bluuebunny/crossref_metadata_2025 huggingface dataset:
Anesthesia (12)
Authors: Silverstein Wendy B. , Saiyed Moin U. , Brown Anthony R.
Published: September 2010

A deltoid motor response is a satisfactory endpoint for successful block. (Columbia Presbyterian Medical Center, New York, NY) Reg Anesth Pain Med 2000;25:356–359.

This study investigates the notion that a deltoid twitch may be just as effective as one in the biceps for predicting a successful motor block. Patients (N = 160) scheduled for shoulder surgery were studied prospectively. Interscalene blocks (ISBs) were performed using neurostimulation according to our standard technique. Twitches of the deltoid or biceps or both, whichever appeared first, were accepted and used as the endpoint for needle placement and injection of local anesthetic. Motor block success, i.e., patient inability to lift the arm against gravity, and minutes to motor block onset were recorded. Of the 160 ISBs performed, a biceps twitch was elicited in 61 patients. In 54 patients, a deltoid twitch was elicited and in 45 patients, both a biceps and deltoid contraction were elicited simultaneously. The failure rate did not differ widely among the groups; there was 1 failed motor block in the deltoid group and none in the other groups. There was no statistically significant difference in onset times between the 3 muscle twitch groups. Conclude that a deltoid twitch is as effective as a biceps twitch in determining accurate needle placement for ISB and in predicting successful motor block. Acceptance of a deltoid twitch during ISB eliminates the need for further probing and may translate into better patient acceptance and in a smaller risk of needle‐induced nerve damage.

Comment by Alan David Kaye, MD, PhD.

Interscalene brachial plexus block provides a valuable technique for shoulder surgery. The literature is in agreement with elicitation of paresthesias versus peripheral nerve stimulation. The literature is somewhat unclear regarding deltoid muscle versus biceps twitch as a satisfactory endpoint, prior to injection of local anesthetic. This prospective study involved 160 patients presenting for elective shoulder surgery. A biceps twitch was elicited in 61 patients; 54 had a deltoid twitch, and in 45 patients, both a biceps and deltoid twitch were elicited. There was no statistically different onset time in the 3 groups; however, the failure rate did not differ in the 3 groups either (only 1 patient in the deltoid group had a failed block). The authors conclude that a deltoid twitch is as effective as one in the biceps at ensuring a successful interscalene brachial plexus block and that repositioning is not warranted if either muscle group is elicited. The authors should be applauded for this study because it strongly suggests that essentially any elicitation of deltoid or biceps twitch will result in a highly successful and clinically useful block.
Anesthesia (14)
Authors: Jahangir Salim M.
Published: September 2010

Tip‐holed spinal needle: a new design concept. (Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh) Reg Anesth Pain Med 2000;25:403–407.

This article discussed new technology regarding the production of finer spinal needles and described a new spinal needle tip design. Complications associated with dura‐arachnoid puncture for spinal anesthesia were taken into account. Postdural puncture headache (PDPH) and needle bending are stated as being significant complications. Although pencil‐point needles significantly reduce PDPH, it is stated that these needles also have their limitations such as obstruction of the delivery port by tissues affecting both cerebrospinal fluid flash back and drug delivery. The problem of tip bending was also addressed. At the center of the discussion was the newly designed spinal needle tip that was created to overcome the disadvantages of other spinal needles. Analyzing the performance of the existing needles, the conclusion was drawn that the criteria of an ideal spinal needle may be as follows: (1) the external diameter of the needle should be as thin as possible and the tip should be a dural fiber‐spreading variety; (2) the shaft and tip should be capable of withstanding forces during needle placement; and (3) it should also have a drug delivery hole that does not weaken the needle or become obstructed by tissue.

Comment by Andrew D. Rosenberg, MD.

This article introduces a new type of needle for performing spinal anesthesia techniques. According to the authors, classic Quincke‐type needles are associated with postdural puncture headache (PDPH), while side port blunt needles may be associated with mechanical problems such as back flow or having tissue obstruct side port. Therefore, the authors designed a new type of needle that is pencil point in shape, but the removal stylet is the component that forms the pencil point. When the stylet is removed, the needle has a conical distal shape with the opening at the end. The authors believe that this “new spreading beveled needle tip” will help alleviate problems with PDPH as well as the problems associated with side port holes. While the idea is very intriguing, it remains to be seen how successful the needle will be.
Headache (44)
Authors: Rapoport Alan , Edmeads John
Published: September 2010

Migraine: the evolution of our knowledge. (The New England Center for Headache, Stamford, CT) Arch Neurol 2000;57:1221–1223.

This brief article described the evolution of knowledge regarding headache pain, namely migraines. By exploring historical literature, quotes related to headache pain and treatments are discussed. Early clinical developments are outlined with references to Hippocrates, Aretaeus the Cappadocian, and Galen. The theories of Thomas Willis regarding pain sensitivity are also provided. Conclude that the history of headache illustrates that the acquisition of understanding is a long‐term, evolving process.
Medicine (47)
Authors: Zylicz Zbigniew
Published: September 2010

Ethical considerations in the treatment of pain in a hospice environment. (Hospice Rozenheuvel, Rozendaal, The Netherlands) Patient Education and Counseling 2000;41:47–53.

