Non-pharmacological Guidelines Research Articles

A combination of metformin and galantamine exhibits synergistic benefits in the treatment of sarcopenia.

Age-associated sarcopenia, characterized by a progressive loss in muscle mass and strength, is the largest cause of frailty and disability in the elderly worldwide. Current treatments involve nonpharmacological guidelines that few subjects can abide by, highlighting the need for effective drugs. Preclinical models were employed to test the benefits of RJx-01, a combination drug composed of metformin and galantamine, on sarcopenia. In worms, RJx-01 treatment improved lifespan, locomotion, pharyngeal pumping, and muscle fiber organization. The synergistic effects of RJx-01 were recapitulated in a transgenic mouse model that displays an exacerbated aging phenotype (Opa1-/-). In these mice, RJx-01 ameliorated physical performance, muscle mass and force, neuromuscular junction stability, and systemic inflammation. RJx-01 also improved physical performance and muscle strength in 22-month-old WT mice and also improved skeletal muscle ultrastructure, mitochondrial morphology, autophagy, lysosomal function, and satellite cell content. Denervation and myofiber damage were decreased in RJx-01-treated animals compared with controls. RJx-01 improved muscle quality rather than quantity, indicating that the improvement in quality underlies the beneficial effects of the combination drug. The studies herein indicate synergistic beneficial effects of RJx-01 in the treatment of sarcopenia and support the pursuit of RJx-01 in a human clinical trial as a therapeutic intervention for sarcopenia.

STEMI-CR: Solution for Patients with Acute Myocardial Infarction at Home-Based Cardiac Rehabilitation Program

STEMI - CR (ST Elevation Myocardial Infarction - Cardiac Rehabilitation) is a program based on a model of home monitoring through digital tools (mobile application and website) in patients who have suffered acute myocardial infarction. This solution found in information technology will be used to address the delivery of services with remote operation between patients and health professionals and allows the delivery of home services through a cardiac recovery program in post-myocardial infarction patients through the automation of PROM’s (Patient Reported Outcomes Measures) and biometric/electrocardiographic data monitored in real time, which can be incorporated into the hospital clinical record. The platform brings together several resources, such as exercise prescription, diet and medication, monitoring exercise plan, prescription history and recording the symptom. It will also be possible to have an avatar, gamification challenges and a communication area (social network), so that patients included in the program can enhance interaction and share their experiences about the various recommended activities and their impact on quality of life. It is based on this conception that any pharmacological and non-pharmacological guidelines can be based, with the expectation of greater patient adherence to CR programs and a significantly impact on the respective prognosis.

India faces a challenge with its mass vaccination efforts

India faces a challenge with its mass vaccination efforts

Effectiveness of an Instructional Program Concerning Non-Pharmacological Guideline on Controlling Essential Hypertension among Patients at AL-Sader Hospital in AL-Najaf AL-Ashraf City

Objective: The aims of present study to detect the effectiveness of instruction program of non-pharmacological guideline on blood pressure and laboratory test.
 
 Methodology: A pre-experimental study was conducted in Al-Sader Teaching Hospital from 8th of September 2019 to 25th of May 2020, in order to find out the effectiveness of instruction program concerning non-pharmacological guideline on controlling essential hypertension among patients. A non- probability (purposive sample) of 50 patients with essential hypertension is selected. Those patients are already diagnosed with Essential Hypertension and had already used the medication and they visited the hospitals for treatment or follow-up or both. A questionnaire is constructed to assess the effectiveness of the instruction program for controlling essential hypertension which consist of four part
 Part one: It is concerned with the patients’ socio-demographic data which include (gender, age, level of education, marital status, economic status, and occupation)
 Part two: Consist of patient health behavior which as exercise, weight, height and assessing of BP. 
 Part three: included list of Laboratory test
 Part four: deals two domain related to patient's knowledge about hypertension which as 15 items and Second domain related to DASH regimen which as 13 items.
 The validity of the questionnaire and the instructional program had been achieved by 10 panel of experts, the descriptive and inferential statistics was used to data analysis of the results.
 Results: The results of the study indicated that the stage of hypertension according to category of hypertension was 44% stage 3 the pre-test and their hypertension was improved in the post-test where become 26% prehypertension, and 22% norm tension.
 Recommendations: The study recommended that the instructional guideline (DASH) should be used and applied to all patients' to health institutions with essential hypertension by the Ministry of Health and health care centers.

A nationwide study on concordance with multimodal treatment guidelines in bipolar disorder

BackgroundMost previous studies on concordance with treatment guidelines for bipolar disorder focused on pharmacotherapy. Few studies have included other treatment modalities.AimsTo study concordance with the Dutch guideline of various treatment modalities in outpatient treatment settings for patients with bipolar disorder and to identity factors associated with concordance.MethodsA nationwide non-interventional study using psychiatrists’ and patients’ surveys.Results839 patients with bipolar or schizoaffective disorder bipolar type were included. Concordance with the guideline was highest for participation of a psychiatrist in the treatment (98%) and for maintenance pharmacotherapy (96%), but lower for supportive treatment (73.5%), use of an emergency plan (70.6%), psychotherapy (52.2%), group psychoeducation (47.2%), and mood monitoring (47%). Presence of a written treatment plan, a more specialized treatment setting, more years of education, and diagnosis of bipolar I disorder versus bipolar II, bipolar NOS, or schizoaffective disorder were significantly associated with better concordance.ConclusionIn contrast to pharmacotherapy, psychosocial treatments are only implemented to a limited extend in everyday clinical practice in bipolar disorder. More effort is needed to implement non-pharmacological guideline recommendations for bipolar disorder.

