Physical Well-being Of Patients Research Articles

The meaning of being conscious during surgery with local or regional anesthesia–A phenomenological hermeneutic study

BackgroundWith increasing prevalence of surgery under local or regional anesthesia, which allows patients to remain conscious during the intraoperative phase, there is a growing need to comprehend the lived experiences associated with this practice. ObjectiveThis study aimed to illuminate the lived experiences of individuals who remained conscious during surgical intervention under local or regional anesthesia. DesignA qualitative design was chosen. Setting(s)Participants in the present study were recruited from three surgical wards located in central Sweden using a purposive sampling strategy. The surgical disciplines included ear, gynecological, hernioplasty, orthopedic, and vessel surgeries. ParticipantsFourteen narrative interviews were conducted with individuals who had undergone elective surgery while conscious. MethodsVerbatim transcribed text was analyzed using a phenomenological-hermeneutic method. ResultsThe lived experience of being conscious during surgery was marked by feelings of hope alongside a sense of losing one's identity and experiencing destabilization. Structural analysis revealed two themes. The first theme, 'being in the hands of others', encompassed subthemes such as 'entering an unfamiliar environment and procedure,' 'losing foothold and a sense of self-identity,' and 'enduring unexpected or anticipated discomfort.' The second theme, 'managing the inevitable for future health concerns,' involved subthemes such as 'pursuing self-acceptance of the situation,' 'entrusting the professionals while seeking signs of a smooth procedure,' and 'Enhancing own resilience through continuous support. ConclusionsBeyond the patient's physical well-being during surgery, the OR team should acknowledge the "person" component and focus on their emotional and social needs in this vulnerable situation. The four meta-paradigms of nursing—person, health, environment, and nursing—significantly influence the conscious patient's experience. Patient or Public ContributionNo patient or public contribution

Complications and psychological impact of pressure ulcers on patients and caregivers.

Pressure ulcers are persistent skin lesions that have substantial detrimental effects on the physical well-being of patients. Moreover, their psychological ramifications for both patients and their caregivers are becoming more widely acknowledged. This research was conducted to examine the psychological ramifications of pressure ulcers and ascertain efficacious approaches to mitigate these effects and improve overall well-being. A cross-sectional study was conducted from March 2022 to December 2023 across tertiary care centres located in Beijing. The cohort consisted of 431 participants, which included primary caregivers and patients who were diagnosed with pressure ulcers. The data were gathered through the utilization of structured questionnaires and semi-structured interviews. These methods encompassed demographic details, clinical characteristics and validated scales that assessed psychological parameters, including quality of life, anxiety, stress and depression. The research exposed substantial psychological toll on both individuals receiving care and those providing care, with caregivers enduring diminished quality of life and elevated levels of anxiety, depression and stress (p < 0.05). A significant positive correlation was identified between the degree of psychological distress and severity of pressure ulcers (p < 0.05). Both location of the ulcer and duration of care were substantial contributors to the psychological burden (p < 0.05). In spite of the apparent necessity, a significant proportion of the participants refrained from obtaining psychological counselling. The results underscored the significant psychological ramifications of pressure ulcers for both individuals receiving care and the caregivers. As a result, comprehensive care strategies that incorporate psychological assistance into the prescribed treatment plan are imperative. This research highlighted the criticality of implementing all-encompassing, interdisciplinary approaches to tackle the complex issues presented by pressure ulcers in an effort to enhance the general welfare of those influences.

Quality of life among older patients receiving faecal microbiota transplant for Clostridioides difficile infection.

Faecal microbiota transplantation (FMT) has mainly been studied in quantitative research to investigate effect rates. However, there is a lack of qualitative studies to explore patient perspectives. To explore perceptions of quality of life in older patients with Clostridioides difficile infection (CDI) at least 1 week after receiving FMT. A qualitative study examining quality of life for patients treated with FMT. Patients with a permanent or transient treatment effect experienced an increase in quality of life in the physical, psychological and social domains. However, patients who did not respond to the treatment experienced negative impacts on their psychological, physical, and social domains. Although patients found the content unappealing, none had reservations about receiving the treatment. This study highlights the importance of considering the psychological, social and physical wellbeing of patients when assessing the efficacy of FMT as a treatment option for patients with CDI. It further emphasises the importance of health professionals identifying patients' individual ways of handling the disease and everyday life to improve their quality of life.

