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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Practice patterns and patient-reported outcomes of care are compared in detail for ten physicians and 12 new health practitioners delivering ambulatory care in two departments of a prepaid group practice, the Columbia Medical Plan (CMP). All providers completed questionnaires for a 50 per cent random sample of patients seen during a two-week period. Patients completed questionnaires prior to receiving care and were interviewed one week and one month after their clinic visits. New health practitioners deliver approximately 75 per cent of well-person care, 56 per cent of problem-oriented care in adult medicine, and 29 per cent of problem care in pediatrics. They have become increasingly involved over time in the treatment of acute conditions and injuries while physicians have retained their predominant role in treating patients with chronic conditions. Thirty-two per cent of visits with new healh providers involved a physician in one or more of the following: decision-making, direct supervision, consultation, or seeing the patient as a second provider of care. Degree of autonomy varied by type of task performed, category of problem treated, and specialty. The following outcomes of care were examined by type of provider: patient-reported change in problem status,including frequency and intensity of pain or discomfort, level of anxiety, and degree of activity limitation; the degree to which physician-specified criteria for the most commonly occurring conditions were met with respect to change in problem status; and patient satisfaction with a number of dimensions of the clinic visit. The analysis suggests that the new health practitioners at the CMP are providing care, within their areas of responsibility, of comparable quality to that delivered by physicians.
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PMID:The role of new health practitioners in a prepaid group practice: provider differences in process and outcomes of medical care. 0 80

A single-blind two-week comparison of benorylate and naproxen tablets was carried out in 85 patients with painful osteoarthritis. The degree of discomfort, pain at rest and on movement, joint stiffness and difficulty using affected joints all improved during the study with no significant difference between the treatments. Both patients' and observers' assessment of overall improvement favoured benorylate although the difference was not statistically significant. The majority had disease of weight-bearing joints for which Benoral was significantly more effective. Both drugs were well tolerated.
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PMID:A comparison of benorylate and naproxen in degenerative arthritis. 3 9

3 patients (2 male, 1 female) presented with symptoms of thyrotoxicosis associated with elevated blood-levels of thyroid hormone and a markedly depressed thyroidal uptake of 131-I. The male patients (aged 59 and 47) each had a cardiac arrhythmia, but did not have any thyroid pain or swelling. The female with a goitre had no discomfort in the neck. Thyrotoxicosis factitia was excluded by history. The subsequent course of their disease was typical of subacute thyroiditis. The elevated thyroid-hormone levels spontaneously fell to normal over a few weeks. In 1 patient, however, chemical hypothyroidism developed. These patients could have been diagnosed as having hyperthyroidism, rather than subacute thyroiditis, since thyroid pain--and swelling in 2 of the cases--was absent. The correct diagnosis was suspected only after finding a thyroidal uptake of 131-I near zero. The thyroidal uptake of 131-I is still important as a routine diagnostic aid in thyroid disease.
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PMID:Thyrotoxicosis due to "silent" thyroiditis. 4 12

All patients with pain must be taken seriously, and both organic and emotional factors investigated. Cultural aspects, early developmental experience, and highly personal meanings may influence the individual's perception of and reaction to pain; specific psychiatric pain states may be identified as well. Treatment is aimed at curing the underlying cause of the discomfort or allowing maximal rehabilitation in chronic conditions.
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PMID:The complaint of pain. 5 20

Surgery is the modality of choice in curative treatment for cancer of the colon and rectum. Since a majority of the patients present advanced disease where the surgical outlook is poor, adjuvant therapy may be warranted. Clinical and experimental data demonstrate the benefits from preoperative radiation therapy and some clinical reports indicate the beneficial effects of postoperative radiotherapy. Two national studies are underway to determine the effectiveness of preoperative radiation therapy in moderate doses. A similar study is suggested to establish the effectiveness of postoperative radiation therapy.For patients who are poor surgical risks, or for a tumor which is considered to be inoperable, and in a selected group, radiation therapy can be used as a curative procedure. Advantages include eliminating the need for a permanent colostomy. In case of failure, electrocoagulation and abdominal perineal resection are still available alternatives.A modest amount of radiation therapy can afford maximum palliation with minimum discomfort to the patient. About 80-90 percent of patients with pain and bleeding and 50 percent of patients with symptomatic liver metastasis respond favorably.
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PMID:Carcinoma of the rectum and rectosigmoid colon: role of radiation therapy. 8 20

