Reduction In Discomfort Research Articles

Complementary and alternative therapies for management of odor in malignant fungating wounds: a critical review

Complementary and alternative therapies for management of odor in malignant fungating wounds: a critical review Georgina Gethin,1 Caroline McIntosh,2 Sebastian Probst3 1School of Nursing and Midwifery, National University of Ireland, Galway, 2Discipline of Podiatric Medicine, National University of Ireland, Galway, Ireland; 3School of Health, University of Applied Sciences Western Switzerland, Geneva, Switzerland Abstract: Malignant fungating wounds (MFWs) affect an estimated 5%–10% of all people with cancer. They have a profound effect on the individual, and their associated symptoms such as bleeding, odor, exudate, and pain cause much distress, anxiety, and social isolation. Odor is cited by patients and clinicians as the worst aspect of such wounds. Strategies to manage odor at the wound site include the use of complementary and alternative therapies. This review aimed to synthesize the current evidence for the use of complementary and alternative therapies in the management of odor in MFWs. No restrictions on date, language, or care setting were applied. Nine databases were searched yielding four papers meeting our criteria. Of the four papers, one was a randomized controlled trial (RCT), and three were case studies. Two papers investigated the use of green tea teabags as a secondary dressing, while others used essential oils either combined with a cream applied directly to the wound or as a secondary dressing. In an RCT, green tea was used as a solution to cleanse the wound followed by the application of green tea teabag as a secondary dressing versus metronidazole powder for the management of odor over 7 days. All patients reported a reduction in odor and physical discomfort, and an improvement in social interaction and appetite, but the difference between groups was not statistically significant. The case studies all reported an improvement in odor management. The use of complementary and alternative therapies in the management of MFW-associated malodor is not supported by evidence from RCTs. Green tea may have potential as a secondary dressing to manage odor. Further research in this area is warranted. Keywords: malignant fungating wound, odor, complementary medicine, alternative medicine&nbsp

Dynamic lens and monovision 3D displays to improve viewer comfort.

Stereoscopic 3D (S3D) displays provide an additional sense of depth compared to non-stereoscopic displays by sending slightly different images to the two eyes. But conventional S3D displays do not reproduce all natural depth cues. In particular, focus cues are incorrect causing mismatches between accommodation and vergence: The eyes must accommodate to the display screen to create sharp retinal images even when binocular disparity drives the eyes to converge to other distances. This mismatch causes visual discomfort and reduces visual performance. We propose and assess two new techniques that are designed to reduce the vergence-accommodation conflict and thereby decrease discomfort and increase visual performance. These techniques are much simpler to implement than previous conflict-reducing techniques. The first proposed technique uses variable-focus lenses between the display and the viewer's eyes. The power of the lenses is yoked to the expected vergence distance thereby reducing the mismatch between vergence and accommodation. The second proposed technique uses a fixed lens in front of one eye and relies on the binocularly fused percept being determined by one eye and then the other, depending on simulated distance. We conducted performance tests and discomfort assessments with both techniques and compared the results to those of a conventional S3D display. The first proposed technique, but not the second, yielded clear improvements in performance and reductions in discomfort. This dynamic-lens technique therefore offers an easily implemented technique for reducing the vergence-accommodation conflict and thereby improving viewer experience.

Effects of self-ligating brackets on oral hygiene and discomfort: a systematic review and meta-analysis of randomized controlled clinical trials.

Self-ligating brackets (SLBs) are widely adopted in clinic owing to their claimed superiorities. Here, we collected and analysed all randomized controlled clinical trials (RCTs) comparing SLBs with conventional brackets (CBs) and thereby investigated whether SLBs can relieve discomfort or promote oral hygiene. Electronic databases including MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, Chinese BioMedical Literature Database and the China National Knowledge Infrastructure were searched to find out RCTs comparing active or passive SLBs with CBs. Two reviewers extracted the data and assessed risks of bias independently. Any disagreement between them was resolved through discussion with a third reviewer. Meta-analysis was conducted on Review Manager 5.3. A total of 12 RCTs with 575 participants were included, and eight of the trials were synthesized quantitatively. Two trials were assessed as low risk of bias, whereas others as unclear risk of bias. Passive SLBs and CBs are not significantly different in plaque control. SLBs and CBs are not significantly different in discomfort reduction at any of four time points (4 h, 24 h, 3 days and 7 days). Clinical evidences from existing RCTs suggest that SLBs do not outperform CBs in reliving discomfort or promoting oral health in clinic.

