bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamic Mechanical Assessment of Muscle Hyperalgesia in Humans: The Dynamic Algometer
Authors: Finocchietti Sara , Graven-Nielsen Thomas , Arendt-Nielsen Lars 
Published: March 2016

BACKGROUND: Musculoskeletal pain is often associated with a nonhomogeneous distribution of mechanical hyperalgesia. Consequently, new methods able to detect this distribution are needed.OBJECTIVE: To develop and test a new method for assessing muscle hyperalgesia with high temporal and spatial resolution that provides complementary information compared with information obtained by traditional static pressure algometry.METHODS: The dynamic pressure algometer was tested bilaterally on the tibialis anterior muscle in 15 healthy subjects and compared with static pressure algometry. The device consisted of a wheel that was rolled over the muscle tissue with a fixed velocity and different predefined forces. The pain threshold force was determined and pain intensity to a fixed‐force stimulation was continuously rated on a visual analogue scale while the wheel was rolling over the muscle. The pressure pain sensitivity was evaluated before, during, and after muscle pain and hyperalgesia induced unilaterally by either injection of hypertonic saline (0.5 mL, 6%) into the tibialis anterior or eccentric exercise evoking delayed‐onset muscle soreness (DOMS).RESULTS: The intraclass correlation coefficient was >0.88 for the dynamic thresholds; thus, the method was reliable. Compared with baseline, both techniques detected hyperalgesia at the saline injection site and during DOMS (P<0.05). The dynamic algometer also detected the widespread, patchy distribution of sensitive loci during DOMS, which was difficult to evaluate using static pressure algometry.DISCUSSION AND CONCLUSION: The present study showed that dynamic pressure algometry is a reliable tool for evaluating muscle hyperalgesia (threshold and pain rating) with high temporal and spatial resolution. It can be applied as a simple clinical bed‐side test and as a quantitative tool in pharmacological profiling studies.
Corticosteroid Therapy in Critical Illness due to Seasonal and Pandemic Influenza
Authors: Yale Philippe , Adhikari Neill KJ , Masse Vincent , Fowler Robert A , Xiong Wei , McGeer Allison , Cann Darlene , Rudnick Wallis , Green Karen , Meade Maureen O , Valiquette Louis , Lamontagne François 
Published: March 2016

BACKGROUND: Survey data suggest that Canadian intensivists administer corticosteroids to critically ill patients primarily in response to airway obstruction, perceived risk for adrenal insufficiency and hemodynamic instability.OBJECTIVE: To describe variables independently associated with systemic corticosteroid therapy during an influenza outbreak.METHODS: The present analysis was retrospective cohort study involving critically ill patients with influenza in two Canadian cities. Hospital records were reviewed for critically ill patients treated in the intensive care units (ICUs) of eight hospitals in Canada during the 2008 to 2009 and 2009 to 2010 influenza outbreaks. Abstracted data included demographic information, symptoms at disease onset, chronic comorbidities and baseline illness severity scores. Corticosteroid use data were extracted for every ICU day and expressed as hydrocortisone dose equivalent in mg. Multivariable regression models were constructed to identify variables independently associated with corticosteroid therapy in the ICU.RESULTS: The study cohort included 90 patients with a mean (± SD) age of 55.0±17.3 years and Acute Physiology and Chronic Health Evaluation II score of 19.8±8.3. Patients in 2009 to 2010 were younger with more severe lung injury but similar exposure to corticosteroids. Overall, 54% of patients received corticosteroids at a mean daily dose of 343±330 mg of hydrocortisone for 8.5±4.8 days. Variables independently associated with corticosteroid therapy in the ICU were history of airway obstruction (OR 4.8 [95% CI 1.6 to 14.9]) and hemodynamic instability (OR 4.6 [95% CI 1.2 to 17.8]).CONCLUSION: Observational data revealed that hemodynamic instability and airway obstruction were associated with corticosteroid therapy in the critical care setting, similar to a recent survey of stated practice. Efforts to determine the effects of corticosteroids in the ICU for these specific clinical situations are warranted.
Empowering Family Physicians to Impart Proper Inhaler Teaching to Patients with Chronic Obstructive Pulmonary Disease and Asthma
Authors: Leung Janice M , Bhutani Mohit , Leigh Richard , Pelletier Dan , Good Cathy , Sin Don D 
Published: March 2016

