Patient Immobility Research Articles

Adult Anaesthesia Practice at Zinder National Hospital

Introduction: Anesthesia allows surgery to proceed smoothly, with pain suppression, patient immobility and neurovegetative protection. The aim of this study is to describe anesthetic practice in adults at Zinder National Hospital. Patients and Method: it was a prospective cross-sectional study including patients aged at least 16 undergoing surgery at the Zinder national hospital from December 4, 2023 to March 3, 2024 (3 months). Results: During the study period, 560 anaesthetic procedures were performed in the operating theatre, of which 329 (58.8%) involved patients aged 16 or over. The mean age was 38.7±17.8, with extremes of 16 and 85 years. Past history was present in 30% of patients, dominated by hypertension. The types of surgery were: visceral surgery 48.9% followed by traumatology 27.1%, all patients were evaluated before anesthesia. General anesthesia (GA) was used in 61.4% of cases. In 55.3% of cases, patients were classified as ASA I. The drug regimen most commonly used for GA was: fentanyl, suxamethonium and ketamine in 38.4% of cases, and for spinal anesthesia, the bupivacaine-fentanyl combination. Anesthesia was provided by 2 anesthesiologists and 10 anesthesia technicians. More than half the patients developed adverse events in the operating room, and one (1) patient died (0.3%). Conclusion: This study provides us with information on the socio-demographic characteristics of patients, the types of surgery and the characteristics of adult anaesthesia at Zinder National Hospital. A number of aspects remain to be improved, including the number of anaesthetists and the availability of equipment such as respirators and capnographs.

Abstract 4144517: Feasibility of Deep Sedation for Catheter Ablation of Atrial Fibrillation Using Pulsed Field Ablation

Introduction: General anesthesia is commonly utilized during catheter ablation of atrial fibrillation (AF) in the United States, providing patient immobility and permitting esophageal temperature management for radiofrequency ablation. Pulsed field ablation (PFA) is associated with shorter procedure time, less risk of esophageal injury, and less dependence on catheter stability compared with radiofrequency ablation. There are limited data available on performing the procedure with deep sedation as an alternative to general anesthesia with endotracheal intubation. Methods: Consecutive patients who underwent catheter ablation of AF at Endeavor Health (Chicago, IL) using pulsed field ablation (Farapulse, Boston Scientific, Marlborough, MA or PulseSelect, Medtronic, Minneapolis, MN) and deep sedation between March and May 2024 were retrospectively included in this study. Deep sedation (monitored anesthesia care) was administered by a certified registered nurse anesthetist and attending anesthesiologist, consisting of bolus and infusion dosing of propofol, dexmedetomidine, fentanyl, and midazolam at the discretion of the practitioner with continuous monitoring of vital signs and end-tidal CO2. The primary endpoint was the rate of airway complications or requirement for conversion to general anesthesia. Secondary endpoints were the rate of acute procedural success (all pulmonary veins isolated), total time in the EP lab, procedure time (from lidocaine to removal of sheaths), and non-procedure time (difference between total time in lab and procedure time). Results: A total of 40 patients (mean age 70.4 ± 13.6 years, BMI 30.2 ± 7.4, 60% females) were included in the analysis. There were no instances of airway complications or conversion from deep sedation to general anesthesia. There was a 100% rate of acute isolation of pulmonary veins. The average total time in the lab was 156.6 ± 41.5 minutes; consisting of a mean procedure time of 107.1 ± 39.7 minutes and non-procedure time 49.5 ± 10.3 minutes. Conclusions: In this initial experience at a single center, deep sedation (monitored anesthesia care) for PFA was associated with no instances of airway complications. The findings may not apply to patients with moderate or severe obstructive sleep apnea or other pulmonary diseases. Although patients generally were amnestic to the procedure, larger studies incorporating patient-reported outcomes are needed, as well as data regarding long-term clinical outcomes and cost.

Disabling Pansclerotic Morphea: A century of discovery.

