This retrospective case study investigates the clinical presentation of a 53-year-old female who underwent mantle field radiotherapy roughly 26 years ago. This patient presents with diffuse muscle atrophy and weakness...This retrospective case study investigates the clinical presentation of a 53-year-old female who underwent mantle field radiotherapy roughly 26 years ago. This patient presents with diffuse muscle atrophy and weakness in the cervical musculature, as well as sensory deficits in the upper extremities. We sought to compare our patient’s symptoms with other patients who had been formally diagnosed with Dropped Head Syndrome (DHS) by reviewing the existing literature. We found that the clinical presentation under investigation was consistent with other patients who had received radiotherapy for Hodgkins’s disease and were then diagnosed with DHS. Electromyography (EMG), nerve conduction studies, and a cervical MRI were unable to identify a separate neurological cause for the symptoms, but the MRI did confirm the presence of diffuse muscle atrophy in the cervical musculature. After reviewing the existing literature and imaging results, we compared our patient’s symptoms to those that define DHS, and both the time of onset, presenting symptoms, and progressing course are consistent with a diagnosis of Dropped Head Syndrome.展开更多
Chronic migraine is a potentially debilitating condition that can be detrimental to someone’s quality of life. Clinical data has proven OnabotulinumtoxinA (BoNT-A) to be an effective prophylactic treatment for chroni...Chronic migraine is a potentially debilitating condition that can be detrimental to someone’s quality of life. Clinical data has proven OnabotulinumtoxinA (BoNT-A) to be an effective prophylactic treatment for chronic headache types, and it is now regularly employed by headache treatment centers. The PREEMPT injection protocol has become the standard treatment regimen surrounding Botox injections for chronic migraine treatment since it was granted approval by the FDA in 2010. This retrospective chart review of patients treated for chronic migraine at Maine Comprehensive Pain Management in Scarborough, Maine, presents an alteration to the standard PREEMPT injection paradigm that reinforces the efficacy of Botox for chronic migraine treatment. We will discuss our Modified PREEMPT injection paradigm, which yields a positive clinical response rate of 95% of patients achieving at least 50% improvement in their migraine headaches. This appears to be the highest established response rate in the literature to date.展开更多
AIM To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement methodology.METHODS Specific intervention strategies(i.e.,comfort po...AIM To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement methodology.METHODS Specific intervention strategies(i.e.,comfort positioning,nonnutritive sucking and sucrose analgesia,distraction) were identified,selected and introduced in three waves,using a Plan-Do-Study-Act framework.System-wide change was measured from baseline to post-intervention by:(1) percent of vaccination visits during which an evidence-based pain prevention strategy was reported as being used; and(2) caregiver satisfaction ratings following the visit.Additionally,self-reported staff and caregiver attitudes and beliefs about pain prevention were measured at baseline and 1-year post-intervention to assess for possible long-term cultural shifts.RESULTS Significant improvements were noted post-intervention.Use of at least one pain prevention strategy was documented at 99% of patient visits and 94% of caregivers were satisfied or very satisfied with the pain prevention care received.Parents/caregivers reported greater satisfaction with the specific pain prevention strategy used [t(143) = 2.50,P ≤ 0.05],as well as greater agreement that the pain prevention strategies used helped their children's pain [t(180) = 2.17,P ≤ 0.05] and that they would be willing to use the same strategy again in the future [t(179) = 3.26,P ≤ 0.001] as compared to baseline.Staff and caregivers also demonstrated a shift in attitudes from baseline to 1-year post-intervention.Specifically,staff reported greater agreement that the pain felt from vaccinations can result in harmful effects [2.47 vs 3.10; t(70) =-2.11,P ≤ 0.05],less agreement that pain from vaccinations is "just part of the process" [3.94 vs 3.23; t(70) = 2.61,P ≤ 0.05],and less agreement that parents expect their children to experience pain during vaccinations [4.81 vs 4.38; t(69) = 2.24,P ≤ 0.05].Parents/caregivers reported more favorable attitudes about pain prevention strategies for vaccinations across a variety of areas,including safety,cost,time,and effectiveness,as well as less concern about the pain their children experience with vaccination [4.08 vs 3.26; t(557) = 6.38,P ≤ 0.001],less need for additional pain prevention strategies [3.33 vs 2.81; t(476) = 4.51,P ≤ 0.001],and greater agreement that their doctors' office currently offers pain prevention for vaccinations [3.40 vs 3.75; t(433) =-2.39,P ≤ 0.05].CONCLUSION Quality improvement methodology can be used to help close the gap in implementing pain prevention strategies during routine vaccination procedures for children.展开更多
文摘This retrospective case study investigates the clinical presentation of a 53-year-old female who underwent mantle field radiotherapy roughly 26 years ago. This patient presents with diffuse muscle atrophy and weakness in the cervical musculature, as well as sensory deficits in the upper extremities. We sought to compare our patient’s symptoms with other patients who had been formally diagnosed with Dropped Head Syndrome (DHS) by reviewing the existing literature. We found that the clinical presentation under investigation was consistent with other patients who had received radiotherapy for Hodgkins’s disease and were then diagnosed with DHS. Electromyography (EMG), nerve conduction studies, and a cervical MRI were unable to identify a separate neurological cause for the symptoms, but the MRI did confirm the presence of diffuse muscle atrophy in the cervical musculature. After reviewing the existing literature and imaging results, we compared our patient’s symptoms to those that define DHS, and both the time of onset, presenting symptoms, and progressing course are consistent with a diagnosis of Dropped Head Syndrome.
