Reduction In Discomfort Research Articles

Effects of semi-rigid arch-support orthotics: an investigation with potential ergonomic implications

For many years, arch-support orthotics have been prescribed for individuals with discomfort and/or abnormal skeletal alignments in the structures of the lower extremity. Recently there has been an increased interest in promoting semi-rigid orthotics as an ergonomic aid for asymptomatic workers who must stand all day at their workplace. A laboratory study was performed to assess the biomechanical impact of prefabricated semi-rigid orthotics on asymptomatic individuals. Ten subjects wore semi-rigid arch-support orthotics (experimental condition) for two months and flexible polyurethane/Sorbothane ® shoe inserts (control condition) for two months. Throughout this 18-week testing period, the subjects returned to the lab to perform a battery of assessment tests at regularly scheduled intervals. These tests examined subject strength, standing posture, stability, fatigue effects, and body part discomfort. The results of this study showed no significant changes in the strength, posture, or stability as a function of insert type. The subjects reported a reduction in low-back discomfort along with an increase in foot discomfort during a fatiguing exertion task while wearing the semi-rigid orthotics as compared to the control condition.

Spectral filters in low‐vision correction

Coloured filters are used to protect the lens, retina and other ocular tissues against the hazard of light damage and to improve the quality of vision mainly in cases of ocular media opacities. Four types of yellow, amber and orange filters have been designed as tinted glasses, shields and colour covering of spectacles. They were tested on 15 adult patients with partial cataract and on 80 children with congenital pathology (i.e. macular hypoplasia, albinism, aphakia after congenital cataract). The majority of the children had nystagmus. The filters with particular spectral characteristics provide reduction of light intensity in the light-damaging range by at least a factor of five. Optimal filters were selected by examination of visual acuity, contrast frequency sensitivity, glare sensitivity and subjective selection by the patients. The effects of filters were: 11-43% increase in corrected visual acuity, 27-34% increase in contrast sensitivity function (CSF) for all frequencies and a marked reduction in glare sensitivity. All patients reported subjective improvement including reduction of photophobia, eye-strain and eye discomfort. It is concluded that coloured filters are able to contribute substantially to rehabilitation of low-vision patients.

Gas-permeable scleral contact lens therapy in ocular surface disease

PURPOSE: To describe the therapeutic benefits of nonfenestrated gas-permeable scleral contact lenses in the management of patients with ocular surface disease. METHODS: The charts of 49 consecutive patients (76 eyes) with ocular surface disease whose management included the use of gas-permeable scleral contact lenses were reviewed. We also developed a questionnaire to assess the impact of lens wear on subjective aspects of activities of daily living. RESULTS: The mean age of the 49 patients was 44.6 years (range, 3 to 87 years); 31 patients were female and 18 were male. The most common indication for fitting of the lenses was Stevens-Johnson syndrome (54 [71%] of the 76 eyes). Other indications included ocular cicatricial pemphigoid, exposure keratitis, toxic epidermal necrolysis, postherpetic keratitis, congenital deficiency of meibomian glands, superior limbal keratoconjunctivitis, Sjögren syndrome, and inflammatory corneal degeneration. The mean follow-up was 33.6 months (range, 2 to 144 months). Improvement in best-corrected visual acuity (defined as a gain of 2 or more Snellen lines) was observed in 40 (53%) of the eyes. In eight (53%) of the 15 eyes with active corneal epithelial defects at the time of lens fitting, the defects healed, whereas in the remaining seven eyes the corneal epithelial defects remained unchanged. Forty-five (92%) of the 49 patients reported improvement in their quality of life as a result of reduction of photophobia and discomfort. The mean wearing time of the gas-permeable scleral contact lenses was 13.7 hours per day (range, 4 to 18 hours). Many patients had preparatory surgical procedures before lens fitting (for example, punctal occlusion or mucous membrane grafting), and some had visual rehabilitation surgical procedures (for example, keratoplasty and/or cataract surgery) after lens fitting. CONCLUSIONS: Gas-permeable scleral contact lens wear provides an additional effective strategy in the surface management and visual rehabilitation of patients with severe ocular surface disease.

