Use Of Bed Rest Research Articles

Prevention and therapy of threatened preterm birth in multiple pregnancy

Preterm birth in multiple pregnancy is an important medical, economic and social problem. Currently, more than half of twins are born prematurely, which puts them at high risk of developing neonatal diseases causing lifelong disability and social maladjustment. In this regard, reducing the frequency of preterm multiple births is an important task of modern obstetrics. Improving perinatal outcomes of multiple pregnancies can only be achieved using the most effective measures that have a good evidence base. At the same time, numerous studies on the effectiveness of therapeutic interventions aimed at prolonging multiple pregnancies have reported contradictory results. This review included most of the randomized controlled trials of methods for the prevention and treatment of threatening preterm birth in multiple pregnancies, as available in PubMed, Google Academy, Elibrary, and the Cochrane Central Register of Controlled Trials. Thus far, studies on the use of bed rest, prophylactic tocolysis, most of the progestins, and cervical cerclage in multiple pregnancy have shown no efficacy in reducing the risk of premature birth. However, encouraging data were obtained on improving neonatal outcomes of multiple pregnancies using vaginal progesterone and an obstetric pessary, but these results require additional confirmation in larger multicenter randomized studies. Further clinical trials are needed to develop algorithms for timely diagnosis and adequate treatment of threatened preterm birth in case of multiple pregnancy, including the use of the most rational preventive and therapeutic methods that have a high evidence level.

PERANCANGAN ULANG (REDESIGN) TEMPAT TIDUR UNTUK LANSIA DENGAN METODE KANSEI ENGINEERING DAN PENDEKATAN GERONTOLOGY

<p class="Default"><em><span>In this research, conducted observations of everyday activities that seniors do in bed. Basically the use of bed rest is used for the elderly, but some seniors also do activities such as eating, embroidery, and others. Bed conditions that exist today are pretty good, but when used by older people often occurs difficulties. Difficulties experienced by older adults when using the position of the bed go to bed by 40% this was due to the high bed, a sitting after lying down as much as 33% this is because the elderly are still using hand and elbow as a support and positioning out of bed by 27%. A. Therefore done to improve the design of the old and new designs in accordance with user expectations for improved attributes in terms of functions and needs of seniors as follows bed frame, headboards, tools to build and support needs (table). Improvements made in order to accommodate all activities with emphasis on the elderly in terms of ergonomics and comfort in its use</span></em></p>

Mobilization of Mechanically Ventilated Patients in Switzerland.

Growing evidence suggests that early mobilization benefits intensive care unit (ICU) patients. However, national practices and the culture of individual ICUs influence mobilization activities. In a 1-day, Swiss point prevalence study conducted in 35 ICUs (representing 45% of all ICUs), the highest level of mobilization for mechanically ventilated patients was characterized using the validated ICU Mobility Scale, along with data collection for potential safety events and mobilization barriers. Among 161 mechanically ventilated patients, a total of 33% (n = 53) had active mobilization, with walking achieved by only 2% (n = 4). More severe organ failure was associated with lower mobilization (respiratory Sequential Organ Failure Assessment score: P = .037, cardiac: P = .008, neurology: P < .001). Barriers to mobilization were reported in 71% (n = 115), with deep sedation significantly higher among patients receiving passive versus active mobilization (14% vs 0%, P = .005). Potential safety events occurred in 20% (n = 33) of patients without significant differences between passive and active mobilization. Availability of physiotherapists and appropriate equipment were not reported barriers. Mobilization during mechanical ventilation occurred infrequently with greater organ failure associated with lower mobilization. Addressing the identified modifiable barriers via structured efforts to achieve multidisciplinary culture change is essential to decrease the common use of bed rest in Swiss ICUs.

Understanding the effects of spaceflight on head–trunk coordination during walking and obstacle avoidance

