Mindfulness Meditation According to the Satipatthana Sutta: A Single-Case Study With Participants as Collaborators.

Objectives: We explored the effects of a mindfulness program based on the satipatthana sutta (instead of a contemporary Western program), with participants as collaborators, using a single-case experimental design. The main question was whether such a training has positive effects and, if so, whether and how the effects vary across participants and measures. Method: Participants chose the design (multiple baseline) and the measures to be repeatedly collected. Then they took part in a 6-week mindfulness training based on the satipatthana sutta; finally, they performed a preliminary data analysis of their own results. Reported are a selection of the visual analyses, intraindividual effect sizes (Tau-U), and the results of single-case meta-analyses over participants, as well as a multivariate graphical analysis of interindividual differences. Results: Substantial training effects were found on average and for the majority of participants for concentration, mind wandering, decentering, positive affect, and well-being. Effects were small for negative affect, and no effects were found for emotion regulation. However, interindividual variation was high, both in respect to specific measures and concerning the overall effect of the training program. Participants' motivation was found to be very high throughout the study. Conclusion: Our findings indicate that a traditional mindfulness program yields effects that are roughly comparable to the effects of secular mindfulness training regimens. Regarding participants as collaborators appears to have a strong motivating effect. And finally, the study demonstrates that using single-case experimental designs (instead of group designs) allows for a more fine-grained analysis of meditation effects. The high interindividual variation points to the possibility that the amount of unexplained variance in group studies is severely underestimated. Results from studies like the current one could have benefits for both theoretical advancement and custom-tailored assignment of specific forms of meditation to specific people with specific aims. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-023-02160-1.

Pain intensity and functionality after percutaneous endoscopic discectomy: a retrospective cohort study / Intensidade de dor e funcionalidade após discectomia endoscópica percutânea: estudo de coorte retrospectivo / Intensidad del dolor y funcionalidad después de la discectomía endoscópica percutánea: un estudio de cohorte retrospectivo

ABSTRACT Objectives To evaluate pain intensity and functional status before and 30 days following percutaneous lumbar endoscopic discectomy. Methods A retrospective cohort study that included patients who underwent percutaneous endoscopic discectomy from January 2019 to October 2020 at the Irmandade Santa Casa de Misericórdia Hospital, in Porto Alegre. The data were collected from the electronic medical records of the patients by two independent physicians. Clinical outcomes were assessed using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Results Forty-six patients with a mean age of 52.6 ± 15.8 years, 27 of whom (58.7%) were male, were evaluated. Regarding clinical outcomes, a statistically significant improvement was observed in the comparison between the pre- and 30-day postoperative VAS and ODI scores, with no significant difference in relation to sex. No peri- or postoperative complications were observed. All patients successfully completed surgery and were discharged after recovery from anesthesia. Conclusion There was a significant improvement in pain and functional status 30 days after percutaneous endoscopic discectomy performed to correct lumbar disc herniation, with no difference in relation to sex. In addition, no peri- or postoperative complications were observed. Future studies, with longer follow-up times, comparing clinical outcomes from the various techniques of percutaneous endoscopic discectomy are necessary. Level of evidence III; Retrospective comparative study.

RESUMO Objetivos Avaliar a intensidade da dor e o estado funcional antes da cirurgia e em 30 dias de pós-operatório de discectomia endoscópica lombar percutânea. Métodos Estudo de coorte retrospectivo. Foram incluídos pacientes tratados com discectomia endoscópica percutânea, de janeiro de 2019 a outubro de 2020, no complexo hospitalar Irmandade Santa Casa de Misericórdia de Porto Alegre. Os dados foram coletados do prontuário eletrônico dos pacientes por dois médicos independentes. Os desfechos clínicos foram avaliados pela pontuação da Escala Visual Analógica (EVA) e do Índice de Incapacidade Oswestry (ODI). Resultados Foram incluídos 46 pacientes no estudo, com média de idade de 52,6 ± 15,8 anos, sendo 27 (58,7%), do sexo masculino. Quanto aos desfechos clínicos, observou-se melhora estatisticamente significativa com relação às escalas de EVA e ODI na comparação entre pré-operatório e 30 dias depois da cirurgia, sem diferença significativa com relação ao sexo. Não foram observadas complicações peri e pós-operatórias. Todos os pacientes completaram a cirurgia com sucesso e receberam alta após recuperação da anestesia. Conclusão Observou-se melhora significativa da dor e do estado funcional 30 dias depois da discectomia endoscópica percutânea realizada para correção da hérnia de disco lombar, sem diferença com relação ao sexo. Além disso, não foram observadas complicações peri e pós-operatórias, assim como não houve necessidade de internação hospitalar. Futuros estudos, com maior tempo de seguimento, que comparem os desfechos clínicos através das diversas técnicas de discectomia endoscópica percutânea fazem-se necessários. Nível de evidência III; Estudo retrospectivo comparativo