Spectral filters in low-vision correction

Coloured filters are used to protect the lens, retina and other ocular tissues against the hazard of light damage and to improve the quality of vision mainly in cases of ocular media opacities.Four types of yellow, amber and orange filters have been designed as tinted glasses, shields and colour covering of spectacles. They were tested on 15 adult patients with partial cataract and on 80 children with congenital pathology (i.e. macular hypoplasia, albinism, aphakia after congenital cataract). The majority of the children had nystagmus. The filters with particular spectral characteristics provide reduction of light intensity in the light-damaging range by at least a factor of five. Optimal filters were selected by examination of visual acuity, contrast frequency sensitivity, glare sensitivity and subjective selection by the patients. The effects of filters were: 11–43% increase in corrected visual acuity, 27–34% increase in contrast sensitivity function (CSF) for all frequencies and a marked reduction in glare sensitivity. All patients reported subjective improvement including reduction of photophobia, eye-strain and eye discomfort. It is concluded that coloured filters are able to contribute substantially to rehabilitation of low-vision patients.

The Lateral Transorbital Canthopexy for Correction and Prevention of Ectropion

There are numerous approaches to correcting laxity of the lateral canthal tendon, each with advantages and drawbacks. Critical evaluation of these techniques is not possible, however, as there is no grading system currently in use to describe this condition or to report outcomes, and prospective trials are lacking. To report and assess a new procedure for repair of the lateral canthus (lateral transorbital canthopexy) and to describe the Ectropion Grading Scale (EGS), with a prospective outcome analysis of their use. Prospective outcome study of 15 consecutive patients (16 procedures). Tertiary referral center in Zurich, Switzerland. Consecutive sample of patients referred for treatment of ectropion of various causes. Preoperative and postoperative EGS grades were recorded, a preoperative and postoperative patient-based questionnaire was administered, and lateral transorbital canthopexy was performed. Outcome was determined by improvement in EGS grade and results of the patient-based symptom questionnaire. There were no surgical failures or complications in the study. An average of 83% reduction in patient-reported discomfort was achieved. Two patients with facial paralysis needed medial canthal repositioning. The EGS allowed clear recording of lower eyelid position before and after lateral transorbital canthopexy, and the procedure was uncomplicated to perform. Lateral transorbital canthopexy is an effective technique for the correction of lower eyelid laxity and appears to allow refined, durable adjustment of the lateral canthus. Self-reported patient satisfaction confirmed the high rate of success of the procedure in this study. The EGS permits critical evaluation and reporting of results and may assist in predicting which patients will need concomitant correction of the medial canthus. Arch Facial Plast Surg. 2000;2:9-15

The reinstatement of dissonance and psychological discomfort following failed affirmations

The research in this article examined the consequences of a failed attempt to reduce dissonance through a self-affirmation strategy. It was hypothesized that disconfirming participants' affirmations would reinstate psychological discomfort and dissonance motivation. In Experiment 1, high-dissonance participants who affirmed on a self-relevant value scale and received disconforming feedback about their affirmations expressed greater psychological discomfort (Elliot & Devine, 1994) than either affirmation-only participants or low-dissonance/affirmation disconformed participants. In Experiment 2, disconfirmation of an affirmation resulted in increased attitude change. The results of both experiments suggested that a failed attempt to reduce dissonance reinstates psychological discomfort and dissonance motivation. We discuss how the reduction of psychological discomfort may play a role in the success of affirmations in reducing dissonance-produced attitude change. Copyright © 2000 John Wiley & Sons, Ltd.

Punch Technique for Preservation of Interdental Papillae at Nonsubmerged Implant Placement

Surgical flap procedures currently used for the placement of endosseous implants often can result in damage to the interdental papilla with subsequent poor esthetics. A simple technique is presented whereby the implants are placed by using a tissue punch and without raising a full thickness flap. At no time is the subperiosteal soft tissue flap raised, and the integrity of the interdental papilla is never disrupted. There is no discontinuation of the alveolar blood supply of the surrounding osseous tissue. In the authors' experience, there has been a significant reduction in postoperative discomfort. It is proposed that this technique warrants further evaluation, especially to compare the rate of bone resorption, because it is hypothesized that because of lack of discontinuation of the blood supply, there might be reduced bone resorption compared with conventional flap procedures.

Analgesics in mice used in cancer research: reduction of discomfort?

