Browse Health
Otolaryngologist (ear, nose, throat)
11 years of experience
Accepting new patients

Education ?

Medical School
Medical College of Ohio (1999)

Awards & Distinctions ?

Associations
American Board of Otolaryngology
American Board of Facial Plastic and Reconstructive Surgery
American Academy of Otolaryngology: Head and Neck Surgery

Affiliations ?

Dr. McLean is affiliated with 4 hospitals.

Hospital Affilations

Score

Rankings

  • University of Michigan Hospitals & Health Centers
    Otolaryngology
    1500 E Medical Center Dr, Ann Arbor, MI 48109
    • Currently 4 of 4 crosses
    Top 25%
  • Henry Ford Hospital
    Otolaryngology
    2799 W Grand Blvd, Detroit, MI 48202
    • Currently 3 of 4 crosses
    Top 50%
  • University of Michigan Health System
  • Ann Arbor Veterans Affairs Medical Center
    2215 Fuller Rd, Ann Arbor, MI 48105
  • Publications & Research

    Dr. McLean has contributed to 72 publications.
    Title Substantial Postoperative Pain is Common Among Children Undergoing Laparoscopic Appendectomy.
    Date April 2012
    Journal Paediatric Anaesthesia
    Excerpt

    Laparoscopic appendectomy is one of the most common surgical procedures performed in children. However, to our knowledge, the postoperative pain experience of children undergoing laparoscopic appendectomy has never been described. In this study, we assessed the postoperative pain experience of children undergoing laparoscopic appendectomy.

    Title Sentinel Lymph Node Biopsy is Accurate and Prognostic in Head and Neck Melanoma.
    Date April 2012
    Journal Cancer
    Excerpt

    Sentinel lymph node biopsy (SLNB) has emerged as a widely used staging procedure for cutaneous melanoma. However, debate remains around the accuracy and prognostic implications of SLNB for cutaneous melanoma arising in the head and neck, as previous reports have demonstrated inferior results to those in nonhead and neck regions. Through the largest single-institution series of head and neck melanoma patients, the authors set out to demonstrate that SLNB accuracy and prognostic value in the head and neck region are comparable to other sites.

    Title A Body Image and Disordered Eating Intervention for Women in Midlife: a Randomized Controlled Trial.
    Date April 2012
    Journal Journal of Consulting and Clinical Psychology
    Excerpt

    This study examined the outcome of a body image and disordered eating intervention for midlife women. The intervention was specifically designed to address risk factors that are pertinent in midlife.

    Title The Role of Tissue Damage in Whiplash-associated Disorders: Discussion Paper 1.
    Date April 2012
    Journal Spine
    Excerpt

    Nonsystematic review of cervical spine lesions in whiplash-associated disorders (WAD).

    Title The Potential Contribution of Stress Systems to the Transition to Chronic Whiplash-associated Disorders.
    Date April 2012
    Journal Spine
    Excerpt

    A narrative description highlighting preclinical and clinical evidence that physiologic stress systems contribute to whiplash-associated disorders (WAD) pathogenesis.

    Title Features Predicting Sentinel Lymph Node Positivity in Merkel Cell Carcinoma.
    Date May 2011
    Journal Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
    Excerpt

    Merkel cell carcinoma (MCC) is a relatively rare, potentially aggressive cutaneous malignancy. We examined the clinical and histologic features of primary MCC that may correlate with the probability of a positive sentinel lymph node (SLN).

    Title Factors Associated with Body Dissatisfaction and Disordered Eating in Women in Midlife.
    Date January 2011
    Journal The International Journal of Eating Disorders
    Excerpt

    In this study, we examined developmentally appropriate factors that may be associated with body dissatisfaction and disordered eating in women in midlife.

    Title Emergency Medical Services Use by the Elderly: Analysis of a Statewide Database.
    Date September 2010
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Excerpt

    Elderly patients use emergency medical services (EMS) at a high rate. Objectives. To test the hypothesis that EMS use for emergency department (ED) transports increases across the life span and to estimate changes in the EMS volume in North Carolina (NC) during the next 20 years due to the aging of the population.

    Title Predictors of Poor Sleep Quality Among Head and Neck Cancer Patients.
    Date July 2010
    Journal The Laryngoscope
    Excerpt

    The objective of this study was to determine the predictors of sleep quality among head and neck cancer patients 1 year after diagnosis.

    Title Effect of Catechol-o-methyltransferase Polymorphism on Response to Propranolol Therapy in Chronic Musculoskeletal Pain: a Randomized, Double-blind, Placebo-controlled, Crossover Pilot Study.
    Date June 2010
    Journal Pharmacogenetics and Genomics
    Excerpt

    Three common haplotypes in the gene encoding catechol-O-methyltransferase (COMT) have been associated with pain modulation and the risk of developing chronic musculoskeletal pain, namely temporomandibular disorder (TMD). Haplotypes coding for higher enzymatic activity were correlated with lower pain perception. Rodent studies showed that COMT inhibition increases pain sensitivity through beta2/3-adrenergic receptors. We hypothesized that the nonselective beta-adrenergic antagonist propranolol will reduce clinical and experimental pain in TMD patients in a manner dependent on the individuals' COMT diplotype.

    Title Making Public Health Policy: What Place for the Alcohol-dependent?
    Date March 2010
    Journal Journal of Law and Medicine
    Excerpt

    Although public policy in general, and health policy in particular, can be powerful and effective tools in shaping a "healthy" environment for citizens, the influences and agendas that underpin them are often lacking in transparency. In the case of the alcohol-dependent, the critical importance of identifying strategies appropriate to their specific needs is often sidelined. This, it is argued, results in part from the influence of the alcohol industry on governments and on social conditions and in part from the ethical underpinnings of public health policy, which depends on maximising social benefits even at the expense of "hard to reach" groups. In addition, much of alcohol policy rests on the kind of' "healthy living" message that appeals to the otherwise healthy While not infantilising people who are dependent on alcohol, consideration must be given to the extent to which their ability to choose health is compromised by the nature of dependence itself.

    Title Are Advance Directives Legally Binding or Simply the Starting Point for Discussion on Patients' Best Interests? Ethical View.
    Date December 2009
    Journal Bmj (clinical Research Ed.)
    Title Live and Let Die.
    Date October 2009
    Journal Bmj (clinical Research Ed.)
    Title Health Status, Not Head Injury, Predicts Concussion Symptoms After Minor Injury.
    Date May 2009
    Journal The American Journal of Emergency Medicine
    Excerpt

    Postconcussion (PC) syndrome etiology remains poorly understood. We sought to examine predictors of persistent PC symptoms after minor injury.