RESUMEN Objetivo Evaluar la intensidad del dolor y el estado funcional antes de la cirugía y 30 días después de la discectomía endoscópica lumbar percutánea. Métodos Estudio de cohorte retrospectivo. Se incluyeron pacientes tratados mediante discectomía endoscópica percutánea, de enero de 2019 a octubre de 2020, en el complejo hospitalario Hermandad Santa Casa de Misericordia de Porto Alegre. Los datos fueron recolectados de los registros médicos electrónicos de los pacientes por dos médicos independientes. Los resultados clínicos se evaluaron mediante la puntuación de la Escala Visual Analógica (EVA) y del Índice de Discapacidad de Oswestry (ODI). Resultados Se incluyeron 46 pacientes en el estudio, con una edad promedio de 52,6 ± 15,8 años, de los cuales 27 (58,7%) eran del sexo masculino. En cuanto a los resultados clínicos, hubo una mejoría estadísticamente significativa en relación a las escalas EVA y ODI al comparar el preoperatorio y 30 días después de la cirugía sin diferencia significativa en cuanto al sexo. No se observaron complicaciones perioperatorias y postoperatorias. Todos los pacientes completaron con éxito la cirugía e fueron dados de alta después de recuperarse de la anestesia, sin casos de reingreso hospitalario. Conclusión Hubo una mejoría significativa del dolor y del estado funcional luego de 30 días de discectomía endoscópica percutánea, realizada para corregir la hernia de disco lumbar, sin diferencias en cuanto al sexo. Además, no hubo complicaciones perioperatorias y postoperatorias, así como tampoco hubo necesidad de hospitalización. Son necesarios estudios futuros, con un período de seguimiento más largo, que comparen los resultados clínicos a través de las diferentes técnicas de discectomía endoscópica percutánea. Nivel de evidencia III; Estudio comparativo retrospectivo.

Estudo comparativo entre rivaroxaban e enoxaparina na profilaxia de tromboembolismo venoso profundo em pacientes submetidos à artroplastia total do quadril / Comparative study between rivaroxaban and enoxaparin in deep venous thromboembolism prophylaxis in patients submitted to total hip arthroplasty

OBJETIVO: Comparar a eficácia e segurança de rivaroxaban com a enoxaparina na profilaxia de trombose venosa profunda (TVP) após artroplastia total de quadril. MÉTODOS: No período de setembro de 2006 a abril de 2007, no Serviço de Ortopedia e Traumatologia do Complexo Hospitalar da Santa Casa de Porto Alegre/RS, foi realizado um ensaio clínico randomizado, duplo-cego, em que foram selecionados 67 pacientes, todos submetidos à artroplastia total de quadril (ATQ). Desses, foram excluídos dois pacientes por falta de adesão à profilaxia proposta após a alta hospitalar. Para um dos grupos foi administrada enoxaparina 40mg, subcutânea seis a oito horas antes da cirurgia e, depois desta, foi adicionado um comprimido de placebo, via oral, durante os primeiros 32 a 36 dias, uma vez ao dia. O outro grupo recebeu rivaroxaban 10mg, via oral, uma vez ao dia, durante os primeiros 32 a 36 dias pós-operatórios. Para fazer o cegamento dos grupos foi administrada uma injeção de placebo subcutâneo seis a oito horas antes da cirurgia e nos 32 a 36 dias subseqüentes. O desfecho principal estudado foi a eficácia na prevenção de TVP, que foi avaliada através de venografia bilateral realizada entre os dias 32 e 36 de pós-operatório e/ou através de sintomas documentados de trombose venosa profunda ou tromboembolismo pulmonar (TEP). O desfecho secundário estudado foi segurança na posologia, avaliada através de sangramento importante e/ou hepatotoxicidade. RESULTADOS: Rivaroxaban e enoxaparina tiveram resultados semelhantes (as diferenças não foram estatisticamente significativas), quando comparados quanto à redução da incidência de TVP até o 36º dia pós-operatório. Não houve diferença quanto à perda sanguínea e a hepatotoxicidade, quando comparadas as drogas. CONCLUSÃO: Em pacientes submetidos à artroplastia total de quadril, o rivaroxaban mostrou-se igualmente eficaz e seguro quanto a enoxaparina na prevenção de trombose venosa profunda e tromboembolismo pulmonar.

