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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Most patients who are homebound or in LTC facilities have multiple health problems that require the cooperation of many different types of providers. Dentists have a specific role in this process because they can improve the quality of life for the elderly by keeping them free of oral infection, restoring their dentition so they can enjoy eating, and restoring facial esthetics. It should be apparent that dental care for these patients is a complicated process. There are many considerations in prescribing the type of treatment needed by each patient. These include the patient's life span, medical history, drug history, mental status, mobility status, neuromuscular coordination, dental status, previous dental experience, dental expectations, and economic status. This information must be gathered by the dentist from the patient, the family, the nursing staff, and the patient's physician. Furthermore, the dentist also must assess the facilities and equipment available to carry out oral health care. Only after such considerations can a dental treatment plan evolve that is appropriate for the individual concerned. Dental care for one patient may be no treatment whatsoever, whereas a different patient in the same institution may require the most technologically sophisticated care that dentistry has to offer. Finally, the following circumstances should suggest that a homebound or institutionalized patient needs an urgent oral/dental evaluation: General Signs and Symptoms; Orofacial pain, Visible oral infection, Difficulty chewing food, Halitosis/dry burning mouth, Visible oral soft tissue lesions (white, red, or ulcerated). Tooth-related signs and symptoms; Visible dental decay, Loose or mobile teeth, Bleeding or sore gums. Denture-related Signs and Symptoms; Loose, ill-fitting, or worn dentures, Missing denture teeth, Home repairs attempted.
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PMID:Oral care for the homebound and institutionalized. 138 42

This is a multisite study examining the internal validity and comprehensiveness of the International Association for the Study of Pain (IASP) diagnostic criteria for Complex Regional Pain Syndrome (CRPS). A standardized sign/symptom checklist was used in patient evaluations to obtain data on CRPS-related signs and symptoms in a series of 123 patients meeting IASP criteria for CRPS. Principal components factor analysis (PCA) was used to detect statistical groupings of signs/symptoms (factors). CRPS signs and symptoms grouped together statistically in a manner somewhat different than in current IASP/CRPS criteria. As in current criteria, a separate pain/sensation criterion was supported. However, unlike in current criteria, PCA indicated that vasomotor symptoms form a factor distinct from a sudomotor/edema factor. Changes in range of motion, motor dysfunction, and trophic changes, which are not included in the IASP criteria, formed a distinct fourth factor. Scores on the pain/sensation factor correlated positively with pain duration (P<0. 001), but there was a negative correlation between the sudomotor/edema factor scores and pain duration (P<0.05). The motor/trophic factor predicted positive responses to sympathetic block (P<0.05). These results suggest that the internal validity of the IASP/CRPS criteria could be improved by separating vasomotor signs/symptoms (e.g. temperature and skin color asymmetry) from those reflecting sudomotor dysfunction (e.g. sweating changes) and edema. Results also indicate motor and trophic changes may be an important and distinct component of CRPS which is not currently incorporated in the IASP criteria. An experimental revision of CRPS diagnostic criteria for research purposes is proposed. Implications for diagnostic sensitivity and specificity are discussed.
Pain 1999 Nov
PMID:Complex regional pain syndrome: are the IASP diagnostic criteria valid and sufficiently comprehensive? 1053 92

This study tested for evidence supporting the clinical lore of three sequential stages of complex regional pain syndrome (CRPS) and examined the characteristics of possible CRPS subtypes. A series of 113 patients meeting IASP criteria for CRPS underwent standardized history and physical examinations to assess CRPS signs and symptoms in four domains identified in previous research: pain/sensory abnormalities, vasomotor dysfunction, edema/sudomotor dysfunction, and motor/trophic changes. K-Means cluster analysis was used to derive three relatively homogeneous CRPS patient subgroups based on similarity of sign/symptom patterns in these domains. The resulting CRPS subgroups did not differ significantly regarding pain duration as might be expected in a sequential staging model. However, the derived subgroups were statistically-distinct, and suggested three possible CRPS subtypes: (1) a relatively limited syndrome with vasomotor signs predominating, (2) a relatively limited syndrome with neuropathic pain/sensory abnormalities predominating, and (3) a florid CRPS syndrome similar to "classic RSD" descriptions. Subtype 3 showed the highest levels of motor/trophic signs and possible disuse-related changes (osteopenia) on bone scan, despite having directionally the briefest pain duration of the three groups. EMG/NCV testing suggests that Subtype 2 may reflect CRPS-Type 2 (causalgia). Overall, these results are consistent with limited previous work that argues against three sequential stages of CRPS. However, several distinct CRPS subtypes are suggested, and these could ultimately have utility in targeting treatment more effectively.
Pain 2002 Jan
PMID:Complex regional pain syndrome: are there distinct subtypes and sequential stages of the syndrome? 1969 1

