Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder.
Med Care. 2014 Dec ;52(12 Suppl 5):S57-64. PMID: 25397825
Charles C Engel, Elizabeth H Cordova, David M Benedek, Xian Liu, Kristie L Gore, Christine Goertz, Michael C Freed, Cindy Crawford, Wayne B Jonas, Robert J Ursano
Charles C Engel
BACKGROUND: Initial posttraumatic stress disorder (PTSD) care is often delayed and many with PTSD go untreated. Acupuncture appears to be a safe, potentially nonstigmatizing treatment that reduces symptoms of anxiety, depression, and chronic pain, but little is known about its effect on PTSD.
METHODS: Fifty-five service members meeting research diagnostic criteria for PTSD were randomized to usual PTSD care (UPC) plus eight 60-minute sessions of acupuncture conducted twice weekly or to UPC alone. Outcomes were assessed at baseline and 4, 8, and 12 weeks postrandomization. The primary study outcomes were difference in PTSD symptom improvement on the PTSD Checklist (PCL) and the Clinician-administered PTSD Scale (CAPS) from baseline to 12-week follow-up between the 2 treatment groups. Secondary outcomes were depression, pain severity, and mental and physical health functioning. Mixed model regression and t test analyses were applied to the data.
RESULTS: Mean improvement in PTSD severity was significantly greater among those receiving acupuncture than in those receiving UPC (PCLΔ=19.8±13.3 vs. 9.7±12.9, P<0.001; CAPSΔ=35.0±20.26 vs. 10.9±20.8, P<0.0001). Acupuncture was also associated with significantly greater improvements in depression, pain, and physical and mental health functioning. Pre-post effect-sizes for these outcomes were large and robust.
CONCLUSIONS: Acupuncture was effective for reducing PTSD symptoms. Limitations included small sample size and inability to parse specific treatment mechanisms. Larger multisite trials with longer follow-up, comparisons to standard PTSD treatments, and assessments of treatment acceptability are needed. Acupuncture is a novel therapeutic option that may help to improve population reach of PTSD treatment.
Article Published Date : Nov 30, 2014
Patient reported extremity symptoms after robot-assisted laparoscopic cystectomy.
J Clin Nurs. 2019 Jan 17;:
Authors: Johansson VR, von Vogelsang AC
AIMS AND OBJECTIVES: To describe patient reported extremity symptoms after robot-assisted laparoscopic cystectomy in patients with bladder cancer.
BACKGROUND: Preventive activities for remaining patient safety due to correct positioning play an important part in perioperative nursing care. Extremity injuries are well-known after prolonged surgery, especially in robot-assisted urologic surgery in the steep Trendelenburg position. The risk of injury increases due to patient-related and operative risk factors.
METHODS: A quantitative prospective observational study was conducted. Patients were followed-up with the QuickDASH (Disabilities in the Arm, Shoulder and Hand), Lower Extremity Functional Scale (LEFS) and a study-specific questionnaire 7-10 days and monthly, up to six months after surgery in patients with extremity symptoms. The study adheres to STROBE (strengthening the reporting of observational studies in epidemiology) guidelines, see Supplementary File 1.
RESULTS: Out of the 94 included participants 46.8% (n=44) experienced extremity symptoms 7-10 days after surgery. Pain, numbness and weakness were the most frequent symptoms. There was a discrepancy between the patients reported symptoms and the documentation in the patient records. Only 13.6% (n=3) of the reported pain was documented, respectively 27.5% (n=11) of other symptoms.
CONCLUSION: A large proportion of the patients report postoperative extremity symptoms after robot-assisted laparoscopic cystectomy. Prevention of complications in the perioperative setting, are together with follow-ups, important nursing activities for maintaining patient safety and may both prevent and detect postoperative extremity symptoms and injuries.
RELEVANCE TO CLINICAL PRACTICE: This study reveals the need of accurate documentation regarding extremity symptoms in digital patient records, as well as continuous follow-ups during the hospital stay and after hospital discharge to enable detection of treatable extremity injuries. The result of this study also indicates the importance of nursing activities such as evidence-based positioning guidelines in the operating theatre for optimal positioning. This article is protected by copyright. All rights reserved.
PMID: 30653776 [PubMed - as supplied by publisher]
Flupirtine Analogues: Explorative Synthesis and Influence of Chemical Structure on KV7.2/KV7.3 Channel Opening Activity.
ChemistryOpen. 2019 Jan;8(1):41-44
Authors: Surur AS, Beirow K, Bock C, Schulig L, Kindermann MK, Bodtke A, Siegmund W, Bednarski PJ, Link A
Neuronal voltage-gated potassium channels KV7.2/KV7.3 are sensitive to small-molecule drugs such as flupirtine, even though physiological response occurs in the absence of ligands. Clinically, prolonged use of flupirtine as a pain medication is associated with rare cases of drug-induced liver injury. Thus, safety concerns prevent a broader use of this non-opioid and non-steroidal analgesic in therapeutic areas with unmet medical needs such as hyperactive bladder or neonatal seizures. With the goal of studying influences of chemical structure on activity and toxicity of flupirtine, we explored modifications of the benzylamino bridge and the substitution pattern in both rings of flupirtine. Among twelve derivatives, four novel thioether derivatives showed the desired activity in cellular assays and may serve as leads for safer KV channel openers.
