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Nakamura, Ryogo. "Diagnosis of Ulnar Wrist Pain." Nagoya University School of Medicine, 2001. http://hdl.handle.net/2237/5370.
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Ohnmeiss, Donna D. "Pain drawings in the evaluation of lumbar disc-related pain /." Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-4069-X/.
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Miller, Amanda Jeannine. "Gender Disparities in Diagnosis and Pain Management." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/491860.
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Urban BioethicsM.A.
The proliferation of social media and other online forums has allowed female patients to share their experiences in the healthcare system. Female patients and women’s health advocates can more easily speak out about instances of gender bias in medicine, which impact women’s access to equitable healthcare and positive healthcare experiences. Although there are some medical studies addressing gender disparities in various aspects of medicine, the impacts of gender bias on healthcare remain understudied and poorly understood. Patient narratives therefore provide an essential insight into the state of gender bias in medicine today. This paper aims to explore these narratives for common themes, to determine whether the current medical literature supports the presence of gender-based disparities, and to highlight the biological, psychological, and sociocultural factors impacting any disparities. Patient narratives frequently cite frustrations with diagnostic errors or delays and inadequate pain management, and the medical literature generally supports women’s accounts of gender disparities in these areas. Several studies of diagnostic disparities show that women more frequently experience delays in diagnosis, missed diagnoses, and incorrect psychiatric diagnoses. Multiple pain management studies have found that women face longer delays in care, lower rates of analgesic administration (particularly opiates), and fewer referrals for nonpharmacologic management strategies. Explanations for these disparities are likely multifactorial, and include provider ignorance of female-specific presentations and diseases, prevalence of understudied diseases in women, misattribution of symptoms to psychogenic causes, communication differences, normalization of female pain, and misconceptions about pain tolerance.
Temple University--Theses
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Buckley, David A. "Improving the diagnosis and treatment of chronic neuropathic pain." Thesis, University of Huddersfield, 2018. http://eprints.hud.ac.uk/id/eprint/34551/.
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Chronic neuropathic pain (CNP) occurs as a consequence of injury to the nervous system. Despite recent advances, CNP lacks objective diagnostic criteria, is often unrelenting and refractory to treatment. The primary aims of this thesis are twofold; the identification of CNP biomarkers using both human cohorts and an animal model (spinal nerve ligation; SNL) of neuropathic pain, and to provide clarity on the role of GTP cylcohydrolase I (GCH1) in CNP. Analysis of GCH1 and related genes and metabolites was conducted. As biomarkers, nitrite/nitrate and neopterin did not differentiate controls from CNP patients. However, significant differences were observed with biopterins, whilst correlations were observed between GCH1, nitrite/nitrate and neopterin, which were notably stronger in patients than controls. Analysis in human cohorts and in the SNL model also inferred that downregulation of GCHFR may contribute to BH4 synthesis. In order to provide clarity on the role of the GCH1 pain protective haplotype, reporter gene assays were used. This demonstrated a potential regulatory role for the GCH1 5’ SNP (rs8007267). In silico prediction of transcription factor binding sites suggested that this may be mediated by the aryl hydrocarbon nuclear translocator. The use of electrophoretic mobility shift assays showed strong specific binding with probe pertaining to the major allele. Further analysis is required to elucidate transcription factor binding, potentially facilitated by 2D-PAGE and mass spectrometry. In order to further elucidate potential CNP biomarkers, microarray analysis and qRT-PCR were performed using blood obtained from CNP patients. Data refinement led to the isolation of 27 potential CNP biomarkers, of which several cross-validated between cohorts. Microarray data, literature evidence, and correlations with previous microarrays provided evidence suggestive of a role for TIMP1. Multiple other genes, including CASP5, TLR4, TLR5, MC1R and CX3CR1, were differentially regulated in CNP. Genes surviving microarray data refinement were subsequently analysed in the dorsal horn of Sprague Dawley and Wistar Kyoto rats after SNL. Several genes, including Dpp3, Mc1r and Timp1, were similarly differentially expressed in the rodent SNL model, which suggests that these genes may be involved in the pathophysiological mechanisms of CNP, and may also function as potential translational biomarkers of CNP. This work provides multiple avenues for expansion and further investigation. Clearly, the challenges associated with biomarker discovery in CNP states are considerable, though it is hoped that this thesis provides valuable insight and the necessary foundation for future work.
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Tidwell, Irene Donna 1956. "NURSING DIAGNOSIS--ALTERATION IN COMFORT-PAIN: VALIDATION OF THE DEFINING CHARACTERISTICS." Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/291287.
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Torstensson, Thomas. "Chronic Pelvic Pain Persisting after Childbirth : Diagnosis and Implications for Treatment." Doctoral thesis, Uppsala universitet, Allmänmedicin och preventivmedicin, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-211847.
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Objectives: To explore the pain mechanism and the origin of the pain and to evaluate a short-term pain relief treatment in women suffering from CPP persisting after childbirth in order to enable physiotherapeutic intervention. Material and methods: Thirty-six parous women with chronic pelvic pain persisting after childbirth were recruited at the Department of Physiotherapy, SundsvallHospital and by advertisements in newspapers and 29 parous women without chronic pelvic pain were recruited from an organized gynaecological screening at a midwifery surgery. All women were provoked by intra-pelvic palpation of 13 predetermined intra-pelvic landmarks. The provoked pain distribution was expressed in pain drawings and the pain intensity verbally on a Likert scale.Also, in a randomised controlled trial the 36 women with chronic pelvic pain were allocated to bilateral injection treatment with either triamcinolone or saline solutions, given once on the ischial spine with follow-up after four weeks. Results: Referred pain provoked on intra-pelvic landmarks follows a specific pattern. In general, pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions. In women with chronic pelvic pain the provoked pain distribution area and pain intensity were magnified as compared to women without chronic pelvic pain. In the clinical trial decreased pain intensity, decreased distribution of pain and improved physical function was achieved among the triamcinolone treatment group as compared to the saline treatment group. Also, a positive correlation was shown between reduced pain intensity and improved function. Conclusions: Referred pain patterns provoked on intra-pelvic landmarks in women with chronic pelvic pain persisting after childbirth are consistent with sclerotomal sensory innervations and indicates allodynia and central sensitisation. This suggests that pain mapping can be used to evaluate and confirm the pain experience and contribute to diagnosis. Also, the pain intensity provoked by stimulation of the intra-pelvic landmarks is suggested to be useful to differentiate women with chronic pelvic pain from those without. Corticosteroid treatment to the ischial spine resulted in decreased pain and increased function.
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Tse, Yuk-hang Jessica, and 謝毓衡. "Application of surface electromyography topography in low back pain rehabilitation." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/208612.
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The management of low back pain (LBP) has long been a challenge as it is a highly prevalent disease worldwide due to the lack of an apparent etiology and a conclusive therapeutic treatment. Heterogeneous groups of LBP patients with diverse medical backgrounds also complicate the problem. A clinical threshold is demanded to match the patients and treatments appropriately in order to maximize the treatment success rate. Besides, the assessments of disability and pain perception due to LBP made by self-evaluated questionnaires in current clinical setting are highly susceptible to subjective feeling and the memory of patients. LBP and spasm are closely related but little is known for the underlying physiology, especially the musculature of LBP patients with spasm. These problems exacerbate the difficulty in LBP rehabilitation further.
Surface electromyography (sEMG) topography is a cutting- edge technology to assess the lumbar muscle in vivo non-invasively by illustrating the distribution of global muscle activity visually. sEMG topography has the potential application as an objective assessment tool for LBP rehabilitation. In present study, sEMG topography was used to address 1) the prognostic value of sEMG topography on LBP rehabilitation, 2) the establishment and validation of a clinical classification threshold for identification of LBP patients who are responsive to exercise therapy and 3) the investigation of sEMG topography in accordance with the physiological outcomes (functional disability, pain perception and spasm).
Forty-five healthy subjects and fifty patients with chronic non-specific LBP were enrolled to the study. sEMG test was conducted to every subject under the motions of lumbar flexion and extension in order to gather the myoelectric signals by a 16-channel sEMG. Various sEMG topographic parameters (sEMG parameters) were developed for quantitative analysis of sEMG topography. They were Root-Mean-Square-Difference of Relative Area (RMSD RA), Relative Width (RMSD RW) and Relative Height (RMSD RH) at flexion and extension.
Results showed that sEMG parameters were of significant prognostic value for LBP patients towards exercise therapy. A clinical threshold of 0.21 was proposed and validated based on the geometric calculation of RMSD RA and RMSD RW at flexion and extension. The threshold was substantiated to increase the success rate of exercise therapy from 46% to 86% when the value measured by sEMG topography was below 0.21. sEMG parameters were found significantly associated with disability and pain perception in a positive manner. Severer disability and pain perception were represented by larger values of sEMG parameters. sEMG topography demonstrated symmetric patterns for patients with or without spasms on bilateral sides of lumbar muscles. The symmetry in sEMG topography evinced the consistency of the musculature of bilateral lumbar muscles while the lost of symmetry might indicate malfunction of lumbar muscles unilaterally.
To conclude, this study corroborated versatile roles of sEMG topography in LBP rehabilitation as a prognosis, clinical threshold, and objective measurement. The findings of this study have paved the way of sEMG topography for future application in clinical setting. A study of larger scale would be recommended to complement the present findings.published_or_final_version
Orthopaedics and Traumatology
Master
Master of Philosophy
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Vickers, Edward Russell. "Neuropathic orofacial pain: a review and guidelines for diagnosis and management." University of Sydney. Anaesthesia and Pain Management, 2001. http://hdl.handle.net/2123/806.
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Neuropathic pain is defined as "pain initiated or caused by a primary lesion or dysfunction in the nervous system". In contrast to physiological pain that warns of noxious stimuli likely to result in tissue damage, neuropathic pain serves no protective function. Examples of neuropathic pain states include postherpetic neuralgia (shingles) and phantom limb / stump pain. This pain state also exists in the orofacial region, with the possibility of several variants including atypical odontalgia and burning mouth syndrome. There is a paucity of information on the prevalence of neuropathic pain in the orofacial region. One study assessed patients following endodontic treatment and found that approximately 3 to 6percent of patients reported persistent pain. Patients predisposed to the condition atypical odontalgia (phantom tooth pain) include those suffering from recurrent cluster or migraine headaches. Biochemical and neurobiological processes leading to a neuropathic pain state are complex and involve peripheral sensitisation, and neuronal plasticity of the central and peripheral nervous systems. Subsequent associated pathophysiology includes regional muscle spasm, sympathetic hyperfunction, and centralisation of pain. The relevant clinical features of neuropathic pain are: (i) precipitating factors such as trauma or disease (infection), (ii) pain that is frequently described as having burning, paroxysmal, and lancinating or sharp qualities, and (iii) physical examination may indicate hyperalgesia, allodynia and sympathetic hyperfunction. The typical patient complains of persistent, severe pain, yet there are no clearly identifiable clinical or radiographic abnormalities. Often, due to the chronicity of the problem, afflicted patients exhibit significant distress and are poor pain historians, thus complicating the clinician's task of obtaining a detailed and relevant clinical and psychosocial history. An appropriate analgetic blockade test for intraoral sites of neuropathic pain is mucosal application of topical anaesthetics. Other, more specific, tests include placebo controlled lignocaine infusions for assessing neuropathic pain, and placebo controlled phentolamine infusions for sympathetically maintained pain. The treatment and management of neuropathic pain is multidisciplinary. Medication rationalisation utilises first-line antineuropathic drugs including tricyclic antidepressants, and possibly an anticonvulsant. Topical applications of capsaicin to the gingivae and oral mucosa are a simple and effective treatment. Neuropathic pain responds poorly to opioid medication. Psychological assessment is often crucial in developing strategies for pain management. Psychological variables include distress, depression, expectations of treatment, motivation to improve, and background environmental factors. To enable a greater understanding of neuropathic pain, thereby leading to improved treatments, high-performance liquid chromatography-mass spectrometry is one analytical technique that has the potential to contribute to our knowledge base. This technique allows drugs and endogenous substances to be assayed from one sample in a relatively short time. The technique can identify, confirm, and measure the concentrations of multiple analytes from a single sample.
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Vickers, E. R. "Neuropathic orofacial pain a review and guidelines for diagnosis and management /." Connect to full text, 2001. http://hdl.handle.net/2123/806.
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Thesis (M. Sc. Med.)--University of Sydney, 2001.Title from title screen (viewed Apr. 23, 2008). Submitted in fulfilment of the requirements for the degree of Master of Science in Medicine to the Dept. of Anaesthesia and Pain Management, Faculty of Medicine. Includes bibliography. Also available in print form.
