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Major Clinical Challenge (major + clinical_challenge)
Selected AbstractsBarriers to, and facilitators of post-operative pain management in Iranian nursing: a qualitative research studyINTERNATIONAL NURSING REVIEW, Issue 4 2008N. Rejeh bscn, mscn Background:, Unrelieved post-operative pain continues to be a major clinical challenge, despite advances in management. Although nurses have embraced a crucial role in pain management, its extent is often limited in Iranian nursing practice. Aim:, To determine Iranian nurses' perceptions of the barriers and facilitators influencing their management of post-operative pain. Methods:, This study was qualitative with 26 participant nurses. Data were obtained through semi-structured serial interviews and analysed using the content analysis method. Findings:, Several themes emerged to describe the factors that hindered or facilitated post-operative pain management. These were grouped into two main themes: (1) barriers to pain management after surgery with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time constraints, limited communication, interruption of activities relating to pain, and (2) factors that facilitated post-operative pain management that included the nurse,patient relationship, nurses' responsibility, the physician as a colleague, and nurses' knowledge and skills. Conclusion:, Postoperative pain management in Iran is contextually complex, and may be controversial. Participants believed that in this context accurate pain management is difficult for nurses due to the barriers mentioned. Therefore, nurses make decisions and act as a patient comforter for pain after surgery because of the barriers to effective pain management. [source] Respiratory Function as a Marker of Bone Health and Fracture Risk in an Older Population,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 5 2009Alireza Moayyeri Abstract Identification of those at high risk of osteoporosis and fractures using clinically available tests beyond BMD measures is a major clinical challenge. We examined forced expiratory volume in 1 s (FEV1), an easily obtainable measure of respiratory function, as a clinical measure for fracture prediction. In the context of the European Prospective Investigation into Cancer-Norfolk Study, 8304 women and 6496 men 42,81 yr of age underwent a health check including spirometry and heel quantitative ultrasonography between 1997 and 2000 and were followed up for incident hip fractures until 2007. The main outcome measures were broadband ultrasound attenuation (BUA) of the heel (cross-sectional analysis) and hip fracture risk (prospective analysis). In multivariate regression models, a 1-liter increase in FEV1 was associated with a statistically significant 2.2-dB/MHz increase in BUA, independent of age, smoking, height, body mass index, history of fracture, and use of corticosteroids. Mean FEV1 was significantly lower among 84 women and 36 men with hip fracture compared with other participants. In multivariate proportional-hazard regression models, the relative risk (RR) of hip fracture associated with a 1-liter increase in FEV1 was 0.5 (95% CI, 0.3,0.9; p < 0.001) for both men and women. RR of hip fracture for a 1 SD increase in FEV1 was approximately equivalent to a 0.5 SD increase in BUA among women (1 SD among men) and an ,5-yr decrease in age among both men and women. Middle-aged and older people with low respiratory function are at increased risk of osteoporosis and hip fracture. FEV1, an easy, low-cost, and feasible clinical measure, may help improve the identification of high-risk groups. [source] Secondary Hypertension: Obesity and the Metabolic SyndromeJOURNAL OF CLINICAL HYPERTENSION, Issue 7 2008Gregory M. Singer MD The epidemic of obesity in the United States and around the world is intensifying in severity and scope and has been implicated as an underlying mechanism in systemic hypertension. Obese hypertensive individuals characteristically exhibit volume congestion, relative elevation in heart rate, and high cardiac output with concomitant activation of the renin-angiotensin-aldosterone system. When the metabolic syndrome is present, insulin resistance and hyperinsulinemia may contribute to hypertension through diverse mechanisms. Blood pressure can be lowered when weight control measures are successful, using, for example, caloric restriction, aerobic exercise, weight loss drugs, or bariatric surgery. A major clinical challenge resides in converting short-term weight reduction into a sustained benefit. Pharmacotherapy for the obese hypertensive patient may require multiple agents, with an optimal regimen consisting of inhibitors of the renin-angiotensin-aldosterone system, thiazide diuretics, ,-blockers, and calcium channel blockers if needed to attain contemporary blood pressure treatment goals. [source] Scaffold Modeling Application in the Repair of Skull DefectsARTIFICIAL ORGANS, Issue 4 2010Weibing Wan Abstract The repair of large segmental bone defects caused by trauma, inflammation, and surgery on tumors pose a major clinical challenge. Tissue-engineered bone is emerging as a good choice for prefabricating cellular scaffold, and computer-aided technologies and medical imaging have created new possibilities in biomedical engineering. An accurate and efficient construction of anatomic models is critical to the application of these computational methods. Such models must be validated prior to application. In this article, we explore the potential of combining these techniques to scaffold and repair a pediatric skull. Working under the hypothesis that the autogenously cultivated osteoblasts can be grown on individualized scaffolds to improve bone regeneration in skull defects, we focus our study on potential problems concerning the segmentation, reconstruction, and mesh simplification for a pediatric skull. We also propose a new framework to improve the accuracy of the model entity from image segmentation to mesh simplification. [source] CLINICAL QUESTION: What is the best management strategy for patients with severe insulin resistance?CLINICAL ENDOCRINOLOGY, Issue 3 2010Robert K. Semple Summary Management of severe insulin resistance (IR) is a major clinical challenge in many patients with obesity or lipodystrophy, and also in rarer patients with proven or suspected genetic defects in the insulin receptor or downstream signalling. The latter group can present at any time between birth and early adult life, with a variable clinical course broadly correlated with the severity of IR. Primary insulin signalling defects are usually associated with poor weight gain rather than obesity. Initially, extreme hyperinsulinaemia produces ovarian enlargement and hyperandrogenism in women, and often fasting or postprandial hypoglycaemia. However, any hypoglycaemia gradually evolves into insulin-resistant hyperglycaemia when beta cell function declines. Optimal management of these complex disorders depends on early diagnosis and appropriate targeting of both high and low glucose levels. In newborns, continuous nasogastric feeding may reduce harmful glycaemic fluctuations, and in older patients, acarbose may mitigate postprandial hypoglycaemia. Insulin sensitization, initially with metformin but later with trials of additional agents such as thiazolidinediones, is the mainstay of early therapy, but insulin replacement, eventually with very high doses, is required once diabetes has supervened. Preliminary data suggest that rhIGF-1 can improve survival in infants with the most severe insulin receptor defects and also improve beta cell function in older patients with milder receptoropathies. The utility of newer therapies such as glucagon-like peptide-1 agonists and dipeptidyl peptidase-IV inhibitors remains untested in this condition. Thus, management of these patients remains largely empirical, and there is a pressing need to collate data centrally to optimize treatment algorithms. [source] | ||||||||||