Vestibular Rehabilitation Therapy Outcomes in Patients With Persistent Postural-Perceptual Dizziness

2019 ◽  
Vol 128 (4) ◽  
pp. 323-329 ◽  
Author(s):  
Ebtessam H. Nada ◽  
Ola A. Ibraheem ◽  
Mohammad R. Hassaan
Keyword(s):  
Side Effects ◽  
Symptom Relief ◽  
Management Strategies ◽  
Vestibular Rehabilitation ◽  
Therapy Outcomes ◽  
Short Term ◽  
Self Assessment ◽  
Rehabilitation Therapy ◽  
Group I

Objectives: Persistent postural-perceptual dizziness (PPPD) represents an important category of vertigo. Medical treatment and psychotherapy provide convenient control of symptoms. However, these management strategies can have inconvenient side effects and short-term relief, respectively. Vestibular rehabilitation therapy (VRT) is a self-conducted habituation program that can be personalized to the subject’s needs to give adequate symptom relief without side effects. The present study aims to test the effect of VRT on patients with PPPD. Methods: Participants were diagnosed as having PPPD by the exclusion of organic vestibular lesions. The study involved 2 groups with PPPD: Group I, treated with the VRT, and Group II, treated with the VRT plus placebo. The Dizziness Handicap Inventory (DHI), a self-assessment scale, was used to evaluate the VRT outcomes. Results: There was a significant decrease in functional, physical, and total scores on the DHI in both groups after VRT. Adding the placebo did not have supplementary outcomes. The patients who did not benefit from the VRT had a significantly longer duration of PPPD, more complex aggravating factors, more composite VRT exercises, and a higher DHI score than the patients who benefited from VRT. Conclusions: Customized VRT adequately reduced symptoms and improved quality of life in subjects with PPPD.

scholarly journals Canadian Consensus Conference on the Management of Gastroesophageal Reflux Disease in Adults – Update 2004

2005 ◽  
Vol 19 (1) ◽  
pp. 15-35 ◽  
Author(s):  
David Armstrong ◽  
John K Marshall ◽  
Naoki Chiba ◽  
Robert Enns ◽  
Carlo A Fallone ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Reflux Disease ◽  
Symptom Relief ◽  
Management Strategies ◽  
Consensus Conference ◽  
Optimal Management ◽  
Barrett’S Epithelium ◽  
Barrett's Epithelium ◽  
Gerd Symptoms

BACKGROUND: Gastroesophageal reflux disease (GERD) is the most prevalent acid-related disorder in Canada and is associated with significant impairment of health-related quality of life. Since the last Canadian Consensus Conference in 1996, GERD management has evolved substantially.OBJECTIVE: To develop up-to-date evidence-based recommendations relevant to the needs of Canadian health care providers for the management of the esophageal manifestations of GERD.CONSENSUS PROCESS: A multidisciplinary group of 23 voting participants developed recommendation statements using a Delphi approach; after presentation of relevant data at the meeting, the quality of the evidence, strength of recommendation and level of consensus were graded by participants according to accepted principles.OUTCOMES: GERD applies to individuals who reflux gastric contents into the esophagus causing symptoms sufficient to reduce quality of life, injury or both; endoscopy-negative reflux disease applies to individuals who have GERD and a normal endoscopy. Uninvestigated heartburn-dominant dyspepsia -- characterised by heartburn or acid regurgitation - includes erosive esophagitis or endoscopy-negative reflux disease, and may be treated empirically as GERD without further investigation provided there are no alarm features. Lifestyle modifications are ineffective for frequent or severe GERD symptoms; over-the-counter antacids or histamine H2-receptor antagonists are effective for some patients with mild or infrequent GERD symptoms. Proton pump inhibitors are more effective for healing and symptom relief than histamine H2-receptor antagonists; their efficacy is proportional to their ability to reduce intragastric acidity. Response to initial therapy - a once-daily proton pump inhibitor unless symptoms are mild and infrequent (fewer than three times per week) - should be assessed at four to eight weeks. Maintenance medical therapy should be at the lowest dose and frequency necessary to maintain symptom relief; antireflux surgery is an alternative for a small proportion of selected patients. Routine testing for Helicobacter pylori infection is unnecessary before starting GERD therapy. GERD is associated with Barrett's epithelium and esophageal adenocarcinoma but the risk of malignancy is very low. Endoscopic screening for Barrett's epithelium may be considered in adults with GERD symptoms for more than 10 years; Barrett's epithelium and low-grade dysplasia generally warrant surveillance; endoscopic or surgical management should be considered for confirmed high-grade dysplasia or malignancy.CONCLUSION: Prospective studies are needed to investigate clinically relevant risk factors for the development of GERD and its complications; GERD progression, on and off therapy; optimal management strategies for typical GERD symptoms in primary care patients; and optimal management strategies for atypical GERD symptoms, Barrett's epithelium and esophageal adenocarcinoma.

