The Effects of Teach Back Method on Caregivers’ Strain in Handling Patients with Prolonged Immobilization

Background: Caregivers’ strain mainly comes from lack of relevant care knowledge and nursing skills. Traditional health education is just a one-way information transmission mode without evaluation and feedback. Objective: To help caregivers’ memory, the researcher utilized a quasi-experimental design to measure the effectiveness of the teach-back method on caregivers’ strain in handling patients with prolonged immobilization. Method: A total of forty caregivers were averagely assigned into treatment (Teach-Back) and comparison group (traditional). Participant’s Data Sheet, The Zarit Burden Interview and Teach Back Assessment Tool was used to gather data. Results: There was a significant difference in caregivers’ strain before and after the Teach-Back Method in treatment (p<0.001) and comparison group (p <0.001). Likewise, a significant difference existed after the Teach-Back Method in the treatment group (p <0.001). Conclusion: The Teach-Back Method is an effective intervention in reducing caregivers’ strain in handling patients with prolonged immobilization.

Feasibility of the modified 30-second sit-to-stand test in an isolation ward of moderate COVID-19

BACKGROUND The recovery after prolonged immobilization during hospitalization because of COVID-19 is the primary goal of moderate to severe COVID-19 rehabilitation. Lower extremity muscle function assessment after immobilization is needed before starting mobilization. Hence, this study aimed to evaluate the feasibility of the modified 30-second sit-to-stand test (m30STS) as one of the prospective tools of functional capacity assessment in moderate COVID-19. METHODS This cross-sectional study recruited the subjects consecutively. All eligible subjects with oxygen saturation (SaO2) ≥95% with or without oxygen supplementation performed the m30STS following the Bohannon’s guidelines. The score of m30STS was calculated based on the number of stands completed within 30 sec. A higher score of the m30STS indicated better lower extremity function. RESULTS Mean score of m30STS was 13.3. No subjects had oxygen desaturation or increased heart rate, and no fall incidents occurred. CONCLUSIONS The m30STS is feasible and safe to evaluate lower extremity for moderate COVID-19 patients with SaO2 >95%. The absence of oxygen desaturation and increase in heart rate showed no increased oxygen consumption during the test.

Simultaneous radio-ulnar cannulation: shifting gears from ‘feasibility’ to ‘applicability’

Conventionally, routes of vascular access commonly include femoral and radial arteries with brachial, ulnar and subclavian arteries being rarely used for coronary interventions. Non-femoral arterial access is being increasingly preferred to minimise groin puncture site complications, prolonged immobilization and duration of hospital stay. However, radial artery cannulation is also fraught with fears of tortuosity, loops, vascular spasm, perforation, pseudoaneurysm formation, arm hematoma and arterial occlusion. In contemporary practice when most of the coronary procedures are being done via transradial access, encountering one of the above-mentioned hurdles often forces the operator to switchover to femoral access. Here, we explore the rationale, feasibility, operational logistics, clinical implications and future directions for using simultaneous radio-ulnar arterial access in the same extremity.

Diagnosis of Pulmonary Embolism

Pulmonary embolism is an acute emergency due to the occlusion of the pulmonary arteries by a venous blood clot. The pathophysiology of pulmonary embolism follows Virchow\'s triad, which encompasses stasis in veins, increased coagulation, and vessel wall trauma. Pregnancy, major trauma or surgery, prolonged immobilization, obesity, medication, and inherited risks are important risks. It is an essential rule-out diagnosis in chest pain and dyspnea patients in the emergency room. It is also responsible for significant mortality if not diagnosed and treated promptly. Physicians utilize multiple algorithmic scores and calculators to supplement diagnosis along with a high degree of clinical suspicion at initial presentation. Clinical diagnosis involves utilizing multiple modalities, including D-dimer, troponin, arterial blood gas analysis, electrocardiogram, bedside echocardiogram, and imaging modalities such as venous duplex, chest computed tomography, ventilation-perfusion scans, and pulmonary angiogram. Some imaging modalities carry the risk of radiation and being invasive. The treatment can itself be short-term or lifelong based on the causative factor. Anticoagulants used in the therapy can itself cause devastating complications if not monitored appropriately. Despite adequate treatment, some of these patients progress to chronic disease resulting in secondary pulmonary hypertension.

