scholarly journals Morphine Versus Loperamide with Intrasite Gel in the Treatment of Painful Dermal Ulcers: A Randomized, Crossover Study

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. E37-E44
Keyword(s):  
Patient Satisfaction ◽  
Repeated Measures ◽  
Rating Scale ◽  
Group Analysis ◽  
Analysis Of Covariance ◽  
Systemic Absorption ◽  
Extensive Literature ◽  
Ulcer Size ◽  
Relieve Pain ◽  
Change In Mean

BACKGROUND: Topical morphine along with intrasite gel has been proven to be a simple and effective method to relieve pain. However, morphine is still not freely available in developing countries due to drug restrictions and stringent laws governing it. Loperamide has been reported to relieve pain caused by stomatitis effectively when given topically. Loperamide, being an mu receptor agonist with no systemic absorption, can serve a dual purpose here. Also loperamide being freely available as an over-the-counter drug can be a surrogate drug for topical application. OBJECTIVES: The primary aim was to compare the efficacy of loperamide and morphine in treating pain when applied topically along with intrasite gel. STUDY DESIGN: Adult patients with healthy wounds with pain on Numeric Rating Scale (NRS-11) greater than 5 with no systemic comorbid illness were divided randomly into 2 groups – group morphine or group loperamide – for 24 hours followed by a 1-day washout and crossover in the other group for 24 hours. Pain was assessed once every day. SETTING: Medical college and hospital. METHODS: The parameters assessed included: (1) characteristics of the ulcer; (2) pain was assessed by NRS-11 at 12-hour intervals for a period of 72 hours; and (3) patient satisfaction. Statistical analysis used repeated measures analysis of variance to measure change in mean NRS-11 within each group. Analysis of covariance was used to compare the mean change in NRS-11 in the 2 groups. RESULTS: Morphine and loperamide were equivocal in pain relief after 12 and 24 hours (P = 0.400 and P = 0.753); however, the patient satisfaction scores were better in the morphine group. LIMITATIONS: The earlier studies performed used injectable forms of morphine, for the sake of comparison, we used powdered morphine and powdered Loperamide diluted with saline. Confounding variables include ulcer size and aetiology, which can be a source of bias. The ulcer size was not standardized due to the paucity of sample to study. Equianalgesic doses of loperamide and morphine could not be found even after an extensive literature search. The loperamide dose used in our case was equal to the dose used orally since the same dose appears effective across a range of oral opioid analgesics. The morphine dose was standardized as 10 mg based on a mixture previously used to treat pain due to epidermolysis bullosa. CONCLUSIONS: Topical loperamide can be an efficacious and novel intervention to treat painful ulcers while avoiding systemic effects. KEY WORDS: Loperamide, morphine, painful ulcer

scholarly journals Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

2012 ◽  
Vol 43 (6) ◽  
pp. 1187-1196 ◽  
Author(s):  
E. Mora ◽  
M. J. Portella ◽  
I. Forcada ◽  
E. Vieta ◽  
M. Mur
Keyword(s):  
Cognitive Impairment ◽  
Processing Speed ◽  
Verbal Memory ◽  
Psychosocial Functioning ◽  
Repeated Measures ◽  
Rating Scale ◽  
Psychosocial Adaptation ◽  
Analysis Of Covariance ◽  
Bipolar Patients

BackgroundPrevious cross-sectional studies report that cognitive impairment is associated with poor psychosocial functioning in euthymic bipolar patients. There is a lack of long-term studies to determine the course of cognitive impairment and its impact on functional outcome.MethodA total of 54 subjects were assessed at baseline and 6 years later; 28 had DSM-IV TR bipolar I or II disorder (recruited, at baseline, from a Lithium Clinic Program) and 26 were healthy matched controls. They were all assessed with a cognitive battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory) twice over a 6-year follow-up period. All patients were euthymic (Hamilton Rating Scale for Depression score lower than 8 and Young mania rating scale score lower than 6) for at least 3 months before both evaluations. At the end of follow-up, psychosocial functioning was also evaluated by means of the Functioning Assessment Short Test.ResultsRepeated-measures multivariate analysis of covariance showed that there were main effects of group in the executive domain, in the inhibition domain, in the processing speed domain, and in the verbal memory domain (p<0.04). Among the clinical factors, only longer illness duration was significantly related to slow processing (p=0.01), whereas strong relationships were observed between impoverished cognition along time and poorer psychosocial functioning (p<0.05).ConclusionsExecutive functioning, inhibition, processing speed and verbal memory were impaired in euthymic bipolar out-patients. Although cognitive deficits remained stable on average throughout the follow-up, they had enduring negative effects on psychosocial adaptation of patients.

