BACKGROUND: Pain assessment is a necessary step in pain management in older people in palliative care. In older people, pain assessment can be challenging due to underreporting and atypical pain manifestations by other distressing symptoms. Anxiety, fatigue, loss of appetite, nausea, insomnia, dyspnoea, and bowel problems correlate with pain in palliative care patients. Insight into these symptoms as predictors may help to identify the underlying presence of pain. This study aimed to develop and test a prediction model for pain in community-dwelling frail older people in palliative care. METHODS: In this cross-sectional observational study, community-care nurses from multiple organizations across the Netherlands included eligible patients (life expectancy
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Previous research has shown clinical effectiveness of dermal substitution; however, in burn wounds, only limited effect has been shown. A problem in burn wounds is the reduced take of the autograft, when the substitute and graft are applied in one procedure. Recently, application of topical negative pressure (TNP) was shown to improve graft take. The aim of this study was to investigate if application of a dermal substitute in combination with TNP improves scar quality after burns. In a four-armed multicenter randomized controlled trial, a split-skin graft with or without a dermal substitute and with or without TNP was compared in patients with deep dermal or full-thickness burns requiring skin transplantation. Graft take and rate of wound epithelialization were evaluated. Three and 12 months postoperatively, scar parameters were measured. The results of 86 patients showed that graft take and epithelialization did not reveal significant differences. Significantly fewer wounds in the TNP group showed postoperative contamination, compared to other groups. Highest elasticity was measured in scars treated with the substitute and TNP, which was significantly better compared to scars treated with the substitute alone. Concluding, this randomized controlled trial shows the effectiveness of dermal substitution combined with TNP in burns, based on extensive wound and scar measurements.
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Objective: To systematically describe changes in pain and functioning in patients with osteoarthritis (OA) awaiting total joint replacement (TJR), and to assess determinants of this change. Methods: MEDLINE®, EMBASE, CINAHL® and Cochrane Database were searched through June 2008. The reference lists of eligible publications were reviewed. Studies that monitored pain and functioning in patients with hip or knee OA during the waiting list for TJR were analyzed. Data were collected with a pre-specified collection tool. Methodological quality was assessed and a best-evidence analysis was performed to summarize results. Results: Fifteen studies, of which two were of high quality, were included and involved 788 hip and 858 knee patients (mean age 59-72 and main wait 42-399 days). There was strong evidence that pain (in hip and knee OA) and self-reported functioning (in hip OA) do not deteriorate during a
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