scholarly journals Is There a Difference in Pain Management of Patients with Upper Extremity Injuries in Relation to Age?

2015 ◽  
Author(s):  
Cheryl Pappas
Keyword(s):  
Pain Management ◽  
Upper Extremity ◽  
Chart Review ◽  
Bone Fractures ◽  
Retrospective Chart Review ◽  
Pain Medication ◽  
World Health ◽  
Long Bone ◽  
Long Bone Fracture ◽  
Extremity Injuries

<p>Timely and appropriate analgesia for the treatment of long bone fractures is a primary goal of Emergency Departments. Despite incentives from the Centers of Medicare and Medicaid and accreditation agencies studies have found the existence of pain management disparities. The purpose of this research study was to conduct a retrospective chart review to investigate if patients with an upper extremity long bone fracture received pain medication within 60 minutes of arrival to the ED and to identify if there was a difference in the pain management of patients, with identical injuries, by age. Katharine Kolcaba’s comfort theory was used to guide the implementation of this project. Pain medication was provided within 60 minutes in 63% of the participants aged 69 and under and 56% of those aged 70 and older. A larger disparity occurred between the groups being medicated appropriately according to the World Health Organization’s guidelines for pain management with 63% of participants aged 18-69 receiving the appropriate pain medication compared to 45 % of participants in the 70 and over age group. The APRN has the opportunity to educate the nurses and members of the interdisciplinary team through evidence based practice in the safe and effective methods for treating acute pain across the lifespan.</p>

scholarly journals The Clinical Spectrum of Primary Cutaneous CD4+ Small/Medium-Sized Pleomorphic T-Cell Lymphoproliferative Disorder: An Updated Systematic Literature Review and Case Series

Dermatology ◽  
2020 ◽  
Vol 237 (4) ◽  
pp. 618-628
Author(s):  
Philip Surmanowicz ◽  
Sean Doherty ◽  
Arunima Sivanand ◽  
Nikoo Parvinnejad ◽  
Jean Deschenes ◽  
...  
Keyword(s):  
T Cell ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Lymphoproliferative Disorder ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Cutaneous Lymphoma ◽  
World Health ◽  
Treatment Modalities ◽  
Systemic Treatments

<b><i>Background:</i></b> Primary cutaneous CD4+ small/medium pleomorphic T-cell lymphoproliferative disorder (SMPLPD) is a provisional entity within the 2016 World Health Organization classification of primary cutaneous lymphomas. The condition is currently classified as a lymphoproliferative disorder to emphasize its benign course and discourage aggressive, systemic treatment modalities. <b><i>Objective:</i></b> To provide a relevant synthesis for the dermatological practitioner on the prevalence, presentation, and treatment of SMPLPD. <b><i>Methods:</i></b> We conducted an updated systematic literature review and a retrospective chart review of diagnosed cases of SMPLPD from 2 Canadian academic cutaneous lymphoma centers. <b><i>Results:</i></b> A total of 23 studies with 136 cases were extracted from the systematic review and 24 patients from our retrospective chart review. SMPLPD proved relatively common accounting for 12.5% of all cutaneous T-cell lymphomas encountered in our cutaneous lymphoma clinics, second in frequency only to mycosis fungoides. The typical clinical presentation was that of an older individual (median age 59 years) with an asymptomatic solitary lesion on their upper extremity. The most common clinical differentials were cutaneous lymphoid hyperplasia, basal cell carcinoma, and lymphoma unspecified. T follicular helper markers were reliably detected. The main treatment modalities were surgical excision, local radiation therapy, and topical or intralesional steroids. Cure was achieved in the vast majority of cases. <b><i>Conclusions:</i></b> SMPLPD is an underdiagnosed T-cell lymphoma with an overtly benign clinical course. The condition has an excellent prognosis and responds well to skin-directed therapies. Practitioners should be aware of this condition to avoid aggressive systemic treatments.

scholarly journals Development and Biocompatibility Characterization of a BioMEMS Sensor for Monitoring the Progression of Fracture Healing

2009 ◽  
Author(s):  
Brandon G. Santoni ◽  
Rohat Melik ◽  
Emre Unal ◽  
Nihan Kosku Perkgoz ◽  
Debra A. Kamstock ◽  
...  
Keyword(s):  
United States ◽  
Fracture Healing ◽  
Bone Fractures ◽  
Financial Burden ◽  
Early Period ◽  
The United States ◽  
Long Bone ◽  
Extremity Injuries ◽  
Manual Manipulation

Orthopaedic extremity injuries present a large medical and financial burden to the United States and world-wide communities [1]. Approximately six million long bone fractures are reported annually in the United States and approximately 10% of these fractures do not heal properly. Though the exact mechanism of impaired healing is poorly understood, many of these non-unions result when there is a communited condition that does not proceed through a stabilized healing pathway [2]. Currently, clinicians may monitor healing visually by radiographs, or via manual manipulation of the bone at the fracture [3]. Unfortunately, the course of aberrant fracture healing is not easily diagnosed in the early period when standard radiographic information of the fracture is not capable of discriminating the healing pathway. Manual assessment of fracture healing is also an inadequate diagnostic tool in the early stages of healing [4].

