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This paper is based upon a research project designed to investigate the nursing management of pain in the community. A theoretical framework is described which has been designed to encompass the complexities of different types of pain, individual differences in reaction to pain, and to identify key differences between patients who cope with pain and those who do not. The framework is based on a model of stress, the concept of controllability, and contemporary learning theory. It identifies a unique role for the nurse in pain management and will be used to direct a study into strategies which nurses can use to enhance the coping abilities and resources of elderly patients in the community with pain. [ABSTRACT FROM AUTHOR]

A randomized, double-blind study of procaine/haematoporphyrin (KH3) has been carried out over two years in a selected population of healthy elderly subjects. The period of study exceeds 500 patient years. The trial population was weighted to contain a larger proportion of subjects aged over 75 years than a standard population; those receiving active KH3 had similar characteristics on entry to those receiving placebo. Over the course of two years, KH3 was shown to be an active substance in that: (a) decrement in the consolidation of new learning was prevented in the treatment group (less than 1.0%, as against 38% in the placebo group); (b) the prevalence of incontinence increased significantly in the placebo group, but not in the active group (P less than 0.05); (c) there was a significant increase in grip strength in the active treatment group (+22%, P less than 0.01 v. placebo); (d) more adverse reactions were observed on treatment with KH3 (P less than 0.005). [ABSTRACT FROM AUTHOR]

A randomized, double-blind study of procaine/haematoporphyrin (KH3) has been carried out over two years in a selected population of healthy elderly subjects. The period of study exceeds 500 patient years. The trial population was weighted to contain a larger proportion of subjects aged over 75 years than a standard population; those receiving active KH3 had similar characteristics on entry to those receiving placebo. Over the course of two years, KH3 was shown to be an active substance in that: (a) decrement in the consolidation of new learning was prevented in the treatment group (<1.0%, as against 38% in the placebo group); (b) the prevalence of incontinence increased significantly in the placebo group, but not in the active group (<0.05); (c) there was a significant increase in grip strength in the active treatment group (+ 22%, <0.01 v. placebo); (d) more adverse reactions were observed on treatment with KH3 (<0.005). [ABSTRACT FROM PUBLISHER]

A double-blind study of the effects of meclofenoxate on memory performance of fit, able, elderly subjects was carried out. A number of performance measures, designed to measure various aspects of memory function were employed. These revealed that meclofenoxate appears to increase the consolidation of new information into long-term memory, but does not affect other aspects of remembering. It was also found that significantly more of the subjects receiving meclofenoxate reported an increased level of mental alertness. [ABSTRACT FROM AUTHOR]

This study is designed to identify factors which influence quality of life for elderly people suffering from painful conditions. It is based upon a theoretical model of control in which mood state is used as the indicator of coping. One hundred and ninety elderly patients took part in semi-structured interviews about their pain and coping experiences, and data were also collected from their nurses in the community. Multivariate statistical analysis revealed that the key determinants of mood were having regrets about the past, being occupied, perceived level of pain control, additional personal problems (notably bereavement) and feeling informed about the painful condition. Active personal coping strategies were identified as more therapeutic than passive strategies. Nurses' data revealed that pain complaints were associated with perceived exaggeration. Few nurses used formal pain assessment. Recommendations for the management of persistent pain in the community are given. [ABSTRACT FROM AUTHOR]

The recall of a five-consonant sequence was tested after retention intervals of 0, 2, 4 and 6 sec. Each subject was tested only once, thus eliminating intra-experimental PI. Two experimental conditions were employed. In one (VV) both the stimulus and interpolated material were presented visually. In the VA condition presentation of the stimulus was visual with auditory presentation of the interpolated material. Significant forgetting occurred in both conditions, VA recall being superior to W. The implications of these results for a unitary theory of memory are discussed. [ABSTRACT FROM AUTHOR]

Unease over the previous management of 67 patients referred for treatment to 3 pain relief clinics led us to investigate the current state of education in pain and pain control in the UK. Twenty-seven medical schools provided data which revealed; (i) in 4 schools no teaching whatsoever is given in these subjects; (ii) in the remainder it is accorded an average of 3.5 hours during the 5 year course, with little evidence of multidisciplinary teaching; (iii) only 10 schools (37%) regularly set questions on pain control in formal examinations. A survey of 219 general practitioners revealed a wide-ranging lack of knowledge about the facilities and approach to treatment at their local pain relief clinic. These findings have wide reaching implications for medical education. At the undergraduate level they demonstrate a need for more multidisciplinary teaching and practical experience in specialist units. Thereafter specialists in pain control must enable practising doctors to keep abreast of new developments. This may require them to devote more time writing for a non-specialist audience and devising short, postgraduate courses. [ABSTRACT FROM AUTHOR]

Studies the impact of within-sequence acoustic similarity on the short-term retention of words and consonants. Minimum presentation interval necessary to equate the immediate recall of the similar and dissimilar sequences; Theoretical significance to psychology.

