AIM To assess the role of narrow band ultraviolet B(UVB) as a treatment option in peritoneal dialysis patients with refractory uremic pruritus.METHODS In this retrospective study, 29 adult patients with end stage rena...AIM To assess the role of narrow band ultraviolet B(UVB) as a treatment option in peritoneal dialysis patients with refractory uremic pruritus.METHODS In this retrospective study, 29 adult patients with end stage renal failure on peritoneal dialysis, and who had refractory uremic pruritus, were given narrow band UVB radiation as an add-on therapy to standard care for a duration of 12 wk. The response to the pruritus was assessed both weekly and at the end of the study period using a visual analogue score(VAS).RESULTS The average VAS score at the end of the study was 3.14 ± 1.59, which was significant compared to the baseline value of 7.75 ± 1.02(P < 0.05). Improvements in symptoms were noted in 19 out of 21(90.4%) patients. However, relapse occurred in six out of the 19 patients who responded. The dropout rate was high during the study period(33.3%).CONCLUSION Narrow band UVB is effective as an add-on therapy in peritoneal dialysis patients with refractory uremic pruritus. However, the present regime is cumbersome and patient compliance is poor.展开更多
BACKGROUND:Pain in the emergency department(ED)is common but undertreated.The objective of this study was to examine the efficacy and safety of intranasal(IN)ketamine used as an analgesic for patients with acute injur...BACKGROUND:Pain in the emergency department(ED)is common but undertreated.The objective of this study was to examine the efficacy and safety of intranasal(IN)ketamine used as an analgesic for patients with acute injury with moderate to severe pain.METHODS:This study was a cross sectional,observational study of patients more than 8 years old experiencing moderate to severe pain[visual analog score(VAS)>50 mm].The initial dose of IN ketamine was 0.7 mg/kg with an additional dose of 0.3 mg/kg if VAS was more than 50 mm after 15minutes.Pain scores and vital signs were recorded at 0,15,30 and 60 minutes.Side-effects,sedation level and patient's satisfaction were also recorded.The primary outcome was the number of patients achieving≥20 mm reductions in VAS at 15 minutes.Other secondary outcome measures were median reduction in VAS at 15,30 and 60 minutes,changes of vital signs,adverse events,satisfaction of patients,and need for additional ketamine.RESULTS:Thirty-four patients with a median age of 29.5 years(IQR 17.5–38)were enrolled,and they had an initial median VAS of 80 mm(IQR 67–90).The VAS decreased more than 20 mm at15 minutes in 27(80%)patients.The reduction of VAS from baseline to 40 mm(IQR 20–40),20 mm(IQR 14–20)and 20 mm(IQR 10–20)respectively at 15,30 and 60 minutes(P<0.001).No critical changes of vital signs were noted and adverse effects were mild and transient.CONCLUSION:This study showed that IN ketamine is an analgesic choice for patients with acute injury in moderate to severe pain in an overcrowded and resource limited ED.展开更多
Aim: To evaluate the effect of epidural analgesia during labour on neonatal-maternal outcomes. Methods: A retrospective cohort study of nulliparous parturients who gave birth in Vasternorrland County, Sweden, over a 2...Aim: To evaluate the effect of epidural analgesia during labour on neonatal-maternal outcomes. Methods: A retrospective cohort study of nulliparous parturients who gave birth in Vasternorrland County, Sweden, over a 2-year period between 2015 and 2016. Neonatal outcomes (Apgar score at 5 min and umbilical cord arterial blood gases), maternal outcomes (perineal injury, total bleeding volume and maternal satisfaction with birth) and labour parameters (mode of delivery and the durations of labour and postpartum hospital stay) were evaluated. Results: The study cohort consisted of 1449 women with singleton pregnancies. Patients were divided