This article discussed some specific ethical problems encountered in hospice practice. Patient's autonomy with all its advantages and disadvantages are highlighted. Ethical considerations with regard to risk taking and the treatment of pain are discussed. The needs of the patients are central to the discussion. Myths regarding opioids and pain therapy goals are addressed, as are approaches to treating intractable pain and dealing with patients who request assisted death. Acceptance of death may result in an active and creative attitude. Conclude that although scientific evidence of the processes taking place is still lacking, the modern hospice may be seen as a complementary, mainstream institution contributing to the development of whole medicine.
Anesthesia (5)
Authors: Montes A. , Warner W. , Puig M.M.
Published: September 2010

Use of intravenous patient‐controlled analgesia for the documentation of synergy between tramadol and metamizol. (Hospital Universitario del Mar, Barcelona, Spain) Br J Anaesth 2000;85:217–223.

This study involved 101 posthysterectomy patients who received at the time of analgesia request (TAR) tramadol (100 mg, Group I) or metamizol (1.2 g, Group II) alone, or combined in 1:1 (Group III), 1:0.3 (Group IV), or 1:3 (Group V) ratio. After 15 min, they received the same treatment by IV patient‐controlled analgesia. Pain intensity (VAS‐PI), analgesic consumption, and adverse effects were assessed at TAR, and periodically for 24 h. Data were analyzed using interaction indexes and isobolograms. All treatments produced equivalent VAS‐PI, percent efficacy, and adverse effects; all other treatments were addictive.

Comment by Octavio Calvillo, MD, PhD.

Synergistic interactions either beneficial or adverse between analgesic drugs remains to be studied quantitatively. The authors propose a new method to quantitate such interactions; this is based on analgesic requirements (IV‐PCA) and pain intensity (VAS‐PI). Data were analyzed using interaction indexes and isobolograms. Isobols are graphic representations of equally effective doses of 2 or more agents. The mean doses of each drug that produces a given response are plotted on the axes of the graph. A zero interaction line (isobol) connects these isoeffective doses in the axis. Using this approach the authors studied 101 posthysterectomy patients. Patients received at the time of analgesia request (TAR) tramadol (100 mg, Group I) or metamizol (1.2 g, Group II), alone or combined 1:1 (Group III), 1:0.3 (Group IV) or 1:3 (Group V). All treatments produced equivalent VAS‐PI, percent efficacy, and adverse effects. Drugs combined in 1:1 ratio synergy became evident both for the analgesic and adverse effects; all other treatments were additive.
Neurology (51)
Authors: Van Hilten J.J. , Van de Beek W.J.T. , Roep B.O.
Published: September 2010

Regional pain syndrome: a distinct clinical entity associated with HLA‐DR13. (Leiden University Medical center. Leiden, The Netherlands) Ann Neurol 2000;48:113–116.

This report discussed 26 patients with a distinct phenotype of complex regional pain syndrome that progressed toward a multifocal or generalized tonic dystonia. The dystonia initiated distally, involved mainly flexor muscles, and was associated with sensory and autonomic symptoms. Dryness of the eyes or mouth and bladder and bowel disturbances were frequently reported. There was no increase in the familial prevalence of autoimmune‐mediated disease. Compared with controls, a significant elevation of HLA‐DR13 was found in the patients. Thus, HLA‐DR13 may be a factor indicating susceptibility to this distinct phenotype of complex regional pain syndrome.
Neurology (53)
Authors: Goldstein David S. , Tack Cees , Li Sheng‐Ting
Published: September 2010

Sympathetic innervation and function in reflex sympathetic dystrophy. (National Institutes of Health, Bethesda, MD) Ann Neurol 2000;48:49–59.

This study examined sympathetic neurocirculatory function and the role of sympathetic postganglionic nerve traffic in maintaining the pain in 30 patients with reflex sympathetic dystrophy. Most had had the condition for more then 1 year, and 14 had undergone sympathectomy for the pain. Positron emission tomographic scanning after administration of 13N‐ammonia was used to assess local perfusion, and 6‐[18F]fluorodopamine was used to assess sympathetic innervation. Rates of entry of norepinephrine in the regional venous drainage (spillovers) and regional plasma levels of L‐dihydroxyphenylalanine (the immediate product of the rate‐limiting enzymatic step in norepinephrine biosynthesis) and dihydroxyphenylglycol (the main neuronal metabolite of norepinephrine) were measured with and without intravenous trimethaphan for ganglion blockade. 13N‐ammonia‐derived radioactivity was less on the affected side than on the unaffected side, whereas 6‐[18F]fluorodopamine‐derived radioactivity was symmetrical. Thus, perfusion‐adjusted 6‐[18F]fluorodopamine‐derived radioactivity was higher on the affected side. Norepinephrine spillover and smaller arteriovenous increments in plasma levels of L‐dihydroxyphenylalanine and dihydroxyphenylglycol did not differ significantly between affected and unaffected limbs, although 4 patients had noticeably less norepinephrine spillover and smaller arteriovenous increments in plasma dihydroxyphenylglycol on the affected side. Trimethaphan decreased the pain in only 2 of 12 nonsympathectomized patients. The results indicate that patients with chronic unilateral reflex sympathetic dystrophy have decreased perfusion of the affected limb, symmetrical sympathetic innervation and norepinephrine synthesis, variably decreased release and turnover of norepinephrine in the affected limb, and failure of ganglion blockade to improve the pain in most cases. These findings suggest augmented vasoconstriction, intact sympathetic terminal innervation, possibly impaired sympathetic neurotransmission, and pain usually independent of sympathetic neurocirculatory outflows.
Neurology (57)
Authors: Argoff Charles E.
Published: September 2010

New analgesics for neuropathic pain: the lidocaine patch. (North Shore University Hospital, Syosset, NY) Clin J Pain 2000;16:S62–266.

