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"Peterson, Cynthia"
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The TMJ healing plan : ten steps to relieving headaches, neck pain and jaw disorders
Helps TMJ sufferers find a new way to alleviate their discomfort, offering tips of on posture, tongue placement, and simple physical therapy exercises that can reduce, relieve, and even eliminate TMJ-associated pain. Each section is illustrated with photos and drawings.
Book
Particulate versus non-particulate corticosteroids for transforaminal nerve root blocks: Comparison of outcomes in 494 patients with lumbar radiculopathy
PurposeWe set out to compare outcomes in CT-guided lumbar transforaminal nerve root block patients receiving either particulate or non-particulate corticosteroids.Materials and methodsThis was a retrospective comparative effectiveness outcomes study on two cohorts of lumbar radiculopathy patients. 321 received particulate and 173 non-particulate corticosteroids at CT-guided transforaminal lumbar nerve root injections. The particulate steroid was used from October 2009 until May 2014 and the non-particulate steroid was used from May 2014. Pain levels were collected at baseline using an 11-point numerical rating scale (NRS) and at 1 day, 1 week and 1 month. Overall ‘improvement’ was assessed using the Patients’ Global Impression of Change (PGIC) at these same time points (primary outcome). The proportions of patients ‘improved’ were compared between the two groups using the Chi-square test. The NRS change scores were compared using the unpaired t-test.ResultsA significantly higher proportion of patients treated with particulate steroids were improved at 1 week (43.2 % vs. 27.7 %, p = 0.001) and at 1 month (44.3 % vs. 33.1 %, p = 0.019). Patients receiving particulate steroids also had significantly higher NRS change scores at 1 week (p = 0.02) and 1 month (p = 0.007).ConclusionParticulate corticosteroids have significantly better outcomes than non-particulate corticosteroids.Key Points• Better pain relief is achieved with particulate steroids.• Significantly more patients report overall ‘improvement’ with particulate steroids.• Significantly more patients report ‘worsening’ at 1 week with non-particulate steroids.
Journal Article
“They don’t know what it’s really like:” qualitative insights into inpatient cardiac nurses’ perceived workload
Background
Measurements of nursing workload often fail to reflect the complexity of nursing work. Nurses’ perceived workload is shaped by many factors, including patient characteristics, personal, social, organizational, and environmental factors. There is a demonstrated interest in developing more comprehensive nurse workload measurement strategies, but little research has employed qualitative methods to investigate the beliefs and experiences of frontline staff. The purpose of this study was to explore inpatient nurses’ perceptions of their workload and the factors that impact their percieved workload levels.
Methods
This was qualitative study using focus groups. Participants were recruited from the cardiac floors of an urban, academic medical center. A total of 17 nurses participated, including nurses from bedside, charge, educator, and nurse manager roles. Focus group transcripts were analyzed by a team of qualitative investigators using conventional content analysis.
Results
Inpatient nurses’ perceived workload is shaped by their work volume, work attributes, and their ability to complete required tasks while providing meaningful, impactful care. The volume of nursing work is comprised of patient-focused, unit-focused, and institutional-focused tasks. Important work attributes include its perceived urgency, difficulty, alignment to the nurse and unit, interference, unpredictability, and individual nursing burden. Overall, participants expressed deep concern over high workloads that compromise holistic nursing care.
Conclusion
Strategies to more comprehensively measure nurses’ perceived workload should account for the breadth and complexity of nursing work. Nurses should advocate for workload measurement systems that more closely reflect their subjective work experiences.
Clinical trial registration number
Not applicable.
Journal Article
Reasons why referring doctors order renal ultrasound contrast studies
PurposeTo determine the indications for CEUS for renal mass evaluation.MethodsThis retrospective, single-center, IRB-approved, HIPAA compliant study analyzed data from 303 consecutive patients scheduled for a renal CEUS to determine the indications for the examination. A chart review was performed from 05/01/2020 through 05/31/2021 on all patients who received a renal CEUS. The patient demographics were extracted as well as the motivating factor for ordering the examination.ResultsFrom the 303 patients, 114 were referred because of an indeterminate mass seen on CT and 28 were referred for long-term follow-up of a mass defined as benign or malignant was identified on CT. 9 patients were referred for a CEUS follow-up due to an indeterminate mass on MRI and 6 patients were referred for long-term follow-up of a mass defined as benign or malignant on MRI. 34 patients were referred for follow-up for characterization of a lesion seen on unenhanced ultrasound. 48 patients and 21 patients were referred for long-term follow-up of a previously observed benign or malignant lesion, respectively, seen on CEUS. CEUS was ordered in 21 patients to follow-up a partial nephrectomy and 5 patients for follow-up of a thermal ablation. 7 patients were referred because of a clinical finding.ConclusionThe main reason for a renal CEUS referral is to characterize a mass which could not be characterized on CT or MRI. Another main indication is for long-term follow-up of lesions to decrease radiation dose. Referrals due to inability to receive CT or MRI contrast or renal insufficiency were minor indications.