Outcomes

2013 ◽  
pp. 221-226
Author(s):  
David L. Scott
Keyword(s):  
Quality Of Life ◽  
Disease Activity ◽  
Short Form ◽  
Organ Damage ◽  
Confounding Factors ◽  
Short Term ◽  
Self Assessment ◽  
The Matrix ◽  
The Impact

Outcomes evaluate the impact of disease. In rheumatology they span measures of disease activity, end-organ damage, and quality of life. Some outcomes are categorical, such as the presence or absence of remission. Other outcomes involve extended numeric scales such as joint counts, radiographic scores, and quality of life measures. Outcomes can be measured in the short term—weeks and months—or over years and decades. Short-term outcomes, though readily related to treatment, may have less relevance for patients. Clinical trials focus on short-term outcomes whereas observational studies explore longer-term outcomes. The matrix of rheumatic disease outcomes is exemplified by rheumatoid arthritis. Its outcomes span disease activity assessments like joint counts, damage assessed by erosive scores, quality of life evaluated by disease-specific measures like the Health Assessment Questionnaire (HAQ) or generic measures like the Short Form 36 (SF-36), overall assessments like remission, and end result such as joint replacement or death. Outcome measures capture the impact of treating rheumatic diseases. They are influenced by disease severity and effective treatment. They also reflect many confounding factors. These include demographic factors like age, gender, and ethnicity and also deprivation, as poverty worsens outcomes. Comorbidities affect outcomes and patients with multiple comorbid conditions have worse quality of life with poorer outcomes. Patient self-assessment has grown in importance; it is simple and understandable. However, self-assessment can vary over time and does not always reflect assessors’ perspectives. Caution is needed comparing outcomes across units; the various confounding factors and measurement complexities make such comparative analyses challenging.

scholarly journals Short-term fasting accompanying chemotherapy as a supportive therapy in gynecological cancer: protocol for a multicenter randomized controlled clinical trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniela Koppold-Liebscher ◽  
Christian S. Kessler ◽  
Nico Steckhan ◽  
Vanessa Bähr ◽  
Cornelia Kempter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Tumor Progression ◽  
Gynecological Cancer ◽  
Controlled Clinical Trial ◽  
Breast Cancer Patients ◽  
Short Term ◽  
Randomized Controlled ◽  
Refined Carbohydrates