PMID: 30652063 [PubMed]
Hindsight bias critically impacts on clinicians' assessment of care quality in retrospective case note review.
Clin Med (Lond). 2019 Jan;19(1):16-21
Authors: Banham-Hall E, Stevens S
Objective To determine whether hindsight bias impacts on retrospective case note review using a five point scoring system based on modern clinical governance toolkits. Design Survey. Setting Clinicians of varying grades invited to complete a short internet survey. Participants Ninety three clinicians were invited to complete an anonymous survey in which they reviewed three case vignettes for the purposes of a fictional clinical governance meeting. For each vignette, participants were randomised to an outcome in which the patient made a full recovery or alternatively died shortly after discharge. Main outcome measure. Participants submit scores from 1 to 5 to indicate the quality of care provided to patients prior to their discharge. These scores were compared to determine whether judgements about the quality of antecedent care were biased by the description of a patient death. Results In two out of three case vignettes clinicians exhibited marked hindsight bias. In a case of a patient with a swollen leg, identical antecedent care was scored as poor by participants when the patient died the next day, but good when the patient recovered (p<0.00001). In a case of headache, care was scored as poor when the patient died but adequate when the patient made a full recovery (p=0.0003). A third case of chest pain did not exhibit hindsight bias. Seniority of clinician had no impact on the tendency to exhibit hindsight bias when reviewing case notes. Conclusion In some cases, clinicians are markedly more critical of identical healthcare when a patient dies compared to when a patient survives. Hindsight bias while reviewing care when a patient survives might prevent identification of learning arising from errors. Additionally, we predict hindsight bias combined with a legal duty of candour will cause families to be informed that patients died because of healthcare error when this is not a fact.
PMID: 30651239 [PubMed - in process]
European headache federation guideline on the use of monoclonal antibodies acting on the calcitonin gene related peptide or its receptor for migraine prevention.
J Headache Pain. 2019 Jan 16;20(1):6
Authors: Sacco S, Bendtsen L, Ashina M, Reuter U, Terwindt G, Mitsikostas DD, Martelletti P
BACKGROUND AND AIM: Monoclonal antibodies acting on the calcitonin gene-related peptide or on its receptor are new drugs to prevent migraine. Four monoclonal antibodies have been developed: one targeting the calcitonin gene-related peptide receptor (erenumab) and three targeting the calcitonin gene-related peptide (eptinezumab, fremanezumab, and galcanezumab). The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based guideline on the use of the monoclonal antibodies acting on the calcitonin gene-related peptide for migraine prevention.
METHODS: The guideline was developed following the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. The working group identified relevant questions, performed systematic review and analysis of the literature, assessed the quality of available evidence, and wrote recommendations. Where the GRADE approach was not applicable, expert opinion was provided.
RESULTS: We found low to high quality of evidence to recommend eptinezumab, erenumab, fremanezumab, and galcanezumab in patients with episodic migraine and medium to high quality of evidence to recommend erenumab, fremanezumab, and galcanezumab in patients with chronic migraine. For several clinical questions, there was not enough evidence to provide recommendations using the GRADE approach and recommendations relied on experts' opinion.
CONCLUSION: Monoclonal antibodies acting on the calcitonin gene-related peptide are new drugs which can be recommended for migraine prevention. Real life data will be useful to improve the use of those drugs in clinical practice.
PMID: 30651064 [PubMed - in process]
Synthetic Fragment of Receptor for Advanced Glycation End Products Prevents Memory Loss and Protects Brain Neurons in Olfactory Bulbectomized Mice.
J Alzheimers Dis. 2018;61(3):1061-1076
Authors: Volpina OM, Samokhin AN, Koroev DO, Nesterova IV, Volkova TD, Medvinskaya NI, Nekrasov PV, Tatarnikova OG, Kamynina AV, Balasanyants SM, Voronina TA, Kulikov AM, Bobkova NV
Activation of receptor for advanced glycation end products (RAGE) plays an essential role in the development of Alzheimer's disease (AD). It is known that the soluble isoform of the receptor binds to ligands and prevents negative effects of the receptor activation. We proposed that peptide fragments from RAGE prevent negative effects of the receptor activation during AD neurodegeneration. We have synthesized peptide fragments from surface-exposed regions of RAGE. Peptides were intranasally administrated into olfactory bulbectomized (OBX) mice, which developed some characteristics similar to AD neurodegeneration. We have found that only insertion of fragment (60-76) prevents the memory of OBX mice. Immunization of OBX mice with peptides showed that again only (60-76) peptide protected the memory of animals. Both intranasal insertion and immunization decreased the amyloid-β (Aβ) level in the brain. Activity of shortened fragments of (60-76) peptide was tested and showed only the (60-70) peptide is responsible for manifestation of activity. Intranasal administration of (60-76) peptide shows most protective effect on morpho-functional characteristics of neurons in the cortex and hippocampal areas. Using Flu-(60-76) peptide, we revealed its penetration in the brain of OBX mice as well as colocalization of Flu-labeled peptide with Aβ in the brain regions in transgenic mice. Flu-(60-76) peptide complex with trimer of Aβ was detected by SDS-PAGE. These data indicate that Aβ can be one of the molecular target of (60-70) peptide. These findings provide a new peptide molecule for design of anti-AD drug and for investigation of RAGE activation ways in progression of AD neurodegeneration.
PMID: 29332040 [PubMed - indexed for MEDLINE]