Pub Date : 2018-11-15DOI: 10.15226/2374-684X/5/2/00162
T. Oleson
An international gathering of world experts in the field of auricular acupuncture met in Singapore in August of 2017 to present the most recent research and clinical findings in this domain of alternative health care. Opening sessions summarized the neurophysiological research that has highlighted the importance of auricular portions of the vagus nerve in understanding the basis for both physiological and clinical benefits that have been observed with auriculotherapy. The alleviation of multiple medical symptoms by transcutaneous auricular vagus nerve stimulation was featured in several studies. Evaluation of recent journal articles in both China and in the West has provided continued support for the clinical benefits of auricular acupuncture. Randomized controlled trials have shown statistically significant improvements in chronic pain, osteoarthritis, post-stroke syndrome, and drug abuse disorders. Active ear points related to body pathology have been observed in newborn infants as well as adults. As such international symposiums often conclude, continued research to further evaluate the advanced application of auriculotherapy is an essential goal Received: July 3
{"title":"Progress in Clinical Applications of Auricular Acupuncture at the International Symposium on Auriculotherapy Held in Singapore","authors":"T. Oleson","doi":"10.15226/2374-684X/5/2/00162","DOIUrl":"https://doi.org/10.15226/2374-684X/5/2/00162","url":null,"abstract":"An international gathering of world experts in the field of auricular acupuncture met in Singapore in August of 2017 to present the most recent research and clinical findings in this domain of alternative health care. Opening sessions summarized the neurophysiological research that has highlighted the importance of auricular portions of the vagus nerve in understanding the basis for both physiological and clinical benefits that have been observed with auriculotherapy. The alleviation of multiple medical symptoms by transcutaneous auricular vagus nerve stimulation was featured in several studies. Evaluation of recent journal articles in both China and in the West has provided continued support for the clinical benefits of auricular acupuncture. Randomized controlled trials have shown statistically significant improvements in chronic pain, osteoarthritis, post-stroke syndrome, and drug abuse disorders. Active ear points related to body pathology have been observed in newborn infants as well as adults. As such international symposiums often conclude, continued research to further evaluate the advanced application of auriculotherapy is an essential goal Received: July 3","PeriodicalId":74840,"journal":{"name":"SOJ anesthesiology & pain management","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42764058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-14DOI: 10.15226/2374-684X/5/2/00161
G. Duarte, Paulo Fernando Azuaga Gaona, HéctorFabián Meza Vera, Edgar Walter LópezSamaniego
Introduction: Anesthetic therapies in neonatal patients with Myelomeningocele and Macrocephaly have important points to keep in mind. Myelomeningocele (MMC) represents the most severe form of spinal dysraphism. Early surgical treatment was associated with a lower rate of complications. Report: Neonatal term patient, suitable for gestational age, with diagnoses of lumbo-sacral myelomeningocele, bilateral bot foot, Macrocephaly and pyelocalic dilatations in both kidneys. Conclusions: Anesthesia of the patient with multiple malformations poses an anesthetic challenge. The neurological deficit can be minimized through careful attention to the preoperative evaluation, good surgical technique, good hemodynamic control and the subsequent control of a multidisciplinary team to be attentive to complications that may present.
{"title":"Anesthetic Management in Neonatal Pediatric Patients with Myelomeningocele and Macrocephaly","authors":"G. Duarte, Paulo Fernando Azuaga Gaona, HéctorFabián Meza Vera, Edgar Walter LópezSamaniego","doi":"10.15226/2374-684X/5/2/00161","DOIUrl":"https://doi.org/10.15226/2374-684X/5/2/00161","url":null,"abstract":"Introduction: Anesthetic therapies in neonatal patients with Myelomeningocele and Macrocephaly have important points to keep in mind. Myelomeningocele (MMC) represents the most severe form of spinal dysraphism. Early surgical treatment was associated with a lower rate of complications. Report: Neonatal term patient, suitable for gestational age, with diagnoses of lumbo-sacral myelomeningocele, bilateral bot foot, Macrocephaly and pyelocalic dilatations in both kidneys. Conclusions: Anesthesia of the patient with multiple malformations poses an anesthetic challenge. The neurological deficit can be minimized through careful attention to the preoperative evaluation, good surgical technique, good hemodynamic control and the subsequent control of a multidisciplinary team to be attentive to complications that may present.","PeriodicalId":74840,"journal":{"name":"SOJ anesthesiology & pain management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47641640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-03DOI: 10.15226/2374-684x/5/2/00160
A. B. Fernández
Children with Autism Spectrum Disorder (ASD) are a heterogeneous group and often need general anesthesia for different procedures and studies. They present with abnormal development in social interaction, communication and sterotyped patterns of behavior and may be more prone to elevated perioperative anxiety. Familiarity with each patient’s behavioral specifics and efforts to alleviate stress is of paramount importance for a smooth perioperative course with minimal events. The perioperative experience for these patients is complex and presents a unique challenge for clinicians. The main targets of these patients are rapid recovery, smooth postoperative pain, early discharge and low stress during the peroperative period [1]. There appears to be little literature in paediatric anaesthetic practice relevant to children suffering with autism. Recent findings suggest a need for rigorous study of the potential problems that autistic children may have when undergoing an anaesthetic.
