p=0.0392) and a higher pain score (p<0.0001) at epidural request. During the labor process, a larger proportion of Uyghur women used the patient-controlled epidural analgesia (PCEA) pump (77.8% vs 53.6%, p=0.0011). They pressed the pump in a significantly shorter time (61.3±41.2 vs 104.0±105.2min, p=0.0015) and for more times (1.9±1.7 vs 1.2±1.4, p=0.0022), contributing to significantly more epidural analgesic use (sufentanil: 0.06±0.02 vs 0.07±0.03 μg/kg/h, p=0.0150, ropivacaine: 0.11±0.04 vs 0.14±0.06 mg/kg/h, p=0.0003, respectively). ConclusionsOur findings suggest that Uyghur women experience labor pain with higher levels of pain with a higher use of epidural analgesics than Han women. Further studies are needed to evaluate whether these differences are clinically relevant.FundingThis study was funded by the National Natural Science Foundation of China (No. 72074162).Ethics and Trial registration: Ethical approval was obtained (www.chictr.org.cn Identifier: ChiCTR2200062630).

Effectiveness of implementing a Best Practice Guideline recommendations to manage pain in oncological hospitalized patients

ObjectiveTo evaluate the effectiveness of implementing the Clinical Best Practice Guideline (BPG) “Assessment and Management of Pain” recommendations for pain control in oncological/oncohaematological hospitalized patients. MethodsAmbispective cohort study. Sample and Setting: Adults admitted to oncological unit in Hospital of Albacete. InterventionImplementation of GBP recommendations. Variables: 1) Demographic data. 2)On implementation of GBP recommendations. 3) Outcome in patients: pain intensity in the first 24 h after admission and maximum intensity during admission Tools: Numeric and Visual Scales. Data collection: indicators exported from clinical history for evaluation of the BPSO® program. Ethical aspects: anonymous data. Data analysis (SPSS®): Descriptive during periods: baseline (T0 = December 2015); initial (T1 = 2017); consolidation (T2 = 2018–2019); sustainability (T3 = 2021–2022). Measurements of central tendency and dispersion, absolute and relative frequencies. Comparison of proportions (Chi-Square) and averages (Student t-test, ANOVA). Statistical significance: p < 0.05. ResultsIncluded 572 patients, 61.5% (352) men. Daily intervention of pain detection was performed in 94.6% (538) of patients (20%–T0; 98.3%–T1; 98.4%–T2; 91.2%–T3; p < 0.001), pain assessment using an appropriate scale in 97.6% (558) (0%–T0; 98.3%–T1; 99.2%–T2; 100%–T3; p < 0.001); 93.7% (535) had a care plan for assessment and management of pain (0%–T0; 98.3%–T1; 96.3%–T2; 92.3%–T3; p < 0.001). The percentage of patients who had severe pain (6–10) during the first 24 hours was reduced from T1 to T3 (5.1%–T1; 6.6%–T2; 2.1%–T3; p = 0.145), but throughout hospitalization increased from T1 to T3 (19.2%–T1; 17%–T2; 22.5%–T3; p = 0.21). ConclusionsImplementation of recommendations has led to a statistically significant improvement over the periods in the study; however, no effectiveness has been shown to reduce pain intensity.

Are subjective reports of exercise intensity accurate in recreational athletes?

Quantifying exercise intensity accurately is crucial for understanding links between cumulative exercise and cardiovascular outcomes. Exercise burden, the integral of intensity and duration is often estimated from subjective self-reports which have uncertain accuracy. We studied 40 endurance athletes (EA) 41 to 69 yrs. with >10 yrs. training history during a scripted outdoor 42 km cycling training session. Heart rate (HR) and power output (Watts) were continuously measured. Reports of perceived exertion (RPE) using a word (RPEWord) and numerical Borg scale (RPEBorg) were obtained during and 30 min. post ride and were related to cardiac (HR) and metabolic (MET·min) exercise endpoints. RPEs were highly variable, underestimating objective metrics of exercise intensity. Poor agreement was observed between either scale reported 30 minutes after exercise relative to heart rate: exercise RPEBorg vs. mean exercise HR and %HRpeak (both rs=.29, p=0.07), with no agreement between either scale vs. other objective endpoints. Agreement between RPEBorg and RPEWord was good during exercise (rs=0.86, 95% CI 0.75 to 0.92, P=0.001), but diminished post ride (rs=0.54, 95% CI 0.28 to 0.73, P=0.001). Different cardiac and metabolic profiles during exercise and a contrast between metabolic and cardiac burden was greater in less fit individuals as they accrued greater cardiac (14039±2649 vs. 11784±1132 HR·min, P<0.01) but lower metabolic (808±59 vs. 858±61 MET·min, P<0.05) burden vs. fitter EA. Caution is advised in interpreting MET·min and HR burden estimated from self-reports. Objective measurements of exercise intensity are required for detailed assessment of the risks and benefits of long-term exercise.