Objectives Recurrent varicose veins following surgery is a common, complex and costly problem in vascular surgery. Treatment for RVV is technically more difficult to perform and patient satisfaction is poorer than after primary interventions. Nevertheless, traditional vein surgery has largely been replaced by percutaneous office-based procedures, and the patients with recurrent varicose veins have not benefited from the same advantages. In this paper, we propose an endovascular laser treatment that allows reducing the invasiveness and complications in case of SFJ and SPJ reflux after ligation and stripping of the great and small saphenous vein. Methods 8 SFJ and 1 SPJ stumps were treated by endovascular laser treatment in out-patient clinic. Endovascular laser treatment was performed with a 1470 nm diode laser and a 400 µc radial slim™ fiber. Intraoperative ultrasoud was used to guide the fiber position and the delivery of tumescent anesthesia. The gravity of chronic venous disease was determined according to the CEAP classification and the severity of symptoms was scored according to the revised Venous Clinical Severity Score (VCSS). Results The average linear endovenous energy density was 237 J/cm. Patients return to daily activities after a mean of 1.9 days after. The VCSS improved drastically from a mean of 8 pre-interventional to 1 at day 30 and until one year. During the follow-up period (mean 8 months, range: 5-17 months), all the stumps except one were occluded. All patients were very satisfied or satisfied with the method. No severe complications occurred. Conclusions Office-based endovascular laser treatment of groin and popliteal recurrent varicose veins with 1470 nm diode laser and radial-slim fiber is a safe and highly effective option, with a high success rate in the early post-operative period.

Aim: Endovenous laser treatment (EVLT) is an accepted form of axial vein ablation for symptomatic venous reflux but its role in the treatment of anterior accessory saphenous vein (AASV) has not been well characterized. The aim of this paper is to show the short-term result of EVLT with a ball-tipped fiber and a 1540 nm diode laser of the AASV with preservation of a competent great saphenous vein (GSV)., Methods: Nine incompetent AASV veins in 8 patients (6 female) were treated. The gravity of chronic venous disease was determined according to the CEAP classification and the severity of symptoms was scored according to the revised Venous Clinical Severity Score. Patient satisfaction was assessed by a 0 to 3 scale., Results: The average linear endovenous energy density was 60.5 J/cm vein (SD: 7.5). Patients returned to daily activities after a mean of 3.8 days (SD: 1.4). 5 patients (63%) have had pain but of mild intensity. No patients developed paresthesia or phlebitis reactions in the treated area. Post-operative ecchymoses are frequent (89%). During the follow-up period (mean 13 months, range: 7-17 months) all the veins were occluded. The VCSS improved drastically from a mean of 3.2 (SD: 1.3) preinterventional to 0 (SD: 0.38) at 17 months. All patients were satisfied or very satisfied with the method. No severe complications occurred., Conclusion: EVLT of an incompetent AASV with a 1540 nm diode laser is a safe and efficient therapy option, with a high success rate and with no evidence of GSV neo-reflux or recurrent varicosities during the follow-up period.