{"title":"Endovenous Dexmedetomidine in Pediatric Patient with Autism Spectrum Disorder Undergoing General Anesthesia","authors":"A. B. Fernández","doi":"10.15226/2374-684x/5/2/00160","DOIUrl":"https://doi.org/10.15226/2374-684x/5/2/00160","url":null,"abstract":"Children with Autism Spectrum Disorder (ASD) are a heterogeneous group and often need general anesthesia for different procedures and studies. They present with abnormal development in social interaction, communication and sterotyped patterns of behavior and may be more prone to elevated perioperative anxiety. Familiarity with each patient’s behavioral specifics and efforts to alleviate stress is of paramount importance for a smooth perioperative course with minimal events. The perioperative experience for these patients is complex and presents a unique challenge for clinicians. The main targets of these patients are rapid recovery, smooth postoperative pain, early discharge and low stress during the peroperative period [1]. There appears to be little literature in paediatric anaesthetic practice relevant to children suffering with autism. Recent findings suggest a need for rigorous study of the potential problems that autistic children may have when undergoing an anaesthetic.","PeriodicalId":74840,"journal":{"name":"SOJ anesthesiology & pain management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48419186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-04DOI: 10.15226/2374-684x/5/2/00159
R. Elsharkawy, Mohamed Nashaat Mohamed, G. Zakari, M. Othman
Study Objective: This trial was designed to test the benefits of adding dexmedetomidine to bupivacaine if compared with the bupivacainefentanyl mixture in paravertebral block for different renal surgeries. Design: Prospective randomized and double-blinded study. Setting: Operative room and postoperative recovery area. Patients: Fifty patients, ASA physical status I and II, aged above 20 years, scheduled for elective open unilateral renal surgeries (nephrectomy, pyelolithotomy and pyeloplasty). Intervention: Patients were randomly allocated by the computer generated list into 2 equal groups (each group had 25patient). Bupivacaine – dexmedetomidine (BD) group received paravertebral bupivacaine 0.2% + dexmedetomidine 1μ/kg for patient below 65 years and 0.5μ/kg for patient above 65 years in a total volume of 20 ml. Bupivacaine fentanyl (BF) group received paravertebral bupivacaine 0.2% + fentanyl 1μ/kg for patient below 65 years and fentanyl 0.5μ/kg for patient above 65 years in a total volume of 20 ml. Measurements: Pain assessed by VAS, heart rate, mean arterial blood pressure, Spo2, postoperative sedation, postoperative adverse effects, total requirement of opioid and first request for analgesia. Main Results: Post-operative visual analogue score and post– operative sedation score were significantly different between both groups in favor of BD group. No satistical difference between both groups as regard HR mean blood pressure and oxygen saturation. No postoperative adverse effects were recorded. Conclusions: The addition of dexmedetomidine to bupivacaine in paravertebral block provides prolonged postoperative analgesia and better sedation score. Also, the addition of dexmedetomidine leads to a reduction in the usage of postoperative opioid.
