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

Forty-eight units were enrolled in a descriptive, cross-sectional study to identify strengths and weaknesses of pain management in a German university teaching hospital. Patients had to be > or =18 years old and able to speak German; intensive care, psychiatric, obstetric and pediatric units were excluded. Structured interviews were conducted by an independent researcher not involved in patient care. Patients were asked about prevalence of pain during the interview at rest, on movement, and during the 24 hours before the interview; patients rated pain intensity at rest and on movement as well as the worst pain 24 hours before the interview by using a 10 cm visual analogue scale (VAS). In addition, patients indicated localization, duration, and causes of pain. Chart analysis was carried out to check for pain medication, ICD-10 diagnoses, and demographic data. To evaluate the adequacy of pain management, the Pain Management Index (PMI) was assessed. A total of 561 of the 825 inpatients who were contacted participated in the study. Fifty percent experienced pain during the interview and 63% reported pain during the preceding 24 hours. Fifty-eight percent had moderate or severe pain (VAS > or = 45 mm) and 36% reported severe pain (VAS > or = 65 mm). Thirty-three percent had pain for more than six months. The most prevalent localization of the strongest pain was in the lower extremities (20%). Fifty percent of patients with pain received pain medication. Patients on the surgical wards (P = 0.002) and those having severe pain (P < 0.001) were more likely to get analgesics. However, 30% of those with VAS> or =65 mm received no analgesic and only 24% had adequate medication. A negative PMI, indicating inadequate pain therapy, was found in 44% (246/559) of the sample. Sex and age did not influence pain prevalence, pain intensity, or pain therapy. Pain prevalence and intensity in this German university hospital were high and pain therapy was inadequate in many cases. Pain management needs to be improved by continuous assessment and adequate pain medication.
J Pain Symptom Manage 2005 May
PMID:Pain prevalence in hospitalized patients in a German university teaching hospital. 1590 52

For thousands of patients with advanced degenerative joint disease, total joint arthroplasty provides improved function, decreased pain, and the opportunity to resume a more active lifestyle (Drake, Ace, & Maale, 2002). Although hip and knee replacements are both successful interventions for degenerative joint conditions, complications may arise that require revision of the original surgery. In 1999, approximately 25,000 revisions of knee replacements (ICD Code 81.22) and 30,000 revisions of hip replacements (ICD Code 81.53) were performed in the United States (American Academy of Orthopaedic Surgeons [AAOS], 2002). Approximately 10,000 revision total hip arthroplasty procedures were performed on Medicare patients in 2000. The total cost of revision surgery, including the 10,000 total knee revision procedures performed on this same patient population during that year, exceeds USD 3 billion (Bourne, Maloney, & Wright, 2004). Descriptions of the risk factors and indications for revision total hip and total knee arthroplasty are included in this article. Nursing interventions and patient education specific to these patient populations are outlined, and a discussion of complications following revision total joint arthroplasty is included.
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PMID:Revision total hip and total knee arthroplasty. 1592 24

This study examines diagnostic concordance, symptomatology and disability among Chinese patients with shenjing shuairuo, ICD-10 neurasthenia, and DSM-IV diagnoses. Patients (N=139) with unexplained somatic complaints completed the Structured Clinical Interview for DSM-III (SCID), the Brief Symptom Inventory (BSI), and the Short Form 36 (SF-36). Shenjing shuairuo could be reclassified as DSM-IV undifferentiated somatoform disorder (30.6%) and somatoform pain disorder (22.4%); however, 44.9% did not qualify for a core DSM-IV diagnosis. Concordance of neurasthenia and shenjing shuairuo was significant (p < .001). Symptom distress and disability was similar to that reported by patients with somatoform and anxiety disorders. Within the Chinese context, shenjing shuairuo describes a heterogeneous group with clinically significant levels of disturbance and disability.
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PMID:Shenjing shuairuo and the DSM-IV: diagnosis, distress, and disability in a Chinese primary care setting. 1611 83

