Deep Breathing Research Articles

Enhancing positioning accuracy in adjuvant radiotherapy for left breast cancer using cervical‐thoracic integrated bracket combined with deep inspiration breath holding

Enhancing positioning accuracy in adjuvant radiotherapy for left breast cancer using cervical‐thoracic integrated bracket combined with deep inspiration breath holding

Recruitment of the diaphragm and sternocleidomastoid muscle during increasing inspiratory pressure loads in healthy young adults

BackgroundInspiratory muscle training (IMT) is often employed to enhance improvement in inspiratory muscle strength. However, the relationship between inspiratory muscle recruitment patterns and increasing inspiratory load remains unclear. Furthermore, the effect of breathing instructions on diaphragm activity at various inspiratory loads is unknown. ObjectiveTo investigate the recruitment activity of the diaphragm and sternocleidomastoid (SCM) muscles under increased inspiratory pressure loading, with and without diaphragmatic breathing instructions, in healthy young adults. MethodsParticipants were invited to breathe, in random order, 6 sets of 10 breaths at inspiratory loads of 30% to 80% maximal inspiratory pressure (MIP), in 10% increments. The measurement process was repeated with a specific focus of diaphragmatic descent during inspiration. Concurrent recorded surface electromyography of the right SCM muscle and right hemi-diaphragm thickness measured by ultrasonography during each targeted breath. ResultsSixty-two adults (31 males, age: 23±3 years) participated in the study. Irrespective of breathing instructions, computed diaphragm thickening fraction (DTf) increased with increasing inspiratory load but peaked at 50%MIP and declined with increasing load to 80%MIP. SCM recruitment increased with increasing inspiratory load to 80%MIP. Forced inspiration with diaphragmatic breathing was associated with a higher DTf and lower SCM muscle activity. The above pattern was similar for both male and female participants. Female participants produced higher SCM activity compared with males but only at inspiration loads below 50%MIP. ConclusionsIn a cohort of young healthy adults, magnitude of diaphragmatic effort was greatest at 50% MIP but declined with increasing inspiratory load to 80%MIP. Forced inspiration combined with focused diaphragmatic breathing accentuated diaphragm contraction and reduced SCM muscle contribution. Our findings show that diaphragmatic muscle recruitment is non-linear and that the generic clinical prescription of an IMT program may need to be reconfigured.

The Relationship Between Ethical Attitudes and Compassion Fatigue in Nurses Working in Surgical Intensive Care Units

Aim This study aimed to explore the relationship between ethical attitudes and compassion fatigue experienced by nurses in surgical intensive care units. Methods It is mixed-design research. The study was conducted with 38 nurses working in the surgical intensive care units of a university hospital who agreed to participate in the study. Quantitative data were collected using the Nurse Information Form, the Ethical Attitude Scale for Nursing Care, and the Compassion Fatigue–Short Scale. Qualitative data were collected using a semistructured questionnaire, through individual interviews with 9 volunteer nurses in surgical intensive care units. Results The study revealed that nurses exhibited high levels of ethical attitudes in nursing care along with high levels of compassion fatigue. During the qualitative data analysis, 4 key themes emerged: ethical approaches in surgical intensive care units, professional quality of life in nurses, the reflections of compassion fatigue on ethical behavior, and nurses’ well-being. Conclusions It was concluded that when compassion fatigue increased in nurses in surgical intensive care units, ethical attitudes in nursing care decreased. Therefore, compassion fatigue can be addressed by programs that support nurses’ well-being, such as meditation, deep breathing, self-compassion exercises, and so on. It can be reduced.