scholarly journals Lumbar Disc Herniation and Preoperative Modic Changes: A Prospective Analysis of the Clinical Outcomes After Microdiscectomy

2021 ◽  
pp. 219256822097608
Author(s):  
Dinesh Kumarasamy ◽  
Shanmuganathan Rajasekaran ◽  
Sri Vijay Anand K. S ◽  
Dilip Chand Raja Soundararajan ◽  
Ajoy Prasad Shetty T ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Back Pain ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Rating Scale ◽  
Lumbar Disc ◽  
Modic Changes ◽  
P Value ◽  
Functional Scores

Study design: Prospective comparative cohort study. Objectives: The study aims to elucidate the relationship between Modic endplate changes and clinical outcomes after a lumbar microdiscectomy. Methods: Consecutive patients undergoing microdiscectomy for lumbar disc herniation (LDH) were prospectively studied. Pre-operative clinical and radiological parameters were recorded. The pain was assessed by Numeric pain rating scale (NPRS), and functional assessment by Oswestry Disability Index (ODI). Minimal clinically important difference (MCID) in outcome was calculated for both the groups. Complications related to surgery were studied. Follow-up was done at 6 weeks, 3 months, 6 months and 1 year. Mac Nab criteria were used to assess patient satisfaction at 1 year. Results: Out of 309 patients, 86 had Modic changes, and 223 had no Modic changes. Both groups had similar back pain (p-value: 0.07) and functional scores (p-value: 0.85) pre-operatively. Postoperatively patients with Modic changes had poorer back pain and ODI scores in the third month, sixth month and 1 year (p-value: 0.001). However, MCID between the groups were not significant (p-value: 0.18 for back pain and 0.58 for ODI scores). Mac Nab criteria at 1 year were worse in Modic patients (p-value: 0.001). No difference was noted among Modic types in the pre-operative and postoperative pain and functional outcomes. Four patients in Modic group (4.7%) and one patient in the non-Modic group (0.5%) developed postoperative discitis (p-value: 0.009). Conclusions: Preoperative Modic changes in lumbar disc herniation is associated with less favorable back pain, functional scores and patient satisfaction in patients undergoing microdiscectomy.

scholarly journals Boxing vs Sensory Exercise for Parkinson’s Disease: A Double-Blinded Randomized Controlled Trial

2021 ◽  
pp. 154596832110231
Author(s):  
Kishoree Sangarapillai ◽  
Benjamin M. Norman ◽  
Quincy J. Almeida
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Randomized Controlled Trial ◽  
Repeated Measures ◽  
Rating Scale ◽  
Controlled Trial ◽  
Motor Symptoms ◽  
Post Intervention ◽  
Randomized Controlled ◽  
Double Blinded

Background. Exercise is increasingly becoming recognized as an important adjunct to medications in the clinical management of Parkinson’s disease (PD). Boxing and sensory exercise have shown immediate benefits, but whether they continue beyond program completion is unknown. This study aimed to investigate the effects of boxing and sensory training on motor symptoms of PD, and whether these benefits remain upon completion of the intervention. Methods. In this 20-week double-blinded randomized controlled trial, 40 participants with idiopathic PD were randomized into 2 treatment groups, (n = 20) boxing or (n = 20) sensory exercise. Participants completed 10 weeks of intervention. Motor symptoms were assessed at (week 0, 10, and 20) using the Unified Parkinson’s Disease Rating Scale (UPDRS-III). Data were analyzed using SPSS, and repeated-measures ANOVA was conducted. Results. A significant interaction effect between groups and time were observed F(1, 39) = 4.566, P = .036, where the sensory group improved in comparison to the boxing group. Post hoc analysis revealed that in comparison to boxing, the effects of exercise did not wear off at washout (week 20) P < .006. Conclusion. Future rehabilitation research should incorporate similar measures to explore whether effects of exercise wear off post intervention.

scholarly journals Statistical analysis of two arm randomized pre-post designs with one post-treatment measurement

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fei Wan
Keyword(s):  
Treatment Effect ◽  
Repeated Measures ◽  
Informed Choice ◽  
Clinical Effectiveness ◽  
Change Score ◽  
Post Treatment ◽  
Analysis Of Covariance ◽  
Alternative Methods ◽  
Main Effect ◽  
Comparable Performance