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) and asthma depend on inhalers for management, but critical errors committed during inhaler use can limit drug effectiveness. Outpatient education in inhaler technique remains inconsistent due to limited resources and inadequate provider knowledge.OBJECTIVE: To determine whether a simple, two‐session inhaler education program can improve physician attitudes toward inhaler teaching in primary care practice.METHODS: An inhaler education program with small‐group hands‐on device training was instituted for family physicians (FP) in British Columbia and Alberta. Sessions were spaced one to three months apart. All critical errors were corrected in the first session. Questionnaires surveying current inhaler teaching practices and attitudes toward inhaler teaching were distributed to physicians before and after the program.RESULTS: Forty‐one (60%) of a total 68 participating FPs completed both before and after program questionnaires. Before the program, only 20 (49%) reported providing some form of inhaler teaching in their practices, and only four (10%) felt fully competent to teach patients inhaler technique. After the program, 40 (98%) rated their inhaler teaching as good to excellent. Thirty‐four (83%) reported providing inhaler teaching in their practices, either by themselves or by an allied health care professional they had personally trained. All stated they could teach inhaler technique within 5 min. Observation of FPs during the second session by certified respiratory educators found that none made critical errors and all had excellent technique.CONCLUSION: A physician inhaler education program can improve attitudes toward inhaler teaching and facilitate implementation in clinical practices.
Is a Single Low Dose of Intrathecal Morphine a Useful Adjunct to Patient‐Controlled Analgesia for Postoperative Pain Control Following Lumbar Spine Surgery? A Preliminary Report
Authors: Yen David , Turner Kim , Mark David 
Published: March 2016

BACKGROUND: Several studies addressing intrathecal morphine (ITM) use following spine surgery have been published either involving the pediatric population, using mid‐ to high‐dose ITM, or not in conjunction with morphine patient‐controlled analgesia (PCA).OBJECTIVES: To determine whether low‐dose ITM is a useful adjunct to PCA for postoperative pain control following elective lumbar spine surgery in adults.METHODS: Thirty‐two patients were enrolled in a double‐blinded randomized controlled trial, and received either ITM or intrathecal placebo. Postoperatively, all patients were given a PCA pump and observed for the first 24 h in a step‐down unit. Measurements of: total PCA morphine consumed in the first 24 h; intensity of pain; pruritus; nausea at 4 h, 8 h and 24 h; time to first ambulation; length of hospital stay; and occurrences of respiratory depression were recorded.RESULTS: The total PCA use was significantly lower in the ITM group. There were lower average pain scores in the ITM group, which increased to that of the intrathecal placebo group over 24 h; however, this failed to attain statistical significance. There were no differences in nausea, pruritus, time to first ambulation or hospital length stay. There were no cases of respiratory depression in either group.CONCLUSIONS: ITM may be a useful adjunct to PCA, but did not decrease time to ambulation or length of stay.
Characteristics and Associations of Pain Intensity in Patients Referred to a Specialist Cancer Pain Clinic
Authors: Pina Paulo , Sabri Elham , Lawlor Peter G 
Published: March 2016

