Objectively measured activity is not associated with average pain intensity 1 week after surgery: A cross-sectional study.

BACKGROUND: Measures of physical activity and pain-related patient-reported outcomes are important components of patient recovery after surgery. However, little is known about their association in the early post-operative period. This study aims to increase this knowledge. Our primary objective was to determine the association between average pain intensity and activity (in steps) 1 week after surgery. Secondary objectives were the association of activity with other patient-reported outcomes, age, sex, comorbidities and body mass index. METHODS: Data were obtained from the PROMPT sub-project of IMI-PainCare. Patients after breast and endometriosis-related surgery, sternotomy and total knee arthroplasty completed pain-related outcomes questionnaires and wore an ActiGraph activity-tracking device. We correlated steps with average pain intensity on post-operative days 6 and 7. Secondary analyses were done using correlations and t-tests. RESULTS: In 284 cases, there was no statistically significant correlation between steps and average pain intensity. In addition, none of the 28 secondary analyses showed a statistically significant result. CONCLUSIONS: Pain-related patient-reported outcome measures and physical activity are separate entities. Both should be measured after surgery to assess patient recovery and to identify treatment deficiencies. SIGNIFICANCE STATEMENT: Measuring recovery is a multi-dimensional challenge. After surgery, clinicians need to be aware that neither pain intensity nor activity levels tell the whole story. Each can hint to problems and treatment requirements.

Chronic intensive care-related pain: Exploratory analysis on predictors and influence on health-related quality of life.

BACKGROUND: There is growing evidence for the development of chronic pain after intensive care. Nonetheless, there is only limited knowledge about factors leading to chronic intensive care-related pain (CIRP). Thus, the primary objective was the identification of predictors of CIRP. Moreover, we aimed to assess the impact of CIRP on patients' health-related quality of Life (HRQOL). METHODS: Comprehensive information on patients' pain before ICU admission and present pain was collected longitudinally by means of the German Pain Questionnaire 6 and 12 months after ICU discharge (ICUDC ). In addition, a subsample of patients underwent Quantitative Sensory Testing (QST). We used Generalized Estimating Equations to identify predictors of CIRP with logistic regression models. RESULTS: In total, 204 patients (197/159 at 6/12 months after ICUDC ) were available for the analyses. In the multivariate models, moderate to severe average pain in the 4 weeks after ICUDC , lower age, female sex, increased inflammation and chronic pain conditions and increased levels of anxiety before ICU admission were predictive for CIRP. In addition, small fibre deficits and lower disease severity were associated with CIRP in the QST subsample (81 patients, 77/55 at 6/12 months after ICUDC ). Patients with CIRP reported significantly lower HRQOL than patients without CIRP. CONCLUSIONS: Chronic intensive care-related pain is associated with specific decrements in HRQOL. Knowledge about the identified predictors is of clinical and scientific importance and might help to reduce the incidence of CIRP. SIGNIFICANCE: Chronic intensive care-related pain is associated with specific decrements in health-related quality of life. While most of the identified predictors for CIRP can only be considered as risk factors, especially adequate (post-) acute pain management should be studied as preventive strategy.

Perceived cognitive impairments after critical illness: a longitudinal study in survivors and family member controls.

BACKGROUND: Many former intensive care unit (ICU) patients report difficulties in cognitive functions especially in their daily life. We aimed to measure perceived cognitive impairments in daily life in survivors of critical illness and their family member controls (FMC). METHODS: Perceived cognitive impairments were assessed two times after ICU discharge using an adapted German version of the "Functional Assessment of Cancer Therapy - Cognitive Function" questionnaire. After 3 months, 127 former patients and 52 FMC participated and 103/127 patients and 36/52 FMC were followed up after 6 months. Baseline information was obtained retrospectively. RESULTS: We found no significant differences between the patient sample and FMC, 3 and 6 months after ICU discharge. Based on questionnaire ratings, cluster analysis divided patients and FMC into a cognitively 'impaired' and a 'non-impaired' cluster. Questionnaire scales differed significantly prior to ICU admission as well as 3 and 6 months after ICU discharge between both clusters. While differences between patients and FMC were less pronounced in the 'non-impaired' cluster, patients were significantly more impaired than FMC at 3 and 6 months after ICU discharge in the 'impaired' cluster. DISCUSSION: A substantial part of former patients were affected by post-ICU cognitive impairment in daily life. Pre-existing cognitive impairments were a risk factor. These patients would probably profit from tailored neurorehabilitative therapy. Therefore, an efficient tool to identify potential patients for neurorehabilitation is needed. The questionnaire revealed good psychometric properties. We recommend a comprehensive validation of the questionnaire in this patient population.

