Therapeutic touch in the treatment of carpal tunnel syndrome.

BACKGROUND: Alternative medical therapies are widely utilized, but there are few objective data to evaluate the effectiveness of these techniques. The purpose of this study was to determine whether one alternative therapy, Therapeutic Touch (TT), can improve objective indices of median nerve function in patients with carpal tunnel syndrome. METHODS: Participants with electrodiagnostically confirmed carpal tunnel syndrome were randomly assigned in single-blind fashion to receive either TT or sham therapeutic touch once weekly for 6 consecutive weeks. The distal latency of the median motor nerve along with visual analog assessments of pain and relaxation were measured before and after each treatment session. RESULTS: Twenty-one participants completed the study. Changes in median motor nerve distal latencies, pain scores, and relaxation scores did not differ between participants in the TT group and participants in the sham treatment group, either immediately after each treatment session or cumulatively. Immediately after each treatment session, however, there were improvements from baseline among all the outcome variables in both groups. CONCLUSIONS: In this small study, TT was no better than placebo in influencing median motor nerve distal latencies, pain scores, and relaxation scores. The changes in the outcome variables from baseline in both groups suggest a possible physiologic basis for the placebo effect.

Left ventricular dysfunction, pulmonary hypertension, obesity, and sleep apnea.

The purpose of this study was to determine the frequency of central and obstructive sleep apnea in adult patients who have echocardiographic evidence of left ventricular dysfunction and pulmonary hypertension. Subjects with left ventricular dysfunction, pulmonary hypertension (pulmonary artery systolic pressure >30 mm Hg) and no lung disease were evaluated for risk factors associated with pulmonary hypertension. Of eight eligible adults, six completed the study. Subjects were from suburban and inner city family practices. Spirometric assessment, pulse oximetry on room air, rheumatologic evaluation, polysomnography, and additional history were taken. All six subjects had sleep apnea (apnea-plus-hypopnea index, or AHI, > or = 20): obstructive, central, or mixed. All were obese, and almost all the subjects had a restrictive pattern on spirometry, which is consistent with obesity. All had a pulmonary artery systolic blood pressure of 35 mm Hg or greater. None had daytime hypoxemia or collagen vascular disease, and none had ever used appetite suppressants. This study found a strong association between pulmonary hypertension and obstructive or central sleep apnea in obese patients with congestive heart failure (CHF). We propose that a pulmonary artery systolic pressure of 35 mm Hg or greater in ambulatory patients with CHF may signify an increased risk of sleep apnea.

Bilateral leg edema, obesity, pulmonary hypertension, and obstructive sleep apnea.

BACKGROUND: Pulmonary hypertension is usually due to an underlying cardiac or pulmonary condition. An association between unexplained pulmonary hypertension and bilateral leg edema in primary care patients was found previously. We undertook this study to identify the frequency of obstructive sleep apnea (OSA) in ambulatory, adult patients with pulmonary hypertension who initially presented with bilateral leg edema. METHODS: Twenty ambulatory adults with bilateral leg edema, echocardiocardiographic evidence of pulmonary hypertension (estimated pulmonary artery systolic pressure >30 mm Hg) without left ventricular dysfunction, and no clinically apparent pulmonary disease [corrected] were enrolled from a suburban family practice and an inner-city family practice during a 3-year period. Spirometric assessment, pulse oximetry, rheumatologic evaluation, polysomnography, and questionnaire information regarding risk factors for pulmonary hypertension were obtained for each subject. RESULTS: Fifteen patients (75%) completed the study. Almost all of the subjects were obese. Nine (60%) of the 15 had OSA. None of the subjects demonstrated an obstructive pattern on spirometric evaluation results, but 9 (60%) had a restrictive spirometry pattern, consistent with their obesity. None of the subjects had daytime hypoxemia. Systemic hypertension was present in two-thirds of the subjects with OSA, and was absent in all of the subjects who lacked OSA. CONCLUSIONS: Bilateral leg edema in obese primary care patients is associated with both OSA and modest pulmonary hypertension. If these findings are generalizable, then bilateral leg edema may be an important clinical marker for underlying OSA.