This paper reports on the development and testing of a tool designed to assess chronic wounds for the clinical signs and symptoms of localized infection. Thirty-one wounds were assessed by two independent nurse observers for the signs and symptoms of infection using the Clinical Signs and Symptoms Checklist. The Clinical Signs and Symptoms Checklist delineates 12 signs and symptoms of infection (i.e., pain, erythema, edema, heat, purulent exudate, serous exudate with concurrent inflammation, delayed healing, discoloration of granulation tissue, friable granulation tissue, pocketing at the base of the wound, foul odor, and wound breakdown) and their definitions. The reliability of each sign or symptom on the checklist was calculated using percent agreement and the Kappa statistic. Percent agreement ranged from 65% to 100%, and Kappa statistics ranged from 0.53 to 1.00, excluding pocketing of the wound base. The reliability estimates obtained for signs and symptoms on the Clinical Signs and Symptoms Checklist compare favorably with other data regarding interclinician agreement on wound assessment. Incorporating a structured approach to assess and monitor for wound infection, such as the Clinical Signs and Symptoms Checklist, may improve clinician skill and accuracy in identifying this condition.
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PMID:A tool to assess clinical signs and symptoms of localized infection in chronic wounds: development and reliability. 1188 55

The Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) is a simple bedside test in two parts-a patient-completed questionnaire and a brief clinical assessment. Its diagnostic capabilities have never been tested in patients with cancer pain. To determine these we conducted a prospective study in outpatients with head and neck cancer. All patients with pain completed the LANSS and underwent a medical assessment with a palliative care physician, whose findings were then reviewed by a pain specialist blinded to the LANSS scores. We assessed acceptability and understanding of the LANSS by patients and calculated the sensitivity and specificity of total LANSS scores and subscores derived from the patient-completed section. Of 130 patients approached, 125 took part. 25 (20%) of these had cancer related pain, mean score on an 11 point numerical rating scale 6.3 (median 6.0, range 3-10). Average age was 60 years (median 60, range 27-84); 56% were male. LANSS completion time was about five minutes, and the procedure was acceptable to all patients. The pain specialist diagnosed neuropathic pain in 14/25 patients, in 13 of whom the neuropathic pain was part of a mixed pain picture. The LANSS correctly identified 11 of these cases (sensitivity 79%; specificity 100%). The patient-completed section alone had a sensitivity of 86% and a specificity of 91%. The LANSS is a simple and suitable screening test for neuropathic pain in patients with head and neck cancer related pain, although some modifications might improve it.
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PMID:Identifying neuropathic pain in patients with head and neck cancer: use of the Leeds Assessment of Neuropathic Symptoms and Signs Scale. 1289 52

It is commonly believed that upward/backward forces applied to the condyle by a chin-cap cause temporomandibular dysfunction (TMD). In the current study the long-term follow-up (2-11 years) of patients treated with a chin-cap was investigated regarding signs and symptoms of TMD. The treatment group consisted of 32 individuals who had a skeletal Class III malocclusion treated using chin-cap therapy (mean age 18.4 years). The two control groups contained 39 untreated subjects with skeletal Class III malocclusions (mean age 15.5 years) and 53 dental students (mean age 19.2 years) with acceptable normal occlusions. Functional examination of the subjects was carried out and those with at least one sign/symptom (clicking, pain, or deviation) were identified as the 'symptomatic' subgroup. The distribution of symptomatic individuals was 25 per cent in the treatment group, 23 per cent in the Class III malocclusion group, and 41.5 per cent in the normal group (dental students). In addition, the frequency of signs and symptoms of TMD in the symptomatic individuals was also investigated. There were no signs of crepitus in any subject, clicking was found in 50 per cent of the treatment group and pain in 54.5 per cent of the normal group. The results of this long-term follow-up indicate that chin-cap treatment is neither a risk factor nor a prevention for TMD. Age and stress factors should always be considered in the evaluation of TMD.
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PMID:Long-term effects of chin-cap therapy on the temporomandibular joints. 1460 15

This article describes the development and validation of the S-LANSS score, a self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. The S-LANSS aims to identify pain of predominantly neuropathic origin, as distinct from nociceptive pain, without the need for clinical examination. Two hundred patients with chronic pain were asked to complete the S-LANSS unaided. A researcher then administered the S-LANSS scale and the Neuropathic Pain Scale (NPS) in interview format. An independent clinician determined the pain type (neuropathic versus nociceptive) and rated his or her certainty about diagnosis. The S-LANSS scale was also incorporated into a chronic pain questionnaire that was sent to 160 community patients and 150 newly referred patients waiting for pain clinic assessment. The S-LANSS scale correctly identified 75% of pain types when self-completed and 80% when used in interview format. Sensitivity for self-completed S-LANSS scores ranged from 74% to 78%, depending on the cutoff score. There were significant associations between NPS items and total score with S-LANSS score. In the postal survey, completed questionnaires were returned by 57% of patients (n = 174). Internal consistency and convergent validity of the survey S-LANSS scores were confirmed. The findings support the S-LANSS scale as a valid and reliable self-report instrument for identifying neuropathic pain and it is also acceptable for use in postal survey research. Establishing valid measures of symptoms and signs in neuropathic pain will allow standardized comparisons with other investigational measures. This might lead to new insights into the relationship between pathophysiologic mechanisms and clinical manifestations of pain.
J Pain 2005 Mar
PMID:The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. 1577 8