Prolonged exposure to spaceflight conditions results in a battery of physiological changes, some of which contribute to sensorimotor and neurovestibular deficits. Upon return to Earth, functional performance changes are tested using the Functional Task Test (FTT), which includes an obstacle course to observe post-flight balance and postural stability, specifically during turning. The goal of this study was to quantify changes in movement strategies during turning events by observing the latency between head-and-trunk coordinated movements. It was hypothesized that subjects experiencing neurovestibular adaptations would exhibit head-to-trunk locking (‘en bloc’ movement) during turning, exhibited by a decrease in latency between head and trunk movement. FTT data samples were collected from 13 ISS astronauts and 26 male 70-day head down tilt bed rest subjects, including bed rest controls (10 BRC) and bed rest exercisers (16 BRE). Samples were analyzed three times pre-exposure, immediately post-exposure (0 or 1-day post) and 2–3 times during recovery from the unloading environment. Two 3D inertial measurements units (XSens MTx) were attached to subjects, one on the head and one on the upper back. This study focused primarily on the yaw movements about the subject׳s center of rotation. Time differences (latency) between head and trunk movement were averaged across a slalom obstacle portion, consisting of three turns (approximately three 60° turns). All participants were grouped as ‘decreaser’ or ‘increaser’, relating to their change in head-to-trunk movement latency between pre- and post-environmental adaptation measures. Spaceflight unloading (ISS) showed a bimodal response between the ‘increaser’ and ‘decreaser’ group, while both bed rest control (BRC) and bed rest exercise (BRE) populations showed increased preference towards a ‘decreaser’ categorization, displaying greater head–trunk locking. It is clear that changes in movement strategies are adopted during exposure to an unloading environment. These results further the understanding of vestibular–somatosensory convergence and support the use of bed rest as an exclusionary model to better understand sensorimotor changes in spaceflight.

Bed rest in singleton pregnancies for preventing preterm birth

Bed rest in hospital or at home is widely recommended for the prevention of preterm birth. This advice is based on the observation that hard work and hard physical activity during pregnancy could be associated with preterm birth and with the idea that bed rest could reduce uterine activity. However, bed rest may have some adverse effects on other outcomes. To evaluate the effect of prescription of bed rest in hospital or at home for preventing preterm birth in pregnant women at high risk of preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (18 December 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2014, Issue 12), MEDLINE (December 2014), EMBASE (December 2014), LILACS (December 2014), and bibliographies of relevant papers. Randomized, cluster-randomized and quasi-randomized controlled trials with reported data that assess clinical outcomes in women at high risk of spontaneous preterm birth who were prescribed bed rest in hospital or at home for preventing preterm birth, and their babies. Two review authors independently assessed eligibility, trial quality and extracted data. Two studies met the inclusion criteria. One study was not considered for the meta-analysis, since data combined singleton and multiple pregnancies. No differences in any maternal and perinatal outcomes were reported by the authors. This study was at low risk of selection, performance, detection and attrition bias. Only data from one study were included in the meta-analysis (1266 women). This study was at unclear risk of bias for most domains due to lack of reporting. Four hundred and thirty-two women were prescribed bed rest at home and a total of 834 women received a placebo (412) or no intervention (422). Preterm birth before 37 weeks was similar in both groups (7.9% in the intervention group versus 8.5% in the control group; risk ratio (RR) 0.92, 95% confidence interval (CI) 0.62 to 1.37). No other results were reported for any of the other primary or secondary outcomes. There is no evidence, either supporting or refuting the use of bed rest at home or in hospital, to prevent preterm birth. Although bed rest in hospital or at home is widely used as the first step of treatment, there is no evidence that this practice could be beneficial. Due to the potential adverse effects that bed rest could have on women and their families, and the increased costs for the healthcare system, clinicians should discuss the pros and cons of bed rest to prevent preterm birth. Potential benefits and harms should be discussed with women facing an increased risk of preterm birth. Appropriate research is mandatory. Future trials should evaluate both the effectiveness of bed rest, and the effectiveness of the prescription of bed rest, to prevent preterm birth.

Sympathetically Mediated Changes in Capacitance

“To be accepted as a paradigm, a theory must seem better than its competitors, but it need not, and in fact never does, explain all the facts with which it can be confronted.” Thomas Kuhn, The Structure of Scientific Revolutions ### Heard on Rounds “A 57-year-old patient with a history of heart failure states that she began experiencing worsening shortness of breath 4 days prior to admission, with lower extremity edema developing 1 day prior to admission. She is compliant with her medications, though has had similar admissions previously. She states that her weight at home increased by “a couple of pounds” 2 days ago and that she increased her diuretic dose but her symptoms worsened. She says that she generally adheres to her low salt diet, but admits to eating pretzels 5 days ago. The physical examination showed BP 136/84, HR 94, weight 3 lbs above baseline, elevated JVP, basilar rales, and 1+ pedal edema.” As the intern finishes the presentation, the Senior expresses surprise that the patient's weight had increased only 3 pounds, and comments about salt and volume overload leading to acute decompensated heart failure (ADHF). The Attending adds that recent data reveal that many patients presenting with ADHF have minimal or no weight gain, but that there is no clear mechanism to explain this phenomenon. They set in place plans for diuresis, increasing vasodilators, and further patient education. On the surface, there is nothing remarkable about this case, and the usual approaches to treat this entity have remained remarkably consistent since the advent of loop diuretics over 50 years ago: salt restriction, patient education, uptitration of medications if not already at optimal doses, and diuresis. However, approximately 1 in 4 such patients are readmitted to the hospital within 30 days,1 and the disease continues to progress. It is clear …