Background: In recent years, laser systems with higher wavelengths, associated with new optical fibers, have shown excellent short-term results in treating saphenous veins and reducing the side effects and, in particular, the postoperative pain. However, if the patients are not anesthetized, they may feel pain even when using low energy with the high-wavelength laser; the only tumescent local anesthesia often does not guarantee a complete pain control during endovenous laser ablation (EVLA). Aim of this study was to demonstrate that the local anesthesia during EVLA of great saphenous veins (GSVs) is not essential for the perioperative comfort of the patient if a mild sedation is made., Methods: Forty-nine incompetent GSVs were treated by EVLA with a cold saline tumescent solution (CSTS) without local anesthetic drugs. EVLA was performed with a 1540-nm diode laser and a 600-μc ball-tipped fiber. Intraoperative ultrasonography was then used to guide delivery of CSTS (cold saline solution 0.9% at 5°C) using a motor pump under intravenous sedation. The gravity of chronic venous disease was determined according to the clinical-etiology-anatomy-pathophysiology classification. Patients rated surgery global pain according to 4 types: "extremely," "rather," "slightly," and "not at all" painful., Results: Twenty-five cases (51%) were classified as C3, 20 (41%) as C2, 6 (13%) as C4, and 1 (2%) as C6. Midazolam 2.5 mg + a mean of 0.16 mg of fentanil (minimum: 0.10; maximum: 0.20; standard deviation [SD]: 0.4) + a mean of 178.21 mg of propofol (minimum: 100; maximum: 300; SD: 47.1) were administrated as intravenous sedation. The total average linear endovenous energy density was 57.7 J/cm. Approximately 250 mL (minimum: 100; maximum: 780) of CSTS was administered. No Patient has had pain during the procedure. All patients were discharged 2.5 hrs after surgery., Conclusions: EVLA under sedation using CSTS without diluted anesthetic drugs is a suitable technique in an outpatients clinic, especially useful if the ablation of the saphenous vein is combined with an extended phlebectomy or if a bilateral treatment is performed, to eliminate the risks of overdose with local anesthesia and with the aim of improving the comfort of the patient., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Endovenous laser ablation (EVLA) is an efficient method to treat incompetent saphenous veins with high occlusion rates. The major side effects are postoperative pain and bruising. Laser systems with higher wavelengths, associated with new energy delivery devices, have recently shown excellent short-term results, while reducing the previously reported side effects. The aim of this study is to show the first outcome after EVLA of incompetent saphenous veins with a newly developed ball-tipped fiber and a new wavelength 1,540-nm diode laser., Methods: Forty-five incompetent saphenous veins in 35 patients (27 women) were treated: 33 great saphenous veins, 6 short saphenous veins, and 6 anterior saphenous veins. The gravity of chronic venous disease was determined according to the clinical-etiology-anatomy-pathophysiology (CEAP) classification, and the severity of symptoms was scored according to the revised Venous Clinical Severity Score. Patient satisfaction was assessed on a 0-3 scale., Results: The average linear endovenous energy density was 63.5 J/cm of vein length. Patients returned to daily activities after a mean of 1.7 days (SD: 2) after treatment. The modified CEAP clinical severity score improved drastically from a preintervention mean of 4.9 (SD: 2.6) to 0.17 (SD: 0.38) at day 30. During the follow-up period (mean: 168 days [range: 90-240 days]), all the veins were occluded. All patients except 1 were satisfied or very satisfied with the method. No severe complications occurred. Two patients (5%) developed mild paresthesia in the treated area, which spontaneously resolved after 3 months. Postoperative ecchymoses are frequent (83%). Sixteen patients (43%) experienced pain, but only 5 patients (14%) described it as quite intense and required analgesic therapy., Conclusion: EVLA of saphenous veins with a 1,540-nm diode laser using a ball-tipped fiber is a safe and efficient therapy option, with a high success rate in the early postoperative period., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To estimate the prevalence of self-reported sleep disorders (SD), to examine associations among demographic characteristics and familiar factors with SD, between SD and daytime sleep-related disorders (DD) and between evening habits and SD., Methods: An anonymous questionnaire was proposed to 1563 students (aged 14-21 years, mean age 16.5 +/- 1.5; 42.8% males, 57.2% females) attending all classes of two high schools in Verona (North-East of Italy). Data were analyzed by some personal and familial characteristics, by definition of three sleeper groups (non problem, occasional problem or problem-sleepers). Moreover SD were put in relation with DD and with some personal evening attitudes., Results: The 75.5% of the subjects report at least one SD. Difficulty falling asleep is the most frequent SD. The DD concern 91.2% of the sample. Females are more involved than males in SD and DD. All SD result strongly associated with the referred DD, except for sleepiness. Sport is significantly correlated with a minor prevalence of SD. Smoking and studying appear to be associated with SD., Conclusions: Since SD in youth constitute an important Public Health matter with a severe social impact they would be accurately studied to offer youth appropriate counselling given the importance of lifestyle in determining good sleep.