Abstract Background/objectives A few preliminary studies have documented the safety and feasibility of repeated short-term fasting in patients undergoing chemotherapy. However, there is a lack of data from larger randomized trials on the effects of short-term fasting on quality of life, reduction of side effects during chemotherapy, and a possible reduction of tumor progression. Moreover, no data is available on the effectiveness of fasting approaches compared to so-called healthy diets. We aim to investigate whether the potentially beneficial effects of short-term fasting can be confirmed in a larger randomized trial and can compare favorably to a plant-based wholefood diet. Methods This is a multicenter, randomized, controlled, two-armed interventional study with a parallel group assignment. One hundred fifty patients, including 120 breast cancer patients and 30 patients with ovarian cancer, are to be randomized to one of two nutritional interventions accompanying chemotherapy: (1) repeated short-term fasting with a maximum energy supply of 350–400 kcal on fasting days or (2) repeated short-term normocaloric plant-based diet with restriction of refined carbohydrates. The primary outcome is disease-related quality of life, as assessed by the functional assessment of the chronic illness therapy measurement system. Secondary outcomes include changes in the Hospital Anxiety and Depression Score and as well as frequency and severity of chemotherapy-induced side effects based on the Common Terminology Criteria of Adverse Events. Explorative analysis in a subpopulation will compare histological complete remissions in patients with neoadjuvant treatments. Discussion/planned outcomes Preclinical data and a small number of clinical studies suggest that repeated short-term fasting may reduce the side effects of chemotherapy, enhance quality of life, and eventually slow down tumor progression. Experimental research suggests that the effects of fasting may partly be caused by the restriction of animal protein and refined carbohydrates. This study is the first confirmatory, randomized controlled, clinical study, comparing the effects of short-term fasting to a short-term, plant-based, low-sugar diet during chemotherapy on quality of life and histological tumor remission. Trial registration ClinicalTrials.gov NCT03162289. Registered on 22 May 2017

scholarly journals Evaluation of Dexmedetomidine Co-Administered with Neostigmine and Bupivacaine for Postoperative Epidural Analgesia in Lower Limb Orthopaedic Surgeries – A Study from Maharashtra, India

2021 ◽  
Vol 10 (32) ◽  
pp. 2634-2639
Author(s):  
Parag Yashawant Dongre ◽  
Aruna Vijay Chandak ◽  
Amol P. Singam
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Lower Limb ◽  
Rescue Analgesia ◽  
Post Surgery ◽  
Group I ◽  
Post Operative Pain ◽  
Key Words Epidural ◽  
Spinal Epidural

BACKGROUND Addition of adjuvants to the neuro axial blocked helps prolongate the duration and quality of analgesia and anaesthesia. The safety and efficacy of drugs dexmedetomidine and neostigmine have been less commonly studied. We wanted to compare post-operative analgesia, haemodynamics, and side effects if any in this study. METHODS Combined spinal - epidural anaesthesia was performed in 60 patients who underwent lower limb surgeries of less than 2 hrs. The patients were given the drug epidurally post-surgery. Group I, II and III were given 10 ml of 0.25 % bupivacaine alone, with 1 microgram per kg of neostigmine and with 0.5 milligram per kg of dexmedetomidine and 1 microgram per kg of neostigmine, respectively. 50 mg tramadol intravenous was kept as rescue analgesic. Parameters which predict haemodynamics, assessment of pain, period of analgesia, demand for rescue analgesia and the chances of side effects were noted over the next ten hrs. RESULTS To conclude, epidural analgesia is the most preferred analgesia these days in management of lower limb orthopaedic surgery’s post-operative pain. When bupivacaine was combined with neostigmine and dexmedetomidine as a neuraxial adjuvant, it prolonged the post-operative analgesia significantly without increasing the side effects of those drugs. The combination of two drugs proved better than the use of single drug alone. CONCLUSIONS Combination of neostigmine and dexmedetomidine when used as a neuraxial adjuvant, significantly prolonged the duration of post-operative analgesia by 274.13 4.539 in lower limb orthopaedic cases compared to neostigmine alone that was 176.23 ± 3.441. KEY WORDS Epidural, Neostigmine, Dexmedetomidine, Orthopaedic Surgeries, Post-Operative Analgesia

scholarly journals Cisplatin combined with capecitabine-induced chemotherapy for local nasopharyngeal carcinoma can improve the quality of life and reduce toxic and side effects

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ying Gao ◽  
Zhe Liu ◽  
Yiting Liu
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Nasopharyngeal Carcinoma ◽  
Short Term ◽  
Intravenous Drip ◽  
Group A ◽  
Group B ◽  
First Time ◽  
Better Than

Abstract Background This study was designed to probe into the effect of cisplatin combined with capecitabine on nasopharyngeal carcinoma (NPC). Methods A total of 136 NPC patients treated for the first time in our hospital from January 2016 to March 2017 were collected and divided into two groups: A and B. Among them, 66 in group A were treated with cisplatin intravenous drip, while 70 in group B were treated with capecitabine on the basis of group A. The efficacy, toxic and side effects, and quality of life of the two groups were observed. Results The short-term efficacy of group B was better than that of group A (p<0.05). The toxic and side effects of group B were lower than that of group A (p<0.05). The quality of life in group B was higher than that in group A (p<0.05). Conclusions Cisplatin combined with capecitabine-induced chemotherapy for local NPC can improve the quality of life and reduce the toxic and side effects.

