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Cardiorenal Medicine 2024The coexistence of heart and kidney diseases, also called cardiorenal syndrome, is very common, leads to increased morbidity and mortality, and poses diagnostic and... (Review)
Review
BACKGROUND
The coexistence of heart and kidney diseases, also called cardiorenal syndrome, is very common, leads to increased morbidity and mortality, and poses diagnostic and therapeutic difficulties. There is a risk-treatment paradox, such that patients with the highest risk are treated with lesser disease-modifying medical therapies.
SUMMARY
In this document, different scientific societies propose a practical approach to address and optimize cardiorenal therapies and related comorbidities systematically in chronic cardiorenal disease beyond congestion. Cardiorenal programs have emerged as novel models that may assist in delivering coordinated and holistic management for these patients.
KEY MESSAGES
(1) Cardiorenal disease is a ubiquitous entity in clinical practice and is associated with numerous barriers that limit medical treatment. (2) The present article focuses on the practical approaches to managing chronic cardiorenal disease beyond congestion to overcome some of these barriers and improve the treatment of this high-risk population.
Topics: Humans; Cardio-Renal Syndrome; Disease Management
PubMed: 38432220
DOI: 10.1159/000538125 -
European Archives of... Sep 2023We investigated recent evidence on the analgesics available for postoperative pain management among patients undergoing septoplasty or rhinoplasty surgery. (Review)
Review
PURPOSE
We investigated recent evidence on the analgesics available for postoperative pain management among patients undergoing septoplasty or rhinoplasty surgery.
METHODS
Studies were retrieved from MEDLINE (through PubMed), Web of Science, and Embase up to 3 August 2022.
RESULTS
Forty-seven studies including 3717 patients were included. There were 45 randomized clinical trials and 2 observational cohort studies. Most of the studies were recently published and conducted in Turkey (n = 27). The majority of the studies performed the intervention preoperatively (n = 26), 11 studies postoperatively, 6 studies intraoperative, 2 studies preoperative plus intraoperative, and 2 studies performed the intervention with preoperative plus postoperative timing. The most evaluated medication was lidocaine (n = 10), followed by levobupivacaine (n = 4), and gabapentin (n = 4). Regarding post-operative pain assessment, the most used scale was the visual analog scale (VAS) (n = 36). Compared to controls, almost all interventions showed a significant benefit in managing post-operative pain. Although it should be mentioned regarding the comparison between opioids and NSAIDs consumption after surgery for pain management, most studies did not show a significant difference between the groups. No major side effects except nausea and vomiting were observed among the reviewed studies.
CONCLUSION
This study summarized the most recent options that are available to manage pain following septorhinoplasty surgery. Recent investigations showed local interventions vs pre/post-operative analgesic medications are highly suggested to be replaced with opioids and NSAIDs as they have shown prominent efficacy with no significant adverse events. Future research is advised to determine the best dosage and administration techniques.
Topics: Humans; Analgesics, Opioid; Pain Management; Rhinoplasty; Analgesics; Pain, Postoperative; Anti-Inflammatory Agents, Non-Steroidal
PubMed: 37272951
DOI: 10.1007/s00405-023-08044-3 -
Journal of Endourology Feb 2024New opioid dependency after urologic surgery is a serious adverse outcome that is well-described in the literature. Patients with stone disease often require multiple... (Review)
Review
New opioid dependency after urologic surgery is a serious adverse outcome that is well-described in the literature. Patients with stone disease often require multiple procedures because of recurrence of disease and hence are at greater risk for repeat opioid exposures. Despite this, opioid prescribing after urologic surgery remains highly variable and in an emergency setting, opioids are still used commonly in management of acute renal colic. Two literature searches were performed using PubMed. First, we searched available literature concerning opioid-sparing pathways in acute renal colic. Second, we searched available literature for opioid-sparing pathways in ureteroscopy and percutaneous nephrolithotomy (PCNL). Abstracts were reviewed for inclusion in our narrative review. In the setting of acute renal colic, multiple randomized control trials have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) attain greater reduction in pain scores, decreased need for rescue medications, and decreased vomiting events in comparison with opioids. NSAIDs also form a core component in management of postureteroscopy pain and have been demonstrated in randomized trials to have equivalent to improved pain control outcomes compared with opioids. Multiple opioid-free pathways have been described for postureteroscopy analgesia with need for rescue narcotics falling under 20% in most studies, including in patients with ureteral stents. Enhanced Recovery After Surgery protocols after percutaneous nephrolithotomy are less well described but have yielded a reduction in postoperative opioid requirements. In select patients, both acute renal colic and after kidney stone surgery, adequate pain management can usually be obtained with minimal or no opioid medication. NSAIDs form the core of most described opioid-sparing pathways for both ureteroscopy and PCNL, with the contribution of other components to postoperative pain outcomes limited because of lack of head-to-head comparisons. However, medications aimed specifically at targeting stent-related discomfort form a key component of most multimodal postsurgical pain management pathways. Further investigation is needed to develop pathways in patients unable to tolerate NSAIDs.