BACKGROUND: Uncontrolled cancer pain (CP) may impair quality of life. Given the multidimensional nature of CP, its poor control is often attributed to poor assessment and classification.OBJECTIVES: To determine the characteristics and associations of pain intensity in a specialist CP clinic.METHODS: Consecutive patients referred to the CP clinic of the Portuguese Cancer Institute (Lisbon, Portugal) had standardized initial assessments and status documentation of the following: Brief Pain Inventory ratings for ‘pain now’ as the outcome variable; initial pain intensity (iPI) on a 0 to 10 scale; pain mechanism (using the Douleur Neuropathique 4 tool to assess neuropathic pain); episodic pain; Eastern Cooperative Oncology Group rating; oral morphine equivalent daily dose (MEDD); Hospital Anxiety Depression Scale and Emotional Thermometer scores; and cancer diagnosis, metastases, treatment and pain duration. Univariable analyses were conducted to test the association of independent variables with iPI. Variables with P<0.1 were entered into a multivariable regression model, using backward elimination and a cut‐point of P=0.2 for final model selection.RESULTS: Of 371 participants, 285 (77%) had moderate (4 to 6) or severe (7 to 10) iPI. The initial median MEDD was relatively low (30 mg [range 20 mg to 60 mg]). In the multivariable model, higher income, Eastern Cooperative Oncology Group rating 3 to 4, cancer diagnosis (head and neck, genitourinary and gastrointestinal), adjuvant use and initial MEDD were associated with iPI (P<0.05). The model’s R2 was 18.6, which explained only 19% of iPI variance.CONCLUSIONS: The diversity of factors associated with pain intensity and their limited explanation of its variance underscore the biopsychosocial complexity of CP. Adequacy of CP management warrants further exploration.
Nitrous Oxide Persistently Alleviates Pain Hypersensitivity in Neuropathic Rats: A Dose‐Dependent Effect
Authors: Ben Boujema Meric , Laboureyras Emilie , Pype Jan , Bessière Baptiste , Simonnet Guy 
Published: March 2016

BACKGROUND: Despite numerous pharmacological approaches, there are no common analgesic drugs that produce meaningful relief for the majority of patients with neuropathic pain. Although nitrous oxide (N2O) is a weak analgesic that acts via opioid‐dependent mechanisms, it is also an antagonist of the N‐methyl‐D‐aspartate receptor (NMDAR). The NMDAR plays a critical role in the development of pain sensitization induced by nerve injury.OBJECTIVE: Using the chronic constriction injury of the sciatic nerve in male rats as a preclinical model of neuropathic pain, the first aim of the present study was to evaluate the lowest N2O concentration and the shortest time of N2O postinjury exposure that would produce persistent relief of neuropathic pain. The second aim was to compare the effects of N2O with gabapentin, a reference drug used in human neuropathic pain relief.METHODS: Changes in the nociceptive threshold were evaluated using the paw pressure vocalization test in rats.RESULTS: Among the various N2O concentrations tested, which ranged from 25% to 50%, only 50% N2O single exposure for 1 h 15 min induced a persistent (minimum of three weeks) and significant (60%) reduction in pain hypersensitivity. A single gabapentin dose (75 mg/kg to 300 mg/kg, intraperitoneally) induced an acute (1 h to 1 h 30 min) dose‐dependent effect, but not a persistent effect such as that observed with N2O.CONCLUSIONS: These preclinical results suggest that N2O is advantageous for long‐lasting neuropathic pain relief after sciatic nerve injury compared with other drugs used in humans such as gabapentinoids or NMDAR antagonists. The present preclinical study provides a rationale for developing comparative clinical studies.
The Association between Sleep‐Disordered Breathing and Magnetic Resonance Imaging Findings in a Pediatric Cohort with Chiari 1 Malformation
Authors: Amin Reshma , Sayal Priya , Sayal Aarti , Massicote Colin , Pham Robin , Al-Saleh Suhail , Drake James , Narang Indra 
Published: March 2016

