With the objective of comparing incidence of adverse events of the opioids codeine, hydrocodone, and tramadol in the relief of cancer pain, we conducted a randomized controlled trial in which patients with cancer were randomly assigned according to a computer-generated schedule to receive one of the three opioids. Of the 177 patients who participated, 62 patients received hydrocodone, 59 patients received codeine, and 56 patients received tramadol. The pain experienced by the participants originated most frequently from the stomach, breast, or prostate gland and was classified as either somatic (33%), visceral (52%), mixed (6%), or neuropathic (9%). At the first visit, 60% of the patients described their pain intensity as moderate (4-6/10), with the remaining 40% of the patients describing their pain as severe (7-10/10). The symptoms most associated with pain were weakness, insomnia. and anorexia. In 77% of the total number of cases, the patient was aware of his/her diagnosis prior to admittance to the palliative care unit. Of the total number of cases, 57% fell in the age range of 60-89 years old and 50% of the participants were female. No significant statistical difference in the analgesic efficacy of the three opioids was found (p: 0.69; chi(2): 0.73). Use of tramadol produced higher rates of adverse events than codeine and hydrocodone: vomiting, dizziness, loss of appetite, and weakness (p< 0.05).
Institutional review board approval was received and informed consent was not required for this Health Insurance Portability and Accountability Act-compliant study. The purpose of this study was to retrospectively assess the time efficiency of three-dimensional volume-rendered images obtained from multi-detector row computed tomographic data for the diagnosis of peroneal tendon subluxation or dislocation by using the consensus interpretation of multiplanar reformatted (MPR) images as the reference standard. The reference standard was provided by two musculoskeletal radiologists, and two less experienced readers evaluated 37 images in 32 patients (24 men, eight women; mean age, 41 years; age range, 18-75 years) with acute calcaneal fractures. An analysis of variance was used to compare interpretation time, and the Wilcoxon signed rank test was used to analyze diagnostic difficulty. The average time required for diagnosis was significantly shorter with volume-rendered images than with MPR images (reader 1: 42 vs 78 seconds, P<.001; reader 2: 50 vs 69 seconds, P<.01).
There was no superior analgesic efficacy with the administration of hydrocodone/acetaminophen when compared to patients receiving tramadol in the relief of cancer pain. Tramadol produced more mild side effects than hydrocodone.
How should the governance system in a non-membership non-profit organization be designed? This organizational form has no shareholders; instead, donors provide funds. Thus, at the organizational level, the board of directors could have all the power. Under this legal form, who controls the board? If too powerful, boards could misuse resources or distract the organization from its foundational goals. We examine the case of private higher education institutions (HEIs) in Colombia and the balance of power in university governance systems which feature this organizational form. Most HEIs in our sample have a kind of assembly of representatives as the governance body with the highest authority and able to appoint and control the board. We specifically discuss the assemblies' reason for being, structure, and functions in private HEIs in Colombia. We analyze a total of 204 HEI governance structures and find governance arrangements with the characteristics of an assembly of representatives in 154 (75.9%). Our analysis highlights features in some of these governance bodies that could lead to overly powerful assemblies (e.g., founder donors with tenure for life). Clearly, a proper balance of power is required to avoid rent-seeking behaviors or the pursuit of harmful private non-monetary benefits from assembly members as well as boards.High Educ (2018) 75:909-924
Lymphoscintigraphy and radionuclide venography were performed as part of the diagnostic workup in a patient with chylothorax and no history of trauma or surgery. Lymphoscintigraphy revealed accumulation of tracer in the left chest wall and lung, and radionuclide venography demonstrated vena cava thrombosis. Chylothorax was felt to be secondary to central venous obstruction in this patient with a history of AIDS and cirrhosis. CT of the chest confirmed thrombosis of the superior and inferior vena cava. Lymphoscintigraphy and radionuclide venography are noninvasive methods useful in the workup of patients with chylothorax.
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