Abstract Background Randomized pre-post designs, with outcomes measured at baseline and after treatment, have been commonly used to compare the clinical effectiveness of two competing treatments. There are vast, but often conflicting, amount of information in current literature about the best analytic methods for pre-post designs. It is challenging for applied researchers to make an informed choice. Methods We discuss six methods commonly used in literature: one way analysis of variance (“ANOVA”), analysis of covariance main effect and interaction models on the post-treatment score (“ANCOVAI” and “ANCOVAII”), ANOVA on the change score between the baseline and post-treatment scores (“ANOVA-Change”), repeated measures (“RM”) and constrained repeated measures (“cRM”) models on the baseline and post-treatment scores as joint outcomes. We review a number of study endpoints in randomized pre-post designs and identify the mean difference in the post-treatment score as the common treatment effect that all six methods target. We delineate the underlying differences and connections between these competing methods in homogeneous and heterogeneous study populations. Results ANCOVA and cRM outperform other alternative methods because their treatment effect estimators have the smallest variances. cRM has comparable performance to ANCOVAI in the homogeneous scenario and to ANCOVAII in the heterogeneous scenario. In spite of that, ANCOVA has several advantages over cRM: i) the baseline score is adjusted as covariate because it is not an outcome by definition; ii) it is very convenient to incorporate other baseline variables and easy to handle complex heteroscedasticity patterns in a linear regression framework. Conclusions ANCOVA is a simple and the most efficient approach for analyzing pre-post randomized designs.

scholarly journals Metacognitive Instruction for Sustainable Learning: Learners’ Perceptions of Task Difficulty and Use of Metacognitive Strategies in Completing Integrated Speaking Tasks

2021 ◽  
Vol 13 (11) ◽  
pp. 6275
Author(s):  
Weiwei Zhang ◽  
Donglan Zhang ◽  
Lawrence Jun Zhang
Keyword(s):  
Foreign Language ◽  
Repeated Measures ◽  
Task Difficulty ◽  
Rating Scale ◽  
Empirical Support ◽  
Metacognitive Strategies ◽  
Production Model ◽  
High Stakes ◽  
Efl Learners ◽  
Metacognitive Instruction

This mixed-methods study investigated English-as-a-foreign-language (EFL) learners’ perceptions of task difficulty and their use of metacognitive strategies in completing integrated speaking tasks as empirical evidence for the effects of metacognitive instruction. A total of 130 university students were invited to complete four integrated speaking tasks and answer a metacognitive strategy inventory and a self-rating scale. A sub-sample of eight students participated in the subsequent interviews. One-way repeated measures MANOVA and structure coding with content analysis led to two main findings: (a) EFL learners’ use of metacognitive strategies, in particular, problem-solving, was considerably affected by their perceptions of task difficulty in completing the integrated speaking tasks; (b) EFL learners were not active users of metacognitive strategies in performing these tasks. These findings not only support the necessity of taking into account learners’ perceptions of task difficulty in designing lesson plans for metacognitive instruction, but also support a metacognitive instruction model. In addition, the findings provide empirical support for the utility of Kormos’ Bilingual Speech Production Model. As the integrated speaking tasks came from a high-stakes test, these findings also offer validity evidence for test development in language assessment to ascertain sustainable EFL learning for nurturing learner autonomy as an ultimate goal.

Effects of Vaporized Perfluorocarbon on Pulmonary Blood Flow and Ventilation/Perfusion Distribution in a Model of Acute Respiratory Distress Syndrome

2001 ◽  
Vol 95 (6) ◽  
pp. 1414-1421 ◽  
Author(s):  
Matthias Hübler ◽  
Jennifer E. Souders ◽  
Erin D. Shade ◽  
Nayak L. Polissar ◽  
Carmel Schimmel ◽  
...  
Keyword(s):  
Blood Flow ◽  
Oleic Acid ◽  
Gas Exchange ◽  
Lung Injury ◽  
Repeated Measures ◽  
Pulmonary Blood Flow ◽  
Analysis Of Covariance ◽  
Inert Gas ◽  
Low Flow ◽  
Repeated Measures Analysis