QUALITY OF THE EDUCATIONAL SERVICE –PERCEPTIONS AND EXPECTATIONS OF THE TEACHERS IN HIGH SCHOOLS FROM SUCEAVA COUNTY, ROMANIA

2017 ◽  
Vol 5 ◽  
pp. 757-763
Author(s):  
Laura Mirela Pintilie
Keyword(s):  
School Performance ◽  
Objective Assessment ◽  
Management Strategies ◽  
Quality Of Services ◽  
Educational Service ◽  
Direct Effects ◽  
Self Assessment ◽  
Material Resources ◽  
Perceptions And Expectations

The goal of this study was to determine the main variables that are part of the management strategies for quality assurance in higher education. The study was conducted in 2016 on a representative sample of secondary schools in Suceava County, Romania. The research methodology has mixed quantitative analysis of collected data using a questionnaire applied to teachers from seven schools in the Suceava County (268 respondents) and qualitative analysis of public documents referring to performances in the secondary education system. To achieve the questionnaire, an adaptation of the SERVQUAL method was used, specific for the services domain. It was aimed at establishing the differences between perceptions and expectations of teachers on human and material resources necessary to ensure the quality of services in education. The results were correlated with data on students’ performances in high school and / or professional school.Changing the mentality of the teachers, self-assessment and objective assessment of the work performed and working conditions can lead to increased quality of educational services with direct effects in improving school performance of direct beneficiaries of education, the students.

Failure of long-term nerve root stimulation to improve neuropathic pain

2008 ◽  
Vol 108 (5) ◽  
pp. 921-925 ◽  
Author(s):  
Ralf Weigel ◽  
Hans-Holger Capelle ◽  
Joachim K. Krauss
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Side Effects ◽  
Nerve Root ◽  
Daily Living ◽  
Short Term ◽  
Test Stimulation ◽  
Root Stimulation

Object Stimulation of dorsal nerve roots or dorsal root ganglia was reported to alleviate neuropathic pain in selected patients during the early postoperative period. A prospective study was initiated to investigate long-term outcome in patients with neuropathic pain of the lower extremities or groin who were treated with selective nerve root stimulation. Methods The study included patients with dermatomally distributed neuropathic pain who were > 18 years of age and in whom the pain was refractory to medical treatment. The patients were prospectively evaluated using a visual analog scale (VAS) for pain and ratings for quality of life, activities of daily living, and depression preoperatively, and after defined intervals postoperatively. Implantation of electrodes was performed via foraminotomy or interlaminar fenestration in an awake procedure. An implantable pulse generator (IPG) was implanted in a second operation after successful test stimulation performed over several days. Results Three patients were included in the study before it was stopped. The mean maximum pain score preoperatively was 9.3. All patients had successful test stimulation with > 50% pain relief prior to implantation of the IPG (mean maximum VAS Score 3.6). The beneficial effect, however, was lost within the next few months despite adjustment of stimulation settings. With higher amplitudes, side effects such as pain attacks or motor phenomena occurred. They disappeared after stopping stimulation, but neuropathic pain recurred to its full extent. The study was stopped 18 months after the first implantation, when the third and last IPG of this series was explanted. Due to the overall short-term effect of stimulation, no relevant changes in ratings for quality of life, activities of daily living, or depression were detected. Conclusions Spinal nerve root stimulation proved to be effective on short-term follow-up in 3 patients with neuropathic pain in a dermatomal distribution. Long-term stimulation, however, was disappointing because of the loss of effectiveness and the occurrence of side effects.

scholarly journals Efficacy and safety of Ketoprofen Gel treatment in patients with low back pain

