Articles: cations.
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Historical Article
Introduction and a brief historical overview of the International Association for the Study of Pain.
The mission of the International Association for the Study of Pain (IASP) is "to bring together scientists, clinicians, healthcare providers, and policymakers to stimulate and support the study of pain and to translate that knowledge into improved pain relief worldwide." The IASP will celebrate its 50th anniversary next year, and the series of articles published in this special issue of its flagship journal PAIN highlights the IASP's achievements over the past 5 decades. This article provides a brief historical overview of the IASP's 50-year journey, including the key "players," events, and initiatives leading to its formation and contributing to its progress. It complements the other articles outlining the contributions that the IASP has made and likely will continue to make to advances in pain education, research, management and advocacy, and its value to the IASP members.
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A critical aspect for most human pain research is the ability of participants to communicate their first-person, experiential perspective to a third-person observer. This communication is frequently accomplished via pain ratings. The scale type can influence the communication of pain experiences and can contribute to gender differences in pain. This study examined the role of gender on pain ratings using noxious and innocuous stimuli across two types of rating scales. ⋯ There are differences in the usage of rating scales in which ratings for auditory, visual and noxious somatosensory stimuli are higher with NRS compared to VAS. Choosing a rating scale for research or clinical use should take this different item functioning into account.
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Healthcare trainees frequently report facing comments from their patients pertaining to their age. Exposure to ageist comments from patients may be related to greater stress and/or burnout in residents and may impact the quality of the resident-patient relationship. However, little empirical work has examined ageism expressed toward anesthesiology residents in clinical care, and therefore not much is known about how residents respond to these comments in practice. This research sought to determine how anesthesiology residents responded to ageist comments. ⋯ These results provide a first step in understanding how ageism may be navigated by residents in clinical encounters. The authors discuss potential avenues for future research and education for responding to ageist remarks for both patients and clinicians.
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Dose selection for brain metastases stereotactic radiosurgery (SRS) classically has been based on tumor diameter with a reduction of dose in the settings of prior brain irradiation, larger tumor volumes, and critical brain location. However, retrospective series have shown local control rates to be suboptimal with reduced doses. We hypothesized that lower doses could be effective for specific tumor biologies with concomitant systemic therapies. This study aims to report the local control (LC) and toxicity when using low-dose SRS in the era of modern systemic therapy. ⋯ It is feasible to achieve acceptable LC in BMs with low-dose SRS. Volume, melanoma histology, and margin dose seem to be predictors for LF. The value of a low-dose approach may be in the management of patients with higher numbers of small or adjacent tumors with a history of whole brain radio therapy or multiple SRS sessions and in tumors in critical locations with the aim of LC and preservation of neurological function.
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Anesthesia and analgesia · Nov 2023
Pro-Con Debate: Electroencephalography-Guided Anesthesia for Reducing Postoperative Delirium.
Postoperative delirium (POD) has significant implications on morbidity, mortality, and health care expenditures. Monitoring electroencephalography (EEG) to adjust anesthetic management has gained interest as a strategy to mitigate POD. In this Pro-Con commentary article, the pro side supports the use of EEG to reduce POD, citing an empiric reduction in POD with processed EEG (pEEG)-guided general anesthesia found in several studies and recent meta-analysis. ⋯ The Con side also contends that the ideal EEG signatures to guide anesthetic titration are currently unknown, and the potential benefits of reduced anesthesia levels may be outweighed by the risks of potentially insufficient anesthetic administration. As the public health burden of POD increases, anesthesia clinicians will be tasked to consider interventions to mitigate risk such as EEG. This Pro-Con debate will provide 2 perspectives on the evidence and rationales for using EEG to mitigate POD.