Effects of acupuncture treatment on natural killer cell activity,pulse rate,and pain reduction for older adults:an uncontrolled,observational study

OBJECTIVE： The aim of this study was to examine the changes in natural killer （NK） cell activity, pulse rate, and pain intensity among older adults before and after acupuncture treatment. METHODS： Fifty-six individuals （16 males and 40 females）, aged 60 to 82 years （mean age 72.4 ＋ 5.0）, who were experiencing pain in the shoulder, low back, or knee, participated in the study. NK cell activity, leukocyte differentiation （granulocytes and lymphocytes）, pulse rate, and blood pressure values were obtained. Pain intensity was evaluated by using the visual analog scale （VAS）. The Wilcoxon test was used to analyze NK cell activity, leukocytes （granulocyte counts and granulocyte-to-lymphocyte ratio）, and the VAS score in accordance with the location of pain complaints before and after acupuncture treatment. RESULTS： NK cell activity decreased after acupuncture treatment for pain in the shoulder-pain and knee-pain groups. Further, the lymphocyte and granulocyte counts increased after acupuncture treatment for the shoulder-pain group. Pulse rate decreased for the shoulder-pain, low-back- pain, and knee-pain groups after acupuncture treatment. The VAS score decreased after acupuncture treatment for the shoulder-pain, low-back-pain, and knee-pain groups. CONCLUSION： This study showed that in older adults, acupuncture treatment decreases pulse rate, relieves pain in the shoulder, low back, and knee, and reduces NK-cell activity.

Acceptability of an acupuncture intervention for geriatric chronic pain: an open pilot study

OBJECTIVE： This study investigated the acceptability and effectiveness of acupuncture for persistent musculoskeletat pain in the elderly and assessed the conditions for a future controlled trial. METHODS： A total of 60 patients, hospitalized in a geriatric hospital were enrolled. The intervention consisted of eight acupuncture sessions. The main outcome was the patient＇s participation rate. Regarding pain, the evaluation was based on pre- and post-treatment variations. As a high proportion of the patients had cognitive impairment, the behavioral pain scale DOLOPLUS-2 was chosen although self evaluation was used wherever possible. RESULTS： The mean age of the patients was 83 years. The acceptance rate was very high （89.6%） and 90% of the patients completed the entire course of treatment. After five weeks, the mean DOLOPLUS score had decreased significantly （P〈0.01）. The patients reported improved sleep quality and a reduction in their anxiety symptoms. Furthermore, caregivers noticed a decrease in patient aggressiveness making care easier. CONCLUSION： Our results suggest that acupuncture is highly acceptable and could be very useful in the management of chronic pain when performed in very old frail people with chronic physical and mental disability. TRIAL REGISTRATION IDENTIFIER： NCT01043692 ClinicalTrials.gov.

Measuring episodic abdominal pain and disability in suspected sphincter of Oddi dysfunction

AIM:To evaluate the reliability of an instrument that measures disability arising from episodic abdominal pain in patients with suspected sphincter of Oddi dysfunction(SOD).METHODS:Although several treatments have been utilized to reduce pain and associated disability,measurement tools have not been developed to reliably track outcomes.Two pilot studies were conducted to assess test-retest reliability of a newly developed instrument,the recurrent abdominal pain intensity and disability(RAPID) instrument.The RAPID score is a 90-d summation of days where productivity for various daily activities is reduced as a result of abdominal pain episodes,and is modeled after the migraine disability assessment instrument used to measure headache-related disability.RAPID was administered by telephone on 2 consecutive occasions in 2 consenting populations with suspected SOD:a pre-sphincterotomy population(Pilot Ⅰ,n = 55) and a post-sphincterotomy population(Pilot Ⅱ,n = 70).RESULTS:The average RAPID scores for Pilots Ⅰ and Ⅱ were:82 d(median:81.5 d,SD:64 d) and 48 d(median:0 d,SD:91 d),respectively.The concordance between the 2 assessments for both populations was very good:0.81 for the pre-sphincterotomy population and 0.95 for the post-sphincterotomy population.CONCLUSION:The described pilot studies suggest that RAPID is a reliable instrument for measuring disability resulting from abdominal pain in suspected SOD patients.