Background Perfluorocarbon (PFC) liquids are known to improve gas exchange and pulmonary function in various models of acute respiratory failure. Vaporization has been recently reported as a new method of delivering PFC to the lung. Our aim was to study the effect of PFC vapor on the ventilation/perfusion (VA/Q) matching and relative pulmonary blood flow (Qrel) distribution. Methods In nine sheep, lung injury was induced using oleic acid. Four sheep were treated with vaporized perfluorohexane (PFX) for 30 min, whereas the remaining sheep served as control animals. Vaporization was achieved using a modified isoflurane vaporizer. The animals were studied for 90 min after vaporization. VA/Q distributions were estimated using the multiple inert gas elimination technique. Change in Qrel distribution was assessed using fluorescent-labeled microspheres. Results Treatment with PFX vapor improved oxygenation significantly and led to significantly lower shunt values (P &lt; 0.05, repeated-measures analysis of covariance). Analysis of the multiple inert gas elimination technique data showed that animals treated with PFX vapor demonstrated a higher VA/Q heterogeneity than the control animals (P &lt; 0.05, repeated-measures analysis of covariance). Microsphere data showed a redistribution of Qrel attributable to oleic acid injury. Qrel shifted from areas that were initially high-flow to areas that were initially low-flow, with no difference in redistribution between the groups. After established injury, Qrel was redistributed to the nondependent lung areas in control animals, whereas Qrel distribution did not change in treatment animals. Conclusion In oleic acid lung injury, treatment with PFX vapor improves gas exchange by increasing VA/Q heterogeneity in the whole lung without a significant change in gravitational gradient.

Immersive Virtual Reality Improves Labor and Delivery Experience for Women: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Elif Gizem Carus ◽  
Nazli Albayrak ◽  
Selen Gur Ozmen ◽  
Halit Mert Bildirici
Keyword(s):  
Virtual Reality ◽  
Patient Satisfaction ◽  
Rating Scale ◽  
Secondary Outcome ◽  
Immersive Virtual Reality ◽  
Labor And Delivery ◽  
Control Groups ◽  
Randomized Controlled ◽  
Pain Scores ◽  
And Control

Abstract Objective: To evaluate the effectiveness of immersive Virtual Reality (VR) in laboring women on patient satisfaction as a distractive tool and pain relief.Methods: Randomized, controlled clinical trial with 42 laboring women allocated to VR intervention and control groups. Among the VR group, patient satisfaction with the use of VR was assessed by a Virtual Reality Satisfaction Survey and questioning whether they would choose VR in future labor. As a primary outcome patient satisfaction scores regarding the overall labor and delivery experience were compared between the two groups. A secondary outcome was pain assessed by a visual pain rating scale in the early and active phases of labor in both groups. Psychometric information was also collected from participants in each group using Beck Anxiety Inventory and Beck Depression Inventory. Results: We observed a high level of patient satisfaction with the use of immersive VR during labor. The survey revealed a mean satisfaction score of 89.6 ± 10.8 out of a maximum of 100. 20 out of 21 (95%) women in the VR group stated that they would like to use VR again in future labor. VR improved pain scores in early labor and contributed positively to overall labor and delivery experience. The mean pain score pre-VR was 2.6±1.2 compared to 2.0±1.3, post-VR, respectively (p<0.01). Anxiety and depression scores were similar in the intervention and control groups (p=0.103, p=0.13, respectively). Conclusion: Immersive VR application during labor was feasible and associated with higher patient satisfaction based on our study. VR also improved pain scores in early labor before epidural placement. Immersive VR may find a place as an adjunct in Labor and Delivery Units to improve the lengthy labor experience for women. Larger studies are needed to confirm these observations. Trial Registration: ClinicalTrials.gov: NCT05032456 / 02/09/2021https://clinicaltrials.gov/ct2/show/NCT05032456

Music Therapy in Enhancing Learning Attention of Children with Intellectual Disability

2021 ◽  
Vol 9 (4) ◽  
pp. 363-367
Author(s):  
Akintunde Oluseyi Dada ◽  
Owoade Philip Adeleke ◽  
Samson Akinwumi Aderibigbe ◽  
Michael Adeife Adefemi ◽  
Martina Ayibeya Apie ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Music Therapy ◽  
Intellectual Disabilities ◽  
Rating Scale ◽  
Home School ◽  
Analysis Of Covariance ◽  
Moderator Variables ◽  
Treatment Package ◽  
Therapy Treatment ◽  
Children With Intellectual Disability

Inattention is one of the significant problems that inhibit learning among children with intellectual disabilities. However, several strategies and therapies have been developed to solve the problem. This study, therefore, investigates the effectiveness of music therapy in enhancing attention among children with intellectual disability. A pretest-posttest control experimental research design was adopted. The experiment was carried out for six weeks using Music Therapy Treatment Package on 24 children with intellectual disability that were randomly selected Modupe Cole Momerial Childcare and Treatment Home/School, Akoka, Yaba, Lagos. A validated Attention Observation Rating Scale (AORS) with a reliability coefficient of 0.88 was used for this study. Three hypotheses were tested in the study, and Analysis of Covariance (ANCOVA) was used for data analysis. This study revealed that music therapy is effective in enhancing attention among children with intellectual disabilities. Sex and level of severity of the disability were also tested as moderator variables, but they have no significant main or interaction effect with music therapy in enhancing attention for children with intellectual disability. The finding is that music therapy is significantly effective in enhancing attention for children with intellectual disability regardless of their sex or level of severity. It was concluded that attention deficit could be improved for children with intellectual disability. Therefore, Music therapy was recommended for use in the school with adequate teacher training.