Validation of different automated segmentation models for target volume contouring in postoperative radiotherapy for breast cancer and regional nodal irradiation

IntroductionTarget volume delineation is routinely performed in postoperative radiotherapy (RT) for breast cancer patients, but it is a time-consuming process. The aim of the present study was to validate the quality, clinical usability and institutional-specific implementation of different auto-segmentation tools into clinical routine. MethodsThree different commercially available, artificial intelligence-, ESTRO-guideline-based segmentation models (M1-3) were applied to fifty consecutive reference patients who received postoperative local RT including regional nodal irradiation for breast cancer for the delineation of clinical target volumes: the residual breast, implant or chestwall, axilla levels 1 and 2, the infra- and supraclavicular regions, the interpectoral and internal mammary nodes. Objective evaluation metrics of the created structures were conducted with the Dice similarity index (DICE) and the Hausdorff distance, and a manual evaluation of usability. ResultsThe resulting geometries of the segmentation models were compared to the reference volumes for each patient and required no or only minor corrections in 72 % (M1), 64 % (M2) and 78 % (M3) of the cases. The median DICE and Hausdorff values for the resulting planning target volumes were 0.87–0.88 and 2.96–3.55, respectively. Clinical usability was significantly correlated with the DICE index, with calculated cut-off values used to define no or minor adjustments of 0.82–0.86. Right or left sided target and breathing method (deep inspiration breath hold vs. free breathing) did not impact the quality of the resulting structures. ConclusionArtificial intelligence-based auto-segmentation programs showed high-quality accuracy and provided standardization and efficient support for guideline-based target volume contouring as a precondition for fully automated workflows in radiotherapy treatment planning.

Effect of Deep Diaphragmatic Breathing on Pain in Patients with Metastatic Gastrointestinal Cancers

Effect of Deep Diaphragmatic Breathing on Pain in Patients with Metastatic Gastrointestinal Cancers

Effects of Respiratory Training on Pulmonary Function, Cough, and Functional Independence in Patients with Amyotrophic Lateral Sclerosis

Background: Respiratory complications in patients with amyotrophic lateral sclerosis (ALS), due to the involvement of respiratory muscles, are the leading cause of death, and respiratory physiotherapy (RP) focuses on addressing these complications. Objectives: The objective was to evaluate the effectiveness of an RP intervention that combines the four specific techniques (inspiratory muscle training, lung volume recruitment, manually assisted coughing, and diaphragmatic breathing training) in patients with ALS. Methods: A quasi-experimental study was carried out, and a specific RP programme was implemented in 15 patients with ALS (12 sessions, 30 min/session, one session/week, duration of three months), based on directed ventilation techniques, lung volume recruitment, manually assisted coughing, and the use of incentive spirometry and a cough assist device, along with a daily home exercise programme. Respiratory functions were assessed (pre- and post-intervention, with follow-up at three months) using Forced Vital Capacity (FVC) and Peak Expiratory Cough Flow (PECF); functionality was assessed using the Revised ALS Functional Rating Scale (ALSFRS-R) and the Modified Barthel Index by Granger. Results: FVC experienced an increase after three months of the intervention initiation (p = 0.30), which was not sustained at the three-month follow-up after the intervention ended. All other variables remained practically constant after treatment, with their values decreasing at follow-up. Conclusion: A specific RP intervention could have beneficial effects on respiratory functions, potentially preventing pulmonary infections and hospitalisations in patients with ALS. It may improve FVC and help stabilize the patient's functional decline. Considering the progressive and degenerative nature of the disease, this finding could support the usefulness of these techniques in maintaining respiratory function.