Disabling pansclerotic morphea (DPM) is a rare systemic inflammatory disorder at the severe end of the localized scleroderma spectrum which primarily affects children under 14 years of age. The disease is characterized by rapid sclerosis with circumferential involvement that frequently extends to the fascia, muscle, and bone. Disease progression often involves development of sclerotic plaques, chronic skin ulcers, and painful joint contractures leading to patient immobility with a high mortality rate. Internal organ fibrosis is typically absent. The aggressive and systemic nature of the disease leads patients to seek multidisciplinary care where current therapies are targeted towards immunomodulation and measures to preserve mobility while limiting infection, but often have limited efficacy. Here, we summarize all DPM patients in the English literature, common clinical symptoms, laboratory investigations, and treatments reported to date. Assessment of published cases suggest that the number of therapies does not influence disease outcome and that female patients were younger at the time of reported death. Clinician familiarity and awareness of common DPM symptoms are important for an accurate and early diagnosis. Furthermore, knowledge of the treatments that have been reported to be effective in mitigating disease progression may be helpful in expanding the treatment options available to patients.

Prosedur Pemeriksaan Digital Subtraction Angiography (DSA) Vena Cerebral Dengan Akses Transradial Pada Kasus Cerebral Venous Thrombosis (CVT)

Background: Cerebral venous thrombosis (CVT) is a form of stroke when blood clots develop in the (venous sinus) of the brain. This condition causes the blood that flows into the brain to be unable to flow out. This can cause reduced blood flow to the brain and damage or kill brain cells if not treated properly. The research aims to determine the digital subtraction angiography (DSA) examination procedure of cerebral veins with trans-radial access in cases of cerebral venous thrombosis (CVT). Method: This type of research is qualitative research with a case study approach. Data was collected on July 20 2023.The research subjects were doctors, interventional radiology doctors, and scrub nurses. By conducting observations, interviews and documentation of the implementation team involved. Results: From the results of observations, documentation and interviews with the implementing team, results were obtained regarding the Cerebral Vein Digital Subtraction Angiography (DSA) examination procedure with transradial access in cases of Cerebral Venous Thrombosis (CVT), including several sub-topics. The Cerebral Digital Subtraction Angiography (DSA) examination procedure with Transradial access is the right action for patients regarding immobility and shorter hospital stays. Conclusion: The Cerebral Vein Digital Subtraction Angiography (DSA) examination procedure with transradial access in cases of Cerebral Venous Thrombosis (CVT) includes patient preparation, tools and materials, examination techniques and post-action care. The Cerebral Vein Digital Subtraction Angiography (DSA) examination procedure with Transradial access is the right action for patients regarding patient immobility and shorter duration of hospital stay. The implementation team consists of a radiology specialist, a scrub nurse and no radiographers involved in the DSA examination room.

Frameless LINAC-Based Stereotactic Radiosurgery is Safe and Effective for Essential and Parkinsonian Tremor

Stereotactic radiosurgery (SRS) to the thalamus is an ablative technique used for treatment of refractory tremor of essential or Parkinsonian origin. Because of the high dose, small target, and required precision, framed SRS on the Gamma Knife has been the historical platform of choice. We tested our recently developed technique to emulate GK dose distributions on a multi-leaf collimator (MLC)-equipped linear accelerator (LINAC) without cumbersome, inefficient cones in a prospective trial of safety and efficacy. We quantified pre-treatment contralateral tremor according to FTM scoring system. We obtained MPRAGE, FGATIR, DTI, and RS-fMRI sequences. We identified the VIM via classical stereotactic reference location and connectomically, and then targeted it to 135 Gy dmax in a manner dosimetrically roughly equivalent to 4 mm GK shot. We adjusted each target such that the 25 Gy isodose line did not overlap the posterior limb of the capsule. We immobilized patients in a highly rigid thermoplastic mask and delivered treatment on an Edge™ LINAC with HDMLC. Intrafraction optical surface monitoring (OSMS) ensured patient immobility. We surveilled post-treatment imaging and recorded tremor scoring, QOL outcomes, and adverse events. We accrued 42 patients (16 female, 26 males; median age 72.5) over 36 months. 38 had essential tremor, 4 had tremor-dominant Parkinson's; 2 withdrew prior to treatment. Ten patients were on therapeutic anti-coagulation, and were not required to discontinue. At time of submission 39 patients had follow-up ≥ 6 months. 35/39 (89.7%) exhibited clinically meaningful tremor reduction. Mean limb tremor reduction among responders was 43.5% (range: 9 - 100%). Time to patient-reported tremor improvement was 0.3 to 15 months. One patient experienced Gr 3, and 4 patients experienced Gr 1-2 toxicity. MLC-based SRS thalamotomy is safe and effective for refractory tremor treatment. Multidisciplinary management is key for proper patient selection, treatment, and monitoring. Our outcomes appear congruent to historical GK controls as well as more modern MRgFUS outcomes.