    Title Proton Mr Spectroscopy in the Evaluation of Cerebral Metabolism in Patients with Fibromyalgia: Comparison with Healthy Controls and Correlation with Symptom Severity.
    Date June 2008
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    BACKGROUND AND PURPOSE: Widespread pain sensitivity in patients with fibromyalgia (FM) suggests a central nervous system (CNS)-processing problem. Therefore, it is conceivable that metabolic alterations exist in pain-processing brain regions of people with FM compared with healthy controls (HC) and that such metabolic data could correlate with clinical symptoms. The purpose of this study was to test these hypotheses using proton MR spectroscopy ((1)H-MR spectroscopy). MATERIALS AND METHODS: There were 21 patients with FM and 27 HC who underwent conventional structural MR imaging and additional 2D-chemical shift imaging (CSI) MR-spectroscopy sequences. For the 2D-CSI spectroscopy, larger volumes of interest (VOIs) were centered at the level of the basal ganglia and the supraventricular white matter. Within these larger areas, 16 smaller voxels were placed in a number of regions previously implicated in pain processing. N-acetylaspartate (NAA)/creatine(Cr), choline (Cho)/Cr and NAA/Cho ratios were calculated for each voxel. Subjects underwent clinical and experimental pain assessment. RESULTS: Mean metabolite ratios and ratio variability for each region were analyzed by using repeated-measures analysis of variance (ANOVA). Correlations between clinical symptoms and metabolite ratios were assessed. Cho/Cr variability in the right dorsolateral prefrontal cortex (DLPFC) was significantly different in the 2 groups; a significant correlation between Cho/Cr in this location and clinical pain was present in the FM group. Evoked pain threshold correlated significantly with NAA/Cho ratios in the left insula and left basal ganglia. CONCLUSION: Our data suggest that there are baseline differences in the variability of brain metabolite relative concentrations between patients with FM and HC, especially in the right DLPFC. Furthermore, there are significant correlations between metabolite ratios and clinical and experimental pain parameters in patients with FM.

    Title Human Tissue Legislation: Listening to the Professionals.
    Date June 2008
    Journal Journal of Medical Ethics
    Excerpt

    The controversies in Bristol, Alder Hey and elsewhere in the UK surrounding the removal and retention of human tissue and organs have led to extensive law reform in all three UK legal systems. This paper reports a short study of the reactions of a range of health professionals to these changes. Three main areas of ethical concern were noted: the balancing of individual rights and social benefit; the efficacy of the new procedures for consent; and the helpfulness for professional practice of the new legislation and regulation. Recognition of these concerns may help in forging a new partnership between professionals and patients and their families.

    Title Dynamic Levels of Glutamate Within the Insula Are Associated with Improvements in Multiple Pain Domains in Fibromyalgia.
    Date April 2008
    Journal Arthritis and Rheumatism
    Excerpt

    OBJECTIVE: Fibromyalgia (FM) is a chronic widespread pain condition that is thought to arise from augmentation of central neural activity. Glutamate (Glu) is an excitatory neurotransmitter that functions in pain-processing pathways. This study was carried out to investigate the relationship between changing levels of Glu within the insula and changes in multiple pain domains in patients with FM. METHODS: Ten patients with FM underwent 2 sessions of proton magnetic resonance spectroscopy (H-MRS) and 2 sessions of functional magnetic resonance imaging (FMRI), each conducted before and after a nonpharmacologic intervention to reduce pain. During H-MRS, the anterior and posterior insular regions were examined separately using single-voxel spectroscopy. The levels of Glu and other metabolites were estimated relative to levels of creatine (Cr) (e.g., the Glu/Cr ratio). During FMRI, painful pressures were applied to the thumbnail to elicit neuronal activation. Experimental pressure-evoked pain thresholds and clinical pain ratings (on the Short Form of the McGill Pain Questionnaire [SF-MPQ]) were also assessed prior to each imaging session RESULTS: Both experimental pain (P = 0.047 versus pretreatment) and SF-MPQ-rated clinical pain (P = 0.043 versus pretreatment) were reduced following treatment. Changes from pre- to posttreatment in Glu/Cr were negatively correlated with changes in experimental pain thresholds (r = -0.95, P < 0.001) and positively correlated with changes in clinical pain (r = 0.85, P = 0.002). Changes in the FMRI-determined blood oxygenation level-dependent effect (a measure of neural activation) were positively correlated with changes in Glu/Cr within the contralateral insula (r = 0.81, P = 0.002). CONCLUSION: Changes in Glu levels within the insula are associated with changes in multiple pain domains in patients with FM. Thus, H-MRS data may serve as a useful biomarker and surrogate end point for clinical trials of FM.

    Title Clinical Ethics Committees, Due Process and the Right to a Fair Hearing.
    Date April 2008
    Journal Journal of Law and Medicine
    Excerpt

    The development of clinical ethics committees in the United Kingdom raises a number of important questions about the extent to which they are compatible with the normative values of due process. If committees are to be active in delivering ethics services, it is argued that attention to due process is important. Based on research outcomes, it seems that the chairs of the United Kingdom clinical ethics committees who responded are reasonably satisfied about the ability of their committees to make ethical decisions and slightly less confident about their ability to make legal decisions. If these committees are to make potentially far-reaching decisions (whether or not involving live consultations), it is argued here that they must pay attention to the rules associated with the legal concept of due process. Equally, evaluation of the clinical ethics committee's counterpart in the United States suggests that they may become increasingly authoritative, especially as their role becomes entrenched. This makes attention to due process even more important. However, it is also proposed that, when committees become concerned about due process, their ability to "do ethics" is constrained.

    Title Comparison of Face-to-face and Internet Interventions for Body Image and Eating Problems in Adult Women: an Rct.
    Date March 2008
    Journal The International Journal of Eating Disorders
    Excerpt

    The aim of this study was to compare the outcomes following an eight-session, small group, therapist-led, intervention for body dissatisfaction, and disordered eating in adult women, delivered either in face-to-face or synchronous, internet mode.

    Title What and Who Are Clinical Ethics Committees For?
    Date February 2008
    Journal Journal of Medical Ethics
    Title Decreased Central Mu-opioid Receptor Availability in Fibromyalgia.
    Date October 2007
    Journal The Journal of Neuroscience : the Official Journal of the Society for Neuroscience
    Excerpt

    The underlying neurophysiology of acute pain is fairly well characterized, whereas the central mechanisms operative in chronic pain states are less well understood. Fibromyalgia (FM), a common chronic pain condition characterized by widespread pain, is thought to originate largely from altered central neurotransmission. We compare a sample of 17 FM patients and 17 age- and sex-matched healthy controls, using mu-opioid receptor (MOR) positron emission tomography. We demonstrate that FM patients display reduced MOR binding potential (BP) within several regions known to play a role in pain modulation, including the nucleus accumbens, the amygdala, and the dorsal cingulate. MOR BP in the accumbens of FM patients was negatively correlated with affective pain ratings. Moreover, MOR BP throughout the cingulate and the striatum was also negatively correlated with the relative amount of affective pain (McGill, affective score/sensory score) within these patients. These findings indicate altered endogenous opioid analgesic activity in FM and suggest a possible reason for why exogenous opiates appear to have reduced efficacy in this population.

