Medicine
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Comparative Study Observational Study
Validation of the behavioral pain scale to assess pain intensity in adult, intubated postcardiac surgery patients: A cohort observational study - POL-BPS.
Patients after cardiac surgery experience significant pain, but cannot communicate effectively due to opioid analgesia and sedation. Identification of pain with validated behavioral observation tool in patients with limited abilities to self-report pain improves quality of care and prevents suffering. Aim of this study was to validate Polish version of behavioral pain scale (BPS) in intubated, mechanically ventilated patients sedated with dexmedetomidine and morphine after cardiac surgery. ⋯ Both mean NRS and BPS scores were significantly higher during nociceptive procedures as compared to assessments at rest, in both sedated and unsedated patients (P < .001). The results of this observational study show that the Polish translation of BPS can be regarded as a useful and validated tool for pain assessment in adult intubated patients. This instrument can be used in both unsedated and sedated cardiac surgery patients with limited communication abilities.
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Modic changes (MCs) associated with low back pain (LBP) have been assessed in a few studies. It has been documented that patients with LBP have MCs in a specific segment, but the relationship between facet joint or disc degeneration and MCs is still disputed. Thus, we aimed to evaluate the correlation between MC and facet joint or disc degeneration using imaging. ⋯ MCs are correlated with the grade of lumbar spine degeneration, including lumbar disc and facet joint degeneration. MCs, especially type II, frequently occurred in severe degeneration of the lumbar disc and facet joint. Thus, MC may be one of the manifestations of lumbar disc and facet joint degeneration.
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Randomized Controlled Trial
Effect of rational emotive behavior therapy on stress management and irrational beliefs of special education teachers in Nigerian elementary schools.
From a rational emotive behavior therapy viewpoint, stress-related disorders originate from irrational beliefs and self-defeating philosophies and attitude. Individuals affected by stress are different from those ones with neurotic problems mainly because the stressed individuals have irrational beliefs about specific, short-term, or more readily identifiable events, in contrast to the more mundane and diffuse difficulties faced by neurotic persons. The present study aimed to examine the impact of a rational emotive behavior therapy (REBT) intervention on the stress levels and irrational beliefs among special education teachers in elementary schools in Nigeria. ⋯ Rational-emotive behavior therapy is an effective therapeutic modality that can be applied by REBT clinicians for the management of stress. Additional clinical assessments will be necessary to further confirm the impact of an REBT intervention on teachers' stress management and irrational beliefs in Nigerian elementary school setting.
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Randomized Controlled Trial Comparative Study
Comparative study of esketamine and racemic ketamine in treatment-resistant depression: Protocol for a non-inferiority clinical trial.
The use of ketamine as an option in the treatment of depressive disorder is growing rapidly, supported by numerous clinical trials attesting its efficacy and safety. Esketamine, the S (+) enantiomer of ketamine, is the most widely used form in the anesthetic environment in some countries, and new studies have shown that it may also be effective in depression and with better tolerability. However, no study so far has directly compared esketamine with racemic ketamine. Here we propose a protocol of a clinical trial to evaluate esketamine as a noninferior medication when compared to ketamine in the treatment of patients with treatment-resistant depression. ⋯ The study was approved by the local Institutional Review Board (University Hospital Professor Edgard Santos-Federal University of Bahia-Number: 46657415.0.0000.0049). Subjects will only participate after voluntarily agreeing and signing the Informed Consent Form. The study findings will be published in peer-reviewed journals and presented at national and international conferences.
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Dexmedetomidine is an effective sedative during spinal anesthesia. However, it requires a loading dose, which can result in transient hypertension, hypotension, bradycardia, and/or sinus arrest. In addition, the time required to reach an appropriate depth of sedation may cause anxiety to the patients. Therefore, we examined whether an intravenous bolus of midazolam could replace the loading dose of dexmedetomidine for sedation during surgery in elderly patients who received spinal anesthesia. ⋯ An intravenous bolus of midazolam is a viable alternative to dexmedetomidine loading for sedation during surgery in elderly patients who received spinal anesthesia. This is especially effective for patients who are at high risk for bradycardia or who want a faster sedation.