This article reviewed the basis for the development of the lidocaine patch and reviewed the reports of the clinical studies published. Potential uses of the lidocaine patch for other conditions in addition to postherpetic neuralgia (PHN) were also discussed. Conclude that it has been clearly established that the lidocaine patch is a safe and effective treatment for PHN and it is recommended as a first‐line treatment based on demonstrated efficacy, quick onset of action, lack of systemic effects, and ease of use with other treatments.

Comment by Enrique Reig, MD.

Intravenous lidocaine is used in pain units for the transient relief of chronic neuropathic pain. If the analgesic result is satisfactory, some physicians start treatment with a lidocaine analogue, oral mexylithene. However, the latter drug is not always well tolerated and its efficacy (in my opinion) is far lower than that of intravenous lidocaine. The recently marketed lidocaine patch is a highly recommended therapeutic alternative if we are considering long‐term treatment with lidocaine. Topical agents act locally (skin, soft tissues, peripheral nerves) and do not cause high blood levels (no higher than 0.6 micgr/mL). Topical 5% lidocaine decreases the ectopic discharges from peripheral afferents, reducing nociceptive input to the CNS. There are few side effects and the main indication is postherpetic neuralgia and all those syndromes with peripheral neuropathic pain. The relief that can be expected after using topical 5% lidocaine is not complete, and it can be associated with other types of drugs (anticonvulsants, antidepressants, analgesics, etc.) to obtain a synergistic effect.
Neurology (62)
Authors: Wikberg  , Andersson C. , Lithner F.
Published: September 2010

Signs of neuropathy in the lower legs and feet of patients with acute intermittent porphyria. (University of Umeå, Umeå, Sweden) J Intern Med 2000;248:27–32.

A total of 356 patients were registered and 339 of them (95%) participated in this neuropathy study. The chronic neurological signs were symmetrical and similar to those in type 1 diabetic patients. Significant impairment was found concerning perception, EDB test, lower leg pain, ankle and knee tendon reflexes, but not concerning dry feet, loss of forefoot arch and hammer toes, on comparing patients with manifest versus latent acute intermittent porphyria (AIP). The neurological signs were more severe in the diabetic patients (n = 298). Five AIP patients had permanent quadriplegia after severe attacks. Conclude that patients with manifest AIP had significantly more signs of distal chronic, symmetrical neuropathy of the axonal type than did patients with latent AIP. More grave neurological lesions appear to develop after severe attacks.
Neurology (65)
Authors: Lee Virginia K. , Simpkins Lynn
Published: September 2010

Herpes zoster and postherpetic neuralgia in the elderly. (University of Virginia, Charlottesville, VA) Geriatr Nurs 2000;21:132–136.

This article described herpes zoster (HZ), its causes, diagnosis, treatment, and associated complications. Postherpetic neuralgia (PHN), the most common complication of HZ, is the primary focus of the discussion. PHN is defined broadly as chronic pain that persists after the characteristic vesicular rash of HZ has resolved.
Anesthesia (7)
Authors: Singelyn François J. , Governeur Jean‐Marie A.
Published: September 2010

Extended “three‐in‐one” block after total knee arthroplasty: continuous versus patient‐controlled techniques. (St. Luc Hospital, Brussels, Belgium) Anesth Analg 2000;91:176–180.

This prospective, randomized, doubled‐blinded study assessed the efficacy of patient‐controlled analgesia (PCA) techniques for an extended “3‐in‐1” block after total knee arthroplasty. A total of 45 patients were divided into 3 groups of 15. Over 48 h, all patients received 0.125% bupivacaine with 1 μg/mL clonidine via a femoral nerve sheath catheter in the following manner: as a continuous infusion at 10 mL/h in Group 1; as a continuous infusion at 5 mL/h plus PCA boluses (2.5 mL/30 min) in Group 2; or as PCA boluses only (10 mL/60 min) in Group 3. Pain scores, sensory block, supplemental analgesia, bupivacaine consumption, side effects, and satisfaction scores were recorded. Pain scores and supplemental analgesia were comparable in the three groups. Bupivacaine consumption was significantly less in Groups 2 and 3 than in Group 1 (P < 0.01), and in Group 3 than in Group 2 (P < 0.01). Side effects and satisfaction were comparable in the 3 groups. Conclude that extended “3‐in‐1” block provides efficient pain relief after total knee arthroplasty and that, compared with a continuous infusion, PCA techniques reduce the total anesthetic consumption without compromise in patient satisfaction or visual analog scale scores. Of the 2 PCA techniques tested, PCA boluses (10‐mL lockout; time 60 min) of 0.125% bupivacaine with 1 μg/mL clonidine was associated with the smallest local anesthetic consumption, and is, therefore, the recommended extended “3‐in‐1” block technique.

Comment by Octavio Calvillo, MD, PhD.

