Complementary pain intervention pilot study in the acute hospitalization phase after lower extremity amputation surgery

Complementary pain intervention pilot study in the acute hospitalization phase after lower extremity amputation surgery. The national prevalence of limb loss is approximately 1.7 million people. Leading causes of this type of loss are diabetes and peripheral vascular disease. Diabetics are more likely than non-diabetics to have an amputation. Sixty percent of non-traumatic amputations occur in diabetics. Although preventive care measures are improving for diabetics, the epidemiological rate of increase in diabetes will continue over the next thirty years. The rate increase is projected to have an equal increase in the amputation rate. Along with amputation, comes a pain sequela that becomes chronic in nature. Pain management after amputation requires a specific regimen of pain control for the amputee. Primary pain management in the acute hospitalization phase focuses on pharmacologic management. To date, no studies have examined a complementary intervention along with pharmacologic measures immediately after surgery. The purpose of this study was to investigate the feasibility and efficacy of a desensitization protocol in the immediate postoperative period for patients who had a major lower limb amputation, along with the impact of demographic factors, clinical factors and treatment fidelity on pain level, use of pain medication, anxiety and depression. Roy's Adaptation Theory and Melzack's Neuromatrix Theory of Pain provide the framework for this study. Using a prospective repeated measure design with convenience sampling, data was collected from twelve patients after lower limb amputation surgery in a large medical facility in the southeastern United States. This study found that in the acute hospital setting after amputation surgery continuous, intermittent and neuropathic pain is present. Total pain intensity mean scores decreased during repeated measurement periods for each pain type. Several correlations were noted in this study. Continuous pain and intermittent pain showed a significant correlation during all time periods of the study. By the last day of the study, present pain, SF-MPQ-2 total score, continuous pain, intermittent pain and neuropathic pain showed a strong correlation with medication dosing. A number of other strong correlations were noted among the measures. Feasibility of the desensitization protocol showed that all participants felt the protocol was easy to use. The majority felt it helped their pain. During self-administration of desensitization the participants recorded each intervention with a numerical pain score before and after intervention. During postoperative days two through five, a large effect size was noted in paired comparisons of pain for each day that reached statistical significance. This study supports previous studies that multiple types of pain are present after amputation surgery. Overall, pain intensity scores decreased during the study. Desensitization was supported as being feasible and efficacious as a complementary therapy for this sample. Nurses provide pain control measures to patients daily. Finding ways to modulate the pain using self-administer techniques such as used in this study provides improved patient outcomes. Further studies need to be conducted in a larger sample on complementary pain measuresPh.D

Factors Associated with Myocardial Infarction Reoccurrence

BACKGROUND: As recurrent myocardial infarctions (MIR) constitute almost a third of the annual MIs, identifying traditional and novel variables related to MIR is important. OBJECTIVE: The aim of this study was to examine modifiable cardiac risks, adiposity, symptoms associated with inflammation (fatigue, depression, sleep) and inflammatory cytokines and MIR by sex and race. METHODS: Using a cross sectional descriptive design, we recruited a convenience sample of adults (N =156) discharged with first MI or had MIR in the last 3 to 7 years. Surveys measured demographics, cardiac risk factors, depression, sleep, and fatigue. Anthropometric measures and cytokines TNFα, IL-6, and hsCRP were obtained. A maximum likelihood regression was calculated to predict MIR. RESULTS: The sample included 57% men and 30% Black participants, and the mean age was 65 years (SD = 12). The hsCRP was the only cytokine related to symptoms: fatigue (r= .309, p < .001) and depression (r = .255, p = .002). An MIR was not associated with race despite White participants reporting better sleep (t = −3.25 (146), p = .002), lower BMI (t = −3.49 (154), p = .001), and fewer modifiable risk factors (t = −2.05 (152), p = .04). An MIR was associated with being male, higher hsCRP and TNFα levels (p < .001), and higher inflammatory symptoms of fatigue (p = .04), depression (p = .01) and poor sleep (p < .001). CONCLUSION: Further examination of biomarkers to understand the mechanisms associated with inflammatory symptoms of fatigue, depression, and poor sleep and MIR is needed

A Pilot Study Investigating the Relationship Between Heart Rate Variability and Blood Pressure in Young Adults at Risk for Cardiovascular Disease

