In 2015, Uhrbrand et al. published the first review on Parkinson´s disease (PD) and exercise entirely based on randomized controlled trials (RCT) applying strict exercise definitions. The present ...review aimed to update the PD literature by assessing the effects of different intensive exercise modalities: resistance training (RT), endurance training (ET), and other intensive exercise modalities (OITM). An updated systematic literature search identified 33 new RCTs. Qualitative and quantitative analyses were performed. A total of 18 RT, 14 ET, and 1 OITM studies were identified (adding to the 8 RT, 6 ET, and 4 OITM studies identified by Uhrbrand et al. in 2015). RT, ET, and OITM were feasible, safe, and did not worsen PD symptoms. Furthermore, RT, ET, and OITM may positively affect functional outcomes (e.g., balance) and depressive symptoms in PD but inconsistencies across these findings warrant cautious conclusions. Meta‐analyses showed that RT had a positive impact on muscle strength (standardized mean difference (SMD) = 0.83 95% CI;0.54, 1.12), functional capacity (Timed Up and Go Test (TUG): SMD = −0.62 −1.01, −0.24), and quality of life (SMD = −0.41 −0.72, −0.09), while ET had a positive impact on cardiorespiratory fitness (SMD = 0.27 0.07, 0.47) and functional capacity (TUG: SMD = −0.21 −0.46, 0.04, 6‐Min Walk Test: SMD = 0.89 0.17, 1.62), and a potentially positive impact on “on‐medication” UPDRS‐III (SMD = −0.15 −0.38, 0.09) and “off‐medication” UPDRS‐III (SMD = −0.19 −0.41, 0.04). In conclusion, RT, ET, and OITM all represent safe, feasible, and beneficial adjunct rehabilitation strategies in PD, with particularly RT and ET showing solid effects.
ABSTRACT
Post‐extubation dysphagia is a condition that is becoming a growing concern. The condition occurs in 3–62% of extubated patients and can be related to mixed aetiologies, such as ...neuromuscular impairment, critical illness and laryngeal damage. The risk factors for developing dysphagia in critically ill patients are under‐diagnosed and perhaps underestimated. Recent studies recommend the implementation of a standardized swallowing screen to prevent aspiration and decrease pneumonia rate and mortality. The aim of this quality improvement initiative was the development of a bedside swallowing screening tool to assess effective swallowing post‐endotracheal extubation. Post‐extubation dysphagia can result in a delay in re‐feeding, with the potential for malnutrition as well as overt and covert aspiration if swallowing is not effectively screened. It is apparent that ICU nurses commence the initial screen for swallowing in the absence of an evidence base of care. A review of current local and international practice guidelines excludes the process of an effective swallowing screen of the extubated patient. Previously, a referral to speech and language therapists would be required to assess swallowing only after an initial review by the ICU medical team. This often leads to delays if the referral is made outside normal working practice, such as weekends or evenings. The initial development of a swallowing screening tool is the first step to promoting a nurse‐led/‐initiated bedside swallow screening tool that will enhance patient care and patient safety. There is growing body of evidence regarding the incidence of post‐extubation dysphagia. Currently, there are very few recognized bedside swallowing screening tools to identify patients at risk. The most serious complication associated with post‐extubation dysphagia is aspiration pneumonia, which is the leading cause of nosocomial infection in the critically ill patient.
Objectives
Fatigue and walking impairment are disabling symptoms of multiple sclerosis (MS). We investigated the effects of progressive aerobic exercise (PAE) on fatigue, walking, cardiorespiratory ...fitness (VO2max), and quality of life in people with MS (pwMS).
Materials & Methods
Randomized controlled trial (1:1 ratio, stratified by sex) with a 24‐week crossover follow‐up and intention‐to‐treat analysis. Allocation to an exercise (24 weeks of PAE followed by self‐guided physical activity) and a waitlist (24 weeks of habitual lifestyle followed by PAE) group. PAE comprised two supervised sessions per week; 30–60 min, 65–95% of maximum heart rate. Fatigue impact (Modified Fatigue Impact Scale; MFIS) and severity (Fatigue Severity Scale; FSS), walking ability (12‐item MS Walking Scale; MSWS‐12) and capacity (Six‐Minute Walk Test; 6MWT, Six Spot Step Test; SSST), quality of life (Short Form 36 health survey; SF‐36), and VO2max were measured at baseline, 24 weeks, and 48 weeks.
Results
Eighty‐six pwMS were enrolled. Following PAE between‐group differences showed reductions in MFIStotal (−5.3 95% CI: −10.9;0.4, point estimate >clinical relevance), MFISphysical subscore (−2.8 −5.6;‐0.1), and MFISpsychosocial subscore (−0.9 −1.6;‐0.2), and an increase in VO2max (+3.5 ml O2/min/kg 2.0;5.1). MSWS‐12 (−5.9 −11.9; 0.2) and 6MWT (+14 m −5;33) differences suggested potential small walking improvements. No changes observed in FSS, SSST, or SF‐36.
Conclusions
In a representative sample of pwMS, PAE induced a clinically relevant reduction in fatigue impact, whereas small and no effects were seen for walking and quality of life, respectively. The results need confirmation in a future trial due to the study limitations.