In a prospective, randomized, double‐blinded study, the authors studied the efficacy of the 3 in 1 block in a group of patients that had undergone total knee arthroplasty. Patients were allocated to 3 groups; all patients had a catheter implanted in the femoral sheath. Over 48 h all patients received 0.125% bupivacaine with 1 μg/mL clonidine. Group 1 received the mixture as a continuous infusion at 10 mL/h. Group 2 received a continuous infusion at 5 mL/h plus PCA boluses (2.5 mL/30 min). Group 3 received 10 mL of solution per 60 min. Pain scores, supplemental analgesia side effects, and patient satisfaction were comparable in all groups. Bupivacaine consumption was significantly lower in Group 2 and Group 3 as compared to Group 1 (P < 0.01). Of the PCA techniques studied, the regimen involving 10 mL per h was associated with the lowest local anesthesia consumption and is, therefore, the recommended technique for extended 3 in 1 block.
Orthopedics (70)
Authors: Lin: Chia‐Chin
Published: September 2010

Applying the American Pain Society's QA standards to evaluate the quality of pain management among surgical, oncology, and hospice inpatients in Taiwan. (Taipei Medical College, Taipei, Taiwan) Pain 2000;87:43–49.

The purpose of this study was two‐fold: first, to apply the American Pain Society (APS) outcome questionnaire to examine and compare the quality of pain management provided in surgical, oncology, and hospice inpatient units in the Taipei area of Taiwan, and second, to provide baseline data of pain management quality in advance of the implementation of national guidelines for cancer pain management. Data revealed that hospice patients reported that they received pain medication within 15 min after they complained of pain. However, a large number of patients never asked for pain medication during hospitalization. Moreover, most patients never requested medication changes even when their perception was that their medication was not effective. The findings of this study may provide support for the effectiveness of hospices in Taiwan in pain management and provide information on the validity of the APS quality standards.
Orthopedics (71)
Authors: Boos Norbert , Semmer Norbert , Elfering: Achim
Published: September 2010

Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging: predictors of low back pain‐related medical consultation and work capacity. (University of Zurich, Zurich, Switzerland) Spine 2000;25:1484–1492.

This prospective study involved 46 asymptomatic individuals who had a high rate of disc herniations (73%) that were observed for an average of 5 years. Four classes of variable were assessed at baseline and follow‐up. Disc herniations and neural compromise did not significantly worsen at follow‐up, whereas disc degeneration progresses in 17 individuals (41.5%). Minor episodes of low back pain occurred in 19 individuals (41.3%), 6 of whom had to seek medical treatment and 5 of whom had to stop work temporarily. The requirement for low back pain‐related medical consultation was predicted with high accuracy by listlessness, job satisfaction, and working in shifts (P < 0.001). Work capacity was best predicted by physical job characteristics, job disaffection, and working in shifts (P < 0.001). Conclude that physical job characteristics and psychological aspects of work were more powerful than magnetic resonance imaging‐identified disc abnormalities in predicting the need for low back pain‐related medical consultation and the resultant work incapacity. However, the conclusions are still preliminary, and replication of the findings in larger and more representative study samples is needed.
Orthopedics (73)
Authors: Fanuele Jason C. , Birkmeyer Nancy J.O. , Abdu William A. , Tosteson Tor D. , Weinstein: James N.
Published: September 2010

The impact of spinal problems on the health status of patients: have we underestimated the effect? (Dartmouth‐Hitchcock Medical Center, Lebanon, New Hampshire) Spine 2000;25:1509–1514.

This prospective study involved 17,774 patients who consulted spine centers and aimed to qualify the effect that spinal diagnoses have on patient's physical functional status (SF‐36 Physical Component Summary (PCS) score) compared with other common conditions and to qualify the effects of comorbidities on physical functional status in spine patients. The study patients were a mean of 47.5 years of age, 54.7% were female, 52.3% had lumbosacral diagnoses, and 82% has had 3 or more months of pain. The population had a mean PCS score of 30.4 ± 9.95 (SD) compared with 50.0 ± 10.00 for the general United States population. The more comorbidities in a patient, the lower the PCS score (Spearman rank correlation = −0.27). The 5 comorbid conditions that lowered the PCS the most included congestive heart failure, chronic obstructive pulmonary disease, renal failure, rheumatoid arthritis, and lupus. Conclude the PCS score is greatly affected in patients with spinal problems. The study population's OCS was lower or similar to the PCS for patients with other illnesses reported in the literature. Further, the presence of comorbidity in spine patients adds to the burden of spinal conditions on functional status.
Orthopedics (77)
Authors: Carragee Eugene J. , Chen Yung , Tanner Cary M. , Hayward Chris , Rossi Michael , Hagle: Chad
Published: September 2010

Can discography cause long‐term back symptoms in previously asymptomatic subjects? (Stanford University School of Medicine, Stanford, CA) Spine 2000;25:1803–1808.

