RESUMEN
BACKGROUND: The Advisory Committee on Immunization Practices advocates that influenza immunization is the most effective method for prevention of illness due to influenza. Recommendations for vaccination of children against influenza have been revised several times since 2002, and as of 2008 include all children 6 months to 18 years of age. Nevertheless, influenza immunization rates have remained low. METHODS: We surveyed practicing pediatricians in Maryland in the spring of 2007 to determine their attitudes and practices toward childhood influenza immunization. RESULTS: The overall response to the survey was 21%. A total of 61% of respondents reported that immunization either is cost neutral or produces a loss, and 36.6% noted it was minimally profitable. Eighty-six percent of respondents were receptive to supporting school-based immunization programs, and 61% indicated that they would participate in such programs. Respondents reported higher rates of immunization of select patient groups than those noted by the Centers for Disease Control and Prevention CONCLUSION: Vaccination was reported to occur at multiple types of patient encounters, as recommended. Survey respondents stated that practice-based immunization was not a profitable service. Pediatricians were supportive of school-based immunization programs, and more than half stated they would be actively involved in such programs. School-based programs may be critical to achieving high vaccination coverage in the school-aged population.
Asunto(s)
Inmunización/estadística & datos numéricos , Vacunas contra la Influenza/administración & dosificación , Pediatría/estadística & datos numéricos , Médicos/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Actitud del Personal de Salud , Niño , Femenino , Adhesión a Directriz , Encuestas de Atención de la Salud , Humanos , Programas de Inmunización/organización & administración , Masculino , Maryland , Persona de Mediana Edad , Servicios de Salud Escolar/organización & administración , Vacunación/métodos , Vacunación/normas , Recursos HumanosRESUMEN
Nine randomized clinical trials, including approximately 25,000 children aged 6-71 months and 2000 children aged 6-17 years, have evaluated the efficacy of live attenuated influenza vaccine (LAIV) against culture-confirmed influenza as compared to placebo or trivalent inactivated vaccine (TIV). We conducted meta-analyses, based on Mantel-Haenszel relative risks from fixed effect models, to provide an estimate of vaccine efficacy (VE). Relative to placebo, year 1 VE for two doses in vaccine-naïve young children was 77% (95% CI: 72%, 80%; P<0.001) against antigenically similar strains and 72% against strains regardless of antigenic similarity. Efficacy was 85%, 76%, and 73% against antigenically similar A/H1N1, A/H3N2, and B, respectively. Year 1 VE of one dose against antigenically similar strains in vaccine-naive children was 60%; efficacy of one dose in previously vaccinated children in year 2 of the various studies was 87%. In head-to-head trials comparing two doses of TIV and LAIV, vaccine-naïve children who received two doses of LAIV experienced 46% fewer cases of influenza illness caused by antigenically similar strains. Similarly, for studies including older children who had been previously vaccinated, those receiving one LAIV dose experienced 35% fewer cases of influenza illness than those receiving one TIV dose. LAIV showed high VE versus placebo with no evidence of difference by age or by circulating subtype. In these studies, LAIV was more effective than TIV.
Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/inmunología , Subtipo H3N2 del Virus de la Influenza A/inmunología , Virus de la Influenza B/inmunología , Vacunas contra la Influenza/inmunología , Gripe Humana/prevención & control , Adolescente , Niño , Preescolar , Ensayos Clínicos como Asunto , Humanos , Incidencia , Lactante , Gripe Humana/inmunología , Placebos , Ensayos Clínicos Controlados Aleatorios como Asunto , Vacunas Atenuadas/inmunologíaAsunto(s)
Amifostina/uso terapéutico , Neoplasias de Cabeza y Cuello/radioterapia , Glándula Parótida/efectos de la radiación , Protectores contra Radiación/uso terapéutico , Xerostomía/prevención & control , Relación Dosis-Respuesta en la Radiación , Humanos , Glándula Parótida/diagnóstico por imagen , Cintigrafía , Radioterapia de Intensidad Modulada/efectos adversos , Glándulas Salivales/diagnóstico por imagen , Glándulas Salivales/efectos de la radiación , Salivación/efectos de la radiación , Xerostomía/etiologíaRESUMEN
UNLABELLED: The Neuropathic Pain Scale (NPS) is a valid measure of the pain qualities and perceived depth of neuropathic pain. However, it does not include a number of pain qualities commonly seen in some neuropathic and non-neuropathic pain conditions. To address this limitation, additional items were added to the NPS to create a 20-item measure (Pain Quality Assessment Scale, PQAS) that would be even more useful for assessing neuropathic pain and also would be used to assess pain qualities associated with non-neuropathic pain. To evaluate the responsivity of the PQAS items to pain treatment, secondary analyses were conducted on data from a trial that compared the efficacy of lidocaine patch 5% versus a single steroid injection in 40 patients with carpal tunnel syndrome. Statistically significant (P < .0025) decreases in 10 of the 20 PQAS pain descriptor ratings occurred with both treatments, and 8 ratings showed nonsignificant trends (.0025 < P < .05) for decreasing before treatment to after treatment. No significant differences were found between the 2 treatment conditions on any of the items. The results support the validity of the PQAS items for assessing the effects of pain treatment on pain qualities of carpal tunnel syndrome. PERSPECTIVE: Clinical trials that include measures of pain qualities can be used to identify the effects of treatments on distinct pain qualities. Measures such as the PQAS can potentially be used to help clinicians target analgesics more efficiently.