During the last decades, an increase is apparent in the use of analgesics for laboratory animals in situations where this was previously considered unnecessary. Mice with advanced tumours often show clear signs of discomfort which may be a result of chronic pain or a result of general ill-being. The syngeneic murine tumour model most frequently used in our experiments was used to investigate whether this discomfort can be reduced with an analgesic. Twenty DBA/2 mice bearing SL2 lymphoma were given 0.5 mg/kg buprenorphine (Temgesic) in food gel twice daily, 20 tumour-bearing mice were given control food gel at the same times. Indicators of well-being were monitored daily. These included behavioural parameters such as exploration, grooming, and posture; food and water consumption and fur quality. All mice showed a clear increase of discomfort with time: explorative behaviours and grooming decreased, while sitting in hunched posture increased. Food and water consumption and fur quality also decreased. Major significant differences between the buprenorphine treated group and the control group were not apparent. In conclusion, we could not document a positive effect or buprenorphine on discomfort in mice as evaluated by our scoring system. It remains possible that pain itself was not the primary cause of the discomfort in mice bearing these tumours, or that the analgesic effect of buprenorphine was insufficient under these circumstances.

Body Part Discomfort Reported by Legal Secretaries and Word Processors before and after Implementation of Mandatory Typing Breaks

Body part discomfort surveys were distributed to 60 legal secretaries, 10 administrative clerks and 10 word processors employed in a large law firm; 15% of the employees in each classification. Surveys were distributed before and 4 weeks after the implementation of mandatory typing breaks. Results indicated that changes in discomfort levels reported for wrists, hands and fingers were not statistically significant. There was an increase in reported discomfort in the lower arms and attributable to a typing skills re-training program. Increased discomfort in the legs, feet and lower back was attributed to the use of adjustable chairs at fixed-height workstations. Reduction in eye, neck and shoulder discomfort was statistically significant. Mandatory typing breaks alone cannot and will not relieve all discomfort associated with highly-intensive computer interactive activity. The introduction of typing training and adjustable chairs will not overcome the restrictions of fixed-height worksurfaces.

Video-assisted thoracoscopic diskectomy and fusion

Thoracoscopic diskectomy has been described in adults as an alternative to thoracotomy for access to the anterior spine for correction of scoliosis, but its use in children for correction of spinal deformities has not been reported. Eight patients have undergone video-assisted thoracoscopic diskectomy with fusion before posterior instrumentation. In five patients, the posterior fusion and instrumentation followed the thoracoscopic procedure under the same anesthesia; in three patients it was staged and performed 1 week later. The mean time required for the thoracoscopic procedure was 174 minutes. Intraoperative bleeding requiring transfusion developed in one patient. No other complications occurred. The authors conclude that the minimally invasive approach for access to the thoracic cavity for anterior diskectomy and fusion will be the preferred approach because of the potential for significant reduction in postoperative discomfort and complications such as atelectasis and pneumonia. Postoperative hospitalization may not be decreased, however, because the patient must still recover from the open posterior instrumentation and fusion operation.

Organic and psychogenic retrograde amnesia: Two sides of the same coin?

Abstract This article describes various forms and etiologies of retrograde amnesias. It questions the validity of the classical distinction into two major forms, organic and psychogenic retrograde amnesia. It emphasizes that there is a continuum, perhaps even a principal similarity, between organic and psychogenic amnesia, which derives from a common brain mechanism underlying both phenomena. The neuronal basis of this continuum is a blockade, disruption or disconnection mechanism affecting access to (or the ‘ecphory’ of) stored engrams. The disconnection is attributable to a disintegration of widespread network systems in the brain. This disintegration may be a consequence of ‘mechanical alterations’ in the brain of organic amnesics. For psychogenic amnesics, it may be induced during autobiographical information processing by desynchronization of access processes to memory patterns, resulting in the reduction of discomfort for the subject. in the widest exegenesis, both forms of retrograde amnesia may be...

Evaluation of the KTP 532 laser in aesthetic facial surgery

This study investigated the ability of the KTP 532 laser to reduce postoperative swelling and bruising in aesthetic facial surgery. Thirty consecutive patients receiving a laser-assist procedure (following skin incision with a scalpel, dissection and hemostasis were accomplished primarily with the laser) were compared to 16 patients who had similar technical operations but relied on scissor/scalpel dissection and electrocautery for hemostasis. Evaluations were performed by comparison of serial photographs after surgery and by patient self-assessment. The clinical observations demonstrated a noticeable reduction in postoperative swelling, bruising, and discomfort in the patients whose procedure was performed with the aid of the laser.