Exercise benefits following breast cancer surgery – a narrative review

One of the most common cancer diseases among women is breast cancer. Treatment following breast cancer surgery leads to many complications. Exercises play an important role from the immediate post operative period which could help in preventing post-surgical complications. Prevention of complications improves the quality of life of women. Though women feel that performing exercises following treatment are difficult there are many positive effects of exercises. This current study was done with an objective to analyse the various effects of exercises especially on the resisted exercises in preventing Secondary lymphedema (SL) and to focus light on the benefits of the exercises during and after chemotherapy. Literature search of PubMed, Clinical Key and Google scholar was performed. For women recovering from breast cancer surgery, resisted exercises, either by themselves or in combination with aerobic exercises, were safe and effective. These exercises improved upper body strength, increased endurance, decreased adipose tissue, decreased waist and hip circumferences, increased lean body mass, improved cardiovascular fitness, improved self-esteem, and decreased depression. Women with breast cancer related lymphedema had a considerable improvement in pain after performing deep breathing exercises combined with upper limb movements. Exercise can help mitigate the negative effects of chemotherapy and helps to overcome cancer related fatigue. Along with conventional exercises including range of motion exercises and aerobic exercises, moderate-intensity upper body resistance exercises are recommended to be a part of exercise protocol prescribed and educated to the women following breast cancer surgery for them to lead a better quality of life.

A slow diaphragmatic breathing intervention for anxiety: How do respiration rate and inhalation/exhalation ratio influence self-reported anxiety?

The primary aim was to investigate how respiration rate and inhalation/exhalation ratio influence self-reported state anxiety during a single slow diaphragmatic breathing exercise session. Eight hundred and twenty-eight participants completed the study at two separate geographical locations (Poland and Spain). Participants performed a 10-min online guided breathing exercise. Respiration rates were sampled from a continuous uniform distribution (ranging from 6 to 12 breaths/min). Similarly, inhalation/exhalation ratios were treated as continuous variables and sampled from a uniform distribution for each participant. An application programed for this experiment displayed visual and auditory cues adjusted for each participant. Before and after the breathing exercise, each participant filled in the Current Anxiety Level Measure questionnaire. Self-trait anxiety was measured with the Clinically Useful Anxiety Outcome Scale. A linear regression model showed that respiration rate, trait anxiety, pre-test anxiety, and nationality (Polish/Spanish) were positively related to post-test anxiety levels. Adding quadratic terms of respiration rate and inhalation/exhalation ratio did not improve model fit. Polish participants exhibited higher post-test anxiety levels compared with the Spanish subsample. Age was negatively associated with post-test anxiety. No significant relationships between inhalation/exhalation ratio and post-test anxiety level were found. Slower respiration rates during a single-session breathing exercise are linearly associated with lower post-test anxiety levels in a large and varied sample. This study is the largest to date and may offer further guidance for predicting expected effect sizes for the relationships between anxiety and respiratory dynamics.

The investigation of ultrasound to assess lateral abdominal wall activation with different types of core exercises

BackgroundCore training is the foundation of physical exercise. The activation of the lateral abdominal wall (LAW) muscles in the core muscles, particularly the transversus abdominal (TrA) muscles, has a stabilizing effect on the chest and abdomen. Therefore, we need to focus on the training effect of the TrA. There are many ways to measure the LAW. Ultrasound can assess the effect of training in real time and intuitively. Therefore, we intend to evaluate the activation of the LAW in different types of core training using ultrasound, to determine the best movements that can activate the TrA and train the core muscles.Methods22 healthy subjects (male 10, female 12, age 22.82 ± 0.98, BMI 20.78 ± 2.27) were included. The subjects were given the following instructions to perform breathing exercises at different positions: calm breathing and deep breathing at 0° hip flexion and 0° knee flexion; calm breathing, deep breathing, abdominal crunches and ball crunches at 45° hip flexion and 90° knee flexion; and calm breathing, deep breathing, abdominal crunches and ball crunches at 90° hip flexion and 90° knee flexion. The muscle thicknesses of the bilateral transversus abdominis (TrA), internal oblique (IO), external oblique (EO), and LAW muscles were measured using ultrasonography at the end of expiration during the above movements.Results(1) The action with the greatest contraction ratio of the TrA was deep exhalation, which was significantly greater than crunch and ball crunch; (2) During deep exhalation, the TrA had the greatest contraction ratio, significantly greater than the IO and EO. (3) The TrA was thinnest during deep exhalation at 90°, followed by 45° and 0°.ConclusionIn healthy young people, deep expiration with 90° hip flexion and 90° knee flexion was the optimal action for activating the LAW, especially the TrA.

