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W Cairns S Smith

Publications and source records attributed to W Cairns S Smith.

18 recordsLinked to original sources
PubMed2006

Pilot study of the incidence and prognosis of degenerative Parkinsonian disorders in Aberdeen, United Kingdom: methods and preliminary results.

The objective of this study was to test the methods for a large study of the incidence and prognosis of Parkinson's disease and other degenerative parkinsonian disorders and provide provisional incidence figures. This was a community-based prospective study to identify patients with newly diagnosed non-drug-induced Parkinsonism (>or=2 of tremor, rigidity, bradykinesia, postural instability) from a population of 148,600 people in Aberdeen, Scotland, over 18 months. Multiple search strategies were used to identify patients, including some population screening. Incident patients and age/sex-matched controls had assessments of impairment, disability, quality of life, mood, and cognition and are being followed up yearly. Two hundred and two people with possible parkinsonian symptoms were assessed, and 82 incident patients were identified, 50 with probable Parkinson's disease. The crude incidences of probable Parkinsonism and probable Parkinson's disease were 31.4/100,000/year (95% CI: 24.5-39.7) and 22.4/100,000/year (95% CI: 16.6-29.6), respectively. The mean age of diagnosis of Parkinson's disease was 76.1 +/- 10.0 years and the incidence was greater in men. The methods were generally successful. Provisionally, we found a higher incidence of Parkinson's disease than other comparable studies, and our patients were considerably older. This may reflect better case ascertainment in the elderly. A larger study is planned.

Aged↗
PubMed2005

Evaluating effectiveness of complex interventions aimed at reducing maternal mortality in developing countries.

BACKGROUND: Reducing the worldwide mortality ratio by 75 per cent between 1990 and 2015 is a key Millennium Development Goal. Randomized controlled trials (RCTs) are the accepted 'gold standard' to assess the effectiveness of interventions but they are not always appropriate for practical, ethical or economic reasons in developing countries. This study examines the use of cluster randomized trials and quasi-experimental (nonrandomized) study designs to evaluate complex interventions implemented to reduce maternal mortality. METHODS: We systematically searched electronic databases including MEDLINE, EMBASE, CINAHL, BNI, ASSIA, IBSS, CSA and COCHRANE. English language publications between 1990 and 2003 were included. Studies that assessed the effects of complex interventions aimed at reducing maternal mortality in developing countries were included. RESULTS: Four cluster randomized trials and eleven quasi-experimental studies were identified. Two cluster randomized trials examined reduction in prenatal visits with no adverse effects on maternal mortality. Two trials assessed the effects of vitamin A supplementation. Both trials found a significant reduction in maternal mortality ratios after vitamin A supplementation. A decline in maternal deaths was reported in eight of the nonrandomized studies. Measuring maternal mortality was a frequent problem because of insufficient sample sizes and/or poor recording methods. Other limitations include lack of suitable comparison groups and difficulties assessing the effects of confounding factors in the quasi-experimental studies. CONCLUSIONS: RCTs may not be appropriate to evaluate complex interventions in maternal mortality and cluster RCTs and quasi-experimental designs may be more suitable. However, further work is required to improve the robustness of such alternative study designs.

Developing Countries↗
PubMed2005

Effects of weight loss in overweight/obese individuals and long-term hypertension outcomes: a systematic review.

Many studies have assessed short-term effects of weight loss on blood pressure, whereas little attention has been paid to long-term effects. We conducted a systematic review to evaluate the long-term effects of weight loss on hypertension outcome measures in adults using literature published from 1966 to 2001. All prospective studies and trials, performed on participants with body mass index of > or =28 kg/m2 with a follow-up of >2 years and weight changes recorded, were included. The data from these studies were used to model the long-term effects on blood pressure. Previous reviews on shorter-term studies indicate a 1:1 drop in blood pressure (mm Hg) with weight loss (kilograms). Our findings, based on studies with follow-up of > or =2 years, demonstrate blood pressure decreases less than this after weight loss. The surgical intervention studies exhibited huge weight losses with undramatic blood pressures changes. When surgical interventions are excluded, the models suggest that for 10 kg weight loss, decreases of 4.6 mm Hg and 6.0 mm Hg in diastolic and systolic blood pressure, respectively, may be expected, about half of that predicted from the short-term trials. Initial blood pressure, the length of follow-up, medication changes, and physiological restrictions may contribute to this reduced effect in the long-term studies. Extrapolation of short-term blood pressure changes with weight loss to the longer term is potentially misleading. The weight/hypertension relationship is complex and needs well-conducted studies with long-term follow-up to examine the effects of weight loss on hypertension outcomes.