Test–Retest Reliability, Training, and Detraining Effects Associated With the Dynavision D2™ Mode A Visuomotor Reaction Time Test

2021 ◽  
pp. 1-9
Author(s):  
Adam J. Wells ◽  
Bri-ana D.I. Johnson
Keyword(s):  
Reaction Time ◽  
Repeated Measures ◽  
Intraclass Correlation ◽  
Analysis Of Covariance ◽  
Repeated Testing ◽  
Retest Reliability ◽  
Sports Science ◽  
Test Retest Reliability ◽  
Mode A ◽  
Training And Detraining

Context: The Dynavision D2™ Mode A test (ModeA) is a 1-minute reaction time (RT) test commonly used in sports science research and clinical rehabilitation. However, there is limited data regarding the effect of repeated testing (ie, training) or subsequent periods of no testing (ie, detraining) on test–retest reliability and RT performance. Therefore, the purpose of this study was to examine the test–retest reliability, training, and detraining effects associated with the D2™ ModeA test. Design: Repeated measures/reliability. Methods: Twenty-four recreationally active men and women completed 15 training sessions consisting of 2 ModeA tests per session (30 tests). The participants were then randomized to either 1 or 2 weeks of detraining prior to completing 15 retraining sessions (30 tests). The training and retraining periods were separated into 10 blocks for analysis (3 tests per block). The number of hits (hits) and the average RT per hit (AvgRT) within each block were used to determine RT performance. Intraclass correlation coefficients, SEM, and minimum difference were used to determine reliability. Repeated-measures analysis of variance/analysis of covariance were used to determine training and detraining effects, respectively. Results: The ModeA variables demonstrated excellent test–retest reliability (intraclass correlation coefficient2,3 > .93). Significant improvements in hits and AvgRT were noted within training blocks 1 to 5 (P < .05). No further improvements in RT performance were noted between training blocks 6 through 10. There was no effect of detraining period on RT. The RT performance was not different between blocks during retraining. Conclusions: It appears that 15 tests are necessary to overcome the training effect and establish reliable baseline performance for the ModeA test. Detraining for 1 to 2 weeks did not impact RT performance. The authors recommend that investigators and clinicians utilize the average of 3 tests when assessing RT performance using the D2 ModeA test.

Functional Magnetic Resonance Imaging (FMRI)-based neurofeedback as a new treatment tool for depression

2011 ◽  
Vol 26 (S2) ◽  
pp. 937-937 ◽  
Author(s):  
D. Linden ◽  
T. Lancaster
Keyword(s):  
Repeated Measures ◽  
Rating Scale ◽  
Mood State ◽  
Control Group ◽  
Target Area ◽  
Post Intervention ◽  
Brain Areas ◽  
Promising Tool ◽  
Treatment Of Depression ◽  
New Treatment

We investigated whether depressed patients who received fMRI-based neurofeedback are able to upregulate the activity in brain areas devoted to positive emotion processing and thereby establish improvements in mood state. Eight medicated patients with major depression participated in four separate fMRI sessions, each of which consisted of an emotion localiser and three neurofeedback runs. Target areas were selected individually with a functional localiser that identified the region most responsive to positive affective images. The target areas were in uni- or bilateral prefrontal cortex, insula or amygdala. During neurofeedback runs, patients received real-time feedback about activation levels in the target area. Each patient learnt to increase target area activity over successive sessions. Depression scores on the 17-item Hamilton Depression Rating Scale improved significantly. No such improvement was seen in a non-neurofeedback control group (N = 8) that was matched for symptom severity, demographics and medication and used the same cognitive/affective strategies that were employed successfully by the neurofeedback group, but outside the scanner. This group difference in treatment effects was supported by a significant interaction between the factors time (pre/post-intervention) and group (neurofeedback/controls) on the repeated measures ANOVA (F(1,14) = 10.15, p = .007). The neurofeedback group showed increasing activity in the ventral striatum and regions involved in cognitive control as training progressed. Upregulation of brain areas responsive to positive affective cues through fMRI-neurofeedback is thus a promising tool in the treatment of depression. The novelty of the present approach consists in the combination of biological and cognitive factors in the same intervention.

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