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    <recommendedItem id="20100101_19_463"
                     title="AAPM: Online Program Helps Manage Pain (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18393?impressionId=1265791641967"
                     
      &lt;p&gt;SAN ANTONIO  --  A personalized, online self-management program helped patients with pain syndromes improve coping skills and reduce stress and depression in two studies reported here.&lt;/p&gt;
&lt;p&gt;Patients randomized to the self-management program demonstrated significant improvement in multiple social, emotional, and behavioral outcomes after six months (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01). Improvement in some parameters occurred within one month. A control group that was not exposed to the program showed no significant improvement.&lt;/p&gt;
&lt;p&gt;&quot;Our goal is to help people communicate better with providers, understand better how they can use social support, understand the comorbid conditions, like anxiety and depression, and develop cognitive skills to help get them through their pain episodes,&quot; said Emil Chiauzzi, PhD, of Inflexxion, the Newton, Mass. company that developed the program.&lt;/p&gt;
&lt;p&gt;Although the studies involved patients with migraine or low-back pain, programs are being developed for other types of pain condition, including several forms of neuropathic pain.&lt;/p&gt;
&lt;p&gt;The online program, demonstrated at &lt;a href=&quot;http://www.painACTION.com&quot; mce_href=&quot;http://www.painACTION.com&quot; target=&quot;_blank&quot;&gt;www.painACTION.com&lt;/a&gt;, employs patient-specific information to generate individualized self-management strategies.&lt;/p&gt;
&lt;p&gt;Patient responses to assessments are analyzed by a &quot;recommendation engine,&quot; which produces content recommendations designed to address each patient&apos;s informational and self-management needs.&lt;/p&gt;
&lt;p&gt;Elements on the Web site include multimedia education units, a pain inventory, interactive tools that provide information based on patient-provider communication, and medication risk management.&lt;/p&gt;
&lt;p&gt;&quot;The content on the Web site is focused on teaching people practical skills to manage the behavioral side of pain,&quot; Jonas Bromberg, PsyD, also of Inflexxion, said in an interview.&lt;/p&gt;
&lt;p&gt;Bromberg presented results of a randomized study involving 210 patients, all of whom met International Headache Society diagnostic criteria for migraine, with or without aura.&lt;/p&gt;
&lt;p&gt;Patients assigned to the online program completed at least eight 30-minute session during the first month of the study and at least five more 30-minute sessions during the five-month follow-up period. Patients in the control group continued to receive usual care without exposure to the Web site.&lt;/p&gt;
&lt;p&gt;Participants assigned to the online program had a minimum set of requirements for each session, which were provided at log-in. Follow-up assessments occurred at one, three, and six months.&lt;/p&gt;
&lt;p&gt;The two groups were balanced with respect to sex and headache frequency and severity, the researchers said.&lt;/p&gt;
&lt;p&gt;Bromberg reported that patients assigned to the self-management program demonstrated significant improvement in: &lt;ul&gt; &lt;li&gt;Headache self-efficacy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01 compared with baseline)&lt;/li&gt; &lt;li&gt;Use of relaxation (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Use of social support (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Pain catastrophizing (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Depression (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Stress (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Chiauzzi presented results from a randomized study of 209 patients with low-back pain. The design was similar to that of the migraine study, except results were analyzed for between-group differences.&lt;/p&gt;
&lt;p&gt;The results showed significant improvement in the study group versus control group with respect to: &lt;ul&gt; &lt;li&gt;Stress (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Coping (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Social supports (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The data showed significant effects of both treatment (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) and time (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) favoring the Web site versus control. Chiauzzi said patients assigned to the Web site had greater mean improvement at posttest, three months, and six months.&lt;/p&gt;