Humans↗
PubMed2004

Steroid prophylaxis for prevention of nerve function impairment in leprosy: randomised placebo controlled trial (TRIPOD 1).

OBJECTIVE: To determine whether addition of low dose prednisolone to multidrug treatment can prevent reaction and nerve function impairment in leprosy. DESIGN: Multicentre, double blind, randomised, placebo controlled, parallel group trial. SETTING: Six centres in Bangladesh and Nepal. PARTICIPANTS: 636 people with newly diagnosed multibacillary leprosy. INTERVENTION: Prednisolone 20 mg/day for three months, with tapering dose in month 4, plus multidrug treatment, compared with multidrug treatment alone. MAIN OUTCOME MEASURES: Signs of reaction, impairment of sensory and motor nerve function, and nerve tenderness needing full dose prednisolone at four months and one year. RESULTS: Prednisolone had a significant effect in the prevention of reaction and nerve function impairment at four months (relative risk 3.9, 95% confidence interval 2.1 to 7.3), but this was not maintained at one year (relative risk 1.3, 0.9 to 1.8). Fewer events occurred in the prednisolone group at all time points up to 12 months, but the difference at 12 months was small. Subgroup analysis showed a difference in response between people with and without impairment of nerve function at diagnosis. CONCLUSIONS: The use of low dose prophylactic prednisolone during the first four months of multidrug treatment for leprosy reduces the incidence of new reactions and nerve function impairment in the short term, but the effect is not sustained at one year. The presence of nerve function impairment at diagnosis may influence the response to low dose prednisolone.

Adolescent↗
PubMed2004

Epidemiology teaching: student and tutor perceptions.

There is concern that undergraduate medical students are not exposed to appropriate opportunities to learn and understand the fundamental principles of epidemiology. In this study the aim was to explore students' and tutors' perceptions of the epidemiology teaching in the first three years of the Aberdeen, UK, medical undergraduate curriculum, with particular reference to the teaching in the Community Course. The study adopted a qualitative approach: six individual interviews and two focus-group meetings with quota samples of medical students in the fourth year, and one focus-group meeting with a purposive sample of Community Course tutors. It was found that most students acknowledged difficulty in learning epidemiology because they perceive the topic to be dry, boring and difficult to understand. However, there is a dawning awareness that it is important and its relevance becomes more obvious to students as they progress through the medical course, especially if they have undertaken an intercalated BSc Medical Sciences degree. Students want practical and clinically relevant teaching. Most students are exam driven and will only make efforts to learn topics that are assessed. Tutors also find epidemiology to be difficult and want their teaching to be clinically relevant.

Adult↗
PubMed2004

Incidence of acute nerve function impairment and reactions in leprosy: a prospective cohort analysis after 5 years of follow-up.

BACKGROUND: Nerve function impairment (NFI) is the key outcome of the pathological processes of infection with Mycobacterium leprae, which can continue after completion of multidrug therapy (MDT) and lead to disability after leprosy patients are released from treatment. The objective of this study was to assess the need for and duration of surveillance of NFI. METHODS: Prospective cohort study of 2664 new leprosy patients in Bangladesh, with an observation period of 36 months in paucibacillary (PB) patients, and 60 months in multibacillary (MB) patients. Incidence rates (IR) were calculated with the number of patients developing NFI, type 1 and type 2 reactions, and silent neuritis for the first time after registration as the numerator, and cumulative person-years at risk (PYAR) as the denominator. Survival curves to the first event of NFI were also calculated. RESULTS: The IR of first event of NFI amongst MB patients was 16.1 per 100 PYAR, with 121/357 (34%) developing NFI during the observation period. Of the 121 with a first event of NFI, 77 (64%) had this within a year after registration, 35 (29%) in the second year, and the remaining 9 (7%) after 2 years. The IR of first event of NFI amongst PB patients was 0.9 per 100 PYAR, with 54/2153 (2.5%) developing NFI during the observation period. Of the 54 with a first event of NFI, 48 (89%) had this within a year after registration, 3 (5.5%) in the second year, and the remaining 3 (5.5%) cases after 2 years. The percentage of PB patients with no NFI at registration surviving without developing NFI during the observation period was 99% and for PB patients with NFI at registration 92%. In MB patients without NFI at registration, the percentage surviving with no NFI during the observation period was 84% and for MB patients with NFI at registration only 36%. CONCLUSION: New episodes of NFI and reactions after registration are common, in particular in MB patients with long-standing NFI at registration. The study highlights the importance of continuing surveillance for NFI of this risk group after registration for 2 years. Active surveillance beyond 2 years is not indicated.