{"title":"The Effects of Paravertebral Buipivacaine-Dexmedetomidine Versus Bupivacaine-Fentanyl in Unilateral Open Renal Surgeries","authors":"R. Elsharkawy, Mohamed Nashaat Mohamed, G. Zakari, M. Othman","doi":"10.15226/2374-684x/5/2/00159","DOIUrl":"https://doi.org/10.15226/2374-684x/5/2/00159","url":null,"abstract":"Study Objective: This trial was designed to test the benefits of adding dexmedetomidine to bupivacaine if compared with the bupivacainefentanyl mixture in paravertebral block for different renal surgeries. Design: Prospective randomized and double-blinded study. Setting: Operative room and postoperative recovery area. Patients: Fifty patients, ASA physical status I and II, aged above 20 years, scheduled for elective open unilateral renal surgeries (nephrectomy, pyelolithotomy and pyeloplasty). Intervention: Patients were randomly allocated by the computer generated list into 2 equal groups (each group had 25patient). Bupivacaine – dexmedetomidine (BD) group received paravertebral bupivacaine 0.2% + dexmedetomidine 1μ/kg for patient below 65 years and 0.5μ/kg for patient above 65 years in a total volume of 20 ml. Bupivacaine fentanyl (BF) group received paravertebral bupivacaine 0.2% + fentanyl 1μ/kg for patient below 65 years and fentanyl 0.5μ/kg for patient above 65 years in a total volume of 20 ml. Measurements: Pain assessed by VAS, heart rate, mean arterial blood pressure, Spo2, postoperative sedation, postoperative adverse effects, total requirement of opioid and first request for analgesia. Main Results: Post-operative visual analogue score and post– operative sedation score were significantly different between both groups in favor of BD group. No satistical difference between both groups as regard HR mean blood pressure and oxygen saturation. No postoperative adverse effects were recorded. Conclusions: The addition of dexmedetomidine to bupivacaine in paravertebral block provides prolonged postoperative analgesia and better sedation score. Also, the addition of dexmedetomidine leads to a reduction in the usage of postoperative opioid.","PeriodicalId":74840,"journal":{"name":"SOJ anesthesiology & pain management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43807763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-26DOI: 10.15226/2374-684x/5/2/00158
C. Baumgartner, S. Strobel, A. Hagedorn, S. Ott, H. Kempf, B. Waschulzik, M. Gröger, Sandra Kress, P. Radermacher, H. Potschka
In this two-part study, the potency of two analgesics on nociception was assessed in African Clawed Frogs (ACFs). First, three different Pain Stimuli (PSs) were evaluated in the frogs during Tricaine Methanesulfonate (MS222) anaesthesia. Using the most effective PS from the preliminary study, the analgesic effects of three different doses of fentanyl and butorphanol were examined in frogs under MS222 anaesthesia. Comparing the three different PSs (5% acetic acid onto skin, toe pinch by a clamp and pull on the ovaries), continuous Blood Pressure (BP) and Heart Rate (HR) recordings of the frogs indicated a sharp and reproducible increase in both parameters in response to acetic acid. That result clearly indicated an increased nociception during MS222 anaesthesia. Therefore, MS222 alone does not provide sufficient analgesia for painful interventions in ACFs. From all tested analgesic groups only 5 mg/kg butorphanol showed a short lasting decreased BP and HR response. In contrast, neither lower dosed butorphanol nor fentanyl in general reduced BP and HR response to a PS, only producing considerable side effects on the haemodynamic system. These findings argue against using fentanyl as an analgesic in ACFs. Butorphanol significantly reduced the nociception in the high dose group. However, considering its limited duration of action and potential adverse effects, further analgesics (e.g., ketamine and metamizole) should be evaluated to improve intraoperative analgesia when using MS222 anaesthesia in ACFs.
{"title":"A Comparison Of The Analgesic Effects Of Fentanyl And Butorphanol In African Clawed Frogs (Xenopus laevis) Under Tricaine Methanesulfonate (MS222) Anaesthesia","authors":"C. Baumgartner, S. Strobel, A. Hagedorn, S. Ott, H. Kempf, B. Waschulzik, M. Gröger, Sandra Kress, P. Radermacher, H. Potschka","doi":"10.15226/2374-684x/5/2/00158","DOIUrl":"https://doi.org/10.15226/2374-684x/5/2/00158","url":null,"abstract":"In this two-part study, the potency of two analgesics on nociception was assessed in African Clawed Frogs (ACFs). First, three different Pain Stimuli (PSs) were evaluated in the frogs during Tricaine Methanesulfonate (MS222) anaesthesia. Using the most effective PS from the preliminary study, the analgesic effects of three different doses of fentanyl and butorphanol were examined in frogs under MS222 anaesthesia. Comparing the three different PSs (5% acetic acid onto skin, toe pinch by a clamp and pull on the ovaries), continuous Blood Pressure (BP) and Heart Rate (HR) recordings of the frogs indicated a sharp and reproducible increase in both parameters in response to acetic acid. That result clearly indicated an increased nociception during MS222 anaesthesia. Therefore, MS222 alone does not provide sufficient analgesia for painful interventions in ACFs. From all tested analgesic groups only 5 mg/kg butorphanol showed a short lasting decreased BP and HR response. In contrast, neither lower dosed butorphanol nor fentanyl in general reduced BP and HR response to a PS, only producing considerable side effects on the haemodynamic system. These findings argue against using fentanyl as an analgesic in ACFs. Butorphanol significantly reduced the nociception in the high dose group. However, considering its limited duration of action and potential adverse effects, further analgesics (e.g., ketamine and metamizole) should be evaluated to improve intraoperative analgesia when using MS222 anaesthesia in ACFs.","PeriodicalId":74840,"journal":{"name":"SOJ anesthesiology & pain management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44446480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-11DOI: 10.15226/2374-684x/5/1/00157
E. Hernández, Z. González, R. F. Castro
Toxic Shock Syndrome (TSS) is an uncommon acute systemic disease, in which toxins that cause high morbidity and mortality are produced [1]. An early diagnosis, a rapid surgical debridement of the areas affected and appropriate antibiotics are the only ways to reduce the elevated mortality of this clinical condition [2]. Using this case, it is intended to stress the extreme gravity and importance of an early intervention of the disease, by attempting to limit the sequelae that could occur and thus being able to give a better quality of life to the patients that survive [2].
