Background: Dementia patients are at an increased risk for undertreatment of pain, compared with older people without dementia, suggesting a relationship between pain medication prescription and cognitive functioning. Studies on a possible relationship between pain medication and cognitive functioning in dementia patients are ambiguous. Objective: The objective of the study ...

Many elderly people experience pain and regularly take analgesic medication. Pain is also frequent in people with dementia, particularly those with severe disease. As no robust clinical guidelines are available for the treatment of pain in the context of dementia, the risk of inadequate treatment in individuals with this condition ...

Aims.  The goal of this brief review is to address studies examining the relationship between physical inactivity and pain in aging and dementia. Background.  A decrease in the level of physical activity is characteristic of older persons, both with and without dementia. Passive behaviour is often considered to be part ...

INTRODUCTION: Ageing, a common background in dementia, is usually associated with painful disorders. Nevertheless, the use of analgesics is limited due to poor communication. On the other hand, dementia lesions are placed in the nociceptive pathways. For this reason, the painful experience becomes different and distinctive for every lesional type. ...

The presentation and management of pain in older adults with dementia are highly complicated. This article addresses assessment challenges and nonpharmacological and pharmacological management strategies related to pain in those with dementia. Vigilant monitoring of comfort level and the effective use of multidimensional pain management strategies could substantially increase quality ...

Aggression is a common form of behavioral disturbance in dementia. Strategies to prevent and treat aggressive behavior are underdeveloped. However, recent work points to several modifiable risk factors that may be targets for intervention. Pain management is an evidence-based, feasible, but potentially underused, strategy that may be incorporated with other ...

Monroe T., Carter M., Feldt K., Tolley B. & Cowan R.L. (2012) Assessing advanced cancer pain in older adults with dementia at the end-of-life. Journal of Advanced Nursing00(0), 000-000.doi: 10.1111/j.1365-2648.2011.05929.x ABSTRACT: Aim.  To assess advanced cancer pain in older adults with dementia at the end-of-life. Background.  Self-report is the gold ...

Peritoneal dialysis (PD) is one of the commonly used choices of continuous renal replacement therapies. Peritoneal membrane is damaged by using solutions with lower biocompatibility, peritonitis episodes, and vintage of PD therapy. Encapsulating peritoneal sclerosis (EPS) is a rare complication of PD and is presented by progressive fibrosis of the ...

PURPOSE: The aim was to present current knowledge about pain assessment in people with dementia and to discuss special challenges and possible solutions. METHODS: A literature search in MEDLINE® was performed. RESULTS: Due to the changing demographics of an aging population, an increasing number of people with dementia is expected. ...

Various proposed algorithms for identifying orofacial pain in those with dementia, but they may lack validity and reliability.

Chest pain is the most common medical complaint among cocaine-using emergency department (ED) patients. Correlates of substance abuse treatment seeking were examined using 3-month post-discharge surveys from 170 ED patients admitted with cocaine-related chest pain. Four treatment categories were specified as the dependent variable in an ordered logistic regression: no ...

To evaluate the variation in tolerance to wireless pH-metry compared with catheter-based pH-metry, and to determine clinical characteristics that might predict reduced tolerance to wireless pH-metry. Consecutive outpatients (n=341) completing wireless (n=234) or catheter-based pH-metry (n=106) were evaluated. All patients completed the pH-Metry Impact Scale and the pH-Metry Symptoms Scale ...

There are gender differences in the presentation, diagnosis, and treatment of chest pain. When compared to men, women may have more atypical presentations of chest pain. In addition, current diagnostic tools are often not definitive regarding cardiac etiology for chest pain in women. The current diagnostic model of chest pain ...

Whether the higher coronary mortality in South Asians compared with White populations is due to a higher incidence of disease is not known. This study assessed cumulative incidence of chest pain in South Asians and Whites, and prognosis of chest pain. Over seven phases of 18-year follow-up of the Whitehall-II ...

Chest pain is a common presentation in the pediatric emergency department (PED). In the majority of cases, no clear medical cause is found. Among adults with noncardiac chest pain, psychopathology including panic disorder is common. We assessed the likelihood and type of psychopathology as well as the health status of ...

Functional chest pain is commonly reproduced by bag distension in the esophageal body. It is unknown whether such pain is primarily associated with mechanical stress and strain (force-deformation) or with changes in mucosal perfusion. Fourteen patients (6M, 8F, average age 55.9 years) underwent ramp bag distension before and after injection ...

