Articles: adult.
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To assess the reliability of an augmented SF-36 instrument, the Treatment Outcomes in Pain Survey ("TOPS"), in patients treated in two pain management programs, and present norms for initial values and treatment-related improvements. ⋯ The accuracy of the TOPS is sufficient to monitor the response of individual patients during multidisciplinary treatment of chronic pain. The TOPS provides needed documentation (e.g., to third-party payors) of the aggregate value of multidisciplinary outpatient treatment of chronic pain as well as its benefit for individual patients.
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The Utstein guidelines recommend that emergency medical services (EMS)-witnessed cardiac arrests be considered separately from other out-of-hospital cardiac arrest cases. The objective of this study was to assess EMS-witnessed cardiac arrest and to determine predictors of survival in this group. ⋯ EMS-witnessed cases are clearly an important subset of out-of-hospital cardiac arrest and are characterized by 2 distinct symptom groups: chest pain and dyspnea. These symptoms are important predictors of survival and may also help determine underlying mechanisms before patient collapse. A later phase of the OPALS study will prospectively evaluate the impact of out-of-hospital advanced life support on the survival of victims of EMS-witnessed cardiac arrest. [De Maio VJ, Stiell IG, Wells GA, Spaite DW, for the OPALS Study Group. Cardiac arrest witnessed by emergency medical services personnel: descriptive epidemiology, prodromal symptoms, and predictors of survival. Ann Emerg Med. February 2000;35:138-146.].
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The present study explored the effects on therapeutic outcomes of training therapists in brief manualized therapy. As part of the Vanderbilt II project, each of 16 therapists (8 psychiatrists and 8 clinical psychologists) treated 2 moderately disturbed adult patients using his or her customary short-term treatment methods; they then received a year of training in a manualized form of brief dynamic therapy, Time-Limited Dynamic Psychotherapy (TLDP); finally, they administered TLDP to 2 additional patients. It was hypothesized that training would result in improved outcomes generally and that differentially greater improvement would be seen in patients commonly considered less suitable for brief dynamic therapy. ⋯ Los resultados a la terminación no apoyaron ninguna de las dos hipótesis. Las mediciones de dependencia interpersonal al año de seguimiento resultaron consistentes con la primera hipótesis, mientras que los resultados de seguimiento fueron inconsistentes con la segunda. Una revisión sistemática de los treinta y dos casos luego del entrenamiento sugiere que la mayoría de los terapeutas no había l.
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The role of stress and mood in the onset and course of sickle cell disease (SCD) pain was examined using a daily diary design. Fifteen adults with SCD completed daily diaries about their pain, stress, mood, and health care and medication use for an average of 94 days. Multilevel random effects models indicated that stress was significantly and positively related to same-day pain ratings. ⋯ Mood also showed significant associations with same-day pain in the expected directions. In addition, stress and mood were associated with health care and medication use during painful episodes. Finally, painful episodes were preceded by increases in stress 2 days previously, suggesting that stress may play a role in the onset of SCD pain.
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Two older adults presented to the emergency department with rib fractures following minor trauma. Both were discharged on oral analgesics and died within 2 days. Rib fractures more often lead to adverse outcomes in older adults. Emergency physicians should consider admitting any such patient who presents with two or more rib fractures.