OBJECTIVE: To compare the effectiveness and safety of rivaroxaban to those of enoxaparin for the prophylaxis of deep venous thrombosis (DVT) after total hip arthroplasty. METHODS: From September 2006 to April 2007, at the Orthopedics and Traumatology Clinic of the Hospital Complex of the Santa Casa of Porto Alegre, State of Rio Grande do Sul, a randomized, double-blind clinical trial was carried out in which 67 patients were selected (n = 67), all of them submitted to total hip arthroplasty (ATQ). Of these patients, two were excluded for lack of adherence to the prophylaxis proposed after hospital release (n = 65). One of the groups was given subcutaneous 40 mg enoxaparin 6 hours to 8 hours before surgery, and after surgery a placebo pill was added, for once a day oral intake, during the first 32 to 36 days. The other group was given oral 10 mg rivaroxaban, once a day, during the first 32 to 36 post-operative days. In order to have the double-blind feature of the study, a subcutaneous placebo injection was given 6 hours to 8 hours before surgery and on the 32 to 36 days following surgery. The main outcome aimed at was the effectiveness in preventing DVT, which was evaluated by bilateral venography carried out between days 32 and 36 after surgery, or through documented symptoms of deep venous thrombosis or pulmonary thromboembolism (PTE). The secondary outcome studied was administration safety, that was evaluated through major bleeding or liver toxicity. RESULTS: Rivaroxaban and enoxaparin showed similar results (the differences were not statistically significant) when compared for the reduction of DVT incidence till the 36th post-operative day. There was no difference in blood loss and liver toxicity when the drugs were compared. CONCLUSION: In patients submitted to total hip arthroplasty, rivaroxaban showed as effective and safe as enoxaparin to prevent deep venous thrombosis and pulmonary thromboembolism.

Intermethod agreement and interobserver correlation of radiologic acromiohumeral distance measurements.

The acromiohumeral distance (AHD) measured on conventional, true anteroposterior radiographs taken with the patient standing and the arm held in neutral rotation can predict the presence or absence of a large, chronic rotator cuff tears, and narrowing of the acromiohumeral distance can predict irreparability of rotator cuff tears. The relation between AHD measured on conventional radiographs and the integrity of the rotator cuff tendons is well known. Conversely, the correlation between the AHD on conventional radiographs and that measured on magnetic resonance imaging (MRI) or computed tomography (CT) scans is unknown. It has also not been determined which method correlates better with fatty infiltration of the rotator cuff muscles and might thereby be a better prognostic value for the outcome of rotator cuff repair. Conventional radiographs, plus MRI and or CT studies taken at the same time of patients with rotator cuff tears, shoulder instability, primary glenohumeral osteoarthritis, or idiopathic frozen shoulder, were randomly selected, and the AHD was measured both on conventional radiographs and on MRI or CT. The values were correlated with the stage of fatty degeneration of the rotator cuff muscles in the cases of rotator cuff tears. The AHD on conventional radiographs was larger than on MRI and CT, and correlation of the values measured (conventional radiography vs MRI and CT) could be demonstrated. For rotator cuff diseases, a significant but moderate correlation (r = 0.6; P < .05) between conventional and MRI was identified, and the conventional values were approximately 0.6 mm greater than the corresponding MRI values. It is, therefore, possible to use the AHD read on MRI or CT studies for prognostic reasons, provided the values obtained are converted accordingly and remembering that the correlation of the values is only moderate.