A self-guided Internet-based intervention for individuals with chronic pain and depressive symptoms: study protocol of a randomized controlled trial

BackgroundDespite the existence of evidence-based therapy options for the treatment of chronic pain and comorbid depressive symptoms (e.g., CBT), many individuals remain untreated. Treatment gaps result from a lack of specialists, patient fear of stigmatization, or patient immobility. Internet-based self-help interventions could serve as an anonymous and flexible alternative treatment option. In a pilot study, chronic pain patients with comorbid depressive symptoms who used a generic Internet-based depression program showed a significant reduction in depressive symptoms (but not pain symptoms) compared to a waitlist control group. Based on these findings, we developed the low-threshold, anonymous, and cost-free Internet-based self-help intervention Lenio that is tailored to the specific needs of chronic pain patients with comorbid depressive symptoms. Lenio is accompanied by the smartphone application (app) COGITO designed to increase therapeutic success. With Lenio and COGITO addressing both chronic pain and depressive symptoms, the trial aims to increase treatment effects of online interventions for chronic pain patients by reducing both depressive symptoms and pain.MethodsThe effectiveness of the Internet-based self-help intervention and accompanying smartphone app will be evaluated in a randomized controlled trial (RCT). A total of 300 participants will be randomized into an intervention group (Lenio/COGITO), an active control group (depression-focused smartphone app), or a waitlist control group. Assessments will be done at baseline, after an 8-week intervention period (post), and after 16 weeks (follow-up). The primary outcome is the post-assessment reduction in “pain impairment” (mean value of impairment in daily life, free time, and work) as assessed by the DSF (German pain questionnaire). Secondary outcomes will include the reduction in depressive symptoms as well as in the severity of pain. DiscussionLenio is one of the first Internet-based interventions to reduce chronic pain and depression that will be empirically evaluated. Internet-based interventions could offer a promising alternative to conventional face-to-face psychotherapy in the treatment of chronic pain patients. The primary objective of the current study is to add essential insight into the feasibility, effectiveness, and acceptance of Internet-based interventions for people with chronic pain and depressive symptoms. Trial registrationDRKS-ID DRKS00026722, Registered on October 6th, 2021.

French survey of sedation practices for pediatric magnetic resonance and computed tomography imaging.

Pediatric magnetic resonance imaging (MRI) and computed tompgraphy (CT) require patient immobility and therefore often require sedation or general anesthesia of patients. Consensus on these procedures is lacking in France. Thus, the aim of this study was to describe the current sedation practices for pediatric MRI and CTin France. From January 2019 to December 2019, an online questionnaire was delivered by electronic mail to a representative radiologist in 60 pediatric radiology centers registered by the French-speaking pediatric and prenatal imaging society. Questions included protocols, drugs used, monitoring and side effects. Representatives of 40 of the 60 (67%) radiology centers responded to the survey. Among them, 31 performed sedation including 17 (55%) centers where radiologists performed sedation without anesthesiologists present during the procedure. The premedication drugs were hydroxyzine (n = 8, 80%) and melatonin (n = 2, 20%), Sedation drugs used for children ages0 to 6years old were pentobarbital (n = 9, 60%), midazolam (n = 2, 13%), chloral hydrate (n = 2, 13%), diazepam (n = 1, 6.5%) and chlorpromazine (n = 1, 6.5%). A written sedation protocol was available in 10/17 (59%) centers. In 6/17 (35%) centers, no monitoring was used during the procedures. Blood pressure monitoring and capnography were rarely used (< 10%) and post-sedation monitoring was heterogeneous. No life-threatening adverse effect was reported, but 6 centers reported at least one incident per year. For half of the responding radiology centers, radiologists performed sedation alone in agreement with the local anesthesiology team. Sedation procedures and monitoring were heterogenous among centers. Adjustment and harmonization of the practices according to the capacity of each center may be useful.