One-year outcomes of a digital twin intervention for type 2 diabetes: a retrospective real-world study

This retrospective observational study, building on prior research that demonstrated the efficacy of the Digital Twin (DT) Precision Treatment Program over shorter follow-up periods​​, aimed to examine glycemic control and reduced anti-diabetic medication use after one-year in a DT commercial program. T2D patients enrolled had adequate hepatic and renal function and no recent cardiovascular events. DT intervention powered by artificial intelligence utilizes precision nutrition, activity, sleep, and deep breathing exercises. Outcome measures included HbA1c change, medication reduction, anthropometrics, insulin markers, and continuous glucose monitoring (CGM) metrics. Of 1985 enrollees, 132 (6.6%) were lost to follow-up, leaving 1853 participants who completed one-year. At one-year, participants exhibited significant reductions in HbA1c [mean change: -1.8% (SD 1.7%), p < 0.001], with 1650 (89.0%) achieving HbA1c below 7%. At baseline, participants were on mean 1.9 (SD 1.4) anti-diabetic medications, which decreased to 0.5 (SD 0.7) at one-year [change: -1.5 (SD 1.3), p < 0.001]. Significant reductions in weight [mean change: -4.8 kg (SD 6.0 kg), p < 0.001], insulin resistance [HOMA2-IR: -0.1 (SD 1.2), p < 0.001], and improvements in β-cell function [HOMA2-B: +21.6 (SD 47.7), p < 0.001] were observed, along with better CGM metrics. These findings suggest that DT intervention could play a vital role in the future of T2D care.

Mindfulness Exercises Reduce Acute Physiologic Stress Among Female Clinicians.

Approximately 50% of clinicians experience excessive emotional, physical, and mental stress, with repercussions across the entire medical system. Mindfulness exercises may mitigate this excessive stress. Heart rate variability (HRV) is an objective stress measure that can quantify which mindfulness exercises provide the greatest stress reduction. To define the impact of specific mindfulness exercises on HRV, a surrogate for physiologic stress, and the relationship between physiologic (HRV) and subjective stress measured by the State-Trait Anxiety Inventory during a one-day mindfulness workshop. This was a prospective observational pilot study performed at a quaternary children's hospital with diverse subspecialists of pediatric nurses, nurse practitioners, and physicians. Our primary outcome measure was change in HRV from baseline during three mindfulness exercises. The grounding, deep breathing, and body scan exercises all produced statistically significant changes in HRV among our 13 female participants. The body scan exercise produced statistically significant changes in all studied HRV parameters compared with baseline. We observed significant increases in Root Mean Square of Successive Differences between normal heartbeats (p = 0.026), high frequency (p ≤ 0.001), and the parasympathetic nervous system index (p ≤ 0.001) reflecting increased parasympathetic tone (e.g., relaxation), whereas sd 2/sd 1 ratio (p ≤ 0.001) and the stress index (p = 0.004) were decreased reflecting sympathetic withdrawal (e.g., decreased stress). Subjective stress decreased after 1-day mindfulness training (44.6 to 27.2) (p < 0.001). Individuals with the largest decrease in subjective stress also had the most improvement in HRV during the body scan exercise. Clinician stress levels (HRV) improved after participating in grounding, deep breathing, and body scan meditations, which may highlight their importance as stress reduction tools for clinicians. Monitoring of HRV during mindfulness exercises may provide deeper understanding of which specific exercises produce the greatest physiologic stress reduction for individual participants and the trend of these changes over time.