Acute Disease↗
PubMed2004

An approach to understanding the transmission of Mycobacterium leprae using molecular and immunological methods: results from the MILEP2 study.

BACKGROUND: The current strategy for leprosy control using case detection and treatment has greatly reduced the prevalence of leprosy, but has had no demonstrable effect on interrupting transmission. METHODS: Three leprosy endemic communities in India were recruited, examined, and followed up sequentially over 2 yrs using nasal swabs and saliva collections. The nasal swabs were tested by polymerase chain reaction for the presence of M. leprae and the saliva was assayed for anti-M. leprae IgA. FINDINGS: Only 1.6% of 2552 nasal swabs were PCR positive, and 68% of saliva samples were positive for ML-IgA. BCG and household contact status was associated with the mucosal immune response, but not with PCR positivity. PCR positivity did not persist and most PCR positive results were in the wet season. INTERPRETATION: The findings contribute to our understanding of the epidemiology of M. leprae and the possible periods of greatest likelihood of exposure and transmission.

Adolescent↗
PubMed2004

Factors influencing the uptake of childhood immunisation in rural areas.

BACKGROUND: Childhood vaccination has been vigorously debated in recent years. Professional and parental confidence in the measles, mumps and rubella (MMR) vaccine in particular has been shaken, as reflected by its decreased uptake. AIM: To investigate the influence of practice type and the method of vaccination call/recall on childhood immunisation coverage. DESIGN: Analysis of childhood immunisation uptake rates. SETTING: General practices in the Highland NHS Health Board area in Scotland. METHOD: Data on the immunisation uptake of individual practices in the region were obtained from the Information and Statistics Division of NHS Scotland. RESULTS: Uptake of all vaccines in children reaching the age of 2 years was lower in practices using their own call/recall system than those engaged with the national system. Inducement practices achieved lower uptake than non-inducement practices for every immunisation studied, with the differences ranging from 4.7% to 7.8%. Compared with group practices, uptake of all vaccines was less for single-handed practices, with the differences ranging from 2.4% to 11.4%. A logistic regression analysis found that high uptake of the diphtheria and meningococcus group C vaccines by the age of 24 months was significantly associated with use of the national call/recall system. Only inducement practice status was significantly associated with reduced uptake in children aged 12 months. CONCLUSIONS: Engagement with the national call/recall system was associated with higher immunisation coverage for children reaching the age of 2 years. Inducement status was associated with low uptake of vaccinations in children reaching the age of 1 year.

Family Practice↗
PubMed2004

The future incidence of leprosy: a scenario analysis.

OBJECTIVE: To investigate the impact of the current strategy for the elimination of leprosy on its incidence and to assess the consequences of failure to sustain this strategy. METHODS: Scenarios for assessing the impact of the elimination strategy were implemented in a computer simulation program. The scenarios reflected the assumptions made regarding contagiousness, transmission and bacille Calmette-Guerin (BCG) vaccination. The trend in case detection rate for the main countries in which leprosy was endemic during 1985-98 was fitted, and incidence up to 2020 was projected. FINDINGS: Owing to the gradual shortening of delays in detection up to 1998, and because of the low relapse rate that occurs with multidrug treatment MDT, incidence is predicted to decrease beyond 2000 in all scenarios. The annual decline was a few per cent higher when favourable assumptions were made about protection and coverage of BCG vaccination. Overall, the predicted annual decline in incidences ranged from 2% to 12%. CONCLUSION: The elimination strategy reduces transmission, but the decline may be slow. Relaxation of control after 2005 is unjustified given the uncertainty about the rate of decline and the adverse effects of longer delays in detection. A long-term strategy for leprosy control should be adopted.

