Articles: outcome.
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This review provides a rigorous investigation of the question of whether the transtheoretical model (TTM) (or stages of change model) is applicable to eating behaviour change. The TTM is currently the most popular of a number of stage theories being used to examine health behaviour change. Stage theories specify an ordered set of 'stages of readiness to change' into which people can be classified and identify the factors that can facilitate movement from one stage to the next. ⋯ Among the key conclusions are: (1) dietary studies using the TTM have been hampered by a focus on nutritional outcomes such as dietary fat reduction, rather than clearly understood food behaviours (e.g. five servings of fruit and vegetables per day); (2) accurate stage classification systems are possible for food-based goals, but major misclassification problems occur with nutrient-based goals; (3) observation of an association between stage and dietary intake is not sufficient to demonstrate the validity of the model for dietary behaviour; (4) there is a need for valid questionnaires to measure all aspects of the TTM, and more research on the whole model, particularly the 'processes of change', rather than on single constructs such as 'stage' (5) cross-sectional studies generally support the predicted patterns of between-stage differences in decisional balance, self-efficacy, and processes of change; (6) studies which test the key hypothesis that different factors are important in distinguishing different stages are rare, as are prospective studies and stage-matched interventions. Only such studies can conclusively determine whether the TTM is applicable to eating behaviour. Since the ultimate test of the TTM will be the effectiveness of stage-matched dietary interventions, the review ends by exploring the requirements for such studies.
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Objective. This study examines, in a retrospective fashion, the effects of intraspinal infusion therapy, primarily using opioids, in the treatment of recalcitrant noncancer pain in a sample of 29 consecutive patients. Patients were, on average, 58 years of age having had one surgery, with a pain duration of 221 months. ⋯ Side effects remain fairly common and require continued attention. Their presence, however, did not appear to deter from the patient's overall sense of satisfaction. Acquiring information from significant others and clinic staff may be a useful adjunct in interpreting the overall outcome.
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We review the evidence base for fluid management in pre-eclampsia. Current understanding of the relevant pathophysiology and the possible impact of styles of fluid management on maternal and fetal outcome are presented. There is little evidence upon which to base the management of fluid balance in pre-eclampsia. ⋯ Pulmonary oedema and oliguria receive particular attention. There is no evidence of long-term renal damage in pre-eclampsia, but there are strong suggestions that pulmonary oedema is linked to fluid administration. Monitoring is discussed and some principles of management are suggested
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Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialComparison of epidural lidocaine and fentanyl to intrathecal sufentanil for analgesia in early labour.
A randomized, double-blind study was undertaken comparing an epidural test dose of lidocaine followed by 100 microg fentanyl (E-LF, n = 19) to combined spinal epidural sufentanil 10 microg (CSE-S, n = 21) in low risk women in early labour. The primary outcome measured was the duration of analgesia; secondary outcomes included the quality of analgesia, incidence and severity of pruritus, lower limb motor blockade, and the ability to ambulate. A P < 0.05 was considered statistically significant. ⋯ The VAS for pruritus were higher in the CSE-S group (P < 0.05) but no patient requested treatment for pruritus. Mild motor weakness was more frequent in the E-LF group (5/19 versus 20/21, P < 0.05) and fewer patients in the E-LF group met criteria for ambulation (13/19 versus 20/21, P < 0.05). While both E-LF and CSE-S provide effective analgesia for women in early labour, the more rapid onset of analgesia, lower VAS pain scores, longer duration of action and lesser impact on ability to ambulate suggest advantages of CSE-S over E-LF.
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Post lumbar laminectomy syndrome with its resultant chronic low back pain is estimated to occur in 20% to 50% of the patients. Among various procedures available, lysis of epidural adhesions is considered as one of the effective therapeutic modalities of management in these patients, and may be performed either non-endoscopically or endoscopically. This retrospective evaluation included 120 post lumbar laminectomy patients who underwent either non-endoscopic adhesiolysis (Group I) or endoscopic adhesiolysis (Group II) with 60 consecutive patients in each group. ⋯ Cost effectiveness analysis showed Group I patients experiencing significant relief at a cost of $40 per week, with one year quality of life improvement for $2,080, whereas it was $135 per week improvement in Group II with a one year quality of life improvement at a cost of $7,020 with significant difference noted in cost effectiveness. In conclusion, non-endoscopic epidural adhesiolysis and administration of corticosteroids and hypertonic saline is a safe and cost effective procedure for relieving chronic intractable pain in post lumbar laminectomy patients who failed to respond to other modalities of treatment. Similarly, endoscopic adhesiolysis with the administration of corticosteroids is also a safe and possibly cost-effective technique for relief of chronic intractable pain failing to respond to other modalities of treatments.