This survey will investigate the views of people with progressive MS in terms of
physiotherapy services. In particular the study will examine the proportion of people with
progressive MS on the MS register who use physiotherapy services, how worthwhile they think
it is for them and how they would like their physiotherapy to be delivered. This survey will
also explore how physiotherapy services for people with progressive MS varies across the UK
and what other types of rehabilitation services are currently used by people with progressive
MS.
Clinical Trials
Clinical Trial – Low Dose Spinal Anesthesia in Cesarean Surgery
Anesthesia for cesarean section requires special importance because it may affect both mother
and the baby. To avoid maternal hypotension related to spinal anesthesia must be the primary
objective during anesthesia. Even though many factors influence sensory nerve block for
surgical anesthesia, local anesthetic dose is the main determinant. Another factor that
influence the sensory nerve block is the obesity related to pregnancy. Due to the enlargement
of epidural venous plexus related to pregnancy, the subarachnoid and epidural space reduces,
so the local anesthetic requirement also reduces. Many investigators recommend lower dose of
local anesthetic in obese patients due to reduced requirement There are many studies about
dose regimens for cesarean anesthesia, but ideal dose have not been found. Investigators have
designed this study to see the effects of conventional dose (10 mg bupivacaine) vs. low dose
plus fentanyl (7,5 mg bupivacaine+25 mcg fentanyl) in obese and normal weight pregnant for
cesarean section. The hypothesis was: the low dose regimen provides surgical anesthesia in
obese patients while avoiding maternal hypotension.
Clinical Trial – Hyperbaric Oxygen, Neutrophil-oxidative Burst, and Cytokines
In this small pilot study, participants (patients and healthy volunteers) will have blood
drawn before and after the study intervention (hyperbaric chamber session or normal pressure
oxygen breathing. This blood will be analyzed for neutrophil oxidative burst and cytokine
analysis.
Clinical Trial – Effects of Gaseous Cryotherapy on Knee ROM After TKA: A Feasibility Study
A pilot study was performed to investigate the feasibility of a large randomized controlled
trial (RCT) to assess the effects of hyperbaric gaseous cryotherapy (HGC) on the change in
knee flexion range of motion in the first two days after total knee arthroplasty.
Clinical Trial – Dexmedetomidine Versus Magnesium Sulphate for Caesarean Delivery
Regional anesthesia has become more popular in cesarean deliveries because most of the
parturients prefer being awake during the birth process. In addition, regional anesthesia may
be a safer method than general. In spinal anesthesia local anesthetics alone may not be
enough for an effective postoperative analgesia and hemodynamic stability of the patient wich
is crucial during cesarean section. So far many adjuvants have been used to augment the
analgesia produced by intrathecal local anesthetics and to reduce their adverse effects .
Various intrathecal adjuvants to local anaesthetics have found to improve the quality and
extend duration of spinal block. Prolongation of duration of spinal block is desirable both
for long procedures and for postoperative pain relief. Efficacy and safty of intrathecal
magnesium as analgesic adjuvant has been tested by several clinical trails in recent
years.Antinociceptive effect of magnesium appears to be relevant for the management of
chronic and post operative pain. These effects are primarily based on regulation of calcium
influx in to the cell. Magnesium blocks calcium influx and non competitively antagonizes NMDA
channels. NMDA receptor signelling plays an impartent in determining the duration of acute
pain3).) addition of magnesium to spinal anaesthesia improved postoperative analgesia in
orthopedic setting. addition of intrathecal magnesium sulfate to 10 mg bupivacaine plus 25µg
fentanyl prolonged spinal anaesthesia in patients undergoing lower extremity surgery.
Dexmedetomidine is a highly selective 2-adrenergic agonist which has been used as
pre-medication and as an adjuvant to general anesthesia.Dexmedetomidine have several
beneficial actions during perioperative period. They decrease sympathetic tone with
attenuation of the neuroendocrine and haemodynamic response to anaesthesia and surgery,
reduce anaesthetic and opiod requirement, cause sedation and analgesia. Dexmedetomidine was
first introduced into clinical practice as a short term intravenous sedative in intensive
care. Like any other adjuvant dexmedetomidine is not free from adverse effects. Use of
dexmedetomidine is often associated with a decrease in heart rate and blood
pressure.Dexmedetomidine was used to enhance the analgesic property of local anaesthetics
like lidocaine bupivacaine and ropivacaine. In vivo and in vitro studies indicated that these
local anaesthetics had significant neurotoxicity. Dexmedetomidine showed protective or growth
promoting properties in tissues, including nerve cells from cortex. Intrathecal
dexmedetomidine has a neuroprotective effect similar to methylprednisolone.
