Mostrando recursos 1 - 20 de 8.015

  1. Using Observational Data to Calibrate Simulation Models

    Murray, Eleanor Jane; Robins, James M.; Seage, George R.; Lodi, Sara; Hyle, Emily Parker; Reddy, Krishna Podditur; Freedberg, Kenneth Alan; Hernan, Miguel Angel
    BACKGROUND: Individual-level simulation models are valuable tools for comparing the impact of clinical or public health interventions on population health and cost outcomes over time. However, a key challenge is ensuring that outcome estimates correctly reflect real-world impacts. Calibration to targets obtained from randomized trials may be insufficient if trials do not exist for populations, time periods, or interventions of interest. Observational data can provide a wider range of calibration targets but requires methods to adjust for treatment-confounder feedback. We propose the use of the parametric g-formula to estimate calibration targets and present a case-study to demonstrate its application. METHODS: We used the...

  2. Using Observational Data to Calibrate Simulation Models

    Murray, Eleanor Jane; Robins, James M.; Seage, George R.; Lodi, Sara; Hyle, Emily Parker; Reddy, Krishna Podditur; Freedberg, Kenneth Alan; Hernan, Miguel Angel
    BACKGROUND: Individual-level simulation models are valuable tools for comparing the impact of clinical or public health interventions on population health and cost outcomes over time. However, a key challenge is ensuring that outcome estimates correctly reflect real-world impacts. Calibration to targets obtained from randomized trials may be insufficient if trials do not exist for populations, time periods, or interventions of interest. Observational data can provide a wider range of calibration targets but requires methods to adjust for treatment-confounder feedback. We propose the use of the parametric g-formula to estimate calibration targets and present a case-study to demonstrate its application. METHODS: We used the...

  3. Bilateral Somatosensory Cortex Disinhibition in Complex Regional Pain Syndrome Type I

    Oaklander, Anne Louise; Lenz, M.; Krumova, E.; Hoeffken, O.; Stude, P.; Lissek, S.; Schwenkreis, P.; Reinersmann, A.; Frettloeh, J.; Richter, H.; Tegenthoff, M.; Maier, C.

  4. Bilateral Somatosensory Cortex Disinhibition in Complex Regional Pain Syndrome Type I

    Oaklander, Anne Louise; Lenz, M.; Krumova, E.; Hoeffken, O.; Stude, P.; Lissek, S.; Schwenkreis, P.; Reinersmann, A.; Frettloeh, J.; Richter, H.; Tegenthoff, M.; Maier, C.

  5. RSD/CRPS: The end of the beginning

    Oaklander, Anne Louise

  6. RSD/CRPS: The end of the beginning

    Oaklander, Anne Louise

  7. Case 16-2004

    Amato, Anthony A.; Oaklander, Anne Louise

  8. Case 16-2004

    Amato, Anthony A.; Oaklander, Anne Louise

  9. Neuropathic Itch

    Oaklander, Anne Louise
    Chronic itch can be caused by dysfunctions of itch-sensing neurons that produce sensory hallucinations of pruritogenic stimuli. The cellular and molecular mechanisms are still unknown. All neurological disease categories have been implicated and neurological causes should be considered for patients with otherwise-unexplained itch. The same neurological illnesses that cause neuropathic pain can also or instead cause itch. These include shingles (particularly of the head or neck), small-fiber polyneuropathies, radiculopathies (e.g., notalgia paresthetica and brachioradial pruritis) and diverse lesions of the trigeminal nerve, root, and central tracts. Central nervous system lesions affecting sensory pathways, including strokes, multiple sclerosis, and cavernous hemangiomas...

  10. Neuropathic Itch

    Oaklander, Anne Louise
    Chronic itch can be caused by dysfunctions of itch-sensing neurons that produce sensory hallucinations of pruritogenic stimuli. The cellular and molecular mechanisms are still unknown. All neurological disease categories have been implicated and neurological causes should be considered for patients with otherwise-unexplained itch. The same neurological illnesses that cause neuropathic pain can also or instead cause itch. These include shingles (particularly of the head or neck), small-fiber polyneuropathies, radiculopathies (e.g., notalgia paresthetica and brachioradial pruritis) and diverse lesions of the trigeminal nerve, root, and central tracts. Central nervous system lesions affecting sensory pathways, including strokes, multiple sclerosis, and cavernous hemangiomas...

  11. Common Neuropathic Itch Syndromes

    Oaklander, Anne Louise
    Patients with chronic itch are diagnosed and treated by dermatologists. However, itch is a neural sensation and some forms of chronic itch are the presenting symptoms of neurological diseases. Dermatologists need some familiarity with the most common neuropathic itch syndromes to initiate diagnostic testing and to know when to refer to a neurologist. This review summarizes current knowledge, admittedly incomplete, on neuropathic itch caused by diseases of the brain, spinal cord, cranial or spinal nerve-roots, and peripheral nerves.

  12. Common Neuropathic Itch Syndromes

    Oaklander, Anne Louise
    Patients with chronic itch are diagnosed and treated by dermatologists. However, itch is a neural sensation and some forms of chronic itch are the presenting symptoms of neurological diseases. Dermatologists need some familiarity with the most common neuropathic itch syndromes to initiate diagnostic testing and to know when to refer to a neurologist. This review summarizes current knowledge, admittedly incomplete, on neuropathic itch caused by diseases of the brain, spinal cord, cranial or spinal nerve-roots, and peripheral nerves.