{"title":"Peritonitis Of Unknown Origin In a Patient With Refractory Shock","authors":"E. Hernández, Z. González, R. F. Castro","doi":"10.15226/2374-684x/5/1/00157","DOIUrl":"https://doi.org/10.15226/2374-684x/5/1/00157","url":null,"abstract":"Toxic Shock Syndrome (TSS) is an uncommon acute systemic disease, in which toxins that cause high morbidity and mortality are produced [1]. An early diagnosis, a rapid surgical debridement of the areas affected and appropriate antibiotics are the only ways to reduce the elevated mortality of this clinical condition [2]. Using this case, it is intended to stress the extreme gravity and importance of an early intervention of the disease, by attempting to limit the sequelae that could occur and thus being able to give a better quality of life to the patients that survive [2].","PeriodicalId":74840,"journal":{"name":"SOJ anesthesiology & pain management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43794431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-04DOI: 10.15226/2374-684x/5/1/00156
M. Sabet, Ziad Tarazi, N. Joshi, B. Zerler, D. Rains, D. Griffith
Background: MDCO-700(cyclopropyl-methoxycarbonyl metomidate) is a novel, potent, positive allosteric modulator of the γ-Aminobutyric Acid type A (GABAA) receptor currently being developed for general anesthesia and procedural sedation. Early studies were conducted with a formulation that had to be stored at frozen conditions. A new formulation was developed to enable storage under refrigerated conditions. The original formulation (MDCO-700-F1) and the new formulation (MDCO-700-F2) were both prepared in Sulfobutyl ether-β-cyclodextrin (Sbeβcd), however MDCO-700-F2 was prepared at a lower concentration and higher pH in order to improve long-term storage stability. The objective of this study was to compare the anesthetic effects of both formulations in male Sprague-Dawley rats. Methods: Rats received doses of either MDCO-700-F1 or MDCO700-F2 ranging from1 to 6 mg/kg. Doses were administered as an intravenous bolus over 5 seconds via surgically implanted jugular vein cannulas. Immediately after the bolus, rats were turned supine and the clinical signs of anesthesia were monitored until they returned to normal behavior. The relationships between dose and the anesthetic effects of MDCO-700 were analyzed and modeledusing pharmacodynamic models. Results: Both formulations rapidly produced similar dosedependent depths of sedation with increasing effect at higher doses. The time required for recovery, as assessed using qualitative and semi-quantitative metrics, increased with increasing dose and was similar for the two formulations. The dose-response for all measured parameters including arousal level, duration of action and full recovery were similar for both formulations. Conclusion: nder the conditions of this study, the data demonstrates that both formulations of MDCO-700 produced equivalent anesthetic effects in rats across the concentration range tested. These results suggest that either formulation can be used for ongoing clinical development.
