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Pain nurses believed there was an over prescription of opioid analgesics in Australia (97.6%), with NPs able to reduce opioid medication doses as part of opioid harm mitigation.
Pain nurses have a breadth of knowledge and experience highlight they can contribute to opioid management in the future, with the support of policy and organizations.
Pain nurses have a breadth of knowledge and experience highlight they can contribute to opioid management in the future, with the support of policy and organizations.
Little is known about long-term bone mineral density (BMD) changes and fractures in lung transplant recipients with cystic fibrosis (CF). We examined femur and lumbar spine (LS) BMD changes in men and women with CF up to 10 years post-transplant and documented post-transplant fracture prevalence.
Retrospective study of individuals who had undergone a lung transplant (2000-2015) and had a pre-transplant and at least one BMD measurement after transplant. Vertebral fractures were assessed on chest computed tomography scans and other fractures abstracted from medical records.
The cohort consisted of 131 individuals; 53% males, median age 28 years [interquartile range 24-35] and 31% having pre-transplant low bone mass. Most recipients were given bisphosphonates after transplant with proportion reaching 94% at 10 years. Up to 10 years post-transplant, men experienced positive or little change in LS BMD, indicating minimal loss from pre-transplant values. In contrast, women displayed negative changes in BMD up to 5 years post-transplant before recovering pre-transplant BMD values by 10 years. Similar patterns were observed at the femur BMD where men demonstrated a lower bone loss and faster recovery towards pre-transplant values than women. After transplant, 88% of recipients maintained their pre-transplant bone status, 3% experienced an improvement, mostly progressing from low bone mass to normal status whereas 9% had a deterioration of their pre-transplant bone status. Twenty-seven recipients suffered fractures in the post-transplant period.
These findings underline that lung recipients with CF remain at risk of skeletal fragility despite prompt initiation of post-transplant anti-osteoporosis therapy.
These findings underline that lung recipients with CF remain at risk of skeletal fragility despite prompt initiation of post-transplant anti-osteoporosis therapy.Concurrent chemoradiotherapy (CCRT) is one of the most promising treatments for advanced head and neck cancer (HNC). On the other hand, CCRT may induce severe edema in laryngo-pharyngeal structures in association with radiation. This is a report of a 66-year-old man with severe obstructive sleep apnea (OSA) associated with edema in laryngo-hypopharynx after CCRT for advanced laryngeal and hypopharyngeal cancer. Tracheostomy was avoided and OSA was controlled by continuous positive airway pressure (CPAP). Subjective symptoms of sleepiness were improved. Though laryngeal edema appeared during the course of CCRT in this case, OSA was not evaluated until snoring had been pointed out and he complained of sleepiness. CCRT for laryngeal and hypopharyngeal cancer have a risk of occurrence of OSA due to irreversible mucous edema in the upper airway. Patients for whom CCRT is planned should be informed about the occurrence of OSA before the treatment because symptoms associated with OSA can negatively impact not only the daytime quality of life but also increase the risk of cardiovascular events. Adenosine disodium triphosphate manufacturer The OSA treatment for post CCRT would be expected to have a positive impact on not only cardiovascular and metabolic systems but also on the cancer treatment survival rate.Scleroderma is a complex multisystem connective tissue disorder. Early visceral disease, such as gastrointestinal (GI) involvement, is associated with significant morbidity and a poorer prognosis. Prompt diagnosis is crucial to allow disease modifying therapies be initiated early in the course of the disease. The primary underlying pathophysiology in the GI tract is dysmotility, muscular atrophy, and fibrosis, and this is reflected in the imaging features. In this paper, we demonstrate the imaging appearances of involvement of the GI tract and describe the use of advanced imaging with magnetic resonance enterography (MRE). A multimodal imaging approach is required to identify both characteristic features of scleroderma and potential complications. Traditional fluoroscopic contrast (barium) studies are still commonly performed for assessment of the oesophagus. More recent advances in cross-sectional imaging allow for thorough three-dimensional assessment of the entire GI tract. MRE is particularly useful for small bowel evaluation while also allowing "pseudodynamic" functional imaging and concomitant assessment of the other abdominal viscera and structures.Inferior vena cava (IVC) injury is a rare but serious consequence of trauma. It presents with high scores on trauma assessment scales and is often life threatening. Factors that contribute to poor survival include delay and difficulty in diagnosis due to non-specific clinical features. As it is a relatively rare entity, imaging in IVC injury is not well described in the literature. As radiologists, it is vital that features of potential IVC injury are recognised promptly and findings relayed to the treating clinician in a timely manner to improve survival and reduce the risk of possible complications. Imaging features that should alert radiologists to IVC injury include contour abnormalities, active extravasation, pseudoaneurysm, and pericaval haematoma. Trauma to the IVC is associated with significant complications. These include exsanguination and refractory shock in the acute period while in the longer term, thrombosis can develop with potential for subsequent pulmonary embolism. Additionally, there are complications that may develop post-surgically including further haemorrhage, IVC stenosis, and infection. We review the spectrum of imaging findings in traumatic IVC injury, which are exemplified with cases from our practice. Furthermore, we discuss important factors to consider during interpretation and the challenges that a radiologist may encounter when making the diagnosis.
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