&lt;p&gt;Qualitative analysis suggested that Web site participants had clinically meaningful improvement in depression, anxiety, and stress.&lt;/p&gt;
&lt;p&gt;Additionally, patients in the self-management program reported a 12.3% decrease in pain from baseline, versus 7% in the control group.&lt;/p&gt;
&lt;p&gt;Access to the Web site did not improve physical functioning.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The studies were funded by the National Institutes of Health.&lt;/p&gt;&lt;p&gt;Chiauzzi and Bromberg are employees of Inflexxion, developer of the online program.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_316"
                     title="STS: Delay in Treating Blunt Aortic Trauma Works Best (CME/CE)"
                     score="0.006"
                     href="http://www.medpagetoday.com/MeetingCoverage/STS/tb/18180?impressionId=1265791641967"
                     
      &lt;p&gt;FORT LAUDERDALE  --  Researchers here suggest that delaying treatment of selected blunt thoracic aortic injuries appears to improve overall survival of these critically ill patients.&lt;/p&gt;
&lt;p&gt;&quot;Although thoracic aortic injury still accounts for significant mortality during blunt trauma, patients reaching specialized trauma centers can achieve good results with thoracic aortic repair,&quot; said Anthony L. Estrera, MD, of the University of Texas Houston Medical School.&lt;/p&gt;
&lt;p&gt;In fact, since 1997, improved treatments have produced a 5.9% annual reduction in operative mortality and a 3% annual reduction among patients with blunt thoracic aorta injuries, he told colleagues at the annual meeting of the Society of Thoracic Surgeons here.&lt;/p&gt;
&lt;p&gt;Estrera reviewed the evolution of treatment, noting that between 1988 and 1996, his institution&apos;s doctors brought 75 patients to the operating room, 71 of whom had open surgery.&lt;/p&gt;
&lt;p&gt;Since then, treatment has changed with methods that include distal perfusion, the concept of treatment delay, and the development of thoracic endovascular aortic repair (TEVAR) using stent devices.&lt;/p&gt;
&lt;p&gt;At the Houston Level I trauma center, doctors treated 60,091 patients between January 1997 and March 2009, including 250 who were admitted with blunt thoracic aortic injury.&lt;/p&gt;
&lt;p&gt;Estrera said the average age of the patients was 32, and 70% were men. About three-fourths of the patients were riding in vehicles involved in accidents. Other victims included pedestrians and bicyclists, people who suffered falls, and one who was injured in a parachuting accident.&lt;/p&gt;
&lt;p&gt;About 35% died at or near time of admission; the others were ultimately repaired, Estrera reported.&lt;/p&gt;
&lt;p&gt;&quot;The overall mortality for the diagnosis of acute thoracic aorta injury was 44%,&quot; he said, including those who did not receive repair. &quot;Of those who underwent operative repair, mortality was 17%.&quot;&lt;/p&gt;
&lt;p&gt;Some 41% of the patients had delayed repair, which was associated with only one death, Estrata added. There was 28% mortality among those patients who underwent early surgery.&lt;/p&gt;
&lt;p&gt;He said 90 percent of the TEVAR cases involved delayed surgery  --  a median of four days from admission to the operating room.&lt;/p&gt;
&lt;p&gt;When researchers attempted to tease out what might be significant factors in reducing mortality, delayed repair &quot;was the only factor that was protective against mortality in this series,&quot; he said.&lt;/p&gt;
&lt;p&gt;Other surgeons agreed that delayed surgery is far more common now.&lt;/p&gt;
&lt;p&gt;&quot;It used to be that any time there was an indication of thoracic aorta disturbance, the patients was rushed to surgery and they underwent this massive surgery where you had to heparinize them,&quot; said Matthew Williams, MD, assistant professor of surgery at the University of Louisville.&lt;/p&gt;
&lt;p&gt;&quot;Since then, this idea of surgical delay has come forth. We let the patient&apos;s injuries calm down and take care of the other injuries and then do the thoracic aorta repair on sort of an elective basis.&lt;/p&gt;
&lt;p&gt;&quot;The combination of this idea and TEVAR has created the major chance in the management of blunt aortic thoracic injury. There is good data now to support this strategy, but if you have a patient that dies while you are waiting, there might be a problem with litigation. That may make some people a little bit reticent.&quot;&lt;/p&gt;