Characterization of Ag/AgCl Dry Electrodes for Wearable Electrophysiological Sensing

With the rising need for on-body biometric sensing, the development of wearable electrophysiological sensors has been faster than ever. Surface electrodes placed on the skin need to be robust in order to measure biopotentials from the body reliably and comfortable for extended wearability. The electrical stability of nonpolarizable silver/silver chloride (Ag/AgCl) and its low-cost, commercial production have made these electrodes ubiquitous health sensors in the clinical environment, where wet gels and long wires are accommodated by patient immobility. However, smaller, dry electrodes with wireless acquisition are essential for truly wearable, continuous health sensing. Currently, techniques for the robust fabrication of custom Ag/AgCl electrodes are lacking. Here, we present three methods for the fabrication of Ag/AgCl electrodes: oxidizing Ag in a chlorine solution, electroplating Ag, and curing Ag/AgCl ink. Each of these methods is then used to create three different electrode shapes for wearable application. Bench-top and on-body evaluation of the electrode techniques was achieved by electrochemical impedance spectroscopy (EIS), calculation of variance in electrocardiogram (ECG) measurements, and analysis of auditory steady-state response (ASSR) measurement. Microstructures produced on the electrode by each fabrication technique were also investigated with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). The custom Ag/AgCl electrodes were found to be efficient in comparison with standard, commercial Ag/AgCl wet electrodes across all three of our presented techniques, with Ag/AgCl ink shown to be the better out of the three in bench-top and biometric recordings.

Frameless MLC-Based Radiosurgical Thalamotomies on the Modern Linear Accelerator Platform ― Prospective Phase I/II Clinical Trial Results

Stereotactic radiosurgery (SRS) to the ventral intermediate nucleus (VIM) of the thalamus has been used with success to manage tremor in select patients. Because of the high doses, small target, & required precision, a non-invasive stereotactic radiosurgery instrument has been the historical choice platform. Our institution recently developed a technique to replicate functional SRS GK dose distributions on a multi-leaf collimator (MLC)-equipped linear accelerator (LINAC) without cumbersome, inefficient cones. We deployed this technique & tested it in a prospective clinical trial of safety & efficacy of SRS thalamotomy for non-DBS candidate patients with medically refractory essential or Parkinsonian tremor.We quantified pre-treatment tremor according to FTM/PROMIS scores. We generated MPRAGE, FGATIR, diffusion-weighted tractographic, & resting-state fMRI sequences. We identified the VIM via both thalamic parcellation & classical stereotactic reference location, & targeted it to 130Gy dmax in a fashion dosimetrically equivalent to 4.5mm GK shot. We adjusted each target such that the 25Gy isodose line did not overlap the posterior limb of the capsule. We immobilized patients in a highly rigid thermoplastic mask. We delivered treatment with a LINAC with high-definition HDMLC & intrafraction optical surface monitoring (OSMS) to ensure patient immobility. We surveilled post-treatment imaging and tremor scores.We accrued 32 patients over 30 months. One withdrew, & one elected to pursue previously declined DBS. At submission, 24 of the 32 patients had ≥6-month follow-up. 23/24 (96%) exhibited clinically meaningful tremor reduction. Median maximum pre- & post-tremor reduction was 59.8% (range: 11 - 100%). Time to patient-reported tremor improvement ranged from 0.3 to 15 months. One patient experienced Grade 2, and none experienced Grade 3 or higher toxicity.Frameless, coneless MLC-based SRS thalamotomy on the LINAC is a safe, effective treatment. Proper implementation requires attentive involvement by an experienced movement disorder radiosurgery team. Data continue to mature, but current results anticipate congruence to historical GK controls. We have expanded the trial to allow 20 additional patients.