The Effectiveness of Deep Breathing Exercise Therapy on Oxygen Saturation among Patients with Ischemic Stroke

Ischemic stroke is an abnormality of central nervous system function in which blood flow decreases significantly, causing hypoxia. This systemic hypoxemia should be avoided; therefore oxygen saturation is monitored in the acute phase. One of the interventions that can be done in order to increase oxygen supply is by deep breathing exercise. The purpose of this study was to determine the effectiveness of deep breathing exercise therapy to increase oxygen saturation on patients with ischemic stroke. This study is a quasi-experimental study with one group pre-posttest design that has been implemented in the neural room of RSUP Dr. M. Djamil Padang with a sample of 16 patients with ischemic stroke who have fulfilled the inclusion criteria. Data was collected directly by measuring oxygen saturation of patients with ischemic stroke before and after a deep breathing exercise intervention. The data were processed by computer and analyzed as univariate and bivariate. Normality test results show the data is not normally distributed so that the analysis used is non-parametric test by using Wilcoxon test. The results showed that deep breathing exercise therapy was effective in increasing oxygen saturation level of patients with ischemic stroke with p = 0,000 so it can be recommended that this therapy can be used as one of the nursing interventions on patients with ischemic stroke to increase the oxygen saturation level.

Breathe and let breathe: Breathing as a political model of organizing

Take a deep breath. Although nothing is more natural or essential to human bodies than breathing, this simple yet vital act is the critical result of complex organizational, material, and political processes. We suggest that breathing can be thought of as a political model of organizing insofar as it shapes questions of life and death while rooting these “operationally” in immediate, urgent, collective and more-than-human intra-action. Breathing is also a social act because the self is bound up with others in a fabric of relations upon which each person depends, and so breathing can serve as a trope for regenerating and rethinking social structures, institutions and organizing blueprints. We take the act of breathing—its literal and metaphorical (im)possibility and collective organization—as the focus of a reflection on relations among humans and between other living beings, humans, and their ecological surroundings. Re-thinking the question of whose breathing we care about and whose breathing counts, we offer a political model that embraces the mutuality principle for post-humanistic and post-anthropocentric organizing and community building. We thereby hope to “inspire” and materialize new social and political realities for organizing our shared future, conceptualized as building a (scholarly) community of breathers who breathe and let breathe.

Novel accelerated carbonation methods based on deep breathing analogous and prediction model for pressurized carbonation of concrete

This research proposes a novel deep breathing analogy (DBA) accelerated carbonation process. Inspired by the breathing mechanism of human lungs, the DBA method involves injecting pure CO2 into a reaction chamber at a specific pressure (inspiration) and subsequently evacuating the gas from the chamber to a negative pressure (exhalation). This process is repeated to remove excess water from the chamber and restore optimal carbonation conditions, which further enhances the efficiency of carbonation for the sample. The effectiveness of this method is evaluated based on weight gain, proportion of captured CO2 and carbonation depth. Results show that the DBA method significantly reduces the inhibition of carbonation. Based on the test results, a correlation between the proportion of captured CO2 and carbonation depth is established. Additionally, a more accurate prediction model for pressurized carbonation is proposed and the economic potential of concrete carbonation is studied.

Atelectasis After Bilateral Costal Cartilage Ear Reconstruction.

This study, through the case analysis of 2 patients with congenital bilateral microtia, explores the causes and preventive strategies of atelectasis after bilateral rib cartilage extraction surgery. Although ear reconstruction technology is quite mature, it may lead to complications, such as atelectasis, due to thoracic surgery and general anesthesia. Pediatric patients are more prone to such complications due to narrower airways, less pulmonary surfactant, and difficulties in pain management. Therefore, for children undergoing bilateral rib cartilage extraction surgery, health care providers need to closely monitor their respiratory status, effectively manage postoperative pain, and encourage them to engage in deep breathing and coughing exercises as much as possible to prevent and improve atelectasis.