Topics: Humans; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Kidney Calculi; Pain Management; Pain, Postoperative; Practice Patterns, Physicians'; Randomized Controlled Trials as Topic; Renal Colic
PubMed: 38009214
DOI: 10.1089/end.2023.0266 -
JAMA Network Open Oct 2023Racial inequities in incidence, morbidity, and mortality are a defining feature of systemic lupus erythematosus (SLE). Health care systems are integral to addressing...
IMPORTANCE
Racial inequities in incidence, morbidity, and mortality are a defining feature of systemic lupus erythematosus (SLE). Health care systems are integral to addressing these inequities. However, qualitative evidence that highlights Black SLE care experiences is limited.
OBJECTIVE
To identify opportunities for improving SLE care based on the experiences and perspectives of Black adults with SLE.
DESIGN, SETTING, AND PARTICIPANTS
In this qualitative study, an interpretive description approach was used and data were analyzed using inductive thematic analysis. Semistructured interviews with Black adults in Michigan who were diagnosed with SLE were conducted. Interviews occurred from November 2, 2021, to July 19, 2022, and data analysis occurred from May 6, 2022, to April 12, 2023.
MAIN OUTCOMES AND MEASURES
Deidentified transcripts from the interviews were analyzed to develop themes that focused on opportunities to improve quality of care and symptom management.
RESULTS
The participants included 30 Black adults with SLE (97% women; mean age, 41 years; range, 18-65 years). Four main themes were identified: (1) awareness of SLE signs and symptoms before diagnosis (participants emphasized delays in diagnosis and how knowledge concerning SLE could be limited in their families and communities); (2) patient-clinician interactions (participants faced discrimination in health care settings and talked about the value of coordinated and supportive health care teams); (3) medication adherence and health effects (participants experienced a range of adverse effects from medications that treat SLE and described how monitoring medication use and efficacy could inform tailored care approaches); and (4) comprehensive care plans after diagnosis (participants reported persistent pain and other symptoms despite treatment). In the context of disease management, participants emphasized the importance of behavioral change and the negative impact of social risk factors.
CONCLUSIONS AND RELEVANCE
The findings of this qualitative study suggest how limited information about SLE, experiences of racism, treatment regimens, and social risk factors may affect Black people with SLE. Future research should further engage and include Black communities within the context of treatment and intervention development to reduce racial inequities.
Topics: Adult; Female; Humans; Male; Black People; Data Analysis; Disease Management; Lupus Erythematosus, Systemic; Qualitative Research; Adolescent; Young Adult; Middle Aged; Aged; Systemic Racism; Social Determinants of Health; Health Equity; Health Education; Health Behavior
PubMed: 37906190
DOI: 10.1001/jamanetworkopen.2023.40688 -
Current Pain and Headache Reports Sep 2023The Acute Perioperative Pain Service has been established as a relatively new but important concept and service in clinical patient care. Many surgical institutions have... (Review)
Review
PURPOSE OF REVIEW
The Acute Perioperative Pain Service has been established as a relatively new but important concept and service in clinical patient care. Many surgical institutions have dedicated inpatient acute pain services with variable compositions. This review aims to investigate the purpose, clinical and economic implications, and future direction of the Acute Perioperative Pain Service (APPS).
