BEFORE YOU READ. Vocabulary practice. Exercise 1. Vocabulary you need.

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1 Text Why read this paper? Because it is relevant to my work? Because my colleagues/chief asked me to? Because I m curious about the topic? Because I want to increase my general knowledge? Because I m looking for some specific information? Because I want to confirm what I already know? Other reasons? BEFORE YOU READ Vocabulary practice Exercise 1. Vocabulary you need. 1. condition condizione; disturbo, patologia 2. deficiency carenza 3. due to dovuto a; a causa di 4. food cibo 5. linked associato a 6. may potrebbe, è possibile 7. news notizie, novità 8. pain dolore 87

2 T H E D O C T O R I S I N 9. painful doloroso 10. paucity pochezza, scarsità 11. poor povero, scarso 12. relief sollievo 13. retrieved reperito 14. skin cute 15. sunlight luce solare 16. supplementation integrazione 17. textbook libro di testo 18. through attraverso 19. undertaken intrapreso Exercise 2. Complete the paragraph with words from the box. aetiology; chronic; exposure; produced; range; suggests Background: Vitamin D is in the skin after sunlight and can also be obtained through food. Vitamin D deficiency has recently been linked with a of diseases including pain. Observational and circumstantial evidence that there may be a role for vitamin D deficiency in the of chronic pain conditions. Exercise 3. As above. assess; events; objectives : To the efficacy and adverse of vitamin D supplementation in chronic painful conditions. Exercise 4. As above. found; main; outcome; participants; treating Results: Four studies, with a total of 294, were included. The studies were heterogeneous with regard to study quality, the chronic painful conditions that were investigated, and the measures reported. Only one study reported a beneficial effect, the others no benefit of vitamin D over placebo in chronic pain. Exercise 5. As above. adults; Authors ; base; insufficient; low; research Conclusions: The evidence for the use of vitamin D for chronic pain in is poor at present. This is due to quality and randomised controlled trials in this area of. READ Exercise 1. Scan the text to find this information. 1. In what journal was this paper originally published? 2. What is a systematic review? (Consult pp of this textbook for information on study designs) 3. What institution are the authors affiliated with? 4. What was the rationale of the study? 5. What is the aim of this study? 6. What were the criteria for inclusion in the systematic review? 7. How many studies met the inclusion criteria? 88

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4 T H E D O C T O R I S I N Think about what you read. Ask yourself questions. Look for parallels with your own experience. Sometimes you can only hypothesize, but that s ok Exercise 1. Think. Do you know what a randomised double blind trial is? (Consult Appendix at the back of this textbook for information on study designs.) Do you know how much exposure to sunlight is necessary to produce Vitamin D? Do you know what the recommended daily amount of vitamin D is? Do you know which foods provide vitamin D? Have you ever heard about a possible beneficial effect of vitamin D in chronic pain conditions? Do you know what adverse effects vitamin D supplements can cause? Do you know how methodological quality is assessed? Do you know what pooled analysis is? (Consult the Appendix at the back of this textbook for information on statistical data.) Based on the authors conclusions of their systematic review will you prescribe vitamin D supplements to your patients with chronic pain? Exercise 2. Reflect. What have I learned by reading this paper that I didn t already know? Is the information clear? Is the information complete? Can I take home any of the information in this paper? What is my opinion on this topic? Am I curious or interested enough to read the full text paper? Just for fun! Do you know what any of these words or phrases mean? Can you give one or two examples of each? 1. beverage: 2. dairy products: 3. grains: 4. meal: 5. poultry: 6. produce: 7. seafood: 8. shellfish: 90

5 Text Why read this paper? Because it is relevant to my work? Because my colleagues/chief asked me to? Because I m curious about the topic? Because I want to increase my general knowledge? Because I m looking for some specific information? Because I want to confirm what I already know? Other reasons? BEFORE YOU READ Vocabulary practice Exercise 1. True or False? If False, write the correct Italian translation. 1. blinded blindato False: cieco, in cieco 2. concerns preoccupazioni 3. data data 4. early precoce 91

6 T H E D O C T O R I S I N 5. outcome esito 6. pain doloroso 7. physician fisico 8. score punteggio Exercise 2. Put these words into the correct columns, and complete the chart. N.B. Sometimes there is no adjective. assess; collect; delayed; findings; improve; management; need; shown; surgery; update Verb Noun Adjective Meaning assess assessment assessed (pp) valutare Exercise 3. Choose the correct meaning. 1. although mentre/tuttavia/sebbene 2. even nonstante/perfino/mentre 3. nevertheless perciò/tuttavia/come 4. still tuttora/inoltre/anche se 5. thus perciò/inoltre/sebbene 6. whether nonostante/se/mentre Exercise 4. Look at the footnotes on pp for new vocabulary. Syntax practice Exercise 1. Translate these sentences. 1. This is an important topic for postoperative pain management. 2. The authors explored the effects of multi-modal medication use in the early post-operative phase and found that it seems to accelerate the rehabilitation phase. 3. More research is needed on aggressive and early multi-modal pain control in post-operative patients. 92