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Stynes, Siobhán Margaret. "The diagnosis and classification of low back-related leg pain." Thesis, Keele University, 2017. http://eprints.keele.ac.uk/3344/.
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Low back-related leg pain (LBLP) is clinically diagnosed as referred leg pain or sciatica. The clinical task of differentiating sciatica from referred leg pain can be challenging but is important for the purpose of treatment choices. There is currently no agreement on which clinical criteria best identify sciatica in clinical or research settings and the spectrum of clinical presentation in patients with LBLP is variable. This thesis aimed to identify diagnostic criteria for sciatica and explore and describe clusters of LBLP patients using cross-sectional data from 609 primary care LBLP consulters. A systematic literature search of LBLP classification systems showed very few systems specifically addressed LBLP classification. Within the systems, there was wide variation in definitions and clinical features of sciatica, with most systems based on clinical opinion. Reliability was merely fair (kappa = 0.35) amongst clinicians diagnosing sciatica but at higher levels of confidence in diagnosis (≥80%), reliability improved (kappa =0.68). Using high confidence clinical diagnosis as a reference standard, with and without confirmatory MRI findings, diagnostic models for sciatica were developed and compared. A simple scoring tool based on the best performing model was devised showing the probability of having sciatica based on results from five clinical items (subjective sensory changes, below knee pain, leg pain worse than back pain, positive neural tension, neurological deficit). Latent class analysis identified five classes of LBLP patients. One class was clearly a referred leg pain group, the other four classes seemed to represent sciatica with varying clinical profiles. This thesis provides a diagnostic tool for sciatica with potential application in clinical and research settings. It also reveals clusters of LBLP patients which could represent more homogenous groups amenable to different treatment approaches. This thesis has provided a strong basis for future work to further explore the clinical utility of the findings.
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Woodley, Stephanie Jane, and n/a. "Lateral hip pain : an anatomical and clinical study." University of Otago. Department of Anatomy & Structural Biology, 2006. http://adt.otago.ac.nz./public/adt-NZDU20061206.162321.
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Lateral hip pain (LHP), characterised by non-specific symptoms in the region of the greater trochanter, is a condition frequently encountered by physiotherapists and other health professionals. However, the pathogenesis of LHP is not well understood. Although pathology of the gluteal tendons and their associated bursae have long been implicated in the cause of this problem, trochanteric bursitis has emerged as the primary clinical diagnosis. In order to determine a differential diagnosis, clinicians are reliant on information collated from the patient history and physical examination, yet the validity of many of the tests used to diagnose LHP has not been established. Abnormalities of the gluteal bursae may give rise to LHP and therefore to ensure precision of clinical assessment and treatment techniques, knowledge of bursal morphology is essential. However, a review of the literature revealed that there are no complete morphological accounts of all the bursae in this area. Therefore, the main purposes of this study were (a) to determine the morphology of the bursae associated with the greater trochanter and (b) to examine the physiotherapy and radiological diagnoses of LHP, and the validity of selected tests used in the diagnosis of LHP.
In the anatomical study, the bursae deep to each of the layered gluteal tendons were examined in 21 embalmed human hips (9 male, 12 female; mean age 79 years, SD 9.4 years) using macro-dissection and histological techniques. Morphological associations, size, positions and histological characteristics of the bursae were recorded. A total of 121 bursae were identified in ten different locations, with an average of six bursae per hip. Variation was evident, but it was typical that at least two bursae were found deep to gluteus maximus (GMax) and the fascia lata, and gluteus medius (GMed). In approximately two-thirds of specimens a single bursa was situated deep to the tendon of gluteus minimus (GMin). All of these bursae demonstrated a synovial lining, which was predominantly areolar in type. This study revealed that numerous bursae are intimately associated with the greater trochanter, and provides new morphological detail which is of significance when considering clinical and biomechanical models of LHP.
A clinical study was undertaken whereby 40 consecutive patients (37 female, 3 male; mean age 54.4 years, SD 9.5 years) with unilateral LHP were recruited prospectively. Each eligible participant underwent a standardised physiotherapy assessment followed by a magnetic resonance (MR) imaging study of the pelvis and both hips. The MR images were analysed in random order by three radiologists blinded to clinical findings and symptomatic side, and the intra-and inter-observer reliability for image analysis was examined using the kappa statistic. To determine the validity of selected clinical tests as evaluated against MR imaging, sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated, and the chi-squared test was used to determine association. As demonstrated by MR imaging, GMed tendon pathology, bursitis, osteoarthritis (OA) and gluteal muscle atrophy are all associated with the report of LHP. Interestingly, these various pathologies were identified in asymptomatic as well as symptomatic limbs. However, while bursitis was equally prevalent in symptomatic and asymptomatic hips, GMed tendon pathology and OA were observed more frequently on the symptomatic side. Furthermore, muscle atrophy which predominantly affected GMin, was specific to symptomatic hips.
Large variation was evident in the strength of agreement between radiologists and there was little agreement between physiotherapy and radiological diagnoses of pathology. Physiotherapists frequently diagnosed trochanteric bursitis as a cause of LHP and while palpation was identified as the most provocative test for reproducing patients complaint of LHP, it was not shown to be a valid technique. Instead, the outcomes pertaining to the validity of the clinical tests indicate that attention should be focused towards the assessment and treatment of gluteal tendon pathology. The two tests that appeared to be most useful for diagnosing gluteal tendon pathology were pain reproduction with passive hip abduction and resisted testing of GMed and GMin. While these findings demonstrate that various pathologies are associated with the report of LHP, they also highlight some problems associated with the use of MR imaging as a reference standard. Before further clinical validation studies of LHP are undertaken in larger populations, it is recommended that verification of MR imaging outcomes are performed against surgical and histological findings.
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Johansson, Kajsa. "Patients with subacromial pain : Diagnosis, treatment and outcome in primary care." Doctoral thesis, Linköping : Univ, 2004. http://www.bibl.liu.se/liupubl/disp/disp2004/med834s.pdf.
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Tough, Elizabeth Anne. "Myofascial trigger point pain- its diagnosis and its treatment with acupuncture." Thesis, University of Exeter, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.489980.
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The overarching aims of this work were to explore the clinical construct of myofascial trigger point pain syndrome, its diagnosis in clinical practice, and its treatment with acupuncture dry needling.
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Awang, Mahmud Awang Bulgiba. "Application of statistical and neural network techniques to chest pain diagnosis." Thesis, University of East Anglia, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.430583.
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Tough, E. A. "Myofascial trigger point pain : its diagnosis & its treatment with acupuncture." Thesis, Exeter and Plymouth Peninsula Medical School, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.701313.
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Siu, Hiu-fai, and 蕭曉暉. "Quantitative lumbar surface EMG topographic analysis: comparison between normal and low back pain patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B4327870X.
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Bogefeldt, Johan. "Low back pain with special reference to prevalence, diagnosis, treatment and prognosis /." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl.[distributör], 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-108070.
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Sanchis, Mora Sandra. "Multidisciplinary approach for improvement of diagnosis and treatment of canine neuropathic pain." Thesis, Royal Veterinary College (University of London), 2017. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.731283.
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Abbott, J. Haxby, and n/a. "Accuracy in the diagnosis of lumbar segmental mobility disorders." University of Otago. Department of Anatomy & Structural Biology, 2005. http://adt.otago.ac.nz./public/adt-NZDU20070205.094640.
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Background: In the clinical examination of patients with low back pain (LBP), musculoskeletal physiotherapists routinely assess lumbar spinal segmental motion by performing physical examination procedures such as observation of active range of motion and palpation of intervertebral motion. The validity of manual assessment of segmental motion, however, has not been adequately investigated.
Methods: In this pragmatic, multi-centre, criterion-related validity study, 138 consecutive patients with LBP were recruited and examined by physiotherapists with postgraduate training in musculoskeletal manual therapy. Clinicians examined each patient�s spine for the presence of segmental motion abnormalities, described as lumbar segmental rigidity (LSR) and lumbar segmental instability (LSI), then referred the patients for flexion-extension (FE) radiographs. The physical examination procedures of interest were: 1) assessment of forward-bending (FB) active range of motion (AROM); 2) FB and backward-bending (BB) passive physiological intervertebral motion testing (PPIVMs) in the sagittal plane; and 3) central postero-anterior passive accessory intervertebral motion testing (PAIVMs). Sagittal displacement kinematics of the lumbar spinal segments were measured from the FE radiographs, and served as the criterion standard against which the clinical assessment results were compared. The kinematic parameters measured were sagittal rotation, sagittal translation, ratio of translation per degree of rotation (TRR), instantaneous axis of rotation (IAR), and centre of reaction (CR). Reference ranges for normal motion were calculated from the analysis of FE radiographs of 30 asymptomatic volunteers. The accuracy and validity of the clinical examination procedures were then calculated, and reported as sensitivity, specificity, and likelihood ratios for a positive test (LR+) and a negative test (LR-).
Results: In patients with LBP, sagittal rotation LSR and sagittal translation LSR had a prevalence of approximately 5.7% (p <0.0005) in this cohort. Sagittal rotation LSI was not found in statistically significant numbers. Sagittal translation LSI was found at a prevalence of 3.6% (p <0.05). Abnormal TRR (23.3%), IAR (17.7%), and CR (16.5%) were more prevalent findings (all p <0.0005). Observation of the quantity of AROM, during FB, is not valid for the assessment of either total lumbar segmental sagittal rotation, or detection of individual segments with abnormal segmental motion. PPIVMs and PAIVMs are specific, but not sensitive, for the detection of rotation LSI and translation LSI. A positive test (grade 4 on a scale from 0 to 4) with BB PPIVMs may have some utility for the diagnosis of rotation LSI or translation LSI, with LR+ of 8.4 and 7.1 respectively (and 95% CIs from around 1.7 to 38). Likelihood ratio statistics for FB PPIVMs were not statistically significant. A positive test (grade 2 on a scale from 0 to 2) with PAIVMs may have some utility for the diagnosis of rotation LSI or translation LSI, with LR+ of 2.7 and 2.5 respectively (and 95% CIs from around 1.01 to 7.5). Neither PPIVMs nor PAIVMs were useful for the detection of LSR, or abnormal quality of motion as measured by TRR, CR, and IAR.
Conclusions: Abnormal spinal segmental motion is associated with the symptom of LBP, in patients presenting to physiotherapists with a new episode of recurrent or chronic LBP, however prevalence is low due to highly variable lumbar segmental motion among asymptomatic individuals. Manual physical examination has moderate validity, but limited utility on its own, for the detection of translation LSI. Further research should investigate the utility of other clinical examination findings for the detection of lumbar segmental mobility disorders.
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Nilsson, Staffan. "Chest pain and ischemic heart disease : Diagnosis and management in primary health care." Doctoral thesis, Linköping : Department of Medical and Health Sciences, Linköpings universitet, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-11390.
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Keeping, Barbara. "Validation of the Spanish Dallas Pain Questionnaire." Thesis, University of North Texas, 1989. https://digital.library.unt.edu/ark:/67531/metadc330691/.
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The purpose of this study was to validate the Spanish version of the Dallas Pain Questionnaire (DPQ). Not only does the DPQ offer the potential of statistical and clinical diagnostic value but also is easily interpretable across cultural lines. No such instrument has presently been validated for the Mexican-American population.
A total of 81 Spanish speaking subjects participated in this study. Of these subjects, 56 were classified as chronic pain patients by nature of their medical diagnosis and duration of pain. The 25 normal subjects were family members of the chronic pain patients and members of the Northern New Mexico Hispanic community chosen at random.
Hypothesis one predicted that reliability would be obtained on Spanish speaking populations based on test-retest with correlation coefficients of the items. The second hypothesis predicted that the Spanish DPQ would have content validity or consistent internal structure on those items that measure the trait or behavior of interest based upon factor analysis approaches and internal consistency measures. Hypothesis three predicted that the Spanish version of the DPQ would significantly correlate with the English version of the DPQ on all four factors.
All four hypotheses were supported. The Spanish DPQ showed reliability over time based on test-retest. The statistics revealed an internally reliable test, alpha coefficient analysis and factor analysis. The validity was supported by significant correlations with the English DPQ and discrimination between chronic and nonchronic pain patients.
While all four hypotheses were upheld, interpretation of the present findings should be moderated by recognition of the limitations of the studies. Future studies should test larger samples to improve confidence in the psychometric properties of the instrument. Still notable limitations of the questionnaire are that the Spanish DPQ is a form that is more accurately viewed as a global measure.
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Sundström, Torbjörn. "Human brain function evaluated with rCBF-SPECT : memory and pain related changes and new diagnostic possibilities in Alzheimer’s disease." Doctoral thesis, Umeå universitet, Diagnostisk radiologi, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-761.
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The aim of this doctoral thesis was to study the influence of memory, pain, age and education on the regional cerebral blood flow (rCBF), i.e. brain function, in early Alzheimer's disease (AD) and in chronic neck pain patients in comparison to healthy controls and in healthy elderly per se. This was done by optimizing single photon emission computed tomography (SPECT) as a method to study rCBF with the tracer Technetium-99m (99mTc) hexamethylpropyleneamine oxime (HMPAO) and by matching all image data to a brain atlas before evaluation. The rCBF-SPECT was evaluated and developed to obtain higher diagnostic accuracy in AD and in chronic neck pain patients it was used to study basic pain related cerebral processes in chronic pain of different origin. A new semimanual registration method, based on fiducial marker, suitable for investigations with low spatial resolution was developed. The method was used to reconstruct images with an improved attenuation and scatter correction by using an attenuation-map calculated from the patients' previously acquired CT images. The influence of age and education on rCBF was evaluated with statistical parametric mapping, SPM in healthy elderly. The main findings were age related changes in rCBF in regions close to interlobar and interhemispheric space but not in regions typically affected in early AD, except for the medial temporal lobe. The theory of a 'cognitive reserve' in individuals with a longer education was supported with findings in the lateral temporal lobe, a region related to semantic memory, and in the frontal lobe. A cross-sectional study of chronic neck pain patients showed extensive rCBF changes in coping related regions in a non-traumatic pain patients compared to both healthy and a pain group with a traumatic origin, i.e. whiplash syndrome. The whiplash group displayed no significant differences in rCBF in comparison with the healthy controls. This suggests different pain mechanisms in these groups. The AD-patients showed a significantly lower rCBF in temporoparietal regions including left hippocampus. These changes were associated to episodic memory performance, and especially to face recognition. The diagnostic sensitivity for AD was high. The face recognition test (episodic memory) was used in AD patients to improve the sensitivity of method, i.e. memory-provoked rCBF-SPECT (MP-SPECT). The results were compared to healthy controls and the reductions of rCBF in temporoparietal regions were more pronounced in mild AD during provocation. Memory provocation increased the sensitivity of AD-related rCBF changes at group level. If a higher sensitivity for AD at the individual level is verified in future studies, a single MP-SPECT study might then be of help to set diagnosis earlier. In conclusion rCBF in temporoparietal regions are associated to an impaired episodic memory in early AD. Changes in these regions do not have a strong connection to chronological age. The diagnostic sensitivity of rCBF-SPECT in AD is high and there is a potentially higher sensitivity if memory provoked investigations are used. The findings in this thesis have given an increased knowledge of underlying cerebral pain processing in non-traumatic and traumatic (whiplash) neck pain. Preliminary results supporting the theory of 'cognitive reserve' by showing a correlation between long education and preserved rCBF was found in healthy elderly.
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Tirlapur, Seema Anushka. "Investigating the diagnosis and management of bladder pain syndrome (BPS) in women with chronic pelvic pain (CPP) : a study of prevalence, diagnostic tests, the effectiveness of neuromodulation, the quality of information available to patients and the discrepancies in rating the level of evidence for the management of BPS." Thesis, Queen Mary, University of London, 2014. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8970.
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The aim of this thesis is to investigate the prevalence and management of bladder pain syndrome (BPS) amongst women with chronic pelvic pain (CPP) through a series of systematic reviews, a structured survey and primary study. It has been acknowledged that the diagnosis and management of BPS is a contentious subject. The mean prevalence of BPS in women with CPP is 61%. I initially carried out a patient and clinician survey to understand how BPS was being managed in the UK. I found wide variation in diagnostic methods and treatments of BPS used by clinicians and experienced by patients with no obvious consensus. Since we know the predominant complaint in these patients is pain (bladder or pelvic) I used patients with pelvic pain as my cohort. Cystoscopy is no longer used as a diagnostic test for BPS. It is possible to diagnose BPS through a consensus expert panel using symptom-based criteria. This method of deriving a reference standard is demonstrated in the primary study, since no gold standard diagnostic test exists for BPS. A case-control feasibility study was undertaken to investigate the accuracy of a group of urinary symptoms to diagnose BPS. While, neither index test of bladder filling pain or bladder wall tenderness can sensitively diagnose BPS alone, the symptoms of bladder filling pain, urinary frequency, pain on urination and pain on full bladder are a good predictor of the condition. A systematic review assessing the reporting outcomes identified five measures that should be included in studies; pain, urinary symptoms, general 8 wellbeing, quality of life and bladder capacity. Of the 19 treatments used for BPS, the level and strength of evidence ratings overestimated quality compared to the GRADE ratings. BPS can be diagnosed symptomatically but there is variable reporting of outcome measures and poor evidence for treatment effectiveness.
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Chalidapongse, Premthip. "The development of a decision support system for the diagnosis of chronic idiopathic facial pain." Thesis, University College London (University of London), 2004. http://discovery.ucl.ac.uk/1446840/.
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The aim of the research was to develop (a) a well structured electronic medical record for a decision support system, and (b) logical algorithms for the diagnosis of Chronic Idiopathic Facial Pain (CIFP) and for educating trainees. This project started by validating the paper-based Facial Pain Proforma (FPP) with a panel of 3 experts. The FPP received a top grade consensus for history and examination. However, family relationships were considered too intrusive by one pain specialist and one clinical psychologist. A retrospective survey of 93 free hand pain histories taken by pain specialists (31 records), oral and maxillofacial registrars (12 records), senior house officers (31 records), and postgraduate students (19 records) were compared to the FPP. This revealed illegible data with many omissions. Medically trained surgeons produced good medical and examination data but overlooked important pain related and psychosocial data. Postgraduate students were often patient-led. A computerised FPP was developed as an electronic medical record - the Electronic Eastman Pain Proforma (EEPP) - using relational database software (Microsoft Access 97). The EEPP was validated for acceptability by clinicians and patients and compared to the free hand history (FH), and the FPP, (119 patients including 40 FH, 46 FPP, and 33 EEPP). Use of the EEPP did not diminish doctor-patient relationship. EEPP's history taking took 22 minutes compared to FPP (18 minutes) and FH (13 minutes). The average rating for EEPP was 2.8 out of 4. The design interface was rated as good. The clinicians were supportive for the concept of an electronic medical record. "Hand-crafted decision trees" were constructed by using expert knowledge and transcribed into "Diagnostic Rules". Machine learning technique were also used to induce comparable diagnostic trees from patient data (n=280). 5-fold cross validation of two induced decision trees showed diagnostic accuracy of 88% and 86%, with reasonable comprehensibility and high discriminative performance. The hand-crafted decision trees were validated using the same data. The resulting accuracy was 85% but comprehensibility was better than that of the induced decision trees. This work strongly supports the development and use of electronic medical records and a diagnostic decision tree system for clinical use.
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Pappada, Holly T. Renzhofer. "THE EXPERIENCE AND PSYCHO-SOCIAL IMPLICATIONS OF CHRONIC PAIN: THE IMPORTANCE OF A MEDICAL DIAGNOSIS." Case Western Reserve University School of Graduate Studies / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=case1586204447441831.
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Dahlgren, Johanna, and Clara Kiesen. "Att leva med endometrios, en sjukdom som styr livet." Thesis, Högskolan Väst, Avdelningen för omvårdnad - grundnivå, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-9705.
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Background: Endometriosis is a disease which, though it impacts one of ten women, has a lack of knowledge in the society and among healthcare professionals. The lack of knowledge causes delays in diagnosis and a lack of comprehension for the women. Aim: The aim of this study was to describe women's experiences of living with endometriosis. Method: The method used in this study was a method to contribute to evidence-based nursing with ground in analysis of qualitative research. Through the similarities and contradictions in the analyzed studies, themes and under-themes were created. Result: Findings showed that the women's experiences often were negative. Friends, family and healthcare professionals normalized the pain and the women often endured the pain in belief that it was normal. The lack of knowledge in endometriosis caused misdiagnosis and diagnostic delays. The endometriosis limited the women's daily living, work and social life by decreasing their activity because of symptoms as pain, nausea, fatigue, heavy bleeding and diarrhea. The disease also affected the women's relationships and the feeling of being a woman. Conclusion: The lack of knowledge in endometriosis caused an unnecessarily suffering among the women with the disease. If the awareness of endometriosis would increase in the society and among healthcare professionals the time for diagnosis and the encounters with patients suffering from endometriosis could improve.
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Bedson, John. "Chronic knee pain and osteoarthritis : an epidemiological study of labels, diagnosis and investigation in general practice." Thesis, Keele University, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.423434.
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Hultman, Elin, and Maria Carlstén. "Den "normala" smärtan - Att leva med endometrios : En litteraturstudie." Thesis, Högskolan i Gävle, Avdelningen för hälso- och vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-13498.
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Syftet med studien var att beskriva hur kvinnor med endometrios upplever att sjukdomen påverkar deras liv och livskvalitet. Metoden var en litteraturstudie med deskriptiv design. Artikelsökningen skedde i databaserna Cinahl, PubMed och PsycINFO samt genom manuell sökning vilket resulterade i 13 vetenskapliga artiklar som uppfyllde studiens inklusionskriterier. Resultatet visar att endometrios kan ha negativ påverkan på många delar av livet och därmed också kvinnans livskvalitet. Smärta till följd av endometrios har visat sig vara en stor del av problematiken som påverkar både vardag, arbetsliv och socialt liv på ett negativt sätt. Kvinnorna känner ett behov att av kontrollera sjukdomen för att kunna få ett så normalt liv som möjligt och lägger därför ofta mycket tid och energi på att söka ny information och alternativa behandlingsformer. Sjukdomen verkar inte särskilt uppmärksammad, varken i samhället eller i sjukvården, trots att man uppskattar att många kvinnor är drabbade i någon grad, och det tar ofta många år att få diagnosen endometrios.Slutsatsen är att kvinnor med endometrios upplever att sjukdomen har negativ påverkan på livskvaliteten. Då många kvinnor är drabbade av sjukdomen är det av stor vikt att allmänsjuksköterskan har kunskap om denna sjukdom för att kunna ge bästa stöd och omvårdnad samt hjälp till en diagnos.The purpose with this study was to describe how women diagnosed with endometriosis experience that the disease affects their life and quality of life. The method was a literature review with a descriptive design. Articles were searched in the databases Cinahl, PubMed, PsycINFO and manual search. 13 scientific articles that met the inclusion criterias were used for this study. The result shows that endometriosis affects many aspects of life in a negative way and it therefore also affects the quality of life. Endometriosis-related pain has shown to be one of the most severe symptoms that affects both daily life, work and social life. These women often feel a need to control their illness to enable a life as normal as possible and often spend a lot of time and energy in the search for new information and alternative treatments. Despite its high prevalence, the general knowledge of endometriosis is poor and it often takes many years of symptoms before a correct diagnosis is made. The conclusion is that women with endometriosis experience that the disease has a negative impact on their quality of life. Because of the high prevalence of endometriosis, it is important for the nurse to have knowledge about the illness in order to be able to aid in the diagnosis and give optimal support and care to this patient category.
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Basson, Reneda A. "The significance of subthreshold symptoms of anxiety in the aetiology of bruxism." Thesis, University of the Western Cape, 2007. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_8155_1248236519.
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Bruxism is an oral parafunctional habit involving clenching and grinding of the teeth that occurs mainly unconsciously, diurnally and nocturnally. It is considered an important contributory factor in the aetiology of myofascial pain (MFP) and temporomandibular disorders (TMD). The aetiology of bruxism is considered to be multifactorial, involving physiological and psychological factors. The aim of this study was to examine the relationship between the subthreshold symptoms (subtle, prodromal, atypical and subclinical symptoms of which the severity precludes diagnosis as a disorder) of anxiety and bruxism in a sample of subjects using a spectrum model.
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Sousa, Rejane dos Santos. "Avaliação de anti-inflamatórios não esteróidais no tratamento da laminite asséptica aguda decorrente de acidose ruminal por oligofrutose em bovinos." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/10/10136/tde-27072017-164410/.
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Objetivou-se avaliar as alterações ruminais e sistêmicas da indução de acidose ruminal e laminite em zebuínos por meio do oferecimento de oligofrutose bem como caracterizar o quadro de laminite, comparar métodos diagnósticos e avaliar a eficácia entre tratamentos com três anti-inflamatórios não esteróidais (AINEs). Foram utilizadas 29 novilhas Nelore, providas de cânula ruminal e pesando 474,5±58,5 kg. A indução iniciou-se com a administração intraruminal de 0,765 g/kg de oligofrutose duas vezes ao dia por três dias consecutivos, seguida de dose única de 10,71g/kg de oligofrutose administrada 72 horas após o início da indução. Durante o período de indução os animais foram submetidos a exame clinico e coleta de sangue e fluido ruminal diariamente e após a dose maior foram avaliados a cada seis horas (durante as 24 horas iniciais) e a cada 12 horas (até 72 horas pós-indução). Duas novilhas não apresentaram quadro de laminite e foram descartadas. Quase metade dos animais (48,1%) teve que ser tratada com bicarbonato e solução salina para correção da acidose metabólica e desidratação. Devido a este tratamento os animais foram analisados em grupos medicado (n=13) e não medicado (n=14). Durante o período de avaliação pós-indução o diagnóstico da laminite foi confirmado após duas respostas positivas ao teste de sensibilidade dolorosa e escore de locomoção. As novilhas com laminite foram alocadas aleatoriamente em quatro grupos que receberam por três dias consecutivos dose diária (endovenosa) dos seguintes medicamentos: Controle (8 mL solução salina isotônica; n=6); Flunixin meglunine (1,1 mg/kg; n=7); Cetoprofeno (3 mg/kg; n=7) e Meloxican (0,5 mg/kg; n=7). Após o início do tratamento com AINEs os animais foram avaliados a cada 12 horas durante 96 horas. A fermentação máxima da oligofrutose ocorreu entre a 6ª e a 12ª h pós-indução com destacado acúmulo de ácido láctico, intensa diminuição da anaerobiose e aumento temporário na osmolaridade ruminal. No grupo medicado existiu uma correlação positiva entre o pH ruminal e o pH sanguíneo (r = 0,90; P = 0,0040), e uma correlação negativa entre o pH sanguíneo e a osmolaridade sanguínea (r =-0,69; P =0,0090) no auge da fermentação ruminal. Ambos os grupos tiveram uma febrícula efêmera e compensação respiratória frente à acidose sistêmica. A maioria dos animais desenvolveu laminite da 24ª h a 72ª h em dígitos de dois membros e uma pequena porcentagem (29,6%) polisinovite nas articulações tarsocrurais. Empregando-se a sensibilidade dolorosa como padrão ouro no diagnóstico o melhor método foi o de escore de locomoção, seguido da plataforma de força e termografia infravermelha. Porém, a plataforma de força não foi sensível para analisar a evolução do tratamento com AINEs dos animais laminíticos. Os três AINEs reduziram semelhantemente o cortisol em relação ao grupo controle (Plt;0,05) e não provocaram danos na mucosa abomasal. O meloxican foi bastante eficaz na diminuição de sensibilidade podal, melhorando da mesma forma que o cetoprofeno o escore de locomoção. Estes dois medicamentos estimularam o retorno do apetite e a melhora da atitude. Deve-se incluir no tratamento da laminite asséptica algum AINE, dando-se preferência ao meloxicam, seguido do cetoprofeno.This study aimed to evaluate ruminal and systemic alterations of laminitis and ruminal acidosis oligofructose-induced in Zebu cattle; characterize laminitis clinical picture and compare methods of diagnostic; and to evaluate the treatment efficacy between three non-steroidal anti-inflammatory drugs (NSAIDs). Twenty-nine rumen-canulated Nelore heifers weighing 474.5 ± 58.5 kg were used. Induction was initiated with intraruminal administration of 0.765 g/kg oligofructose twice a day for three consecutive days, followed by single dose of 10.71 g/kg oligofructose administered 72 hours after beginning of induction. During the induction period the animals underwent clinical examination, blood and ruminal fluid collection daily and after induction were evaluated every 6 hours (during the initial 24 hours) and every 12 hours (up to 72 hours post-induction). Two heifers that did not present laminitis were discarded. Almost half of the animals (48.1%) had to be treated with bicarbonate and saline for correction of metabolic acidosis and dehydration. Due to this treatment the animals were analyzed in groups medicated (n=13) and unmedicated (n =14). After induction, the diagnosis of laminitis was confirmed after two positive responses to the pain sensitivity and locomotion score tests. Heifers with laminitis were randomly assigned to four groups that received, for three consecutive days, daily doses (intravenous) of the following medications: Control (8 mL isotonic saline; n=6); Flunixin meglunine (1.1 mg/kg; n=7); Ketoprofen (3 mg/kg; n=7) and Meloxican (0.5 mg/kg; n=7). After NSAIDs treatment the animals were evaluated every 12 hours up to 96 hours. The maximum fermentation of oligofructose occurred between the 6th and 12th hour post-induction with marked accumulation of lactic acid, intense decrease of anaerobiosis and temporary increase in ruminal osmolarity. In the medicated group, there was a positive correlation between ruminal and blood pH (r =0,90; P= 0,0040), and a negative correlation between blood pH and blood osmolarity (r =-0,69; P=0,0090) at the peak of ruminal fermentation. Both groups had a mild fever and respiratory compensation due systemic acidosis. Most animals developed laminitis 24 to 72 hours after induction in digits of two limbs and a small percentage (29.6%) had polysinovite in the tarsocrural joints. Using the pain sensitivity as gold standard, the best diagnostic method was the locomotion score, followed by the force platform and infrared thermography. Notwithstanding, the force platform was not sensitive to evaluate animals during the treatment of laminitis with NSAIDs. The three NSAIDs similarly reduced cortisol in relation to control group (P<0.05) and did not cause damage to the abomasal mucosa. Meloxicam was very effective in reducing hoof sensibility, improving in the same way as ketoprofen the locomotion score. These two drugs stimulated the return of appetite and improved attitude. For the treatment protocol of aseptic laminitis a NSAID should be included, with preference to meloxicam followed by ketoprofen.
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Ohrt, Helene Jule 1954. "Nursing diagnosis--alteration in comfort-pain: Validation of the defining characteristics and exploration of the nursing interventions." Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/291363.
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A retrospective validation study was implemented to identify the defining characteristics of the nursing diagnosis Alteration in Comfort-Pain, specifically chest pain. The interventions instituted by coronary care nurses to relieve the chest pain were also explored. Fifty-two records were reviewed. A Demographic Instrument (DI) and Alteration in Comfort-Pain (Chest Pain) Intervention Instrument (ACPII) were developed for the study and the Alteration in Comfort-Pain Assessment Tool for Chest Pain (ACPAT-CP) was revised from the Alteration in Comfort-Pain Assessment Tool (ACPAT) for the study. The three instruments were assessed for content validity and reliability. The critical defining characteristic was determined to be a verbal complaint of chest pain with or without a specific descriptor and nurses made the appropriate nursing diagnosis for chest pain in the majority of the records reviewed. Nursing interventions documented for the relief of chest pain were interdependent interventions, specifically monitoring and an electrocardiogram. The results indicated that there is a need for improved documentation in nurses' notes.
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Glenn, Brandon Norman. "EVALUATION OF EXPAREL® FOR POSTOPERATIVE PAIN/NUMBNESS IN SYMPTOMATIC TEETH WITH A PULPAL DIAGNOSIS OF NECROSIS." The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1437137510.
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Woods, Alexander J. "Responses to chest pain : development and initial evaluation of an evidence-based information resource." Thesis, University of Stirling, 2009. http://hdl.handle.net/1893/2320.
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Coronary heart disease is the leading cause of premature death in the UK. Chest pain, the most common symptoms associated with this disease, accounts for 1% of all primary care consultations, 5% of visits to emergency departments, and up to 40% of emergency admissions to hospital. When people experience acute coronary symptoms such as chest pain, or other symptoms such as pain in the arms, back or shoulder pain and pain in the jaw and neck, we know that prompt diagnosis and treatment of heart disease can significantly reduce mortality. However, we also know that when people experience these symptoms they can wait sometime before seeking medical help. Part of the problem may be that people do not attribute their symptoms a serious problem such as heart disease. Whilst several campaigns have been aimed at the general population there is no information resource targeted at people who may be at risk of heart disease to help them understand and evaluate their symptoms and take prompt action. The overall aim of this thesis is to fill this gap by producing a piloted draft information resource which aims to help people to respond effectively to symptoms that might be attributable to heart disease for people at high risk of heart disease. Using focus group discussions and individual interviews with people who had experienced symptoms that might be attributable to heart disease or might be at high risk of heart disease experiential data about their response to symptoms were gathered. Participants were also asked their views on what an information resource should be like and their experiences and views formed the basis of the content of the first draft of the information resource. In making sense of their symptom the participants drew upon a range of past experiences and the experiences of others to help them; participants who experienced severe symptoms sought help quickly; those whose symptoms were mild or transient waited, in some cases a considerable time, before seeking help. Previous personal experience may be the factor that helped those who acted quickly. Whereas the experience of others, evident in many of the accounts of those who waited, may not be sufficient to help people interpret and make sense of their own symptom experiences. The information resource incorporated the experiences of people with symptoms that ended up being attributable to heart disease and included examples of the range of symptoms that can be encountered to illustrate the different ways in which heart disease can be manifested as well as information drawn from best practice resources in the management of heart disease. Participants in the original focus group discussions and interviews were asked to be involved in the development of the resource and seventeen agreed. The information resource went through three drafts; at each stage changes were made to incorporate respondent views; at the penultimate draft health professionals’ views were also sought and used to inform the final draft which is now ready for further evaluation.
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王平. "中醫對疼痛辨治形式種類的文獻研究." HKBU Institutional Repository, 2014. https://repository.hkbu.edu.hk/etd_oa/6.
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疼痛是臨床的最常見症狀之一，也是很多疾病的重要標誌。有效緩解疼痛是臨床治療的重要目的。中醫對疼痛治療有豐富的經驗，中醫學中很多外感和內傷雜病都以疼痛為早發症狀。 有關疼痛辨治值得學習的文獻很多，但從分類辨治的角度時常出現有辨無治，有治無辨的情況。不經過大量的文獻閱讀難以滿足所有臨床需要。 本文從辨治結合的角度，通過多層次多角度總結不同中醫理論來探討的疼痛辨治，希望能夠有助於更準確地判斷病情以及有的放矢的針對性治療，爲更好地認識和掌握疼痛做一點探索。 採用文獻檢索的方式搜集相關文獻。以計算機爲工具，應用WindowsOffice套件等軟件，收集古代經典及近現代中醫疼痛辨治相關文獻。 資料來源主要包括： 中國期刊全文數據庫 香港浸會大學圖書館醫學專著 以中醫辨治疼痛爲主要線索，檢索項綜合了以下檢索途徑：題名、作者、主題、關鍵詞。 搜索“疼痛”、“中醫”、“辨治”、“研究”、“分類”等關鍵詞。 檢索出136篇近現代中醫疼痛辨治方面文獻，並參考相關古典文獻、當代中醫教材等。 在此基礎上適當整理，分類歸納辨治方法的理論及應用病案。分別從辯因、辨機、辨位、辨經、辨病、辨時、辨方、辨藥、辯性等九方面歸納總結，概括爲以辨論治的內容共九類，有辨無治的內容一類以及綜合應用一類。因辨論治，在臨床上隨症應變，以不同組合綜合應用居多。治療方法有應用中藥、方劑、外敷、鍼灸、推拿以及近代常用技術電針、埋線等。 通過對辨治結合的研究歸納，以及對疼痛辨治更注重邏輯性的分類論述，清晰展示現有的疼痛理論研究概況。 關鍵詞：疼痛，辨治，分類，綜述。
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Nasser, Felipe. "Avaliação clínica e técnica do tratamento endovascular percutâneo na síndrome da congestão pélvica através da técnica de embolização." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5151/tde-18062007-115245/.
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Um conjunto de evidências sugere que a síndrome da congestão pélvica está associada às varizes pélvicas. A congestão pélvica é explicada em muitos casos pela insuficiência das veias ovarianas em drenar o fluxo venoso dos ovários. No presente estudo, realizou-se a avaliação clínica e técnica do tratamento endovascular percutâneo na síndrome da congestão pélvica através da técnica de embolização. Foram tratadas 113 mulheres, das quais 100 foram acompanhadas pelo período de um ano e a análise dos resultados foi baseada nessa amostra. Os resultados clínicos foram baseados na avaliação da sintomatologia durante o período de acompanhamento, com a utilização da escala visual analógica. A avaliação técnica baseou-se no sucesso da realização dos procedimentos e na avaliação das complicações. As pacientes selecionadas com diagnóstico clínico da síndrome foram submetidas ao estudo angiográfico que revelou insuficiência das veias ovarianas previamente ao tratamento por embolização. Obteve-se sucesso técnico em todos os casos, caracterizado pela possibilidade de realização do cateterismo seletivo das veias ovarianas e ilíacas internas com embolização das mesmas. A remissão total dos sintomas foi observada em 37 pacientes (32.7%) e parcial em 63 pacientes (55.4%). Foi observado significativo alívio dos sintomas (p < 0,001), confirmados pela redução dos valores obtidos através da escala analógica visual. A principal complicação foi a migração do agente embolizante metálico, no entanto, com resolução endovascular de todos os casos e sem repercussão clínica. O tratamento endovascular das varizes pélvicas por meio da embolização apresentou resultados satisfatórios em relação aos sintomas apresentados e mostrou-se como método seguro e com baixos índices de complicação.A great body of evidence suggests that the pelvic congestion syndrome is associated to female varicocile. Pelvic congestion is explained in many cases by ovarian and internal iliac vein insufficiency. The endpoint of the study was the measurement of clinical outcomes and technical success of transcatheter embolotherapy in order to obtain relief of symptoms. The treatment group included 113 patients but only 100 were submitted for a follow up period. We had initial technical success rate of the ovarian and internal iliac vein embolization in all cases. It was used a visual analog scale (VAS) during the 12 months follow up period. The selected patients with the diagnosis of the syndrome were submitted to an angiographic evaluation to reveal ovaric and internal iliac vein insufficiency previous embolization. The technical success was determined by the ability to successfully embolize the ovarian and internal ilac varices and the clinical evaluation by the improvement of symptoms after the following period. A total relief of symptoms was observed in 37 patients (32.7%) and partial relief in 63 (55.4%). Nevertheless, it was seen an important general relief of every symptom (p < 0.001), as well a reduction of the values. The main complication was coil distal embolization, nevertheless, all of them were solved by endovascular approach without clinical repercussion. The transcatheter embolotherapy of the pelvic congestion syndrome provides significant symptomatic improvement, initial technical success and showed no significant long-term complications.
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Edwards, Mark Christopher. "Matching treatment with recurrent abdominal pain symptoms: an evaluation of dietary fiber and relaxation treatments." Diss., Virginia Polytechnic Institute and State University, 1989. http://hdl.handle.net/10919/54354.
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Several etiological models of recurrent abdominal pain (RAP) in children have been proposed but no one model has been able to adequately account for the symptoms of all children with RAP. The present study proposed that symptom presentation may provide a basis for treatment selection. Two etiological models were tested in the present study: the constipation model and the operant learning model. Subjects were assigned to either model based upon whether or not they presented with symptoms of constipation. The treatments derived from these two models were: daily dietary fiber supplements, and teaching children relaxation skills and teaching parents to respond to their child’s pain complaints by encouraging their child to cope with pain through relaxation. Thirteen subjects between the ages of six and 12 years of age were treated in a nonconcurrent multiple baseline A-B or A-B-C design. To control for nonspecific effects, some subjects in each model received the treatment suggested by the alternative model first. All four subjects in the constipation model showed substantial reductions in stomachache activity following the introduction of the dietary fiber treatment. Of the nine subjects in the operant learning model, one showed substantial reductions in stomachache activity following the introduction of the relaxation and parent instruction treatment, two showed reductions during both treatments, four responded to the dietary fiber treatment, and two showed no response to treatment. Results support the effectiveness of a dietary fiber treatment for children with RAP with symptoms of constipation. Minimal support was obtained for the effectiveness of a relaxation and parent instruction treatment for children with RAP without symptoms of constipation. Limitations, implications and directions for future research are discussed.Ph. D.
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Malavasi, Laís de Matos. "Physiological and behavioral effects of opioids in pigs subjected to abdominal surgery /." Uppsala : Dept. of Clinical Sciences, Swedish University of Agricultural Sciences, 2005. http://epsilon.slu.se/200580.pdf.
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Eriksson, Louise, and Julia Asadi. "INTRAORAL INJEKTION AV AKTIV OCH ICKE-AKTIV LOKALANESTETIKA - Normalt gensvar och gensvar i relation till upplevd bedövningskänsla." Thesis, Malmö universitet, Odontologiska fakulteten (OD), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-19953.
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Syfte: Det behövs mer forskning inom diagnostik för orofacial smärta. Syftet med studien är att undersöka om den subjektiva bedövningsupplevelsen som erhålls vid aktiv anestesi kan jämföras med den som erhålls vid injektion av aktiv placebo, samt om aktiv placebo påverkar smärttröskel samt smärtkänslighet vid stickstimuli hos friska individer. Material och metod: 31 friska deltagare randomiserades i tre grupper. En grupp fick aktiv injektion (Xylocain 2,0 %), en grupp fick aktiv placebo injektion (Xylocain 0,1%) och en grupp fick icke aktiv placebo (fysiologisk koksaltlösning). Deltagarna utsattes för tre intraorala tester före och efter injektion som mätte mekaniskt beröringsstimuli, smärta vid stickstimuli, smärttröskel samt stimuluskvalitet. Deltagarna fick efter injektion gradera sin bedövningsupplevelse på en 0-10 NRS skala. Resultaten analyserades med parat T-test, ANOVA One-Way, post-hoc T-test med Bonferronickorrektion samt Fishers exakta test. P<0,05 ansågs vara statistiskt signifikant. Resultat: Bedövningsupplevelsen i gruppen aktiv placebo skilde sig signifikant från aktiv injektion (p<0,001) men inte från icke-aktiv placebo (p=0,980). Sticksmärttröskeln vid aktiv placebo skilde sig signifikant från aktiv injektion (p<0,001) men inte från inaktiv placebo (p = 0,052). Smärtintensitet vid stickstimuli skilde sig signifikant mellan före och efter injektion inom gruppen aktiv injektion (p=0,035) men inte för aktiv placebo (p = 0,690) och icke-aktiv placebo (p = 0,726).Slutsats: Ingen skillnad sågs mellan icke-aktiv placebo och aktiv placebo i förmågan att förändra friska deltagares smärttröskel samt smärtkänslighet för stickstimuli och samtidigt ge en upplevelse hos deltagaren om att vara bedövad. Aktiv placebo gav alltså ingen fördel framför icke aktiv placebo. 0,1 % Xylocain uppfyller inte de krav som kan ställas på en bra aktiv placebo.Aim: More research is needed in diagnostics of orofacial pain. Investigating whether the subjective anesthetic experience obtained in active anesthesia can be compared to that obtained with the injection of active placebo, and whether active placebo affects pain threshold and pain sensitivity under a piercing stimulus in healthy individuals.Materials and Methods: 31 healthy subjects were randomized into three groups. One group received active injection (Xylocain 2.0 %), one group received active placebo (Xylocain 0.1 %) and one group received non-active placebo (physiological saline). The participants were subjected to three intraoral tests before and after injection, which measured allodynia, pain sensitivity under a piercing stimulus, pain threshold and stimulus quality. Participant appreciated their anesthetic experience on a 0-10 NRS scale after injection.Results: The anesthetic experience in the active placebo group was significantly different from active injection (p <0.001) but not from non-active placebo (p=0.980). The pain threshold at active placebo was significantly different from active injection (p <0.001) but not from non-active placebo (p = 0.052). Pain intensity in stick stimuli was significantly different between pre- and post-injection within the active injection group (p =0.035) but not for active placebo (p = 0.690) and non-active placebo (p = 0.726).Conclusion: The study found no difference between non-active placebo and active placebo in the ability to alter healthy participant's pain threshold and pain sensitivity under a piercing stimulus and at the same time give the participant an experience of being anesthetized. 0.1% Xylocain does not meet the requirements for a good active placebo.
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Vaughn, Boyd Aaron. "The Predictive Ability of Specific Questions Related to Symptoms in the Diagnosis of Endodontic Disease." VCU Scholars Compass, 2005. http://scholarscompass.vcu.edu/etd/1304.
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The purpose of this study was to test the predictive ability of specific questions in diagnosis of pulpal and periradicular disease in a dental school population. 210 patients were recruited to fill out a questionnaire, and undergo a clinical examination for pulpal and/or periradicular disease.The Questionnaire asked if the patient had in the last 6 months: 1. a toothache that kept them up at night 2. a toothache that required pain killers 3. facial swelling caused by a tooth 4. injury to any teeth 5. a broken tooth 6. a tooth darker in color than the surrounding teeth 7. a bump, pimple, or boil on the gums. 8. a toothache after eating or drinking something hot or cold 9. repeated sharp pain in the same area while chewing 10. A toothache or facial swelling that caused them to visit an emergency room.Examiners were blinded to the responses on the questionnaire and then, based on the clinical examination and testing, determined the presence or absence of endodontic disease. The data was analyzed using univariate logistic regression models.Results: The most predictive questions were #1 and #2 (p-value Conclusion: Patients with pain that wakes them at night or that requires analgesics were greater than 3 times more likely to have endodontic disease at the time of examination.
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Brink, Yolandi. "Sitting posture : a predictive factor for upper quadrant musculoskeletal pain in computing high school students." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71876.
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Thesis (PhD)--Stellenbosch University, 2012.Includes bibliography
ENGLISH ABSTRACT: Introduction: The increased prevalence of adolescent upper quadrant musculoskeletal pain (UQMP) is becoming a great concern to health professionals. The risk factors associated with adolescent UQMP are complex and multifactorial, including, among others sitting as a physical risk factor. However, no evidence exists to support sitting postural angles as a potential predictive factor for adolescent UQMP in computing high school students. Thus, the current project aimed to describe the three-dimensional (3D) sitting postural angles of computing South African high school students in a real-life setting, using a well-tested and documented posture measurement instrument. Methodology: This research project is comprised of seven related studies. Part I of the dissertation presents a systematic review describing the reliability and validity testing of posture measurement instruments. This is followed by three primary correlation and repeated measures observational studies aimed at ascertaining the reliability and validity of a newly developed 3D Posture Analysis Tool (3D-PAT) in the measurement of nine sitting postural angles of computing high school students. Part II of the dissertation presents a systematic review, that evaluates the latest published research evidence of whether sitting is related to UQMP, and, if so, to identify the elements of sitting that significantly contribute to UQMP. This review is followed by a description of a cohort study, with a prospective period of one year. The 3D-PAT was implemented in a clinical research setting in order to measure the 3D sitting posture of a cohort of asymptomatic computing high school students and in order to assess the outcome, seated-related UQMP, prospectively. The prospective study design enabled the research project to contribute to an understanding of any causative relationship between the exposure (sitting postural angles) and the outcome (seated-related UQMP) in a subgroup of adolescents (computer users). Results: After the first phase of psychometric testing of the 3D-PAT using high school students, the findings indicated that the instrument required modifications prior to further psychometric testing. The second phase of testing revealed that the 3D-PAT compared very well with the reference standard for measurement of the X-, Y- and Z-coordinates of the reflective markers on a mannequin. The findings from the phase three study, again using high school students, indicated that the 3D-PAT compared very well with the reference standard and justified its use for the measurement of six sitting postural angles of the upper quadrant in computing high school students. For the cohort study, a 60% response rate for participation was achieved at baseline, with 98% of the students participating at six-month and 80% at one-year follow up. Of the students, 33.5% complained of seated-related UQMP during the follow-up period. Exposure to increased head flexion (>80°) (ρ=0.0001) and the combination of increased head flexion and decreased cranio-cervical angles (ρ=0.007) were significant predictors of seated-related UQMP for those computing high school students complaining of pain greater than the 90th percentile for such. Conclusion: The project described in the current dissertation is the first research project to assess sitting postural angles in asymptomatic high school students, while they worked on desktop computers in a school computer classroom and to assess UQMP prospectively. The research project reports a causal relationship between increased head flexion and seated-related UQMP as increased head flexion was found to be a predictor of seated-related UQMP developing within six to 12 months for computing high school students with a pain score equal or greater than the 90th percentile for pain. The research project emphasises that further research is warranted to investigate the causal pathway between sitting posture and adolescents’ UQMP.
AFRIKAANSE OPSOMMING: Inleiding: Die stygende voorkoms van boonste-kwadrant muskuloskeletale-pyn (BKMP) onder adolessente is besig om ’n groot bron van kommer vir professionele gesondheidswerkers te word. Die risiko-faktore waarmee adolessente BKMP gepaard gaan, is kompleks en multifaktories. Dit sluit onder andere sit as ’n fisiese risiko-faktor in. Daar is egter nog geen bewyse om sittende posturale hoeke as potensiële voorspeller van adolessente BKMP te ondersteun nie. Dus beoog hierdie projek om die drie-dimensionele (3D) sittende posturale hoeke van Suid-Afrikaanse hoërskoolleerders wat ook rekenaargebruikers is, in ’n werklike omgewing te beskryf, deur gebruik te maak van ’n instrument wat postuur meet en wat goed getoets en gedokumenteerd is. Metodiek: Hierdie navorsingsprojek is saamgestel uit sewe studies. Gedeelte I van die proefskrif bied ’n sistematiese oorsig van betroubaarheids- en geldigheidstoetsing van instrumente wat postuur meet. Dit word gevolg deur drie primêre korrelasie studies en studies vir die waarneming van herhaalde meting wat die betroubaarheid en geldigheid van n nuut-ontwikkelde 3D instrument vir posturale analise (3D-PAT) bepaal, wanneer nege sittende posturale hoeke van hoërskoolleerders wat rekenaars gebruik, gemeet word. Gedeelte II van die proefskrif bied ’n sistematiese oorsig van die jongste gepubliseerde navorsing om te evalueer of daar bewyse is dat sit verband hou met BKMP, en, indien wel, om die elemente van sit wat betekenisvol bydra tot BKMP, te identifiseer. Die sistematiese oorsig word deur ’n beskrywing van ‘n jaarlange kohortstudie gevolg. Die 3D-PAT is gebruik in ’n kliniese-navorsingsraamwerk om die 3D-sitpostuur van ’n kohort simptoomvrye hoërskoolleerders wat rekenaargebruikers is, te meet en sitverwante BKMP as uitkoms in die vooruitsig te stel. Die studie ontwerp het dit vir die navorsingsprojek moontlik gemaak om ’n insiggewende bydrae te lewer tot begrip vir enige oorsaaklikheidsverwantskap tussen die blootstelling (sittende posturale hoeke) en die uitkoms (sitverwante BKMP) in ’n subgroup van adolessente (rekenaargebruikers). Resultate: Na afloop van die eerste psigometriese toesting van die 3D-PAT, waarin hoërskoolleerders gebruik is, het bevindings daarop gedui dat die instrument verander moet word voordat toetsing kan voortgaan. Die tweede fase van toetsing het getoon dat die 3D-PAT baie goed vergelyk met die verwysingstandaard vir die meet van die X-, Y- en Z-koördinate van die reflektiewe merkers op ’n mannekyn. Die bevindings van die derde fase van die studie, waartydens hoërskoolleerders weer gebruik is, het aangedui dat die 3D-PAT baie goed vergelyk met die verwysingstandaard. Dit het die gebruik van die instrument om ses sittende posturale hoeke van die boonste kwadrant van hoërskoolleerders wat rekenaars gebruik te meet, bevestig. Die kohortstudie het ’n 60%-reaksiesyfer vir deelname behaal tydens die basislynmetings, waarvan 98% leerders deelgeneem het aan die sesmaande-opvolgmetings en 80% aan die eenjaaropvolgmetings. ’n Totaal van 33.5% van die leerders het gekla van sitverwante BKMP gedurende die eenjaar opvolgperiode. Blootstelling aan ’n vergrootte kopfleksie-hoek (>80°) (ρ = 0.0001) en die kombinasie van ’n vergrootte kopfleksie- en verminderde kranio-servikale hoek (ρ = 0.007) was betekenisvolle voorspellers van sitverwante BKMP vir die hoërskoolleerders wat rekenaars gebruik en kla van groter pyn as die 90ste persentiel daarvan. Gevolgtrekking: Hierdie projek is die eerste navorsing wat sittende posturale hoeke van simptoomvrye hoërskoolleerders wat op tafelrekenaars in die skool se rekenaarklaskamer werk, meet en BKMP voorspel. Die navorsingsprojek rapporteer ‘n oorsaaklikheidsverwantskap tussen ‘n vergrootte kopfleksie-hoek en sitverwante BKMP omdat vergrootte kopfleksie ‘n voorspeller is van sitverwante BKMP wat binne ses tot 12 maande by hoërskoolleerders wat rekenaars gebruik, met ‘n pyntelling gelyk of groter as die 90ste persentiel van pyn, ontwikkel. Die navorsingsprojek beklemtoon dat verdere navorsing om die oorsaaklikheidsroete tussen sitpostuur en adolessente BKMP te ondersoek, geregverdig is.
Medical Research Council of South Africa
National Research Fund
Division of Research Development and Support of Stellenbosch University
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Thomson, Jessie. "Algorithms for automatic analysis of radiographs of the knee with application in diagnosis and monitoring of osteoarthritis." Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/algorithms-for-automatic-analysis-of-radiographs-of-the-knee-with-application-in-diagnosis-and-monitoring-of-osteoarthritis(22af4216-3ff4-41b5-ac44-1dd4d83a53bd).html.
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Osteoarthritis (OA) of the knee is a disease that deteriorates the bones and surrounding soft tissue of the affected joint. Categorisation of the disease into grades of severity is subject to errors of measurement and poor observer agreement. There is an urgent need for automated methods to measure radiographic features and remove, as far as possible, the element of subjectivity in assessment. This project creates a fully automated system to analyse all aspects of the knee in radiographs. The methods evaluate explicit and implicit features of: overall shape, trabecular structure, osteophytes, tibial spines and intercondylar notch, and joint space shape. The project develops the first fully automated osteophyte detection algorithms, improved trabeculae features using raw pixel intensities, and a better analysis of joint space using shape models. This project is the first to combine explicit and implicit features across the whole of the knee, and applies these features to classify radiographs using four main outcomes: current OA, current pain, later onset OA, and later onset pain. The results find a strong current OA classification rate, with an Area Under the ROC Curve (AUC) of 0.904 and weighted kappa of 0.49 (0.48-0.51). The remaining later onset and pain experiments report weaker results; these results suggest that radiographic features in Posterior-Anterior (PA) view radiographs have a weak association with clinical and later onset OA.
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MacKenzie, James. "The Proportion of Adolescents Complaining of Anterior Knee Pain with Osteochondritis Dissecans and the Utility of Screening Radiographs in its Diagnosis." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/604313.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Osteochondritis dissecans is a rare condition which can cause disabling knee pain in adolescents. Treatment and prognosis hinges upon the stage of the lesion and early detection is paramount 1‐3. Until recently, epidemiologic information regarding OCD in adolescents was unavailable. However in 2013 Kessler et al. demonstrated an incidence of 9.5/100,000 in the general adolescent population 4. Chief complains from patients with OCD usually localize pain to the knee joint line, but less commonly, patients may complain of anterior knee pain. This retrospective chart review looked at the amount of OCD diagnoses in adolescents specifically complaining of anterior knee pain without causative trauma in the years 2009 and 2010 at a major children’s hospital. It was noted that 7.5% of children with this presentation had a diagnosis of OCD. This number was over three orders of magnitude higher than the incidence seen in the general adolescent population as established by Kessler and may support the use of screening radiographs in this subset of patients to detect OCD in its early stages.
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Santos, SÃnia Maria Josino dos. "Dor aguda: RevisÃo do diagnÃstico de enfermagem em pacientes com infarto agudo do miocÃrdio." Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=14799.
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nÃo hÃO estudo tem por objetivo revisar o diagnÃstico de enfermagem (DE) Dor aguda em pacientes hospitalizados com infarto agudo do miocÃrdio (IAM). Estudo metodolÃgico de validaÃÃo de diagnÃsticos de enfermagem, desenvolvido em trÃs etapas fundamentadas no modelo de Hoskins (1989): anÃlise de conceito de dor aguda, validaÃÃo por especialistas e validaÃÃo clÃnica. Na primeira etapa utilizaram-se o modelo de Walker e Avant (2005) e a revisÃo integrativa conforme Whittemore; Knafl (2005) a partir da busca em periÃdicos indexados, por meio do acesso nas bases de dados CINHAL, SCOPUS e PUBMED, de estudos publicados sobre dor aguda no infarto agudo do miocÃrdio no perÃodo de 2006 a 2012. Para a busca nas bases de dados utilizou-se o vocabulÃrio MeSH â Medical Subject Headings of U.S National Library of Medicine e o DeCS â Descritores em CiÃncias da SaÃde em lÃngua inglesa e espanhola: acute pain; myocardial infarction e dolor agudo, el infarto miocardio. Para a busca nas trÃs bases de dados e cruzamento dos descritores utilizou-se o operador booliano âANDâ. Para ampliar a busca empregou-se o cruzamento: âacute painâ and âmyocardial infarctionâ. Aplicados os critÃrios de inclusÃo e exclusÃo, restaram 29 estudos. Encontraram-se quatro atributos crÃticos essenciais para a compreensÃo do conceito dor aguda no infarto agudo do miocÃrdio: qualidade (constrictiva, opressiva, pressÃo, aperto e peso, sensaÃÃo de esmagamento, tÃpica isquÃmica, dilacerante e triturante); localizaÃÃo (regiÃo retroesternal, subesternal, torÃcica, do lado esquerdo do peito, centro do esterno emeio do peito, peito direito); tempo e duraÃÃo (inÃcio sÃbito, prolongada com duraÃÃo de 15 a 30 minutos, recorrente e intermitente); irradiaÃÃo (pescoÃo, ombro esquerdo, mandÃbula, regiÃo interescapular, braÃo direito e esquerdo, costas, estÃmago, abdome, epigastro, pulso braquial e radial esquerdo). Foram identificadas 14 caracterÃsticas definidoras(CDs) na anÃlise de conceito, das quais oito encontraram correspondÃncia no DE Dor aguda da NANDA-I. Elaborou-se um instrumento com a definiÃÃo construÃda na anÃlise de conceito, a constante na NANDA-I e as 14 CDs e respectivas definiÃÃes conceituais e referÃncias empÃricas identificadas. Submeteu-se esse instrumento ao crivo de 22 especialistas em terminologias de enfermagem e/ou dor aguda e/ou infarto agudo do miocÃrdio. Dos especialistas (54,54%) optaram pela definiÃÃo resultante da anÃlise de conceito. ApÃs o julgamento, recomenda-se, alÃm das oito CDs identificadas na NANDA-I, o acrÃscimo de mais seis CDs ao DE Dor aguda identificadas na anÃlise de conceito: Dispneia; Fraqueza; Fadiga; NÃusea; VÃmito e Palidez. As 14 CDs analisadas e validadas por especialistas foram testadas na prÃtica clÃnica, por meio de um estudo transversal realizado com 125 pacientes com diagnÃstico de IAM. Os achados mostraram que Relato de dor aguda, Diaforese, Fadiga, Palidez e Fraqueza, sÃo bons indicadores da ocorrÃncia do diagnÃstico de enfermagem Dor aguda no infarto agudo do miocÃrdio. As CDs PressÃo sanguÃnea elevada, DistÃrbio do sono, FrequÃncia cardÃaca elevada, FrequÃncia respiratÃria elevada, DispnÃia, NÃusea, VÃmito, Ansiedade e Medo nÃo foram indicadores satisfatÃrios do diagnÃstico em estudo. Portanto, cinco CDs demonstraram-se conforme a anÃlise de conceito, validaÃÃo por especialistas e validaÃÃo clÃnica, apropriadas para avaliar o DE Dor aguda em pacientes com IAM.
The objective of the study was the nursing diagnosis validation (ND) of Acute Pain of patient with Acute Myocardial Infarction (AMI). Methodological study developed in three stages of nursing diagnosis validation, found by the Hoskins model (1989): concept analysis, validation by specialists and clinical validation. In the first stage were Walker and Avant model (2005) and Whittemore; Knafl (2005) integrative review from the indexed journal search by the CINHAL, SCOPUS and PUBMED database access of studies published in the period between 2006 and 2012. The Pubmed and Cinahl database search used the indicated terminology, the MeSH â Medical Subject Headings of U.S National Library of Medicine English vocabulary. The Scopus database had DeCS â Descriptors Health Science structure vocabulary. To identify the different uses of acute concept, there was a study survey with the controlled descriptors Acute Pain and Myocardial Infarction in English language and Dolor Agudo and Infarto Miocardio in Spanish language. In the three databases search descriptorÂs crossing we used the Boolean operator âANDâ. âAcute painâ and âmyocardial infarctionâ enlarge the crossing search. After applying the exclusion and inclusion criteria, 29 studies remained (from 535). There were four essential critical characteristics to understand acute pain concept. They are quality (constrictive, oppressive, pressure, tightness and weight, crushing feeling, typical ischemic, heartbreaking and grinding); location (retrosternal region, substernal, chest, the left side of the chest, sternum and through the center of the chest, right chest); time length (sudden onset, prolonged lasting 15 to 30 minutes, recurrent and intermittent); irradiation (neck, left shoulder, jaw, interscapular region, right and left arm, back, stomach, abdomen, epigastrium, left radial and brachial pulse). For the Acute Pain ND, NANDA-I presents 18 defined characteristics (DCs) identifying eight in the concept analysis adequate for Acute Pain diagnosis in AMI patients. Besides these ones, we found six more, in 15 DCs. There were elaboration of an instrument with the concept analysis definition, the constant NANDA-I and 14 DCs and their conceptual definitions and identified empiric references. Twenty-two specialists studied this instrument in nursing terminology and/or acute pain and/or acute myocardial infarction. From them (54,54%) they opted concept analysis definition. After appreciation, there were recommendation of the eight DCs identified in the NANDA-I and six new DCs for the ND Acute pain identified in the concept analysis. They were dyspnea; weakness; fatigue; nausea; Vomiting and paleness. The specialist tested in the clinical practice the 14 analyzed and validated DCs, through a transversal study done with 125 patients with AMI diagnosis. The findings showed that the acute pain, Diaphoresis, Fatigue, Paleness and Weakness are good indicators of the Acute Pain nursing diagnosis. The Elevated Blood Pressure, Sleep Disturbance, Elevated Heart Rate, Elevated Respiratory Rate, Dyspnea, Nausea, Vomiting, Anxiety and Fear DCs, were not satisfactory indicators of the study diagnosis. Therefore, five DCs were according to concept analysis, specialist validation and clinical validation, right to evaluate the Acute Pain ND in AMI patients.
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Corrêa, Consuelo Garcia. "Dor: validação clínica no pós-operatório de cirurgia cardíaca." Universidade de São Paulo, 1997. http://www.teses.usp.br/teses/disponiveis/7/7135/tde-15092006-170613/.
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O objetivo deste estudo foi estimar a validade de conteúdo das características definidoras da dor. A população foi composta por dois grupos de 40 pacientes em pós-operatório de cirurgia cardíaca. Um dos grupos foi composto por pacientes com dor e o outro grupo por pacientes sem dor no momento da avaliação. As características estudadas foram classificadas em função da freqüência de ocorrência nos pacientes com dor, como maiores - entre 80 e 100%, menores - entre 50 e 79% e irrelevantes - inferior a 50%. Trinta e duas características definidoras possíveis foram identificadas na literatura. Para cada característica definidora foi construída uma definição operacional com critérios para sua mensuração que foram validados por juízes. Todos os pacientes foram observados e entrevistados quanto a presença de cada uma das características definidoras. Foram aplicados testes estatísticos paramétricos e não-paramétricos para identificar as diferenças entre os grupos segundo as características definidoras. O grupo de pacientes com dor foi estatisticamente diferente do grupo de pacientes sem dor pela maior frequência de ocorrência ou por apresentar escores mais elevados nas seguintes dezenove características definidoras: Maiores- comunicação de descritores de dor, desconforto, medo da dor, alteração no padrão de sono, comportamento protetor, comportamento doloroso, irritabilidade, inquietação, expressão facial de dor, aumento da frequência cardíaca, imobilidade; Menores- ansiedade, diminuição na ingestão de alimentos, focalização limitada, afastamento do contato social, prejuízo nos processos de pensamento, postura não usual, elevação da pressão arterial, alteração no padrão respiratório. Estudos similares em outras populações com dor aguda e com dor crônica serão úteis para o desenvolvimento do conhecimento nessa área.The aim of this study was to estimate the content validity of pain defining characteristics. The sample consisted of two groups of 40 post-operative heart surgery patients of which one was composed of patients experiencing pain. The defining characteristics were graded according to frequency in the patients in pain: major, minor and irrelevant. Thirty-two possible defining characteristics were identified in the literature. Operational definitions and measurement criteria were developed for each of the defining characteristics being validated by experts. Each patient was observed and interviewed with regard to the presence of each of the defining characteristics. Parametric and non-parametric statistical tests were performed in order to identify the differences between groups according to defining characteristics. The group experiencing pain had statistically different results from the group without pain because there was a higher frequency or higher scores in the following nineteen defining characteristics: Major- verbal report of pain, discomfort, fear of reinjury, sleep disturbance, guarding behaviour distraction behaviour, irritability, restlessness, facial expressions of pain, increased heart beat, immobility; Minor- anxiety, loss of appetite, self focus, withdrawal, impaired thought process, unusual posture, increased blood pressure and changes in respiratory patterns. Studies of the same defining characteristics in other sample groups of acute and chronic pain patients might be useful in the development of knowledge in this field.
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Fernandes, Marcella Lima Victal 1986. "Adaptação dos instrumentos "the interstitial cystitis symptom index and problem index" e "pelvic pain and urgency/frequency (PUF) patient symptom scale" para a cultura brasileira : Adaptation of the questionnaire "the interstitial cystitis symptom index and problem index" and "pelvic pain and urgency/frequency (PUF) patient symptom scale" to the brazilian culture." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310965.
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Orientador: Maria Helena Baina de Moraes LopesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivou-se traduzir, adaptar para a cultura brasileira e avaliar as medidas psicométricas de confiabilidade de teste-reteste e validade discriminante dos instrumentos "The Interstitial Cystitis Symptom Index and Problem Index" (The O'Leary-Sant) e "Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale" utilizados no diagnóstico de cistite intersticial. Foram realizadas as etapas metodológicas recomendadas pela literatura internacional para a adaptação cultural. As etapas de tradução, síntese das traduções e retro-tradução foram realizadas satisfatoriamente e a avaliação das versões síntese, pelo comitê de especialistas resultou em algumas alterações, assegurando as equivalências entre as versões originais e traduzidas. O "PUF" foi pré-testado entre 40 sujeitos e o "The O'Leary-Sant" em uma amostra de 50 indivíduos devido a necessidade de ajustes em decorrência da baixa escolaridade da população. O processo de tradução e adaptação foi realizado com sucesso e os instrumentos, após as modificações, demonstraram ser de fácil compreensão e rápido preenchimento. A estabilidade foi avaliada usando-se teste-reteste, com intervalo de 3 a 7 dias entre as duas aplicações. Para verificar a validade discriminante foram usados três grupos: um de pacientes com cistite intersticial (CI), e dois grupos controles: um formado por indivíduos com pelo menos um sintoma indicativo de CI (controle 1) e outro por pessoas sem sintomas (controle 2). O teste-reteste foi aplicado a 24 pacientes com CI (grupo de estudo). O coeficiente de correlação intra-classe (CCI) foi de 0,56, IC: 95% (0,21-0,78) para o índice de sintomas do "The O'Leary-Sant", 0,48, IC: 95% (0,10-0,73) para o índice de problemas do "The O'Leary-Sant" e de 0,49, IC: 95% (0,12-0,74) para o PUF. Para a análise da validade discriminante entre os grupos utilizou-se o teste exato de Fisher e odds ratio para identificar as diferenças. O p-valor <0,0001 indicou que, considerando um nível de significância de 5%, a hipótese nula foi rejeitada, isto é, houve indícios de que pelo menos dois grupos eram diferentes em relação à proporção de casos com cistite intersticial. Concluiu-se que os dois instrumentos analisados não atingiram valor adequado para confiabilidade, o que gera a necessidade de futuros estudos de análises de medidas psicométricas em uma amostra maior de pacientes com cistite intersticial
Abstract: The objective was to translate, adapt to the Brazilian culture and to evaluate psychometric measures of test-retest reliability and discriminant validity of the instruments "The Interstitial Cystitis Symptom Index and Problem Index" (The O'Leary-Sant) and "Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale" used in the diagnosis of interstitial cystitis. We made the methodological steps recommended by the international literature for cultural adaptation. The steps of translation, synthesis of translations and back-translation were performed satisfactorily and evaluation the versions of the synthesis by the committee of experts has resulted in some changes, ensuring the equivalence between the original and translated versions. The "PUF" was pre-tested among 40 subjects and "The O'Leary-Sant" in a sample of 50 individuals due to the need for adjustments due to the low education population. The translation and adaptation process was successful and the instruments, after changes, proved easy to understand and fill quickly. However, this is a study prior to the validation process and will be pressing the use of the instrument in new research to be assessed its measurement properties. The stability of test-retest was evaluated using intervals of 3 to 7 days between the two applications. To check the discriminant validity were used three groups: patients with interstitial cystitis (IC), and two control groups: one composed of individuals with at least one symptom of CI (control 1) and another for those without symptoms (control 2). The test-retest was administered to 24 patients with IC (study group). The Intraclass Correlation Coefficient (ICC) was 0.56, IC: 95% (0.21-0.78) for the index of symptoms of "The O'Leary-Sant", 0.48, IC: 95% (0.10-0.73) for the index of issues of "The O'Leary-Sant" and 0.49, IC: 95% (0.12-0.74) for PUF. For the analysis of discriminant validity between groups used the Fisher exact test and odds ratios to identify the differences. The p-value <0.0001 indicated that, considering a significance level of 5%, the null hypothesis is rejected, ie, there were signs that at least two different groups were compared to the proportion of patients with interstitial cystitis. It was concluded that the two instruments analyzed did not reach the appropriate value for reliability, which creates the need for future studies of analyzes of psychometric measures in a larger sample of patients with interstitial cystitis
Mestrado
Enfermagem e Trabalho
Mestra em Ciências da Saúde
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Zakaria, Hassan. "Analgesic Use in U.S. Emergency Departments for Patients Reporting Moderate to Severe Pain: Diagnosis and Select Patient Characteristics Influencing Narcotic Analgesic Prescribing Practices." VCU Scholars Compass, 2007. http://scholarscompass.vcu.edu/etd/888.
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Objective: This study aims to examine the relationship between emergency department patient encounter characteristics and narcotic analgesic prescribing practices in order to determine what patient characteristics, if any, influence the decision to prescribe narcotics.Methods: Cross sectional data on patients presenting to U.S. emergency departments from the 2003 and 2004 National Hospital Ambulatory Medical Care Survey were analyzed. Patients reporting moderate to severe pain were included in the sample and analysis. Chi square tests of significance were used to assess the association between individual demographic and encounter characteristics to narcotic prescription or administration. Separate multiple logistic regressions were then performed on patients presenting with one of the three most common diagnosis categories or reasons for visit, since this was thought to also influence the decision to prescribe narcotics or not. Multivariate analysis produced adjusted odds ratios and 95% confidence intervals in order to determine the independent associations between each predictor variable and narcotic medication prescription or administration.Results: Our sample included 26,248 individuals presenting to U.S. emergency departments with moderate to severe pain as recorded by the NHMCS survey. Various patient and encounter characteristics appeared to influence narcotic administration in the univariate analysis including age, race, ethnicity, alcohol use, method of payment, geographic location and whether or not visit was related to a work injury or illness. No gender differences were found. Combining the top 3 reasons for visit, we found that race, patient alcohol use, age, geographic location and ethnicity all had significant bearing on the prescription of narcotics. Much of this was true when looking at top three diagnoses. Age, race, patient alcohol use, and geographic location were all associated with significantly different rates of narcotic administration, while ethnicity dropped out of significance. Black race, in both subcategories of analysis, showed the greatest association with decreased odds of receiving narcotic drugs in the ED.Conclusion: While initiatives like Healthy People 2010 are aimed at improving health and eliminating health care disparities, it appears that disparities still do exist on many levels. As it has been concluded through various other studies, it appears that race does influence health care providers' decisions to prescribe or administer narcotics. In January of 2001 JAHCO revised their standards to better address pain management of patients in the United States. While pain may be better-evaluated and recorded and overall rates or pain medication administration or prescription may have improved, it appears that the common disparities have not.
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Mazoni, Simone Roque. "Elaboração e validação do diagnóstico de enfermagem dor de parto." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/83/83131/tde-06112012-193210/.
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O estudo teve como proposta analisar se o fenômeno da dor de parto está retratado no diagnóstico de enfermagem Dor Aguda da taxonomia NANDA-I e propor e validar o Diagnóstico Dor de parto. Seguiu-se os preceitos de Hoskins (1989) e Fehring (1986) para as fases da análise de conteúdo e validação clínica do diagnóstico. Na primeira fase foi analisado o conceito de \"dor em situação de parto\" segundo referencial teórico de Walker e Avant (2005) com sumarização dos dados analisados por meio de revisão integrativa da literatura à estrutura metodológica de Whittemore (2005). A análise do conceito \"dor em situação de parto\" reforçou a pertinência de se propor um novo diagnóstico e submetê-lo a análise por peritos. O diagnóstico construído foi submetido a dez enfermeiros obstetras, sendo o mesmo à análise de conteúdo aprovado quanto à definição, fatores relacionados (período de dilatação: fase latente, fase ativa, fase de transição; período de expulsão), características definidoras e inserção do diagnóstico ao Domínio 12 - Conforto e à Classe 1 - Conforto físico; das 28 características definidoras submetidas às opiniões sobre o grau de indicação para o diagnóstico, 9 foram muito indicativas do diagnóstico: evidência observada de contração uterina à média ponderada de 0,95, alteração do tônus muscular (0,93), alteração da frequência respiratória (0,85), comportamento expressivo (0,85), expressão facial de dor (0,85), evidência observada de dor (0,85), diaforese (0,83), relato verbal ou codificado (0,80) e alteração da frequência cardíaca (0,80), sendo o cálculo DCV total igual a 0,73. Outras 13 foram validadas (escores maiores de 0,50) e 6 foram consideradas não representativas (escores inferiores a 0,50). Vinte e duas características definidoras identificadas na análise de conceito foram testadas clinicamente em parturientes em fase ativa do trabalho de parto. Foram observadas 49 parturientes na fase ativa inicial (FAI) e 37 na fase ativa final (FAF). Para análise da homogeneidade entre as parturientes que fizeram uso de analgésicos e as que não fizeram uso de analgésicos e as variáveis intervenientes: indução de parto, característica da bolsa, líquido amniótico, técnicas alternativas para alívio da dor, relaxamento e descida fetal e intervenção analgésica e, para análise das diferenças de frequências de ocorrência de características definidoras entre as fases ativa inicial e final do trabalho de parto foi utilizado o teste exato de Fisher. Prova de Mann-Whitney foi realizada para a relação dos escores de intensidade de dor entre o uso e não uso do analgésico. Para análise da relação entre amplitude de pressão intrauterina e escores de dor, nas fases ativa inicial e final do trabalho de parto foi utilizado o teste de Correlação de Spearman. Seis características definidoras estiveram presentes na FAI, e também foram os indicadores principais na FAF, são elas: relato verbal ou codificado (FAI e FAF: 100%), evidência observada de contração uterina (FAI: 98%; FAF: 100%), alteração do tônus muscular (FAI: 98%; FAF: 100%), evidência observada de dor (FAI e FAF: 100%), comportamento expressivo (FAI: 93,9%; FAF: 100%) e expressão facial de dor (FAI: 87,8%; FAF: 100%). Em ambas as fases não foram observadas: alteração na frequência cardíaca, alteração na frequência respiratória, alterações na pressão sanguínea, dilatação pupilar, exceto para alteração da pressão arterial e dilatação pupilar em que houve presença em uma parturiente para cada indicador. Os resultados mostraram diferenças estatisticamente significantes (p ≤ 0,05) para diaforese, expressão facial de dor, gestos protetores/comportamento de defesa, posição antálgica para evitar dor, comportamento de distração, foco em si próprio e relato de pressão no períneo, sendo estas predominantes na FAF. Observou-se correlação linear positiva entre a referência verbal (pelos escores de intensidade de dor) e a amplitude de pressão intrauterina, com aumento do escore de intensidade de dor à medida que aumenta a pressão em mmHg na fase ativa inicial (rS = 0,381; p = 0,008) e na fase ativa inicial de parturientes em uso do analgésico (rS = 0,758; p = 0,002). O estudo mostrou a dor em situação de parto como fenômeno peculiar a um evento fisiológico em seus diferentes períodos, com achados que apontam para um novo diagnóstico de enfermagem.The study aimed to analyze if the phenomenon of labor pain is characterized in the nursing diagnosis Acute Pain of NANDA-I taxonomy and to develop and validate the diagnosis Labor Pain. The precepts of Hoskins (1989) and Fehring (1987) for the phases of content analysis and clinical validation of the diagnosis were followed. In the first phase, the concept of \"labor pain\" according to the theoretical referential of Walker and Avant (2005) was analyzed, with summarization of the data using integrative literature review of the methodological framework of Whittemore (2005). The construction of the concept \"labor pain\" reinforced the relevance of proposing a new diagnosis and subjecting it to the analysis by experts. The diagnosis was submitted to ten obstetric nurses and approved regarding the definition, related factors (period of dilatation: latent phase, active phase, transition phase of labor; period of expulsion), defining characteristics and insertion of diagnosis to the Domain 12 - Comfort and to the Class 1 - Physical Comfort; of the 28 defining characteristics submitted to the opinions on the degree of indication for the diagnosis, 9 were very indicative of the diagnosis: evidence observed of uterine contraction to the average of 0.95, change in muscle tone (0.93), change in respiratory rate (0.85), expressive behavior (0,85), facial expression of pain (0.85), observed evidence of pain (0.85), diaphoresis (0.83), verbal or coded report (0.80), and change in heart rate (0.80), being the CVD total calculation equal to 0.73. Another 13 were validated (scores greater than 0.50) and 6 were considered unrepresentative (scores below 0.50).Twenty-two defining characteristics identified in concept analysis were clinically tested in pregnant women in active phase of labor. 49 parturient women were observed during initial active phase (IAP) and 37 in the final active phase (FAP). To analyze the homogeneity among parturient women who used analgesics and those who did not use analgesics and the intervening variables: induction of labor, characteristic of placenta, amniotic fluid, alternative techniques for pain relief, relaxation and decrease fetal and analgesic intervention; and the Fisher\'s exact test was used to analyze differences in frequencies of occurrence of the defining characteristics between the initial and final active phase of labor. Mann-Whitney test was performed for the relationship of pain intensity scores between the use and non use of the analgesics. The Spearman correlation test was used to analyze the relationship between intrauterine pressure amplitude and pain scores, in the initial and final phases of labor. Six defining characteristics were present in the initial active phase (IAP), and were also the main indicators in the final active phase (FAP), which are: verbal or coded report (IAP and FAP: 100%), observed evidence of uterine contraction (IAP: 98%, FAP: 100%), abnormal muscle tone (IAP: 98%, FAP: 100%), observed evidence of pain (IAP and FAP : 100%), expressive behavior (IAP: 93.9%, FAP: 100%), and facial expression of pain (IAP: 87.8%; FAP: 100%). In both phases were not observed: change in heart rate, change in respiratory rate, change in blood pressure, pupil dilation, except for change in blood pressure and pupil dilation that was present in one parturient for each indicator. The results showed statistically significant differences (p ≤ 0.05) considering diaphoresis, facial expression of pain, protective gestures/defensive behavior, antalgic position to avoid pain, distraction behavior, focus on yourself and report of pressure in the perineum, which are predominant in the IAP. Positive linear correlation between the verbal reference (by scores for pain intensity) and amplitude of intrauterine pressure was observed, with higher scores of pain intensity when increasing pressure in mmHg in the initial phase (rS = 0.381; p = 0.008) and the initial active phase of parturient women in use of analgesics (rS = 0.758; p = 0.002). The study showed the situation of labor pain as a phenomenon peculiar to a physiological event at different periods, with findings that point to a new nursing diagnosis.
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Body, Richard. "Clinical decision rules to enable exclusion of acute coronary syndromes in Emergency Department patients with chest pain." Thesis, Manchester Metropolitan University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.497776.
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Background: Diagnosis of acute coronary syndromes (ACS) in the Emergency Department (ED) is a topical and contentious issue. Current diagnostic techniques rely on hospital admission for troponin testing. Only a minority of those admitted prove to have ACS while unacceptable proportions of those discharged have unrecognised ACS. Aims: We aimed to evaluate the diagnostic and prognostic value of individual clinical findings and novel biomarkers in ED patients with suspected cardiac chest pain. We then aimed to derive a clinical decision rule (CDR) to potentially enable safe, immediate discharge of a proportion of patients from the ED while risk stratifying others to facilitate triage to an appropriate level of in-patient care. Methods: We recruited patients who presented to the ED with suspected cardiac chest pain. Variables that have previously been shown to predict diagnosis of acute myocardial infarction (AMI) or to predict outcome were prospectively recorded. Blood was drawn at presentation for levels of eight biomarkers. Patients underwent 12-hour troponin testing and were followed up for the composite primary outcome of AMI, death or urgent coronary revascularisation for six months. Variables that were univariate predictors (p<0.05) of outcome were entered into a multivariate analysis using recursive partitioning. Results: While many clinical findings and levels of all eight novel biomarkers were found to be significant predictors of outcome, none could be used individually to confirm or exclude ACS in the ED. We derived a nine-point CDR that combined clinical findings with biomarker levels to effectively stratify patients into four risk groups. 14.2% of patients were identified as being at ‘no risk’ and had a 0.0% outcome rate. The rule performed significantly better than two commonly used risk scores and may improve on triage decisions made in actual clinical practice. Conclusion: ACS remains a difficult diagnosis to confidently confirm or refute in the ED. Our CDR may help to avoid unnecessary hospital admissions while improving on triage decisions made for the remaining in-patients. Prospective validation of our findings is warranted.
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Vandi, Matteo. "Diagnosi differenziale nel dolore laterale di gomito come strumento di valutazione fisioterapica: una scoping review." Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2020. http://amslaurea.unibo.it/21893/.
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Background: il dolore laterale di gomito (LEP) è una problematica muscolo-scheletrica che interessa la componente epicondiloidea degli estensori di polso e dita. Movimenti ripetitivi di flesso-estensione e prono-supinazione del gomito, sollevamenti di carichi pesanti e frequenti estensioni di polso contro resistenza contribuiscono all’insorgere della patologia, portando a una riduzione della partecipazione durante le attività di vita quotidiana.
Obiettivo: L’obiettivo della scoping review è quello di raccogliere informazioni in letteratura riguardanti la diagnosi differenziale nel dolore laterale di gomito al fine di fornire strumenti utili a discriminare tutte quelle che possono essere le problematiche e patologie associate per poi programmare un piano terapeutico mirato ed efficace.
Metodi: la ricerca è avvenuta consultando banche dati disponibili online quali PubMed, PEDro e Cochrane Library e tramite ricerca manuale bibliografica. Sono stati analizzati articoli che trattano la diagnosi differenziale nel LEP di qualsiasi tipologia, in lingua inglese e riguardanti il genere umano.
Risultati: sono stati inseriti 26 articoli rispondenti ai criteri di eleggibilità, di cui 16 revisioni, 3 studi diagnostici, 1 studio comparativo, 1 studio terapeutico e 5 Case Report. È stato creato un diagramma di flusso per descrivere le fasi del processo di ricerca, mentre il contenuto dei singoli articoli è stato schematizzato in una tabella sinottica.
Conclusioni: ad oggi eseguire una corretta diagnosi differenziale in presenza di LEP risulta complicato. Tante sono le patologie che possono essere causa di questa problematica e molte di queste risultano difficili da discriminare fra loro. In letteratura non sono presenti un cluster di test e un algoritmo decisionale validati e affidabili che permettano di inquadrare meglio un soggetto con LEP. L’imaging rappresenta uno strumento utile per la diagnosi differenziale, ma allo stesso tempo non deve sostituire il giudizio clinico.
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Chanques, Gérald. "Douleur, troubles neurologiques et psychologiques acquis en reanimation adulte : physiopathologie et prise en charge." Thesis, Montpellier 1, 2010. http://www.theses.fr/2010MON1T003/document.
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Les patients hospitalisés en réanimation présentent fréquemment des troubles neurologiques (troubles de la vigilance, troubles du sommeil, dysfonctions cognitives multiples, confusion mentale), psychologiques (anxiété, dépression, syndromes délirants), des syndromes douloureux et de l'inconfort. Ces troubles ont en commun : la problématique de leur définition et de leur reconnaissance par l'équipe de réanimation, leur expression fréquente par un comportement d'agitation, une association avec la réponse de stress post-agressive rencontrée au cours des pathologies traitées en réanimation. La physiopathologie de ces troubles est complexe, impliquant à la fois la pathologie qui a déterminé l'hospitalisation du patient en réanimation, ses antécédents médicaux, mais aussi la réanimation elle-même par les thérapeutiques invasives qui y sont utilisées, ainsi que la sédation médicamenteuse ou le coma artificiel. En outre, ces troubles peuvent être associés dans leur expression comme dans leur détermination, certain pouvant être cause ou conséquence d'un autre. L'objectif de cette thèse était de montrer qu'une prise en charge diagnostique et thérapeutique rationalisée de la douleur, des troubles neurologiques et psychologiques était associée à un meilleur pronostic du patient en réanimationPatients who are hospitalized in Intensive Care Units (ICU) develop frequent neurological disorders (vigilance disorders, sleep disorders, multiple cognitive disorders, delirium), psychological disorders (anxiety, depression, delusion), pain syndrom and discomfort. These disorders have jointly the problem of their definition and recognition by the ICU team, their frequent expression by an agitated behaviour, an association with the post-aggressive stress response affecting pathologies treated in the ICU setting. The physiopathology of these disorders is complex, implying both the pathology which had determined the admission of the patient to the ICU and his/her medical history, but also either the invasive therapeutics used by the intensive medicine and the administration of sedatives or therapeutic coma. Moreover, theses disorders can be associated either in their expression and their cause, some of them able to be a cause or a consequence of another. The objective of this thesis was to show that a rationalized diagnostic and therapeutic management of pain, neurological and psychological disorders was associated with a better outcome of the patient in the ICU