Journal Article
Is there a difference in treatment outcomes between epidural injections with particulate versus non-particulate steroids?
Objectives
To compare the outcomes of patients after interlaminar computed tomography (CT)-guided epidural injections of the lumbar spine with particulate vs. non-particulate steroids.
Methods
531 consecutive patients were treated with CT-guided lumbar interlaminar epidural injections with steroids and local anaesthetics. 411 patients received a particulate steroid and 120 patients received a non-particulate steroid. Pain levels were assessed using the 11-point numerical rating scale (NRS) and overall reported ‘improvement’ was assessed using the Patients Global Impression of Change (PGIC) at 1 day, 1 week and 1 month post-injection.
Descriptive and inferential statistics were applied.
Results
Patients receiving particulate steroids had statistically significantly higher NRS change scores (
p
= 0.0001 at 1 week;
p
= 0.0001 at 1 month).
A significantly higher proportion of patients receiving particulate steroids reported relevant improvement (PGIC) at both 1 week and 1 month post injection (
p
= 0.0001) and they were significantly less likely to report worsening at 1 week (
p
= 0.0001) and 1 month (
p
= 0.017).
Conclusion
Patients treated with particulate steroids had significantly greater pain relief and were much more likely to report clinically relevant overall ‘improvement’ at 1 week and 1 month compared to the patients treated with non-particulate steroids.
Key Points
•
CT-guided epidural injections of the lumbar spine with particulate vs. non-particulate steroids.
•
Good outcomes with particulate steroids.
•
Less pain relief in patients with non-particulate steroids.
•
Less improvement in patients with non-particulate steroids.
Journal Article
Value of MR arthrography findings for pain relief after glenohumeral corticosteroid injections in the short term
ObjectivesThis study was conducted in order to determine the predictive value of MR arthrography findings for pain relief after glenohumeral corticosteroid injection.MethodsThis study prospectively enrolled 212 patients (mean age 51.4 years; range 15–90) who underwent fluoroscopy-guided glenohumeral corticosteroid injection. All patients received MR arthrography of the shoulder less than 3 months prior to the infiltration and returned questionnaires which assessed patients’ shoulder pain using the 11-point numeric rating scale (NRS), covering a 1-month follow-up period. MR arthrograms were retrospectively assessed for abnormalities of the rotator cuff, long biceps tendon, glenohumeral bone, cartilage, and labrum as well as for synovitis, bursitis, and signs of adhesive capsulitis. MR arthrography findings were compared to patients’ NRS change using the Mann–Whitney U and Kruskal–Wallis tests for univariate analysis and multiple linear regression for multivariate analysis.ResultsPain reduction of ≥ 2 points was considered to represent clinically relevant improvement, which was seen in 71% of patients 1 week and in 74% of patients 1 month after glenohumeral injection. Univariate analysis of MR findings showed that signs of adhesive capsulitis and an intact labrum were associated with significantly higher NRS reductions after 1 month in comparison to patients without these findings (median 4 vs. 3, p = 0.007 and 4 vs. 2, p = 0.003, respectively). Multivariate analysis proved both factors to be independent predictors of improved outcome after 1 month (beta = 0.176, p = 0.039 and beta = 0.212, p = 0.001, respectively).ConclusionsGlenohumeral corticosteroid injections for pain relief have a high success rate with 74% of patients reporting clinically relevant improvement after 1 month. Signs of adhesive capsulitis and an intact labrum on MR arthrography are independent predictors of a better outcome.Key Points• Seventy-four percent of patients report clinically relevant improvement 1 month after glenohumeral corticosteroid injection.• Signs of adhesive capsulitis and an intact labrum on MR arthrography are independent predictors of a high pain level decrease.
