Meaningful cut-off pain intensity for breakthrough pain changes in advanced cancer patients

Abstract OBJECTIVES: To assess the level of pain intensity at which patients feel the impetus to ask for a breakthrough cancer pain (BTcP) medication, and level of pain intensity at which patients consider they have achieved acceptable pain control after receiving a BTcP medication. METHODS: A consecutive sample of patients who were receiving oral morphine equivalents equal to or more than 60\u2009mg daily, and were prescribed rapid onset opioids for the management of episodes of BTcP, were included in the study. Focused educational activities regarding BTcP and numerical scales were established during hospital admission. At discharge patients were interviewed to find out what was the pain intensity level which gave the impetus to take the BTcP medication, what was the pain intensity for acceptable pain control after a BTcP medication had been given, and which factors prevented the patient calling for BTcP medication. A brief COPE (coping orientation to problems experienced) questionnaire was also administered. RESULTS: Fifty-two patients were recruited for this study. The meaningful pain intensity for asking for a BTcP medication was 7.1; 77% of patients had a pain intensity of 7-8 on a numerical scale of 0-10. The meaningful pain intensity for adequate analgesia after a BTcP medication was 3.5. Similarly, 77% of patients had a pain intensity of 3-4. There was no relationship with the variables examined. Concerns by patients about the use of BTcP medications were minimal. CONCLUSION: The meaningful BTcP intensity and pain intensity expected after BTcP medication can be useful in selecting patients in studies of BTcP. The principal limitation of this study was the specific setting of an acute unit with specific features and the relatively low number of patients. This observation should be followed up by further surveys with a larger number of patients and different settings

Carotid Ultrasound Boundary Study (CUBS): An Open Multicenter Analysis of Computerized Intima–Media Thickness Measurement Systems and Their Clinical Impact

Common carotid intima–media thickness (CIMT) is a commonly used marker for atherosclerosis and is often computed in carotid ultrasound images. An analysis of different computerized techniques for CIMT measurement and their clinical impacts on the same patient data set is lacking. Here we compared and assessed five computerized CIMT algorithms against three expert analysts’ manual measurements on a data set of 1088 patients from two centers. Inter- and intra-observer variability was assessed, and the computerized CIMT values were compared with those manually obtained. The CIMT measurements were used to assess the correlation with clinical parameters, cardiovascular event prediction through a generalized linear model and the Kaplan–Meier hazard ratio. CIMT measurements obtained with a skilled analyst's segmentation and the computerized segmentation were comparable in statistical analyses, suggesting they can be used interchangeably for CIMT quantification and clinical outcome investigation. To facilitate future studies, the entire data set used is made publicly available for the community at http://dx.doi.org/10.17632/fpv535fss7.1

Assessment of acute myocardial infarction: current status and recommendations from the North American society for cardiovascular imaging and the European society of cardiac radiology

There are a number of imaging tests that are used in the setting of acute myocardial infarction and acute coronary syndrome. Each has their strengths and limitations. Experts from the European Society of Cardiac Radiology and the North American Society for Cardiovascular Imaging together with other prominent imagers reviewed the literature. It is clear that there is a definite role for imaging in these patients. While comparative accuracy, convenience and cost have largely guided test decisions in the past, the introduction of newer tests is being held to a higher standard which compares patient outcomes. Multicenter randomized comparative effectiveness trials with outcome measures are required

Mitochondrial DNA polymorphism analyzed by restriction endonucleases in two sardinian populations

Polymorphism of mitochondrial DNA by means of restriction endonucleases analysis has been studied in two sardinian isolates, formerly subjected to different selective pressure due to malaria. The mitochondrial DNA haplotype frequencies differ significantly between the two villages. An evaluation of variability through Wahlund variance analysis rules out selective factors and suggests drift

Polimorfismo genetico mitocondriale in popolazioni sarde esposte a differente pressione selettiva malarica

Studio dei polimorfismi del DNA mitocondriale analizzati mediante enzimi di restrizione, in relazione alla suscettibilit\ue0 all'infezione malarica. Sono state individuate numerose differenze statisticamente significative tra gli individui provenienti da isolati sardi di montagna (non soggetti ad infezione malarica) rispetto a quelli di pianura (soggetti all'infezione. Tuttavia l'analisi della varianza secondo Wahlund ha dimostrato che le differenze sono dipendenti da deriva genetica