This prospective controlled study aimed to determine whether discography might cause long‐term low back symptoms in selected patients. Twenty‐six patients without preexisting low back pain were observed for 1 year after lumbar discography to determine the effects of lumbar discography in 3 experimental groups: 10 patients who had remote cervical spine surgery with excellent results (pain‐free group); 10 patients who had the same surgery with poor results (chronic pain group); and 6 patients who had primary somatization disorders. Two control groups were also observed: a group of patients with somatization disorder who were similarly evaluated but without discography and a group of patients with low back pain observed for 1 year after discography without surgery. In the 3 experimental groups (no back pain before discography) no subject with normal psychometric testing had persistent pain after discography (0/11), whereas 6 (40%) of the 15 with abnormal psychometric tests results reported significant new low back pain. None of the pain‐free group (0/10), 20% of the chronic neck pain group (2/10), and 66% of the somatization group (4/6) continued to have significant back pain 1 year after injection. Psychological testing and occupational disability strongly predicted continued pain after discography. The control groups had no significant change in low back symptomatology during the year of observation. Conclude that discography in a subject group without low back pain, but with significant emotional and chronic pain problems may result in reports of significant back pain for at least 1 year after injection. Subjects with normal psychometric test results had no reports of significant long‐term back pain after discography.
Pediatrics (80)
Authors: Wilson J.M. , Wise R. , Klein M.D.
Published: September 2010

Palliative care for children. (American Academy of Pediatrics, Elk Grove Village, IL) Pediatrics 2000;106:351–357.

This article presented an integrated model for providing palliative care for children living with a life‐threatening or terminal condition. Advice on the development of a palliative care plan and on working with parents and children is also provided. Barriers to the provision of effective pediatric palliative care and potential solutions are identified. The American Academy of Pediatrics recommends the development and broad availability of pediatric palliative care services based on child‐specific guidelines and standards. Such services will require widely distributed and effective palliative care education of pediatric health care professionals. The Academy offers guidance on responding to requests for hastening death, but does not support the practice of physician‐assisted suicide or euthanasia of children.
Pharmacology (82)
Authors: Eckhardt Klaus , Ammon Susanne , Hofmann Ute , Riebe Anja , Gugeler Nadja , Mikus: Gerd
Published: September 2010

Gabapentin enhances the analgesic effect of morphine in healthy volunteers. (Dr. Margarete Fischer Bosch Institut fuer Klinische Pharmakologie, Stuttgart, Germany) Anesth Analg 2000;91:185–191.

This randomized, placebo‐controlled, double‐blinded study investigated the pharmacodynamic and pharmacokinetic interaction of Gabapentin (GBP) and morphine in 12 healthy male volunteers. Morphine (60 mg, controlled release) or placebo was administered at 8:00 a.m., and GBP (600 mg) or placebo was administered at 10:00 a.m., thus comparing the analgesic effect of placebo + GBP (600 mg) with placebo + placebo and morphine (60 mg) + GBP in comparison to morphine plus placebo by using the cold pressor test. The duration and intensity of the side effects were assessed by using visual analog scales. The analgesic effect was evaluated by the change in the area under the curve of pain tolerance. Placebo + GBP did not present any significant analgesic effect compared with placebo + placebo. A siginificant increase in pain tolerance was observed comparing the combination of morphine and GBP with morphine and placebo. The observed adverse events after placebo + GBP were not significantly different compared with placebo + placebo. Morphine + placebo led to the expected opioid‐mediated side effects. They were significantly more pronounced compared with placebo + placebo, but did not differ significantly compared with the combination of morphine + GBP. Concerning the pharmacokinetic variables of morphine and its glucuronides, no significant difference between morphine + placebo and morphine + GBP was observed, whereas the area under the curve of GBP significantly increased, and apparent oral clearance and apparent renal clearance of GBP decreased when morphine was administered concomitantly. These results suggest 2 different sites for the pharmacokinetic interaction—1 at the level of absoption and the other at the level of elimination. The study reveals both a pharmacodynamic and pharmacokinetic interaction between morphine and GBP, leading to an increased analgesic effect of morphine + GBP. These results and the good tolerability of GBP should favor clinical trials investigating the clinical relevance of the combination of morphine and GBP for treating severe pain.
Physical Medicine and Rehabilitation (85)
Authors: Dursun Erbil , Dursun Nigar , Ural Canan Eksi , Çakci: Aytül
Published: September 2010

Glenohumeral joint subluxation and reflex sympathetic dystrophy in hemiplegic patients. (Kocaeli University, Kocaeli, Turkey) Arch Phys Med Rehabil 1999; 81:944–946.

This is a case‐controlled study of the relationship between glenohumeral joint subluxation and reflex sympathetic dystrophy (RSD) in hemiplegic patients set in an inpatient rehabilitation hospital. Thirty‐five hemiplegic patients with RSD (RSD group) and 35 hemiplegic patients without RSD (non‐RSD group) were included in this study. Patients with rotator cuff rupture, brachial plexus injury, or spasticity greater than stage 2 on the Ashworth scale were excluded. Both the RSD and non‐RSD groups were assessed for presence and grade of subluxation from radiographs using a 5‐point categorization. The degree of shoulder pain of the non‐RSD group was assessed by a visual analogue scale of 10 points. Glenohumeral subluxation was found in 74.3% of the RSD group and 40% of the non‐RSD group (P = 0.004). In the non‐RSD group, 78.6% of the patients with subluxation and 38.1% of the patients without subluxation reported shoulder pain (P = 0.019). No correlation was found between the degree of shoulder pain and grade of subluxation in the non‐RSD group (P = 0.152). Conclude that the findings suggest that shoulder subluxation may be a causative factor for RSD. Therefore, prevention and appropriate treatment of glenohumeral joint subluxation should be included in rehabilitation of hemiplegic patients.

