Electroanalgesia en el síndrome de dolor lumbar agudo: efectividad comparativa de TIF versus TENS: estudio preliminar / Electro-analgesia in the low back pain syndrome: comparative effectiveness of TIF versus TENS: preliminary study

Introduction: Low back pain (LBP) is a prevalent condition, which causes an important economic and clinical impact to individuals during their productive work-life. Electro-anaesthesia methods of choice are Interferential Current (IC) and transcutaneous Electric Nervous Stimulation (TENS). The objetive of this study is to determine the effectiveness of both therapies, as well as variability in the measurement of pain. We also preliminary evaluate the comparative effectiveness of IC and TENS by determining the mean difference of decreased acute back pain in patients treated at Hospital of Trabajador, in Temuco, Chile. Material and Method: 30 LBP patients were studied (0-3 weeks evolution). Intensity of pain before and after the aplication of IC and TENS was assessed usin the Visual Analogue Scale (VAS). IC intervention considered an amploitude.frequency spectrum ranging from 5 Hz to 10 Hz, with vector, while TENS was an asymmetric biphasic stimulus with a phase time of 150 useg, using a frequency of 100 Hz, pulses of 2 Hz. These were applied using four rubber electrodes (60 mm by 40 mm) placed on the lumbar zone for a period of 30 minutes. Results: The study group included 67 por ciento (n = 20) male with an average age of 38.3 years (SD: 9.5 years), 67 por ciento of them were workmen. The reduction of pain mean difference in patients treated with TENS was 1.24 cm (p = 0005), and 2.18 cm (p = 0001) with IC. The difference of both results, adjusted by VAS baseline, age, sex, and occupation of patients was 0.91 cm (p = 0.0261) in favour of IC. Conclusions: The magnitude of treatment effects for TENS was 18.4 por ciento, and 31.5 por ciento for IC in relation to baseline pain. In this study group, there were no clinically relevant differences to control LBP in patients inmediately after application, between IC and TENS. Both demonstrated to be effective.

Estimating risk factors for patients with potential drug-related problems using electronic pharmacy data. IMPROVE investigators.

OBJECTIVE: To validate a computer-based program to identify patients at high risk for drug-related problems. DESIGN: Computerized analysis of pharmacy dispensing records and manual review of medical records. SETTING: Ambulatory clinics at a Veterans Affairs Medical Center. PATIENTS: 246 randomly selected patients who were receiving at least one outpatient medication in the previous 24 months. MAIN OUTCOME MEASURES: Presence of six previously established criteria regarding medication use. These criteria are five or more medications, > or = 12 doses per day, four or more changes to the medication regimen, three or more chronic diseases, history of noncompliance, and presence of a drug requiring therapeutic drug monitoring (TDM). RESULTS: Spearman rho rank order correlation coefficients ranged from 0.63 to 0.91 for criteria pertaining to the number of medications, daily doses, changes in the medication regimen, and number of chronic diseases (all significant, p = 0.0001). The computer program underestimated the number of chronic diseases and overestimated the number of daily doses. The level of agreement between the computer program and chart review for patient noncompliance was low (Kappa = 0.38), with the computer more likely to indicate a patient was noncompliant. A high level of agreement was seen between the computer program and chart review for the presence of a drug requiring TDM (Kappa = 0.83). For all six criteria, the computer program had a sensitivity of 65.7% and specificity of 88.2%. CONCLUSIONS: When compared with medical records, the use of this program to evaluate electronic pharmacy data can be efficient to screen large numbers of patients who may be at high risk for drug-related problems. This method may be useful for clinical pharmacists in providing pharmaceutical services to patients who are most likely to benefit.

Prospective validation of a scoring system for predicting neonatal morbidity after acute perinatal asphyxia.