RECENT FINDINGS
There is growing evidence of the multiple benefits of a dedicated APPS, especially pertaining to patients at higher risk of poorly controlled postoperative pain. Healthcare providers furthermore realize the importance of the perioperative pain management continuity of care, consisting of preoperative pain evaluations and post-discharge follow-up in an outpatient pain management setting, in coordination with the primary teams. The Transitional Pain Service (TPS) has emerged as the next step in this evolution and has been successfully implemented at various medical centers. With the growing number of surgical procedures and the increasing complexity of the patient population, effective management of acute postoperative pain continues to be challenging, despite ongoing advances in clinical care, analgesic modalities, and research. The APPS is becoming the clinical standard of care for managing postoperative pain, and its role continues to expand worldwide.
Topics: Humans; Pain Clinics; Aftercare; Patient Discharge; Pain Management; Pain, Postoperative
PubMed: 37354296
DOI: 10.1007/s11916-023-01133-2 -
Australasian Psychiatry : Bulletin of... Jun 2024To consider the contribution of non-clinical factors in the rising rate of mental health presentations and explore the associated silence within the psychiatric...
OBJECTIVE
To consider the contribution of non-clinical factors in the rising rate of mental health presentations and explore the associated silence within the psychiatric profession.
CONCLUSION
Medicalisation, concept creep and group think, alongside societal demand and expectations, have collectively contributed toward a distorted view of mental health and illness. Equitable service provision has been hindered by the silence of important perspectives.
Topics: Humans; Psychiatry; Mental Disorders; Mental Health Services; Medicalization
PubMed: 38444074
DOI: 10.1177/10398562241236317 -
Current Problems in Cardiology Jun 2024In the realm of cardiovascular health, isolated left ventricular noncompaction (LVNC) stands out for its distinct morphological features and the clinical challenges it... (Review)
Review
In the realm of cardiovascular health, isolated left ventricular noncompaction (LVNC) stands out for its distinct morphological features and the clinical challenges it presents, particularly in adults. This literature review explores the intricacies of LVNC, aiming to unravel its epidemiological spread, diagnostic hurdles, and therapeutic strategies. Despite technological advancements in cardiac imaging that have improved the recognition of LVNC, a significant gap persists alongside a fragmented understanding of its pathogenesis. The studies scrutinized reveal a broad spectrum of prevalence rates influenced by diverse diagnostic tools and demographic variables. This variation underscores the complexity of accurately identifying LVNC and the resultant implications for clinical management. The review succinctly addresses the need for precise guidelines to navigate the diagnosis of LVNC and outlines the imperative for tailored clinical management approaches that cater to the wide array of patient presentations, from asymptomatic cases to those with severe cardiac dysfunction. By highlighting the critical gaps in current literature-namely the absence of standardized diagnostic criteria and a comprehensive pathogenic model-the review sets the stage for future research directions. These endeavors are essential for enhancing diagnostic accuracy, refining management protocols, and ultimately improving patient outcomes in this complex subset of cardiomyopathy, thus contributing significantly to the advancement of cardiovascular medicine.
Topics: Humans; Isolated Noncompaction of the Ventricular Myocardium; Adult; Disease Management
PubMed: 38608914
DOI: 10.1016/j.cpcardiol.2024.102571 -
BMC Palliative Care Jul 2023Pain is a significant problem for many people with advanced disease or a serious illness. Culture and ethnicity can affect the experience and management of pain....
Experiences of pain and pain management in advanced disease and serious illness for people from South Asian communities in Leeds and Bradford: a qualitative interview study.
BACKGROUND
Pain is a significant problem for many people with advanced disease or a serious illness. Culture and ethnicity can affect the experience and management of pain. However, there is limited research in South Asian communities in the UK on their experiences of pain. The aim of this study is to explore the experiences and attitudes of patients and family carers from South Asian communities about pain and its management within advanced disease or serious illness.