Abstract No. 146 A retrospective study on clinical outcomes of diagnostic angiograms executed via 3Fr inner dilator access

5Fr sheaths (actual external diameter 7Fr) are generally employed as the formal access for lower extremity angiograms. At our institution we have demonstrated successful execution of angiograms with safe clinical outcomes using 3Fr inner dilators. Benefits to this technique include potential lower risk of complications and decreased patient immobilization. The purpose of this study is to review the utility and clinical outcomes of diagnostic angiograms conducted via 3Fr inner dilator. An intra-institutional retrospective review of patients who underwent lower extremity angiogram during the last 4 years was conducted. Patients were eligible for analysis if they had undergone diagnostic angiography using a 3Fr inner dilator. Patients were excluded from the study in the setting of upsizing catheter access, bilateral angiography, or arterial interventions immediately post-procedure. Data points including indication for angiogram, amount of radiopaque contrast used, dose of external radiation, blood loss were gathered. Amount of contrast used and radiation exposure were averaged. Postprocedural arterial complications, specifically access-site pseudoaneurysm, hematoma, and severe access site pain within 30 days post-angiogram were recorded. 32 patients were eligible for the study. Observed indications for angiography included peripheral vascular disease or Arteriovenous malformation workup, lower extremity trauma or infection, and surgical free flap planning. Average amount of contrast used was 42.8 ± 12.1 mL. Average radiation exposure was 116.4 ± 81.0 mGy. No procedure-related complications were observed in any of the patients. While 50% of angiograms were unremarkable for arterial disease, this technique yielded pathology such as stenosis, complete occlusion, and vascular injury. It is quite suitable and beneficial to conduct diagnostic angiograms with 3Fr inner dilators. Indeed, in the setting of an unremarkable unilateral diagnostic angiogram, the aforementioned method provides adequate diagnostic information while providing the added benefit of minimal complication rate and reduced patient immobility. Our group concludes that 3Fr inner dilator is a plausible initial approach to unilateral diagnostic angiography and upsizing to a 5Fr catheter is only necessary in the setting of added therapeutic intervention.

Open Surgical Guides – A Novel Concept in Computer Guided Implantology

Dental implants have become so popular that more than 5 million implants are placed each year by dentists in the United States alone. However, it is generally observed that a majority of implants are placed in a less-than-ideal manner. Computer-guided surgeries are proven to have a positive impact on implant placement as well as implant treatment planning. But, despite the indisputable compensations, only a partial number of clinicians regularly practice directed transplant surgery nowadays. This article aims to examine the challenges in guided implant surgery and how a novel concept of the open guide is trying to solve these issues. The latter was used during a CT scan and was eventually converted into an actual surgical guide. However, using conventional guides is not a guarantee for proper implant placement. The reason for that was inherent in their design. Conventional guides take marvelous leeway in the drilling trajectory and no drilling depth control. Using them relies on several variables that may not be trustworthy, such as hand stability, patient immobility, and another person’s feedback on the drilling angle. Bone quality can also affect the osteotomy in situations of immediate implant placement, as the drills commonly bounce off dense bone affecting the angulation and point of entry. From a safety perspective, conventional guides do not consider the patient’s relevant anatomy.

Early Detection of Deep Venous Thrombosis in Trauma Patients.

BackgroundThis study was performed to determine whether trauma patients are at an increased risk of developing deep venous thrombosis (DVT) within the first 48 hours of hospitalization.Materials and methodsA retrospective review was performed using a prospectively maintained database of patients admitted to a trauma center during a five-year time period. Patients hospitalized for greater than 48 hours who received a screening venous duplex for DVT were included in the study.ResultsThere were 1067 venous duplex scans obtained, 689 (64.5%) within the first 48 hours of admission (early DVT group), 378 (35.4%) after the first 48 hours (late DVT group). Only 142 (13.2%) patients had a positive duplex scan for DVT, 55 (early group), 87 (late group). Comorbid conditions of congestive heart failure (P = 0.02), pelvic fractures (P = 0.04), and a lower initial systolic blood pressure on presentation (p = 0.04) were associated with early DVT. Head trauma (P < 0.01), mechanical ventilation (P < 0.001), and transfusion of blood products (P < 0.001), were predictors of DVT in the late group.ConclusionsTrauma patients are at an increased risk of developing venous thrombosis early in the hospital course due to comorbidities associated with trauma. Whereas, venous thrombosis in trauma patients diagnosed after the first 48 hours of hospitalization appears to be associated with prolonged patient immobility.