The growing prevalence of multimorbidity places a strain on primary healthcare globally. The current study's aim was to identify, appraise, and synthesize published qualitative longitudinal research ...on individuals' experiences concerning living with multimorbidity through time. The authors searched two electronic databases, MEDLINE and CINAHL, and performed an additional literature search in Google Scholar. A thematic synthesis approach was used to analyze the qualitative data across the studies. A total of 10 reports that met the inclusion and exclusion criteria were included in the synthesis. Five descriptive themes emerged from the analysis of the living experiences of individuals with multimorbidity: (1) perceiving multimorbidity, (2) managing chronic conditions, (3) emotional struggles in everyday life with multimorbidity, (4) interactions with the healthcare system and healthcare professionals, and (5) family support. This meta-synthesis provides insights into the diverse perceptions of multimorbidity and how individuals cope with their chronic conditions in their daily lives. The findings highlight the importance of establishing effective patient-centered care that acknowledges and supports the multifaceted needs of this population. It is also recommended to involve a psychological component in the care of individuals with multimorbidity, as part of a collaborative and interprofessional approach.
Critical care: A concept analysis Christensen, Martin; Liang, Mining
International journal of nursing sciences,
07/2023, Letnik:
10, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The terms critical care and the Intensive Care Unit (ICU) are often used interchangeably to describe a place of care. Defining critical care becomes challenging because of the colloquial use of the ...term. Using concept analysis allows for the development of definition and meaning. The aim of this concept analysis is to distinguish the use of the term critical care to develop an operational definition which describes what constitutes critical care.
Walker and Avant’s eight-step approach to concept analysis guided this study. Five databases (CINAHL, Scopus, PubMed, ProQuest Dissertation Abstracts and Medline) were searched for studies related to critical care. The search included both qualitative and quantitative studies written in English and published between 1990 and 2022.
Of the 439 papers retrieved, 47 met the inclusion criteria. The defining attributes of critical care included 1) a maladaptive response to illness/injury, 2) admission modelling criteria, 3) advanced medical technologies, and 4) specialised health professionals. Antecedents were associated with illness/injury that progressed to a level of criticality with a significant decline in both physical and psychological functioning. Consequences were identified as either death or survival with/without experiencing post-ICU syndrome.
Describing critical care is often challenging because of the highly technical nature of the environment. This conceptual understanding and operational definition will inform future research as to the scope of critical care and allow for the design of robust evaluative instruments to better understand the nature of care in the intensive care environment.
We quantify the general equilibrium effects on economic growth of improving the quality of institutions at the regional level in the context of the implementation of the European Cohesion Policy for ...the European Union and the UK. The direct impact of changes in the quality of government is integrated in a general equilibrium model to analyse the system‐wide economic effects resulting from additional endogenous mechanisms and feedback effects. The results reveal a significant direct effect as well as considerable system‐wide benefits from improved government quality on economic growth. A small 5 per cent increase in government quality across European Union regions increases the impact of Cohesion investment by up to 7 per cent in the short run and 3 per cent in the long run. The exact magnitude of the gains depends on various local factors, including the initial endowments of public capital, the level of government quality, and the degree of persistence over time.
The prevalence of vitamin D deficiency is high among pregnant women. Vitamin D deficiency in pregnancy is associated with increased risk of adverse pregnancy outcomes especially complications related ...to placental dysfunction and insulin resistance. The objective of this study is to investigate if a higher dose of vitamin D supplementation in pregnancy reduces the prevalence of vitamin D deficiency and prevents adverse pregnancy outcome with special emphasize on preeclampsia, foetal growth restriction and gestational diabetes.
GRAVITD is a double-blinded randomised trial with parallel groups where all pregnant women attending the free of charge national nuchal translucency scan programme in gestational week 10-14 at Randers Regional Hospital are invited to participate. Enrolment started in June 2020. Participants are randomised in a two armed randomization with a 1:1 allocation ratio into 1) control group - receives 10 µg of vitamin D or 2) intervention group - receives 90 µg of vitamin D. A total of 2000 pregnant women will be included. Maternal blood samples and questionnaires describing life-style habits are collected upon enrolment. For half of the participants blood samples and questionnaires will be repeated again in 3rd trimester. Blood samples will be analysed for 25-hydroxy-vitamin D using high-performance liquid chromatography coupled with tandem mass spectrometry. Upon delivery, placental tissue and umbilicalcord blood will be collected and information on maternal and fetal outcomes will be exstracted from medical records. The primary outcomes are serum levels of 25-hydroxy-vitamin D ≥ 75 nmol/L and the rate of preeclampsia, foetal growth restriction and gestational diabetes. Secondary outcome includes identification and impact on placental functions related to vitamin D. A tertiary outcome is to initiate a cohort of children born from mothers in the trial for future follow-up of the effects of vitamin D on childhood health.
Provided that this trial finds beneficial effects of a higher dose of vitamin D supplementation in pregnancies, official recommendations can be adjusted accordingly. This will provide a low-cost and easily implementable adjustment of prenatal care which can improve health for both mother and child during pregnancy and beyond.
ClinicalTrial.gov: NCT04291313 . Registered February 17, 2020.
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