Exploring real-world symptom impact and improvement in well-being domains for tardive dyskinesia in VMAT2 inhibitor-treated patients via clinician survey and chart review.

Two vesicular monoamine transporter 2 (VMAT2) inhibitors are approved in the United States (US) for the treatment of tardive dyskinesia (TD). There is a paucity of information on the impact of VMAT2 inhibitor treatment on patient social and physical well-being. The study objective was to elucidate clinician-reported improvement in symptoms and any noticeable changes in social or physical well-being in patients receiving VMAT2 inhibitors. A web-based survey was offered to physicians, nurse practitioners, and physician assistants based in the US who prescribed valbenazine for TD within the past 24 months. Clinicians reported data from the charts of patients who met the inclusion criteria and were allowed to recall missing information. Respondents included 163 clinicians who reviewed charts of 601 VMAT2-treated patients with TD: 47% had TD symptoms in ≥2 body regions, with the most common being in the head or face and upper extremities. Prior to treatment, 93% of patients showed impairment in ≥1 social domain, and 88% were impaired in ≥1 physical domain. Following treatment, among those with improvement in TD symptoms (n = 540), 80% to 95% showed improvement in social domains, 90% to 95% showed improvement in physical domains, and 73% showed improvement in their primary psychiatric condition. In VMAT2-treated patients with TD symptom improvement, clinicians reported concomitant improvement in psychiatric disorder symptoms and in social and physical well-being. Regular assessment of TD impact on these types of domains should occur simultaneously with movement disorder ratings when evaluating the value of VMAT2 inhibitor therapy.

Assessment of psychosomatic state in patients with acute pancreatitis

Relevance of the research. Assessment of the psychosomatic state of patients after acute pancreatitis helps to understand the impact of the emotional state on the chronicity of the disease and can lead to improved treatment planning and rehabilitation of these patients.The aim of the study is to assess the psychosomatic state of patients after the primary episode of acute pancreatitis.Materials and methods. An examination of 80 patients undergoing inpatient treatment for acute pancreatitis was carried out. Psychological questionnaires were used to determine the peculiarities of the psychosomatic state in the examination. The WAM technique was used to assess the state of health, activity and mood. An appropriate clinical questionnaire was used to identify and evaluate the signs of neurotic conditions. The Holmes and Rahe method was used to determine the degree of resistance to stress.Results. According to the scale of "well-being", it was found that the average values of patients corresponded to the low level. The data showed a moderate level when analyzing the scores on the "activity" and "mood" scales. Due to the clinical questionnaire for the detection and assessment of neurotic states, it was determined that the presence of maladaptive states characterizes the psychosomatic state of patients with acute pancreatitis; regardless of gender, the average values among the groups correspond to the level of the disease state. Using the methodology for assessing stress resistance, it was found that patients after the disease identified a low level of stress resistance, without a significant difference between the sexes of the subjects.Conclusions. With the WAM method, indicators of low well-being, activity, and mood indicate a low level of psycho-emotional and physical well-being in patients who have suffered acute pancreatitis. The psychosomatic state of patients with acute pancreatitis is characterized by a low level of resistance to stress and the presence of such maladaptive conditions as anxiety and asthenia, regardless of gender.

A mixed-methods study to inform development of a caregiver-specific problem list for cancer distress screening.

Oncology guidelines for distress management recommend use of the single-item distress thermometer (DT) and accompanying Problem List (PL) to identify patients with high distress levels and their potential sources of distress. However, oncology practices have yet to establish standardized protocols to screen and triage caregivers with high distress levels. With an eye toward integrating caregiver-centered support services into cancer care, this mixed-methods study sought to assess caregiver distress and challenges that may contribute to their distress. Nineteen caregivers of metastatic breast cancer patients (60% female, 47% ethnic/racial minority) completed an interview and a survey comprised of the DT, the original 39-item PL, and five additional caregiver-specific PL items. Caregivers reported moderate distress levels and more than half exceeded the National Comprehensive Cancer Network (NCCN) cut-off, denoting significant distress. There was no association between caregiver distress and the number of items endorsed on the original PL. Qualitative analysis identified nine problem domains as areas of caregiver unmet need needs (i.e., practical challenges, caregiving responsibilities, social/relationship issues, caregiver and patient emotional well-being, caregiver and patient physical well-being, spiritual well-being, and communication). Two of the problem domains (caregiving responsibilities and communication) were not captured in any way by the original PL. With further research and development, the identified domains could serve as the basis for a caregiver-specific PL to facilitate triage and referral when incorporated as part of routine distress screening.