Implementation of a Novel Near Visual Acuity Chart in an Emergency Department Setting.

The quality of visual acuity (VA) measurement in emergency department (ED) settings can be affected by patient immobility and lack of standardized testing conditions. We implemented a previously validated, novel VA chart, the Runge Sloan letter near card, in a hospital ED and evaluated its impact on frequency and consistency of VA testing. Two hundred seventeen hospital ED ophthalmology consult records from December 1, 2016, to November 15, 2017, were evaluated in an IRB-approved protocol. Frequency of VA measurement and agreement between nonophthalmic ED technicians and ophthalmology physicians-in-training were assessed. Implementation of the Runge card saw missed technician VA evaluations decrease from 36% (43/120) to 21% (20/97) of ophthalmic consults (p = .01), without significant change in agreement of VA measurements. After implementation, the proportion of VA measurements differing between technicians and residents by ≤2 lines was 51%; with pinhole testing, it improved to 64% (p < .05). In patients with good VA of >20/80, pinhole increased agreement from 58% to 73% (p < .05). Implementation of the Runge card was associated with improved frequency of VA measurement and, when combined with pinhole testing, increased agreement rates. Our findings suggest utility of training in the use of the Runge card in ED settings.

Comparison of efficacy and safety of dexmedetomidine versus propofol infusion for maintaining depth of general anesthesia when muscle relaxants are not used

Background: In surgeries where direct nerve stimulation is required intraoperatively, the use of long-acting muscle relaxants should be avoided. The study aimed to assess the efficacy of dexmedetomidine versus propofol infusion in providing an adequate depth of general anesthesia where long-acting muscle relaxants were not used intraoperatively and to compare hemodynamics in both the groups. Patients and Methods: It was a prospective randomized controlled study done in forty patients undergoing total parotidectomy or brachial plexus surgeries. Group D received an intravenous (IV) bolus of dexmedetomidine 1 mcg/kg body weight before induction, followed by infusion at 0.7 mcg/kg/h intraoperatively. In Group B, the infusion of propofol was started at a rate of 1.5 mg/kg/h to a maximum of 100 mg/h after intubation. In both the groups, if the patient moved, bucked on the endotracheal tube, or if there were signs of inadequate depth of anesthesia, a bolus of propofol 0.5 mg/kg IV was given and repeated as required. Statistical analysis was performed using Mann–Whitney U-test and Fisher's exact test. Results: The number of times propofol bolus was required intraoperatively did not show any significant difference between groups. The mean heart rate was significantly lower in Group D before induction. At any other time points, the mean systolic blood pressure and mean arterial blood pressure were comparable in both the groups. Conclusion: Both dexmedetomidine and propofol infusions are equally effective and safe in providing an adequate depth of general anesthesia as reflected by patient immobility during surgeries where long-acting muscle relaxants were not used.

P3741Incidence and outcomes of delirium in patients undergoing transcatheter aortic valve replacement