The Indonesian version of the Premature Infant Pain Profile-Revised:Translation and adaptation of a neonatal pain assessment

Purpose: Pain assessment is a key component of good pain management in hospitalized infants.This study aimed to translate and adapt a version of pain measurement in infants,the Premature Infant Pain Profile Revised (PIPP-R) into Indonesian.Method: The adaptation process of the measuring instrument used a modified Brislin method which included forward translation,back translation 1,group discussion 1,back translation 2,group discussion 2,and pilot testing on neonatal nurses: feasibility test,inter-rater reliability using intraclass correlation (ICC),and internal consistency using Cronbach's α coefficient.Results: The PIPP-R version in English has been translated into Indonesian.In general,nurses assessed this measuring instrument as feasible.The inter-rater reliability showed a high agreement (ICC =0.968,P=0.001) and this measuring instrument had good internal consistency (Cronbach's α=0.856).Conclusion: The Indonesian version of PIPP-R is easy to use and shows good psychometric properties.The use of this measuring instrument will help nurses and researchers obtain accurate infant pain intensity measurement values.

Multidimensional Pain Inventory(MPI):Adaptation to Orthodontic Patients and Its Psychometric Properties

Background: Pain perception may result from orthodontic treatment and should be considered in clinical management. Its assessment should not be limited to the intensity of perceived pain but should also consider the psychosocial and behavioral aspects involved. Objective: The aims of this study were to adapt and validate the Multidimensional Pain Inventory (MPI) for orthodontic patients, and present a proposal to calculate an overall score of the pain-related aspects and compare these scores with the usual methodology used. Methods: Face validity of the MPI was estimated and orthodontic version (MPI-Orthodontic) was developed. Factorial validity was evaluated by confirmatory analysis. Convergent and discriminant validity and reliability were estimated. The fit of Second-Order Hierarchical Models was estimated. Concurrent validity of MPI-Orthodontic was evaluated against the Visual Analogue Scale. Invariance of the factorial models was evaluated for independent samples and according to sex and age. Overall score was calculated using the matrix of regression weights and compared to simple arithmetic mean. Results: 507 individuals (63.3% women;age: 26.32 (SD = 11.70) years) participated. For the fit of Part I (psychosocial aspects) of the MPI-Orthodontic, it added correlation between two items and excluded one item;for Part II (behavioral aspects) two items were excluded. The models presented adequate fit to the sample. Reliability was adequate. MPI-Orthodontic presented invariance for independent samples and adequate concurrent and divergent validity. Score obtained with the simple arithmetic mean was overestimated for Part I and underestimated for Part II. Conclusion: MPI-Orthodontic was valid, reliable and invariant for the evaluation of the orthodontic pain. It is recommended to calculate overall weighted scores for pain assessment.

布地奈德局部应用对扁桃体切除术后反应的影响

扁桃体切除术后疼痛反应历来是耳鼻咽喉科医师面临的较为棘手的问题。疼痛严重者影响睡眠和进食,是影响患者恢复的一个重要因素。布地奈德混悬液是一种非卤化的糖皮质激素,具有糖皮质激素的强大的抗炎作用,减少炎性递质的合成,减少渗出、减轻肿胀、减轻术后咽部疼痛。我科对30例慢性扁桃体炎患者行双侧扁桃体剥离术,对患者的单侧创面进行布地奈德混悬液局部压迫处理,对术后反应情况进行观察。

