Adherence to exclusive enteral nutrition by adults with active Crohn's disease is associated with conscientiousness personality trait: a sub-study.

BACKGROUND: It is probable that psychosocial factors predict adherence to exclusive enteral nutrition (EEN). Conscientiousness is an intrapersonal factor associated with greater medication adherence and healthy eating behaviours. This sub-study aimed to determine whether adherence to EEN was associated with conscientiousness. METHODS: Two groups of adults aged 16-40 years, were recruited to use EEN. Adults with active Crohn's disease used either EEN for 8 weeks or 2 weeks of EEN followed by 6 weeks of partial enteral nutrition (PEN). A control group of healthy adults used EEN for 2 weeks. Participants who reported eating food during EEN, ate more than one meal per day during PEN, or could not initiate or tolerate the oral nutritional supplements were defined as non-adherent. Conscientiousness was measured using the conscientiousness subset of the Big Five Inventory. RESULTS: Thirty-eight patients with active Crohn's disease (mean age 24.8 years) and 21 healthy adults (mean age 27.3 years) completed the conscientiousness questionnaire. In the Crohn's disease group, 23 (59%) completed and adhered to the treatments compared to 17 (81%) healthy adults; their conscientiousness scores were similar. Adherence and completion by the Crohn's disease group were associated with a greater mean conscientiousness score 35.57 (95% confidence interval = 32.88-38.25) compared to 30.13 (95% confidence interval = 26.53-33.73) in the non-adherent Crohn's disease group (P = 0.014). CONCLUSIONS: Conscientiousness was associated with treatment adherence. EEN can be a cognitively and emotionally demanding treatment for active adults with Crohn's disease; thus, considering personality traits may help determine suitable candidates.

Total spinal anesthesia: a rare complication of intrathoracic intercostal nerve block.

Total spinal anesthesia following intrathoracic intercostal nerve blocks with bupivacaine performed for postoperative pain relief during thoracotomy is described. Possible mechanisms for this complication include: (1) inadvertent placement of the needle through an intervertebral foramen, (2) puncture of a long dural cuff, and (3) intraneural injection with central spread. Recognition of this potential complication is important, and facilities for proper support must be available.

The use of transcutaneous electrical nerve stimulation (TENS) in the treatment of facial pain.

The purpose of this article is to provide guidelines for the use of transcutaneous electrical nerve stimulation (TENS) in the differential diagnosis and treatment of facial pain. Most practitioners familiar with electrical modalities are aware that TENS is a physiologically-specific therapy for treating and resolving facial pain related to various neurological and/or myofascial conditions. This article proposes the added use of TENS as a diagnostic tool. The effect on the patient's pain level from the trials of various combinations of rate and width settings provides the practitioner specific information to aid in a diagnosis. Guidelines to differential diagnosis as well as protocols for office and home use of this non-invasive, non-addictive and effective modality will be presented.

Atrioventricular conduction in dogs during anesthesia with isoflurane.

The effects of 1.25, 2.0, and 2.5 MAC isoflurane on atrioventricular conduction were studied by His-bindle electrocardiography during atrial pacing in ten dogs. No effect upon atrioventricular conduction as evidenced by changes in A--H interval (the time of conduction from low right atrium to His-bundle, representing primary AV nodal conduction) was found at these concentrations. Atrial pacing to 200 beats/min did not influence the A--H interval at the three anesthetic concentrations. The stability of cardiac rhythm observed clinically with isoflurane may be related to this lack of effect upon the AV node.