546 research outputs found
Adult complex regional pain syndrome type I: A narrative review
No full textComplex regional pain syndrome type I (CRPS I) is a multifactorial painful disorder with a complex pathogenesis. Both peripheral and central mechanisms are involved. Acute CRPS I is considered to be an exaggerated inflammatory disorder; however, over time, because of altered function of the sympathetic nervous system and maladaptive neuroplasticity, CRPS I evolves into a neurological disorder. This review thoroughly describes the pathophysiological aspects of CRPS I and summarizes the potential therapeutic options. The mechanisms and targets of the treatment are different in the early and late stages of the disease. This current review builds on a previous review by this author group by deepening the role of the peripheral classic and neuronal inflammatory component in the acute stage of this painful disorder. Level of evidence: Not applicable
Analysis of quality palliative care in a specialized medicine setting: an observational study
No full textBACKGROUND: Recently health economic expenditure has increased considerably determining an increased awareness of excessive use of "low-value care" treatments, especially for chronic-degenerative diseases. AIM: Describing Quality of life (QoL) of patients and palliative care's skills of nurses in internal medicine unit. METHODS: Observational study conducted in an internal medicine unit that admit patients with chronic critical illness. Patients' QoL was measured with the integrated Palliative Care Outcome Scale (IPOS), and nursing staff skills regarding palliative care with the Questionnaire of Professional Skills Nurses in Palliative Care (QVPICP). IPOS was administered at admission and one week later. RESULTS: All the patients (n=13) accepted to participate to the study (mean age 80 years; SD 15). Eight (61%) were female. All the nurses invited (n=17) completed the QCPICP. Most of them was female (70%). The mean age was 40 years SD 14. Nurses perceived they have skills, knowledge, and abilities to approach patient's palliative care path (mean QVPICP: 7). IPOS means scores were worse in the following variables: pain (before: 3; after: 4); lack of mobility (before: 3; after: 4); sleepiness (before: 3; after: 4); depression (before: 3; after: 4). CONCLUSION: Patient's QoL showed a worsening in the after assessment. Although nurses perceived themselves skilled in taking care of patients with palliative care needs, organizations may not allow nurses to perform their role to the best of their competencies. NURSING IMPLICATION: Team briefing and debriefings in internal medicine unit may promote a holistic approach aimed at improving patients' QoL
Understanding peripheral neuropathic pain in primary care: diagnosis and management
No full textObjective: To describe an approach that allows for a dedicated clinical assessment and accurate recognition of peripheral neuropathic pain in primary care and to provide an update on the available pharmacologic therapies. Materials and methods: Medline was searched using the key word "neuropathic pain". Searches were refined for each pathophysiological mechanism, diagnosis and treatment by adding appropriate key words. Results: The distinction between neuropathic and nociceptive pain is essential for an adequate treatment because these forms of pain differ in their underlying mechanisms and therefore in their response to different drugs. Conclusions: Chronic pain with neuropathic characteristics presents a significant challenge as it is often unresponsive to conventional analgesics. The correct diagnosis and early management of peripheral neuropathic pain not only improve health-related outcomes, but also yield significant cost benefit to society
Pathophysiology of Complex Regional Pain Syndrome Type I: Update
No full textBackground: Complex regional pain syndrome type I (CRPS I), also known as reflex sympathetic dystrophy (RSD), develops as disabling painful disorder following a trauma or surgery to a limb. We provide a review based on the current literature concerning the epidemiology and pathophysiology of CRPS I. Possible pathophysiological mechanisms of CRPS I are inflammation, sy mpathetic-afferent coupling and cortical changes.
Methods: A literature search was conducted using, as electronic bibliographic database, Medline from 1980 until today.
Results: CRPS I is a multifactorial disorder with complex aetiology and pathogenesis.
Conclusions: The pathophysiology of CRPS I is complex and may change during its course. CRPS I is more than a peripheral disease because peripheral mechanisms such as neurogenic inflammation and sympathetic-afferent coupling inconclusively explain its pathophysiology. CRPS I is a pain disorder involving the somatosensory, the somatomotor and the
sympathetic nervous systems. Genetic findings suggest there might be a predisposition to CRPS I and it has been confirmed in multiple studies that psychological factors are not predictors for the development of CRPS I. The complexity and diversity of the mechanisms involved will be liable to the heterogeneity of the clinical presentation and may explain the difficulty
of achieving an evidence-based treatment of CRPS I
Complex regional pain syndrome type I: a comprehensive review
No full textBackground: Complex regional pain syndrome type I (CRPS I), formerly known as reflex sympathetic dystrophy (RSD), is a chronic painful disorder that usually develops after a minor injury to a limb. This topical review gives a synopsis of CRPS I and discusses the current concepts of our understanding of CRPS I in adults, the diagnosis, and treatment options based on the limited evidence found in medical literature. CRPS I is a multifactorial disorder. Possible pathophysiological mechanisms of CRPS I are classic and neurogenic inflammation, and maladaptive neuroplasticity. At the level of the central nervous system, it has been suggested that an increased input from peripheral nociceptors alters the central processing mechanisms. Methods: A literature search was conducted using, as electronic bibliographic database, Medline from 1980 until 2014. Results: An early diagnosis and multidisciplinary treatment are necessary to prevent permanent disability. Conclusions: The pharmacological treatment of CRPS I is empirical and insufficiently effective. Further research is needed regarding the therapeutic modalities discussed in the guidelines. Physical therapy is widely recommended as a first-line treatment. The efficacy of local anesthetic sympathetic blockade as treatment for CRPS I is questionable
Confronto tra rumori di diversa natura in termini di influenza sulla performance umana tramite misure prestazionali e monitoraggio del battito cardiaco
No full textBridging RF-Voltage to coaxial power standard in the 100 MHz range
No full textElectromagnetic power standard realized by means of
the microcalorimetric technique fails below some
MHz because of a reduced sensitivity of the system.
This causes a metrological lack in the calibration of
coaxial
power
sensors
whose
broadband
characteristics span from dc up to 50 GHz. However,
as coaxial transmission lines admit pseudo potential
functions, power meter calibration can be done in
term of radio frequency (RF) voltage from dc up to
100 MHz at least. The paper describes how INRIM
works around the drawback of the microcalorimeter at
low frequencies
Family History and the Risk of Breast and Gastric Cancer
No full textEpidemiologists have used family history, usually of first degree relatives, as a marker for genetic risk, knowing that family history reflects the consequences of genetic susceptibilities, shared environment, and common behaviors. The role of family history on breast and gastric cancer risk has been evaluated in multiple studies. As for breast cancer, informative valid,and precise estimates of the role of family history derive from a reanalysis of individual data from 52 epidemiologicstudies including over 58,000 women with breast cancer and 100,000 controls, which estimated an approximately two fold increased risk for women with family history; the risk increased with the number of affected relatives, decreased with age and was greater the younger the relatives were when their breast cancer was diagnosed. As for gastric cancer, a meta-analysis published in 2018 and based on 36 case-control and 4 cohort studies found a significant pooled relative risk of about 2; in line with that, a subsequent analysis based on individ-ual participant data from 17 studies participating in the Stomach cancer Pooling (StoP) Project foundan 80% increased risk in subject with at least on first-degree relative affected by gastriccancer
- …