&lt;p&gt;Estrera said surgeons still have some concerns about TEVAR itself. &quot;The problem with TEVAR is the unknown factor of what is the durability of the TEVAR device especially in the younger patients,&quot; he said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Estrera and Williams did not have any relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_148"
                     title="SCCM: Sedating Drugs May Slow Elders&apos; Recovery (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SCCM/tb/17973?impressionId=1265791641967"
                     
      &lt;p&gt;MIAMI BEACH  --  Elderly patients sedated with morphine or haloperidol (Haldol) in surgical intensive care units were less likely to to be discharged to their homes and more likely to be discharged to a nursing facility than patients given other sedatives, often resulting in a poorer quality of life, researchers reported here.&lt;/p&gt;
&lt;p&gt;Patients who received morphine were 2.57 times more likely to be discharged to a nursing home, rehabilitation center, or a skilled nursing facility (&lt;em&gt;P&lt;/em&gt;=0.029), Carrie Miller, MS, CRNP of the Hospital of the University of Pennsylvania in Philadelphia, told attendees at the annual meeting of the Society of Critical Care Medicine.&lt;/p&gt;
&lt;p&gt;Patients who were given haloperidol were 12.46 times more likely to be discharged to one of those facilities rather than to their home.&lt;/p&gt;
&lt;p&gt;Similarly, the risk of having a significantly reduced function from baseline admission was five times greater if the patient had received haloperidol (&lt;em&gt;P&lt;/em&gt;=0.044) and 2.76 times more likely if the patient had received morphine (&lt;em&gt;P&lt;/em&gt;=0.011), Miller said.&lt;/p&gt;
&lt;p&gt;&quot;While older adults frequently require medications to treat pain, anxiety, and delirium, little is know about the effects these medication have on older adults&apos; functional ability or quality of life,&quot; Miller said.&lt;/p&gt;
&lt;p&gt;To shed some light on the question, she and her colleagues evaluated 114 patients in three surgical ICUs. Mean age was about 75, some 60% were men, and 85% were white. Overall, 37% were undergoing general surgical procedures, while 35% had undergone vascular procedures and 16% were trauma patients.&lt;/p&gt;
&lt;p&gt;Patients&apos; level of consciousness and delirium status were assessed daily and information about medication use was gleaned from the ICU flow sheet and the computerized administration record.&lt;/p&gt;
&lt;p&gt;The most frequently used narcotic in the surgical ICU was fentanyl (Duragesic), administered to 77 patients; the most frequently used sedative was midazolam (Versed); and the most frequently used antipsychotic was haloperidol.&lt;/p&gt;
&lt;p&gt;Miller and her colleagues noted that use of propofol (Diprivan) appeared to be associated with better outcomes as far as discharge to one&apos;s home was concerned.&lt;/p&gt;
&lt;p&gt;They noted that there was &quot;considerable discrepancy&quot; between medication usage and dosage recorded on the patients&apos; flow sheet and medication administration record. &quot;Researchers and clinicians should consider that administered prn medications may not always be recorded on the nursing flow sheet,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;The study did not control for confounding variables such as the severity of illness or comorbidities that may have affected outcomes, Miller said.&lt;/p&gt;
&lt;p&gt;&quot;This is an interesting study,&quot; said Suzan Streichenwein, MD, a private practice geriatric psychiatrist in West Palm Beach, Fla. &quot;It would be valuable for future studies to include the severity of illness or more specific details about the type of surgery relative to the dosages of morphine used and its influence on the discharge functional outcomes.&lt;/p&gt;
&lt;p&gt;&quot;Tests diagnosing mild cognitive impairment and/or dementia preop versus postop as well as the time period under anesthesia in relation to outcomes would also be helpful,&quot; said Streichenwein, who was not involved in the study.&lt;/p&gt;
&lt;p&gt;Streichenwein told &lt;em&gt;MedPage Today&lt;/em&gt; that other possible confounding factors require further studies in this area.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;None of the clinicians had relevant financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
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                     title="Elderly Benefit From Cochlear Implants"
                     score="-0.005"
                     href="