Long-Bone Fracture Pain Management in the Emergency Department

2012 ◽  
Vol 38 (3) ◽  
pp. 211-217 ◽  
Author(s):  
Ptlene Minick ◽  
Patricia C. Clark ◽  
Jo Ann Dalton ◽  
Eva Horne ◽  
Debbie Greene ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Bone Fracture ◽  
Long Bone ◽  
Long Bone Fracture

Development of a Bioabsorbable Glass-Reinforced-Glass Intra-Osseous Scaffold for Fracture Healing

2011 ◽  
Vol 9 ◽  
pp. 81-91
Author(s):  
Philip Boughton ◽  
Y. Chen ◽  
C. Thompson ◽  
G. Roger ◽  
Jari Hyvarinen ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Bone Fractures ◽  
Stress Shielding ◽  
Long Bone ◽  
Hematopoietic Tissue ◽  
Shear Tests ◽  
Intramedullary Canal ◽  
Long Bone Fracture ◽  
Torsional Loads ◽  
Mechanically Stabilized

Intramedullary (IM) nails are routinely used to stabilize long bone fractures. They can however lead to stress shielding, pain, migration, obstruct hematopoietic tissue, become a loci for infection, and require subsequent surgical retrieval. Novel intra-osseous scaffold (IOS™) prototypes for fracture healing have been developed to function as a regenerative scaffold to enhance callous formation under mechanically stabilized conditions then resorb. Prototype fixation pins and rod systems were formed from glass-reinforced-glass. Flexion, torsion and shear tests were performed to evaluate the composite pins and rods. A modular rod design was successfully deployed and dilated while in a deformable state. When fitted and gripping the intramedullary canal then set in a rigid state. An obliquely sectioned ovine femur was used as a long bone fracture model for deployment and mechanical verification. Flexural support provided by the intramedullary scaffold was superior to multiple k-wire fixation, while the k-wire approach was more stabilizing under torsional loads. Glass reinforced glass samples were mechanically tested after soaking for up to 4 weeks in saline. Strength and modulus of the composite was reduced to approximately 25% of initial values after 2 weeks.

Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway

2015 ◽  
Vol 31 (8) ◽  
pp. 560-563 ◽  
Author(s):  
Nicole Marie Schacherer ◽  
Dana Erikson Ramirez ◽  
Steven Barron Frazier ◽  
Amy M. Perkins
Keyword(s):  
Clinical Pathway ◽  
Bone Fractures ◽  
Pain Medication ◽  
Long Bone ◽  
Long Bone Fractures

Clinical Guidelines and Policies: Can they Improve Emergency Department Pain Management?

2005 ◽  
Vol 33 (4) ◽  
pp. 783-790 ◽  
Author(s):  
James Ducharme
Keyword(s):  
Pain Management ◽  
Practice Patterns ◽  
Bone Fractures ◽  
Relevant Information ◽  
Long Bone ◽  
Specific Patient ◽  
Change In Practice ◽  
Prevalence Of Pain ◽  
A Prospective Study ◽  
Patient Subgroups

The prevalence of pain in patients presenting to Emergency Departments (ED) has been well documented by both Cordell and Johnston. Equally well documented has been the apparent failure to adequately control that pain. In 1990 Selbst found that patients with long bone fractures received little analgesia in the ED, and Ngai, et al., showed that the under-treatment of pain continued after discharge. In a prospective study, Ducharme and Barber found that up to one third of patients presented with severe pain and were often unrelieved at discharge. Even though specific patient subgroups appear to be at greater risk, all patients are potential victims of oligoanalgesia - the under-treatment of pain. Despite an ever increasing volume of research about pain in emergency medicine, dissemination of relevant information with widespread change in practice patterns has not been witnessed. Recent studies continue to affirm that pain management in the ED is suboptimal.

The Relationship Between Patient Age and Pain Management of Long Bone Fracture in the Emergency Department

2013 ◽  
Vol 62 (4) ◽  
pp. S127-S128
Author(s):  
E. Boccio ◽  
S. Pasternak ◽  
E. Kintzer ◽  
J. D'Amore ◽  
M.F. Ward ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Bone Fracture ◽  
Long Bone ◽  
Patient Age ◽  
Patient Âgé ◽  
Long Bone Fracture ◽  
The Relationship

Internal Fixation of Long Bone Fractures in Farm Animals

1993 ◽  
Vol 06 (01) ◽  
pp. 36-41 ◽  
Author(s):  
A. Steiner ◽  
U. Iselin ◽  
C. Lischer ◽  
J. A. Auer
Keyword(s):  
Internal Fixation ◽  
Bone Fracture ◽  
Bone Fractures ◽  
Farm Animals ◽  
Long Bone ◽  
Fracture Treatment ◽  
Long Bone Fractures ◽  
Long Bone Fracture

This study demonstrates that long bone fracture treatment in food and fibre producing animals is in most cases successful. The greatest disadvantage of such treatment are the costs of the surgery and implants.

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