Cardiovascular autonomic function in middle-aged people with long-term cervical and upper thoracic spinal cord injuries

Objectives To examine cardiovascular autonomic function in middle-aged people with long-term cervical and upper thoracic spinal cord injury (SCI) compared with the general population, and explore if the neurological level of injury (NLI) is related to cardiovascular autonomic function. Design Population-based cross-sectional study with matched controls. Setting Outpatient SCI unit in Southern Sweden. Participants Twenty-five individuals (20% women, mean age 58 years and mean time since injury 28 years, NLI C2-T6, American Spinal Injury Association Impairment Scale A-C) from the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA). Matched controls were obtained from the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) at a ratio of 5:1. Interventions Not applicable. Outcome measures 24 h electrocardiography and deep breathing tests. 24 h ambulatory blood pressure (BP) monitoring and orthostatic BP tests. Results In individuals with SCI compared with controls, heart rate variability (24h mean SD of the normal-to-normal interval 112 ms vs 145 ms, P < 0.001) and diastolic orthostatic BP increase (2.0 and 9.4 mmHg, P < 0.001), were significantly lower, whereas BP variability was significantly higher (24h mean systolic SDBP 17.8 mmHg vs 15.7 mmHg, P = 0.029). Circadian patterns of heart rate variability and BP (lack of nocturnal dip) were significantly different among the individuals with SCI than controls. Higher NLI was significantly (P < 0.05) correlated with impairments to various cardiovascular autonomic function variables. Conclusions This exploratory study indicates that cardiovascular autonomic function is impaired in middle-aged people with long-term cervical and upper thoracic SCI compared with the general non-SCI population, and more pronounced with a higher NLI. Future research is needed to understand the pathophysiological mechanisms underlying these impairments, and the prognostic significance for individuals with SCI. Trial registration ClinicalTrials.gov identifier: NCT03515122.

Prospective Trial on the Impact of Weekly Cone Beam Computed Tomography-Guided Correction on Mean Heart Dose in Breast Cancer Breath-Hold Radiation Therapy

PurposeSurface-guided radiotherapy (SGRT) in breast cancer radiotherapy (RT) may decrease the need for image guidance such as cone beam computed tomography (CBCT). The goal of this study is to evaluate the impact of CBCT image guidance on the cumulative and interfractional variation of mean heart dose (MHD) during breath-hold radiotherapy in patients with breast cancer. We hypothesize that weekly CBCT is not necessary in SGRT-assisted breath-hold, but is still needed in patients treated with voluntary deep inspiration breath hold (vDIBH) and active breathing control (ABC) to maintain a stable MHD. Methods and materialsThis is a prospective, single-centre trial that sequentially assigned breast cancer patients to adjuvant RT 40-50Gy in 15-25 fractions using vDIBH, ABC or SGRT to reproduce the breath-hold. The MHD was estimated on each of the weekly CBCT images before and after online correction. The cumulative and interfractional variation of MHD, which were represented by the average and standard deviation (SD) of MHD in each patient, were compared in the series of CBCT before and after online correction, to evaluate whether online CBCT-guided correction could lead to a more reproducible MHD. ResultsFifty-five patients were included (vDIBH=16, ABC=19, SGRT=20). CBCT-guided online correction was associated with a significant decrease in the interfractional variation of MHD in vDIBH (SD difference: 22.6cGy, p=0.0389) and ABC (SD difference: 9.9cGy, p=0.0262), but not in SGRT (p=0.2272). CBCT-guided online correction had no impact on the cumulative MHD in all three groups. ConclusionsThis study demonstrated that CBCT-guided online correction could reduce the interfractional variation of MHD in ABC or vDIBH. When SGRT was available, CBCT-guided correction had no impact on the stability of MHD across the treatment fractions. Future studies may explore whether the CBCT frequency could be reduced to less than weekly in SGRT, to decrease treatment time and the radiation dose associated with CBCT.

A dynamic link between respiration and arousal.

