Background Ageing,immobilization,sepsis or cachexia reduce muscle mass and function.The age-related loss,i.e.sarcopenia,contributes to frailty and results in a loss of mobility and autonomy in aging and disease.Affect...Background Ageing,immobilization,sepsis or cachexia reduce muscle mass and function.The age-related loss,i.e.sarcopenia,contributes to frailty and results in a loss of mobility and autonomy in aging and disease.Affected individuals are often socially isolated,have a greater risk of metabolic disorders and psychosomatic problems.As a result,quality of life and life expectancy are affected.Immobilization and lack of adequate stimuli to the skeletal muscle seem to play a central part in these problems.To overcome them,resistance training(i.e.,weightlifting)is an effective intervention.Statement of the problem Despite the efficacy of resistance training for increasing muscle mass and function,this treatment is underused in clinical practice.We argue that this is due to a lack of a generally applicable methodology.Methods and framework To address this and related problems,we have formed the Network of Expertise for Immobilization-induced Muscle Disorders(KNIMS)to develop a potential algorithm for treating sarcopenia and other immobilization-related muscle disorders.An important aspect of the proposed method is that it is defined as a formal algorithm that consists of two stages.Stage A aims to recover bed-ridden patients’ability to stand by applying vibration-tilt table technology.Stage B aims at rehabilitating compromised gait,using a combination of squats,lunges and single leg raises.It is anticipated that this algorithm-based approach will enhance the ability for standardization and documentation,whilst reducing resource efforts at the same time,which will be equally useful to clinical practice and to clinical research.展开更多
Introduction: Tube thoracostomy is an invasive procedure, which may result in life-threatening injury to major organs and blood vessels. We propose a new approach for inserting tube thoracostomies to improve the safet...Introduction: Tube thoracostomy is an invasive procedure, which may result in life-threatening injury to major organs and blood vessels. We propose a new approach for inserting tube thoracostomies to improve the safety of this procedure, termed guided blunt dissection. In this article, we compared the safety of this new approach with traditional blunt dissection and two commercially available Seldinger tube thoracostomy kits in an ex vivo model. Methods: We recruited 32 clinicians from a variety of medical specialties with a range of experience in performing tube thoracostomy. Each clinician was required to perform tube thoracostomy using all four approaches in a randomised order. Objectively, each insertion was categorised as “safe” if the lung remained intact and “unsafe” if the lung deflated. Subjectively, participants were asked to rank each approach in order of perceived safety on a four-point scale. Statistical analysis was performed using a Fisher’s exact test. Results: Objectively, guided blunt dissection was significantly safer than both Seldinger approaches (p 0.0001), but not traditional blunt dissection (p = 0.71). Subjectively, none of the approaches were felt to be superior. Conclusions: These data support the conclusions that, in this ex vivo model, the new guided blunt dissection approach provided a safe method for tube thoracostomy. Guided blunt dissection produced less lung deflations relative to competing methods, certainly when compared objectively to Seldinger techniques. Of note, the Seldinger approaches were perceived by the participants to be as safe despite there being an increased incidence of lung injury associated with their use in this model. This indicates that it was not always possible for the clinician to determine when lung injury had occurred. This potential for lung injury when using Seldinger approaches for tube thoracostomy should be emphasised.展开更多
文摘Background Ageing,immobilization,sepsis or cachexia reduce muscle mass and function.The age-related loss,i.e.sarcopenia,contributes to frailty and results in a loss of mobility and autonomy in aging and disease.Affected individuals are often socially isolated,have a greater risk of metabolic disorders and psychosomatic problems.As a result,quality of life and life expectancy are affected.Immobilization and lack of adequate stimuli to the skeletal muscle seem to play a central part in these problems.To overcome them,resistance training(i.e.,weightlifting)is an effective intervention.Statement of the problem Despite the efficacy of resistance training for increasing muscle mass and function,this treatment is underused in clinical practice.We argue that this is due to a lack of a generally applicable methodology.Methods and framework To address this and related problems,we have formed the Network of Expertise for Immobilization-induced Muscle Disorders(KNIMS)to develop a potential algorithm for treating sarcopenia and other immobilization-related muscle disorders.An important aspect of the proposed method is that it is defined as a formal algorithm that consists of two stages.Stage A aims to recover bed-ridden patients’ability to stand by applying vibration-tilt table technology.Stage B aims at rehabilitating compromised gait,using a combination of squats,lunges and single leg raises.It is anticipated that this algorithm-based approach will enhance the ability for standardization and documentation,whilst reducing resource efforts at the same time,which will be equally useful to clinical practice and to clinical research.
文摘Introduction: Tube thoracostomy is an invasive procedure, which may result in life-threatening injury to major organs and blood vessels. We propose a new approach for inserting tube thoracostomies to improve the safety of this procedure, termed guided blunt dissection. In this article, we compared the safety of this new approach with traditional blunt dissection and two commercially available Seldinger tube thoracostomy kits in an ex vivo model. Methods: We recruited 32 clinicians from a variety of medical specialties with a range of experience in performing tube thoracostomy. Each clinician was required to perform tube thoracostomy using all four approaches in a randomised order. Objectively, each insertion was categorised as “safe” if the lung remained intact and “unsafe” if the lung deflated. Subjectively, participants were asked to rank each approach in order of perceived safety on a four-point scale. Statistical analysis was performed using a Fisher’s exact test. Results: Objectively, guided blunt dissection was significantly safer than both Seldinger approaches (p 0.0001), but not traditional blunt dissection (p = 0.71). Subjectively, none of the approaches were felt to be superior. Conclusions: These data support the conclusions that, in this ex vivo model, the new guided blunt dissection approach provided a safe method for tube thoracostomy. Guided blunt dissection produced less lung deflations relative to competing methods, certainly when compared objectively to Seldinger techniques. Of note, the Seldinger approaches were perceived by the participants to be as safe despite there being an increased incidence of lung injury associated with their use in this model. This indicates that it was not always possible for the clinician to determine when lung injury had occurred. This potential for lung injury when using Seldinger approaches for tube thoracostomy should be emphasised.