Chronic myocardial ischemia often presents with a fairly typical history, but patients can present with atypical chest pain or pain referred to a less-typical location like the jaw, stomach, or back. Sometimes patients describe symptoms usually not attributed to heart disease, like indigestion or feeling cold and clammy, in the ...

Cardiac syndrome X (CSX) is defined as a typical anginal-like chest pain with a transient ischemic electrocardiogram, but without abnormal coronary angiography. It is usually accepted that endothelial dysfunction, inflammation, oxidative stress and estrogen deficiency are the main reasons of CSX. There are some methods to treat CSX including statins, ...

Chest pain is one of the most common symptoms driving patients to a physician's office or the hospital's emergency department. In approximately half of the cases, chest pain is of cardiac origin, either ischemic cardiac or nonischemic cardiac disease. The other half is due to noncardiac causes, primarily esophageal disorder. ...

Thoracic pain and discomfort are symptoms that lead many patients to the presentation in private practice or emergency admissions in hospitals. It is one of the most common complaints in the acute care setting. Attendant symptoms like agitation and fear are often signals of unstableness, but can also be alarming ...

To investigate gender differences in chest pain perception among Chinese patients with acute myocardial infarction. Thrombolytic therapy is beneficial to outcomes of acute myocardial infarction if administered within 12 hours from the onset of chest pain. However, cardiac symptom interpretation may impact time of presentation to hospital. Differences in cardiac ...

Background Decision making in chest pain of uncertain origin is challenging. Objectives To evaluate the predictive value of simple characteristics of pain presentation in patients coming to the emergency department with chest pain and without electrocardiogram ischaemia or raised troponin. Methods 789 patients were studied. The following categorical pain characteristics ...

To investigate the diagnostic efficacy of 24-h and exertional esophageal pH-metry and manometry in patients with recurrent chest pain. The study included 111 patients (54% male) with recurrent angina-like chest pain, non-responsive to therapy with proton pump inhibitors. Sixty-five (59%) had non-obstructive lesions in coronary artery angiography, and in 46 ...

The effect of myotomy for achalasia on chest pain has not been clarified. The current study aimed to investigate the therapeutic effect of laparoscopic myotomy on chest pain associated with achalasia and to identify prognostic factors for outcomes. Between March 2005 and September 2008, 95 patients were available for detailed ...

KEY FINDINGS: The number of noninjury emergency department (ED) visits in which abdominal pain was the primary reason for the visit increased 31.8%. The percentage of ED visits for which chest pain was the primary reason decreased 10.0%. Use of advanced medical imaging increased strongly for ED visits related to ...

Boerhaave's syndrome is a very rare disease characterised by a spontaneous rupture of the oesophagus. It is often misdiagnosed and there is no consensus as to the best treatment. We describe a case of a 61 year-old man without significant previous medical history presenting in the emergency room with acute ...

Cardiac computed tomography (CCT) is a well-validated investigation for the non-invasive assessment of coronary artery disease (CAD). The National Institute for Clinical Excellence (NICE) have recently released guidelines incorporating CCT into the diagnostic algorithm for chest pain of recent onset. To assess the frequency of eligibility for CCT in medical ...

Chest pain in pacemaker patients can be difficult to evaluate due to alterations in QRS and ST segments on the surface ECG. A high prevalence of ischaemic heart disease in this population also serves to influence the differential diagnosis. We highlight four cases, all with simple yet informative imagery, in ...

The case of a woman with progressive substernal chest pain is described. A 55-year-old woman arrived at the emergency department (ED) with a complaint of progressive substernal chest pain. Her medical history included hypertension and dyslipidemia. Upon arrival to the ED, the patient was free of chest pain. A chest ...

Chest pain is a frequent chief complaint among the pediatric population. To date, limited data exist on the full spectrum of emergent cardiac disease among such patients; and existing data have been limited to relatively small cohorts. The aims of the study were to investigate the emergent cardiac etiologies of ...

Chest pain in children is common, but rarely heralds serious underlying cardiac pathology. Despite this, the anxiety of missing a potentially life threatening condition creates a large burden of referrals and diagnostic testing. We evaluated patients diagnosed with 1 of 9 serious cardiac diseases and detailed the clinical signs and ...

We are reporting the case of a 37-year-old immunocompetent patient who presented with anterior chest wall swelling, jaw swelling and pain, back pain, night sweats, and unintentional weight loss. He underwent mediastinoscopy with lymph node biopsy, which revealed caseating and noncaseating granuloma and special stains positive for acid-fast bacteria. Cultures ...