Consecutive new neurology inpatients and outpatients (N=198) were assessed for somatoform disorders by using the Schedules for Clinical Assessment in Neuropsychiatry. Sixty-one percent of the patients (59% of the female patients and 63% of the male patients) had at least one medically unexplained symptom, and 34.9% fulfilled the diagnostic criteria for an ICD-10 somatoform disorder (27.7% of the male patients, 41.3% of the female patients, 20.5% of the inpatients, and 43.2% of the outpatients). The prevalence figures were about the same when DSM-IV criteria for somatoform disorders were used. Of the patients with a somatoform disorder, 60.5% also had another mental disorder. Somatization disorder, somatoform autonomic dysfunction, pain disorder, and neurasthenia were equally prevalent (6%-7%); dissociative (conversion) disorders and undifferentiated somatoform disorders were found in 2-3% of the patients. Fifty percent of the patients with somatoform disorders were identified by the neurologists.
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PMID:Somatoform disorders among first-time referrals to a neurology service. 1628 33

The higher prevalence of depression in specific diseases and older persons is discussed. This prevalence varies greatly according to the method used to collect data. A risk group can only be defined if information on diseases and other influencing factors are collected uniformly. The target diagnoses Parkinson's disease, stroke, myocardial infarction, cancer, diabetes mellitus, chronic pain, multiple infarct syndrome, Alzheimer's and other dementia were recorded from 1208 geriatric patients of the ZAGF municipal hospital in Munich, Germany. Logistic regression was used to identify chronic pain as the main cofactor for an association with depression (clinical diagnoses by ICD-10) and depressive symptoms (via GDS [Geriatric Depression Scale]). This association was also found for multimorbid patients with chronic pain. Impairment of the activities of daily living and the clinical setting were important additional cofactors. Pain patients are therefore at higher risk for depression.
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PMID:[Relation between certain diseases and frequency of depression in geriatric patients]. 1682 Oct 65

The aim of this study was to describe bodily symptoms in severe depression, testing the hypotheses that patients with depression compared with healthy controls have several specific bodily symptoms and complaints, and furthermore that changes in severity of depression correlate to changes in bodily symptoms. Inpatients (n=29) with a diagnosis of moderate to severe depression (ICD-10) and 29 matched healthy controls were included in the study. Bodily symptoms were assessed with the Body Awareness Scale (BAS) and the severity of depression with the Hamilton Depression Scale (HDS). Patients were assessed twice, i.e. when admitted to hospital and again when discharged. The patients with severe depression had more muscular tension, pain-complaints, restricted breathing, negative attitudes towards own body and lesser centring in movements compared with the healthy controls (p<0.001). Improvement in bodily symptoms was statistically significant (p<0.01), and an improvement in depression score was observed. The findings of the study may underline the importance of investigating bodily symptoms in depression and indicates a need for a specific physiotherapeutic treatment of patients with moderate to severe depression.
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PMID:Bodily symptoms in moderate and severe depression. 1692 38

This study assessed the "real-world" risk of serious gastrointestinal (GI) toxicities, defined as perforations, ulcers and bleeds (PUBs) in a U.S. representative population that was using two commonly available over-the-counter (OTC) non-selective nonsteroidal antiinflammatory drugs (NSAIDs), naproxen or ibuprofen with or without concomitant aspirin usage. A retrospective review of a commercially available electronic medical record (EMR) database containing the ambulatory health record data for over 3.2 million individuals was conducted. Subjects were eligible for inclusion in the study if they received an OTC dosage of naproxen (220 mg) or ibuprofen (200 mg). An index date for each subject was defined as the first mention of an OTC NSAID in the medication list of the EMR dataset. Subjects were excluded from the analysis if they met any criteria, which can lead to GI bleeding complications. The dataset was analyzed for PUBs, as indicated by the ICD-9 diagnosis codes for gastric, duodenal, peptic, or gastrojejunal ulcers, or GI hemorrhage, as well as the concomitant use of aspirin. A pre/post-analysis was conducted using a case-crossover design with subjects as their own controls. The index date was the defining event, in order to determine the odds ratio associated with OTC NSAID usage. A pre-index time period of 365 days was used for prior PUBs. For the post-index time period, only PUBs that occurred within 90 days of the OTC NSAID index date were considered. The data set contained 11,957 subjects on naproxen and 38,507 subjects on ibuprofen. In both cases, OTC NSAID usage was associated with a statistically significant increase in the odds ratio for PUBs. Subjects on ibuprofen had an odds ratio of 1.38 (95% CI 1.07-1.78, P=0.01). Naproxen subjects exhibited an odds of 1.54 (95% CI 1.04-2.28, P=0.03). The concomitant aspirin population consisted of 2,328 naproxen subjects and 4,843 ibuprofen subjects. Concomitant aspirin usage was also associated with a significantly higher risk for PUBs than the corresponding monotherapy. Subjects taking both ibuprofen and aspirin had an odds ratio of 3.36 (2.36-4.80, P<.00001), while those on naproxen and aspirin had an odds ratio of 2.07 (1.23-3.49, P=.005) relative to those subjects on ibuprofen and naproxen monotherapy, respectively. Utilizing a national electronic medical record database representing patients seen predominantly in a primary care setting, this study has documented the "real-world" risk associated with the use of two common OTC NSAIDs, as well as the increased risk associated with concomitant aspirin use in this population.
J Pain Palliat Care Pharmacother 2006
PMID:Gastrointestinal complications of over-the-counter nonsteroidal antiinflammatory drugs. 1693 73