{"title":"MDCO-700, a New Generation Anesthetic: Evaluation of Two Formulations in Sprague-Dawley Rats","authors":"M. Sabet, Ziad Tarazi, N. Joshi, B. Zerler, D. Rains, D. Griffith","doi":"10.15226/2374-684x/5/1/00156","DOIUrl":"https://doi.org/10.15226/2374-684x/5/1/00156","url":null,"abstract":"Background: MDCO-700(cyclopropyl-methoxycarbonyl metomidate) is a novel, potent, positive allosteric modulator of the γ-Aminobutyric Acid type A (GABAA) receptor currently being developed for general anesthesia and procedural sedation. Early studies were conducted with a formulation that had to be stored at frozen conditions. A new formulation was developed to enable storage under refrigerated conditions. The original formulation (MDCO-700-F1) and the new formulation (MDCO-700-F2) were both prepared in Sulfobutyl ether-β-cyclodextrin (Sbeβcd), however MDCO-700-F2 was prepared at a lower concentration and higher pH in order to improve long-term storage stability. The objective of this study was to compare the anesthetic effects of both formulations in male Sprague-Dawley rats. Methods: Rats received doses of either MDCO-700-F1 or MDCO700-F2 ranging from1 to 6 mg/kg. Doses were administered as an intravenous bolus over 5 seconds via surgically implanted jugular vein cannulas. Immediately after the bolus, rats were turned supine and the clinical signs of anesthesia were monitored until they returned to normal behavior. The relationships between dose and the anesthetic effects of MDCO-700 were analyzed and modeledusing pharmacodynamic models. Results: Both formulations rapidly produced similar dosedependent depths of sedation with increasing effect at higher doses. The time required for recovery, as assessed using qualitative and semi-quantitative metrics, increased with increasing dose and was similar for the two formulations. The dose-response for all measured parameters including arousal level, duration of action and full recovery were similar for both formulations. Conclusion: nder the conditions of this study, the data demonstrates that both formulations of MDCO-700 produced equivalent anesthetic effects in rats across the concentration range tested. These results suggest that either formulation can be used for ongoing clinical development.","PeriodicalId":74840,"journal":{"name":"SOJ anesthesiology & pain management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45827587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-01-01DOI: 10.15226/2374-684X/2/2/00120
Heshan Liu, A. Tan, R. Qin, D. Sargent, A. Grothey, J. Buckner, P. Schaefer, J. Sloan
INTRODUCTION Current standard evaluation of Peripheral Neuropathy (PN) is based on an investigator-reported classification system that is commonly unable to correctly reflect the subjective symptoms for patients. Thus more reliable methods to assess PN are needed. This study assessed alternative methods of assessing patient-reported PN in 5 North Central Cancer Treatment Group (NCCTG) clinical trials. METHOD Two single-item assessments relating to numbness and tingling were used to measure PN. Patients' Quality Of Life (QOL) was also assessed using the Uniscale, Symptom Distress Scale (SDS), Profile of Mood States (POMS), Brief Pain Inventory (BPI) and Subject Global Impression of Change (SGIC). Wilcoxon tests compared QOL scores between patients with PN (score > 50) vs. no PN (score ≤ 50). Changes from baseline in QOL were compared by Wilcoxon rank sum test with a 20-point change in PN defined as clinically meaningful. Both distribution-based and anchor-based approaches were used to derive estimates of Minimal Important Differences (MID). Standardized Response Means (SRM), Effect Sizes (ES) and Guyatt's responsiveness statistic were used to measure responsiveness. RESULTS The proportion of patients reporting numbness (tingling) at baseline was 10.7% (10.0%) and 18.4% (17.8%) at last assessment. The correlation between numbness and tingling at baseline was 0.81, and at last assessment was 0.83. Patients with substantial PN reported an average of 10 points lower overall QOL, mood and worse symptom distress and 20 points lower in the BPI interference items. Patients having a ≤ 20 point worsening in PN score reported significantly worse in symptom distress and BPI worst pain, but not in POMS or overall QOL. The MID estimates were similar between numbness and tingling items but varied depending on the approach used. Responsiveness statistics indicated that the two PN assessments are sensitive and responsive instruments for cancer patients with PN. CONCLUSIONS The two PN items for numbness and tingling were redundant. Evidence of criterion validity and responsiveness indicates that these simple measures of PN can be used successfully in cancer clinical trials.