Evaluation of the KTP 532 laser in aesthetic facial surgery

This study investigated the ability of the KTP 532 laser to reduce postoperative swelling and bruising in aesthetic facial surgery. Thirty consecutive patients receiving a laser-assist procedure (following skin incision with a scalpel, dissection and hemostasis were accomplished primarily with the laser) were compared to 16 patients who had similar technical operations but relied on scissor/scalpel dissection and electrocautery for hemostasis. Evaluations were performed by comparison of serial photographs after surgery and by patient self-assessment. The clinical observations demonstrated a noticeable reduction in postoperative swelling, bruising, and discomfort in the patients whose procedure was performed with the aid of the laser.

Case reports: Molar distalization with static repelling magnets. Part II

The following two nonextraction therapy case reports demonstrate four important points: (1) Static repelling magnets, with certain characteristic parameters, distalize molars rapidly without adverse effects that are clinically discernible. Beneficial properties such as considerably reduced patient compliance requirements for force application, reduced mobility and discomfort, and mostly bodily movement are demonstrated clinically. (2) Anchorage can be controlled by using conventional techniques of anchorage augmentation or force reduction. (3) Treatment can be satisfactorily completed and documented in accord with contemporary criteria, with conventional therapeutic methods, once the initial, most difficult, magnetic molar distalization is completed. (4) The mechanism of action that accounts for the bioeffects remains unclear. However, we hypothesize that observed reduction of mobility and discomfort during rapid movement, combined with basic research and other clinical data, are attributable to the simultaneous, synergistic property of the magnetic force field, which disrupts the local equilibrium and also the static magnetic bioeffect. Among others, one distinguishing and pertinent bioeffect may be an increased rate of osteogenesis and bone remodeling, which may be very dependent on correct dosage through a possible biologic window and the field geometry. (A M J O RTHOD D ENTOFAC O RTHOP 1995;108:547-55.)

Does decompression diminish the discomfort of severe dysthyroid orbitopathy?

We assessed whether patients perceived that surgical decompression had reduced the discomfort of dysthyroid orbitopathy. Standard pain instruments were administered to 13 consecutive patients of a university-based oculoplastic practice who had undergone two-wall orbital decompression for dysthyroid optic neuropathy. We used visual analog scale (VAS) ratings of pre- and postoperative orbital discomfort. On a 0 to 10 scale, relief of discomfort after decompression was rated as moderate or better (VAS > 9.0) in 13 of 13 patients (mean VAS = 9.22, SD = 0.91) and complete (VAS = 10.0) in 8 of 13. Patients perceived that surgical decompression was associated with a clinically and statistically significant (p < 0.001) reduction of discomfort.

Dynamic Epidermal Cooling During Pulsed Laser Treatment of Port-Wine Stain

The clinical objective in the treatment of a patient with port-wine stain (PWS) undergoing laser therapy is to maximize thermal damage to the PWS, while at the same time minimizing nonspecific injury to the normal overlying epidermis. With dynamic cooling, the epidermis can be cooled selectively. When a cryogen spurt is applied to the skin surface for an appropriately short period of time (on the order of tens of milliseconds), the cooling remains localized in the epidermis, while leaving the temperature of the deeper PWS vessels unchanged. Comparative measurements obtained by a fast infrared imaging detector demonstrated that the surface temperature prior to laser exposure could be reduced by as much as 40 degrees C using the dynamic cooling technique. No skin surface textural changes were noted on PWS test sites cooled with a 20- to 80-millisecond cryogen spurt after flashlamp-pumped pulsed dye laser (FLPPDL) exposure (lambda = 585 nm; tau p = 450 microseconds) at the maximum light dosage possible (10 J/cm2). In contrast, epidermal necrosis occurred on the uncooled sites after such exposure. Six months after laser exposure, clinically significant blanching on the cooled sites indicates laser photothermolysis of PWS blood vessels did occur. Our preliminary experiments demonstrate the feasibility of selectively cooling the normal overlying epidermis without affecting the temperature of the deeper PWS vessels. Furthermore, protection of the epidermis from thermal injury, produced by melanin light absorption at clinically relevant wavelengths, can be achieved effectively. An additional advantage of dynamic epidermal cooling is reduction of patient discomfort associated with FLPPDL therapy. Further studies are under way to determine an optimum strategy for applying this dynamic cooling technique during pulsed laser treatment of patients with PWS and others with selected dermatoses (dermal melanocytic lesions and tattoos).

