Postgraduate medical journal
-
Randomized Controlled Trial
Effects of breathing exercises using home-based positive pressure in the expiratory phase in patients with COPD.
Patients with chronic obstructive pulmonary disease (COPD) commonly have higher intrinsic positive end-expiratory pressure (PEEPi). A breathing exercise programme strategy employing an appropriate PEEP may improve their pulmonary functional capacity, exercise tolerance and health-related quality of life. Breathing with an expiratory resistive load, which is a method of modulating spontaneous breathing against PEEPi, has not been fully studied in patients with COPD. The objective of this study was to investigate the role of changing spontaneous breathing in home-based conditions and regulating spontaneous breathing with breathing exercises in patients with COPD. ⋯ Improvements in 6MWT results, pulmonary function and CAT scores are associated with a successful response to breathing against PEEPi in patients with COPD.
-
The 'two-week wait'(2WW) referral pathway was introduced in the United Kingdom to reduce waiting times for treatment of cancer. There has been a debate regarding the efficacy of 2WW pathway since its implementation. ⋯ 2WW referral does not achieve early diagnosis nor does it lead to an improvement in the rate of curative treatment in UGI and LGI malignancies. No improvement in short-term survival is seen in UGI malignancies nor in LGI malignancies on multivariate analysis by virtue of 2WW referral.
-
The current technique taught for examining the muscles of the upper limb does not differentiate between the various causes of weakness in the arm, in particular peripheral nerve and nerve root lesions. The 5.3.5 rule describes examining the muscles in a specific order: 5 at the shoulder, 3 at the elbow and 5 at the wrist and hand. The examiner records the number of the weak muscles. ⋯ This rule enables the diagnosis of all peripheral nerve and nerve root problems (radiculopathy) that cause weakness in the arm. It does not require detailed knowledge of neuroanatomy. It does require the examiner to learn how to examine each muscle so that they do not miss weakness or 'detect' weakness when there is none.
-
Infarction of the insula is a common scenario with large tissue-volume strokes in the middle cerebral artery territory. Considered to be part of the central autonomic network, infarction of this region is associated with autonomic disturbances, in particular cardiovascular dysregulation. Risk of aspiration following stroke is also associated with involvement of the insula, consistent with its purported participation in complex functions of the mouth and pharynx. ⋯ Chemosensory, autonomic, vestibular, auditory, somatosensory, language and oropharyngeal functional deficits are all recognised, among others. Long-term sequelae are unknown but profound symptoms, such as hemiparesis, are usually transient. Understanding the patterns of dysfunction highlighted provides the basis for future strategies to optimise stroke management on the discovery of insula involvement.