Abstract Introduction and objective Delirium is a frequent problem in the intensive care unit (ICU), often underdiagnosed, and is associated with increased mortality. We sought to evaluate the incidence and implact on prognosis of delirium in patients admitted to ICU after transcatheter aortic valve replacemente (TAVR). Methods We included 294 patients admitted to ICU from February 2013 to December 2017 after transfemoral aortic valve implantation. Incidence of delirium was assessed using DSM-IV diagnostic criteria. Risk factors were evaluated, as well as overall mortality and incidence of hospital readmissions. Results The mean clinical follow-up was 526 days. Delirium was diagnosed in 60 patients (20.4%). In most cases (78.3%), it occurred in the first 24 hours after the procedure. Age, cognitive impairment and peripheral artery disease were risk factors for the development of Delirum, without finding differences by sex, cardiovascular risk factors (except dyslipidemia) or the usual treatment with benzodiazepines or neuroleptics. Severe bleeding during the procedure was also associated with a higher incidence, but no risk augmentation was seen with the use of general anaesthesia, the urgency of the procedure, use of a transient pacemaker for more than 24 hours after the intervention or the development of a peripheral vascular complication during admission (both related to patient immobility). The development of Delirium was associated with longer hospital stay (10.8 vs 7.9 days, p=0.004) and with higher mortality (38.8% vs 20.4%, p=0.007). No differences were found in hospital readmissions during follow-up (54.3% vs 48.2%, p=0.453). Conclusion Delirium is a frequent complication after TAVR. Age, cognitive impairment and peripheral arteriy disease were risk factors for its development, but no factors that determine patient immobility, use of general anesthesia or the urgency of the procedure. Delirum after TAVR is associated with longer in-hospital stay and with higher mortality.

Exercise Physiologists: Key to Providing Early Mobilization in the Intensive Care Unit.

Patient immobility and a lack of physical activity in the intensive care unit results in a myriad of negative patient and hospital outcomes. To report research findings related to the use of exercise physiologists in promoting and providing aggressive and progressive early mobilization within the intensive care unit. This observational cohort study used the researcher-generated 12-point Activity Mobilization Evaluation Scale and delirium prevention bundle in 3 medical-surgical intensive care units to track patients' progress with mobilization. On average, most of the 216 patients in the study population realized a 1.6-point change (P < .001) in activity level with intervention by an exercise physiologist. Almost all of the study population (97%) maintained or increased the level of activity after receiving a minimum of 1 session with an exercise physiologist (mean, 3.5 sessions per day) during the 3-month study period. The introduction of exercise physiologists in the intensive care units proved to be a novel, safe, and effective strategy that maintained or increased the activity level of 97% of study patients.

Materiality in information environments: Objects, spaces, and bodies in three outpatient hemodialysis facilities

The materiality of information environments, and its role in information behavior, has received little attention. We present an ethnographic study involving 156 hours of observation and 28 patient interviews in outpatient hemodialysis facilities. Using an extended “Semiotic Framework for Information Systems Research,” the findings show that objects, spaces, and bodies were integral to 6 sociomaterial layers of facility information environments: the physical, empiric, syntactic, semantic, pragmatic, and social world. Objects of importance in the information environments included dialysis machines, instruments, records, paper documents, televisions, furniture, thermostats, lighting, and personal possessions. Spatial features, including compartmentalization, displays, distance, proximity, and spatially‐grounded routines, also constituted information environments. The information environments were also shaped by patient immobility, bodily discomforts, and orientation to bodily states. Each sociomaterial layer introduced enablers and constraints to information access, flow, and acceptance; these combined to construct patients primarily as passive recipients of information rather than active seekers and producers of information. A sociomaterial perspective and related focus on objects, spaces, and bodies offers a lens for professional information practice. We contribute information environment design guidance to facilitate such practice and stress that the value of certain sources and types of information can be materially encoded in an environment.

Safety and Efficacy of Dexmedetomidine versus Propofol Infusion as an Adjunct to Transtracheal Block in Ensuring Patient Immobility During General Anesthesia without the Use of Muscle Relaxants.