Trajectories of physical well-being among adults with acute myeloid leukemia.

e19040 Background: Adults with acute myeloid leukemia (AML) commonly experience physical decline related to their disease and treatment which is associated with negative outcomes. However, physical trajectories differ among patients. Identifying distinct physical trajectories may help guide clinical decision making and supportive care interventions. In this secondary analysis, we examined physical trajectories of patients with AML and factors associated with these trajectories. Methods: We used data from patients with newly diagnosed AML in four clinical trials. Functional Assessment of Cancer Therapy Physical Well-Being sub scale (FACT-PWB, range 0-28) was measured from baseline to day 200, up to 5 timepoints per patient. We used group-based trajectory models (GBTM) weighted for mortality-related drop out to identify groups of patients with similar trajectories of change in FACT-PWB and estimate the association of baseline demographics (age, marital status, education) and clinical factors (AML risk, baseline FACT-PWB, depression, anxiety) with group membership. The number of groups was selected based on clinical interpretability and model fit statistics. Results: We included 343 patients with ≥ 1 FACT-PWB score during up to 200 days of follow-up. Mean age was 65 (SD 12.7), most had intermediate risk AML (178, 52%), received intensive treatment (244, 71%), and died during the follow up period (199, 58%). The GBTM with 4 patterns of change in FACT-PWB showed the best fit for our data (Table). The largest group (Group 2: N = 188, 55%) declined slightly in the first month, then stabilized, while those in the smallest group (Group 1: N = 16, 5%) declined steadily in the first 3 months before improving and stabilizing. Lower baseline FACT-PWB was associated with membership in Group 3: Slight improvement then stable (115, 34%) and Group 4: Steep improvement then stable (24, 7%)), relative to Group 2 (p &lt; .001). Other variables were not associated with group membership. Conclusions: Adults newly diagnosed with AML show distinct patterns of change in their physical well-being after starting treatment. Future studies should measure self-reported and objective physical function in addition to physical well-being in patients with AML, especially with recent change in treatment landscape, to better understand their trajectories. [Table: see text]

Tai Chi Exercise for Mental and Physical Well-Being in Patients with Depressive Symptoms: A Systematic Review and Meta-Analysis.

Tai Chi is a mindfulness-body practice that has physiological and psychosocial benefits and can be integrated into the prevention and rehabilitation of various medical conditions; however, the effectiveness of Tai Chi in the treatment of depression remains unclear. This review aimed to determine the effects of Tai Chi exercise on mental and physical well-being in patients with depressive symptoms. We searched databases for English language publications that appeared during January 2000-2022. The included trials were RCTs that involved people with depression with no other medical conditions, and included both adolescent and adult samples. A meta-analysis was performed using a random effects model and the heterogeneity was estimated using I2 statistics. The quality of each trial was assessed according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology. The eight trials were divided into two comparisons: (1) a combination of Tai Chi and antidepressants versus standard antidepressants; (2) Tai Chi versus no intervention. The Tai Chi intervention showed improvements in mental and physical well-being as evidenced by the reductions in depression and anxiety and improved quality of life (QOL) of the patients with depressive symptoms. Further well-controlled RCTs are recommended with a precision trial design and larger sample sizes.