Chronic pain is generally regarded as being divided into two mutually exclusive pain mechanisms: nociceptive and neuropathic. Recently, this dichotomous approach has been questioned and a model of chronic pain being 'more or less neuropathic' has been suggested. To test whether such a spectrum exists, we examined responses by patients with chronic pain to validated neuropathic pain assessment tools and compared these with ratings of certainty about the neuropathic origin of pain by their specialist pain physicians. We examined 200 patients (100 each with nociceptive and neuropathic pain) and administered the self-complete Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS score) and the Neuropathic Pain Scale (NPS). Clinicians were asked to rate their certainty of the presence of neuropathic pain mechanisms on a 100 mm visual analogue scale (VAS) (0='not at all neuropathic in origin' to 100='completely neuropathic in origin'). The whole sample was divided into tertiles based on ascending ratings of diagnostic certainty by clinicians using the VAS and labelled 'unlikely', 'possible' and 'definite' neuropathic pain. There were significant differences in median S-LANSS and NPS composite scores between all tertile groups. There were also significant differences between many S-LANSS and NPS item scores between groups. We have shown that higher scores on both the S-LANSS and the NPS are indicative of greater clinician certainty of neuropathic pain mechanisms being present. These data support the theoretical construct that pain can be more or less neuropathic and that pain of predominantly neuropathic origin may be a useful clinical concept.
Pain 2006 Jun
PMID:Can pain can be more or less neuropathic? Comparison of symptom assessment tools with ratings of certainty by clinicians. 1654 Feb 49

This study aimed to explore the relationship between pain mechanism, pain intensity, and leg ulcer characteristics using a 6-month longitudinal cohort study in a community setting in the north of England. Patients with leg ulceration referred consecutively to district nurses were invited to participate (n=96). The main outcome measures were pain intensity using daily visual analogue scores, leg ulcer characteristics (etiology, size, location, duration), and LANSS (Leeds Assessment of Neuropathic Symptoms and Signs). Results suggested that type, duration, position, and size of the leg ulcer had no effect on average daily pain scores. Using the LANSS questionnaire, 43.5% of respondents reported symptoms suggestive of a neuropathic mechanism to their pain. Patients with neuropathic symptoms had higher average daily pain scores (p<0.001). Fewer people had healed ulcers at 6 months with neuropathic symptoms compared with those with no neuropathic symptoms (30.8 vs. 52.1%). It would seem that the severity of pain can not be predicted by the type, size, position, or duration of ulceration. Patients who scored positively for neuropathic symptoms had higher average daily pain scores and fewer had healed leg ulcers at 6 months compared with those who did not experience neuropathic signs and symptoms.
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PMID:Painful leg ulceration: a prospective, longitudinal cohort study. 1735 49

The Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), an assessment tool to determine if pain is predominantly neuropathic, has not been validated in a community setting. Previously identified residents of Olmsted County, Minnesota, with chronic pain were recruited using a stratified randomization process to increase the frequency of neuropathic pain in the study sample. Subjects completed the S-LANSS in mailed and telephone formats, and underwent clinical assessment to determine if a component of their pain was neuropathic. Sensitivity and specificity of the S-LANSS as compared to the clinical assessment were determined. Two hundred and five subjects participated in the study. Eighty-three subjects (40%) had a positive S-LANSS score in the mailed, as did 59 of 173 (34%) in the telephone format, with little inter-subject difference in scores (p=0.57). Clinical assessment identified a component of neuropathic pain in 37% of the sample (75/205). Compared to clinical assessment, sensitivity and specificity in the mailed S-LANSS were 57% (95% CI, 46-69%) and 69% (95% CI, 61-77%), respectively, and in the telephone S-LANSS were 52% (95% CI, 39-64%) and 78% (95% CI, 68-85%), respectively. The sensitivity and specificity of the S-LANSS in both formats were lower than the initial S-LANSS validation study. Differences in survey format and subject population could account for these differences, suggesting that the S-LANSS is best suited as a screening tool and its use to determine the prevalence of neuropathic pain in population studies should be viewed cautiously.
Pain 2007 Nov
PMID:Validation of the S-LANSS in the community setting. 1788 75


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