A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis: a pilot trial

BACKGROUND： An increasingly aging population implies an increasing prevalence of osteoarthritis （OA） of hip or knee. It has been ascertained that unspecific hydrotherapy of OA according to Sebastian Kneipp not only improves the range of mobility but also reduces pain significantly and increases the quality of life of the patients affected. OBJECTIVE： The main aim of this pilot study was to determine the effects of hydrotherapy in comparison to conventional physiotherapy, and to analyze the feasibility of the study design under clinical circumstances. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： The study design is a prospective randomized controlled three-arm clinical pilot trial, carried out at a specialist clinic for integrative medicine. Thirty patients diagnosed with symptomatic OA of hip or knee and radiologic findings were randomly assigned to one of two intervention groups and a control group： hydrotherapy （group 1）, physiotherapy （group 2）, and both physiotherapy and hydrotherapy （group 3, control group） of the affected joint. MAIN OUTCOME MEASURES： Primary outcome： pain intensity of the affected joint in the course of inpatient treatment; secondary outcome： health-related quality of life, joint-specific pain and mobility in the course of the study. RESULTS： Concerning the main outcome, intervention group 1 showed most beneficial effects in the course of inpatient treatment, followed by groups 3 and 2, and also the indirect flexion ability of hip or knee together with the general patient mobility through the ＂timed up and go＂ test were mainly improved within group 1 followed by groups 3 and 2. CONCLUSION： The results of this pilot study demonstrate beneficial effects of hydrotherapy. The study design is feasible. For statistically significant evidence and a robust conclusion of efficacy of Kneipp＇s hydrotherapy, a larger sample size is necessary. TRIAL REGISTRATION NUMBER： NCT 00950326.

Intraoperative body temperature and emergence delirium in elderly patients after non-cardiac surgery:A secondary analysis of a prospective observational study

Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.Methods:This study was a secondary analysis of a prospective observational study.Taking baseline body temperature as a reference,intraoperative absolute and relative temperature changes were calculated.The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference.ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.Results:A total of 874 patients were analyzed with a mean age of 71.8±5.3 years.The incidence of ED was 38.4%(336/874).When taking 36.0°C,35.5°C,and 35.0°C as thresholds,the incidences of absolute hypothermia were 76.7%(670/874),38.4%(336/874),and 17.5%(153/874),respectively.In multivariable logistic regression analysis,absolute hypothermia(lowest value<35.5°C)and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age,education,preoperative mild cognitive impairment,American Society of Anesthesiologists grade,duration of surgery,site of surgery,and pain intensity.Relative hypothermia(decrement>1.0°C from baseline)and its cumulative duration were also associated with an increased risk of ED,respectively.When taking the relative increment>0.5°C as a threshold,the incidence of relative hyperthermia was 21.7%(190/874)and it was associated with a decreased risk of ED after adjusting above confounders.Conclusions:In the present study,we found that intraoperative hypothermia,defined as either absolute or relative hypothermia,was associated with an increased risk of ED in elderly patients after non-cardiac surgery.Relative hyperthermia,but not absolute hyperthermia,was associated with a decreased risk of ED.Registration:Chinese Clinical Trial Registry(No.ChiCTR-OOC-17012734).

Effectiveness and clinical benefit of a therapy of combined non-pharmaceutical Traditional Chinese Medicine for knee osteoarthritis: a randomized controlled study

OBJECTIVE: To compare the efficacy of honey mouthwash 12.5% and chlorhexidine solution 0.2% to reduce the rate of oropharyngeal bacterial colonization in mechanically-ventilated patients.METHODS: This study was a randomized, single blind, phase Ⅲ controlled clinical trial. Sixty patients newly admitted to internal and trauma Intensive Care Units of the two educational hospitals of Sanandaj city affiliated with Kurdistan University of Medical Sciences were selected by convenience sampling and allocated to two groups of 30 patients using random blocks design. In each group,the mouthwash was applied twice a day for four consecutive days. Swab samples were taken from the mouth and throat of all patients three times a day(pre-intervention, two days, and four days after the intervention) and then the samples were transferred onto the blood agar and eosin methylene blue(EMB) culture plates and investigated for bacterial growth and colonization after 24-48 h.RESULTS: The findings showed that oropharyngeal colonization was not significantly different between the two groups, pre-intervention, two days,and four days after the intervention(P > 0.05). Rinsing with honey mouthwash 12.5% led to the inhibition of Staphylococcus aureus and Pseudomonas aeruginosa on the fourth day of the intervention in all samples.CONCLUSION: None of the studied solutions contributed to the reduction of oropharyngeal bacterial colonization. It seems that the growth inhibition of Staphylococcus aureus and Pseudomonas aeruginosa by the honey 12.5% mouthwash in mechanically-ventilated patients need further investigation.