    Title Internet-delivered Targeted Group Intervention for Body Dissatisfaction and Disordered Eating in Adolescent Girls: a Randomized Controlled Trial.
    Date September 2007
    Journal Journal of Abnormal Child Psychology
    Excerpt

    This study evaluated a targeted intervention designed to alleviate body image and eating problems in adolescent girls that was delivered over the internet so as to increase access to the program. The program consisted of six, 90-minute weekly small group, synchronous on-line sessions and was facilitated by a therapist and manual. Participants were 73 girls (mean age=14.4 years, SD=1.48) who self-identified as having body image or eating problems and were randomly assigned to an intervention group (n=36) (assessed at baseline, post-intervention and at 2- and 6-months follow-up) or a delayed treatment control group (n=37) (assessed at baseline and 6-7 weeks later). Clinically significant improvements in body dissatisfaction, disordered eating, and depression were observed at post-intervention and maintained at follow-up. Internet delivery was enthusiastically endorsed. The program offers a promising approach to improve body image and eating problems that also addresses geographic access problems.

    Title Mild Traumatic Brain Injury: an Update for Advanced Practice Nurses.
    Date May 2007
    Journal The Journal of Neuroscience Nursing : Journal of the American Association of Neuroscience Nurses
    Excerpt

    Nearly 75% of persons with brain injury experience a mild injury. These people do not often enter the healthcare system by traditional means, nor do they always present with visible signs and symptoms of injury. In fact, people who experienced brain trauma are likely to seek help in primary care settings and from advanced practice nurses (APNs). Because the symptom experience can be complicated by impaired perception or mood, delays in seeking help, and faulty explanations for their symptoms, APNs need to rule out competing diagnoses, offer brief psychoeducational treatment, and refer the person to an appropriate specialist for therapy when needed.

    Title Cerebrospinal Fluid Corticotropin-releasing Factor Concentration is Associated with Pain but Not Fatigue Symptoms in Patients with Fibromyalgia.
    Date January 2007
    Journal Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology
    Excerpt

    Previous studies have identified stress system dysregulation in fibromyalgia (FM) patients; such dysregulation may be involved in the generation and/or maintenance of pain and other symptoms. Corticotropin-releasing factor (CRF) is the principal known central nervous system mediator of the stress response; however, to date no studies have examined cerebrospinal fluid (CSF) CRF levels in patients with FM. The relationship between CSF CRF level, heart rate variability (HRV), and pain, fatigue, and depressive symptoms was examined in patients with FM. Among participants (n=26), CSF CRF levels were associated with sensory pain symptoms (r=0.574, p=0.003) and affective pain symptoms (r=0.497, p=0.011), but not fatigue symptoms. Increased HRV was also strongly associated with increased CSF CRF and FM pain. In multivariate analyses adjusting for age, sex, and depressive symptoms, the association between CSF CRF and sensory pain symptoms (t=2.54, p=0.027) persisted. Women with FM who reported a history of physical or sexual abuse had lower CSF CRF levels than women who did not report such a history. CSF CRF levels are associated with both pain symptoms and variation in autonomic function in FM. Differences in CSF CRF levels among women with and without a self-reported history of physical or sexual abuse suggest that subgroups of FM patients may exist with different neurobiological characteristics. Further studies are needed to better understand the nature of the association between CSF CRF and pain symptoms in FM.

    Title Comparison of Clinical and Evoked Pain Measures in Fibromyalgia.
    Date September 2006
    Journal The Journal of Pain : Official Journal of the American Pain Society
    Excerpt

    Evoked pain measures such as tender point count and dolorimetry are often used to determine tenderness in studies of fibromyalgia (FM). However, these measures frequently do not improve in clinical trials and are known to be influenced by factors other than pain such as distress and expectancy. The purpose of this investigation was to determine whether evoked pain paradigms that present pressure stimuli in a random fashion (eg, Multiple Random Staircase [MRS]) would track with clinical pain improvement in patients with FM better than traditional measures. Sixty-five subjects enrolled in a randomized clinical trial of acupuncture were observed longitudinally. Clinical pain was measured on a 101-point numerical rating scale (NRS) and the Short Form McGill Pain Questionnaire (SF-MPQ), whereas evoked pressure sensitivity was assessed via manual tender point count, dolorimetry, and MRS methods. Improvements in clinical pain and evoked pain were assessed irrespective of group assignment. Improvement was seen in clinical pain during the course of the trial as measured by both NRS (P = .032) and SF-MPQ (P = .001). The MRS was the only evoked pain measure to improve correspondingly with treatment (MRS, P = .001; tender point count and dolorimeter, P > .05). MRS change scores were correlated with changes in NRS pain ratings (P = .003); however, this association was not stronger than tender point or dolorimetry correlations with clinical pain improvement (P > .05). Pain sensitivity as assessed by random paradigms was associated with improvements in clinical FM pain. Sophisticated pain testing paradigms might be responsive to change in clinical trials. PERSPECTIVE: Trials in fibromyalgia often use both clinical and experimental methods of pain assessment; however, these two outcomes are often poorly correlated. We explore the relationship between changes in clinical and experimental pain within FM patients. Pressure pain testing that applies stimuli in a random order is associated with improvements in clinical pain, but this association was not stronger than other experimental techniques.

    Title The Development of Persistent Pain and Psychological Morbidity After Motor Vehicle Collision: Integrating the Potential Role of Stress Response Systems into a Biopsychosocial Model.
    Date July 2006
    Journal Psychosomatic Medicine
    Excerpt

    OBJECTIVES: Persistent pain and psychological sequelae are common after motor vehicle collision (MVC), but their etiology remains poorly understood. Such common sequelae include whiplash-associated disorders (WAD), fibromyalgia, and posttraumatic stress disorder (PTSD). Increasing evidence suggests that these disorders share overlapping epidemiologic and clinical features. A model is proposed in which central neurobiological systems, including physiologic systems and neuroanatomical structures involved in the stress response, are an important substrate for the development of all 3 disorders and interact with psychosocial and other factors to influence chronic symptom development. METHODS: Epidemiologic and clinical characteristics regarding the development of these disorders after MVC are reviewed. Evidence suggesting a role for stress response systems in the development of these disorders is presented. RESULTS: Contemporary evidence supports a model of chronic symptom development that incorporates the potential for interactions between past experience, acute stress responses to trauma, post-MVC behavior, and cognitive/psychosocial consequences to alter activity within brain regions which process pain and to result in persistent pain, as well as psychological sequelae, after MVC. Such a model incorporates factors identified in prior biopsychosocial theories and places them in the landscape of our rapidly developing understanding of stress systems and CNS pain-modulating pathways. CONCLUSION: New models are needed to stimulate deeper examination of the interacting influences of initial tissue damage, acute pain, psychosocial contingencies, and central stress pathways during chronic symptom development after MVC. Deeper understanding could contribute to improved treatment approaches to reduce the immense personal and societal burdens of common trauma-related disorders.