Background:In surgeries where nerve stimulation study is required intraoperatively, the use of long-acting muscle relaxants should be avoided.Aim of Study:This study aimed to assess the efficacy of dexmedetomidine versus propofol infusion as an adjunct to transtracheal block to ensure patient immobility during general anesthesia without the use of muscle relaxants and to compare hemodynamics in both the groups. Settings and Design:It was a prospective randomized controlled trial done at a tertiary care center.Subjects and Methods:Forty adult patients undergoing brachial plexus surgeries were included in the study and all patients received a transtracheal block just before the induction. After standardized induction and intubation, Group D received intravenous (i.v.) bolus of dexmedetomidine 0.5 μg.kg-1 body weight followed by infusion at 0.5 μg/kg/h intraoperatively. In Group B, the infusion of propofol was started at 1 mg/kg/h after induction. In both the groups, if the patient moved, bucked on endotracheal tube, or if there were signs of inadequate depth of anesthesia, bolus of propofol 0.5 mg.kg-1 i.v. was given and repeated as required.Statistical Tests Used:Mann–Whitney U-test and Fisher's exact test were used for the statistical analysis.Results:Number of times propofol bolus was required intraoperatively and hemodynamic parameters were comparable in both the groups at all-time points. Time to extubate was significantly higher in Group P compared to Group D (16.06 ± 5.78 vs. 9.61 ± 11.53 min).Conclusion:The use of dexmedetomidine infusion as an adjunct to transtracheal block is superior to propofol infusion in view of significantly shorter extubation time though both the agents provided comparable intraoperative hemodynamics and patient immobility.

Bone loss in MPTP mouse model of Parkinson's disease is triggered by decreased osteoblastogenesis and increased osteoclastogenesis

Bone loss is a non-motor symptom of Parkinson's disease (PD). It is unclear whether a patient's immobility or the endocrine changes in the body causes bone deterioration. To address this issue, we used an animal model of the disease where Swiss albino mice were injected with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) on day 1 and were left untreated for eight weeks. Behavioral phenotypes of PD, and striatal acetylcholinesterase and dopamine levels were measured. Cortical and trabecular bones were assessed by μ-CT and histology. Gene expression studies were done through quantitative real-time PCR. Effect of MPP+ and MPTP-treated mice serum on MC3T3E-1, SH-SY5Y, and primary osteoclast cells were also studied. Our results demonstrated that MPTP treatment leads to PD like symptoms. It shows a loss of trabecular bone mass and quality by decreasing osteoblast and increased osteoclast number and activity. This effect was accompanied by reduced osteogenic and elevated osteoclastogenic genes expression. While MPP+ had a cytotoxic effect on dopaminergic neurons, it did not affect bone cells. However, ex-vivo treatment of the serum from MPTP-treated mice decreased osteoblastogenesis and increased osteoclastogenesis in cell culture. In conclusion, our study suggests that MPTP-induced parkinsonian features in mice leads to trabecular bone loss by decreased bone formation and increased bone resorption due to changes in the serum circulating factors. This study characterizes the microarchitectural and cellular changes in the skeleton of a mouse model of PD that can be further utilized to investigate therapeutic avenues to treat bone loss in PD patients.

Feasibility and Results of a Mobile Haemophilia Outpatient Care Pilot Project.

Regular visits at haemophilia treatment centres (HTCs) in rural regions are often dependent on the access to a private car due to lack of or limited availability of public means. Therefore, a mobile haemophilia outpatient care (MHOC) concept providing home visits to haemophilia patients has been developed by the Saarland HTC, which is located in a rural German region. Haemophilia patients and their parents were home visited at least twice (baseline, follow-up) by trained medical staff. Socio-demographic and clinical data were collected and interviews were performed asking the patients and parents about their needs and expectations towards such a MHOC. Seventy-nine patients were enrolled (56 adults, 23 children), 62.0% severely affected, 48.1% on prophylaxis, with a mean age of 37.4 ± 16.4 years (17-78) and 9.8 ± 4.2 years (3-16), respectively. Median travel distance to the HTC was 43.5 km (3-200). Note that 92.4% considered an intense binding to the HTC and a MHOC concept as 'rather/very important' (88.6%). They expected from a MHOC to provide consulting and educating activities, support in elderhood issues and treatment. For 35.4%, a MHOC could currently provide additional support, mainly due to patient's immobility and need of consultancy. They mainly used services in terms of consultancy in social-legal affairs and support in contacting authorities. The results of this study support the hypothesis that a MHOC concept is a needful supplement in haemophilia comprehensive care and will improve the challenging haemophilia treatment, especially for those with limited access to HTCs or with disabilities.