2021 ◽  
Vol 11 (1) ◽  
pp. 28-34
Author(s):  
V.V. Povoroznyuk ◽  
A.S. Musiienko ◽  
N.V. Zaverukha ◽  
A.A. Tkachuk
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Side Effects ◽  
Functional Capacity ◽  
Lumbar Region ◽  
Low Back ◽  
Group I ◽  
Gel Treatment ◽  
Systemic Side Effects

Background. The purpose was to study the effectiveness and safety of Ketoprofen gel (Fastum gel) therapy in patients with low back pain (LBP) caused by degenerative-dystrophic changes of the spine. Materials and methods. 24 males and females aged 50-69 years with LBP lasting over 14 days were examined, with a further division into two groups. Group I – 12 patients received thin ketoprofen applications on the lumbar region 2 times a day for 10 days. Group II – 12 patients who received thin applications of Vaseline on the same area 2 times a day for 10 days. Patients used the study drugs as a monotherapy. Examination was performed before the treatment initiation, after 10 and 20 days of treatment. Results. Patients receiving ketoprofen applications had a significantly reduced pain intensity registered by all four components of VAS and the Roland-Morris questionnaire. At the same time, the functional capacity by Schober (t = 3.54, p = 0.005) and Tomayer (t = 3.08, p = 0.01) tests was significantly improved. The quality of life according to the EuroQul-5D scale in patients who used the topical ketoprofen significantly increased by 45 % (t = 4.19, p = 0.002), and life expectancy according to the Oswestry questionnaire by 39.3 % after 10 days of treatment (t = 3.9, p = 0.002). 75 % of patients from the main group and 33.3 % from the compa­rison group assessed the effectiveness of treatment as high according to the Likert index. Neither group reported localized nor systemic side effects. Conclusions. Monotherapy of ketoprofen gel significantly reduced the intensity of pain and improved the functional capacity of patients with LBP. The absence of side effects during treatment indicates its high safety profile for patients.

scholarly journals Comparison of Effect of Clonidine Added to Bupivacaine-Fentanyl Mixture on the Quality of Spinal Anaesthesia and Peri-Op Analgesia with Bupivacaine-Fentanyl or Bupivacaine-Clonidine Mixture in Major Orthopaedic Lower Limb Surgeries

2017 ◽  
pp. 97
Author(s):  
Milin Raju Shah ◽  
Gauri Diwan
Keyword(s):  
Side Effects ◽  
Spinal Anaesthesia ◽  
High Dose ◽  
Motor Blockade ◽  
Randomised Study ◽  
Group I ◽  
Analgesia Requirement ◽  
Mean Time ◽  
Effective Analgesia

Introduction: With side effects of central neuroaxial opioids or of high dose intrathecal clonidine in combination with bupivacaine in spinal anaesthesia, my study is to ascertain if small dose of clonidine when added to bupivacaine-fentanyl mixture improves spinal anaesthesia, without producing side effects, as compared to bupivacaine-fentanyl or bupivacaineclonidine mixture. Methods: It’s a prospective, double blinded randomised study of 90 ASA grade I-II patients, aged between 20-60 yrs, of either sex, weighing between 40-70 kgs, scheduled for major orthopaedic surgeries. Patients were randomly divided into 3 groups of 30 patients each as Group I (BCF): Bupivacaine 0.5%H 2.6ml + Fentanyl 20mcg + Clonidine 30mcg Group II (BC): Bupivacaine 0.5%H 2.6ml + Clonidine 30mcg Group III (BF): Bupivacaine 0.5%H 2.6ml + Fentanyl 20mcg Duration of sensory and motor blockade and effective analgesia mean time till two segment regression, haemodynamic profile, post-op pain and analgesia requirement were recorded. Results: The duration of sensory and motor blockade, effective analgesia and mean time till two segment regression were significantly longer in group BCF as compared to group BC (P – 0.002) and in group BC as compared to group BF (P – 0.01). The incidence of intra-op pain and requirement of postop analgesia in the first 24 hours was significantly more in group BF as compared to other groups (P-0.01). Conclusion: Low dose Clonidine when added to Bupivacaine-Fentanyl mixture improves the quality of peri-op analgesia without significant side effects.

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