    Title Sex Selection: Intergenerational Justice or Injustice?
    Date March 2006
    Journal Medicine and Law
    Excerpt

    Arguments surrounding the issue of sex selection focus on the potential, negative outcomes of permitting such choices. In this article, it is argued that--rather than being negative--sex selection (particularly for, but not confined to, family balancing reasons) can be a positive reflection of the reproductive liberties which have been won over the last century. It is accepted that this argument applies most clearly in cultures where there is no overt preference for one sex over another, but in those societies where this does not apply, it is equally unlikely that the concept of reproductive choice is valued. The article argues that permitting intending parents to choose the sex of their child--while likely to be a relatively rare event--is in line with the concept of intergenerational justice, in that it may serve not just the interests of intending parents but also those of the children to be born.

    Title Permanent Vegetative State: the Legal Position.
    Date January 2006
    Journal Neuropsychological Rehabilitation
    Excerpt

    Medicine's diagnostic and therapeutic capacities raise increasingly complex ethical and legal issues for consideration. This is particularly so when the patient is in a permanent vegetative state. This article reviews the current legal position in the case of adults in permanent vegetative state (pVS), with particular attention to the devices used by courts in reaching decisions about whether or not to prolong assisted nutrition and hydration. The article further considers the impact of the Human Rights Act 1998, and argues that the current legal position is significantly, if not determinatively, based on clinical judgement, even where there is some doubt about whether or not the cases actually meet the terms of the Royal College of Physicians (RCP) diagnostic guidelines. In addition, the article asks whether or not the devices used by courts to permit withdrawing assisted nutrition and hydration from patients in pVS could be categorised as assisted death, and notes the (arguable) weakness of these devices as a basis for derogation from the sanctity of life principle.

    Title Efficacy of Milnacipran in Patients with Fibromyalgia.
    Date December 2005
    Journal The Journal of Rheumatology
    Excerpt

    Fibromyalgia (FM) is a common musculoskeletal condition characterized by widespread pain, tenderness, and a variety of other somatic symptoms. Current treatments are modestly effective. Arguably, the best studied and most effective compounds are tricyclic antidepressants (TCA). Milnacipran, a nontricyclic compound that inhibits the reuptake of both serotonin and norepinephrine, may provide many of the beneficial effects of TCA with a superior side effect profile.

    Title Momentary Relationship Between Cortisol Secretion and Symptoms in Patients with Fibromyalgia.
    Date December 2005
    Journal Arthritis and Rheumatism
    Excerpt

    OBJECTIVE: To compare the momentary association between salivary cortisol levels and pain, fatigue, and stress symptoms in patients with fibromyalgia (FM), and to compare diurnal cycles of cortisol secretion in patients with FM and healthy control subjects in a naturalistic environment. METHODS: Twenty-eight patients with FM and 27 healthy control subjects completed assessments on salivary cortisol levels and pain, fatigue, and stress symptoms, 5 times a day for 2 consecutive days, while engaging in usual daily activities. Only those participants who adhered to the protocol (assessed via activity monitor) were included in the final analyses. RESULTS: Twenty FM patients and 16 healthy control subjects adhered to the protocol. There were no significant differences in cortisol levels or diurnal cortisol variation between FM patients and healthy controls. Among women with FM, a strong relationship between cortisol level and current pain symptoms was observed at the waking time point (t = 3.35, P = 0.008) and 1 hour after waking (t = 2.97, P = 0.011), but not at the later 3 time points. This association was not due to differences in age, number of symptoms of depression, or self-reported history of physical or sexual abuse. Cortisol levels alone explained 38% and 14% of the variation in pain at the waking and 1 hour time points, respectively. No relationship was observed between cortisol level and fatigue or stress symptoms at any of the 5 time points. CONCLUSION: Among women with FM, pain symptoms early in the day are associated with variations in function of the hypothalamic-pituitary-adrenal axis.

    Title Characterization and Consequences of Pain Variability in Individuals with Fibromyalgia.
    Date December 2005
    Journal Arthritis and Rheumatism
    Excerpt

    A growing body of evidence suggests that real-time electronic assessments of pain are preferable to traditional paper-and-pencil measures. We used electronic assessment data derived from a study of patients with fibromyalgia (FM) to examine variability of pain over time and to investigate the implications of pain fluctuation in the context of a clinical trial.

    Title Biomedical Models of Fibromyalgia.
    Date October 2005
    Journal Disability and Rehabilitation
    Excerpt

    Fibromyalgia (FM) and chronic widespread pain (CWP) are common, but the etiology of these disorders remains poorly understood. A large body of data indicates a neurobiological basis for these disorders, but this information has not been effectively transmitted to many medical professionals.

    Title Fibromyalgia After Motor Vehicle Collision: Evidence and Implications.
    Date September 2005
    Journal Traffic Injury Prevention
    Excerpt

    Assess currently available evidence regarding the ability of a motor vehicle collision (MVC) to trigger the development of fibromyalgia (FM).

    Title Regulating Research and Experimentation: a View from the U.k.
    Date May 2005
    Journal The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics
    Title Predicting Chronic Symptoms After an Acute "stressor"--lessons Learned from 3 Medical Conditions.
    Date February 2005
    Journal Medical Hypotheses
    Excerpt

    Stressful events occur in the lives of millions of individuals each year. Such events, or "stressors", are experiences that threaten personal well-being, and include traumatic events such as motor vehicle collision, infectious illness, and situations such as military deployment. While most individuals recover from such events, others develop persistent somatic symptoms, such as chronic pain and fatigue, and/or psychological disturbances, such as posttraumatic stress disorder. Recent findings from the study of risk factors for the development of chronic somatic symptoms after a traumatic, infectious, or situational stressor suggest that similar pre-event, event-related, and post-event risk factors influence the development of chronic symptoms in each condition. Females, and those with pre-event distress or psychological factors, may be at higher risk of developing chronic symptoms after such events. Regarding the event, or "stressor", it appears as though the intensity or specific characteristics of exposure may be a relatively unimportant predictor of patient outcome. Instead, other factors such as the worry, or expectation, of chronicity may increase the risk of chronic symptom development. After the event, inactivity and time off work appear to increase the risk of chronic symptoms. Health care providers have an important role in emphasizing the benefits of resuming usual activities, and downplaying potential benefits of continuing in the sick role (e.g., time off work, increased family attention). While many aspects of the complex interaction of biological, psychological, and social factors that influence patient outcome after a stressful event remain to be elucidated, it appears that for the present, one of the most important interventions is to continue to emphasize to patients the old saying, "rest makes rust".