Physiotherapy Interventions as an Adjunct Approach in Patients with Primary Dysmenorrhea: A Narrative Review

Primary Dysmenorrhea (PD) is a major contributor in teenage and young female absenteeism following menstrual cramps and abdomen pain before and during their menstrual cycle. Prostaglandin secretion causes uterine muscles and blood arteries to contract. The discomfort is usually modest, but in some cases, it is so terrible that it prevents them from going to work for many days in a month without any social, psychological and physical activity. The purpose of this review was to assess impact of physiotherapy on psychological, social and physical wellbeing in patients with PD. Physiotherapy intervention without surgical management can improve psychological, physical and social wellbeing of PD patients. All articles incorporated in the review were reported to reduce the pain intensity and the frequency in PD. A healthier and more appropriate eating style, as well as more frequent physical activity can help school and college going females to avoid dysmenorrhea. Educational activities can help in raising awareness among young women about the importance of a healthy diet and physical activity. The present review concluded that physiotherapy treatment strategies are effective treatments for reducing pain and psychological effects on PD females. Conservative management by physiotherapy reduces intensity and frequency of pain, anxiety, depression, stress, poor sleep quality and improved quality of life in PD.

RISK FACTORS OF LIFE QUALITY REDUCTION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

It is a known fact that the presence of a chronic disease or chronic pain syndrome reduces the quality of life (QoL). Despite considerable achievements in the diagnostics and treatment of systemic lupus erythematosus (SLE) over the past decades and improvements in the long-term prognosis of patients, many challenges remain unsolved. The investigation of the quality of life can help to comprehensively evaluate patients' health, the effectiveness and safety of treatment and identify other causes of reduced quality of life that are not directly related to the disease.&#x0D; Aim of the academic paper lies in evaluating quality of life parameters using the SF-36 questionnaire in patients with SLE and analyzing risk factors for its reduction.&#x0D; Materials and Methods. A questionnaire was conducted using the Medical Outcomes Study Short Form 36 questionnaire (SF-36) of 36 patients with systemic lupus erythematosus aged 18 to 62 years, regardless of disease activity at the time of examination, and 24 practically healthy persons, comparable in age and gender ratio. The main parameters of the quality of life in the 2 groups were compared, as well as their dependence on clinical manifestations and therapy was studied.&#x0D; Results and Dyscussion. Physical well-being in patients with SLE (29.6±2.97) is significantly lower (p&lt;0.001) than in healthy individuals (55.8±3.31). The level of mental well-being does not differ significantly, but its components, such as social functioning (p=0.047) and vital activity (p=0.01) are reduced in patients with SLE. The level of physical well-being is lower in the groups of patients with the presence of arthritis (p=0.026), avascular necrosis of the femoral head before surgery (p=0.019) and skin rash (p=0.032) in the clinical picture compared to patients without these manifestations. The use of cyclophosphamide (p=0.046) and mycophenolate mofetil (p=0.012) is associated with a higher level of mental well-being.&#x0D; Conclusions. Patients with SLE have a lower level of quality of life compared to healthy individuals of the corresponding age and gender. The risk factors for reducing the level of physical well-being are the presence of arthritis, skin rash and avascular necrosis of the femoral head (prior to surgical intervention). The level of mental well-being is significantly higher among patients taking cyclophosphamide and/or mycophenolate mofetil.&#x0D; Abbreviations:&#x0D; ACR - American College of Rheumatology&#x0D; AIDS - acquired immunodeficiency syndrome&#x0D; ANFH - avascular necrosis of femoral head&#x0D; CF - Cyclophosphamide&#x0D; EULAR - The European Alliance of Associations for Rheumatology&#x0D; GC - glucocorticoids&#x0D; MMF - Mycophenolate mofetil&#x0D; SLE - systemic lupus erythematosus&#x0D; SLICC - The Systemic Lupus Erythematosus International Collaborating Clinics&#x0D; QoL - Quality of life

Same-day discharge after brain tumor resection: a prospective pilot study.

PurposeOutpatient brain surgery has many advantages for the psychological and physical wellbeing of patients, as well as reduced costs to the health care system. Compared with inpatient admissions, same day discharges reduce patient exposure to nosocomial infection, thromboembolic complications, and medical error. We aim to establish a prospectively collected quality outcomes database to examine the outcomes of patients that undergo brain tumor resection and are discharged home the same day as surgery.MethodsWe have established a prospectively collected quality outcomes database to examine the outcomes of all patients that underwent brain tumor resection by a single neurosurgeon (R.J.K) at our institution from August 2020 to August 2021 and were discharged home the same day as surgery.ResultsOver the one-year period this study was conducted, 37 of 334 patients met inclusion criteria for the outpatient protocol. Thirty-two patients were discharged on the same day as surgery. Five patients (14%) were considered eligible for outpatient surgery but were ultimately admitted to the hospital postoperatively and were discharged after an overnight observation. No postoperative complications were noted at two-week postoperative follow-up.ConclusionIn select patients undergoing brain tumor surgery, same day discharge should be considered. Establishing a multidisciplinary team of physicians, nurses, radiologists, and physical therapists is critical to achieving this aim. Physicians should have a low threshold to admit a patient with concerning exam findings, complications, or complicated past medical history. Once discharged, open communication with the patient and their family is critical to detect complications that should trigger rehospitalization and intervention.