Carbon dioxide insufflation during colonoscopy can significantly decrease post-interventional abdominal discomfort in deeply sedated patients: A prospective, randomized, double-blinded, controlled trial.

CO2 has been reported to be absorbed from the bowel more rapidly than air, resulting in a discomfort reduction after colonoscopy. Its role in deeply sedated patients is limited. This study was designed to investigate the efficacy and safety of CO2 insufflation during colonoscopy in patients deeply sedated with propofol. A total of 125 continuous patients were randomly assigned to receive either CO2 (n = 63) or air (n = 62) insufflation during propofol-sedated colonoscopy. Postcolonoscopy abdominal pain, distention, and satisfaction were assessed at 1, 3, and 24 h after the procedure, and the proportions of pain-free and distention-free patients were compared. Residual bowel gas in the colon and small bowel was evaluated at 1 h after colonoscopy. End-tidal CO2 and O2 saturation was measured for safety analysis. There was a significant difference between the two groups regarding the postcolonoscopy abdominal pain, distention, and subjective satisfaction at 1 h (P < 0.001) and 3 h (P < 0.01) after the procedure. Patients' pain and distention at 1 and 3 h after the procedure were significantly lower in the CO2 group (P < 0.01). Residual bowel gas in the colon and small bowel was significantly less in the CO2 group (P < 0.001). There was no significant difference in end-tidal CO2 levels between two groups before, during, and after the procedure. Compared with air, CO2 insufflation during colonoscopy reduced postcolonoscopy abdominal discomfort and improved patients' satisfaction. It was safe to use CO2 insufflation in deeply sedated colonoscopy.

Reduction of self-perceived discomforts in critically ill patients in French intensive care units: study protocol for a cluster-randomized controlled trial.

BackgroundIt is now well documented that critically ill patients are exposed to stressful conditions and experience discomforts from multiple sources. Improved identification of the discomforts of patients in intensive care units (ICUs) may have implications for managing their care, including consideration of ethical issues, and may assist clinicians in choosing the most appropriate interventions. The primary objective of this study was to assess the effectiveness of a multicomponent program of discomfort reduction in critically ill patients. The secondary objectives were to assess the sustainability of the impact of the program and the potential seasonality effect.Methods/designWe conducted a multicenter, cluster-randomized, controlled, single (patient)-blind study involving 34 French adult ICUs. The experimental intervention was a 6-month period during which the multicomponent program was implemented in the ICU and included the following steps: identification of discomforts, immediate feedback to the healthcare team, and implementation of targeted interventions. The control intervention was a 6-month period during which any program was implemented. The primary endpoint was the monthly overall score of self-reported discomfort from the French questionnaire on discomforts in ICU patients (IPREA). The secondary endpoints were the scores of the discomfort items of IPREA. The sample size was 660 individuals to obtain 80 % power to detect a 25 % difference in the overall discomfort score of IPREA between the two groups (design effect: 2.9).DiscussionThe results of this cluster-randomized controlled study are expected to confirm that a multicomponent program of discomfort reduction may be a new strategy in the management of care for critically ill patients.Trial registrationClinicalTrials.gov NCT02442934 , registered 11 May 2015.

