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Understanding the individual’s response to pain has con- siderable theoretical value naprosyn 250 mg low cost arthritis knee diet treatment, but perhaps more importantly can facilitate re- covery from pain and promote the rehabilitation process purchase 500mg naprosyn fast delivery arthritis uk pain centre. Indeed, a further elucidation of key individual differences is essential if we are to improve the way treatments are delivered to ensure that treatment outcomes are maxi- mized through the inclusion of patient preferences and a consideration of cultural differences. Increased and more extended multidisciplinary work- ing will bring about cross-fertilization of ideas to give a more holistic pic- ture of the experience and treatment of pain to ensure better targeted inter- 202 SKEVINGTON AND MASON ventions to account for patient variability, and the development of more comprehensive treatment programs, in addition to an understanding of pat- terns of concordance and adherence with treatment regimens. Enthusiasm for empirical work in relatively new avenues of inquiry such as psycho- neuroimmunology will add to the understanding of pain and facilitate the development of more comprehensive theory. We need to take a more holistic view of the patient in his or her social and environmental context, and this requires several actions; in particular, it requires multidisciplinary teamwork. We should be harnessing the en- ergy and ideas of health economists, policymakers, medical sociologists, and anthropologists into pain research in order to better understand indi- vidual well-being, or lack of it. There is also a need to create gender- and cul- ture-sensitive psychosocial therapies that could take account of individual differences, and that are better tailored to meet the particular needs of the social groups who participate. In addition, we need to account for the vari- ability and complexity of individual differences through developing ways of systematically investigating and assessing all possibilities, to ensure that important factors are not being overlooked. The structure of the model outlined in this chapter could also be used as an interview framework for a semistructured interview to generate an over- all assessment in a systematic social assessment. Not all elements of the model have yet been properly operationalized; some may need multidimen- sional scales to be developed, rather than answers to single items. Once this is done, we can evaluate the elements of the model collectively, to look at how each factor contributes to overall patient well-being and to a greater understanding of how the individual responds to pain. When this informa- tion is available, we shall be in a better position to say more precisely which factors best predict outcomes for chronic pain patients. The relative importance of these elements may well point to the value of social interven- tions that could be applied simultaneously alongside biological interven- tions, like medication, epidural anesthetic, and psychological interventions, like self-management regimes or cognitive behavior therapy. ACKNOWLEDGMENTS Professor Skevington thanks the Irish Pain Society for the opportunity to present an early draft of this chapter at their Inaugural Scientific meeting in Dublin, 2001. Appraisals of control and predictability in adapting to a chronic disease. Emotional and marital disturbance in spouses of chronic low back pain patients. Response variability to analgesics: A role for non-specific activation of endogenous opioids. Self-efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain pa- tients. Women’s experience of stigma in relation to chronic fatigue syndrome and fibromyalgia. Evidence-based practice in family therapy and systematic consultation II—Adult focused problems. Prediction of treatment outcome from clinically de- rived MMPI clusters in rehabilitation for chronic low-back-pain. Psychological variables associated with pain perceptions among individu- als with chronic spinal cord injury pain. Depression in rheumatoid arthritis: A systematic review of the literature with meta-analysis. The patient is not a blank sheet: Lay beliefs and their relevance to patient education. Pain demands attention: A cognitive-affective model of the interruptive function of pain. Worry and chronic pain patients: A description and analysis of individual differences. Patients’ and professionals’ understand- ings of the causes of chronic pain: Blame, responsibility and identity protection. Chronic pain from the perspective of health: A view based on systems theory. Psychological reactance as a factor in patient noncompli- ance with medication taking: A field experiment. A comparative study of differences in the referral behaviour pat- terns of men and women who have experienced cardiac-related chest pain.
Participants 165 patients admitted with heart failure due to left ventricular systolic dysfunction naprosyn 500 mg with amex arthritis fever. The intervention started before discharge and continued thereafter with home visits for up to 1 year discount naprosyn 500 mg fast delivery sarcoid arthritis definition. Main outcome measures Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure. Results 31 patients (37%) in the intervention group died or were readmitted with heart failure compared with 45 (53%) in the usual care group (hazard ratio − 0·61, 95% confidence interval 0·33 to 0·96). Compared with usual care, patients in the intervention group had fewer readmissions for any reason (86 versus 114, P = 0·018), fewer admissions for any reason (86 v 114), fewer admissions for heart failure (19 v 45, P < 0·001) and spent fewer days in hospital for heart failure (mean 3·43 v 7·46 days, P = 0·0051). Conclusions Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure. When writing your abstract, put your most concise and important sentences on a page, join them into an abstract and then count the words. Some journals such as Science and Nature that are very well regarded in scientific circles request very short abstracts, which may be as low as 100 words. MEDLINE® accepts only 250 words before it truncates the end of the abstract and cuts off your most important sentences, that is the conclusion and interpretation in the final sentences. Other people can often be more objective and ruthless than you can be with your own writing. A friend of mine says that the first draft is the down draft – you just get it down. Anne Lamott1 Introductions should be short and arresting and tell the reader why you undertook the study. In essence, this section should be brief rather than expansive and the structure should funnel down from a broad perspective to a specific aim as shown in Figure 3. This should lead directly into the second paragraph that summarises what other people have done in this field, what limitations have been encountered with work to date, and what questions still need to be answered. This, in turn, will lead to the last paragraph, which should clearly state what you did and why. This sequence is logical and naturally provides a good format in which to introduce your story. Paragraph 1: What we know Paragraph 2: What we don’t know Paragraph 3: Why we did this study Figure 3. Topic sentences, especially for the first introductory sentence, are a great help. Richard Smith, editor of the BMJ, stresses the importance of trying as hard as you can to hook your readers in the first line. Few readers want to plough through a detailed history of your research area that goes over two or more pages. In the introduction section, you do not need to review all of the literature available, although you do need to find it all and read it in the context of writing the entire paper. In appraising the literature, it is important to discard the scientifically weak studies and only draw evidence from the most rigorous, most relevant, and most valid studies. Ideally, you should have done a thorough literature search before you began the study and have updated it along the way. This will be invaluable in helping you to write a pertinent introduction. You should avoid including a lot of material in the introduction section that would be better addressed in the discussion. You should never be tempted to put “text book” knowledge into your introduction because readers will not want to be told basic information that they already know. For example, the sentence, Asthma is the most common chronic disease of childhood, must be one of the most overused phrases in the last decade. All scientists working in asthma research and most people in the community already know this and don’t want to be told it yet again. Similarly, a phrase that defines the problem such as, Asthma is a condition in which the airways narrow in response to commonly occurring environmental stimuli, is not appropriate, except in a paper about the mechanisms of airway narrowing.
