Purpose. To investigate adherence to our pain protocol considering analgesics administration, number and timing of pain assessments, and adjustment of analgesics upon unacceptably high (NRS ≥ 4) and ...low (NRS ≤ 1) pain scores. Material and Methods. The pain protocol for patients in the intensive care unit (ICU) after cardiac surgery consisted of automated prescriptions for paracetamol and morphine, automated reminders for pain assessments, a flowchart to guide interventions upon high and low pain scores, and reassessments after unacceptable pain. Results. Paracetamol and morphine were prescribed in all 124 patients. Morphine infusion was stopped earlier than protocolized in 40 patients (32%). During the median stay of 47 hours IQR 26 to 74 hours, 702/706 (99%) scheduled pain assessments and 218 extra pain scores were recorded. Unacceptably high pain scores accounted for 96/920 (10%) and low pain scores for 546/920 (59%) of all assessments. Upon unacceptable pain additional morphine was administered in 65% (62/96) and reassessment took place in 15% (14/96). Morphine was not tapered in 273 of 303 (90%) eligible cases of low pain scores. Conclusions. Adherence to automated prescribed analgesics and pain assessments was good. Adherence to nonscheduled, flowchart-guided interventions was poor. Improving adherence may refine pain management and reduce side effects.
We report a shape memory effect in Cu–Zn thin films grown by electrodeposition on pyrolytic graphite from pyrophosphate-based electrolytes. Cu–Zn films showing a martensitic transformation could only ...be obtained after the optimization of thermal annealing parameters such as annealing temperature, Zn vapour pressure and fast quenching. By means of controlling the Zn vapour pressure during annealing using a bulk reference Cu–Zn alloy, the chemical composition of the films could be adjusted and the martensitic transformation temperatures of the films could be tuned.
Chronic thoracic pain after cardiac surgery is a serious condition affecting many patients. The aim of this study was to identify predictors for chronic thoracic pain after sternotomy in cardiac ...surgery patients by analysing patient and perioperative characteristics.
A follow-up study was performed in 120 patients who participated in a clinical trial on pain levels in the early postoperative period after cardiac surgery. The presence of chronic thoracic pain was evaluated by a questionnaire 1 yr after surgery. Patients with and without chronic thoracic pain were compared. Associations were studied using multivariable logistic regression analysis.
Questionnaires of 90 patients were analysed. Chronic thoracic pain was reported by 18 patients (20%). In the multivariable regression model, remifentanil during cardiac surgery, age below 69 yr, and a body mass index above 28 kg m−2 were independent predictors for chronic thoracic pain {odds ratios 8.9 95% confidence interval (CI) 1.6–49.0, 7.0 (95% CI 1.6–31.7), 9.1 (95% CI 2.1–39.1), respectively}. No differences were observed in patient and perioperative characteristics between patients receiving remifentanil (58%, n=52) compared with patients not receiving remifentanil (42%, n=38). The association between remifentanil and chronic thoracic pain appeared dose-dependent, both for total dose and for dose corrected for kilogram lean body mass and duration of surgery (P-value for trend: <0.01 and <0.005, respectively).
In this follow-up study in cardiac surgery patients, intraoperative remifentanil was predictive for chronic thoracic pain in a dose-dependent manner. Randomized studies designed to evaluate the influence of intraoperative remifentanil on chronic thoracic pain are needed to confirm these results.
Abstract
Objective: This study examines the influence of patient demographics and peri- and postoperative (≪7 days) characteristics on the incidence of chronic thoracic pain 1 year after cardiac ...surgery. The impact of chronic thoracic pain on daily life is also documented. Methods: A prospective cohort study of 146 patients admitted to the intensive care unit after cardiac surgery via sternotomy was carried out. Pain scores (numeric rating scale 0-10) were recorded during the first 7 postoperative days. One year later, a questionnaire was used to evaluate the incidence in the 2 preceding weeks of chronic thoracic pain (numeric rating scale >0) associated with the primary surgery. Results: One year after surgery, 42 (35%) of the 120 responding patients reported chronic thoracic pain. Multivariate regression analysis of patient characteristics revealed that non-elective surgery, re-sternotomy, severe pain (numeric rating scale ≥4) on the third postoperative day, and female gender were all independent predictors of chronic thoracic pain. In addition, the chronic sufferers reported more sleep disturbances and more frequent use of analgesics than their cohorts. Conclusions: We have identified a number of factors correlated with persistent thoracic pain following cardiac surgery with sternotomy. Awareness of these predictors may be useful for further research concerning both the prevention and treatment of chronic thoracic pain, thereby potentially ameliorating the postoperative quality of life of a significant proportion of patients. Meanwhile, chronic thoracic pain should be discussed preoperatively with patients at risk so that they are truly informed about possible consequences of the surgery.