The mechanism by which intrathecal alpha 2-adrenergic agonists prolong the motor and sensory
block of local anesthetics is not clear. It may be an additive or synergistic effect
secondary to the different mechanisms of action of local anesthetic and alpha 2 adrenergic
agonist. The local anesthetics act by blocking sodium channels, whereas the alpha 2
adrenergic agonist acts by binding to pre synapyic C fibre and post synaptic dorsal horn
neurons. Intrathecal alpha 2 adrenergic agonist produce analgesia by depressing the realease
of C fibre transmission by hyperpolarization of post synaptic dorsal horn neurons. Li et al
observed that Glutamate is involved in excitatory neurotransmission nociception and plays an
essential role in relaying noxious stimuli in the spinal cord. Intrathecal injection of alpha
2 adrenergic agonists produces potent antinociceptive effects by altering spinal
neurotransmitter release and effectively treats acute pain.
Clinical Trial – Modulation of Biomarkers in Patients With Flesh-eating Bacterial Infections After With Hyperbaric Oxygen Treatment
The purpose of this study is to investigate the effects of hyperic oxygen treatment on the
immune response in patients with necrotizing soft tissue infections
Clinical Trial – Reduction of Venous Emboli Load After Breathing Normobaric Oxygen Compared to Air
Primary objective:
– Assessment of venous gas emboli load post diving when breathing normobaric oxygen compared
to air.
Secondary objectives:
– Assessment of flammatory activity in blood post diving
– Assessment of fluid markers of central nervous system injury in blood post diving
– Assessment of DCS frequency
– Comparison of TCD and TTD consistency in venous gas emboli measurements
Clinical Trial – Dexmedetomidine for Sedation in Total Knee Replacements
Dexmedetomidine has demonstrated benefits both in sedation, and post-operative pain control,
with less respiratory depression than other common sedatives. Traditionally, dexmedetomidine
has been used with a large loading dose and infusion, which has been known to cause
dose-dependent negative side-effects (Abdallah et al., 2013). Single dose dexmedetomidine
produces less negative side-effects, but still effective sedation and reduced post-operative
pain (Jung et al., 2013). There is evidence for its benefits with general anesthesia but only
a few studies exist investigating its benefits when administered for sedation purposes with
spinal anesthesia, and no studies primarily examine post-operative opioid consumption. The
investigators hypothesize that single dose dexmedetomidine for procedural sedation will
reduce opioid consumption after total knee arthroplasty (TKA).
Clinical Trial – Spinal Morphine Provides an Effective Pain Control in Patients Undergoing Transurethral Resection of Prostate Gland
Pain after transurethral resection of prostate is considered mild to moderate severity from
detrusor muscle spasm and traction from urinary catheter. Numerous pain relieve methods have
been studied including spinal opioids, spinal anesthesia with local anesthetic and
dexmedetomidine, periprostatic nerve blockade with bupivacaine and mixing of prilocaine with
distilled water irrigation while undergoing a procedure. Most of patients having this
procedure are in elderly period, thus many anesthetists avoided spinal morphine which may
cause respiratory depressant effect postoperatively. Although previous studies showed
effectiveness of spinal morphine 25-200 mcg, some patients suffered from neuraxial opioid
side effects.
The aim of this study is to demonstrate efficacy of local anesthetic with intrathecal
morphine 50 mcg providing pain relieve after transurethral resection of prostate compare to
spinal anesthesia with sole local anesthetic.
Clinical Trial – Hyperbaric Oxygen Therapy Registry
The purpose of the Hyperbaric Oxygen Therapy Registry (HBOTR) is to provide real world
patient outcome and side effect information from electronic health records submitted to a
specialty specific hyperbaric registry as part of "Stage 2 of Meaningful Use," including data
provided to meet PQRS requirements via the registry’s QCDR mission.
Goals include understanding the value of HBOT among patients treated for a variety of
conditions in relation to the frequency and severity of HBOT side effects. While randomized,
controlled trials can establish the efficacy of treatments like HBOT, because they routinely
exclude patients with co-morbid conditions common to those patients seen in usual clinical
practice, the results of RCTs are usually non-generalizable. Real world data can be used to
better understand the effectiveness of HBOT among typical patients, as well as the risks
associated with treatment.