BACKGROUND: The prevalence of sleep‐disordered breathing (SDB) reported in the literature for Chiari malformation type 1 (CM1) is uniformly high (24% to 70%). In Canada, there is limited access to pediatric polysomnography (PSG). Therefore, the identification of clinical features would be invaluable for triaging these children.OBJECTIVE: To identify demographic features, clinical symptoms/signs and radiological findings associated with SDB in a large pediatric cohort with CM1.METHODS: A retrospective review was conducted on children with CM1 who underwent baseline PSG. Data were collected on patient demographics (age, sex, weight, height, body mass index), clinical symptoms (chart review and clinical questionnaires), diagnostic imaging of the brain and cervicothoracic spine, and medical history at the time of referral.RESULTS: A total of 68 children were included in the review. The mean (± SD) age of the children at the time of PSG was 7.33±4.01 years; 56% (n=38) were male. There was a 49% prevalence of SDB in this cohort based on the overall apnea‐hypopnea index. Obstructive sleep apnea was the predominant type of SDB. Tonsillar herniation was significantly correlated with obstructive apnea‐hypopnea index (r=0.24; P=0.036).CONCLUSIONS: A direct relationship between the degree of cerebellar tonsillar herniation and obstructive sleep apnea was demonstrated. However, further prospective studies that include neurophysiological assessment are needed to further translate the central nervous system imaging findings to predict the presence of SDB.
The Medical Life of Henry Norman Bethune
Authors: Deslauriers Jean , Goulet Denis 
Published: March 2016

BACKGROUND: Henry Norman Bethune is one of the most exciting and incredible surgeons that Canada has ever produced. Indeed, he is often characterized as one of the world’s best‐known surgeons. He was an innovator and his scientific contributions have stood the test of time. In Canada, he will forever be remembered as a social activist committed to the welfare of the poor and to the reform of the health care system. In the People’s Republic of China, he is idolized and remains the only foreigner to ever become a national hero.OBJECTIVE: To detail the numerous and significant achievements of Henry Norman Bethune in the field of thoracic surgery and as a social activist and describe his heroic war‐time actions on the battlefields of both Spain and China.METHOD: Information was gathered through the reading of the numerous publications written about the life and work of Bethune, interviews with knowledgeable people from Canadian and Chinese universities, analysis of Bethune’s own publications, and extensive experience of one of the authors in China.RESULTS: In the social sense, Henry Norman Bethune had a difficult personality, but he was deeply caring about the plight of his patients, especially the poor. As a thoracic surgeon, he could be ingenious, thoughtful and effective but he could also be abrasive, restless and temperamental. His scientific contributions were sound and, at the time, gained worldwide attention. As an activist, he led a crusade to reform the Canadian health care system, demanding free health care for all. His outstanding work during the Spanish Civil War, where he organized the first ever mobile blood transfusion unit, and during the Sino‐Japanese war, where he was totally committed to the welfare of both soldiers and civilian population, were deliberate acts of resistance against Fascist onslaught and enthusiasm for the Communist cause.CONCLUSIONS: Henry Norman Bethune was unconventional and a revolutionary, but he was brilliant. He will forever be remembered as an innovative thoracic surgeon and outstanding humanitarian.
Application of a Cold Patch for Relieving Pain after Transepithelial Photorefractive Keratectomy
Authors: Zeng Yuan , Li Yi , Gao Jian-Hua 
Published: March 2016

Although photorefractive keratectomy often results in better corneal stability and fewer corneal flap complications than LASIK, pain remains a major drawback of the procedure. The authors compared the safety and efficacy of a postoperative cold patch versus intraoperative application of a chilled balanced salt solution on transepithelial photorefractive keratectomy‐related postoperative pain.BACKGROUND: A return toward toward photorefractive keratectomy has occurred due to better corneal stability and fewer corneal flap complications; however, pain remains a major drawback of the procedure. Currently, clinical pain control measures focus on the administration of pain medications, which may delay corneal epithelial healing and has, occasionally, led to serious corneal toxicity.OBJECTIVES: To investigate the safety and efficacy of a cold patch on postoperative pain and other relevant consequences of transepithelial photorefractive keratectomy.METHODS: A prospective, randomized controlled study was conducted. Forty patients (80 eyes) scheduled to undergo transepithelial photorefractive keratectomy for myopia or myopic astigmatism were randomly and equally assigned to be treated with ice‐cold balanced salt solution during surgery (wash group) or to wear a postoperative cold patch on the eye for 24 h. The main outcomes were pain score on a visual analogue scale, postoperative eyelid edema, conjunctival hyperemia, epithelial healing time, haze and postoperative best‐corrected visual acuity.RESULTS: All patients completed the final tests. Demographic characteristics and pain scores during surgery were similar between the two groups. The mean postoperative pain scores of patients in the cold patch group at 8 h, 16 h and 24 h were significantly lower than those of patients in the wash group. Scores for postoperative eyelid edema and conjunctival hyperemia in the cold patch group were also lower than in the wash group. Patients in the cold patch group used fewer painkillers. Epithelial healing time, haze and early recovery of visual acuity were similar between the two groups. No eyelid frostbite was observed.CONCLUSION: Wearing a cold patch on the eye after transepithelial photorefractive keratectomy effectively relieved pain and inflammation, and reduced the use of painkillers without any side effects.
Effects of Continuous Fascia Iliaca Compartment Blocks for Postoperative Analgesia in Patients with Hip Fracture
Authors: Nie Hongling , Yang Ya-Xiong , Wang Yang , Liu Yong , Zhao Bin , Luan Bo 
Published: March 2016