Viewing brain function through the lense of other physiological processes has critically added to our understanding of human cognition. Further advances though may need a closer look at the interactions between these physiological processes themselves. Here we characterise the interplay of the highly periodic, and metabolically vital respiratory process and fluctuations in arousal neuromodulation, a process classically seen as non-periodic. In data of three experiments (N = 56 / 27 / 25 women and men) we tested for covariations in respiratory and pupil size (arousal) dynamics. After substantiating a robust coupling in the largest dataset, we further show that coupling strength decreases during task performance compared with rest, and that it mirrors a decreased respiratory rate when participants take deeper breaths. Taken together, these findings suggest a stronger link between respiratory and arousal processes than previously thought. Moreover, these links imply a stronger coupling during periods of rest, and the effect of respiratory rate on the coupling suggests a driving role. As a consequence, studying the role of neuromodulatory arousal on cortical function may also need to consider respiratory influences.Significance statement We characterise the interplay of the respiratory rhythm and pupil diameter dynamics as a well-known proxy for arousal. Although we consistently find respiratory modulation of pupillary changes, they were most pronounced during periods of rest (compared to during task performance) and dependent on respiratory rate (deep vs. normal breathing).

Improving Mental Health Outcome in Hypertensive Patients: The Role of Relaxation Techniques

Background: Relaxation techniques (progressive muscle relaxation and deep breathing) have an impact on the patients with hypertension as they produce a relaxation response within the body and thus, are efficient in lowering the stress and blood pressure in the patients. Objective: This study aims to determine the role of relaxation techniques (progressive muscle relaxation and deep breathing) on improving mental health outcome in hypertensive patients (depression, anxiety and stress). Methodology: A Quasi-experimental design used to guide this study, it was conducted by use of a pre-posttest approach during the period 26th of November, 2023 to 7th of April, 2024. A non-probability (purposive) sampling has been performed during a selection of (100) patients who attending Outpatient Clinic in Al-Diwaniyah Teaching Hospital, (50) patients as control group and (50) patients as study group. The researcher used a socio-demographic and psychological parameter scale (DASS-21). Results: The findings of the current study show highly statistically significant differences in post-test between study and control group (at P ≤ 0.001). On other hand, there is no statistically significant difference in the pre-test between the two group of all psychological parameter (at P ≤ 0.05). Conclusion: Based on the study's findings, progressive muscle relaxation and deep breathing exercises can both proved to be significantly effective in improve mental health in hypertensive patients (depression, anxiety and stress). Recommendations: In order to reduce hypertension and other psychological parameters in patients with essential hypertension, the researcher suggested combining pharmacological therapies with non-drug therapy (relaxation techniques intervention) in the management of hypertension.

Enriching Clinical Trials Enrolling Children With Cerebral Malaria Using Admission Demographics, Physical Examination and Point-of-care Testing Results.

Multiple clinical trials evaluating therapies for cerebral malaria (CM) have failed to demonstrate improved outcomes. This may derive from inclusion of children at all risk levels, including those at low risk of mortality or neurologic morbidity, limiting power to detect significant differences between intervention arms. One solution is enrichment, enrolling clinical trial participants at higher risk of adverse outcomes. We assessed if demographic, physical examination and point-of-care laboratory testing results in combination could identify children with CM at higher risk of death or neurologic disability. Retrospective case-control study of 1674 children hospitalized with CM in Blantyre, Malawi. We used univariate and multivariate analyses of admission factors to find the most parsimonious model associated with death or neurologic disability. To assess the clinical utility of the models, we evaluated derived probability density curve separation. Blantyre Coma Score (BCS), deep breathing and high blood lactate were independently associated with mortality. The derived receiver operating curve yielded an area under the curve of 0.7118. There was poor separation of derived probability density curves predicting death or survival, indicating limited clinical utility of this model. On multivariate modeling of neurologic sequelae in CM survivors, only BCS was associated with adverse outcomes (area-under-the-curve = 0.6151). Probability density curves again largely overlapped, demonstrating limited utility of BCS alone in outcome prediction. Combinations of admission demographic, clinical and point-of-care laboratory factors are inadequate to predict prognosis in children with CM. Higher technology assessment methods are necessary for clinical trial enrichment.