BCG Vaccine↗
PubMed2003

Blood pressure in relation to birth weight in twins and singleton controls matched for gestational age.

Associations between adult blood pressure and birth weight were investigated in 122 same-sex twin pairs aged 18-50 years and 86 singleton controls matched according to maternal age and parity, gender, gestational age, and current age who were recruited via an obstetric database in Aberdeen, Scotland, in 1999. Twins weighed on average 425 g less than controls at birth (p < 0.001) but did not differ significantly in adult height or systolic or diastolic blood pressure from the controls. Among controls, the differences in systolic and diastolic blood pressure per kg of difference in birth weight, adjusted for gender, gestational age, current age, body mass index, smoking, physical activity level, and alcohol intake, were -4.3 (95% confidence interval (CI): -12.8, 4.3) and -6.1 (95% CI: -10.8, -1.5) mmHg/kg, respectively. In unpaired analysis among all twins, the equivalent values were -0.1 (95% CI: -4.0, 3.8) mmHg/kg for systolic pressure and -0.4 (95% CI: -2.9, 2.2) mmHg/kg for diastolic pressure, while in within-pair analysis the values were -0.9 (95% CI: -6.4, 4.6) mmHg/kg for systolic pressure and -0.2 (95% CI: -4.1, 3.7) mmHg/kg for diastolic pressure. The results suggest that in-utero growth restriction in twins is not a major determinant of their blood pressure as adults.

Alcohol Drinking↗
PubMed2003

Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study.

OBJECTIVE: To examine the association between hypertensive diseases of pregnancy (gestational hypertension and pre-eclampsia) and the development of circulatory diseases in later life. DESIGN: Cohort study of women who had pre-eclampsia during their first singleton pregnancy. Two comparison groups were matched for age and year of delivery, one with gestational hypertension and one with no history of raised blood pressure. SETTING: Maternity services in the Grampian region of Scotland. PARTICIPANTS: Women selected from the Aberdeen maternity and neonatal databank who were resident in Aberdeen and who delivered a first, live singleton from 1951 to 1970. MAIN OUTCOME MEASURES: Current vital and cardiovascular health status ascertained through postal questionnaire survey, clinical examination, linkage to hospital discharge, and mortality data. RESULTS: There were significant positive associations between pre-eclampsia/eclampsia or gestational hypertension and later hypertension in all measures. The adjusted relative risks varied from 1.13-3.72 for gestational hypertension and 1.40-3.98 for pre-eclampsia or eclampsia. The adjusted incident rate ratio for death from stroke for the pre-eclampsia/eclampsia group was 3.59 (95% confidence interval 1.04 to 12.4). CONCLUSIONS: Hypertensive diseases of pregnancy seem to be associated in later life with diseases related to hypertension. If greater awareness of this association leads to earlier diagnosis and improved management, there may be scope for reducing a proportion of the morbidity and mortality from such diseases.

Adult↗
PubMed2003

A clinical prediction rule for nerve function impairment in leprosy patients-revisited after 5 years of follow-up.

Nerve function impairment (NFI) commonly occurs during or after chemotherapy in leprosy. We previously described a clinical prediction rule to estimate the risk of NFI occurring within 2 years of diagnosis, based on 2510 patients who are followed up in the Bangladesh Acute Nerve Damage Study (BANDS). This prediction rule assigns new leprosy patients to one of three risk groups based on leprosy group and the presence or absence of NFI at registration. Updated data with up to 5 years of follow-up showed that 95% of all NFI occurred within 2 years. This study confirms the validity of the rule and supports the conclusion that there is little value for the detection of NFI in extending follow-up beyond 2 years.

Adolescent↗
PubMed2003

The prognostic importance of detecting mild sensory impairment in leprosy: a randomized controlled trial (TRIPOD 2).