Comment by Miles Day, MD.

The purpose of this study was to examine the relationship between shoulder subluxation in hemiplegic patients and reflex sympathetic dystrophy. They also examined if subluxation is associated with shoulder pain and the grade of subluxation in patients with subluxation and no reflex sympathetic dystrophy (RSD). Patients with injuries to the rotator cuff of the brachial plexus, marked spasticity, and major trauma to joint structures were excluded as these can be precipitating factors for RSD. The study noted a significantly higher presence of shoulder subluxation within the RSD group and the presence of pain was significantly high in patients with shoulder subluxation in the non‐RSD group. The take home message of this article is that any measure or treatment that can be applied to the glenohumeral joint should be performed to eliminate the possibility of the patient developing RSD and subsequently hindering further rehabilitation in these patients.
An Opioid Screening Instrument: Long‐Term Evaluation of the Utility of the Pain Medication Questionnaire
Authors: Holmes Cara P. , Gatchel Robert J. , Adams Laura L. , Stowell Anna W. , Hatten Alyson , Noe Carl , Lou Leland
Published: September 2010

Abstract:  The Pain Medication Questionnaire (PMQ) was designed to assess the risk for opioid medication misuse in chronic pain patients. A preliminary study showed a positive relationship between higher PMQ scores and concurrent measures of substance abuse, psychopathology, and physical/life‐functioning. Using a larger sample size, the present study sought to replicate these findings, and to expand upon them by examining the relationship between PMQ scores and various treatment outcomes. The PMQ was administered to 271 newly evaluated chronic pain patients who were subsequently re‐evaluated immediately post‐treatment, as well as six months following discharge. Subgroups were then formed according to the lowest (L‐PMQ), middle (M‐PMQ), and highest (H‐PMQ) one‐third of PMQ total scores. It was found that the H‐PMQ group was 2.6 times more likely to have a known substance‐abuse problem, 3.2 times more likely to request early refills of prescription medication, and 2.3 times more likely to drop out of treatment, as compared to the L‐PMQ group. They also had diminished biopsychosocial functioning. In addition, at six months following discharge, patients who completed the program experienced a significant decrease in PMQ scores over time relative to those patients who were unsuccessfully discharged from the program or who dropped out. This study represents the second stage in the development of a psychometrically sound screening tool for measuring risk for opioid medication misuse among chronic pain patients, and findings suggest the long‐term utility of the PMQ in identifying patients who are more likely to complete and benefit from a pain management program.
Right Ventricular Function in Adult Patients with Eisenmenger Physiology: Insights from Quantitative Echocardiography
Authors: Kalogeropoulos Andreas P. , Border William L. , Georgiopoulou Vasiliki V. , Pernetz Maria A. , Howell Sharon , McConnell Michael , Lerakis Stamatios , Butler Javed , Book Wendy M. , Martin Randolph P.
Published: September 2010

Background: The favorable outcomes of Eisenmenger syndrome (ES) relative to other forms of pulmonary arterial hypertension (PAH) have been partially attributed to a unique adaptation of the right ventricle (RV). However, conventional measures of RV function may not adequately express this adaptation. Methods: We studied 23 patients with ES (age 43 ± 17 years, 16 women, pulmonary artery systolic pressure [PASP] 93 ± 26 mmHg), 25 patients with PAH (age 44 ± 13 years, 17 women, PASP 92 ± 19 mmHg), and 25 subjects without known structural disease (age 45 ± 16 years, 17 women). We evaluated long‐ and short‐axis function of the RV with two‐dimensional strain and anatomical M‐mode echocardiography, respectively. Results: Long‐axis function of the RV was comparable between patients with ES and PAH although depressed relative to controls (global strain, −15.6 ± 4.7, −14.9 ± 4.3, and −22.4 ± 2.8%, respectively, P < 0.001; global RV systolic strain rate, −0.77 ± 0.26, −0.84 ± 0.24, and −1.11 ± 0.21 1/sec, respectively, P < 0.001). However, short‐axis RV function was significantly better in patients with ES versus those with PAH and preserved relative to controls (RV fractional shortening by anatomical M‐mode, median [interquartile range], 21%[14–33%], 14%[10–16%], and 26%[22–36%], respectively, P = 0.002 for ES vs. PAH, P = 0.09 for ES vs. controls). This differential was not reflected in conventional measures of RV function (fractional area change, 32 ± 10 vs. 29 ± 8% in ES and PAH, respectively, P = 0.26). Conclusion: In patients with ES, the RV is characterized by preserved short‐axis function, despite a depressed long‐axis function. Thus, conventional assessment of RV function might not be suitable for patients with ES. (Echocardiography 2010;27:937‐945)
Echocardiographic Study of a Mestizo‐Mexican Population with Marfan Syndrome
Authors: Espínola‐Zavaleta Nilda , Iqbal Fahad M. , Nanda Navin C. , Enríquez‐Rodríguez Eduardo , Amezcua‐Guerra Luís M. , Bojalil‐Parra Rafael , Reyes Pedro A. , Soto María Elena
Published: September 2010