Dual isotope subtraction SPECT-CT in the diagnosis of primary hyperparathyroidism

light in treating actinic keratoses (AK) with a marked reduction in patient discomfort which is a limiting factor in c-PDT. The aim of this study was to quantify the radiant exposure received by patients having d-PDT between the months of April and July. A further objective was to compare it with artificial white light (wl-PDT) using a theatre light andwith two c-PDT units, an Omnilux© and an Akitilite©. Quantities measured using calibrated equipment during patient d-PDT included irradiance, illuminance, and light spectra. An IPL Radiometer with a PDT detector, an ATP data logger light meter and a Bentham DMc150-MDE compact double integrated spectroradiometer were used respectively. The effective dose (Jeff) was calculated, which is the spectrum weighted by the absorption spectrum of the photosensitizer. The impact of weather conditions and time of year on effective dose was evaluated. The effective dose from daylight ranged from 3.2 Jeff on an overcast day to 43 Jeff on a sunny day for 2 hour treatments. Effective dose for two hours across the treatment area for wl-PDT was between 4.1 and 9.1 Jeff. Typically c-PDT units deliver approximately 1 Jeff in 10–20 minutes. d-PDT is a viable treatment option in Ireland. A review of patients at one and three months showed treatment was effective in reducing AKs, with low pain scores. Treatment scheduling is limited to between April and September for patient comfort (average temperature at least 10 °C) and to avoid lengthier treatment times.

Differences in Dry Eye Questionnaire Symptoms in Two Different Modalities of Contact Lens Wear: Silicone-Hydrogel in Daily Wear Basis and Overnight Orthokeratology.

Purpose. To compare the ocular surface symptoms and signs in an adult population of silicone-hydrogel (Si-Hy) contact lens (CL) wearers with another modality of CL wear, overnight orthokeratology (OK). Materials and Methods. This was a prospective and comparative study in which 31 myopic subjects were fitted with the same Si-Hy CL and 23 underwent OK treatment for 3 months. Dry eye questionnaire (DEQ) was filled in at the beginning of the study and then after 15 days, 1 month, and 3 months using each CL modality. The tear quality was evaluated with noninvasive tear break-up time. Tear production was measured with Schirmer test. Tear samples were collected with Schirmer strips being frozen to analyze the dinucleotide diadenosine tetraphosphate (Ap4A) concentration with High-Performance Liquid Chromatography (HPLC). Results. After refitting with ortho-k, a reduction in discomfort and dryness symptoms at the end of the day (p < 0.05, χ 2) was observed. No significant changes were observed in Ap4A concentration in any group. Bulbar redness, limbal redness, and conjunctival staining increased significantly in the Si-Hy group (p < 0.05, Kruskal–Wallis test). Conclusion. Discomfort and dryness symptoms at the end of the day are lower in the OK CL group than in the Si-Hy CL group.

Efficacy of Ketamine as an Adjunct to Local Anesthesia in the Surgical Removal of Impacted Mandibular Third Molars - A Split Mouth Prospective Controlled Clinical Study.

The removal of impacted teeth is one of the most common procedures performed by oral and maxillofacial surgeons. Reduction of discomfort post-operatively and efficient local anesthesia are imperative for success in surgical practice. At sub-anesthetic doses, ketamine has a noticeable analgesic action, which can be used to supplement local anesthesia with minimal side effects. To assess the efficacy of low-dose ketamine as an adjunct to local anesthesia in the management of pain, swelling and trismus after surgical removal of impacted mandibular third molars. Twenty five patients with bilaterally symmetrical impacted mandibular third molars requiring surgical removal under local anesthesia were selected for the controlled clinical study. The third molar sites of all patients enrolled in the trial were randomly assigned into 2 groups: Local Anesthesia (Lignocaine) Alone [LAA] and Local Anesthesia plus ketamine [LAK]. 5ml of local anesthetic (Lignocaine Hydrochloride 2% with epinephrine 1:100,000) was injected in the 'LAA' group while the 'LAK' group received 5ml of local anesthetic plus 0.2mg/kg ketamine. Patients were blinded to the solution used and the operator recorded the group (LAA or LAK) and the respective site (Right or Left) for analysis. Bilaterally symmetrical impacted mandibular molars were removed at an interval of 15 days. Facial swelling on post-operative days was significantly lower in the LAK group than in the LAA group (p<0.05). The pain scores on the VAS were significantly higher in the LAA group than in the LAK group (p<0.05). The role of ketamine in low doses as an analgesic and anti-inflammatory is evident in our study. The combination of a local anesthetic and sub-anesthetic doses of ketamine injected for surgical removal of impacted third molars provides good local anesthesia while alleviating post-operative sequelae for the patient by providing a degree of post-operative analgesia with less swelling.

Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy.

To describe mesial temporal lobe ablated volumes, verbal memory, and surgical outcomes in patients with medically intractable mesial temporal lobe epilepsy (mTLE) treated with magnetic resonance imaging (MRI)-guided stereotactic laser interstitial thermal therapy (LiTT). We prospectively tracked seizure outcome in 20 patients at Thomas Jefferson University Hospital with drug-resistant mTLE who underwent MRI-guided LiTT from December 2011 to December 2014. Surgical outcome was assessed at 6 months, 1 year, 2 years, and at the most recent visit. Volume-based analysis of ablated mesial temporal structures was conducted in 17 patients with mesial temporal sclerosis (MTS) and results were compared between the seizure-free and not seizure-free groups. Following LiTT, proportions of patients who were free of seizures impairing consciousness (including those with auras only) are as follows: 8 of 15 patients (53%, 95% confidence interval [CI] 30.1-75.2%) after 6 months, 4 of 11 patients (36.4%, 95% CI 14.9-64.8%) after 1 year, 3 of 5 patients (60%, 95% CI 22.9-88.4%) at 2-year follow-up. Median follow-up was 13.4 months after LiTT (range 1.3 months to 3.2 years). Seizure outcome after LiTT suggests an all or none response. Four patients had anterior temporal lobectomy (ATL) after LiTT; three are seizure-free. There were no differences in total ablated volume of the amygdalohippocampus complex or individual volumes of hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, and fusiform gyrus between seizure-free and non-seizure-free patients. Contextual verbal memory performance was preserved after LiTT, although decline in noncontextual memory task scores were noted. We conclude that MRI-guided stereotactic LiTT is a safe alternative to ATL in patients with medically intractable mTLE. Individualized assessment is warranted to determine whether the reduced odds of seizure freedom are worth the reduction in risk, discomfort, and recovery time. Larger prospective studies are needed to confirm our preliminary findings, and to define optimal ablation volume and ideal structures for ablation.

Ramosetron Reduces Symptoms of Irritable Bowel Syndrome With Diarrhea and Improves Quality of Life in Women

Previous studies have indicated that serotonin-3-receptor antagonists might have a sex-specific effect in patients with irritable bowel syndrome with diarrhea (IBS-D). Alosetron has been approved for the treatment of only women, and ramosetron has been approved for the treatment for only men. We performed a randomized, placebo-controlled, phase 3 study to determine whether ramosetron reduces symptoms of IBS-D in women. We performed a prospective study of 576 female outpatients with IBS-D (according to the Rome III criteria), from February 2013 through February 2014, at 70 academic Gastroenterology Departments in Japan. After a 1-week baseline period, subjects received either 2.5 μg ramosetron (n = 292) or placebo (n = 284) once daily for 12 weeks. Primary end points were the monthly rates of response for relief from overall IBS symptoms and increased stool consistency at the last evaluation point. Quality of life (QOL) also was quantified. A significantly higher proportion of patients given ramosetron reported global improvement (50.7%; 95% confidence interval [CI], 44.8-56.6) than patients given placebo (32.0%; 95% CI, 26.7-37.8)--a difference of 18.6% (95% CI, 10.7-26.5; P < .001). The relative risk was 1.58 (95% CI, 1.29-1.94) and the number needed to treat was 6 (95% CI, 4-10). A significantly higher proportion of patients in the ramosetron group reported increased stool consistency (40.8%; 95% CI, 35.1%-46.6%) than in the placebo group (24.3%; 95% CI, 19.4%-29.7%)--a difference of 16.5% (95% CI, 8.9%-24.0%; P < .001). Patients receiving ramosetron had significant reductions in abdominal pain and discomfort (P = .001) and greater improvement in QOL (P = .002) compared with placebo. Ramosetron induced constipation in 11.0% of patients. In a randomized, placebo-controlled study of 576 women with IBS-D, 2.5 μg ramosetron per day reduced symptoms and increased stool consistency and QOL. Clinicaltrials.gov no: NCT01870895.