Accuracy and Quality of YouTube Videos as a Source of Information on Vitiligo.

PurposeVitiligo is a skin condition characterized by patchy depigmentation in the skin, affecting not just the physical well-being of patients, but also the mental, emotional, and social aspects of their lives. Social media provides a platform where patients can interact and share experiences, and for physicians and experts to disseminate knowledge on the disease. This study aimed to evaluate the accuracy and overall quality of vitiligo-related content on YouTube.MethodsThirty videos were screened by relevance according to the inclusion criteria. Videos were categorized as either healthcare or non-healthcare sources, and viewer engagement ratio was calculated for each. Three independent vitiligo experts rated the content using the following assessment tools: DISCERN, Accuracy in Digital-health Instrument (ANDI), and Global Quality Scale (GQS). Lastly, Cronbach’s alpha was used to estimate the inter-rater reliability and consistency.ResultsMost of the screened videos came from health-care sources (57%). Non-healthcare sources achieved a slightly higher viewer engagement ratio, although the difference is not statistically significant (p = 0.23). DISCERN score was low overall in most videos. However, DISCERN score was higher for health-care sources as compared to non-healthcare sources (30.5 ± 9.4 vs 22.7 ± 4,2, p = 0.009). Scores of ANDI and GQS were higher for health-care sources but not statistically significant. There was a good internal consistency in DISCERN rating among the evaluators (0.86).ConclusionOur study shows a low overall accuracy and quality of YouTube videos on vitiligo. It is recommended that health-care sources improve their information material in terms of quality and viewer engagement, as very little can be done to prevent non-healthcare sources in publishing their own videos. Efforts in educating the public on making distinction between evidence and non-evidence-based claims should also be taken.

Assessment of Perception of Palliative Care among the Patients of Palliative Therapy

Background: The assessment of the good health and well-being of palliative care patients is summarised in this protocol analysis. It will bring about the financial and physical wellbeing of patients. The standard of life of patients and their families has been reviewed.&#x0D; Methods: It is a cross-sectional analysis involving selected villages in the Wardha district. A sample of 95 participants will be taken from Wardha Palliative Care. Patients will be randomly allocated to the survey by the Jawaharlal Nehru Medical College of Wardha District Department of Community Medicine. A pre-designed multidimensional survey questionnaire will be prepared and pre-tested for quantitative data collection . The pro forma used to gather the data will include their current disease and disease management and will integrate the psychosocial and moral elements of hospital care. The motive of this research is to understand the interpretation of palliative care in the lives of affected patients. The goal of this study is to know the conception of a compromised patient living.&#x0D; Results: Using descriptive and inferential statistics using the chi-square test, the result will be obtained by attributing the baseline and terminal consequences.&#x0D; Conclusion: The purpose of this research is to define the predictive, mediating and moderating functions of select variables: self-efficacy, disease, psychosocial, spiritual caregiver. The findings of this study will influence the interpretation of the resilience of patients with palliative care and will enhance functional outcomes for emotional, mental and spiritual health. This change in attitude would be beneficial to them in their lives. And the patient's quality of life will improve.

High intensity interval training safety and efficacy in patients with advanced NSCLC receiving systemic treatment: Results of a prospective trial.