目前周围神经病变(PN)的标准评估是基于研究者报告的分类系统，通常不能正确反映患者的主观症状。因此，需要更可靠的方法来评估PN。本研究评估了5个中北部癌症治疗组(NCCTG)临床试验中评估患者报告的PN的替代方法。方法采用两项与麻木和刺痛相关的单项评估来测量PN。患者的生活质量(QOL)也通过unscales, Symptom Distress Scale (SDS)， Profile Of Mood States (POMS)， Brief Pain Inventory (BPI) and Subject Global Impression Of Change (SGIC)进行评估。Wilcoxon试验比较有PN(评分为bbb50)和无PN(评分≤50)患者的生活质量评分。通过Wilcoxon秩和检验比较生活质量与基线的变化，并将PN变化20点定义为有临床意义。基于分布的方法和基于锚点的方法都被用来得出最小重要差异(MID)的估计。采用标准化反应方法(SRM)、效应量(ES)和Guyatt反应性统计量来测量反应性。结果基线时报告麻木(刺痛)的比例为10.7%(10.0%)，末次评估时报告麻木(刺痛)的比例为18.4%(17.8%)。基线时麻木感和刺痛感的相关系数为0.81，最终评估值为0.83。严重PN患者报告的总体生活质量、情绪和症状窘迫平均降低10分，BPI干扰项平均降低20分。PN评分恶化≤20分的患者报告的症状窘迫和BPI最严重疼痛明显加重，但POMS或总体生活质量无明显差异。麻木和刺痛项目的MID估计值相似，但根据使用的方法而有所不同。反应性统计表明，这两种PN评估对患有PN的癌症患者是敏感和反应性的工具。结论麻醉和刺痛两个PN项目是多余的。标准效度和反应性的证据表明，这些简单的PN测量方法可以成功地用于癌症临床试验。
{"title":"Comparing and Validating Simple Measures of Patient-Reported Peripheral Neuropathy for Oncology Clinical Trials: NCCTG N0897 (Alliance) A Pooled Analysis of 2440 Patients.","authors":"Heshan Liu, A. Tan, R. Qin, D. Sargent, A. Grothey, J. Buckner, P. Schaefer, J. Sloan","doi":"10.15226/2374-684X/2/2/00120","DOIUrl":"https://doi.org/10.15226/2374-684X/2/2/00120","url":null,"abstract":"INTRODUCTION Current standard evaluation of Peripheral Neuropathy (PN) is based on an investigator-reported classification system that is commonly unable to correctly reflect the subjective symptoms for patients. Thus more reliable methods to assess PN are needed. This study assessed alternative methods of assessing patient-reported PN in 5 North Central Cancer Treatment Group (NCCTG) clinical trials. METHOD Two single-item assessments relating to numbness and tingling were used to measure PN. Patients' Quality Of Life (QOL) was also assessed using the Uniscale, Symptom Distress Scale (SDS), Profile of Mood States (POMS), Brief Pain Inventory (BPI) and Subject Global Impression of Change (SGIC). Wilcoxon tests compared QOL scores between patients with PN (score > 50) vs. no PN (score ≤ 50). Changes from baseline in QOL were compared by Wilcoxon rank sum test with a 20-point change in PN defined as clinically meaningful. Both distribution-based and anchor-based approaches were used to derive estimates of Minimal Important Differences (MID). Standardized Response Means (SRM), Effect Sizes (ES) and Guyatt's responsiveness statistic were used to measure responsiveness. RESULTS The proportion of patients reporting numbness (tingling) at baseline was 10.7% (10.0%) and 18.4% (17.8%) at last assessment. The correlation between numbness and tingling at baseline was 0.81, and at last assessment was 0.83. Patients with substantial PN reported an average of 10 points lower overall QOL, mood and worse symptom distress and 20 points lower in the BPI interference items. Patients having a ≤ 20 point worsening in PN score reported significantly worse in symptom distress and BPI worst pain, but not in POMS or overall QOL. The MID estimates were similar between numbness and tingling items but varied depending on the approach used. Responsiveness statistics indicated that the two PN assessments are sensitive and responsive instruments for cancer patients with PN. CONCLUSIONS The two PN items for numbness and tingling were redundant. Evidence of criterion validity and responsiveness indicates that these simple measures of PN can be used successfully in cancer clinical trials.","PeriodicalId":74840,"journal":{"name":"SOJ anesthesiology & pain management","volume":"2 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67332097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-01-01DOI: 10.15226/2374-684x/1/1/00104
Anahita Dabo Trubelja
Septic shock is characterized by an uncontrolled systemic inflammatory response that contributes to organ dysfunction, failure and eventually death. The importance of the adrenal glands for survival under conditions of physiologic stress has been known since the early 20th century. Clinical studies explored the potential therapeutic role of corticosteroids in the treatment of sepsis and septic shock. Despite controversies on the benefit-to-risk ratio, they are widely used. The longstanding adoption of corticosteroids in the treatment of severe sepsis likely relies on the prompt reversal of septic shock often seen at the bedside. This current review was designed to provide readers with a clear understanding and rationale for using corticosteroids, while presenting a review of the Surviving Sepsis Guidelines and the results from the implementation of the Surviving Sepsis Campaign.
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