Shared Decision-Making in Acute Pain Services.

PURPOSE OF REVIEW The implementation of shared decision-making (SDM) in acute pain services (APS) is still in its infancies especially when compared to other medical fields. RECENT FINDINGS Emerging evidence fosters the value of SDM in various acute care settings. We provide an overview of general SDM practices and possible advantages of incorporating such concepts in APS, point out barriers to SDM in this setting, present common patient decisions aids developed for APS and discuss opportunities for further development. Especially in the APS setting, patient-centred care is a key component for optimal patient outcome. SDM could be included into everyday clinical practice by using structured approaches such as the "seek, help, assess, reach, evaluate" (SHARE) approach, the 3 "MAking Good decisions In Collaboration"(MAGIC) questions, the "Benefits, Risks, Alternatives and doing Nothing"(BRAN) tool or the "the multifocal approach to sharing in shared decision-making"(MAPPIN'SDM) as guidance for participatory decision-making. Such tools aid in the development of a patient-clinician relationship beyond discharge after immediate relief of acute pain has been accomplished. Research addressing patient decision aids and their impact on patient-reported outcomes regarding shared decision-making, organizational barriers and new developments such as remote shared decision-making is needed to advance participatory decision-making in acute pain services

Studying How Health Literacy Influences Attention during Online Information Seeking

Health literacy affects how people understand health information and, therefore, should be considered by search engines in health searches. In this work, we analyze how the level of health literacy is related to the eye movements of users searching the web for health information. We performed a user study with 30 participants that were asked to search online in the context of three work task situations defined by the authors. Their eye interactions with the Search Results Page and the Result Pages were logged using an eye-tracker and later analyzed. When searching online for health information, people with adequate health literacy spend more time and have more fixations on Search Result Pages. In this type of page, they also pay more attention to the results' hyperlink and snippet and click in more results too. In Result Pages, adequate health literacy users spend more time analyzing textual content than people with lower health literacy. We found statistical differences in terms of clicks, fixations, and time spent that could be used as a starting point for further research. That we know of, this is the first work to use an eye-tracker to explore how users with different health literacy search online for health-related information. As traditional instruments are too intrusive to be used by search engines, an automatic prediction of health literacy would be very useful for this type of system

Prospective, randomized, double-blind trial to investigate the efficacy and safety of corneal cross-linking to halt the progression of keratoconus

Background: Corneal cross-linking is widely used to treat keratoconus. However, to date, only limited data from randomized trials support its efficacy. Methods: The efficacy and safety of corneal cross-linking for halting progression of keratoconus were investigated in a prospective, randomized, blinded, placebo controlled, multicentre trial. Twenty-nine keratoconus patients were randomized in three trial centres. The mean age at inclusion was 28 years. Longitudinal changes in corneal refraction were assessed by linear regression. The best corrected visual acuity, surface defects and corneal inflammation were also assessed. These data were analysed with a multifactorial linear regression model. Results: A total of 15 eyes were randomized to the treatment and 14 to the control group. Follow-up averaged 1098 days. Corneal refractive power decreased on average (+/-standard deviation) by 0.35 +/- 0.58 dioptres/year in the treatment group. The controls showed an increase of 0.11 +/- 0.61 dioptres/year. This difference was statistically significant (p = 0.02). Conclusions: Our data suggest that corneal cross-linking is an effective treatment for some patients to halt the progression of keratoconus. However, some of the treated patients still progressed, whereas some untreated controls improved. Therefore, further investigations are necessary to decide which patients require treatment and which do not

Review of Large Carnivore Conservation: Integrating Science and Policy in the North American West

The management and conservation of large carnivores is of worldwide concern and is as much about human values, interactions, and governance as carnivore biology. Susan Clark and Murray Rutherford continue their work on coexisting with large carnivores ( Clark et al. 2005 ) with a new edited volume Large Carnivore Conservation: Integrating Science and Policy in the North American West . Large Carnivore Conservation that expands on the same themes as their previous work with case studies from Arizona to the Yukon. While focusing on the North American West, Clark and Rutherford hope to provide a holistic approach to carnivore management in general

Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery

Using functional MRI (fMRI) we investigated 13 upper limb amputees with phantom limb pain (PLP) during hand and lip movement, before and after intensive 6-week training in mental imagery. Prior to training, activation elicited during lip purse showed evidence of cortical reorganization of motor (M1) and somatosensory (S1) cortices, expanding from lip area to hand area, which correlated with pain scores. In addition, during imagined movement of the phantom hand, and executed movement of the intact hand, group maps demonstrated activation not only in bilateral M1 and S1 hand area, but also lip area, showing a two-way process of reorganization. In healthy participants, activation during lip purse and imagined and executed movement of the non-dominant hand was confined to the respective cortical representation areas only. Following training, patients reported a significant reduction in intensity and unpleasantness of constant pain and exacerbations, with a corresponding elimination of cortical reorganization. Post hoc analyses showed that intensity of constant pain, but not exacerbations, correlated with reduction in cortical reorganization. The results of this study add to our current understanding of the pathophysiology of PLP, underlining the reversibility of neuroplastic changes in this patient population while offering a novel, simple method of pain relief

Mechanical properties and thermal expansion behaviour in leucite containing materials

The effect of a change in sodium content and thermal history on a leucite composition material produced by a coprecipitation process was studied. Five materials with formulae of (K( 1− x ),Na x ) 2 O-Al 2 O 3 -4SiO 2 ( x = 0.0, 0.2, 0.4, 0.6, 0.8) were investigated for differences in phases, thermal expansion, and strength. Strengths of up to 175 MPa were obtained for a leucite composition material ( x = 0.0). Sodium was effective in lowering the thermal expansion coefficients of these materials. Leucite was linked to higher flexural strengths, but was present only in those specimens which were sintered at 1200 °C. Leucite was not present in those specimens sintered at 1100 °C or lower. Porosity was present in all specimens sintered at 1000 °C or higher.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44726/1/10853_2004_Article_BF00356582.pd