Bed Rest in Pregnancy

The use of bed rest in medicine dates back to Hippocrates, who first recommended bed rest as a restorative measure for pain. With the formalization of prenatal care in the early 1900s, maternal bed rest became a standard of care, especially toward the end of pregnancy. Antepartum bed rest is a common obstetric management tool, with up to 95% of obstetricians utilizing maternal activity restriction in some way in their practice. Bed rest is prescribed for a variety of complications of pregnancy, from threatened abortion and multiple gestations to preeclampsia and preterm labor. Although the use of bed rest is pervasive, there is a paucity of data to support its use. Additionally, many well-documented adverse physical, psychological, familial, societal, and financial effects have been discussed in the literature. There have been no complications of pregnancy for which the literature consistently demonstrates a benefit to antepartum bed rest. Given the well-documented adverse effects of bed rest, disruption of social relationships, and financial implications of this intervention, there is a real need for scientific investigation to establish whether this is an appropriate therapeutic modality. Well-designed randomized, controlled trials of bed rest versus normal activity for various complications of pregnancy are required to lay this debate to rest once and for all.

The use of titanium non-penetrating clips to close the spinal dura

We present the results of our initial experience in the use of non-penetrating titanium clips in the closure of spinal dura. A retrospective analysis of case notes of patients identified from the unit database was carried out, limited to adults. A proforma that included demographic details, the diagnosis, the procedure undertaken, whether or not additional dural closure methods were used, the use of bed rest and any complications, including cerebrospinal fluid (CSF) leak. There were 58 patients with a mean age of 53 years. The commonest diagnoses were meningioma, ependymoma and neurofibroma. Eight patients had additional methods of dural closure used and approximately half the patients had a period of postoperative bed rest. Eight patients (13.7%) had a CSF leak. Our early experience with the use of non-penetrating clips for the closure of the spinal dura is presented. We have found them easy to use, especially in anatomically-restricted spaces and rapid in their application. However, our results have revealed an unexpectedly high complication rate. A further prospective study to evaluate them more fully is planned.

The Evolution of Bed Rest as a Clinical Intervention

Bed rest as a therapy can be traced back to Hippocrates and has been used for many types of illnesses since then. It is still commonly used as an intervention in pregnancy despite known physiological and psychological side effects. Some historical and social reasons why nurses and other health care providers are slow to change practice are provided. Evidence from randomized trials is urgently needed to support or refute the use of bed rest in pregnancy.

8:30 Implementation of clinical practice guidelines in workers compensation board patients with acute mechanical back pain: a prospective randomized trial

Purpose of study: The study objectives were to assess the degree to which the patterns of practice of primary care physicians in managing workers compensation board (WCB) patients are in compliance with current practice guidelines and determine whether providing family physicians and their patients with the guidelines would alter the degree of adherence.Methods used: A total of 724 patients with nonradicular lower back pain of less than 2 weeks duration and accepted WCB claims were randomized into five groups: Group 1, physicians received a single information package summarizing the guidelines for managing acute mechanical back pain at 0 to 4 weeks after injury; Group 2, physicians received the same package and, in addition, their patients received a layperson's summary of the guidelines at 0 to 4 weeks after injury; Group 3, physicians received the information package three times, at 0–4-week, 5–8-week and 8–12-week postinjury periods; Group 4, physicians and their patients received the information packages at the 0–4 week, 5–8 week and 8–12-week postinjury periods; Group 5, neither the physicians nor their patients received any guideline information (control group). The compulsory WCB physician report forms were collected and scored. The primary outcome was compliance with guideline recommendations regarding specific patient history items, physical examination procedures and treatment recommendations. The chi-squared test was used to compare the five groups.of findings: Primary care physicians in the control group demonstrated a high degree of compliance with the recommended history taking, physical examination procedures and imaging guidelines but were in poor compliance with the guideline-recommended treatments. Providing the physicians ± patients with a single information package (ie, Groups 1 and 2) did not result in any significant improvement in compliance. Information provided at three separate intervals (Group 3) improved compliance with some recommended treatments, such as exercise, medications, less use of bed rest and passive physiotherapy, but not others including recommendation for spinal manipulation, work modification and return to normal activity. No added benefit was observed when providing patients with an information package (Group 4).Relationship between findings and existing knowledge: In the last 8 years, 12 countries have published evidence-based guidelines to assist primary care physicians in the management of acute and chronic lower back pain. Despite this large international effort and high degree of agreement among independent multidisciplinary panels of experts, a number of studies have demonstrated that the implementation of the guidelines has been largely unsuccessful. No prior published studies have examined guideline implementation strategies in primary care physicians managing WCB patients. The results of this study provide convincing evidence that ignorance of the guidelines is not the only contributing factor in determining the patterns of practice of primary care physicians.Overall significance of findings: Providing physicians with information regarding clinical practice guidelines for the management of acute back pain at three stages of the patient's clinical course (ie, 0 to 4, 4 to 8 and 8 to 12 weeks after injury) altered some aspects of physician pattern of practice, but results were not ideal. Alternate strategies need to be developed for improving physician compliance with clinical practice guidelines for treatment of WCB patients with acute lower back pain.Disclosures: No disclosures.Conflict of interest: Dr. Paul Bishop, grant research support from the Workers Compensation Board of British Columbia.