文摘Chronic migraine is a potentially debilitating condition that can be detrimental to someone’s quality of life. Clinical data has proven OnabotulinumtoxinA (BoNT-A) to be an effective prophylactic treatment for chronic headache types, and it is now regularly employed by headache treatment centers. The PREEMPT injection protocol has become the standard treatment regimen surrounding Botox injections for chronic migraine treatment since it was granted approval by the FDA in 2010. This retrospective chart review of patients treated for chronic migraine at Maine Comprehensive Pain Management in Scarborough, Maine, presents an alteration to the standard PREEMPT injection paradigm that reinforces the efficacy of Botox for chronic migraine treatment. We will discuss our Modified PREEMPT injection paradigm, which yields a positive clinical response rate of 95% of patients achieving at least 50% improvement in their migraine headaches. This appears to be the highest established response rate in the literature to date.
基金Supported by the Pfizer Medical Education Group in part
文摘AIM To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement methodology.METHODS Specific intervention strategies(i.e.,comfort positioning,nonnutritive sucking and sucrose analgesia,distraction) were identified,selected and introduced in three waves,using a Plan-Do-Study-Act framework.System-wide change was measured from baseline to post-intervention by:(1) percent of vaccination visits during which an evidence-based pain prevention strategy was reported as being used; and(2) caregiver satisfaction ratings following the visit.Additionally,self-reported staff and caregiver attitudes and beliefs about pain prevention were measured at baseline and 1-year post-intervention to assess for possible long-term cultural shifts.RESULTS Significant improvements were noted post-intervention.Use of at least one pain prevention strategy was documented at 99% of patient visits and 94% of caregivers were satisfied or very satisfied with the pain prevention care received.Parents/caregivers reported greater satisfaction with the specific pain prevention strategy used [t(143) = 2.50,P ≤ 0.05],as well as greater agreement that the pain prevention strategies used helped their children's pain [t(180) = 2.17,P ≤ 0.05] and that they would be willing to use the same strategy again in the future [t(179) = 3.26,P ≤ 0.001] as compared to baseline.Staff and caregivers also demonstrated a shift in attitudes from baseline to 1-year post-intervention.Specifically,staff reported greater agreement that the pain felt from vaccinations can result in harmful effects [2.47 vs 3.10; t(70) =-2.11,P ≤ 0.05],less agreement that pain from vaccinations is "just part of the process" [3.94 vs 3.23; t(70) = 2.61,P ≤ 0.05],and less agreement that parents expect their children to experience pain during vaccinations [4.81 vs 4.38; t(69) = 2.24,P ≤ 0.05].Parents/caregivers reported more favorable attitudes about pain prevention strategies for vaccinations across a variety of areas,including safety,cost,time,and effectiveness,as well as less concern about the pain their children experience with vaccination [4.08 vs 3.26; t(557) = 6.38,P ≤ 0.001],less need for additional pain prevention strategies [3.33 vs 2.81; t(476) = 4.51,P ≤ 0.001],and greater agreement that their doctors' office currently offers pain prevention for vaccinations [3.40 vs 3.75; t(433) =-2.39,P ≤ 0.05].CONCLUSION Quality improvement methodology can be used to help close the gap in implementing pain prevention strategies during routine vaccination procedures for children.