The efficacy of a topical lidocaine/prilocaine anesthetic gel in 35% trichloroacetic acid peels.

A topical formulation of lidocaine and prilocaine has been shown to provide effective anesthesia for certain superficial skin treatments. To evaluate the efficacy of a topical self-occluding gel containing lidocaine 2.5% and prilocaine 3.5% in reducing the discomfort of 35% trichloroacetic acid (TCA) peels. Ten patients who had previously undergone 35% TCA peels were treated with this anesthetic gel prior to their second 35% TCA peel. They rated their level of discomfort in comparison with their previous peel with no anesthesia. Eight of 10 patients reported at least a 40% reduction in discomfort. However, there was a tendency for the anesthetic gel to enhance the depth of the peel. Topical lidocaine/prilocaine gel is an effective agent for reducing the discomfort associated with 25% TCA peeling. However, it should only be used with TCA below 30% concentrations due to its ability to enhance the depth of the peel.

Image Quality Criteria Applied to Digital Radiography

Film-screen radiography has been replaced more and more by digital imaging methods. The aim of this development is the extension of diagnostic capabilities and the reduction of patient discomfort and side effects such as radiation dose. For digital image intensifier radiography and luminescence radiography the image quality and the dose value can be adapted to the diagnostic problem in a broad range. Capabilities of digital radiography have changed the strategy of imaging. To decrease the dose value image quality has to be chosen to be not as good as possible but as good as necessary to answer the diagnostic question. Digital image intensifier radiography, for example, allows a dose reduction to 10% in comparison with film screen for special diagnostic problems. Digital radiography increases the diagnostic information and gives, additionally, the chance to lower the dose values significantly.

Effectiveness of workplace accommodations for a corporate telephone operator with a full left-arm prosthesis: A case study

A corporate telephone operator and voice mail programmer was involved in a serious automobile accident resulting in left-arm amputation and through rehabilitation received a full left-arm prosthesis. Upon returning to work in her previous job capacity, some work activities and work area configurations were identified as problematic during task performance. Work methods and work area configuration were evaluated regarding their appropriateness for supporting return to work and long-term accommodation. Job activity analysis determined all reaches, clearances, and forces and their compliance with recommended criteria. A body part comfort/discomfort survey (BPCDS) was administered pre- and post-accommodation to elicit information regarding workplace problem areas and provide a measure to assess accommodation effectiveness. Workstation, support equipment, work area, seating, task assignments, and work methods were modified to more appropriately support operator task performance. Comparison of pre- and post-accommodation BPCDS indicates a significant reduction in operator discomfort with residual discomfort associated with the orthopedic prosthesis. This case study illustrates the use of the principles and techniques of industrial ergonomics to develop workplace accommodations. The area of ergonomics, medical ergonomics,is an example of the development of reasonable accommodations for physically challenged workers in the spirit of compliance with the Americans with Disabilities Act (ADA).

Pam after subcutaneous injection of recombinant human erythropoietin: does Emla cream help?

Recombinant human erythropoietin (rHuEpo) is used to correct anaemia in dialysis patients. Subcutaneous administration of rHuEpo may be associated with pain at the injection site. This study assessed the pain of subcutaneous infiltration of two different preparations of rHuEpo, alpha and beta, and the value of a local anaesthetic (Emla) cream, in reducing the pain of infiltration. Forty-eight haemodialysis patients were enrolled into a double-blind, placebo-controlled, paired-comparison study. Pain was assessed using a visual analogue scale, a verbal descriptive scale and a direct comparison between paired treatments. Subcutaneous injection of rHuEpo alpha was more painful than rHuEpo beta (P < 0.001); using placebo cream 42% of patients described the pain of rHuEpo alpha as severe or very severe, whereas none of the patients found rHuEpo beta so painful. Application of Emla for at least 2 h prior to injection resulted in a significant reduction in the pain of both preparations, but was unable to reduce the pain of rHuEpo alpha to that of rHuEpo beta. Subcutaneous injection of rHuEpo alpha is more painful than rHuEpo beta, even after application of Emla. Although the discomfort of rHuEpo beta is graded as very mild by most adult patients the use of Emla is associated with a significant reduction in discomfort, which may be of benefit to paediatric patients.