The Effect of Electric Stimulation Techniques on Pain and Tenderness at the Myofascial Trigger Point: A Systematic Review.

BACKGROUND: Myofascial pain is a prevalent chronic pain disorder, affecting a large proportion of the general population. Electric stimulation techniques such as transcutaneous electric stimulation (TENS) and electroacupuncture have been shown to be effective for managing chronic pain conditions including myofascial pain. The goal of this study was to review the literature on the effectiveness of electric stimulation techniques on myofascial pain. METHODS: A comprehensive systematic search of three databases-Medline, EMBASE, and Cochrane CENTRAL-was conducted using key words related to myofascial pain and trigger points, as well as various electric stimulation techniques. A total of 15 articles passed the inclusion and exclusion criteria for the study. Data were extracted from these studies and assessed qualitatively and quantitatively. Standardized mean differences (SMDs) were computed from pain intensity measures extracted from these studies. Subgroup analyses were performed to assess the effectiveness of treatment modality, number of treatment sessions, frequency of stimulation, location of treatment, and duration of treatment. RESULTS: The SMD for electric stimulation techniques on reported pain intensity was significant (P = 0.03), as was the SMD for the electroacupuncture subgroup (P = 0.02); the TENS subgroups' effect was not significant (P = 0.17). The subgroup analyses tentatively suggest that frequency and number of treatments do not influence pain intensity, whereas the duration of treatment may have an effect. The qualitative results of this study revealed variability in the results among studies delivering TENS treatments. CONCLUSIONS: Electric stimulation is effective at mitigating reported pain intensity at the location of the trigger point. Electroacupuncture presented with significant and larger effect sizes of improvement relative to TENS for reported pain intensity. Given that this review included a small number of studies, there is a need for additional research to confirm its findings. Additionally, studies assessing the parameters and physiological location of treatment are needed to inform the clinical use and recommendations of electric stimulation treatments.

Fuzzy c-means segmentation of major vessels in angiographic images of stroke.

Patients suffering from ischemic stroke develop varying degrees of pial arterial supply (PAS), which can affect patient response to reperfusion therapy and risk of hemorrhage. Since vessel segmentation may be an important part in identifying PAS, we present a fuzzy c-means (FCM) clustering method to segment major vessels in x-ray angiograms. Our approach consists of semiautomatic region of interest (ROI) delineation, separation of major vessels from capillary blush and/or background noise through FCM clustering, and identification of the major vessel category. This method was applied to a database of x-ray angiograms of 24 patients acquired at various frame rates. The ground truth for performance evaluation was the designation by an expert radiologist selecting image pixels as being vessel or nonvessel. From receiver operating characteristic (ROC) analysis, area under the ROC curve (AUC) was the performance metric in the task of distinguishing between major vessels and blush or background. When clustering data into three categories and performing FCM segmentation on each ROI separately, the AUC was 0.89 for the entire database and [Formula: see text] for all examined frame-rates. In conclusion, our method showed promising performance in identifying major vessels and is anticipated to become an integral part of automatic quantification of PAS.

Impact of prior antiplatelet therapy on risk of embolism in infective endocarditis.

BACKGROUND: Embolism is a dreaded complication of infective endocarditis (IE). Currently, antimicrobial therapy is the only medical intervention proven to decrease the risk of embolism associated with IE. We hypothesized that, because platelet aggregation is operative in the pathogenesis of vegetation formation, embolism associated with IE should occur less frequently among patients who have received prior, continuous daily antiplatelet therapy for noninfectious reasons. METHODS: We studied a retrospective cohort of adult patients with a diagnosis of IE who presented to the Mayo Clinic (Rochester, MN) during 1980-1998. The cohort was divided into 2 groups on the basis of whether they had received continuous daily antiplatelet therapy for at least 6 months prior to the time of hospitalization for IE. Antiplatelet therapy included aspirin, dipyridamole, clopidogrel, ticlopidine, or any of combination of these agents. The primary end point was a symptomatic embolic event that occurred prior to or during hospitalization. Multivariable logistic regression was used to assess the impact of continuous daily antiplatelet therapy on risk of symptomatic emboli associated with IE. RESULTS: One hundred forty-seven (24.5%) of 600 patients experienced a symptomatic embolic event; the most common embolic manifestation was stroke (in 48.2% of patients). Embolic events occurred significantly less often among those who had received prior, continuous daily antiplatelet therapy (12.0% of patients who had received therapy vs. 27.8% patients who had not receive therapy; P<.001). After adjustment for several covariates known to influence both risk of embolism and propensity for antiplatelet use, the adjusted odds ratio for a symptomatic embolic event was 0.36 (95% confidence interval, 0.19-0.68; P=.002) for patients receiving continuous daily antiplatelet therapy. CONCLUSIONS: The risk of symptomatic emboli associated with IE was reduced in patients who received continuous daily antiplatelet therapy before onset of IE.

Informed consent for medical procedures: local and national practices.

BACKGROUND: No studies have assessed whether clinicians obtain informed consent for invasive medical procedures, and there are no explicit national standards to guide the process. HYPOTHESIS: Informed consent practices are inconsistent for commonly performed invasive medical procedures. METHODS: A simple questionnaire was electronically mailed and/or faxed to training program directors of critical care medicine and internal medicine departments, and to ICU directors in the state of Connecticut. The questionnaire listed common invasive medical procedures and asked the respondents to check those for which practitioners routinely obtain informed consent in their hospital. RESULTS: The three samples, national intensivists (88 respondents), Connecticut intensivists (29 respondents), and national internists (56 respondents) demonstrated heterogeneity of consenting practices. The rate of obtaining consent for common vascular access procedures ranged from 20 to 90%. The rates of obtaining consent for Foley catheterization and nasogastric intubation were uniformly < 10%, and those for endoscopic procedures were > 90%. Separate consent (beyond the general consent to treat) was not uniformly obtained for the transfusion of blood products (range, 74 to 93%) and common diagnostic medical procedures (eg, thoracentesis, paracentesis, or lumbar puncture; range, 77 to 96%). Surgical intensivists reported that the obtaining of consent for invasive procedures was less routine compared to medical intensivists. Lower rates of consent were noted by those respondents who used a "blanket" consent form, which was signed at the time of hospital admission, to cover subsequent procedures. CONCLUSIONS: In this relatively small sample, there was no uniform practice of informed consent for commonly performed invasive medical procedures. Consent was routinely obtained for GI endoscopy, bronchoscopy, and medical research, and was not obtained for Foley catheterization and nasogastric intubation. The obtaining of consent for vascular cannulation and diagnostic procedures was not routine in the ICUs of a substantial number of respondents. Explicit standards that delineate specifically which procedures require consent may be required to assure more uniform practices.