Background: The cardiovascular manifestations of Marfan syndrome (MFS) are the main causes of morbidity and mortality. This study describes the clinical and echocardiographic findings in a Mestizo‐Mexican population affected by the disease. Methods: A total of 166 patients previously diagnosed with MFS were recruited for the study, 114 of them underwent complete clinical history, with emphasis on Ghent nosology criteria, and transthoracic echocardiography, with 68 patients also undergoing transesophageal study. Results: Major cardiovascular criteria from the Ghent nosology predominated in adults (P < 0.0001), minor criteria in children (P = 0.007). Among pediatric patients, 83% had a New York Heart Association (NYHA) functional class of I; however, 64% of the adult patients had an NYHA class ≥II, (P < 0.0001). Corrected aortic echocardiographic measurements of both groups demonstrated statistically significant differences. Children had a greater prevalence of mitral valve prolapse, while adults more frequently presented with aortic complications. Seven patients died during follow‐up from aortic complications, one child and six adults. Conclusions: Based on the data, we can conclude that MFS in the Mestizo‐Mexican population has a distinctly different clinical pattern in children and adults, and a graver prognosis in adults. Adult patients with MFS are significantly more likely, than children, to have aortic dilation, aortic aneurysm, aortic regurgitation, aneurysm rupture, aortic dissection, and fatal outcome. Children with MFS are more likely, than adults, to present with asymptomatic mitral and tricuspid prolapse and mitral valve regurgitation. (Echocardiography 2010;27:923‐930)
Relationship between Bicuspid Aortic Valve Morphology and Aortic Wall Degeneration: Further Evidence Is Emerging
Authors: Cannata Aldo , Francesco Russo Claudio , Martinelli Luigi
Published: September 2010

(Echocardiography 2010;27:1028)
Response to Letter Regarding: Relationship between Bicuspid Aortic Valve Morphology and Aortic Wall degeneration: Further Evidence Is Emerging
Authors: Jassal Davinder S. , Bhagirath Kapil M. , Tam James W. , Chan Kwan L.
Published: September 2010

(Echocardiography 2010;27:1029)
PRACTICING ANTHROPOLOGY FROM WITHIN THE ACADEMY: COMBINING CAREERS
Authors: Young Philip D.
Published: September 2010

In this article, I use my own career as a lens through which to view the challenges of combining an academic career with that of a (part‐time) practitioner of applied anthropology. My main focus is on the particular variety of practice known as international development. Based mostly on my own experiences both in and outside of academia, but with occasional references to what I know of the experiences of academic colleagues who have also done applied work, I offer advice to students who want an academic job and would also like to do applied anthropology of one sort or another. Lessons and advice are derived from three long‐term projects in which I participated as a practitioner: Plan Guaymí (Panama), the Southern Manpower Development Project (SMDP—Sudan), and Development Strategies for Fragile Lands in Latin America and the Caribbean (DESFIL). I examine the challenges and rewards of combining an academic career in anthropology with work in the nonacademic world of the practitioner. I highlight contrasts between what is valued in academe and in the world of practice. Finally, I suggest a series of strategies for promotion and tenure.
LEARNING APPLIED ANTHROPOLOGY IN FIELD SCHOOLS: LESSONS FROM BOSNIA AND ROMANIA
Authors: Van Arsdale Peter W.
Published: September 2010

This chapter illustrates how principles of applied anthropology can be learned through ethnographic or “cultural” field schools. Aside from a well‐rounded classroom education, aspiring applied anthropologists ideally should have substantial “experience in the field” before graduating, either through individualized experiences (the more common approach), or through group experiences. The chapter focuses on the latter, and discusses how such field experiences can enhance a student's emerging undergraduate or graduate career track. In addition, using two complementary types of field school (Project Bosnia and Project Romania, both at the University of Denver), the author addresses the concept of pragmatic humanitarianism, as well as the benefits of hands‐on group experiences of this nature for students and civil society at large.
WORKING FOR THE FEDERAL GOVERNMENT: ANTHROPOLOGY CAREERS
Authors: Fiske Shirley J.
Published: September 2010

The federal government is arguably the largest employer of anthropologists outside of academia. The most comprehensive data on numbers of anthropologists are from the U.S. Office of Personnel Management. These data and their limitations are described. This chapter argues that applied and practicing anthropology are at historic employment levels, with at least five agencies having “institutional presence” of in‐house anthropologists. Much of the growth is based on statutes enacted in the 1960s and 1970s, and solidified by anthropologists who codified their use around agency missions. Five agencies with institutional presence are highlighted, as examples of careers in the federal government. In addition the chapter describes careers and career paths in the federal government for a number of specialty areas including international development, both as a consultant and as a full‐time permanent government employee, cultural resource management, the legislative branch, forensic and physical anthropology, natural resource management, and defense and security sectors, by using interviews and career cameos of senior anthropologists in those agencies. The chapter concludes with specific information on where to find vacancy announcements and how to respond to them; collective experience of lessons learned in seeking federal careers; and the author's views on the importance of engagement for anthropologists in policies, issues, and program management in the federal sector.
APPLIED ANTHROPOLOGY AND EXECUTIVE LEADERSHIP
Authors: Pillsbury Barbara L.K.
Published: September 2010