BACKGROUND: Effective analgesia is essential for the postoperative care of orthopedic patients.OBJECTIVES: To evaluate the efficacy of continuous fascia iliaca compartment block (FIB) as postoperative analgesia after hip fracture surgery, and to compare FIB with patient‐controlled intravenous analgesia (PCIA) using fentanyl for 48 h postoperatively.METHODS: Patients with hip fractures who were scheduled for open reduction and internal fixation surgery using the antirotation proximal femoral nail technique were randomly assigned to the FIB or PCIA groups. Postoperative pain was assessed using a numeral rating scale at 2 h, 4 h, 6 h, 12 h, 24 h and 48 h after analgesia was started. Delirium, postoperative nausea and vomiting (PONV), and pruritus were also monitored.RESULTS: Patients in the FIB group reported less pain than those in the PCIA group (P=0.039, d=−0.3). The change in pain scores over time was similar between the two groups. There were six patients with PONV and five patients with pruritus in the PCIA group, while no PONV or pruritus was noticed in the FIB group (P=0.013). Ten (19.6%) patients in the FIB group and three (5.7%) patients in the PCIA group developed postoperative delirium (P=0.032, d=0.77).CONCLUSION: Continuous FIB is a safe and effective technique for postoperative analgesia after hip fracture surgery, making it an option for pain management in elderly patients with hip fractures.
Analysis of Radiofrequency Lesions in Egg Whites in Vitro Produced by Application of the Tew Electrode for Different Temperatures and Times
Authors: Kwon Young Suk , Lim So Young , Kim Jong Ho , Jang Ji Su , Kim Chul Ho , Kwon Kwang Jun , Yon Jun Heum 
Published: March 2016

BACKGROUND: Understanding the size and shape of radiofrequency lesions is important to reduce side effects when applied to patients.OBJECTIVES: To investigate the radiofrequency lesions produced by the application of the Tew electrode for different temperatures and times.METHODS: The white from a fresh hen’s egg was placed in a rectangular glass container and warmed to 37°C. After immersion of the Tew electrode in the egg white, radiofrequency lesions were produced at 65°C, 70°C, 75°C, 80°C, 85°C and 90°C. For each temperature, photographs were taken at 10 s, 20 s, 30 s, 40 s, 50 s, 60 s, 70 s, 80 s, 90 s, 100 s, 110 s and 120 s. The size of the lesion was measured at each temperature and time. A mixed model was used to analyze the data.RESULTS: The size of the lesion increased with increasing temperature and time. There were statistically significant differences in the size of the internal radius between the 65°C and 70°C groups and the 70°C and 75°C groups, as well as in the 70°C and 75°C groups in the size of the external radius and the 60°C to 80°C groups in the size of the distal radius. The maximum lesion size was produced at 90°C and 120 s, and was 1.06±0.16 mm in internal radius, 0.37±0.15 mm in external radius, 0.39±0.04 mm in distal radius.CONCLUSION: The Tew electrode produces lesions following the contour of the tip, and the internal radius is larger than the external and distal radius. The best combination of temperature and time for lesioning using the Tew electrode is 80°C, for 60 s to 90 s.