Asunto(s)
Síndrome del Túnel Carpiano/psicología , Dimensión del Dolor , Dolor/psicología , Administración Tópica , Adolescente , Adulto , Anciano , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Síndrome del Túnel Carpiano/complicaciones , Síndrome del Túnel Carpiano/tratamiento farmacológico , Interpretación Estadística de Datos , Femenino , Humanos , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Dolor/tratamiento farmacológico , Dolor/etiologíaRESUMEN
UNLABELLED: Although pain is acknowledged to be a multidimensional experience that can vary in intensity, quality (eg, burning, sensitive), and spatial characteristics (eg, location on body, perceived depth), its qualitative and spatial domains continue to be rarely assessed in pain clinical trials. One factor that may be contributing to the relatively rare assessment of pain quality and spatial characteristics is the lack of research addressing whether knowledge about these aspects of pain contributes important information beyond that provided by pain intensity alone. For example, there is no research that has examined whether measures of pain quality and perceived depth add anything to the understanding of the impact of pain on function. In the current study, secondary analyses of pretreatment data from clinical trials of patients from 3 diagnostic groups (osteoarthritis, low back pain, and peripheral neuropathy) indicated that measures of pain quality and perceived depth were significantly associated with pain interference with functioning, independent of global pain intensity and unpleasantness. No single pain descriptor emerged as universally important, however, although the findings suggest that: 1) sharp, deep, and perhaps especially sensitive pain may be important in patients with painful peripheral neuropathy; 2) sharp, sensitive, itchy, deep, and surface pain may be key pain descriptors important to persons with low back pain; and 3) perhaps deep pain may be the sole key pain descriptor important among persons with osteoarthritis. The findings support the potential utility of including measures of specific pain qualities and perceived depth in pain clinical trials and provide an initial empirical basis for determining which pain descriptors may be most closely linked to patient functioning. PERSPECTIVE: Specific pain qualities, such as sharp, sensitive, and itchy pain, and perceived depth of pain appear to play a significant and unique role in the prediction of pain interference in addition to global pain intensity and unpleasantness. These findings suggest that measures of these specific pain domains could play an important role in understanding the impact of pain on patient functioning.
Asunto(s)
Actividades Cotidianas/psicología , Síntomas Afectivos/psicología , Dimensión del Dolor/métodos , Umbral del Dolor , Dolor/fisiopatología , Dolor/psicología , Adulto , Síntomas Afectivos/etiología , Síntomas Afectivos/fisiopatología , Anciano , Ensayos Clínicos como Asunto/estadística & datos numéricos , Evaluación de la Discapacidad , Femenino , Humanos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/psicología , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico , Osteoartritis/fisiopatología , Osteoartritis/psicología , Dolor/diagnóstico , Dimensión del Dolor/psicología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Enfermedades del Sistema Nervioso Periférico/psicología , Valor Predictivo de las PruebasRESUMEN
UNLABELLED: Although a number of measures of pain qualities exist, little research has examined the potential for these measures to identify the unique effects of pain treatments on different pain qualities. We examined the utility of the Neuropathic Pain Scale (NPS) for assessing changes in pain qualities after open label lidocaine patch 5% in 3 samples of patients: patients with peripheral neuropathic pain, low back pain, and osteoarthritis. With one exception ("cold" pain in subjects with low back pain), each of the NPS items showed significant change after open label lidocaine patch. In addition, significantly larger changes were observed for the NPS items reflecting global pain intensity and pain unpleasantness and for items assessing sharp and deep pain than for items assessing cold, sensitive, and itchy pain. The pattern of changes in pain qualities did not differ across the 3 diagnostic groups, but it did differ from the patterns of changes in pain qualities associated with other analgesic treatments. The results support the potential utility of the NPS for assessing the patterns of changes in pain qualities that can be observed after pain treatment. PERSPECTIVE: Pain clinical trials that include measures of pain qualities, such as the NPS, might identify distinct patterns of treatment effects on those pain qualities. This research might be used to help clinicians target analgesics to match the specific qualities associated with a patient's pain and to better understand the mechanisms of analgesic effects in drug development programs.