The use of combined hormonal contraception in the context of the COVID-19 pandemic

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) was declared the cause of a global pandemic in early 2020. Patients with COVID-19 are at high risk for thrombotic occlusions of the arteries and veins. There are many ways that explain the high risk of thrombosis in COVID-19, they are conditionally divided into two main categories: mechanisms in which the renin-angiotensinaldosterone system is involved and mechanisms that affect the regulation of the immune response. It is assumed that the uncomplicated course of the disease is characterized by endothelial dysfunction, but if the process progresses with a pronounced immune response, plasma coagulation factors may also be involved, which significantly increases the risks of thromboembolic complications. The use of combined hormonal contraception (CHC) in the current conditions raises a number of concerns. According to some researchers, disorders of the hemostasis system observed in patients with COVID-19 may worsen while taking CHC and increase the risk of thromboembolic complications, which is especially important in severe disease with prolonged immobilization. However, with the use of CHC, the increase in thrombotic risks is explained primarily by changes in the plasma component of the hemostasis sys tem. At first glance, the recommendations to stop hormone therapy with confirmed COVID-19 seem logical, but they are based only on the procoagulant activity of estrogens, and not on real evidence. In patients with COVID-19, the increase in coagulation is associ ated with massive damage to the vascular endothelium (the so-called «external» coagulation pathway) and the immune response, and not with a primary increase in the level of coagulation factors per se. At the same time, stopping the intake of estrogens deprives the patient of their important protective effect. Thus, it became necessary to develop clinical guidelines for the management of women using contraception in the context of the COVID-19 pandemic.

Intensive Care Unit-Acquired Weakness and Positioning-Related Peripheral Nerve Injuries in COVID-19: A Case Series of Three Patients and the Latest Literature Review

A subgroup of COVID-19 patients requires intensive respiratory care. The prolonged immobilization and aggressive treatments predispose these patients to develop intensive care unit-acquired weakness (ICUAW). Furthermore, this condition could increase the chance of positioning-related peripheral nerve injuries. On the basis of the latest literature review, we describe a case series of three patients with COVID-19 who developed ICUAW complicated by positioning-related peripheral nerve injuries Every patient presented sensorimotor axonal polyneuropathy and concomitant myopathy in electrophysiological studies. Furthermore, muscle MRI helped the diagnosis of ICUAW, showing massive damage predominantly in the proximal muscles. Notably, nerve ultrasound detected positioning-related peripheral nerve injuries, even though the concomitant ICUAW substantially masked their clinical features. During the acute phase of severe COVID-19 infection, most medical attention tends to be assigned to critical care management, and neuromuscular complications such as ICUAW and positioning-related peripheral nerve injuries could be underestimated. Hence, when starting post-ICU care for COVID-19 cases, the combination of electrophysiological and imaging studies will aid appropriate evaluation on the patients with COVID-19-related ICUAW.

Mice Lacking the Calcitonin Receptor Do Not Display Improved Bone Healing

Despite significant advances in surgical techniques, treatment options for impaired bone healing are still limited. Inadequate bone regeneration is not only associated with pain, prolonged immobilization and often multiple revision surgeries, but also with high socioeconomic costs, underlining the importance of a detailed understanding of the bone healing process. In this regard, we previously showed that mice lacking the calcitonin receptor (CTR) display increased bone formation mediated through the increased osteoclastic secretion of sphingosine-1-phosphate (S1P), an osteoanabolic molecule promoting osteoblast function. Although strong evidence is now available for the crucial role of osteoclast-to-osteoblast coupling in normal bone hemostasis, the relevance of this paracrine crosstalk during bone regeneration is unknown. Therefore, our study was designed to test whether increased osteoclast-to-osteoblast coupling, as observed in CTR-deficient mice, may positively affect bone repair. In a standardized femoral osteotomy model, global CTR-deficient mice displayed no alteration in radiologic callus parameters. Likewise, static histomorphometry demonstrated moderate impairment of callus microstructure and normal osseous bridging of osteotomy ends. In conclusion, bone regeneration is not accelerated in CTR-deficient mice, and contrary to its osteoanabolic action in normal bone turnover, osteoclast-to-osteoblast coupling specifically involving the CTR-S1P axis, may only be of minor relevance during bone healing.