    Title The Feasibility of Pain Assessment in the Prehospital Setting.
    Date July 2004
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Excerpt

    OBJECTIVE: To determine the feasibility of prehospital pain measurement among patients 13 years of age or older using a verbal and numeric rating scale and to assess the severity of pain in a prehospital patient population. METHODS: Retrospective cross-sectional study of emergency medical services (EMS) run sheets after the adoption of a universal prehospital pain assessment protocol. Data were abstracted from a sequential (1:4) sample of run sheets from the first three months after adoption of the protocol. Verbal rating scale (VRS) and numeric rating scale (NRS) pain assessment information was obtained, along with demographic, location, and call information. Run sheets without pain assessment underwent structured review and classification according to predefined protocol. Descriptive statistics and 95% confidence intervals were calculated. RESULTS: A total of 1,227 run sheets were reviewed, 582 (47%) of patients were male, and 452 (36%) were 65 years of age or older. A total of 907 (75%) were nontrauma transports and 27 (2%) were unconscious. Among conscious patients, pain was assessed using the protocol in 1,002 of 1,200 (84% [range, 81%-86%]). Among patients reporting pain, 104 of 518 (20% [range, 17%-24%] completed a VRS but not an NRS. The greatest risk factor for no pain assessment was altered mental status (39% of patients not assessed). Forty-eight percent (23 of 48) of patients with altered mental status reporting pain completed a VRS only. Thirty-one percent (range, 28%-34%) of all patients in the sample reported moderate or severe pain. CONCLUSION: Prehospital pain assessment using a VRS and NRS was feasible in this patient population. Further studies are needed to confirm this finding in other settings. Moderate or severe pain was present in approximately 31% of patients.

    Title Rates of At-risk Drinking Among Patients Presenting to the Emergency Department with Occupational and Nonoccupational Injury.
    Date April 2004
    Journal Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
    Excerpt

    OBJECTIVES: To compare the characteristics and rates of at-risk drinking among patients presenting to the emergency department (ED) with occupational and nonoccupational injury. METHODS: Cross-sectional survey of injured patients presenting to a university hospital ED. Injured patients were prospectively identified, and consenting patients completed a survey including questions regarding quantity/frequency of alcohol use, TWEAK, CAGE, and work-relatedness of injury. Major trauma and motor-vehicle collisions were excluded. Demographic and injury information was obtained from the medical record. Patients with a TWEAK score > or =3, CAGE score > or =2, or who exceeded NIAAA quantity/frequency guidelines were defined as at-risk drinkers. Analysis utilized the Student t-test for continuous variables, and frequency and chi-square analysis for categorical variables. RESULTS: Among 3,476 enrolled patients, 766 (22%) had work injuries and 2,710 (78%) had nonwork injuries. Patients with work injuries were as likely as patients with nonwork injuries to be at-risk drinkers; 35% of patients with an occupational injury and 36% of those with a nonoccupational injury were at-risk drinkers (odds ratio = 0.96). CONCLUSIONS: Patients presenting to the ED with an occupational injury have rates of at-risk drinking similar to other injury patients, and may be an important group in which to target brief alcohol interventions.

    Title Human Rights, Reproductive Freedom, Medicine and the Law.
    Date February 2004
    Journal Medical Law International
    Title Visual Analog Pain Scores and the Need for Analgesia.
    Date January 2004
    Journal Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
    Title Interventions in the Human Genome.
    Date October 2003
    Journal The Modern Law Review
    Title The Epidemiology of Pain in the Prehospital Setting.
    Date February 2003
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Excerpt

    OBJECTIVE: To develop national estimates of the epidemiology of pain in the prehospital setting. METHODS: Cross-sectional data on a probability sample of 21,103 emergency department (ED) visits from the 1999 National Hospital Ambulatory Medical Care Survey were analyzed. For patients arriving by ambulance, the frequencies (95% confidence intervals) of patients presenting with no level of pain reported (data unknown or missing) and those reporting no, mild, and moderate or severe pain were determined. The reasons for visit among those with moderate or severe pain, and the ED narcotic analgesic use among those with pain information reported and not reported, were also determined. RESULTS: Of the 102.8 million patients visiting the ED in 1999, 14.5 million arrived by ambulance. Fifty-three percent (49-58%) were female. Seven million six hundred thousand [52% (48-56%)] had no information on presenting level of pain reported, 2.0 million [14% (2-25%)] had no pain, 2.0 million [14% (3-25%)] had mild pain, and 2.9 million 120% (12-29%)] had moderate or severe pain. Among those with moderate or severe pain, the most common reasons for visit were injuries 27% (11-43%) and non-injury musculoskeletal symptoms 18% (0-39%). Narcotic analgesics were ordered or continued in 13% (0-29%) of those with no presenting level of pain recorded and 21% (9-34%) of those for whom the presenting level of pain was recorded. CONCLUSION: Pain is a common condition among prehospital patients: 20% reported moderate to severe pain. Given the use of narcotic analgesics among those for whom pain information was not reported, this is likely a conservative estimate.

    Title Post-mortem Human Reproduction: Legal and Other Regulatory Issues.
    Date September 2002
    Journal Journal of Law and Medicine
    Excerpt

    Increasingly women are seeking to establish pregnancies using sperm retrieved from their dead or dying partners. This raises a number of issues of a broad nature, but is also of significance in terms of the relationship between regulatory mechanisms and private choices. This article reviews this relationship with specific reference to the United Kingdom position, but also taking account of case law and regulation in Australia, particularly in the State of Victoria.

    Title Emergency Medical Services Outcomes Research: Evaluating the Effectiveness of Prehospital Care.
    Date August 2002
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Title Commentary on Glannon and Ross, and Mckay.
    Date July 2002
    Journal Journal of Medical Ethics
    Excerpt

    The patient-doctor relationship has recently come under intense scrutiny, resulting in a re-evaluation of the basis of that relationship. The papers by Glannon and Ross, and McKay seek to identify the sources of authority in the patient-doctor relationship by evaluating it in terms of the concept of altruism. In this paper I argue that the analysis of Glannon and Ross, and of McKay is unnecessary and that the analysis offered by the latter is also flawed. I do acknowledge, however, that Glannon and Ross's description of doctors' responsibilities and patients' roles has much to commend it.

    Title Isolated Fluid in the Cul-de-sac: How Well Does It Predict Ectopic Pregnancy?
    Date February 2002
    Journal The American Journal of Emergency Medicine
    Excerpt

    We examined the risk of ectopic pregnancy among patients with isolated abnormal cul-de-sac fluid at transvaginal ultrasound. We conducted a retrospective cohort study of all ED patients presenting January 1995 to August 1999 with abdominal pain or vaginal bleeding and a positive beta-hCG test. The risk of ectopic pregnancy in patients with a moderate volume of anechoic fluid was compared with those with either a large volume of anechoic fluid or any echogenic fluid. Ectopic pregnancy was diagnosed in 16/38: 42%(95% CI 26%-59%) of patients with isolated cul-de-sac fluid, 5/23: 22% (95% CI 7%-42%) of patients with moderate amount of anechoic fluid, and 11/15: 73% (95% CI 45%-92%) of patients with a large volume of fluid or any echogenic fluid. These differences were significant (P =.005). Patients with isolated abnormal cul-de-sac fluid are at moderate risk for ectopic pregnancy. The risk increases if the fluid is echogenic or the volume is large.