Application of platelet-rich fibrin in endodontic surgery: a pilot study

AimTo assess preliminarily the potential benefits of the use of the platelet-rich fibrin (PRF) in modern endodontic surgical procedures in terms of radiographic healing acceleration and postoperative discomfort reduction. MethodologyEleven patients with chronic apical periodontitis were randomly assigned to either the PRF (n=7) or the control group (n=4). Postoperative swelling and pain were assessed with a questionnaire. Radiographic healing was scored according to Molven's scale up to a period of one year. Data were statistically analyzed with non-parametric tests. ResultsIn the PRF group the patients experienced less pain in the 2–6h postoperatively as well as oedema, which never exceeded the moderate intraoral swelling. Radiographic healing was detectable earlier in the PRF group, with the majority of cases scored as complete healing after 2–3 months. ConclusionsThe adjunctive use of PRF might promote the acceleration of the radiographic healing and reduce the postoperative discomfort.

The effect of leek (Allium iranicum (Wendelbo)) leaves extract cream on hemorrhoid patients: A double blind randomized controlled clinical trial

IntroductionConsidering the known pharmacological effects of Allium iranicum and the use of this herb in traditional Persian medicine (TPM) as an antihemorrhoid agent, we evaluated the efficacy of A. iranicum leaf extract cream for management of hemorrhoids in a double blind randomized placebo control trial. MethodsEighty patients with symptomatic hemorrhoids were randomly allocated to three groups to receive topical leek cream or placebo cream or routine cream for the management of hemorrhoids (antihemorrhoid) for a period of 3 weeks. Bleeding severity (primary), pain, defecation discomfort, anal itching severity, and overall subjective improvement (secondary) were assessed as outcomes of this study. ResultsA significant reduction was observed in the bleeding severity, anal pain, defecation discomfort and anal itching of all patients. The leek cream group had significantly less bleeding severity than standard antihemorrhoid and placebo groups at the end of the study (0.26±0.75, 0.83±1.09, 0.35±0.93, respectively P=0.04). The number of patients with more than 50% subjective improvement was also significantly more in the leek cream group compared to other groups (12, 5, 6, respectively P=0.04). The mean reductions in pain, defecation discomfort and anal itching showed no significant difference between the three groups (P=0.07, 0.39, 0.33, respectively). ConclusionThe current study showed significantly better outcomes for the leek group compared to the standard antihemorrhoid and placebo groups for bleeding severity and overall subjective improvement. However, there was no difference among topical use of leek, routine antihemorrhoid and placebo creams symptomatic relief of pain, defecation discomfort and itching. This trial was registered by Iranian Registry of Clinical Trials with the code: IRCT2014010816143N1 and also registered in ClinicalTrials.gov with identifier: NCT02301052.

Scientific Opinion on the substantiation of a health claim related to β‐galactosidase from Kluyveromyces lactis in Colief® and a reduction of gastrointestinal discomfort pursuant to Article 14 of Regulation (EC) No 1924/2006

Following an application from Cross Vetpharm Group UK Ltd, submitted for authorisation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of the United Kingdom, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to β-galactosidase from Kluyveromyces lactis in Colief® and a reduction of gastrointestinal discomfort. The Panel considers that the food is sufficiently characterised in relation to the claimed effect. A reduction of gastrointestinal discomfort is a beneficial physiological effect for infants and young children. The applicant provided two human intervention studies for the substantiation of the health claim. No conclusions could be drawn from one of the two studies for the scientific substantiation of the claim, as the information provided in the publication and that supplied later by the applicant was inadequate to allow a scientific evaluation. The second study with methodological limitations showed an effect of the food on crying time in infants fed exclusively with milk. This study also provided some evidence for the proposed mechanism by which β-galactosidase could exert the claimed effect. In weighing the evidence, the Panel took into account that one study with methodological limitations showed an effect of β-galactosidase from Kluyveromyces lactis in Colief® on infant crying time, that no other human studies in which these results have been replicated were provided, and that there was some evidence for a mechanism by which the food could exert the claimed effect. The Panel concludes that the evidence provided is insufficient to establish a cause and effect relationship between the consumption of β-galactosidase from Kluyveromyces lactis in Colief® and a reduction of gastrointestinal discomfort.