Integrated Assessment of Pharmacological and Nutritional Cardiovascular Risk Management: Blood Pressure Control in the DIAbetes and LifEstyle Cohort Twente (DIALECT).

Cardiovascular risk management is an integral part of treatment in Type 2 Diabetes Mellitus (T2DM), and requires pharmacological as well as nutritional management. We hypothesize that a systematic assessment of both pharmacological and nutritional management can identify targets for the improvement of treatment quality. Therefore, we analysed blood pressure (BP) management in the DIAbetes and LifEstyle Cohort Twente (DIALECT). DIALECT is an observational cohort from routine diabetes care, performed at the ZGT Hospital (Almelo and Hengelo, The Netherlands). BP was measured for 15 min with one minute intervals. Sodium and potassium intake was derived from 24-hour urinary excretion. We determined the adherence to pharmacological and non-pharmacological guidelines in patients with BP on target (BP-OT) and BP not on target (BP-NOT). In total, 450 patients were included from August 2009 until January 2016. The mean age was 63 ± 9 years, and the majority was male (58%). In total, 53% had BP-OT. In those with BP-NOT, pharmacological management was suboptimal (zero to two antihypertensive drugs) in 62% of patients, and nutritional guideline adherence was suboptimal in 100% of patients (only 8% had a sodium intake on target, 66% had a potassium intake on target, 3% had a sodium-to-potassium ratio on target, and body mass index was <30 kg/m2 in 35%). These data show pharmacological undertreatment and a low adherence to nutritional guidelines. Uncontrolled BP is common in T2DM, and our data show a window of opportunity for improving BP control, especially in nutritional management. To improve treatment quality, we advocate to incorporate the integrated monitoring of nutritional management in quality improvement cycles in routine care.

Changes in Adherence to Non-Pharmacological Guidelines for Hypertension.

This study aimed to compare levels of adherence to non-pharmacological guidelines between patients with and without hypertension diagnoses, and examined temporal changes in adherence during recent decades. We used data from the Korean National Health and Nutrition Examination Survey (1998–2012), including 13,768 Korean hypertensive patients aged ≥ 30 years who were categorized according to the presence or absence of a hypertension diagnosis, based on blood pressure and self-reported information. Adherence to the guidelines was calculated for 6 components, including dietary and lifestyle habits. A multivariable generalized linear regression model was used. The proportion of hypertensive patients aware of their condition increased from 33.4% in 1998 to 74.8% in 2012 (p < 0.001), although these increments plateaued during recent survey years. Patients with hypertension diagnoses were older, and more likely to be female,and have lower education levels than those without hypertension diagnoses, for most survey years. Overall adherence levels were poor (mean score 2 of 6), and levels of adherence to non-pharmacological habits did not significantly differ between patients with and without hypertension diagnoses. However, overall adherence levels improved significantly among patients with hypertension diagnoses: from 2.09 in 1998 to 2.27 in 2012 (p = 0.007), particularly regarding sufficient vegetable/seaweed consumption (p = 0.03), maintaining a normal weight (p = 0.03), and avoidance of smoking (p < 0.001). Awareness of hypertension is increasing, but hypertensive Korean patients demonstrate poor overall adherence to non-pharmacological hypertension management guidelines. These findings suggest that well-planned education programs should be continued after hypertension is diagnosed.

Eight Years Later, Are We Still Hurting Newborn Infants?

Objective: To study whether new pharmacological and nonpharmacological guidelines lowered numbers of painful procedures in neonates and changed the amount and frequency of analgesic therapy as compared to the results of our previous study in 2001. Design: A prospective observational study. Setting: Level III NICU of the Erasmus MC-Sophia Children's Hospital, Rotterdam. Participants: Neonates admitted at postnatal ages less than 3 days with length of stay at least 72 h. Main Outcome Measures: Number of all potentially painful procedures and analgesic therapy recorded at the bedside during the first 14 days of NICU stay. Results: A total number of 21,076 procedures were performed in the 175 neonates studied during 1,730 patient-days (mean 12.2). The mean number of painful procedures per neonate per day was 11.4 (SD 5.7), significantly lower than the number of 14.3 (SD 4.0) in 2001 (p < 0.001). The use of analgesics was 36.6% compared to 60.3% in 2001. Sixty-three percent of all peripheral arterial line insertions failed versus 37.5% in 2001 and 9.1% venipunctures failed versus 21% in 2001. Conclusions: The mean number of painful procedures per NICU patient per day declined. Nonpharmacological pain- or stress-reducing strategies like NIDCAP and sucrose were fully embedded in our pain management. As further reduction of the number of painful procedures is unlikely, we should apply more nonpharmacological interventions and explore newer pharmacological agents.