    Title Permanent Vegetative State and the Law.
    Date October 2001
    Journal Journal of Neurology, Neurosurgery, and Psychiatry
    Title The Impact of Changes in Hcfa Documentation Requirements on Academic Emergency Medicine: Results of a Physician Survey.
    Date October 2001
    Journal Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
    Excerpt

    BACKGROUND: The Health Care Financing Administration (HCFA) has dramatically increased documentation and procedural supervision required by faculty in academic emergency departments (EDs). OBJECTIVES: To determine academic emergency medicine (EM) physicians' perceptions of the impact of HCFA documentation requirements (HDR) on teaching time, clinical efficiency, and job satisfaction. METHODS: An observational cross-sectional study was done using a survey of New England academic EM faculty from September to December 1999. E-mail surveys were followed by hard copy to nonresponders. Teaching time, clinical efficiency, and job satisfaction were rated on a five-point Likert scale. Yes/no questions about other possible benefits of HCFA regulations were asked. Frequency (95% CI) and chi-square analyses were performed. RESULTS: One hundred seventy-four of 233 (75%) responded. Eighty-nine percent (95% CI = 84% to 93%) of the respondents thought teaching time was somewhat or markedly decreased by changes in HDR (somewhat 46%, markedly 43%). Seventy-nine percent (95% CI = 73% to 85%) believed clinical efficiency was somewhat or markedly decreased by changes in HDR (somewhat 49%, markedly 30%). Eighty percent (95% CI = 73% to 86%) reported somewhat or markedly decreased job satisfaction due to changes in HDR (somewhat 56%, markedly 24%). Twenty-one percent (95% CI = 15% to 27%) believed changes in HDR had improved patient care by requiring increased patient supervision. Forty-eight percent (95% CI = 40% to 56%) thought that changes in documentation requirements had decreased medicolegal risk by improving patient documentation. CONCLUSIONS: Most academic EM physicians in New England perceive that HDR have decreased clinical efficiency, teaching time, and job satisfaction. These findings suggest that changes in HDR may have a substantial impact on many different aspects of emergency care provided in academic settings.

    Title Lidocaine-induced Conduction Disturbance in Patients with Systemic Hyperkalemia.
    Date December 2000
    Journal Annals of Emergency Medicine
    Excerpt

    We report 2 cases in which lidocaine, given for wide-complex tachycardia in the presence of hyperkalemia, precipitated profound conduction disturbance and asystole. The electrophysiologic effects of hyperkalemia and its interaction with lidocaine are reviewed. In patients with known hyperkalemia and wide-complex tachycardia, treatment should be directed at hyperkalemia, rather than following treatment algorithms for wide-complex tachycardia.

    Title Withholding and Withdrawing Life-prolonging Treatment.
    Date March 2000
    Journal Medical Law International
    Title Loop Electrosurgical Excision Procedure for Partial Upper Vaginectomy.
    Date January 2000
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVES: Partial upper vaginectomy consists of removal of the vaginal apex and is indicated for the diagnosis and treatment of vaginal intraepithelial neoplasia and recurrent cancer. We present a novel surgical approach to partial upper vaginectomy by use of the loop electrosurgical excision procedure. STUDY DESIGN: A total of 15 consecutive patients with abnormal vaginal cytologic results were treated by the loop electrosurgical excision procedure for partial upper vaginectomy. After submucosal injection of local anesthetic, the loop electrode was used to resect the upper third of the vagina. An iodoform vaginal pack was placed for 24 hours. All patients with high-grade vaginal intraepithelial neoplasia received intravaginal 5-fluorouracil cream postoperatively. RESULTS: The mean blood loss was 0 mL, and the mean surgical time was 30 minutes. A complication developed in 1 patient (7%). One case of invasive carcinoma was diagnosed. No recurrences have developed in any patients with vaginal intraepithelial neoplasia after hysterectomy. CONCLUSIONS: The loop electrosurgical excision procedure for partial upper vaginectomy can be performed quickly, with minimal blood loss, minimal complications, and minimal recurrence of neoplasia, and it provides a histologic specimen for evaluation.

    Title Legal and Ethical Aspects of the Vegetative State.
    Date January 2000
    Journal Journal of Clinical Pathology
    Excerpt

    The diagnosis of persistent or permanent vegetative state (PVS) raises ethical and legal problems. Strict adherence to the doctrine of the sanctity of life would require carers to continue to maintain the individual, perhaps for many years. However, few would regard this as an appropriate outcome when the person clearly has no capacity to interact with the environment and has no likelihood of recovery. However, the ethical and legal commitment to the sanctity of life has led courts to employ a variety of approaches to this situation in order to find a way in which the person in PVS can be allowed to die. It is argued that each of the approaches is disingenuous and ultimately unhelpful. What the law is doing is endorsing non-voluntary euthanasia, but dressing it up as something else. This is unhelpful for all concerned and the time has come for a review of all end of life decisions so that doctors, patients, and relatives can make honest decisions without fear of legal reprisal.

    Title Dialysis Treatment Withdrawal--legal Aspects (uk).
    Date August 1998
    Journal Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
    Title Genetic Screening of Children: The U.k. Position.
    Date March 1997
    Journal The Journal of Contemporary Health Law and Policy
    Title Research Ethics Committees: Principles and Proposals.
    Date January 1996
    Journal Health Bulletin
    Title Legal and Ethical Considerations of the Human Genome Project.
    Date April 1995
    Journal Medical Law International
    Title Mapping the Human Genome--friend or Foe?
    Date January 1995
    Journal Social Science & Medicine (1982)
    Excerpt

    The Human Genome Project represents one of science's most significant advances. It offers to individuals and communities the capacity to make informed and autonomous decisions. However, it also poses fundamental questions which, it is argued, should be in contemplation now. If mechanisms for the resolution of these issues are not in place before the conclusion of the project, and are not available to guide and control its progress, individual privacy may be seriously affected. Employers, insurers and many other groups may seek access to information which would otherwise be confidential to the individual; families may be torn apart by the information held by one member in respect of the collective gene pool of the family unit. The law has a key role to play in encouraging the sensible use of this information, whilst at the same time protecting individuals and their rights.

    Title Antigenic Variants of Plasmodium Chabaudi Chabaudi As and the Effects of Mosquito Transmission.
    Date July 1993
    Journal Parasite Immunology
    Excerpt

    Previous results, using a passive transfer assay, have shown that recrudescences of Plasmodium chabaudi chabaudi AS strain are antigenically different from the infecting parental population and also that the recrudescence appears to be a mix of antigenic types. This present study examines further these recrudescent populations using an indirect fluorescent antibody test on live, schizont-infected red blood cells. This analysis shows that ten clones derived from a recrudescence are all antigenically different from the parent population and that some are different from each other. The use of this method to examine the antigenic types of recrudescent clones after transmission through mosquitoes also demonstrates a resulting change in antigenicity. Such results showing a link between mosquito transmission and varying antigenicity may have important implications in terms of immunity and vaccine development.

