Faculty Opinions recommendation of Diagnostic Performance of Self-Assessment for Constipation in Patients With Long-Term Opioid Treatment.

Background: Long-term use of opioids for chronic noncancer pain is associated with sex hormone disturbances. The interferences with sex hormones, sexual function, and depression were investigated in patients with chronic noncancer pain. Methods: A cross-sectional multicenter survey was conducted on 170 officially registered outpatients receiving long-term opioid treatment in nine medical centers in Taiwan between October 2018 and July 2019. Serum sex hormone levels were examined after the collection of self-administered questionnaires containing the Taiwanese version of the Brief Pain Inventory, depressive status, and sexual function interference. Results: Among 117 (68.8%) questionnaire responses from 170 enrolled outpatients, 38 women and 62 men completed the sex hormone tests, among whom only 23 (23%) had previously received blood hormone tests. Low serum total testosterone levels were detected in 34 (89.5%) women (<30 ng/dL) and 31 (50%) men (<300 ng/dL). Over 60% of women and men reported reduced sexual desire and function despite a nearly 50% reduction in pain intensity and daily function interference over the previous week after opioid treatment. Women generally had higher risks of a depression diagnosis (p = 0.034) and severe depressive symptoms (p = 0.003) and nonsignificantly lower opioid treatment duration (median 81 vs. 120 months) and morphine milligram equivalent (median 134 vs. 165 mg/day) compared with men. Conclusions: This survey demonstrated the high prevalence of depression diagnosis, low sex hormone levels, and reduced sexual function among Taiwanese patients with chronic noncancer pain receiving prolonged opioid therapy. Regular hypogonadal screenings are recommended for further management.

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Long-term Outcome after Carpal Tunnel Decompression – A Prospective Randomised Study of the Indiana Tome and a Standard Limited Palmar Incision

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193408090104 ◽

2008 ◽

Vol 33 (3) ◽

pp. 332-336 ◽

Cited By ~ 14

Author(s):

T. R. CRESSWELL ◽

C. HERAS-PALOU ◽

M. J. BRADLEY ◽

S. T. CHAMBERLAIN ◽

R. H. HARTLEY ◽

...

Keyword(s):

Carpal Tunnel ◽

Randomised Trial ◽

Open Group ◽

Self Assessment ◽

Term Outcome ◽

Long Term Outcome ◽

Randomised Study ◽

Functional Scores ◽

Median Nerve Injury

This randomised trial compared the results of carpal tunnel decompression using the TM Indiana Tome (Biomet, Warsaw, Indiana, USA) and a standard limited palmar open incision. Two hundred patients were randomly selected to have a carpal tunnel decompression with either the Indiana Tome or a limited palmar technique. They were assessed clinically for 3 months and using the Levine–Katz self-assessment evaluation for 7 years. After 7 years, there were 62 returned questionnaires from the open group and 53 from the Tome group. There were no significant differences in functional scores, pain, scar tenderness, pinch and grip strength at 3 months. There were two complications in the open group and nine in the Tome group, including one median nerve injury. There was both a higher rate of immediate complications, and more recurrences and persisting symptoms at 7 years in the Indiana Tome group.

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Development of a self-assessment behavioral and psychological symptoms of dementia competency scale for care teams at long-term geriatric care facilities

Geriatric Nursing ◽

10.1016/j.gerinurse.2021.03.008 ◽

2021 ◽

Vol 42 (3) ◽

pp. 628-634

Author(s):

Noriko Maeda ◽

Yumiko Tsutsumi ◽

Sayoko Niwa

Keyword(s):

Psychological Symptoms ◽

Geriatric Care ◽

Self Assessment ◽

Care Facilities ◽

Behavioral And Psychological Symptoms

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Development and validation of a tool for patient reporting of symptoms and signs of the post-thrombotic syndrome

Thrombosis and Haemostasis ◽

10.1160/th15-04-0318 ◽

2016 ◽

Vol 115 (02) ◽

pp. 361-367 ◽

Cited By ~ 19

Author(s):

Kristin Kornelia Utne ◽

Waleed Ghanima ◽

Siv Foyn ◽

Susan Kahn ◽

Per Morten Sandset ◽

...

