Articles: function.
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In recent years most industrialized nations have been confronted with a dramatic increase in cases dealing with back pain which, because of the associated costs, has put a strain on health care systems. Because of the tremendous costs caused by patients with chronic illnesses, there is a common interest in identifying determinants responsible for the pain becoming chronic. According to the fear-avoidance model, chronic back pain is the cause of specific patient beliefs according to their perception and appraisal of back pain and their assumptions about the connection between pain and work activities. These fear-avoidance beliefs are assumed as the main cognitive factors of adapting to chronic invalidism. In this study a German version of a self-reporting instrument that assesses fear-avoidance beliefs (FABQ, Waddell et al. 1993) is presented. ⋯ The results suggest that primary target points for further investigation include an analysis of the patients' beliefs about their pain, with special emphasis on fear-avoidance beliefs. It is also necessary to analyze the behavioral assumptions of the fear-avoidance model in an experimental design. Furthermore, our results concerning the psychometric properties of the questionnaire should be proved in a far larger sample of back pain patients.
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"Pain under Discussion" aims at the education of patients with chronic headache and back pain by applying a standardized manual with detailed instructions for seven sessions in a group setting. Apart from encouraging a reconceptualization of the patients' pain experience with reference to a bio-psycho-social model, the program provides information about the vicious circle of pain, avoidance and demoralization and relies heavily on behavioral assumptions about the process of chronicity. Patients are offered participation in progressive relaxation according to Jacobson, they learn to engage in pleasant activities, and are instructed to more and more maintain an upright body position during various activities of every day life. The study evaluates the outcome of the training. Moreover, as an algorithm for grading pain patients according to their level of chronicity has recently been developed by Gerbershagen, we use this algorithm in order to investigate the relationship between the outcome of treatment and the assigned level of chronicity. In addition, we test the assumption that a higher level of chronicity is related to a lower level of psychological functioning pre treatment. ⋯ Irrespective of the initial pain grading of the patients the training program has proven to be effective with regard to different outcome measures.
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Journal of anesthesia · Jun 1997
Effect of external high-frequency oscillation on severe cardiogenic pulmonary edema.
Effective gas exchange can be maintained in animals without endotracheal intubation using external high-frequency oscillation (EHFO). The aim of this study was to evaluate the effect of EHFO in patients with respiratory failure due to severe cardiogenic pulmonary edema. Seven patients were ventilated with EHFO for 2h at 60 oscillations·min(-1), with a cuiras pressure of 36 cmH2O (-26 to +10) and an inspiratory to expiratory ratio of 1:1, with EHFO. ⋯ Arterial CO2 pressure (Paco2) did not, however, decrease. Increased stroke volume without a change in pulmonary artery wedge pressure (preload) suggests either improved inotropic function of the left ventricle or reduced left ventricular afterload with EHFO. The use of EHFO may be effective not only for gas exchange but also for left ventricular function in patients with severe cardiogenic pulmonary edema.
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Journal of anesthesia · Jun 1997
Right ventricular performance during hypotension induced by prostaglandin E1, nicardipine HCl, glycerine trinitrate, and isosorbide dinitrate.
This study investigated right ventricular (RV) performance during hypotensive anesthesia and compared the effect of the vasodilators prostaglandin E1 (PGE1), nicardipine HCl (Nic), glycerin trinitrate (GTN), and isosorbide dinitrate (ISDN) on RV function. Fifty patients were allocated into four groups [PGE1 (n=20), Nic (n=10), GTN (n=10), and ISDN (n=10)] in random order. Pulmonary and RV hemodynamics were measured using a rapid-response thermodilution catheter before and during induced hypotension, when systolic arterial pressure was maintained at 80 mmHg. ⋯ Nic was a useful alternative agent for hypotensive anesthesia. GTN and ISDN reduced RV preload and RVSV; however, cardiac output was maintained by increasing heart rate (HR). Therefore, such nitrates should be used under an adequate RV preload.