Executive leadership is about mobilizing, managing, inspiring, and empowering others to achieve goals greater than what can be accomplished through individual works. Leadership flows from but is more than management and administration. Leadership can be learned—and typically is learned over time. This article presents a “hierarchy of executive capabilities”—from Highly Capable Individual, to Contributing Team Member, to Competent Manager, to Effective Leader, to Executive. The central message is that anthropologists, like all technical specialists who contemplate moving into management and up the ladder to executive leadership, must recognize that it will not be possible to stay on the cutting edge of their special area of knowledge and must be willing to give up being “the expert” in that area. This is illustrated through the careers of three anthropologists as they transitioned from traditional areas of anthropological knowledge into management and executive positions of increasing responsibility. The article discusses rewards but also assesses losses that occur along the way. It identifies the skills needed as one transitions up the management ladder and summarizes advice to anthropologists interested in executive careers. It also discusses ways in which a background in anthropology assists or may hinder in executive leadership. The context is primarily the world of international development assistance.
FURTHER RESOURCES FOR CAREERS IN APPLIED ANTHROPOLOGY
Authors: Shaffer Scarlett
Published: September 2010

This article is offers different resources related to career‐building in the field of practicing anthropology. The information provided complements the insights and recommendations of the various authors featured in this bulletin. To begin with, a list of nongovernmental and governmental organizations that employ anthropologists and individuals with anthropological skills has been provided. Online job boards and an annotated bibliography on the subjects of career building in practicing anthropology are also included. In addition to these resources, this article seeks to connect the reader with other individuals involved in practicing anthropology to broaden their career opportunities through professional networks. For this purpose, there are links to community groups such as professional and local practitioner organizations. The sources offered are by no means exhaustive, but they are useful for widening the reader's knowledge, expanding their career opportunities, and generating ideas for furthered field experience in the realm of practicing anthropology.
INTRODUCTION: TRACKING THE CONTEXT OF MOBILE LIVES
Authors: Meerwarth Tracy L. , Gluesing Julia C. , Jordan Brigitte
Published: September 2010

Many employees recognize that they are doing major amounts of professional work away from what might be considered their official workspace. Some knowledge workers are beginning to see a different world for themselves where work and home are allowed to blur and where periods of paid work alternate throughout the day with periods devoted to family and leisure. Because of rapid improvements in technology and changes in the global economy, worker mobility and distributed work have become a central topic for employees and companies alike. In this volume we begin to remedy a shortcoming in the literature on these topics by center‐staging accounts of personal experience. Contributors' narratives revolve around observations they made about their own behavior, illustrations of successes, and descriptions of the tensions inherent in mobile life and work. Thus, the articles reflect the authors' self‐conscious awareness of their individual mobile lives and, most importantly, how their lives contribute to and are shaped by larger societal patterns. In this introduction we provide an overview of the individual articles that follow, as well as some background for an informed reading, by discussing some of the driving forces behind the transition from conventional work styles to mobile and distributed patterns of work. We critically review some of the literature on the work and lifestyle transition that constitutes the central theme for this volume, including the effects of globalization, the development of tools for remote collaboration, and the blurring of home and office work. We elaborate our review of the literature on mobility and distributed work to highlight the stylistic, methodological, and topical contributions of this volume, thereby deepening our understanding of how this new mobility fits into the broader cultural and economic landscape.
OCCUPATIONAL WEBSITES AS LOCATIONS FOR REMOTE AND MOBILE WORKER CULTURE: AN EXAMINATION OF TEMPORARY WORKER WEBSITES
Authors: Gossett Loril M.
Published: September 2010

This article examines the instrumental role that websites play in developing and sustaining a work‐related culture for remote and mobile employees that often find themselves working alone or without coworkers from their parent company. More specifically, this article focuses on temporary worker websites, such as http://www.notmydesk.com and http://www.Temp24‐7.com, to illustrate how these on‐line communities foster a distinctive occupational community for temporary workers. Specific stories, postings, and other information contained on these sites reveals the lived experiences of temporary workers. The author's personal experiences in the industry, combined with examples taken from specific temporary worker websites, illustrate how the remote and mobile nature of this occupation impacts workers both on and off the job.
IDENTITY IN A VIRTUAL WORLD: THE COEVOLUTION OF TECHNOLOGY, WORK, AND LIFECYCLE
Authors: Gluesing Julia C.
Published: September 2010

This article draws on personal experiences of remote work that is facilitated by virtual or on‐line communication and collaboration technologies. This personal story illustrates how technology, work, and lifecycle coevolve and how the integration of work, family, and friends into the new, virtual workspaces can open up new conceptualizations of personal identity. An identity that is discretely bounded and that is dependent on physical surroundings can give way to one that more closely aligns with the lived experiences of mobile work and life. If we think of identity as multiple, as open to possibility, and as flexibly responsive to multiple cultures and contexts, we can alter our ideas about work and its relationship to our lives in ways that more closely align with today's hybridized, dematerialized and decontextualized world.
REMOTE OR MOBILE WORK AS AN OCCASION FOR (RE)STRUCTURING PROFESSIONAL AND PERSONAL IDENTITIES
Authors: Strawn Perri
Published: September 2010

Writing from the perspective of both a remote and mobile worker, I explore the ways in which regular and frequent physical relocation challenges and redefines my relationship to home and work. This article explores questions surrounding how an employee who is “remote” is seen by others, including peers and senior management, and the role remote workers play in the culture of the firm. This article also discusses strategies to cope with the sense of fragmentation that results from constant relocations because of travel among work, home, and other locations, in other words, how to bridge the “there–not there,”“seen–not seen” disjunctures that frame the experience of being a remote worker.