Evaluation of the use of low-level laser therapy in pain control in orthodontic patients: A randomized split-mouth clinical trial.

To evaluate the effect of using low-level laser therapy (LLLT) to control pain and discomfort during orthodontic treatment. A randomized, split-mouth clinical trial was conducted with 30 volunteers in need of orthodontic treatment, of both genders, aged between 18 and 40 years, who were randomly divided into two groups. One hemiarch was considered the exposed group (EG) and the other, the placebo group (PG). Both groups had elastic separators placed mesially and distally to the first molars of the two hemiarches at different times. The EG received an AIGaAs diode LLLT (810 nm, 100 mW, 2J/cm(2)) application for 15 seconds per point (interdental papilla at the mesial, distal, and near the root apex) immediately after separator placement on the maxillary right side. The PG also had elastics placed around the maxillary right molars, but received only simulated LLLT application. The elastics were left in place for 5 days, and after a waiting period of 1 week, they were inserted on the left side in both groups; however, the order of laser application was changed. While the separator remained in place, the patient marked his degree of perceived discomfort on a Visual Analog Scale (VAS) at 5 minutes (T0), 24 hours (T1), and 120 hours (T2), after LLLT application. A statistically significant difference was observed (P < .005) in reducing discomfort in the exposed group compared with the placebo group. This reduction of discomfort in the EG was observed at all time intervals. A sincle AIGaAs diode LLLT application may be indicated for the control or reduction of pain in the early stages of orthodontic treatment.

Continuous noninvasive hemoglobin monitoring: ready for prime time?

Determination of hemoglobin (Hb) concentration is essential for the detection of anemia and hemorrhage and is widely used to evaluate a patient for a possible blood transfusion. Although commonly accepted as intrinsic to the process, traditional laboratory measurements of Hb are invasive, intermittent, and time-consuming. Noninvasive Hb (NIHb)-monitoring devices have recently become available and promise the potential for detecting sudden changes in a patient's Hb level. In addition to reduced delays in clinical intervention, these devices also allow for a reduction in patient discomfort, infection risk, required personnel, and long-term costs. Unfortunately, it has been shown that many clinical factors can influence their accuracy. Many studies have been published on the accuracy and precision of NIHb-monitoring devices in various clinical settings. A recent meta-analysis has shown a small mean difference but wide limits of agreement between NIHb and laboratory measurements, indicating that caution should be used by physicians when making clinical decisions based on this device. NIHb measurements may currently be considered to be a supplemental tool for monitoring trends in Hb concentration, but are not currently developed enough to replace an invasive approach. Moreover, further studies are still required before implementing NIHb in the clinical decision-making process. Specifically, no studies have demonstrated that this technology improves clinical outcomes or patient safety.

Effectiveness of remifentanil & propofol infusion for procedural sedation in patients undergoing gastrointestinal endoscopic procedures: a systematic review protocol

Effectiveness of remifentanil & propofol infusion for procedural sedation in patients undergoing gastrointestinal endoscopic procedures: a systematic review protocol

MP25-19 EFFICACY OF RECTAL POVIDONE-IODINE SWABS IN DECREASING INFECTIOUS COMPLICATIONS AFTER TRANSRECTAL PROSTATE BIOPSY