into two groups according to whether during labour they were administered epidural analgesia using bupivacaine and sufentanil (EDA group, n = 615) or not (non-EDA group, n = 834). The rate of assisted vaginal delivery was significantly higher in the EDA group than in the non-EDA group (15.6% and 11.3%, respectively, p < 0.05), whereas the rates of caesarean section were similar. The duration of the active phase of labour was significantly longer in the EDA group than in the non-EDA group (489 ± 217 min versus 371 ± 210 min, respectively, p < 0.001). The Apgar score at 5 min and umbilical cord blood pH were lower and the base deficit greater in the EDA group (p < 0.001, p < 0.001 and p < 0.01, respectively). Bleeding volume was similar between the groups after adjusting for gestational age. Women in the EDA group were more satisfied with their labour experience, as measured by the visual analogue scale (p Conclusion: The results of this study suggest that EDA affects delivery and neonatal-maternal outcomes negatively, but increases the mother’s satisfaction with labour.展开更多
Background and Aims:A visual analogue score (VAS),based on application of a visual analogue scale,has been widely used to assess pruritus in clinical studies of patients with cholestatic liver disease.A VAS is a numer...Background and Aims:A visual analogue score (VAS),based on application of a visual analogue scale,has been widely used to assess pruritus in clinical studies of patients with cholestatic liver disease.A VAS is a numerical score of the severity of the perception of pruritus,and,hence,is inherently subjective.The objective of this study was to assessthe reliability of a VAS as an index of pruritus in cholestatic patients.Methods:In 8 patients with chronic pruritus due to primary biliary cholangitis,values for a VAS of pruritus were compared with corresponding measurements of scratching activity,which were generated by a monitoring system specifically designed to quantitate this activity.The relationship between individual values for the VAS and corresponding values for scratching activity during a specific interval immediately preceding the recording of the VAS was examined by determining the Spearman's rank correlation coefficient.Results:The mean Spearman's rank correlation coefficient between individual values for the VAS and corresponding mean values for scratching activity was 0.072;the range of these coefficients was-0.04 to 0.26.A VAS of pruritus is an unreliable index of scratching activity,and,hence,of the pathophysiological process responsible for the pruritus of cholestasis.Conclusion:It is concluded that the use of a VAS as a primary quantitative endpoint in trials of the efficacy of potential therapies for the pruritus of cholestasis may be inappropriate.展开更多
AIM: To evaluate the clinical usefulness of Daikenchuto (DKT) in hepatecomized patients. METHODS: Twenty patients were enrolled with informed consent. Two patients were excluded because of cancelled operations. The re...AIM: To evaluate the clinical usefulness of Daikenchuto (DKT) in hepatecomized patients. METHODS: Twenty patients were enrolled with informed consent. Two patients were excluded because of cancelled operations. The remaining 18 patients were randomly chosen for treatment with DKT alone or combination therapy of DKT and lactulose (n = 9, each group). Data were prospectively collected. Primary end points were Visual Analogue Scale (VAS) score for abdominal bloating, total Gastrointestinal Symptoms Rating Scale (GSRS) score for abdominal symptoms, and GSRS score for abdominal bloating. RESULTS: The VAS score for abdominal bloating and total GSRS score for abdominal symptoms recovered to levels that were not significantly different to preoperative levels by 10 d postoperation. Combination therapy of DKT and lactulose was associated with a significantly poorer outcome in terms of VAS and GSRS scores for abdominal bloating, total GSRS score, and total daily calorie intake, when compared with DKT alone therapy. CONCLUSION: DKT is a potentially effective drug for postoperative management of hepatectomized patients, not only to ameliorate abdominal bloating, but also to promote nutritional support by increasing postoperative dietary intake.展开更多