METHODS
Qualitative thematic analysis based on descriptive phenomenology (Sundler et al. 2019). Qualitative semi-structured interviews with patients or family carers from South Asian communities (N = 15). Interviews were recorded, transcribed and analysed using an inductive approach. Public and Patient Involvement representatives from British South Asian communities were consulted for guidance.
RESULTS
There were five key themes from the interviews: The importance of communication about pain with healthcare professionals; Concerns about taking pain medication; Personal resilience, privacy and self-management; Gender, culture and pain; Home pain management as struggle and frustration.
CONCLUSION
To improve pain management for people from South Asian communities with advanced disease or a serious illness, there are a number of important issues for healthcare professionals from palliative and primary care services to address. These include: greater awareness around people's fears and concerns about pain medication; their potential use of alternative pain management strategies; and cultural issues such as resilience, privacy, dignity and gender roles. Effective communication between doctors, patients and family members could be improved by using a 'cultural humility' model; providing clear and accessible pain medication information; understanding and taking account of people with both low, and medium levels, of English language proficiency; and improving patient trust. Additionally, improvements to out of hours services could improve pain management for all patients managing their pain at home.
Topics: Humans; Asian People; Family; Pain; Pain Management; Qualitative Research; United Kingdom
PubMed: 37464365
DOI: 10.1186/s12904-023-01208-2 -
Nursing Standard (Royal College of... Sep 2023There is little evidence to suggest that people with dementia experience less pain than those without dementia, however they are less likely to report their pain due to...
There is little evidence to suggest that people with dementia experience less pain than those without dementia, however they are less likely to report their pain due to the cognitive impairments they experience as their dementia progresses. A comprehensive pain assessment that involves family members, carers and/or friends in the process is crucial to gain an understanding of a person's medical and pain history, and to ensure effective pain management in people with dementia. This article describes the identification, assessment and management of pain in older people with dementia. The author includes a fictional case study with the aim of supporting nurses to reflect on possible indicators of pain in a person with dementia and to consider the tools they may use when identifying and assessing this pain.
Topics: Humans; Aged; Pain Management; Dementia; Pain; Pain Measurement
PubMed: 37574998
DOI: 10.7748/ns.2023.e12165 -
Frontiers in Immunology 2023Visceral leishmaniasis (VL) is a severe and often fatal form of leishmaniasis caused by in the Indian sub-continent. Post Kala-azar Dermal Leishmaniasis (PKDL) is a... (Review)
Review
Visceral leishmaniasis (VL) is a severe and often fatal form of leishmaniasis caused by in the Indian sub-continent. Post Kala-azar Dermal Leishmaniasis (PKDL) is a late cutaneous manifestation of VL, typically occurring after apparent cure of VL, but sometimes even without a prior history of VL in India. PKDL serves as a significant yet neglected reservoir of infection and plays a crucial role in the transmission of the disease, posing a serious threat to the VL elimination program in the Indian sub-continent. Therefore, the eradication of PKDL should be a priority within the current VL elimination program aimed at achieving a goal of less than 1 case per 10,000 in the population at the district or sub-district levels of VL endemic areas. To accomplish this, a comprehensive understanding of the pathogenesis of PKDL is essential, as well as developing strategies for disease management. This review provides an overview of the current status of diagnosis and treatment options for PKDL, highlighting our current knowledge of the immune responses underlying disease development and progression. Additionally, the review discusses the impact of PKDL on elimination programs and propose strategies to overcome this challenge and achieve the goal of elimination. By addressing the diagnostic and therapeutic gaps, optimizing surveillance and control measures, and implementing effective intervention strategies, it is possible to mitigate the burden of PKDL and facilitate the successful elimination of VL in the Indian sub-continent.
Topics: Humans; Leishmaniasis, Visceral; Leishmania donovani; Asian People; Disease Management; India
PubMed: 37638047
DOI: 10.3389/fimmu.2023.1236952