Journal Article
Attitudes towards limited drug prescription rights: A survey of South African chiropractors
Background: Several surveys that have been published show opinions regarding a change in the scope of chiropractic practice to include prescription rights. Currently, research into the attitudes of South African chiropractors towards having this right is non-existent.Aim: To ascertain the attitudes of South African chiropractors towards the inclusion of drug prescription rights in their scope of practice.Setting: The study was conducted on chiropractors registered with the Allied Health Professions Council of South Africa and members of the Chiropractic Association of South Africa.Method: A self-administrative online questionnaire was developed, and sent via email to all registered chiropractors in South Africa in February 2020. Descriptive statistics were used to analyse the data.Results: The response rate for this study was 15.9% (n = 138). 84% (n =105) were in favour of limited prescription rights for over-the-counter medication. However, 79.6% (n = 98) did not agree to full prescriptions rights for non-musculoskeletal drugs. A total of 33.6% (n = 42) rarely recommended OTC and prescription-based analgesics, muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) to their acute patients and 37.9% (n = 52) rarely recommended these drugs to chronic patients. 68.8% (n = 86) were confident in their knowledge of musculoskeletal drugs and 91.2% (n = 112) agreed on further education and training in pharmacology for those practitioners seeking limited medication prescription rights.Conclusion: The majority of South African chiropractor respondents indicated an interest in expanding their scope of practice to include limited prescription rights.Contribution: These findings could indicate a shift in the attitudes of chiropractors towards drug prescription rights within the profession.
Journal Article
Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings- A prospective Study
Purpose
To investigate long-term pain reduction and ‘improvement’ in patients with indirect cervical nerve-root-blocks in comparison to MRI findings.
Material and Methods
One hundred and twelve patients with MRI confirmed cervical radiculopathy and an indirect cervical nerve-root-block were included. Two radiologists independently evaluated the MRI examinations. 12 different MRI abnormalities at the level and side of infiltration were compared to pain relief and ‘improvement’ at 1-month, 3-months and 1-year post injection.
Results
The proportion of patients reporting clinically relevant 'improvement' was 36.7 % at 1-month, 53.9 % at 3-months and 68.1 % at 1-year. At 1-month post injection, a statistically significantly lower percentage of patients eventually requiring surgery reported improvement and lower NRS change scores compared to those who did not undergo surgery (p = 0.001). Patients with extrusion of the disc were around 4-times more likely to have surgery. At 1-year post-injection the presence of nerve-root compromise was significantly linked to treatment outcome (p = 0.011).
Conclusion
Patients with nerve root compression were more likely to report improvement at 1 year. Patients with disc extrusions have less pain relief and are 4 times more likely to go to surgery than patients with disc protrusions.
Key Points
•
Good long term outcomes after indirect nerve root infiltrations with non
-
particulate steroids
.
•
The presence of nerve root compression was a predictive finding of
‘
improvement
’.
•
Significantly less patients subsequently having surgery had lower NRS scores 1
-
month post injection
.
•
There is less pain relief in patients with disc extrusions
.
•
There are less improvement in patients with modic type I changes
.
Journal Article
Relationship of specific MRI findings to treatment outcomes in patients receiving transforaminal epidural steroid injections
Objectives
To determine whether specific MRI findings are related to outcomes after lumbar transforaminal epidural steroid injections (TFESI) and to assess the inter-rater reliability of imaging diagnosis.
Materials and methods
A prospective outcomes study on 156 consecutive patients with 1-month follow-up outcomes data and MRI within 3 months of TFESI was conducted. Pain levels (numerical rating scale) (NRS) were recorded prior to injection. Overall ‘improvement’ was determined using the Patients Global Impression of Change (PGIC) scale and NRS data were collected at three time points post injection. Two radiologists independently evaluated all images blinded to treatment outcome for reliability of diagnosis. The Chi-square test compared MRI findings for the senior radiologist to ‘improvement’. NRS change scores were compared to MRI findings with the unpaired
t
-test or ANOVA. Kappa and percent agreement assessed inter-rater agreement of diagnosis.
Results
The only abnormality linked to ‘improvement’ (
p
= 0.03) and higher NRS change scores (
p
= 0.0001) at 1 month was the disc herniation morphology ‘protrusion + sequestration’. Patients with degeneration by osteophytes (
p
= 0.034), grade 3 foraminal nerve root compression (
p
= 0.01) and foraminal/extraforaminal location of herniation (
p
= 0.014) also had higher 1 month NRS change scores. Reliability of diagnosis was ‘fair’ to ‘substantial’ depending on MRI findings.
Conclusions
Patients with disc protrusion plus sequestration were significantly more likely to report overall improvement and more pain reduction at 1 month. Higher pain reduction was noted in patients with degeneration by osteophytes, grade 3 foraminal nerve root compression, or foraminal/extraforaminal disc herniation location.
Journal Article