718 research outputs found
Intravenous opioids for chemotherapy-induced severe mucositis pain in children: Systematic review and single-center case series of management with patient- or nurse-controlled analgesia (PCA/NCA)
BACKGROUND:
Chemotherapy-induced oral mucositis can result in severe pain. Intravenous (IV) opioids are recommended, but management protocols vary. We systematically reviewed studies reporting IV opioid use for pain related to chemotherapy-induced severe oral mucositis in children and conducted a large single-center case series.
METHODS:
Ovid MEDLINE, PubMed, and Cochrane databases were searched for studies reporting IV opioid duration and/or dose requirements for severe mucositis. Secondly, our pain service database was interrogated to describe episodes of opioid administration by patient- or nurse-controlled analgesia (PCA/NCA) for children with mucositis and cancer treatment-related pain.
RESULTS:
Seventeen studies (six randomized trials, two prospective observational, three retrospective cohort, six retrospective case series) included IV opioid in 618 patients (age 0.3–22.3 years), but reported parameters varied. Mucositis severity and chemotherapy indication influenced IV opioid requirements, with duration ranging from 3 to 68 days and variable dose trajectories (hourly morphine or equivalent 0-97 mcg/kg/h). Our 7-year series included PCA/NCA for 364 episodes of severe mucositis (302 patients; age 0.12–17.2 years). Duration ranged from 1 to 107 days and dose requirements in the first 3 days from 1 to 110 mcg/kg/h morphine. Longer PCA/NCA duration was associated with: higher initial morphine requirements (ρ = 0.46 [95% CI 0.35, 0.57]); subsequent increased pain and need for ketamine co-analgesia (118/364 episodes with opioid/ketamine 13.9 [9.8–22.2] days vs opioid alone 6.0 [3.9–10.8] days; median [IQR]); but not with age or sex.
CONCLUSIONS:
Management of severe mucositis pain can require prolonged IV opioid therapy. Individual and treatment-related variability in analgesic requirements highlight the need for regular review, titration, and management by specialist services
The cost of inadequate sleep among on-call workers in Australia: A workplace perspective
© 2018 by the authors. Licensee MDPI, Basel, Switzerland. On-call or stand-by is becoming an increasingly prevalent form of work scheduling. However, on-call arrangements are typically utilised when workloads are low, for example at night, which can result in inadequate sleep. It is a matter of concern that on-call work is associated with an increased risk of workplace injury. This study sought to determine the economic cost of injury due to inadequate sleep in Australian on-call workers. The prevalence of inadequate sleep among on-call workers was determined using an online survey, and economic costs were estimated using a previously validated costing methodology. Two-thirds of the sample (66%) reported obtaining inadequate sleep on weekdays (work days) and over 80% reported inadequate sleep while on-call. The resulting cost of injury is estimated at 1.71–2.73 billion). This equates to 2.53 million per incident classified as full incapacity, and $1.78 million for each fatality. To the best of our knowledge this is the first study to quantify the economic cost of workplace injury due to inadequate sleep in on-call workers. Well-rested employees are critical to safe and productive workplace operations. Therefore, it is in the interest of both employers and governments to prioritise and invest far more into the management of inadequate sleep in industries which utilise on-call work arrangements
Tissue Localization and Extracellular Matrix Degradation by PI, PII and PIII Snake Venom Metalloproteinases: Clues on the Mechanisms of Venom-Induced Hemorrhage
20 páginas, 4 figuras, 3 tablas y 7 tablas en material suplementario.Snake venom hemorrhagic metalloproteinases (SVMPs) of the PI, PII and PIII classes were compared in terms of tissue localization and their ability to hydrolyze basement membrane components in vivo, as well as by a proteomics analysis of exudates collected in tissue injected with these enzymes. Immunohistochemical analyses of co-localization of these SVMPs with type IV collagen revealed that PII and PIII enzymes co-localized with type IV collagen in capillaries, arterioles and post-capillary venules to a higher extent than PI SVMP, which showed a more widespread distribution in the tissue. The patterns of hydrolysis by these three SVMPs of laminin, type VI collagen and nidogen in vivo greatly differ, whereas the three enzymes showed a similar pattern of degradation of type IV collagen, supporting the concept that hydrolysis of this component is critical for the destabilization of microvessel structure leading to hemorrhage. Proteomic analysis of wound exudate revealed similarities and differences between the action of the three SVMPs. Higher extent of proteolysis was observed for the PI enzyme regarding several extracellular matrix components and fibrinogen, whereas exudates from mice injected with PII and PIII SVMPs had higher amounts of some intracellular proteins. Our results provide novel clues for understanding the mechanisms by which SVMPs induce damage to the microvasculature and generate hemorrhage.This work was performed in partial fulfillment of the requirements for the PhD degree for Cristina Herrera at Universidad de Costa Rica.Peer reviewe
Crack-Like Processes Governing the Onset of Frictional Slip
We perform real-time measurements of the net contact area between two blocks
of like material at the onset of frictional slip. We show that the process of
interface detachment, which immediately precedes the inception of frictional
sliding, is governed by three different types of detachment fronts. These
crack-like detachment fronts differ by both their propagation velocities and by
the amount of net contact surface reduction caused by their passage. The most
rapid fronts propagate at intersonic velocities but generate a negligible
reduction in contact area across the interface. Sub-Rayleigh fronts are
crack-like modes which propagate at velocities up to the Rayleigh wave speed,
VR, and give rise to an approximate 10% reduction in net contact area. The most
efficient contact area reduction (~20%) is precipitated by the passage of slow
detachment fronts. These fronts propagate at anomalously slow velocities, which
are over an order of magnitude lower than VR yet orders of magnitude higher
than other characteristic velocity scales such as either slip or loading
velocities. Slow fronts are generated, in conjunction with intersonic fronts,
by the sudden arrest of sub-Rayleigh fronts. No overall sliding of the