Keyword(s):

Reference Method ◽

Patient Reporting ◽

Self Assessment ◽

Post Thrombotic Syndrome ◽

Supplementary Material ◽

Development And Validation ◽

Kappa Agreement ◽

Symptoms And Signs ◽

Patient Self Assessment

SummaryPost-thrombotic syndrome (PTS) is a long-term complication of deepvein thrombosis (DVT). The Villalta scale is the recommended tool for diagnosing PTS, but requires a clinician’s assessment in addition to patient self-assessment. In the present study, we validated a self-administered tool for patient reporting of leg symptoms and signs as a mean to assess PTS. We first validated a form for patient self-reported Villalta (PRV1), then developed and validated a visually assisted form (PRV2). The validity of PRV1 and PRV2 was assessed in patients diagnosed with DVT between 2004 and 2012. Median time from DVT to inclusion was 5.1 and 3.5 years for PRV1 (n=162) and PRV2 (n=94), respectively. Patients were requested to complete the PRV form before a scheduled visit. PTS diagnosed by the original Villalta scale during the visit served as the reference method. PRV1 showed only moderate agreement for diagnosing PTS compared with the original Villalta scale (kappa agreement 0.60, 95 % CI 0.48–0.72), whereas PRV2 showed very good agreement (0.82, 95 % CI 0.71–0.94). In the validation of PRV2, PTS was diagnosed in 54 (57 %) patients according to the original Villalta scale and in 60 (64 %) by PRV2. The sensitivity of PRV2 to detect PTS was 98 % and the specificity was 83 %. We conclude that the visually assisted form for PRV is a valid and sensitive tool for diagnosing PTS. Such a tool could be applied in further clinical studies of PTS, making studies less resource demanding by reducing the need for in-person clinic visits.Supplementary Material to this article is available online at www.thrombosis-online.com.

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Identifying optimal dosage regimes under safety constraints: An application to long term opioid treatment of chronic pain

Statistics in Medicine ◽

10.1002/sim.7566 ◽

2018 ◽

Vol 37 (9) ◽

pp. 1407-1418 ◽

Cited By ~ 2

Author(s):

Eric B. Laber ◽

Fan Wu ◽

Catherine Munera ◽

Ilya Lipkovich ◽

Salvatore Colucci ◽

...

Keyword(s):

Chronic Pain ◽

Optimal Dosage ◽

Opioid Treatment ◽

Safety Constraints

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Opioid Analgesia: Perspectives on Right Use and Utility

January 2018 - Pain Physician ◽

10.36076/ppj.2007/10/479 ◽

2007 ◽

Vol 3;10 (5;3) ◽

pp. 479-491 ◽

Cited By ~ 2

Author(s):

Jane C. Ballantyne

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Side Effects ◽

Clinical Decision Making ◽

Analgesic Efficacy ◽

Clinical Decision ◽

Opioid Analgesia ◽

Opioid Treatment

The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a backdrop of considerable caution that has been based upon fears of addiction. Of course, opioids may cause addiction, but the “principle of balance” may justify that “…efforts to address abuse should not interfere with legitimate medical practice and patient care.” Yet, situations are increasingly encountered in which opioid-maintained patients are refractory to analgesia during periods of pain, or even during the course of chronic treatment. The real question is whether analgesic efficacy of opioids can be maintained over time. Overall, the evidence supporting long-term analgesic efficacy is weak. The putative mechanisms for failed opioid analgesia may be related to tolerance or opioid-induced hyperalgesia. Advances in basic sciences may help in understanding these phenomena, but the question of whether long-term opioid treatment can improve patients’ function or quality of life remains a broader issue. Opioid side effects are well known, but with chronic use, most (except constipation) subside. Still, side effects can negatively affect the outcomes and continuity of therapy. This paper addresses 1) what evidence supports the long-term utility of opioids for chronic pain; 2) how side effects may alter quality of life; 3) the nature of addiction and why it is different in pain patients, and 4) on what grounds could pain medication be denied? These questions are discussed in light of patients’ rights, and warrant balancing particular responsibilities with risks. These are framed within the Hippocratic tradition of “producing good for the patient and protecting from harm,” so as to enable 1) more informed clinical decision making, and 2) progress towards right use and utility of opioid treatment for chronic pain. Key Words: Opioids, chronic pain, addiction, side effects, utility, ethics

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Department of Corrections

Pediatrics in Review ◽

10.1542/pir.5.3.94 ◽

1983 ◽

Vol 5 (3) ◽

pp. 94-94

Keyword(s):

Correct Response ◽

Self Assessment ◽

Department Of Corrections ◽

Long Term Prognosis

In the April issue of PIR (4:333, 1983), Self-Assessment Quiz question 8, answer C, was listed in the Answer Key as being a correct response. This was an error. Death due to hydrocephalus should not be included in the long-term prognosis in the majority of properly managed patients with meningomyelocele.

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