12054 Background: Patients with advanced NSCLC experience fatigue and physical deconditioning altering their quality of life. Safety and feasibility of high intensity exercise in advanced NSCLC has not been explored yet. Methods: We report the results of a single-center, prospective two-arm study. Patients with advanced NSCLC actively receiving systemic therapy or having completed treatment less than 2 months prior to enrollment were included. Patients were allocated to either an intervention arm consisting of kinesiologist supervised high intensity interval training (HIIT) at 2 sessions per week for a total of 12 weeks; or a control arm of home exercise guided by an informative pamphlet. All patients were evaluated at baseline, 6 and 12 weeks by a kinesiologist. Quality of life (QoL) exercise surveys and measurement of strength were measured. Results: Sixty patients were enrolled between January 2018 and March 2020. The study was interrupted due to COVID-19. Thirty-two patients were included in the exercise program and 28 patients in the control group. Both groups were balanced in respect to baseline characteristics. A total of 32 (53%) patients went off protocol, 13 (18%) patients stopped due to symptomatic disease progression which included 2 (3%) deaths, 2 (3%) stopped due to COVID-19 preoccupations and the remaining patients withdrew for other reasons. 42 (70%) patients were evaluated at 6-weeks and 28 (47%) completed the 12-week follow-up, with equal distribution in each group. There were no significant difference at 12 weeks in the physical assessment nor the overall QoL scores between both groups: FACT-L on 135 points (+4.1 vs +1.7, p = 0.342) and FACIT on 52 points (+3 vs -0.2, p = 0.832). Patients in the exercise group demonstrated a significant improvement at 12 weeks in the Lung Cancer Symptoms domain on 28 points (22.3 vs 19.8, p = 0.015) as well as the Physical Wellbeing domain on 28 points (23.6 vs 20.6, p = 0.056) compared to the control group, respectively. No significant exercise related complications were reported. After the study, 9 of the 14 patients (64%) who completed the HIIT program continued to exercise virtually with a kinesiologist in contrast to none in the control group. Conclusions: This study demonstrated the safety and potential benefit of a HIIT program on lung-specific and physical wellbeing in patients with advanced NSCLC on active treatment. This study provides further support on the role of supervised physical exercise in patients living with cancer. Clinical trial information: 16.229.

Innovations to Increase Home Hemodialysis Utilization: The Transitional Care Unit.

A large proportion of patients undergoing incident dialysis start in-center hemodialysis with suboptimal preparation and predialysis education. Transitional care units deliver a structured program by dedicated staff, with less patient-to-staff ratios than in regular in-center dialysis care, with the goals of supporting the emotional and physical well-being of patients while providing them with education and equipping them with the right tools to start their journey on dialysis. Key components of these programs include an emphasis on patient activation and self-management, educating and supporting patients to make informed modality choices, timely coordination of care, and an integrated approach to formation and use of the dialysis access. While data are still limited on best practices and on outcomes of these programs at a large scale, endorsing the model of transitional care units is a step in the right direction to fill the gap in our current care system.

The Association Between Pressure Ulcer/Injury Development and Short-term Mortality in Critically Ill Patients: A Retrospective Cohort Study.