OBJECTIVE: To prospectively validate a previously reported scoring system for identifying the near-term infant at risk for the multiple organ system sequelae of acute perinatal asphyxia. STUDY DESIGN: Prospective observational study. SETTING: Three Denver teaching hospitals, each providing comprehensive obstetric care. SUBJECTS: Newborn infants of 36 weeks or more gestation. INTERVENTION: None. STATISTICAL ANALYSIS: Chi-squared analysis with Fisher's exact test. OUTCOME: Scores consisting of graded abnormalities in fetal heart rate monitoring, umbilical arterial base deficit, and 5-minute Apgar score were calculated by the research nurse after admission of the infant to the nursery (range of possible scores, 0 to 9). A second nurse, blinded to these data, prospectively followed the newborn's hospital course for multiple organ system morbidity. RESULTS: Three thousand two hundred thirty-eight newborns were studied; 366 required neonatal intensive care unit admission. Eleven newborns had a score > or = 6 (mean umbilical artery pH = 6.98, base deficit = 17.1 mEq/L). Morbidities in these 11 newborns included seizures (2), hypoxic-ischemic encephalopathy (5), respiratory distress (9), hypotension (7), renal dysfunction (9), hypoglycemia/hypocalcemia (4), and thrombocytopenia or disseminated intravascular coagulopathy (3). The odds ratio (OR) and 95% confidence interval (CI) for newborns admitted to the neonatal intensive care unit with a score > or = 6 for having multiple organ system morbidity, defined as three or more affected organ systems, was 38.5 (95% CI, 9.2 to 127.8). The scoring system showed a stronger relationship with multiple organ system morbidity than did isolated individual indicators commonly used to identify asphyxia calculated on the same subjects: for those with pH < 7.00, OR 24 (95% CI, 6.4 to 94.1); base deficit > or = 10 mEq/L, OR 4.5 (95% CI, 1.9 to 10.3), and 5-minute Apgar score < or = 3, OR 7.4 (95% CI, 1.3 to 38.1). CONCLUSION: This scoring system, encompassing both immediate intrapartum and postpartum measures and acid-base status proximate to the time of delivery, is useful for rapidly identifying the term and near-term newborn at risk for multiple organ system morbidity after acute perinatal asphyxia.

Predicting neonatal morbidity after perinatal asphyxia: a scoring system.

Predicting immediate neonatal morbidity after perinatal asphyxia has been difficult. A review of asphyxiated neonates greater than or equal to 36 weeks' gestation admitted to The Children's Hospital Newborn Intensive Care Unit in 1983 was conducted to devise a scoring system that would rapidly predict organ dysfunction observed in the immediate neonatal period. Comparison of potential score components to morbidity by multiple regression analysis yielded significant association with abnormalities in fetal heart rate monitoring, the 5-minute Apgar score, and neonatal base deficit. A scoring system was devised whose sensitivity (93.8%) and specificity (81.3%) were more predictive than any of its individual components. Prospective analysis in a similar population in 1984 validated its ability to distinguish severe from moderate morbidity after asphyxia. Positive predictive value for the score in the combined study groups (n = 98) was 79% and the negative predictive value was 83%. The scoring system may offer a rapid and accurate prediction of organ dysfunction in the immediate neonatal period after asphyxia.

Reducing adolescent obesity through a school health program.

The feasibility and effectiveness of conducting a school-based multi-component behavioral weight reduction program was tested on 119 overweight junior high school students. Four schools in the metropolitan New York area were randomly assigned to either the experimental or control conditions. After participating in a school-wide health-profile screening, students in the experimental group were invited to participate in a ten-session weight reduction program that included behavior modification, nutrition education, and exercise management. Comparison of the experimental and control groups with respect to changes on weight and triceps skinfold measures indicated significant differences between the two groups. Although the long-term effectiveness of the weight reduction program cannot be determined, the present study clearly demonstrates the short-term effectiveness and feasibility of conducting such a program in a school setting.

Relative importance of growth hormone and sex steroids for the growth at puberty of trunk length, limb length, and muscle width in growth hormone-deficient children.

We have followed the growth of stature, sitting height, skinfolds, muscle widths measured radiologically, and skeletal maturity in growth hormone-deficient patients in whom hGH was given and withheld in alternating three-month periods throughout puberty (referred to as "off-hGH" and "on-hGH" periods). Six boys and four girls had true isolated GH deficiency and developed puberty spontaneously. Two boys had gonadotrophin deficiency plus GH deficiency, and five boys had multiple deficiencies; in these boys the signs of puberty were induced by hormone treatment. Boys with true isolated deficiency grew about two-thirds as much in height in the off-hGH periods as in the on-hGH periods; their total gain in height during the adolescent spurt would have been about 20 cm, instead of 30 cm, if hGH had been discontinued at the beginning of puberty. The effect of hGH was entirely on growth in leg-length, however, which virtually ceased during the off-hGH periods. Growth in sitting height altered little when hGH was withdrawn. Growth in limb muscles, however, was GH dependent throughout puberty; during the majority of periods when hGH was withheld, muscle was actually lost; this occurred in the boys who were receiving large doses of testosterone as well as in those producing their own normal amounts. Subcutaneous fat diminished when hGH was given and increased when it was withdrawn; this occurred independently of administration of testosterone. There was little evidence that growth of pubic and axillary hair progressed faster during on-hGH periods, except perhaps in patients with multiple deficiencies. There was some evidence, however, that bone age progressed less rapidly during on-hGH periods than during off-hGH periods in the patients with isolated deficiency. The results in the girls agreed with those in boys so far as stature was concerned, but the relationship with sitting height and leg length appeared to be different; the reasons for this are discussed. We conclude that all children with GH deficiency should continue on treatment with hGH throughout puberty, ideally until growth ceases.