The past decade has brought rapid advances in CT technology, which allows increasingly precise application to the study of coronary arteries and acute chest pain. The literature has expanded to lend quantifiable justification to the intuitive appeal of a rapid, reproducible, 3D study of the heart and vasculature. More complete ...

Cocaine is the only drug to show a rise in misuse between 1996 and 2007 in England and Wales. It can cause chest pain and myocardial infarction. This study assessed the prevalence of cocaine use in patients presenting with chest pain, and determined the association between cocaine use and chest ...

Chest pain, a frequent complaint during childhood, rarely originates from a cardiac pathology. Although it usually is idiopathic, it also could be associated with psychogenic, musculoskeletal, respiratory, and digestive disorders. This study aimed to investigate a possible relation between bone mineral density and chest pain in children. Bone mineral density ...

Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT. We screened a database of patients treated with SBRT between August 2004 and August 2008 to ...

The NICE guidance on recent onset chest pain urges GPs to assess the nature and timing of acute pain rapidly and arrange urgent admission for suspected acute coronary syndrome. A 12-lead ECG should be performed and treatment commenced with 300 mg aspirin and GTN spray. Other pain relief such as ...

Mediastinal teratomas are typically benign and asymptomatic, but they undergo sudden enlargement or rupture into neighboring organs in some patients owing to intratumoral hemorrhage, leading to serious complications. We report the case of a mediastinal mature teratoma that was discovered because of the sudden onset of chest pain accompanied by ...

Patients presenting with acute chest pain without a rise in cardiac troponins are considered to be at low risk of adverse cardiac events and are often considered for early discharge without further inpatient investigation. However, there is evidence that this commonly encountered patient group has a significant rate of early ...

Diagnosing the aetiology of chest pain is challenging. There is still a lack of data on the diagnostic accuracy of signs and symptoms for acute coronary events in low-prevalence settings. To evaluate the diagnostic accuracy of symptoms and signs in patients presenting to general practice with chest pain. Cross-sectional diagnostic ...

BACKGROUND: Many patients present to the emergency department with chest pain. While in most of them chest pain represents a benign complaint, in some patients it underlies a life-threatening illness. OBJECTIVES: To assess the routine evaluation of patients presenting to the ED with acute chest pain by means of a ...

Although beta-blockers prevent adverse events after myocardial infarction, they are contraindicated when chest pain is associated with recent cocaine use. Recommendations against this use of beta-blockers are based on animal studies, small human experiments, and anecdote. We sought to test the hypothesis that beta-blockers are safe in this setting. We ...

This study was designed to assess the application of diagnostic guidelines to the management of chest pain by an observational study carried out in a small town (Ragusa) of southeast Sicily. This study was an attempt to compare a Sicilian experience with the literature. In this observational study, we examined ...

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Should you place one or two chest drains in patients undergoing lobectomy?' Altogether >200 papers were found using the reported search, of which six represented the best evidence to answer the clinical ...

Epipericardial fat necrosis is an uncommon benign entity of unknown cause, with only 20 cases reported in the English-language literature. It should be remembered as a possible diagnosis in a person who presents with acute pleuritic chest pain and paracardiac density or pleural effusion on chest radiography (X-ray). The computed ...

Chest wall syndrome (CWS) is the most frequent aetiology of chest pain in a primary care setting. The aims of the study are to describe the epidemiology, clinical characteristics and prognosis of CWS and to provide a simple decision rule for diagnosis. We included 1212 consecutive patients with chest pain ...

The present study was designed to assess the value of the presenting symptom of "typical" anginal pain, "atypical/nonanginal" pain, or the lack of chest pain in predicting the presence of inducible myocardial ischemia using cardiac stress testing in emergency department patients being evaluated for possible acute coronary syndrome. We performed ...

While acute torsion of the gallbladder is an uncommon pathology, as this case demonstrates, it can present with sudden onset of chest pain, and must be borne in mind as a differential diagnosis in this patient demographic if early recognition and definitive management are to be made possible.

AIM: The purpose of this study was to quantify the difference between the current process flow model for a typical patient workup for chest pain and development of a new process flow model that incorporates DMAIC (define, measure, analyze, improve, control) Six Sigma and evidence-based medicine in a best practices ...

Patients do not always have typical anginal chest pain in case of acute coronary syndromes. Many atypical chest pain forms were found associated with acute coronary syndrome, especially in the upper part of the body. Bilateral thigh pain should be kept in mind as a dissimilar projection of anginal chest ...