7 T e x t READ Exercise 1. Scan the text to find this information. 1. In what journal was this paper originally published? 2. What is a prospective, randomized, controlled, double-blind study? (Consult the Appendix at the back of this textbook for information on study designs) 3. What is the clinical evidence topic of this BMJ EvidenceUpdate? 4. How relevant is this paper considered to anesthesiology? 5. How relevant is this paper considered to orthopedic surgery? 6. What institution are the authors affiliated with? 7. What was the rationale of the study? 8. What is the aim of this study? 9. What were the criteria for patient selection? 10. How many subjects where enrolled in each arm of the study? 11. What treatment did each group receive? 12. What was the primary outcome? hip anca; -sparing che riduce il bisogno (es. di un farmaco); consumption consumo; assunzione; crutch stampella; walking frame deambulatore; at rest a riposo; up to fino a. 93

8 T H E D O C T O R I S I N EvidenceUpdates BMJ Evidence Centre Clinical Evidence Topic: Osteoarthritis of the hip DISCIPLINE RELEVANCE TO PRACTICE IS THIS NEWS? Anesthesiology 6/7 6/7 Physical Medicine and Rehabilitation 5/7 5/7 Special Interest - Pain Physician 6/7 6/7 Surgery Orthopaedics 6/7 5/7 Copyright McMaster University All rights reserved. Comments from Clinical Raters Anesthesiology This an interesting study in that the decrease in morphine use, although statistically significant, is not surprising and clinically the difference is not that great (19±12 mg in the placebo group to 14±13 mg study group). What is surprising is the benefit apparently conferred at 1, 3 and 6 months postoperatively for pain reduction in the ketamine group. Physical Medicine and Rehabilitation As ketamine is getting hard to obtain in France, unfortunately the relevance of this study may be moderate. Physical Medicine and Rehabilitation This is an important topic for postoperative pain management. The authors explored the effects of multi-modal medication use in the early post-operative phase and found that it seems to accelerate the rehabilitation phase. Also, the reduction in morphine consumption serves public health concerns about opioid addiction. More research is needed on aggressive and early multi-modal pain control in post-operative patients. Special Interest - Pain Physician Ketamine infusion during 24 hours perioperatively decreased morphine consumption and decreased the number of patients experiencing long-lasting pain and discomfort after total hip replacement. Special Interest - Pain Physician Fascinating study that showed a 24-hr infusion of ketamine after hip arthroplasty reduced pain and improved function for 180 days of follow-up. It would be interesting to see this study repeated, although the authors mention similar findings in oncologic surgery. Special Interest - Pain Physician A well designed study whose most interesting finding was a secondary outcome related to the incidence of chronic pain. A follow-up study designed to specifically confirm these findings would be helpful. Rater valutatore; in that in quanto; what ciò che; get hard diventare difficile; addiction dipendenza; helpful d aiuto. 94

9 T e x t AFTER YOU READ Exercise 1. Translate the clinical raters comments. Anesthesiology 1. This an interesting study in that the decrease in morphine use, although statistically significant, is not surprising and clinically the difference is not that great (19 12 mg in the placebo group to mg study group). 2. What is surprising is the benefit apparently conferred at 1, 3 and 6 months postoperatively for pain reduction in the ketamine group. Physical Medicine and Rehabilitation 3. As ketamine is getting hard to obtain in France, unfortunately the relevance of this study may be moderate. Special Interest - Pain Physician 4. A well designed study whose most interesting finding was a secondary outcome related to the incidence of chronic pain. 5. A follow-up study designed to specifically confirm these findings would be helpful. Exercise 3. Reflect. What have I learned by reading this paper that I didn t already know? Is the information clear? Is the information complete? Can I take home any of the information in this paper? What is my opinion on this topic? Am I curious or interested enough to read the full text paper? Exercise 2. Complete this chart based on the information provided in the abstract. ketamine placebo morphine consumption at 24h day 30 crutches or walking frame day no. of patients with pain at rest day 180 no. of patients with pain at rest Remember that Abstract are subject to a world limit. The information provided in an abstract is therefore rarely complete. Consult the full text for complete details. 95