  13. Progression of dystonia in complex regional pain syndrome

    Oaklander, Anne Louise

  14. Progression of dystonia in complex regional pain syndrome

    Oaklander, Anne Louise

  15. Effects of distal nerve injuries on dorsal-horn neurons and glia: Relationships between lesion size and mechanical hyperalgesia

    Lee, Jace; Siegel, Sandra Marie; Oaklander, Anne Louise
    Penetrating limb injuries are common and usually heal without long-lasting effects, even when nerves are cut. However, rare nerve-injury patients develop prolonged and disabling chronic pain (neuralgia). When pain severity is disproportionate to severity of the inciting injury, physicians and insurers may suspect exaggeration and limit care or benefits, although the nature of the relationship between lesion-size and the development and persistence of neuralgia remains largely unknown. We compared cellular changes in the spinal dorsal-horn (the initial CNS pain-processing area) after partial or total tibial-nerve axotomies in male Sprague–Dawley rats to determine if these changes are proportional to the numbers...

  16. Effects of distal nerve injuries on dorsal-horn neurons and glia: Relationships between lesion size and mechanical hyperalgesia

    Lee, Jace; Siegel, Sandra Marie; Oaklander, Anne Louise
    Penetrating limb injuries are common and usually heal without long-lasting effects, even when nerves are cut. However, rare nerve-injury patients develop prolonged and disabling chronic pain (neuralgia). When pain severity is disproportionate to severity of the inciting injury, physicians and insurers may suspect exaggeration and limit care or benefits, although the nature of the relationship between lesion-size and the development and persistence of neuralgia remains largely unknown. We compared cellular changes in the spinal dorsal-horn (the initial CNS pain-processing area) after partial or total tibial-nerve axotomies in male Sprague–Dawley rats to determine if these changes are proportional to the numbers...

  17. Endoneurial pathology of the needlestick-nerve-injury model of Complex Regional Pain Syndrome, including rats with and without pain behaviors

    Klein, M.M.; Lee, Jeung Woon; Siegel, Sandra Marie; Downs, H.M.; Oaklander, Anne Louise
    Current rodent models of neuropathic pain produce pain hypersensitivity in almost all lesioned animals and not all identified experimental effects are pain specific. 18G needlestick-nerve-injury (NNI) to one tibial nerve of outbred Sprague-Dawley rats models the phenotype of Complex Regional Pain Syndrome (CRPS), a post-traumatic neuropathic pain syndrome, leaving roughly half of NNI rats with hyperalgesia. We compared endoneurial data from these divergent endophenotypes searching for pathological changes specifically associated with pain-behaviors. Tibial, sural, and common sciatic nerves from 12 NNI rats plus 10 nerves from sham-operated controls were removed 14 days post-surgery for morphometric analysis. PGP9.5+ unmyelinated-fibers were quantitated...

  18. Endoneurial pathology of the needlestick-nerve-injury model of Complex Regional Pain Syndrome, including rats with and without pain behaviors

    Klein, M.M.; Lee, Jeung Woon; Siegel, Sandra Marie; Downs, H.M.; Oaklander, Anne Louise
    Current rodent models of neuropathic pain produce pain hypersensitivity in almost all lesioned animals and not all identified experimental effects are pain specific. 18G needlestick-nerve-injury (NNI) to one tibial nerve of outbred Sprague-Dawley rats models the phenotype of Complex Regional Pain Syndrome (CRPS), a post-traumatic neuropathic pain syndrome, leaving roughly half of NNI rats with hyperalgesia. We compared endoneurial data from these divergent endophenotypes searching for pathological changes specifically associated with pain-behaviors. Tibial, sural, and common sciatic nerves from 12 NNI rats plus 10 nerves from sham-operated controls were removed 14 days post-surgery for morphometric analysis. PGP9.5+ unmyelinated-fibers were quantitated...

  19. Cervical spinal cord injection of epidural corticosteroids: Comprehensive longitudinal study including multiparametric magnetic resonance imaging

    Cohen-Adad, Julien; Buchbinder, Bradley R.; Oaklander, Anne Louise
    Despite widespread use, the efficacy of epidural corticosteroid injections (ESI) for osteoarthritis-associated neck or radicular pain remains uncertain, so even rare serious complications enter into discussions about use. However various factors impede investigation and publication of serious adverse events. To that end, we developed new magnetic resonance imaging (MRI) techniques for spinal cord white-matter quantification and employed best-available physiological tests to characterize a cervical spinal cord lesion caused by inadvertent intramedullary injection of Depo-Medrol. A 29-year-old woman with mild cervical osteoarthritis had 2 years of headache and neck pain (concussion and whiplash) after two minor motor-vehicle accidents. During C5–6 ESI,...

  20. Cervical spinal cord injection of epidural corticosteroids: Comprehensive longitudinal study including multiparametric magnetic resonance imaging

    Cohen-Adad, Julien; Buchbinder, Bradley R.; Oaklander, Anne Louise
    Despite widespread use, the efficacy of epidural corticosteroid injections (ESI) for osteoarthritis-associated neck or radicular pain remains uncertain, so even rare serious complications enter into discussions about use. However various factors impede investigation and publication of serious adverse events. To that end, we developed new magnetic resonance imaging (MRI) techniques for spinal cord white-matter quantification and employed best-available physiological tests to characterize a cervical spinal cord lesion caused by inadvertent intramedullary injection of Depo-Medrol. A 29-year-old woman with mild cervical osteoarthritis had 2 years of headache and neck pain (concussion and whiplash) after two minor motor-vehicle accidents. During C5–6 ESI,...

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