The aim of this retrospective study was to examine the association between PU/I development and mortality in a large cohort of consecutively admitted critically ill patients. Data from adult patients ( >18 years of age) admitted to an intensive care unit (ICU) between 2010 and 2013 were extracted from the ICU electronic clinical information system. Patients were excluded if they had a PU/I present on admission, no recorded admission modified Jackson/Cubbin (mJ/C) or Sequential Organ Failure Assessment (SOFA) score, or their ICU outcome was undetermined. The mJ/C risk scale (score range 9-48) was used to assess the PU/I risk (the lower the score, the higher the PU/I risk), the SOFA score (score range 0-24; the higher the SOFA score, the sicker the patient, with a higher risk of death) was used to assess the severity of the condition and outcome. ICU outcome was defined as 1) moved from the ICU to a ward/recovering or 2) no response to ICU treatment/deceased. All data were transferred to statistical software for analysis. Logistic regression analysis was used to examine the outcome related to PU/I development, SOFA, and mJ/C scores. Descriptive contingency tables of different scenarios were used to further evaluate relationships among different risk factors related to mortality; the Wald χ2 test was used to assess the statistical significance of the contingency tables. Of the 6582 patients admitted, 6089 were included for analysis. Two hundred, one (201) had a PU/In on admission, 212 had missing mJ/C or SOFA scores, and ICU outcome was undetermined in 80 patients. Patient mean age was 61.1 ± 15.8 (range 18-94) years; 3891 (63.9%) were male, average length of stay (LOS) was 3.6 days, denoted by quartile (Q) (median 1.58 days; Q1: 0.9, Q3: 3.9 days), and 1589 (26.1%) stayed 3 days or more in the ICU. The incidence of PU/I was 6.9% (423 patients), and ICU mortality rate was 9.1% (n=553). The mean LOS of patients with PU/I was 13.35 ± 15.56 days (median 8.95, Q1: 4.88, Q3: 16.2) and 2.84 ± 3.87 days for patients with no PU/I (median: 1.20, Q1: 0.90, Q3: 3.17; P <.0001). Mean LOS was 3.42 ± 5.95 days (median: 1.30, Q1: 0.90, Q3: 3.70) among recovering and 5.00 ± 7.17 days among deceased patients (median 2.56, Q1: 1.26, Q3: 6.40; P <.0001). The proportion of patients with an admission mJ/C score of 29 or less ranged from 48.8% to 51.5%, and the mean SOFA score was 7.0 ± 3.2. PU/I development and SOFA or mJ/C scores were independent predictors of mortality. The probability of a negative outcome was higher in persons with PU/Is compared to persons with no PU/Is. Persons with lower SOFA scores (ie, less severely ill patients) and higher mJ/C scores for each factor separately (ie, at low risk of PU/I development) each factor separately had a lower mortality risk. PU/I development in critically ill patients treated at an ICU is an independent predictor of mortality, even though the PU/I incidence and hospital mortality were relatively low. The ICU admission SOFA and mJ/C score also were independent prognosticators of ICU mortality. Future research could focus on the role of different steps in the cascade of PU/I development, especially to the role of inflammation.

СLINICAL AND LABORATORY DATA AND ALGORITHM OF MANAGEMENT OF ADULT PATIENTS WITH POLYARTICULAR VARIANT OF JUVENILE IDIOPATHIC ARTHRITIS

Relevance. The polyarticular variant of juvenile idiopathic arthritis (JIA) is a disease that begins in childhood and leads to joint damage and disability in adulthood with significant social losses. At 18, patients go under the supervision of adult rheumatologists, often accompanied by loss of control of the disease due to insufficient compliance from both the patient and the physician. Today, there is no documented process for the transfer of patients from childhood to adulthood in Ukraine. Therefore, creating an algorithm for managing such patients is an urgent task.The polyarticular variant of JIA is a disease that begins in childhood and leads to joint damage and disability in adulthood with significant social losses.&#x0D; Objective of this study was to evaluate the clinical and laboratory status and to develop an algorithm for managing adult patients with polyarticular variant of JIA, depending on the detection of RF or/and A-CCP.&#x0D; Materials and methods. The study included 168 adult patients from different regions of Ukraine who were diagnosed with JIA in childhood between 1984 and 2014 without severe comorbidities. Inclusion criteria were: 16 to 60 years old; duration of the disease more than 3 years; the presence of documentary evidence of childhood diagnosis of JIA (ambulatory card, hospital records). Among patients with JIA were identified 53 patients with polyarticular variant, of whom 42 or 25% - with RF (-) polyarthritis and 11 or 6.5% - with RF (+) polyarthritis. The disease activity was evaluated by DAS28 and JADAS-10. The questionaries SF-36, HAQ, TAS-20, PHQ-9 were analyzed and remote articular JADI-A and extra-articular JADI-E damages were evaluated. Statistical studies were performed using IBM SPPS Statistics version 25.0.0.0 software, the results were considered to be reliable at 5% critical level (P &lt;0.05). &#x0D; Results. The negative correlation of JADI-A and the patient's physical well-being PCS (r = -0.27, p &lt;0.05) and physical functioning (r = -0.24, p &lt; 0.05), pain intensity (r = -0.24, p &lt;0.05), general health (r = -0.24, p &lt;0.05), vital activity (r = -0, 19, p &lt;0,05), social functioning (r = -0,27, p &lt;0,05), mental health (r = -0,22, p &lt;0,05) according to SF-36. The severity of extra-articular damages JADI-E correlated with PCS (r = -0.22, p &lt;0.05) and physical functioning (r = -0.28, g &lt;0.05), pain intensity (r = -0.20, p &lt;0.05), general health (r = -0.23, p &lt;0.05), and mental health (r = -0.23, p &lt;0.05), but also had a positive rcorrelation with HAM-A (r = 0.25, p &lt;0.05), depression scale (r = 0.28, p &lt;0, 05) and PHQ-9 (r = 0.28, p &lt;0.05). Significantly lower level of physical health was established in patients who requires prosthetics (p &lt;0.001) compared to those who did not need prosthetics. &#x0D; Conclusion. Based on the results obtained, algorithms for managing adult patients with JIA positive for RF or / and A-CCP were developed, depending on the detected articular and extra-articular damages and the need for prosthetics and the psychological status.

