Acute low back pain is marked by variability: An internet-based pilot study

<p>Abstract</p> <p>Background</p> <p>Pain variability in acute LBP has received limited study. The objectives of this pilot study were to characterize fluctuations in pain during acute LBP, to determine whether self-reported 'flares' of pain represent discrete periods of increased pain intensity, and to examine whether the frequency of flares was associated with back-related disability outcomes.</p> <p>Methods</p> <p>We conducted a cohort study of acute LBP patients utilizing frequent serial assessments and Internet-based data collection. Adults with acute LBP (lasting ≤3 months) completed questionnaires at the time of seeking care, and at both 3-day and 1-week intervals, for 6 weeks. Back pain was measured using a numerical pain rating scale (NPRS), and disability was measured using the Oswestry Disability Index (ODI). A pain flare was defined as 'a period of increased pain lasting at least 2 hours, when your pain intensity is distinctly worse than it has been recently'. We used mixed-effects linear regression to model longitudinal changes in pain intensity, and multivariate linear regression to model associations between flare frequency and disability outcomes.</p> <p>Results</p> <p>42 of 47 participants (89%) reported pain flares, and the average number of discrete flare periods per patient was 3.5 over 6 weeks of follow-up. More than half of flares were less than 4 hours in duration, and about 75% of flares were less than one day in duration. A model with a quadratic trend for time best characterized improvements in pain. Pain decreased rapidly during the first 14 days after seeking care, and leveled off after about 28 days. Patients who reported a pain flare experienced an almost 3-point greater current NPRS than those not reporting a flare (mean difference [SD] 2.70 [0.11]; p < 0.0001). Higher flare frequency was independently associated with a higher final ODI score (<it>ß </it>[SE} 0.28 (0.08); p = 0.002).</p> <p>Conclusions</p> <p>Acute LBP is characterized by variability. Patients with acute LBP report multiple distinct flares of pain, which correspond to discrete increases in pain intensity. A higher flare frequency is associated with worse disability outcomes.</p

Clinical and economic systematic literature review to support the development of an integrated care programme for chronic disease prevention and management for the Irish health system

Report prepared for the Clinical Strategy and Programmes Division (CSPD) of the Health Service Executive to support the work of integrated clinical care programmes.Based on a clinical and economic systematic review of the international literature, this report presents the evidence on integrated care programmes and generic models of care designed for chronic disease prevention and management. This evidence will support the work of integrated clinical care programmes in Ireland through the Clinical Strategy and Programmes Division of the HSE

Introduction to National Certification Examinations

This book chapter is an introduction to national certification examinations for adult-gerontology acute care Nurse Practitioners

Pancreatitis Quality of Life Instrument: Development of a new instrument

Objectives: The goal of this project was to develop the first disease-specific instrument for the evaluation of quality of life in chronic pancreatitis. Methods: Focus groups and interview sessions were conducted, with chronic pancreatitis patients, to identify items felt to impact quality of life which were subsequently formatted into a paper-and-pencil instrument. This instrument was used to conduct an online survey by an expert panel of pancreatologists to evaluate its content validity. Finally, the modified instrument was presented to patients during precognitive testing interviews to evaluate its clarity and appropriateness. Results: In total, 10 patients were enrolled in the focus groups and interview sessions where they identified 50 items. Once redundant items were removed, the 40 remaining items were made into a paper-and-pencil instrument referred to as the Pancreatitis Quality of Life Instrument. Through the processes of content validation and precognitive testing, the number of items in the instrument was reduced to 24. Conclusions: This marks the development of the first disease-specific instrument to evaluate quality of life in chronic pancreatitis. It includes unique features not found in generic instruments (economic factors, stigma, and spiritual factors). Although this marks a giant step forward, psychometric evaluation is still needed prior to its clinical use

Image, manuscript, print: Le Roman de la rose, ca. 1481-1538

This thesis examines the transmission and reception of images in Le Roman de la rose manuscripts and printed editions of the late fifteenth and early sixteenth centuries. Through in-depth case studies, I analyse how illustrators, editors, and readers used printed imagery in Rose books ca. 1481-1538, during the period of Rose printed edition production, exploring wider cross-disciplinary issues concerning the history of the book, the relationship between word and image, and readership practices following the advent of French printing. I argue that the mobility of printed imagery, which was facilitated in part by the wider dissemination of woodcuts in workshops, influenced the form and function of images in books. In addition, I problematize the 'transition' from manuscript to print in the later Middle Ages, through an investigation of artisans' personal and professional collaborations and evidence of image sharing between hand-illustrated and printed books. Bookmakers and readers used printed imagery in fascinating ways in books, appropriating and modifying woodcuts in order to engage with certain subjects and motifs. Readers' visual responses to books are under-examined, and I assess how readers' drawings add insight into their understanding of printed editions and those editions' visual iconography. French books contain a large body of evidence pertaining to image production and reception, but printed imagery is often overlooked, despite its potential to shed light on the practices of illustrators, editors, and readers. I provide new strategies for examining patterns of printed image production, circulation, and reception in the visual presentations of manuscripts and printed editions of this period. I also deepen understanding of the Rose and its consumption in the later Middle Ages and Renaissance, probing the role of images in books.This thesis is not currently available on ORA

Genetic diversity and phylogeny of the Christmas Island flying fox (Pteropus melanotus natalis)

The Christmas Island flying fox (Pteropus melanotus natalis) is thought to be declining to critically low levels. Mitochondrial sequences of the cytochrome oxidase 1 (CO1) and cytochrome b (Cytb) genes and the D-loop were generated from 28 animals and used with maximum likelihood, Bayesian inference, and maximum parsimony methods to determine its relationship to other Pteropus species. In all analyses, P. m. natalis mapped to a large clade containing Pacific Ocean island and Australian Pteropus species. Analysis using the large numbers of available Cytb sequences for Pteropus showed that P. m. natalis maps to a subclade that contains P. hypomelanus sequences from bats originating from Pulau Panjang, an island off the northeast coast of Java. P. hypomelanus was found to be polyphyletic, mapping to 3 separate subclades. These 3 genetically and geographically defined populations are likely to represent 3 separate species. Eighteen D-loop haplotypes were identified, suggesting that P. m. natalis maintains a degree of genetic diversity similar to other insular flying fox species