Use of the fetal fibronectin assay to avert unnecessary hospitalization and bedrest in patients with preterm labor symptoms: a cost analysis

Objective: To model cost implications of the fetal fibronectin (fFN) assay in management of patients with symptoms of preterm labor based on data from a previously published multicenter trial. Study design: Data from a trial of fFN in 763 patients with symptoms of preterm birth was used to create a decision analytic model. Standard management in the trial was compared with a theoretic management plan using fFN results to guide decisions regarding hospitalization and use of bedrest. Average costs and durations of antepartum and delivery hospitalizations for patients with preterm labor were obtained from a data set of 404,466 patients delivered in California in 1993. Average bedrest costs were obtained using data from the US Bureau of Labor Statistics ($89 per day). A cost savings of $3,000 from the use of betamethasone prior to 34 weeks was assumed based on estimates from the NIH consensus conference. All patients were treated equally until fFN results were obtained. All fFN positive patients were admitted, given steroids, and discharged after an average of 2.5 days of bedrest. Results: Under baseline assumptions, theoretic management using fFN cost $3,900 per patient vs estimates of $4,820 in the trial. This resulted in savings of $919 per patient, which was robust under sensitivity analysis of all costs in the model. Conclusions: Addition of fFN management of threatened preterm labor has theoretic cost advantages when compared to existing patterns of clinical management.

Does bed rest produce changes in orthostatic function comparable to those induced by space flight?

Use of bed rest to simulate microgravity exposure is not well validated. We compared heart rate (HR) and blood pressure (BP) responses to standing in bed-rest (BR) subjects (n=11) to those of two astronaut groups. One astronaut group (n=28) fluid loaded (FL) before landing by consuming a water and salt tablet mixture, the second astronaut group (n=8) did not (NL). Bed-rest or microgravity exposure lasted approximately 7.0 days. Preexposure, the responses to standing did not differ between groups. Postexposure, all groups demonstrated an increased HR response ( p<0.01), a decreased SBP response ( p<0.05), no change in DBP response, and a reduced PP response ( p<0.05) compared to preexposure. Change in HR response was lowest for the FL group, presumably due to increased plasma volume induced by fluid consumption. These findings generally support bed rest as a valid simulator of microgravity.

Bed rest in a sydney teaching hospital

This paper looks at two surveys of bed rest, conducted in a general hospital. The first survey, conducted early one afternoon, assessed the prevalence of bed rest within the hospital. It was found that most of the patients (67%) were in bed, and nearly half of those (42%) were in bed for reasons other than being too sick or unsafe to be up, or because bed rest was part of their treatment. A second survey, in which a sample of general hospital patients was repeatedly observed throughout the day, found that patients with no requirements for bed rest spent 63% (95% confidence limits: 51-75%) of the active part of the day in bed. It may be that because of the nature of hospital design, many patients are unnecessarily confined to bed because there is simply nowhere else to go. Inappropriate use of bed rest has implications for patient health and the utilization of scarce hospital resources.

The Medical Management of Traumatic Hyphaema: A Survey of Opinion among Ophthalmologists in the UK

Current attitudes to the medical management of traumatic hyphaema were investigated by means of a postal survey. A single page questionnaire was sent to all consultant ophthalmologists in the UK who were members of the college of ophthalmologists. The response rate was 50%. Opinion was sharply divided on the use of bed rest, padding and topical therapy. However, there was almost universal agreement that systemic therapy, either steroids or antifibrinolytics, were not indicated.