Acupuncture therapy for patients with hemifacial spasm: A protocol of systematic review and meta-analysis.

Background:Hemifacial spasm (HFS) brings a lot of trouble to patients’ daily life, having a severe influence on the psychological and physical wellbeing of patients. Relevant researches suggested that acupuncture therapy has potential benefits for HFS. However, there is no consistent conclusion. The purpose of our study is to assess whether acupuncture therapy is effective and safe for HFS.Methods:To collect relevant randomized controlled trials (RCTs), the following electronic databases will be searched: Web of Science, the Cochrane Library, EMBASE, MEDLINE, ISI Web of Knowledge, PsycINFO, Allied and Alternative Medieine, Chinese National Knowledge Infrastructure, Wanfang data, and Chinese Scientific Journals Database. We will take the cure rate and the total effective rate as the primary outcomes, and change in intensity after treatment, change in frequency after treatment, the recurrence rate, and adverse events as secondary outcomes. Endnote software 9.1 will be used for study selection, Review Manager software 5.3, and STATA 13.0 software will be used for analysis and synthesis.Results:Current relevant studies will be synthesized to assess whether acupuncture therapy is effective and safe for HFS.Conclusion:Our research will provide evidence of acupuncture therapy for HFS.Registration:International Prospective Register of Systematic Reviews (PROSPERO) CRD42019142473.

Comparison of the effectiveness of oral morphine versus oral tramadol on early pain control in opioid-naive patients with moderate cancer pain.

11581 Background: Adequate pain control, an essential part of cancer care remains a challenge in resource limited countries like Nepal. Early use of morphine for Moderate Cancer Pain (MCP) and not sequential World Health Organization (WHO) analgesic ladder seems reasonable in the setting of limited access to health care. The purpose of this study was to compare efficacy of oral Morphine (MOR) with oral Tramadol (TRM) in control of pain as well as physical wellbeing in patients (pts) with MCP using Edmonton Symptom Assessment Scale (ESAS). Methods: An IRB approved randomized phase II trial was performed in opioid-naive pts with MCP as defined by pain score in Numerical rating score (NRS)of 4-6.Patients were randomized to receive MOR syrup 5 mg 4 hourly or TRM 50 mg four times a day. Titration of dose was done in both groups for 3 days as per standard recommendation for MOR or till maximum recommended daily dose for TRM. MOR was changed to prolonged release form at Day 4.The primary endpoint was number of early responders, defined as pts with at least 20% reduction in pain intensity on NRS on Day 3. Secondary outcome was number of patients with highly meaningful pain reduction, defined as decrease in pain intensity on NRS by ≥ 5 and improvement in physical well-being with ESAS at Day 7. Results: 68 pts consented and were randomized, 34 in each arm. The primary endpoint occurred in 94.1% pts in MOR and 55.9% in TRM (p &lt;0.001). Number of patients with highly meaningful pain reduction was significantly higher in MOR than in TRM (76.5% vs. 32.35%; p&lt;0.001). Improvement in general physical wellbeing as assessed by ESAS was better in morphine group. No difference in adverse effects was noted between the treatment arms. Conclusions: In this study Morphine was superior to Tramadol in the control of pain with statistically significant difference in the primary and secondary endpoints. So, early use of morphine skipping the WHO sequential analgesic ladder for moderate cancer pain seems a higher value option in resource scarce country with limited access to healthcare.

Food allergy test in chronic urticaria adult patients: A cross sectional study

Food allergy test in chronic urticaria adult patients: A cross sectional study - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.027, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol