Risultati per: LBP (Low Back Pain): Cosa dicono le linee guida del mal di schiena

Question: A 44-year-old Vietnamese woman with a past medical history of hypertension presented with a 3-day history of diffuse intermittent abdominal pain associated with nausea, nonbloody nonbilious emesis, and brown loose stools. She noted worsening multiarticular joint pain including her fingers, wrists, shoulders, hips, and knees, associated with morning stiffness. She recalled a similar episode of abdominal pain with concurrent joint symptoms 2 months ago, which spontaneously resolved.

Background
Behavioural activation (BA) is an effective treatment for depression; however, it is unclear if it can be used to manage pain.

Objectives
To conduct a scoping review of primary research that reported using BA to support people living with chronic pain to understand how BA had been used in relation to pain. In addition, we wanted to understand whether there were any reported changes in that pain, and how and who delivered BA.

Eligibility criteria
Primary research published in English.

Sources of evidence
We searched seven databases MEDLINE, Ovid Embase, Ovid Emcare, PsycINFO, CINAHL, Scopus and Web of Science, for primary research. No initial date limit was used with the date the searches were conducted used as the end date limit (1 July 2021).

Charting methods
A customised data extraction table was developed, piloted and used.

Results
551 papers were screened for inclusion, with 15 papers included in our review. Studies were conducted in North America and in Canada. These included three case studies, nine uncontrolled trials and three randomised controlled trials. Only two studies reported pain as the primary outcome. BA was applied across a range of pain related conditions. The dose of BA ranged from 3 to 16 sessions. Duration of treatment was 3 weeks to 12 months. Most studies reported reductions in pain following exposure to BA.

Conclusion
BA has the potential to reduce pain. Caution needs to be exercised in the interpretation of these findings as a high risk of bias was observed in most studies. High-quality research is required to test if BA is an effective intervention for chronic pain.

Question: A 78-year-old woman presented to the emergency department with 2 weeks of right upper quadrant abdominal pain, fatigue, and weight loss. She described a loss of appetite, but denied fever, chills, or diarrhea. There was no history of prior biliary disease, hepatitis, recent travel, drug use, or new sexual partners. Her history was notable for psoriatic arthritis, which was well-controlled on ustekinumab. The physical examination was remarkable for tenderness in the right upper quadrant without other stigmata of liver disease.

BackgroundPatient and public involvement is an integral component of clinical research. A YPAG is group of young people with active involvement in the design and conduct of clinical research aimed at CYP.1 2 Active collaboration with a YPAG can be mutually beneficial and can have a positive impact on study design and conduct.2 3 We report on the involvement of young people, their influence on study design and the perceived benefits to members.MethodA UK secondary school was approached and ten 16–17 year old students agreed to form a YPAG. Three 1-hour sessions were planned involving arts-based activities to explore key challenges, predetermined iteratively by the research team. Activities involved group work to explore and propose solutions for effective CYP recruitment and data collection, produce a study logo and review the plain English summary.ResultsYPAG members produced insightful arts-based posters containing important ideas and concepts that were incorporated into the study design. A study logo was created, diaries and electronic communication methods to collect data were added and a variety of age-based leaflets were added to the recruitment strategy. Members reported several benefits from the sessions, including enhanced creative and problem-solving skills and members enjoyed the teamwork and collaborative approach.ConclusionYPAG involvement resulted in meaningful improvements to research design and members gained new knowledge, transferrable skills and improved confidence. This experience should help inform YPAG involvement in future research.ReferencesNational Institute for Health Research (2021) NIHR resource for public involvement – Involving children and young people as advisors in research. Available at: https://www.learningforinvolvement.org.uk/?opportunity=nihr-involving-children-and-young-people-as-advisors-in-research Accessed 06-Dec-2021Rouncefield-Swales A, Harris J, Carter B, Bray L, Bewley T, et al. (2021) Children and young people’s contributions to public involvement and engagement activities in health-related research: A scoping review. PLOS ONE 16(6): e0252774. https://doi.org/10.1371/journal.pone.0252774Abrehart N, Frost K, the Young Persons Advisory Group. et al. (2021) ‘A little (PPI) MAGIC can take you a long way’ : involving children and young people in research from inception of a novel medical device to multi-centre clinical trial Roald Dahl, James and the Giant Peach (1961). Res Involv Engagem 7, 2 https://doi.org/10.1186/s40900-020-00243-0.Conflict of interestGAW received funding to conduct this project through a post-doctoral bridging fellowship. HT, TB, EM and RT received financial compensation, in line with NIHR/INVOLVE guidelines, for their involvement in the YPAG group.FundingThis project formed part of a post-doctoral bridging fellowship supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM) and Health Education England. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

BackgroundAdequate management of pain in children if often a neglected aspect, usually underevaluated and under-treated. This study is a continuous review to see if pharmacological methods provided during the prehospital care of pediatric trauma patients is proper.MethodRetrospective study of clinical records of children up to 18 year of age, assisted between 2017 and 2018. Mild pathologies excluded. Epidemiological variables: age, gender, diagnosis, pediatric trauma score(PTS), analgesia, numeric rate scale(NRS), drugs administered. Quantitative variables: central and dispersión measures. Inferential statistical análisis: relationship quantitative variables, Student’s t test and categorical variables, Chi square. 95% confidence intervals, p