Fibromyalgia is a complex of symptoms predominantly affecting females and consisting of widespread pain. Etiology and pathogenesis are not sufficiently known yet, however, there is the assumption that fibromyalgia is looked at as being an illness with biological, psychological, and social aspects. Therefore, the treatment of fibromyalgia calls for a multimodal therapy approach. The importance of fibromyalgia has been recognized within the German health system by creating the new ICD code M79.70 and by assigning fibromyalgia its own rheumatologic DRG (I79Z). In future research of fibromyalgia special attention needs to be placed upon gender-specific problems.
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PMID:[Fibromyalgia. Diagnostics--disease approach--therapy]. 1722 48

In describing the patterns of utilization of healthcare services by dementia patients in comparison to age- and sex-matched controls the study was to provide information on special care needs of patients with dementia concerning somatic diseases. A representative sample of insured individuals from 1998 to 2002 (the "Versichertenstichprobe AOK Hessen/KV Hessen") provided the database. Patients with dementia were defined according to the ICD-coded billing diagnoses. Regarding general practitioner visits, patients with dementia have approx. 11 additional contacts per year compared to their controls. A smaller percentage of patients with dementia present to a specialist (excluding neurologists/psychiatrists). Furthermore, the two groups differ as to the kind of specialists visited, which in turn is associated with different service and prescription patterns. The study was not able to clarify whether the differences are possibly due to the GPs' prioritization of treatment of dementia patients. Both physicians and nurses should be sensitized to the possibility that dementia patients may not be able to explicitly mention existing diseases and impairments (such as cardiovascular and sensory disorders, pain). Moreover, physicians and other professionals involved in the management of dementia patients should be trained to pay special attention to the particular care-related problems (pressure ulcers, infections or inadequate fluid intake).
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PMID:[Utilization patterns of dementia patients in the light of statutory health insurance data]. 1745 59

In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all acknowledged risk factors, along with specific occupational and environmental factors. A familial history of renal carcinoma is also likely to increase the risk. Renal carcinoma may remain clinically occult for most of its course. The classic presentation of pain, haematuria, and flank mass occurs in only 9% of patients and is often indicative of advanced disease. Approximately 30% of patients with renal carcinoma present with metastatic disease, 25% with locally advanced renal carcinoma and 45% with localized disease. Metastases are typically found in the lung, soft tissue, bone, liver, cutaneous sites, and central nervous system. The most important staging technique is a computed tomography (CT) scan of the whole abdomen. Survival rates are more favourable for patients with tumours confined to the kidney. Five-year survival for patients with metastatic renal carcinoma is comprised between 0 and 20%. Radical nephrectomy is the standard intervention for renal cancer. Intrinsic resistance to chemotherapy has long been a hallmark of renal carcinoma. Limited options are available for the systemic therapy, and no chemotherapeutic regimen is accepted as a standard of care. Biologic agents represent the major effective therapies for widespread metastatic renal cancer. An antiangiogenic strategy, the neutralization of VEGF, can slow the growth rate of advanced cancer.
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PMID:Renal cancer. 1766 11


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