    Title Early Appearance of Variant Parasites in Plasmodium Chabaudi Infections.
    Date May 1990
    Journal Parasite Immunology
    Excerpt

    Previous studies have shown that the recrudescence parasitaemias seen in mice infected with Plasmodium chabaudi AS strain are antigenically different from the infecting parent population. Antigenic differences between recrudescent and parent populations were demonstrated in a passive transfer assay. In the present study, using the same assay system, it has been shown that in some mice, variant parasites (i.e. different from the parent population) can be detected at a time when the primary parasitaemia is still patent but in remission. This is the first report in Plasmodium of variant parasites being detected during the course of a patent primary parasitaemic episode of an infection initiated with a cloned line.

    Title Host Diet in Experimental Rodent Malaria: a Variable Which Can Compromise Experimental Design and Interpretation.
    Date September 1989
    Journal Parasitology
    Excerpt

    Over the past few years several experienced groups studying malaria have encountered significant problems with their particular rodent malaria-host system. This has involved, in some cases, periods during which the recovery of cryopreserved parasite stocks and growth of bloodstream parasites was markedly inhibited and, in other cases, periods of drastically increased mortality rates. The common factor linking these incidents was that they coincided with alterations in the experimental animal diet used. The inhibition of growth of cryopreserved stabilates or bloodstream parasites was abolished by supplementation with p-aminobenzoic acid (PABA) or by changing the diet used. Although the suppressive effects of diets lacking PABA on parasite growth have been known for over 30 years, the variation of PABA levels in modern laboratory animal feed concentrates is not well recognized. We have not established the exact cause of increased mortality, but it has been overcome by changing the diet used. We are documenting our experiences with this potential variable to forewarn workers in other laboratories of possible problems inherent in the use of different diets.

    Title The Effect of Mosquito Transmission of Antigenic Variants of Plasmodium Chabaudi.
    Date August 1987
    Journal Parasitology
    Excerpt

    Plasmodium chabaudi AS strain in mice is characterized by an acute primary parasitaemia, and one or more less acute recrudescences. Previous work has shown, using a passive protection assay, that the recrudescent parasites are usually antigenically different from parasites of the parent population with which the mice were first infected. In this study the effect of mosquito transmission on the antigenic expression of recrudescent populations of P. chabaudi was examined. In the first experiments the recrudescent population which was antigenically different from the parent population was uncloned. After transmission through Anopheles stephensi the recrudescent population appeared to revert to an antigenic type similar to that of the parent population. In the second experiment clones from a recrudescent population were mosquito transmitted and again the parasites of the primary patent parasitaemia in the mice, bitten by the infected mosquitoes, had reverted to the parental type. It is suggested that antigenic variants of P. chabaudi AS strain may revert to a basic type after mosquito transmission.

    Title Antigenic Diversity in Babesia Divergens: Preliminary Results with Three Monoclonal Antibodies to the Rat-adapted Strain.
    Date April 1987
    Journal Research in Veterinary Science
    Excerpt

    Three murine monoclonal antibodies were raised against the rat-adapted strain of Babesia divergens. In the indirect fluorescent antibody test (IFAT) the monoclonals did not react with B microti or B bovis. The monoclonals in IFAT gave high titres with the rat-adapted strain of B divergens, but showed variable reactivity with field isolates of the parasite indicating antigenic diversity in this parasite. Two of the monoclonals, as ascitic fluid, were protective against the rat-adapted strain in splenectomised rats.

    Title Antigenic Variation in Plasmodium Chabaudi: Analysis of Parent and Variant Populations by Cloning.
    Date December 1986
    Journal Parasite Immunology
    Excerpt

    Nineteen of 22 recrudescent populations of Plasmodium chabaudi AS strain were found to be significantly less sensitive to the protective activity of pools of immune serum, than the parent population from which they were derived. The immune sera were collected from donor mice which had been infected with the parent population and had just reduced the patent primary parasitaemia to subpatent levels. Clones prepared from the parent population (which had previously been cloned) and recrudescent variant populations were tested for their sensitivity to the immune sera. It was found that all the clones from the parent population were sensitive to the immune sera but some were more sensitive than others and that a recrudescent variant population could include both sensitive and insensitive parasites. Two insensitive clones of the recrudescent population were found to be different from each other.

    Title Consent, Dissent, Cement.
    Date May 1985
    Journal Scottish Medical Journal
    Excerpt

    The patient-doctor relationship has two fundamental components. The first is the application of the skill and knowledge of the doctor in the care of the whole patient and family. The second is the right of the individual to have information about his or her illness or treatment, and to be involved in decision making. This relationship is built on trust and comes sharply into focus in the area of consent to take part in clinical trials. The argument is put forward that the use of written information should be seen as an extension of the communication between the doctor and the patient, and not as a legally restrictive device. The concept of an agreement, both on the part of the doctor and of the patient, to take part in a clinical trial is developed.

    Title Induction of Secondary Antibody Responses to Plasmodium Chabaudi in Vitro.
    Date August 1983
    Journal Clinical and Experimental Immunology
    Excerpt

    Spleen cells and peripheral blood mononuclear cells (PBMC) from mice, which had recovered from infection with Plasmodium chabaudi, were induced to produce anti-P. chabaudi antibody by incubating the cells with P. chabaudi parasitized red cells in Marbrook cultures. The anti-malarial antibody was assayed using the indirect fluorescent antibody test. Spleen cells and PBMC from mice infected 2-4 months previously gave higher antibody titres in culture than similar cells from mice infected a year previously. There was a good correlation between the ability of spleen cells or PBMC to be stimulated to produce antibody in vitro and the ability of mice similar to the cell donors to resist a challenge infection. Some immunity can be adoptively transferred with both spleen cells and PBMC.

    Title Plasmodium Chabaudi: Antigenic Variation During Recrudescent Parasitaemias in Mice.
    Date March 1983
    Journal Experimental Parasitology
    Title Plasmodium Chabaudi: Relationship Between the Occurrence of Recrudescent Parasitaemias in Mice and the Effective Levels of Acquired Immunity.
    Date December 1982
    Journal Experimental Parasitology
    Title Double-isotope Derivative Assay of Methylglyoxal.
    Date May 1972
    Journal Analytical Biochemistry
    Title Human Tissue Legislation And Medical Practice: A Benefit Or A Burden?
    Date
    Journal Medical Law International
    Excerpt

    The scandals surrounding organ removal and retention throughout the United Kingdom provoked several Inquiries and ultimately led to law reform. Although the medical professions were well represented at the Inquiries, little was heard of the voices of those at the 'coal face'. In this scoping study, funded by the Wellcome Trust, we interviewed a number of doctors and others engaged in the uses of human tissue and organs to explore their hopes, concerns and fears about the role of the law in their practices. We found that those involved in transplantation were more aware of, and more actively involve with, the law, whereas others, such as pathologists, had less direct engagement with the law. Most of those we interviewed expressed the hope that law reform would provide much-needed clarity. Although some expressed concern that the law might be over-intrusive, most felt that the placing of authority firmly in the hands of the person him or her self to decide what should happen to their bodies was to be welcomed.