A study of atenolol and nebivolol in prehypertension

Background: Patients with prehypertension have an increased risk of cardiovascular disease. The coexistence of prehypertension with risk factors increases cardiovascular morbidity and mortality. That’s why it is important to treat pre-hypertensive patients having risk factors. The objective was to evaluate the effect of atenolol and nebivolol in pre-hypertensive patients. Methods: Pre-hypertensive patients having risk factors were selected, and non-pharmacological therapy was advised to all patients. Those patients who were not able to follow strictly non-pharmacological guidelines and remained pre-hypertensive were included in this study. Pre-hypertensive patients were divided into three groups. One group received atenolol 50 mg orally, once daily. Second group received nebivolol 5 mg orally, once daily. Third group received placebo orally, once daily. All groups received treatment for 1 month. Results: In the nebivolol group after 1 month of study, the mean reduction in systolic blood pressure (SBP) was 134.2±3.07-118.26±4.66 and mean reduction in diastolic BP (DBP) was 87.13±1.87-80.73±1.99. Reduction in SBP and DBP in the nebivolol group was significant (p≤0.0001). In the placebo, and atenolol group results were not significant. Conclusion: Nebivolol produces a significant reduction in SBP and DBP in pre-hypertensive patients. Atenolol and placebo did not show beneficial results.

Osteoarthritis: physical medicine and rehabilitation—nonpharmacological management

Osteoarthritis (OA) is the most common joint disease, mainly affecting middle-aged and elderly persons. People with OA of the knee or hip experience pain and deconditioning that may lead to disability. Treatment goals include pain control, maximizing functional independence, and improving quality of life within the constraints imposed by both OA and comorbidities. Exercise is a core recommendation in all nonpharmacological guidelines for the management of patients with knee or hip OA; it is supposed to ameliorate pain and maybe function as well. Therapeutic ultrasound, neuromuscular as well as transcutaneous electrostimulation, pulsed magnetic field therapy, low-level laser therapy, thermal agents, acupuncture, and assistive devices such as insoles, canes, and braces can be used additionally in a multimodal therapeutic program. They may positively influence pain and function, mobility, and quality of life in patients suffering from OA of the lower limbs.

189 Still Hurting Newborn Babies Eight Years after we Found Out!

ObjectiveTo study whether new pharmacological and non-pharmacological guidelines lowered numbers of painful procedures in neonates and changed the amount and frequency of analgesic therapy as compared to the results of...

Delirium—Awareness, observation and interventions in intensive care units: A national survey of Swedish ICU head nurses

To survey the awareness and observation of delirium, and interventions used for delirium in Swedish intensive care units (ICUs) and to examine the influence of hospital categories and staff education on the afore-mentioned. A questionnaire was sent to all Swedish adult patient ICUs (n=82) and completed by 55 units. The reported prevalence of delirium was 9.4%. Assessment of delirium was performed by 62% of the ICUs, commonly by observing symptoms. Most of the suggested non-pharmacologic interventions were reported to be used by at least 85% of the units. Drugs were used by 96%, most commonly haloperidol, propofol and benzodiazepines. Written pharmacological guidelines existed in 26% of the units, while 9% had non-pharmacological guidelines. Regular observation of delirium was more common in larger hospitals than in smaller ones and education was associated with reporting a higher prevalence of delirium. As in other countries, this study demonstrated that the awareness of delirium in ICUs is low with a lack of implementation of validated screening tools for its diagnosis. Emphasis should be placed on education and implementation of these tools to improve the quality of care for ICU patients.

Critical Care Clinicians’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia

Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended. To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia. Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia. The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience. A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia.

Communication between patients with chronic kidney disease and nurses about managing pain in the acute hospital setting

The aim of this paper is to examine communication between patients with chronic kidney disease and nurses about managing pain in the acute hospital setting. While pain often accompanies chronic kidney disease, little is known about managing pain in actual clinical practice. A single group, non-comparative design was used. Research methods included observations and interviews to examine pain communication in all five adult renal units in the state of Victoria, Australia. A thematic approach was used to analyse the data. Observations and interviews were carried out with 14 nurses and 53 patients and 103 incidents of pain communication occurred during observations. Three themes were identified: complexity of pain, knowledge about pain management and contextual characteristics of the renal units. The nature of the patients' pain and effects of analgesics on the body shaped the complexity of pain in chronic kidney disease. Various causes of pain contributed to difficulties in management. Patients had acute pain from surgical procedures, in particular, phantom limb pain. They also had chronic pain arising from leg cramps, restless leg syndrome, and muscle and bone pain. Knowledge about pain management comprised the use of written resources about analgesics and information exchange among health professionals. Contextual characteristics involved the perceived urgency of pain communication and environmental stressors. The findings emphasize the need to capture dynamic processes of pain management in patients with chronic kidney disease to facilitate understandings about complex communication needs of this vulnerable group. Specific analgesic and non-pharmacological guidelines for patients with chronic kidney disease should be developed and made available in practice to facilitate effective pain management. Change champions of renal units are needed to support nurses in dedicating specified time for communicating with patients about managing pain.