A Multimodal Approach for Postoperative Pain Management After Lumbar Decompression Surgery: A Prospective, Randomized Study.

A multimodal approach for postoperative pain management after lumbar decompression surgery: a prospective, randomized study.

J Spinal Disord Tech. 2013 Aug; 26(6): 291-7
Garcia RM, Cassinelli EH, Messerschmitt PJ, Furey CG, Bohlman HH

A prospective and randomized study.The objective of this study was to assess the efficacy of a novel multimodal analgesic regimen in reducing postoperative pain and intravenous morphine requirements after primary multilevel lumbar decompression surgery.The use of opioid medications after surgery can lead to incomplete analgesia and may cause undesired side effects such as respiratory depression, somnolence, urinary retention, and nausea. Multimodal (opioid and nonopioid combination) analgesia may be an effective alternative to morphine administration leading to improved postoperative analgesia with diminished side effects.After Institutional Review Board approval, 22 patients who underwent a primary multilevel lumbar decompression procedure were randomly assigned to receive either only intravenous morphine or a multimodal (celecoxib, pregabalin, extended release oxycodone) analgesic regimen. Postoperatively, all patients were allowed to receive intravenous morphine on an as needed basis. Intravenous morphine requirements were then recorded immediately postoperative, at 6, 12, 24 hours, and the total requirement before discharge. Patient postoperative pain levels were determined using the visual analog pain scale and were documented at 0, 4, 8, 12, 16, 24, and 36 hours postoperative.There were no significant differences in available patient demographics, intraoperative blood loss, or postoperative hemovac drain output between study groups. Total postoperative intravenous morphine requirements in addition to morphine requirements at all predetermined time points were less in patients randomized to receive the multimodal analgesic regimen. Visual analog pain scores were lower at all postoperative time points in patients randomized to receive the multimodal analgesic regimen. Time to solid food was significantly less in the multimodal group. There were no major identifiable postoperative complications in either treatment group.Opioid and nonopioid analgesic combinations appear to be safe and effective after lumbar laminectomy. Patients demonstrate lower intravenous morphine requirements, better pain scores, and earlier time to solid food intake. HubMed – depression

Association between obesity and depressive disorder in adolescents at high risk for depression.

Int J Obes (Lond). 2013 Jul 26;
Hammerton G, Thapar A, Thapar AK

Objective:To examine the relationship between Body Mass Index (BMI) and depressive disorder, in adolescents at high risk for depression.Design:Prospective longitudinal 3-wave study of offspring of parents with recurrent depression. Replication in population based cohort study.Subjects:337 families where offspring were aged 9-17 years at baseline and 10-19 years at the final data point. Replication sample of adolescents from population based cohort study aged 11-13 years at first assessment and 14-17 years at follow-up.Measurements:High risk sample used BMI, skin-fold thickness, DSM-IV defined major depressive disorder and depression symptoms using the Child and Adolescent Psychiatric Assessment (CAPA). Replication sample used BMI, DSM-IV depressive disorder and depression symptoms using the Development and Well-Being Assessment (DAWBA).Results:289 adolescents were included in the primary analyses. The mean BMI for each age group in this sample were significantly higher than population norms. There was no significant longitudinal association between categories of weight (or BMI) and new onset depressive disorder or depression symptoms. Similar results were found for skin-fold thickness. The association was also tested in a replication population-based sample and found to be non significant in the subsample of offspring with mothers that had experienced recurrent depression in the past. BMI at age 12 years was however a significant predictor of depression symptoms, but not of depressive disorder, at age 15 years for the total unselected population.Conclusion:BMI does not significantly predict the development of depression in the offspring of parents with recurrent depression.International Journal of Obesity accepted article preview online, 26 July 2013. doi:10.1038/ijo.2013.133. HubMed – depression

Acne vulgaris, probiotics and the gut-brain-skin axis: from anecdote to translational medicine.

Benef Microbes. 2013 Jul 25; 1-15
Bowe WP, Patel NB, Logan AC

Acne vulgaris has long been postulated to feature a gastrointestinal mechanism, dating back 80 years to dermatologists John H. Stokes and Donald M. Pillsbury. They hypothesised that emotional states (e.g. depression and anxiety) could alter normal intestinal microbiota, increase intestinal permeability, and contribute to systemic inflammation. They were also among the first to propose the use of probiotic Lactobacillus acidophilus cultures. In recent years, aspects of this gut-brain-skin theory have been further validated via modern scientific investigations. It is evident that gut microbes and oral probiotics could be linked to the skin, and particularly acne severity, by their ability to influence systemic inflammation, oxidative stress, glycaemic control, tissue lipid content, and even mood. This intricate relationship between gut microbiota and the skin may also be influenced by diet, a current area of intense scrutiny by those who study acne. Here we provide a historical background to the gut-brain-skin theory in acne, followed by a summary of contemporary investigations and clinical implications. HubMed – depression

Associations between emotional intelligence, depression and suicide risk in nursing students.

Nurse Educ Today. 2013 Jul 22;
Aradilla-Herrero A, Tomás-Sábado J, Gómez-Benito J

The most important factor which predisposes young people to suicide is depression, although protective factors such as self-esteem, emotional adaptation and social support may reduce the probability of suicidal ideation and suicide attempts. Several studies have indicated an elevated risk of suicide for health-related professions. Little is known, however, about the relationship between perceived emotional intelligence and suicide risk among nursing students.The main goals were to determine the prevalence of suicide risk in a sample of nursing students, to examine the relationship between suicide risk and perceived emotional intelligence, depression, trait anxiety and self-esteem, and to identify any gender differences in relation to these variables.Cross-sectional study of nursing students (n=93) who completed self-report measures of perceived emotional intelligence (Trait Meta-Mood Scale, which evaluates three dimensions: emotional attention, clarity and repair), suicide risk (Plutchik Suicide Risk Scale), self-esteem (Rosenberg Self-esteem Scale), depression (Zung Self-Rating Depression Scale) and anxiety (Trait scale of the State-Trait Anxiety Inventory).Linear regression analysis confirmed that depression and emotional attention are significant predictors of suicidal ideation. Moreover, suicide risk showed a significant negative association with self-esteem and with emotional clarity and repair. Gender differences were only observed in relation to depression, on which women scored significantly higher. Overall, 14% of the students were considered to present a substantial suicide risk.The findings suggest that interventions to prevent suicidal ideation among nursing students should include strategies to detect mood disorders (especially depression) and to improve emotional coping skills. In line with previous research the results indicate that high scores on emotional attention are linked to heightened emotional susceptibility and an increased risk of suicide. The identification and prevention of factors associated with suicidal behaviour in nursing students should be regarded as a priority. HubMed – depression