The gold standard for quantification of pain is a person's self-report. However, we need objective parameters for pain measurement when intensive care patients are not able to report pain themselves. ...An increase in pain is currently thought to coincide with an increase in stress hormones. This observational study investigated whether procedure-related pain is associated with an increase of plasma cortisol, adrenaline, and noradrenaline. In 59 patients receiving intensive care after cardiac surgery, cortisol, adrenaline, and noradrenaline plasma levels were measured immediately before and immediately after patients were turned for washing, with or without concurrent removal of drain tubes. Numeric rating scale scores were obtained before, during, and after the procedure. Unacceptably severe pain (numeric rating scale >=4) was reported by seven (12%), 26 (44%), and nine (15%) patients, before, during and after the procedure, respectively. There was no statistically significant association between numeric rating scale scores and change in cortisol, adrenaline, and noradrenaline plasma levels during the procedure. Despite current convictions that pain coincides with an increase in stress hormones, procedural pain was not associated with a significant increase in plasma stress hormone levels in patients who had undergone cardiac surgery. Thus, plasma levels of cortisol, adrenaline, and noradrenaline seem unsuitable for further research on the measurement of procedural pain.
Mandibular movement recording has long been established as the method for the physiological design of indirect dental restorations. Condylar movement recording is the basis for individual, ...patient-specific programming of partially or fully adjustable articulators. The settings derived from these recordings can generally be used in both traditional mechanical and electronic virtual articulators. For many years, condylar movement recordings have also provided useful information about morphological conditions in the temporomandibular joints (TMJs) of patients with masticatory system dysfunction based on the recorded movement patterns. The latest clinical application for recorded jaw-motion analysis data consists of functional monitoring of the patient as a diagnostic and surveillance tool accompanying treatment. Published parameters for the analysis of such recordings already exist, but a standardized and practicable protocol for the documentation and analysis of such jaw-movement recordings is still lacking. The aim of this article by a multicenter consortium of authors is to provide an appropriate protocol with the documentation criteria needed to meet the requirements for standardized analysis of computer-assisted recording of condylar movements in the future.
The estimated incidence of temporomandibular joint dislocation in Germany is at least 25/100 000 per year. A correct diagnosis and the initiation of appropriate treatment without delay are essential ...if permanent damage to the joint is to be avoided.
This review is based on pertinent publications retrieved by a systematic search in the PubMed, Cochrane, Embase, and ZB Med databases.
The initial search yielded 24 650 hits; duplicates were removed and 136 studies were chosen for further analysis. The diagnosis of temporomandibular joint dislocation is generally made clinically from the finding of a lower jaw that is fixed in the open position. Acute dislocations are manually repositioned at once. The most common method is Hippocratic repositioning, in which the physician's thumb is placed laterally next to the teeth and the other fingers are placed on the lower surface of the lower jaw. The physician then exerts pressure, first caudally, then dorsally. Repositioning is carried out in two steps. For dislocations that have been present for a longer time, manual repositioning may be ineffective and surgery may be needed. Recurrent dislocation can be treated in a minimally invasive way with botulinum toxin injections or autologous blood therapy. Surgery may be needed if these methods are ineffective.
There have been no more than a few randomized, controlled trials of treatments for temporomandibular joint dislocation, in particular concerning minimally invasive and open surgical treatments, and therefore only limited evidence-based conclusions can be drawn. Nonetheless, the diagnostic and therapeutic standards that have been established in recent years have gained wide international acceptance.
The Environmental Scanning Electron Microscope (ESEM) equipped with a Gaseous Secondary Electron Detector (GSED) was used to image and analyze materials of different density, composition and ...structure applied in dentistry. Under ESEM conditions (at a H2O vapor pressure of 1–10 Torr) the hydrated surfaces of native teeth, which were coated with different polymers, generated a topographic and also a material specific contrast. The backscattered (BSE) and the secondary (SE) electrons involved into the imaging process produced a cascade-dependent mixed signal at the GSED. The material-specific contrast, generated by the BSE cascade, depends mainly on the atomic number z of the investigated material. The topographic contrast is based principally on the SE cascade. For the exact differentiation of the specific signal components inside of the ESEM, we additionally used a backscattered electron detector (BSED), the application of which allowed us to detect pure BSEs and no signals from cascade-dependent electrons. Conventional scanning electron microscopy (CSEM) used to investigate and image the structures of teeth and applied dental materials needs time-consuming and often artifact-inducing preparation steps before the partially hydrated specimen can be investigated, whereas the ESEM technology permits the imaging of hydrated organic structures with no prior specimen preparation. In the ESEM the interfaces between the hydrated organically structured tooth surfaces and the artificially applied polymer materials with its specific bond characteristics can be analyzed very fast and repeatedly (e.g. after etching series) at a reproducible high quality level.
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