biopsies (USTRPB) is a long-standing and current practice in many centers around the globe. Strong evidence supporting such recommendation is lacking. The objective of the present trial is to analyze the difference in complications among patients with and without pre-biopsy enemas. METHODS: Single center, randomized prospective study. We included patients scheduled for USTRPB in our Institution (march 2013-ongoing). One group (A) applied two glycine enemas and the other (B) did not apply any enemas. Urinalysis and urine culture were performed prior and 5 days post-biopsy. A clinical evaluation was performed 10 days after the biopsy. Clinical complications were defined as need for hospitalization, sepsis or urinary retention. A “visualization score” was done by the urologist performing the biopsy (blinded to the study). IBM SPSS Statistics Version 22 was used for data analysis. Chi square analysis was used for categorical variables and Student-T for comparing means with normal distributions. RESULTS: 139 patients were included. Mean age was 64.79 (48-93) years old. 33.9% were hypertensive and 21.4% diabetic. All patients had a pre-biopsy urine culture (96% were negative and 4% received culture guided treatment). 56.5% used enemas. PostUSTRPB complications and visualization scores are shown in table. Other complains after biopsy were hematuria (74.1%), hematospermia (29.5%), rectal bleeding (40.2%) and fever (12.5%), without group differences. 31.8% of patients had prostate cancer, without any group differences. CONCLUSIONS: Our preliminary data shows that the routine use of pre-biopsy rectal enema did not lead to a significant decrease in terms of complications, visualization or diagnostic accuracy when compared to the absence of pre-biopsy enemas. Further more, the omission of pre-biopsy enemas could result in a cost and discomfort reduction to the patient.

Testing the efficacy of pure versus guided mirror exposure in women with bulimia nervosa: A combination of neuroendocrine and psychological indices

Background and ObjectivesBody exposure improves body image problems in women with eating disorders. However it has almost always been combined with other interventions. Thus, the efficacy of body exposure alone (i.e., pure exposure) remains largely unclear. We aimed to compare the efficacy of two body exposure techniques through psychological and neuroendocrine indices recorded within and between successive sessions. MethodTwenty-nine women with high body dissatisfaction and diagnosis of bulimia nervosa were randomly assigned to one of two treatment groups: Pure Exposure (n = 14) or Guided Exposure (n = 15). Participants received 6 exposure sessions. After each session, changes in thoughts (positive/negative) and body satisfaction were assessed. Also, we assessed the body discomfort experienced by participants within and between sessions. Finally, the changes in salivary cortisol levels within and between the initial and final treatment sessions were measured. ResultsBoth groups showed a reduction in negative thoughts and a progressive increase in positive thoughts throughout the treatment. However, the increase in body satisfaction and the reduction in subjective discomfort within the sessions were greater in the pure exposure group. The cortisol levels during the initial and final treatment sessions decreased in both groups. LimitationsMethodological limitations are reported. ConclusionsThese results suggest that pure and guided exposures are effective interventions for improving thoughts and neuroendocrine responses, although pure exposure increased more body satisfaction feelings in bulimic women. Subjective discomfort also showed different patterns of change within and along sessions for each treatment. Reasons for these results are discussed.

Short-term sedation of mechanically ventilated ICU patients with propofol, benzodiazepines, or dexmedetomidine: systematic review and meta-analysis on awakening and recovery times

Sedation in the ICU is crucial in reduction of patients' discomfort, in particular in patients undergoing mechanical ventilation to help tolerate intubation and reduce pain and anxiety. Propofol (Pr) is a widely used option, but other viable alternatives for short-term sedation (STS; that is, <24 hours) include benzodiazepines (BDZ) and dexmedetomidine (Dx). We aimed at pooling all available evidence on the comparative effects of Pr in terms of awakening and recovery times after STS in mechanically ventilated ICU patients.

Patterns of Discomfort

A review of literature on comfort and discomfort indicates an increase in physical discomfort during the workday. In this paper, three different types of occupations were studied to identify whether a similar discomfort pattern exists in these occupations while participants perform work throughout the work day and workweek. Results are that sedentary and labor intensive occupations show an increase in physical discomfort throughout the workday. In addition, during the workweek, each occupation had a peak discomfort day and all occupations experienced a reduction of discomfort at the end of the last day of the workweek. Acknowledging and understanding why, when, and where discomfort peaks occur could assist in varying task scheduling to improve job performance. Future research should include emotional and psychological discomfort assessments, investigation of effects of age, time of year, and location in the world are warranted.