Phagocyte function: The phagocytic function of leucocytes is reduced during the neonatal period 500mg naprosyn amex arthritis pain relief gloves reviews. Where possible buy naprosyn 250mg with visa arthritis research back pain, radiographers who are suffering from viral infections (e. If this is unavoid- able, then increased attention should be given to measures designed to minimise cross-infection, in particular hand-washing2. Warmth The pre-term neonate has difﬁculty in maintaining adequate body temperature as a result of having a relatively large surface area compared to body weight, and an inability to produce heat by shivering. As a consequence, the neonate is susceptible to heat loss and its associated clinical complications (e. To address this issue, neonates are generally nursed fully clothed unless this is prohibited by medical treatment (e. Additional precautions of warming or covering all objects that may come into direct contact with the neonate (e. Neonatal in-patients who are particularly at risk from heat loss may be nursed beneath a radiant warmer and this may need to be removed during radiographic examination to facilitate the positioning of the x-ray tube. Radiographers should ensure that the length of time the heater is removed is minimised and that the heater is replaced upon completion of the examination. Neonates examined within the radiology department are still susceptible to heat loss and a convec- tor heater should be available within the imaging department to enable the examination room to be warmed. Alternatively, departments undertaking a large volume of neonatal examinations may employ a radiant warmer (Fig. Noise Sudden loud noises can precipitate sleep disturbance, crying, tachycardia, 1 hypoxaemia and raised intracranial pressure in the neonate and as a result it is recommended that noise levels within the incubator should not exceed 45 deci- bels5. Possible sources of loud noise for a neonate nursed within an incubator are objects being placed on the incubator roof and closure of the incubator doors. Respiratory and cardiovascular pathology Respiratory difﬁculty or distress frequently presents during the neonatal period and has a variety of causes. An important factor in the differential diagnosis of underlying pathology is the time at which symptoms of respiratory distress occur2 (Table 6. Transient tachypnoea Transient tachypnoea of the newborn is an ill-deﬁned but common condition thought to result from a delay in the clearing of amniotic ﬂuid from the lungs6. Symptoms typically manifest within 3 hours of birth and a clinical diagnosis is 98 Paediatric Radiography Table 6. Onset: birth–6 hours Onset: >6 hours post-delivery Onset: any time after birth Transient tachypnoea Pneumonia Upper airway obstruction Hyaline membrane disease Congenital heart disease Neurological disorders Meconium aspiration Underlying metabolic illness Pneumothorax Persistent pulmonary hypertension Congenital malformations Fig. Chest radiography under- taken within a few hours of birth may show evidence of hyperinﬂation, pleural effusion, ﬂuid within the ﬁssures, streaky opaciﬁcation and prominent vascular markings6 (Fig. However, these radiographic ﬁndings are also consistent with neonatal pneumonia and further radiographic examinations may be required to monitor the progress of the condition. Complete clinical and radio- graphic resolution of transient tachypnoea should occur within 24 hours. Surfactant diminishes alveolar surface tension thereby preventing atelectasis (collapse) of the alveoli and acini and assisting in the maintenance of normal respiratory function. The 7 incidence of HMD is directly related to gestational age at the time of birth with very pre-term babies being most at risk. Clinical symptoms of HMD include cyanosis, tachypnoea, expiratory ‘grunting’ and intercostal retraction8. Regular radiographic assessment is likely to be requested to monitor the progress of the disease. Radiographically, the lungs are under-inﬂated and appear opaque or mottled, although air bronchograms may be evident (Fig. Meconium aspiration Meconium is a dark green discharge that results from the ‘sloughing off’ of dead bowel wall cells during foetal development. It is contained within the intestines of the full-term foetus and is usually passed within 24 hours of delivery. However, if foetal distress should occur during delivery then evacuation of meconium into the amniotic ﬂuid may occur and in a small amount of cases (1%), aspiration of the meconium will result8 causing respiratory obstruction (air trap- ping) and distress. Radiographic examination of the neonatal chest will reveal hyperinﬂated lungs and patchy, bilateral opaciﬁcation2 which may become more diffuse as the condition progresses (Fig. Clinically, symptoms of respiratory distress as a result of meconium aspiration resolve within 3–5 days of delivery although radiographic resolution may take up to 1 year. Pulmonary interstitial emphysema Surfactant deﬁciency in the premature neonate may result in the rupture of small airways and dissection of air into the interstitial space where it forms small cysts within the interlobular septae (pulmonary interstitial emphysema).
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