This study was designed to investigate whether leprosy patients diagnosed with mild sensory impairment have a better prognosis when treated with steroids than similarly impaired patients treated with placebo. A multi-centre, randomized, double-blind, placebo-controlled trial was conducted in Nepal and Bangladesh. Patients were eligible if they had a confirmed leprosy diagnosis, were between 15 and 50 years old, had mild sensory impairment of the ulnar or posterior tibial nerve of less than 6 months duration and did not require steroids for other reasons. 'Mild impairment' was defined as 'impaired on the Semmes-Weinstein monofilament test, but testing normal on the ballpen sensory test'. Subjects were randomized to either prednisolone treatment starting at 40 mg per day, tapering over 4 months, or placebo. Nerve function was monitored monthly. Any patient who deteriorated was taken out of the trial and was put on full-dose steroid treatment. Outcome assessment was done at 4, 6, 9 and 12 months from the start of the treatment. Outcome measures were the proportion of patients needing full-dose prednisolone and the Semmes-Weinstein sum scores. Each patient contributed only one nerve to the analysis. Seventy-five patients had nerves eligible for analysis, of whom 41 (55%) and 34 (45%) were allocated to the prednisolone and placebo arms, respectively. At 4 months, three patients in the prednisolone arm (7%) and six in the placebo arm (18%) had an outcome event requiring full dose steroids. At 12 months, these proportions had almost reversed, 11 (27%) and 6 (18%) in the treatment and placebo arms, respectively. In the latter group, 75% had recovered spontaneously after 12 months. Prednisolone treatment of sensory impairment of the ulnar and posterior tibial nerves detectable with the monofilament test, but not with the ballpen test, did not improve the long-term outcome in terms of recovery of touch sensibility, not did it reduce the risk of leprosy reactions or nerve function impairment beyond the initial 4-month treatment phase. Two unexpected main findings were the strong tendency of mild sensory impairment to recover spontaneously and the fact that patients with mild sensory impairment without any other signs or symptoms of reaction or nerve function impairment are relatively rare.

Adult↗
PubMed2003

Treatment with corticosteroids of long-standing nerve function impairment in leprosy: a randomized controlled trial (TRIPOD 3).

Some leprosy patients with long-standing nerve function impairment (NFI) appear to have responded favourably to treatment with corticosteroids. This study investigated whether patients with untreated NFI between 6 and 24 months duration and who are given standard regimen corticosteroid therapy, will have a better treatment outcome than a placebo group. A multicentre, randomized, double-blind placebo-controlled trial was conducted in Nepal and Bangladesh. Subjects were randomised to either prednisolone treatment starting at 40 mg/day, tapered by 5 mg every 2 weeks, and completed after 16 weeks, or placebo. Outcome assessments were at 4, 6, 9, and 12 months from the start of treatment. 92 MB patients on MDT were recruited, of whom 40 (45%) received prednisolone and 52 (55%) placebo treatment. No demonstrable additional improvement in nerve function, or in preventing further leprosy reaction events was seen in the prednisolone group. Overall, improvement of nerve function at 12 months was seen in about 50% of patients in both groups. Analysis of subgroups according to nerve (ulnar and posterior tibial), duration of NFI, and sensory and motor function, also did not reveal any differences between the treatment and placebo groups. There was however, indication of less deterioration of nerve function in the prednisolone group. Finally, there was no difference in the occurrence of adverse events between both groups. The trial confirms current practice not to treat long-standing NFI with prednisolone. Spontaneous recovery of nerve function appears to be a common phenomenon in leprosy. Leprosy reactions and new NFI occurred in a third of the study group, emphasizing the need to keep patients under regular surveillance during MDT, and, where possible, after completion of MDT.

Adolescent↗
PubMed2003

Adverse events of standardized regimens of corticosteroids for prophylaxis and treatment of nerve function impairment in leprosy: results from the 'TRIPOD' trials.

Reactions in leprosy causing nerve function impairment (NFI) are increasingly treated with standardized regimens of corticosteroids, often under field conditions. Safety concerns led to an assessment of adverse events of corticosteroids, based on data of three trials studying prevention of NFI (the TRIPOD study). A multicentre, randomized, double-blind placebo-controlled trial was conducted in leprosy control programmes in Nepal and Bangladesh. Treatment was with prednisolone according to fixed schedules for 16 weeks, starting in one trial with 20 mg/day (prophylactic regimen: total dosage 1.96 g) and in the other two trials with 40 mg/day (therapeutic regimen: total dosage 2.52 g). Minor adverse events were defined as moon face, fungal infections, acne, and gastric pain requiring antacid. Major adverse events were defined as psychosis, peptic ulcer, glaucoma, cataract, diabetes and hypertension. Also, the occurrence of infected plantar, palmar, and corneal ulceration was monitored, together with occurrence of TB. Considering all three trials together, minor adverse events were observed in 130/815 patients (16%). Of these, 51/414 (12%) were in the placebo group and 79/401 (20%) in the prednisolone group. The relative risk for minor adverse events in the prednisolone group was 1.6 (P = 0.004). Adverse events with a significantly increased risk were acne, fungal infections and gastric pain. Major adverse events were observed in 15/815 patients (2%); 7/414 (2%) in the placebo group and 8/401 (2%) in the prednisolone group. No major adverse events had a significantly increased risk in the prednisolone arm of the trials. No cases of TB were observed in 300 patients who could be followed-up for 24 months. Standardized regimens of corticosteroids for both prophylaxis and treatment of reactions and NFI in leprosy under field conditions in developing countries are safe when a standard pre-treatment examination is performed, treatment for minor conditions can be carried out by field staff, referral for specialized medical care is possible, and sufficient follow-up is done during and after treatment.