Etiology and diagnosis of bilateral leg edema in primary care.

PURPOSE: To identify the causes of bilateral leg edema in a primary care setting, and to determine the ability of primary care providers to arrive at the correct diagnosis using the information available at the initial clinical encounter. PATIENTS AND METHODS: Fifty-eight ambulatory adult patients with bilateral leg edema were enrolled at an inner city family practice during a 3-year period. Historical information, physical examination findings, and clinical impressions of primary care providers were compared with the results of laboratory evaluations consisting of echocardiograms, venous duplex ultrasound leg scans, serum albumin levels, and when appropriate, 24-hour urinalyses. RESULTS: Forty-five patients (78%) completed the study. The initial clinical impression was venous insufficiency in 32 (71%) patients and congestive heart failure in 8 (18%) patients. In actuality, 15 (33%) patients had a cardiac condition as a cause of their leg edema, and 19 (42%) had pulmonary hypertension. All of the patients with heart disease, and almost all of those with pulmonary hypertension, were age 45 years or older. Only 10 (22%) of the subjects had venous insufficiency. Renal conditions, medication use, and hypoalbuminemia were less common. CONCLUSIONS: Utilizing clinical information only, many patients with cardiopulmonary pathology were incorrectly diagnosed as having more benign conditions, most commonly venous insufficiency. Echocardiographic evaluation, including an estimation of pulmonary artery pressure, may be advisable in many patients with bilateral leg edema, especially if they are at least 45 years old.

Taped therapeutic suggestions and taped music as adjuncts in the care of coronary-artery-bypass patients.

A randomized, single-blinded, placebo-controlled trial examined the benefits of taped therapeutic suggestions and taped music in coronary-artery-bypass patients. Sixty-six patients listened to either suggestion tapes or music tapes, intraoperatively and postoperatively; 29 patients listened to blank tapes intraoperatively and listened to no tapes postoperatively. Half the patients who listened to a tape found it helpful. There were no significant differences between groups in length of SICU or postoperative hospital stay, narcotic usage, nurse ratings of anxiety and progress, depression, activities of daily living, or cardiac symptoms. There were no significant differences in these same outcomes between the patients who were helped by the tapes and the patients not helped. These results suggest that if taped therapeutic suggestions have a measurable effect upon cardiac surgery patients, demonstrating this effect will require more detailed patient evaluations to identify subgroups of patients responsive to this type of intervention.

Suggestion, relaxation, and hypnosis as adjuncts in the care of surgery patients: a review of the literature.

Eighteen clinical trials which employed an intervention using hypnosis, suggestion, or relaxation to facilitate the recovery of surgery patients were critically reviewed. Sixteen studies credit the intervention with facilitating either the physical or emotional recovery of patients following surgery. Two studies failed to document any positive outcome attributable to the intervention. The available literature suggests that hypnosis, suggestion, and relaxation are underutilized techniques which can shorten postoperative hospital stays, promote the physical recovery of patients from surgery, and aid in the psychological and emotional response of patients following surgery.

Continuity of care in a family practice residency program. Impact on physician satisfaction.

One of the primary benefits of continuity of care is its influence upon patient and physician satisfaction. This prospective pilot study involved a cohort of 14 second- and third-year family practice residents and 4 full-time faculty at a community hospital-based family practice residency in Cleveland, Ohio. Rates of continuity that physicians experience were calculated using the usual provider continuity (UPC) measure of continuity, and were correlated with physician satisfaction with outpatient care using a practice satisfaction scale (PSS) developed specifically for this purpose. Residents and faculty were also asked to rank order the importance of several aspects of outpatient care, including continuity of care. The results indicate that both residents and faculty value continuity of care highly compared with other aspects of outpatient care. The average continuity rates were 59% for second-year residents, 54% for third-year residents, and 82% for faculty. The UPC continuity measure correlated highly with the PSS scores (corrected r2 = .55; P less than .001). The data support the hypothesis that continuity of care with patients is an important determinant of resident and faculty physician satisfaction with their outpatient experience.