The incidence of complications following supine phlebography was studied in 109 patients (142 legs) retrospectively and 89 patients (106 legs) prospectively. Virtually all patients had some discomfort during the procedure, while three patients had delayed pain for up to 4 days following examination. Three patients developed hives, one of whom also had bronchospasm. There were two cases with subcutaneous extravasation. The shorter endothelial contact time of supine phlebography compared to the semiupright technique might explain the reduced incidence of pain.
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PMID:Complication rate with supine phlebography. 10 Oct 35

A technique for arthrography of the temporomandibular joint using multidirectional tomography is described that greatly simplifies interpretation. In 21 attempts, 20 successful arthrograms were obtained in patients complaining of pain, tenderness, and clicking and locking of the joint who had not responded to conservative therapy. Abnormalities demonstrated were perforation of the meniscus, anterior dislocation and subluxation of the meniscus; and redundancy of the bilaminar zone. In all 11 patients who underwent surgical meniscoplasty, disc abnormalities included thinning, perforation, flaccidity, and bilaminar redundancy. No permanent complications of the arthrographic procedure occurred, but temporary postprocedure discomfort was frequent. This preliminary experience with temporomandibular joint arthrotomography suggests this easily performed procedure offers reliable information about disc function and integrity that may assist in a selection of patients for meniscoplasty and other surgical treatment.
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PMID:Arthrotomography of the temporomandibular joint: new technique and preliminary observations. 10 75

Before public finance is committed to a particular public health measure it is essential that the project should be analytically evaluated. Cost-benefit analysis is one method of choosing between alternative programmes. It suffers from the disadvantage that, while costs can be accurately assessed, the benefit to an individual of freedom from pain, discomfort or inconvenience cannot be simply expressed in monetary terms. Such benefits may therefore be omitted from calculations of cost-benefit and a programme with valuable indirect or intangible benefits may not receive adequate consideration in competition with other alternatives. Futhermore, since benefits may only accrue some time after expenditure has been incurred, inflation distorts the significance of cost-benefit calculations. Cost-effectiveness analysis is an alternative method which enables one to determine the least expensive of several alternative methods of achieving a stated objective. The application of these concepts to preventive programmes against dental caries is described. Distinction must be made between the effectiveness of preventive measures during controlled clinical trials on limited numbers of subjects and their value when applied under field conditions to the whole community. Detailed comparisons are made between various methods of the application of fluorides caries prevention by community fluoridation water supply, school water fluoridation and topical application of fluorides. It is concluded that while completely accurate and valid analyses of cost-effectiveness are not possible, they do enable dentistry to view its activities more objectively and to indentify the real issues which should affect future decisions.
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PMID:Methods of assessing the cost-effectiveness of caries preventive agents and procedures. 11 Jul 4

Different techniques to improve the denture supporting area in the mandible by means of lingual sulcoplastry are discussed. A method for lingual sulcoplastry is presented and compared with other methods. This method is considered superior to transplantation and flap techniques as it causes less pain and discomfort and allows an early finish of the denture work. Yet the result of the operations with this technique seems to be compatible.
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PMID:Lingual sulcoplasty with a modified preparation technique. 11 73

This double-blind study designed to assess the effect of trans-r-amino-methyl-cyclohexane acid (AMCA) vs. placebo on development of alveolitis sicca dolorosa (ASD) had as preoperative registration requirements age, sex, use of oral contraceptives, menstrual cycle, smoking, and degree of impaction at time of operation. Following operation for impacted molars, AMCA or placebo was applied, and 5 days later the postoperative course was evaluated. Overall, AMCA did not have enough local inhibition of plasminogen activation to prevent development of ASD, since incidence of ASD was 7.5% in the treated side and 5% in the placebo side. Menstrual period did not augment postoperative discomfort. Oral contraceptive use, however, gave a much higher risk of developing ASD, and it is recommended that women withdraw from oral contraception before oral surgery. Smoking increased postoperative pain.
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PMID:Tranexamic acid in alveolar sockets in the prevention of alveolitis sicca dolorosa. 12 Mar 39


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