    Title Catechol O-methyltransferase Haplotype Predicts Immediate Musculoskeletal Neck Pain and Psychological Symptoms After Motor Vehicle Collision.
    Date
    Journal The Journal of Pain : Official Journal of the American Pain Society
    Excerpt

    Genetic variations in the catechol-O-methyltransferase (COMT) gene have been associated with experimental pain and risk of chronic pain development, but no studies have examined genetic predictors of neck pain intensity and other patient characteristics after motor vehicle collision (MVC). We evaluated the association between COMT genotype and acute neck pain intensity and other patient characteristics in 89 Caucasian individuals presenting to the emergency department (ED) after MVC. In the ED in the hours after MVC, individuals with a COMT pain vulnerable genotype were more likely to report moderate-to-severe musculoskeletal neck pain (76 versus 41%, RR = 2.11 (1.33-3.37)), moderate or severe headache (61 versus 33%, RR = 3.15 (1.05-9.42)), and moderate or severe dizziness (26 versus 12%, RR = 1.97 (1.19-3.21)). Individuals with a pain vulnerable genotype also experienced more dissociative symptoms in the ED, and estimated a longer time to physical recovery (median 14 versus 7 days, P = .002) and emotional recovery (median 8.5 versus 7 days, P = .038). These findings suggest that genetic variations affecting stress response system function influence the somatic and psychological response to MVC, and provide the first evidence of genetic risk for clinical symptoms after MVC. PERSPECTIVE: The association of COMT genotype with pain symptoms, psychological symptoms, and recovery beliefs exemplifies the pleiotropic effects of stress-related genes, which may provide the biological substrate for the biopsychosocial model of post-MVC pain. The identification of genes associated with post-MVC symptoms may also provide new insights into pathophysiology.

    Title Immunophenotypic Heterogeneity of Primary Sinonasal Melanoma with Aberrant Expression of Neuroendocrine Markers and Calponin.
    Date
    Journal Applied Immunohistochemistry & Molecular Morphology : Aimm / Official Publication of the Society for Applied Immunohistochemistry
    Excerpt

    Primary sinonasal melanoma is an aggressive tumor that often presents a diagnostic challenge owing to its rarity and variable morphology. Unusual immunophenotypic expression of sinonasal melanoma compounds the problem particularly in a limited tissue sample. We studied immunohistochemical patterns of 5 primary sinonasal melanoma using antibodies against pan-cytokeratin, S-100, HMB-45, Melan-A, chromogranin, synaptophysin, neurofilament protein, and calponin and correlated these patterns with histologic appearance. Sinus/nasal mucosa from non-neoplastic cases were stained for Melan-A to evaluate prevalence of melanocytes in the benign mucosa in comparison to the staining pattern of the mucosa adjacent to the tumor. Similar to previous report, small cell pattern appeared to be over represented in the sinonasal melanoma. Small cell population in 4 cases was almost devoid of pigment, and also was either completely negative or only focally positive for S-100. Three cases stained positive for neuroendocrine markers and neurofilament protein bringing olfactory neuroblastoma and small cell neuroendocrine carcinoma in as differential diagnosis. Three cases were focally positive for calponin without spindle cell morphology or desmoplastic reaction. Immunophenotypic heterogeneity along with the unconventional histomorphology of sinonasal melanoma compounds diagnostic problem and warrants a precautionary approach to avoid misinterpretation. It is necessary to apply a broad panel of immunohistochemistry for the purpose of screening when sinonasal melanoma is considered as a differential diagnosis.

    Title Potential Processes Involved in the Initiation and Maintenance of Whiplash Associated Disorders (wad).
    Date
    Journal Spine
    Excerpt

    STRUCTURED ABSTRACT: Study Design. Non systematic review and discussion of the aetiological processes involved in whiplash associated disorders (WAD).Objective. To summarise the research and identify priorities for future research.Summary of Background Data. Whilst there is convergent evidence of a peripheral lesion in some individuals following whiplash injury, in the majority of injured people, a lesion cannot be established with current imaging technology. Therefore it is important to consider processes that underlie the initiation and maintenance of whiplash pain as this may allow for the development and testing of interventions to target these processes and improve outcomes.Methods. A non-systematic review was performed to summarize current knowledge regarding potential aetiological processes involved in the initiation and maintenance of WAD and to identify future research priorities.Results. There are several aetiological processes potentially involved in the initiation and maintenance of WAD. These include augmented nociceptive processing; stress system responses; psychosocial and sociocultural factors. Recent findings also indicate that morphological changes in the neck muscles of injured people show some association with poor recovery but the mechanisms underlying these changes are not clear. Preliminary evidence indicates associations between these processes. Future research priorities include: more sophisticated investigation and analysis of interactions between the various processes; whether the modification of these processes is achievable and if modification can improve health outcomes; to clarify factors involved in the initiation of whiplash pain versus those involved in symptom maintenance.Conclusion. Research to date indicates that there are several physiological and psychological aetiological processes that may underlie the initiation and maintenance of whiplash related pain and disability. Further research is required to determine relationships and interactions between these factors and to determine if their modification is possible and will improve outcomes following injury.

    Title Older Us Emergency Department Patients Are Less Likely to Receive Pain Medication Than Younger Patients: Results From a National Survey.
    Date
    Journal Annals of Emergency Medicine
    Excerpt

    STUDY OBJECTIVE: The purpose of this study is to determine whether older adults presenting to the emergency department (ED) with pain are less likely to receive pain medication than younger adults. METHODS: Pain-related visits to US EDs were identified with reason-for-visit codes from 7 years (2003 to 2009) of the National Hospital Ambulatory Medical Care Survey. The primary outcome was the administration of an analgesic. The percentage of patients receiving analgesics in 4 age groups was adjusted for measured covariates, including pain severity. RESULTS: Pain-related visits accounted for 88,031 (46.9%) ED visits by patients aged 18 years or older during the 7-year period. There were 7,585 pain-related ED visits by patients aged 75 years or older, representing an estimated 3.65 million US ED visits annually. In comparing survey-weighted unadjusted estimates, pain-related visits by patients aged 75 years or older were less likely than visits by patients aged 35 to 54 years to result in administration of an analgesic (49% versus 68.3%) or an opioid (34.8% versus 49.3%). Absolute differences in rates of analgesic and opioid administration persisted after adjustment for sex, race/ethnicity, pain severity, and other factors and multiple imputation of missing pain severity data, with visits by patients aged 75 years and older being 19.6% (95% confidence interval 17.8% to 21.4%) less likely than visits by patients aged 35 to 54 years to receive an analgesic and 14.6% (95% confidence interval 12.8% to 16.4%) less likely to receive an opioid. CONCLUSION: Patients aged 75 years and older with pain-related ED visits are less likely to receive pain medication than patients aged 35 to 54 years.

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