BackgroundDistraction therapies are widely used to manage pain and anxiety in paediatric emergency departments (ED). Paediatric patients also comprise up to 13% of some ambulance services workloads1 yet only a single study exists outlining the ad-hoc use of paramedic-initiated distraction therapy.2 Building rapport with frightened, unwell children is challenging for paramedics, but is essential to facilitate rapid assessment and care.1,3.This review aims to identify effective ED distraction techniques potentially suitable for use in paediatric patients in the prehospital setting.MethodDatabases and grey literature sources including Ovid Medline, EMBASE and CINAHL and Google Scholar were searched from their beginning to October 2021. English language interventional or observational studies were included if they reported on distraction techniques suitable for use in the prehospital setting, paediatric ED presentations, and pain and/or anxiety.ResultsOf the 4,054 records screened, 27 met the eligibility criteria. Twenty randomised trials and seven interventional studies involved children aged three months to 18 years. Distraction techniques were digital, non-digital and environmental adaptations and included virtual-reality, cartoons, music, vibration devices, bubble-blowing and ambient lighting. Ten studies reported significant reductions in self-reported pain and seven for self-reported anxiety. Some reported reduced pharmacological administration and improved patient cooperation, and parent and/or healthcare provider satisfaction when using distraction. Studies were highly heterogeneous with 17 distractors and 21 pain and/or anxiety measurement tools used.ConclusionA range of effective distraction techniques exist in paediatric EDs that may be suitable for the prehospital setting to manage pain and/or anxiety and improve patient outcomes.ReferencesFowler J, Beovich B, Williams B. Improving paramedic confidence with paediatric patients: a scoping review. Australasian Journal of Paramedicine 2017;15(1).Preston C and Bray L. Developing understanding and awareness of children’s distress, distraction techniques and holding. Journal of Paramedic Practice 2015;7(3):122–130.Cushman JT, Fairbanks RJ, O’Gara KG, et al. Ambulance personnel perceptions of near misses and adverse events in pediatric patients. Prehosp Emerg Care 2010;14:477–84.Conflict of interestNone.FundingAU$4000 in funding has been provided by the Australia and New Zealand College of Paramedicine, and AU$11,000 in funding was provided through a Monash University Advancing Womens Research Success Grant for this program of research. Dr Eastwood, Dr Howell and Professor Cameron are supported by the National Health and Medical Research Council (NHMRC) Prehospital Emergency Care Centre for Research Excellence (PEC-ANZ; #1116453).

BackgroundPrevious studies in the prehospital setting have reported wide variation in the incidence and severity of pain, and that documentation of pain scores is poor. The aim of our study was to investigate and describe the incidence and severity of patient-reported pain that is recorded by pre-hospital emergency care patients in Ireland.MethodWe used data from our electronic patient care record (ePCR) repository to perform this retrospective cohort study of all emergency care episodes recorded by National Ambulance Service practitioners during 2020. Descriptive analysis of patient and care characteristics and regression analyses for the outcomes pain recorded and severity of pain were performed.ResultsOf the 212,401 patient care episodes included, 138,195 (65%) included a pain score (75,445 = no pain; 18,378 = mild pain; 21,451 = moderate pain; 22,921 = severe pain). The likelihood of pain being recorded was most strongly associated with the Glasgow Coma Score, working diagnosis, call location, and patient age. The variables showing strongest association with pain severity were transport outcome, working diagnosis, and patient age. Sensitivity analysis confirmed that all regression models performed better than chance, but that all models were relatively weak at predicting the outcomes.ConclusionUsing a large real-world dataset, we have demonstrated patient and care episode characteristics that are associated with recording and severity of self-reported pain. We have identified actionable improvements that will strengthen the prediction accuracy of routinely collected data and ultimately improve pain management for our patients.Conflict of interestNone to declare.FundingNo specific funding received or sought for this study.

Stroke, Ahead of Print. BACKGROUND:Lp(a) (lipoprotein(a)) contributes to cardiovascular disease mainly through proatherogenic and proinflammatory effects. Here, we aimed to evaluate whether a residual stroke risk of Lp(a) would remain when the LDL-C (low-density lipoprotein cholesterol) and inflammatory levels are maintained low.METHODS:This prospective cohort study included 9899 patients with ischemic stroke or transient ischemic attack from the Third China National Stroke Registry who had measurements of plasma Lp(a) and were followed up for 1 year. Cutoffs were set at the 50 mg/dL for Lp(a). LDL-C was corrected for Lp(a)-derived cholesterol (LDL-Cc [LDL-C corrected]) and cutoffs were set at 55 and 70 mg/dL.The threshold values of IL-6 (interleukin 6) and hsCRP (high-sensitive C-reactive protein) were the median 2.65 ng/L and 2 mg/L. Multivariable-adjusted hazard ratio (HR) were calculated using Cox regression models for each category to investigate the associations of Lp(a) with stroke recurrence within 1 year.RESULTS:Among all patients, those with Lp(a) ≥50 mg/dL were at higher stroke recurrence risk than those with Lp(a)