BACKGROUND: Cardiovascular disease is one of the leading causes of death globally with hypertension being a primary cause of premature death from this disease process. Individuals with a family history of cardiovascular disease and hypertension are at a greater risk for developing the same sequela. Autonomic cardiac control is important in the level of cardiac function. One intervention that is effective in improving cardiovascular function is heart rate variability biofeedback training. The purpose of our study was to determine the effectiveness of heart rate biofeedback training on HRV and blood pressure in individuals with a family history of cardiovascular disease. METHODS: Thirty-four participants (76.5% female, 22.7 ± 4.3 years) completed a baseline assessment and training using an established short-term HRV protocol followed by two weeks of at-home paced breathing employing a smartphone application. The participants were then reassessed in a biofeedback clinic. RESULTS: The participants physiological measures showed a significant increase in means between pre and post intervention of SDNN (t (32) = 2.177, p =.037) and TP, (t (32) = 2.327 p = .026). Correlation noted a medium effect on diastolic blood pressure and high frequency heart rate variability, F, r = .41, n =33, p < .05. A multiple regression with all predictor variables in the model found no significance with diastolic and systolic blood pressure. CONCLUSIONS: The findings from this pilot study demonstrated that a two-week paced breathing intervention may assist in reducing heart rate and diastolic blood pressure while improving heart rate variability. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40885-021-00185-z

Factors Associated with Discharge to a Skilled Nursing Facility after Transcatheter Aortic Valve Replacement Surgery

An assumption regarding transcatheter aortic valve replacement (TAVR), a minimally invasive procedure for treating aortic stenosis, is that patients remain at, or near baseline and soon return to their presurgical home to resume activities of daily living. However, this does not consistently occur. The purpose of this study was to identify preoperative factors that optimally predict discharge to a skilled nursing facility (SNF) after TAVR. Delineation of these conditions is an important step in developing a risk stratification model to assist in making informed decisions. Data was extracted from the American College of Cardiology (ACC) transcatheter valve therapy (TVT) registry and the Society of Thoracic Surgeons (STS) database on 285 patients discharged from 2012–2017 at a tertiary referral heart institute located in the southeastern region of the United States. An analysis of assessment, clinical and demographic variables was used to estimate relative risk (RR) of discharge to a SNF. The majority of participants were female (55%) and white (84%), with a median age of 82 years (interquartile range = 9). Approximately 27% (n = 77) were discharged to a SNF. Age > 75 years (RR = 2.3, p = 0.0026), female (RR = 1.6, p = 0.019), 5-meter walk test (5MWT) >7 s (RR = 2.0, p = 0.0002) and not using home oxygen (RR = 2.9, p = 0.0084) were identified as independent predictive factors for discharge to a SNF. We report a parsimonious risk-stratification model that estimates the probability of being discharged to a SNF following TAVR. Our findings will facilitate making informed treatment decisions regarding this older patient population

All blood, No stool: enterohemorrhagic Escherichia coli O157:H7 infection

Enterohemorrhagic Escherichia coli serotype O157:H7 is a pathotype of diarrheagenic E. coli that produces one or more Shiga toxins, forms a characteristic histopathology described as attaching and effacing lesions, and possesses the large virulence plasmid pO157. The bacterium is recognized worldwide, especially in developed countries, as an emerging food-borne bacterial pathogen, which causes disease in humans and in some animals. Healthy cattle are the principal and natural reservoir of E. coli O157:H7, and most disease outbreaks are, therefore, due to consumption of fecally contaminated bovine foods or dairy products. In this review, we provide a general overview of E. coli O157:H7 infection, especially focusing on the bacterial characteristics rather than on the host responses during infection

The steel–concrete interface

Although the steel–concrete interface (SCI) is widely recognized to influence the durability of reinforced concrete, a systematic overview and detailed documentation of the various aspects of the SCI are lacking. In this paper, we compiled a comprehensive list of possible local characteristics at the SCI and reviewed available information regarding their properties as well as their occurrence in engineering structures and in the laboratory. Given the complexity of the SCI, we suggested a systematic approach to describe it in terms of local characteristics and their physical and chemical properties. It was found that the SCI exhibits significant spatial inhomogeneity along and around as well as perpendicular to the reinforcing steel. The SCI can differ strongly between different engineering structures and also between different members within a structure; particular differences are expected between structures built before and after the 1970/1980s. A single SCI representing all on-site conditions does not exist. Additionally, SCIs in common laboratory-made specimens exhibit significant differences compared to engineering structures. Thus, results from laboratory studies and from practical experience should be applied to engineering structures with caution. Finally, recommendations for further research are made

Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England:results from the Bug Watch community cohort study

Background: Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye). Methods: Bug Watch was an online prospective community cohort study of the general population in England (2018–2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity. Results: The cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe. Conclusions: Most people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population