Asunto(s)
Dolor de la Región Lumbar/diagnóstico , Neuralgia/diagnóstico , Dimensión del Dolor/métodos , Administración Cutánea , Adulto , Anciano , Análisis de Varianza , Anestésicos Locales/administración & dosificación , Ensayos Clínicos como Asunto/métodos , Femenino , Humanos , Lidocaína/administración & dosificación , Dolor de la Región Lumbar/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Neuralgia/tratamiento farmacológico , Nociceptores , Osteoartritis/complicacionesRESUMEN
OBJECTIVE: To determine the impact of the lidocaine patch 5% on pain qualities associated with low-back pain (LBP) through use of the Neuropathic Pain Scale (NPS). PATIENTS AND METHODS: Patients were enrolled in an open-label, non-randomized, prospective, 6-week study involving 8 clinical trial sites in the United States. Eligible patients had non-radicular LBP and reported moderate-to-severe pain on the NPS at study enrollment. Patients were stratified to 3 groups based on the duration of their LBP, defined as acute/sub-acute (< 3 months), short-term chronic (3-12 months), or long-term chronic LBP (> 12 months). The lidocaine patch 5% was applied to the area of maximal pain, using no more than a total of 4 patches changed every 24 h. Effectiveness was measured by change from baseline to Week 2 and Week 6 in 4 composite measures of the NPS: NPS-10, NPS-4, NPS-8, and NPS-non-allodynia. Safety was assessed by adverse events (AEs), dermal assessment of application site(s), and skin sensory testing. RESULTS: In the combined patient population (n = 71), 6 weeks of treatment with lidocaine patch 5% significantly improved all 4 NPS composite measures at both Week 2 and Week 6 (p < 0.001). Separate analyses by subgroups revealed differential improvements in the 4 composite measures. Eleven patients (15.5%) experienced treatment-related AEs that were primarily mild-to-moderate and dermal in nature. CONCLUSIONS: In patients with moderate-to-severe LBP, 2 weeks and 6 weeks of treatment with the lidocaine patch 5% significantly reduces the intensity of pain qualities as measured by all 4 NPS composite measures. Lidocaine patch 5% is well tolerated with few systemic AEs and may provide beneficial pain relief for patients receiving multidisciplinary treatment without increasing risks for adverse drug interactions. Pain scales such as the NPS offer the ability to measure various pain qualities experienced by LBP patients and may allow clinicians to assess the treatment impact of different medications.
Asunto(s)
Anestésicos Locales/administración & dosificación , Lidocaína/administración & dosificación , Dolor de la Región Lumbar/tratamiento farmacológico , Dimensión del Dolor/métodos , Administración Cutánea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Resultado del Tratamiento , Estados UnidosRESUMEN
OBJECTIVE: To determine the impact of the lidocaine patch 5% on pain qualities associated with chronic pain from postherpetic neuralgia (PHN), painful diabetic neuropathy (DN), and low-back pain (LBP), using the Neuropathic Pain Scale (NPS). PATIENTS AND METHODS: Patients with PHN, painful DN, and LBP were enrolled if they had partial response to gabapentin-containing analgesic regimens and if they reported moderate-to-severe pain on the NPS at study enrollment. Eligible patients were included in an open-label, non-randomized, prospective, 2-week study across 7 clinical trial sites in the United States. The lidocaine patch 5% was applied to the area of maximal pain, using no more than a total of 4 patches changed every 24 h. Patients were maintained on their other analgesic regimens with no dose adjustment or additions allowed. Treatment effect was measured by change from baseline to Week 2 in 4 composite measures of the NPS: NPS-10, NPS-4, NPS-8, and NPS-non-allodynia. Safety was assessed by adverse events (AEs), dermal assessment of application site(s), and skin sensory testing. RESULTS: In the combined patient population (n = 77), 2 weeks of treatment with the lidocaine patch 5% significantly improved all 4 composite measures (p < 0.01). In the subgroup analyses, the lidocaine patch 5% demonstrated numerical advantage for all 4 NPS composite measures for the PHN patients (n = 8), and significantly improved all 4 composite measures for the painful DN patients (n = 41; p < 0.001) and LBP patients (n = 28; p < or = 0.005). Overall, 8 patients (10%) experienced mild-to-moderate treatment-related AEs. CONCLUSIONS: The lidocaine patch 5% effectively reduces the intensity of all common pain qualities in patients with moderate-to-severe chronic pain resulting from PHN, painful DN, or LBP. Treatment is well tolerated in combination with other analgesic regimens, with no reports of serious AEs or adverse drug interactions. Assessment scales such as the NPS may offer the possibility to differentiate between various pain states and to assess treatment outcomes for various pain qualities associated with a given pain state.