Articles: chronic.
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As seen in this CME online activity (available at http://journal.cme.chestnet.org/copd-hot-hmv), acute exacerbations of COPD are associated with significant levels of morbidity and mortality. Acute noninvasive ventilation has been demonstrated its clinical efficacy and cost-effectiveness in reducing intubation rate and mortality and in patients with acute decompensated hypercapnic exacerbations of COPD. However, those patients with evidence of chronic hypercapnic respiratory failure have worse long-term outcomes compared with patients who have only transient hypercapnia during the acute phase returning to eucapnia in the recovery stage. ⋯ The addition of home noninvasive ventilation to home oxygen therapy in patients with persistent hypercapnia led to improved admission-free survival. The noninvasive ventilation was titrated to overnight measures of transcutaneous CO2 to achieve control of nocturnal hypoventilation, which improved daytime chronic respiratory failure. Home noninvasive ventilation is a complex intervention requiring a multidisciplinary team and long-term patient follow-up to maximize the clinical benefit to the patient.
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Pain is experienced within and influenced by social environments. For children with chronic pain, the child-parent relationship and parental beliefs about pain are particularly important and may influence pain outcomes. Pain-related injustice perceptions have recently been identified as an important cognitive-emotional factor for children with pain. ⋯ Our findings indicated that both the degree (concordant vs discordant) and direction (discordant low child-high parent vs discordant high child-low parent) of similarity between child and parent injustice perceptions were associated with child-reported pain intensity, stress, functional disability, and quality of life. The poorest outcomes were reported when children considered their pain as highly unjust, but their parents did not. These findings highlight the important role of parents in the context of pain-related injustice perceptions in pediatric chronic pain.
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The use of spinal cord stimulator (SCS) treatment has been particularly effective as an adjunct in treating mixed neuropathic, nociceptive, and radicular pain conditions. There are no published studies on the use of SCS for chronic pain syndrome after laparoscopic cholecystectomy. We successfully used an SCS on a 31-year-old woman with a 4-year history of intractable right-sided subcostal pain after laparoscopic cholecystectomy. This case provides strong evidence that SCS should be considered as a treatment option for chronic postsurgical pain after laparoscopic cholecystectomy not amenable to standard therapies.