目的研究针刺联合悬吊运动治疗非特异性下腰痛(nonspecific low back pain,NLBP)的临床效果。方法采用随机数字表法,将2020年3月至2023年1月在湖南中医药大学第一附属医院针灸推拿康复科进行治疗的60例NLBP患者分为观察组、对照组,各30...目的研究针刺联合悬吊运动治疗非特异性下腰痛(nonspecific low back pain,NLBP)的临床效果。方法采用随机数字表法,将2020年3月至2023年1月在湖南中医药大学第一附属医院针灸推拿康复科进行治疗的60例NLBP患者分为观察组、对照组,各30例。两组患者在常规处理的基础上,对照组采用针刺治疗,观察组采用针刺联合悬吊运动治疗,均治疗4周。观察两组患者疼痛视觉模拟评分(visual analogue scale,VAS)、功能障碍问卷(roland morris disability questionnaire,RMDQ)、中医症候积分、肌肉紧张度、生物力学特征、生活质量综合评定问卷(generic quality of life inventory 74,GQOL-74)、生活活动能力(Barthel指数)及疗效。结果治疗后,两组患者VAS、RMDQ评分、中医症候积分、两侧竖脊肌、多裂肌紧张度及腰背屈/伸比值(flexion/extension,F/E)均较治疗前下降(P<0.05),且观察组上述指标均低于对照组(P<0.05);治疗后,两组患者腰背伸状态下峰力矩(peak torque,PT)、平均功率(average power,AP)、GQOL-74及Barthel评分较治疗前升高(P<0.05),且观察组上述指标均高于对照组(P<0.05);经过治疗后,观察组总有效率(93.33%)高于对照组的(73.33%)(P<0.05)。结论单纯针刺和针刺联合悬吊运动在治疗NLBP上均有一定的疗效,可有效缓解患者疼痛,改善竖脊肌、多裂肌主动活动功能,提高生活质量,且针刺结合悬吊运动疗效优于单纯针刺治疗,值得临床推广应用。展开更多
文摘AIM To assess the role of narrow band ultraviolet B(UVB) as a treatment option in peritoneal dialysis patients with refractory uremic pruritus.METHODS In this retrospective study, 29 adult patients with end stage renal failure on peritoneal dialysis, and who had refractory uremic pruritus, were given narrow band UVB radiation as an add-on therapy to standard care for a duration of 12 wk. The response to the pruritus was assessed both weekly and at the end of the study period using a visual analogue score(VAS).RESULTS The average VAS score at the end of the study was 3.14 ± 1.59, which was significant compared to the baseline value of 7.75 ± 1.02(P < 0.05). Improvements in symptoms were noted in 19 out of 21(90.4%) patients. However, relapse occurred in six out of the 19 patients who responded. The dropout rate was high during the study period(33.3%).CONCLUSION Narrow band UVB is effective as an add-on therapy in peritoneal dialysis patients with refractory uremic pruritus. However, the present regime is cumbersome and patient compliance is poor.
文摘BACKGROUND:Pain in the emergency department(ED)is common but undertreated.The objective of this study was to examine the efficacy and safety of intranasal(IN)ketamine used as an analgesic for patients with acute injury with moderate to severe pain.METHODS:This study was a cross sectional,observational study of patients more than 8 years old experiencing moderate to severe pain[visual analog score(VAS)>50 mm].The initial dose of IN ketamine was 0.7 mg/kg with an additional dose of 0.3 mg/kg if VAS was more than 50 mm after 15minutes.Pain scores and vital signs were recorded at 0,15,30 and 60 minutes.Side-effects,sedation level and patient's satisfaction were also recorded.The primary outcome was the number of patients achieving≥20 mm reductions in VAS at 15 minutes.Other secondary outcome measures were median reduction in VAS at 15,30 and 60 minutes,changes of vital signs,adverse events,satisfaction of patients,and need for additional ketamine.RESULTS:Thirty-four patients with a median age of 29.5 years(IQR 17.5–38)were enrolled,and they had an initial median VAS of 80 mm(IQR 67–90).The VAS decreased more than 20 mm at15 minutes in 27(80%)patients.The reduction of VAS from baseline to 40 mm(IQR 20–40),20 mm(IQR 14–20)and 20 mm(IQR 10–20)respectively at 15,30 and 60 minutes(P<0.001).No critical changes of vital signs were noted and adverse effects were mild and transient.CONCLUSION:This study showed that IN ketamine is an analgesic choice for patients with acute injury in moderate to severe pain in an overcrowded and resource limited ED.
基金This work was supported by a grant from Sveriges Kommuner och Landsting(SKL-medel).