Adolescent↗
PubMedDate not supplied

A review of chronic pain after inguinal herniorrhaphy.

BACKGROUND: Chronic pain was believed to be a recognized but infrequent complication after inguinal hernia repair. Evidence suggests that patients with chronic pain place a considerable burden on health services. However, few scientific data on chronic pain after this common elective operation are available. OBJECTIVES: To review the frequency of chronic pain and to discuss etiological theories and current treatment options for patients with chronic post herniorrhaphy pain. MATERIALS AND METHODS: All studies of postoperative pain after inguinal hernia repair with a minimum follow-up period of 3 months, published between 1987 and 2000, were critically reviewed. RESULTS AND DISCUSSION: The frequency of chronic pain after inguinal hernia repair was found to be as high as 54%, much more than previously reported. Quality of life of these patients is affected. Chronic pain is reported less often after laparoscopic and mesh repairs. Recurrent hernia repair, preoperative pain, day case surgery, delayed onset of symptoms, and high pain scores in the first week after surgery, however, were identified to be risk factors for the development of chronic pain. Definition of chronic pain was not explicit in the majority of the reviewed studies. Accurate evaluation of the frequency of chronic pain will require standardization of definition and methods of assessment. Prospective studies are required to define the role of risk factors identified in this review.

Chronic Disease↗
PubMedDate not supplied

Quantitative assessment of chronic postsurgical pain using the McGill Pain Questionnaire.

OBJECTIVES: The McGill Pain Questionnaire (MPQ) provides a quantitative profile of 3 major psychologic dimensions of pain: sensory-discriminative, motivational-affective, and cognitive-evaluative. Although the MPQ is frequently used as a pain measurement tool, no studies to date have compared the characteristics of chronic post-surgical pain after different surgical procedures using a quantitative scoring method. METHODS: Three separate questionnaire surveys were administered to patients who had undergone surgery at different time points between 1990 and 2000. Surgical procedures selected were mastectomy (n = 511 patients), inguinal hernia repair (n = 351 patients), and cardiac surgery via a central chest wound with or without saphenous vein harvesting (n = 1348 patients). A standard questionnaire format with the MPQ was used for each survey. The IASP definition of chronic pain, continuously or intermittently for longer than 3 months, was used with other criteria for pain location. The type of chronic pain was compared between the surgical populations using 3 different analytical methods: the Pain Rating Intensity score using scale values, (PRI-S); the Pain Rating Intensity using weighted rank values multiplied by scale value (PRI-R); and number of words chosen (NWC). RESULTS: The prevalence of chronic pain after mastectomy, inguinal herniorrhaphy, and median sternotomy with or without saphenectomy was 43%, 30%, and 39% respectively. Chronic pain most frequently reported was sensory-discriminative in quality with similar proportions across different surgical sites. Average PRI-S values after mastectomy, hernia repair, sternotomy (without postoperative anginal symptoms), and saphenectomy were 14.06, 13.00, 12.03, and 8.06 respectively. Analysis was conducted on cardiac patients who reported anginal symptoms with chronic post-surgical pain (PRI-S value 14.28). Patients with moderate and severe pain were more likely to choose more than 10 pain descriptors, regardless of the operative site (P < 0.05). DISCUSSION: The prevalence and characteristics of chronic pain was remarkably similar across different operative groups. This study is the first to quantitatively compare chronic post-surgical pain using similar methodologies in heterogeneous post-surgical populations.

Aged↗