Current medical research and opinion
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Review published clinical trial studies on pharmacological treatment of stroke using both the Barthel Index (BI) and Modified Rankin Scale (MRS) as outcome measures, and to highlight the differences in psychometric properties and cut-off scores through a systematic review. ⋯ Despite the lack of uniformity in the cut-off points used in the trials, the follow-up time after administration of therapy, and the amount of time within which treatment is initiated after onset of stroke symptoms, the MRS seems to be more sensitive and responsive as compared to the BI in measuring stroke disability. However, more studies are required to differentiate the BI and the MRS that would help in selecting a scale that would appropriately capture outcomes among stroke patients.
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparison of postoperative pain outcomes after vertical or Pfannenstiel incision for major gynecologic surgery.
The Pfannenstiel incision is commonly used for gynecologic surgery. It is not known if this incision is associated with less postoperative pain compared to a vertical midline incision. Therefore, as part of a study to evaluate the postoperative analgesic effects and dose response of intravenous adenosine in patients undergoing open abdominal gynecologic surgery, this manuscript compares postoperative pain and analgesic consumption in patients who had a midline vertical incision or a Pfannenstiel incision. ⋯ There was no significant difference in postoperative pain and opioid consumption in patients undergoing major abdominal gynecologic surgery performed with either a midline or Pfannenstiel incision. However, it is important to note that since this a secondary analysis of data from a primary study investigating the dose response of IV adenosine, the patients were not prospectively randomized into the two incision types.
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To assess the validity of the patient global assessment (PGA) of the method of pain control, a single-item patient-reported outcome measure of a method of pain control for patients experiencing postoperative pain. ⋯ Findings suggest that both the content and construct validity of the PGA of the method of pain control in clinical trial settings are supported. However, this conclusion is potentially limited by the use of a narrow range of therapeutic interventions and, in some cases, small sample sizes in the clinical trials used to assess construct validity. The PGA of the method of pain control is an informative and useful measure for assessing pain control provided by different drug delivery systems for patients experiencing postoperative pain.
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The purpose of this analysis was to assess the differences in lost time and health-benefit costs (HBCs) among employees treated with disease modifying treatments (DMTs) for multiple sclerosis (MS). ⋯ Patients treated with 'A' reported significantly lower SL costs, SL days, and STD costs than patients treated with 'C', suggestive of greater real world benefits with 'A'. Despite small sample sizes and the retrospective nature, the study provides interesting insights into the use of DMTs in MS. The study also revealed important areas of future research, specifically the need for development of methods to determine which MS patient groups respond best to which DMT treatments.
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The semi-synthetic opioid, buprenorphine, has the general structure of morphine but differs from it in significant ways, both pharmacologically and clinically. A number of long-term studies have shown effective, long-lasting analgesia in moderate to severe cancer and non-cancer pain, including neuropathic pain, with a low incidence of constipation, nausea, dizziness and tiredness. The treatment of moderate to severe chronic pain has improved as a result of the development of new methods of administration of this substance, particularly the introduction of the transdermal drug delivery system, which offers a number of advantages over the usual oral and parenteral routes. ⋯ The consensus was that transdermal buprenorphine has a valuable role to play in the treatment of chronic cancer pain because of its efficacy and good safety and tolerability profile, including a low risk of respiratory depression, a lack of immunosuppression and a lack of accumulation in patients with impaired renal function.