Nonaneurysmal subarachnoid hemorrhage: Prevalence of perimesencephalic hemorrhage in a consecutive series

The perimesencephalic type of nonaneurysmal subarachnoid hemorrhage (SAH) is a recently described clinical and radiological entity, with a good outcome. We carried out a retrospective analysis of 294 patients with subarachnoid hemorrhage, of whom 62 had a negative four-vessel angiography. We identified 20 cases with the typical computed tomographic (CT) pattern of perimesencephalic hemorrhage, in whom the prognosis was invariably good. However, five cases of aneurysmal subarachnoid hemorrhage had a more or less similar CT appearance: the diagnosis cannot be made on the CT image only and angiography remains mandatory. The use of bed rest, antifibrinolytics, and calcium antagonists is discussed.

Mortality From Pulmonary Embolism

To the Editor.— As possible explanations for the decrease in fatal pulmonary embolism (PE) observed in their study, Dismuke and Wagner 1 point to the increasing use of prophylactic minidose heparin, pulmonary angiography, and therapeutic anticoagulation during the period of their study. Other factors, particularly changes in physicians' use of bed rest and early mobilization, may also have played a role. Immobility and prolonged bed rest are acknowledged risk factors for venous thrombosis and PE, and early mobilization of bed-bound patients has been shown to reduce the incidence of venous thrombosis. 2 Changes have occurred over recent years in the way physicians utilize activity as a mode of therapy, with a trend toward less enforced bed rest, earlier supervised mobilization, and shorter hospital stays. For example, in the 1950s patients with myocardial infarction (MI) were usually rested for four to eight weeks. 3 In 1970, even uncomplicated MI was still

Role of rest and ambulation in liver disease; management of acute infectious hepatitis.

The current use of bed rest in the treatment of diseases of the liver is admittedly empiric. All observers have agreed that bed rest during the acute stage of hepatitis generally improves the immediate symptoms. Hepatic tenderness is less under conditions of rest, while increase in size and tenderness of the liver frequently occurs with ambulation. Laboratory evidence of worsening hepatic function often parallels the change in liver size and tenderness. When the resistance of the host is high, and possibly when the virus is of a low degree of virulence, no permanent deleterious effects result from relapses due to early ambulation. Recovery progresses satisfactorily despite lack of rest. However, these clinical and laboratory signs of relapse may be the first indications of a more serious progressive hepatitis. The role of bed rest has not been tested by controlled observations under such circumstances. Until studies of this nature have been made, the judicious use of bed rest in the treatment of the acute stages of hepatic disease is recommended.

Tuberculosis in Children and Adolescents: A Five to Fifteen Year Follow-up of 105 Patients

SUMMARY 1. In the 10 year period between 1939 – 1948 inclusive, there were 110 admissions at the Pollak Hospital through the age of 15 years for tuberculosis. This study is based on 105 (95.4 per cent) patients in whom clinical information was available five to 15 years after their first entrance into the hospital. 2. These cases are classified. Of the group of 55 (52.3 per cent of the total) with primary infection (parenchymal and/or glandular components), 47 (85.4 per cent) are alive and well five to 15 years later. The remainder (14.6 per cent) died from hematogenous complications (miliary and meningeal) in the pre-antibiotic era. 3. Of the group of 47 (44.8 per cent) with re-infection pulmonary disease, 32 (68 per cent) are living five to 15 years later (up to January 1, 1954) and all but two are inactive. Fifteen (32 per cent) in this group died; 12 from progressive pulmonary tuberculosis and three from tuberculous meningitis. The re-admission rate was 40 per cent compared to 7.4 per cent for the first infection cases. 4. The remaining three (all living) had extra pulmonary tuberculous foci without roentgen evidence of thoracic disease. 5. Prognostic factors in the primary infection and therapeutic measures in the re-infection groups are discussed. The best results in the latter patients were obtained with the use of bed rest and artificial pneumothorax.

Aminophylline as supplement to mercurial diuretics in intractable congestive heart failure.

Management of the persistently edematous patient in an advanced stage of congestive heart failure presents a serious problem frequently encountered in medical practice. Such a patient is commonly considered refractory to treatment when he no longer responds to the combined use of bed rest, low salt diet, adequate digitalization and repeated mercurial injections. In particular, the lack of an adequate response to mercurial diuretics is generally regarded as an ominous sign,¹indicating that the terminal stage of heart failure has been reached. Since all other measures are generally regarded as auxiliary to digitalis therapy, the most rigid criteria of full digitalization must be fulfilled before a therapeutic regimen can be called a failure. Whenever it can be established that inadequate digitalization is not at fault, different therapeutic approaches must be considered. There are on record cases in which serum sodium reached abnormally low levels as a result of repeated