Eye movement disorders are different in Parkin-linked and idiopathic early-onset PD.

OBJECTIVES: Parkin gene mutations are the most common cause of early-onset parkinsonism. Patients with Parkin mutations may be clinically indistinguishable from patients with idiopathic early-onset Parkinson disease (EOPD) without Parkin mutations. Eye movement disorders have been shown to differentiate parkinsonian syndromes, but have never been systematically studied in Parkin mutation carriers. METHODS: Eye movements were recorded in symptomatic (n = 9) and asymptomatic Parkin mutation carriers (n = 13), patients with idiopathic EOPD (n = 14), and age-matched control subjects (n = 27) during established oculomotor tasks. RESULTS: Both patients with EOPD and symptomatic Parkin mutation carriers showed hypometric prosaccades toward visual stimuli, as well as deficits in suppressing reflexive saccades toward unintended targets (antisaccade task). When directing gaze toward memorized target positions, patients with EOPD exhibited hypometric saccades, whereas symptomatic Parkin mutation carriers showed normal saccades. In contrast to patients with EOPD, the symptomatic Parkin mutation carriers showed impaired tracking of a moving target (reduced smooth pursuit gain). The asymptomatic Parkin mutation carriers did not differ from healthy control subjects in any of the tasks. CONCLUSIONS: Although clinically similarly affected, symptomatic Parkin mutation carriers and patients with idiopathic EOPD differed in several oculomotor tasks. This finding may point to distinct anatomic structures underlying either condition: dysfunctions of cortical areas involved in smooth pursuit (V5, frontal eye field) in Parkin-linked parkinsonism vs greater impairment of basal ganglia circuits in idiopathic Parkinson disease.

Derivation of the refraction equations for higher-order aberrations of local wavefronts at oblique incidence.

From the literature the calculation of power and astigmatism of a local wavefront after refraction at a given surface is known from the vergence and Coddington equations. For higher-order aberrations (HOAs) equivalent analytical equations do not exist. Since HOAs play an increasingly important role in many fields of optics, e.g., ophthalmic optics, it is the purpose of this study to extend the "generalized Coddington equation" to the case of HOA (e.g., coma and spherical aberration). This is done by local power series expansions. In summary, with the results presented here, it is now possible to calculate analytically the local HOA of an outgoing wavefront directly from the aberrations of the incoming wavefront and the refractive surface.

Absolute ocular fundus dimensions measured by multiple-beam interference fringes.

Multiple-beam interference fringes have been projected onto the retina to serve as a size reference for fundus photography. The absolute fringe spacing is determined by measurable parameters. The interference fringes are extremely narrow so that fringe maxima and fundus structures can be perceived equally well, and a high precision of measurement is achieved. The method has been applied to a model eye of varying ametropia (within +/- 7 diopters). The reproducibility of measurement is within 0.5%. In vivo measurements on human eyes demonstrate the clinical applicability.

A combined tc-PO2 and skin blood flow sensor.

A new approach to the determination of energy delivered to the skin during transcutaneous oxygen tension (tc-PO2) measurements was tested. The test was carried out using a tc-PO2 electrode constructed with an active thermal shield in order to provide more sensitive and specific heat transport measurements, and consequently to create the possibility of determining skin blood flow rates. The oxygen measurement properties did not differ from the conventional tc-PO2 electrode. In vivo measurements were performed on 11 adult volunteers. Skin blood flow was determined by a blood flow cessation technique to be 0.124 +/- 0.053 ml . cm-2 . min-1 at the start of the experiments, rising to 0.164 +/- 0.61 ml . cm-2 . min-1. Tc-PO2 changed from 56.2 +/- 9.8 mmHg (7.5 +/- 1.3 kPa) to 68.3 +/- 9.0 mmHg(9.1 +/- 1.2 kPa). It is concluded that a thermally shielded electrode makes it possible to determine the convectional component of the heat loss from the electrode to the skin and consequently to compute a relative measure of skin blood flow rate. The observed change in computed skin blood flow rate was correlated to the observed change in tc-PO2 (P less than 0.1).