interface occurs until either of the slower two fronts traverses the entire
interface, and motion at the leading edge of the interface is initiated. Slip
at the trailing edge of the interface accompanies the motion of both the slow
and sub-Rayleigh fronts. We might expect these modes to be important in both
fault nucleation and earthquake dynamics.Comment: 19 page, 5 figures, to appear in International Journal of Fractur
Heart rate changes during partial seizures: A study amongst Singaporean patients
INTRODUCTION: Studies in Europe and America showed that tachycardia, less often bradycardia, frequently accompanied partial seizures in Caucasian patients. We determine frequency, magnitude and type of ictal heart rate changes during partial seizures in non-Caucasian patients in Singapore. METHODS: Partial seizures recorded during routine EEGs performed in a tertiary hospital between 1995 and 1999 were retrospectively reviewed. All routine EEGs had simultaneous ECG recording. Heart rate before and during seizures was determined and correlated with epileptogenic focus. Differences in heart rate before and during seizures were grouped into 4 types: (1) >10% decrease; (2) -10 to +20% change; (3) 20–50% increase; (3) >50% increase. RESULTS: Of the total of 37 partial seizures, 18 were left hemisphere (LH), 13 were right hemisphere (RH) and 6 were bilateral (BL) in onset. 51% of all seizures showed no significant change in heart rate (type 2), 22% had moderate sinus tachycardia (type 3), 11% showed severe sinus tachycardia (type 4), while 16% had sinus bradycardia (type 1). Asystole was recorded in one seizure. Apart from having more tachycardia in bilateral onset seizures, there was no correlation between side of ictal discharge and heart rate response. Compared to Caucasian patients, sinus tachycardia was considerably less frequent. Frequency of bradycardia was similar to those recorded in the literature. CONCLUSIONS: Significant heart rate changes during partial seizures were seen in half of Singaporean patients. Although sinus tachycardia was the most common heart rate change, the frequency was considerably lower compared to Caucasian patients. This might be due to methodological and ethnic differences. Rates of bradycardia are similar to those recorded in the literature
The Cosmology of Composite Inelastic Dark Matter
Composite dark matter is a natural setting for implementing inelastic dark
matter - the O(100 keV) mass splitting arises from spin-spin interactions of
constituent fermions. In models where the constituents are charged under an
axial U(1) gauge symmetry that also couples to the Standard Model quarks, dark
matter scatters inelastically off Standard Model nuclei and can explain the
DAMA/LIBRA annual modulation signal. This article describes the early Universe
cosmology of a minimal implementation of a composite inelastic dark matter
model where the dark matter is a meson composed of a light and a heavy quark.
The synthesis of the constituent quarks into dark mesons and baryons results in
several qualitatively different configurations of the resulting dark matter
hadrons depending on the relative mass scales in the system.Comment: 31 pages, 4 figures; references added, typos correcte
Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight?
<p>Abstract</p> <p>Background</p> <p>Physicians are encouraged to counsel obese patients to lose weight, but studies measuring the quality of physicians' counseling are rare. We sought to describe the quality of physicians' obesity counseling and to determine associations between the quality of counseling and obese patients' motivation and intentions to lose weight, key predictors of behavior change.</p> <p>Methods</p> <p>We conducted post-visit surveys with obese patients to assess physician's use of 5As counseling techniques and the overall patient-centeredness of the physician.. Patients also reported on their motivation to lose weight and their intentions to eat healthier and exercise. One-way ANOVAs were used to describe mean differences in number of counseling practices across levels of self-rated intention and motivation. Logistic regression analyses were conducted to assess associations between number of 5As counseling practices used and patient intention and motivation.</p> <p>Results</p> <p>137 patients of 23 physicians were included in the analysis. While 85% of the patients were counseled about obesity, physicians used only a mean of 5.3 (SD = 4.6) of 18 possible 5As counseling practices. Patients with higher levels of motivation and intentions reported receiving more 5As counseling techniques than those with lower levels. Each additional counseling practice was associated with higher odds of being motivated to lose weight (OR 1.31, CI 1.11-1.55), intending to eat better (OR 1.23, CI 1.06-1.44), and intending to exercise regularly (OR 1.14, CI 1.00-1.31). Patient centeredness of the physician was also positively associated with intentions to eat better (OR 2.96, CI 1.03-8.47) and exercise (OR 26.07, CI 3.70-83.93).</p> <p>Conclusions</p> <p>Quality of physician counseling (as measured using the 5As counseling framework and patient-centeredness scales) was associated with motivation to lose weight and intentions to change behavior. Future studies should determine whether higher quality obesity counseling leads to improved behavioral and weight outcomes.</p
Acute kidney disease and renal recovery : consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup
Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of > 90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process. For patients in whom pathophysiologic processes are ongoing, the term acute kidney disease (AKD) has been proposed to define the course of disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD
Where the Sidewalk Ends: Jets and Missing Energy Search Strategies for the 7 TeV LHC
This work explores the potential reach of the 7 TeV LHC to new colored states
in the context of simplified models and addresses the issue of which search
regions are necessary to cover an extensive set of event topologies and
kinematic regimes. This article demonstrates that if searches are designed to
focus on specific regions of phase space, then new physics may be missed if it
lies in unexpected corners. Simple multiregion search strategies can be
designed to cover all of kinematic possibilities. A set of benchmark models are
created that cover the qualitatively different signatures and a benchmark
multiregion search strategy is presented that covers these models.Comment: 30 pages, 8 Figures, 3 Tables. Version accepted at JHEP. Minor
changes. Added figur
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