Bilateral foot drop after COVID-19-related acute respiratory distress syndrome: A case report

In these days of the pandemic, we have faced with the locomotor system problems following severe acute respiratory syndrome-coro- navirus 2 (SARS-CoV-2) infection. While some of these problems are related to the disease itself, some of them are associated with the prolonged immobilization during the infection. Long-term intensive care unit admissions of patients may also lead to various types of neuropathies, extending the recovery period. The real burden of the novel coronavirus-2019 (COVID-19) is still unclear. In particular, after a prolonged hospitalization period, the duration of rehabilitation may be longer to gain independence in daily living activities. In this report, we present a different aspect of the COVID-19 with bilateral foot drop in a 53-year-old female patient. To the best of our knowledge, this case is the first report of both peroneal and sciatic nerve damage following COVID-19.

Quality Analysis of YouTube Videos Presenting Shoulder Exercises after Breast Cancer Surgery

<b><i>Background:</i></b> The prolonged immobilization suggested after breast cancer (BC) surgery causes morbidity. Patients search the Internet, especially social networks, for recommended exercises. <b><i>Objective:</i></b> The aim of this observational study was to assess the quality of YouTube videos, accessible for any patient, about exercises after BC surgery. <b><i>Methods:</i></b> A systematic search was performed on YouTube. One hundred and fifty videos were selected and analyzed. Two statistical analyses were conducted based on machine-learning techniques. Videos were classified as “Relevant” and “Non-Relevant” using principal component analysis models. Popularity was evaluated by Video Power Index (VPI), informational quality and accuracy were measured using the DISCERN Scale and Global Quality Scale (GQS). Scoring criteria for exercises were established according to the exercises recommended by the Oncology Section of the American Physical Therapy Association (APTA). Interobserver agreement and individual correlations were statistically examined. <b><i>Results:</i></b> DISCERN scored a mean of 50.97 (standard deviation [SD] 19.19). HONcode scored 78.30 (11.02) and GQS scored 3.49 (0.74). Average number of views was 53,963 (SD 67,376), mean duration was 9:42 min (9:15), mean days online was 2,158 (922), mean view ratio was 27.14 (30.24), mean likes was 245 (320.5), mean dislikes was 13.4 (14.2), and mean VPI was 93.48 (5.42). <b><i>Conclusion:</i></b> The quality of YouTube videos of recommended exercises post-BC surgery is high and can be a translational activity to improve patients’ behavior. Health institutions and NGOs, with higher popularity levels than academic institutions, should consider this information when implementing new policies focused on video quality which can contribute to adaptive behavior in patients.

Case study on Deep Vein Thrombosis with its Systemic management

Deep vein thrombosis commonly known as DVT has globally about 1–2 per 1000 population cases. The rate of Mortality is high; About 6% death cases occurs within primary 30 days of DVT by the primarily through pulmonary embolism, and also about 13% of patients with the pulmonary embolism. Among treated patients, about 20–50% develop post-thrombotic syndrome (PTS) after DVT, and 3% develop chronic thromboembolic pulmonary hypertension after pulmonary embolism.3,4 After 3–6 months of anticoagulation, VTE recurs in up to 40% of patients within 10 years. The risk of recurrence is two- to threefold higher after unprovoked than provoked VTE. Deep Vein thrombosis (DVT) is a life-threatening condition which may lead to sudden death as an immediate complication due to formation of thrombo-embolism. DVT is associated with various risk factors such as prolonged immobilization, inflammation, and/or coagulation disorders including muscular or venous injury. Deep venous thrombosis (DVT) frequently occurs in the lower limb. Successful treatment of DVT exclusively by the use of the different remedies has rarely been recorded in peer-reviewed journals. The present case report intends to record yet another case of DVT in a patient cured exclusively Since this report is based on a single case of recovery, results of more such cases are warranted to strengthen the outcome of the present study.