文摘Aim: To evaluate the effect of epidural analgesia during labour on neonatal-maternal outcomes. Methods: A retrospective cohort study of nulliparous parturients who gave birth in Vasternorrland County, Sweden, over a 2-year period between 2015 and 2016. Neonatal outcomes (Apgar score at 5 min and umbilical cord arterial blood gases), maternal outcomes (perineal injury, total bleeding volume and maternal satisfaction with birth) and labour parameters (mode of delivery and the durations of labour and postpartum hospital stay) were evaluated. Results: The study cohort consisted of 1449 women with singleton pregnancies. Patients were divided into two groups according to whether during labour they were administered epidural analgesia using bupivacaine and sufentanil (EDA group, n = 615) or not (non-EDA group, n = 834). The rate of assisted vaginal delivery was significantly higher in the EDA group than in the non-EDA group (15.6% and 11.3%, respectively, p < 0.05), whereas the rates of caesarean section were similar. The duration of the active phase of labour was significantly longer in the EDA group than in the non-EDA group (489 ± 217 min versus 371 ± 210 min, respectively, p < 0.001). The Apgar score at 5 min and umbilical cord blood pH were lower and the base deficit greater in the EDA group (p < 0.001, p < 0.001 and p < 0.01, respectively). Bleeding volume was similar between the groups after adjusting for gestational age. Women in the EDA group were more satisfied with their labour experience, as measured by the visual analogue scale (p Conclusion: The results of this study suggest that EDA affects delivery and neonatal-maternal outcomes negatively, but increases the mother’s satisfaction with labour.
文摘Background and Aims:A visual analogue score (VAS),based on application of a visual analogue scale,has been widely used to assess pruritus in clinical studies of patients with cholestatic liver disease.A VAS is a numerical score of the severity of the perception of pruritus,and,hence,is inherently subjective.The objective of this study was to assessthe reliability of a VAS as an index of pruritus in cholestatic patients.Methods:In 8 patients with chronic pruritus due to primary biliary cholangitis,values for a VAS of pruritus were compared with corresponding measurements of scratching activity,which were generated by a monitoring system specifically designed to quantitate this activity.The relationship between individual values for the VAS and corresponding values for scratching activity during a specific interval immediately preceding the recording of the VAS was examined by determining the Spearman's rank correlation coefficient.Results:The mean Spearman's rank correlation coefficient between individual values for the VAS and corresponding mean values for scratching activity was 0.072;the range of these coefficients was-0.04 to 0.26.A VAS of pruritus is an unreliable index of scratching activity,and,hence,of the pathophysiological process responsible for the pruritus of cholestasis.Conclusion:It is concluded that the use of a VAS as a primary quantitative endpoint in trials of the efficacy of potential therapies for the pruritus of cholestasis may be inappropriate.
基金Supported by Grant from Tsumura and Co, the pharmaceutical company
文摘AIM: To evaluate the clinical usefulness of Daikenchuto (DKT) in hepatecomized patients. METHODS: Twenty patients were enrolled with informed consent. Two patients were excluded because of cancelled operations. The remaining 18 patients were randomly chosen for treatment with DKT alone or combination therapy of DKT and lactulose (n = 9, each group). Data were prospectively collected. Primary end points were Visual Analogue Scale (VAS) score for abdominal bloating, total Gastrointestinal Symptoms Rating Scale (GSRS) score for abdominal symptoms, and GSRS score for abdominal bloating. RESULTS: The VAS score for abdominal bloating and total GSRS score for abdominal symptoms recovered to levels that were not significantly different to preoperative levels by 10 d postoperation. Combination therapy of DKT and lactulose was associated with a significantly poorer outcome in terms of VAS and GSRS scores for abdominal bloating, total GSRS score, and total daily calorie intake, when compared with DKT alone therapy. CONCLUSION: DKT is a potentially effective drug for postoperative management of hepatectomized patients, not only to ameliorate abdominal bloating, but also to promote nutritional support by increasing postoperative dietary intake.
